Hips, Butt and Thighs
The exercises below will challenge your hips, butt and thighs in a whole new way. Many of these moves involve using paper plates to add intensity to the moves. As always, check with your doctor if you have any injuries or medical issues and avoid any exercise that causes pain or discomfort. You'll find instructions and tips at the end of the page.
Side Lunge Slide
Stand with feet hip-width apart, left foot resting on a paper plate. Bend the right leg while sliding the left foot to the side, torso upright and abs in. Slowly slide left foot back to starting position, repeating 8-12 times. Switch legs and repeat for 2-3 sets.
Lunge Slide
Stand with feet hip-width apart, left foot resting on a paper plate. Bend the right leg while sliding the left foot back into a lunge position, keeping the right knee behind the toe, torso upright and abs in. Slowly slide left foot back to starting position and repeat 8-12 times. Switch legs and repeat on each leg for 2-3 sets.
Front One-Legged Squat
Stand on a step or small platform. Lift left leg out in front of step and bend the right leg, bringing the toe of the left foot to the floor. Touch the floor lightly and keep the knee of the bent leg in line with toes. Straighten the right leg and repeat 8-12 times. Switch legs and repeat for 2-3 sets.
Chair Squat
Stand in front of a chair with feet hip-width apart, abs in and torso straight. Slowly bend your knees and lower and until you're almost touching your butt to the chair. Hold for 2-3 seconds, knees behind the toes, and straighten. Repeat for 12-16 reps, 2-3 sets.
Heel Drops with Leg Extension
Stand on step or platform with left leg on the step, right leg hanging off the side. Bend the left leg and lower the right foot towards the floor (a few inches). Straighten the left leg and bring the right leg out to the side, foot flexed, in a leg extension. Repeat 8-12 times, switch legs for 2-3 sets.
Hip Extension
On a flat or inclined step or platform, lie facedown with hips on the edge of the step, legs straight out behind you with toes resting lightly on the floor. Squeeze the glutes and hamstrings and straighten the legs until they are level with the hips. Hold for 2-3 seconds, and lower letting toes lightly touch the floor. Repeat for 2-3 sets of 8-12 repetitions.
Exercise tips and instructions:
For Beginners: Do one set of 8-12 repetitions of each exercise with light weight or no weight 2-3 times a week, with at least one day of rest between workouts
For Intermediates: Do 1-2 sets of 8-12 repetitions of each exercise using light-medium weights, 2-3 times a week with at least one day of rest between workouts.
For Advanced: Do 2-3 sets of 8-12 repetitions of each exercise, using enough weight that you can ONLY complete the desired number of setps, 2-3 times a week with at least one day of rest between workouts.
Make sure you...
Warm up with 5-10 minutes of cardio and stretching
Cool down with a long stretch
Drink plenty of water
Do this workout in addition to an upper body workout and regular cardio exercise for best results.
Sunday, November 30, 2008
Heart attack/Myocardial Infarction
Myocardial Infarction (Heart Attack
What is a myocardial infarction?
Myocardial infarction (MI) means that part of the heart muscle suddenly loses its blood
supply. Without prompt treatment, this can lead to damage to the affected part of the heart.
An MI is sometimes called a heart attack or a coronary thrombosis. An MI is part of a range
or disorders called 'acute coronary syndromes'. There is a brief explanation of the term
'acute coronary syndrome' at the end of this leaflet.
Understanding the heart and coronary arteries
The heart is mainly made of special muscle. The heart pumps blood into arteries (blood
vessels) which take the blood to every part of the body.
Like any other muscle, the heart muscle needs a good blood supply. The coronary arteries
take blood to the heart muscle. The main coronary arteries branch off from the aorta. (The
aorta is the large artery which takes oxygen-rich blood from the heart chambers to the
body.) The main coronary arteries divide into smaller branches which take blood to all parts
of the heart muscle.
What happens when you have a myocardial infarction?
Myocardial infarction (MI) is usually caused by a blood clot that stops blood flow in a
heart (coronary) artery. Call for an ambulance immediately if you develop severe chest
pain. Treatment with a 'clot busting' drug or an emergency procedure to restore blood
flow through the blocked artery are usually done as soon as possible to prevent
damage to heart muscle. Other treatments help to ease the pain and prevent
complications. Reducing risk factors can help to prevent an MI.
If you have an MI, a coronary artery or one of its smaller branches is suddenly blocked. The
part of the heart muscle supplied by this artery loses its blood (and oxygen) supply. This
part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word
'infarction' means death of some tissue due to a blocked artery which stops blood from
getting past.)
If one of the main coronary arteries is blocked, a large part of the heart muscle is affected. If
a smaller branch artery is blocked, a smaller amount of heart muscle is affected. In people
who survive an MI, the part of the heart muscle that dies ('infarcts') is replaced by scar
tissue over the next few weeks.
What causes myocardial infarction?
Thrombosis - the cause in most cases
The common cause of an MI is a blood clot (thrombosis) that forms inside a coronary artery,
or one of its branches. This blocks the blood flow to a part of the heart.
Blood clots do not usually form in normal arteries. However, a clot may form if there is some
atheroma within the lining of the artery. Atheroma is like fatty patches or 'plaques' that
develop within the inside lining of arteries. (This is similar to water pipes that get 'furred up'.)
Plaques of atheroma may gradually form over a number of years in one or more places in
the coronary arteries. Each plaque has an outer firm shell with a soft inner fatty core.
What happens is that a 'crack' develops in the outer shell of the atheroma plaque. This is
called 'plaque rupture'. This exposes the softer inner core of the plaque to blood. This can
trigger the clotting mechanism in the blood to form a blood clot. Therefore, a build up of
atheroma is the root problem that leads to most cases of MI. (The diagram above shows
four patches of atheroma as an example. However, atheroma may develop in any section of
the coronary arteries.)
Treatment with 'clot busting' drugs or a procedure called angioplasty (see below) can break
up the clot and restore blood flow through the artery. If treatment is given quickly enough
this prevents damage to the heart muscle, or limits the extent of the damage.
Uncommon causes
Various other uncommon conditions can block a coronary artery and cause an MI. For
example: inflammation of the coronary arteries (rare); a stab wound to the heart; a blood
clot forming elsewhere in the body (for example, in a heart chamber) and travelling to a
coronary artery where it gets stuck; cocaine abuse which can cause a coronary artery to go
into spasm; complications from heart surgery; and some other rare heart problems. There
are not dealt with further.
The rest of this leaflet deals only with the common cause - thrombosis over an atheroma
plaque.
Who has a myocardial infarction?
MI is common. About 180,000 people in the UK are admitted to hospital each year with an
MI. Most MIs occur in people over 50, and become more common with increasing age.
Sometimes younger people are affected. An MI is three times more common in men than
women. An MI may occur in people known to have heart disease such as angina. It can also
happen 'out of the blue' in people with no previous symptoms of heart disease. (Atheroma
often develops without any symptoms at first.)
What are the symptoms of a myocardial infarction?
Severe chest pain is the usual main symptom. The pain may also travel up into your jaw,
and down your left arm, or down both arms. You may also sweat, feel sick, and feel faint.
Page 2 of 7
The pain may be similar to angina, but it is usually more severe and lasts longer. (Angina
usually goes off after a few minutes. MI pain usually lasts more than 15 minutes -
sometimes several hours.)
A small MI occasionally happens without causing pain (a 'silent MI'). It may be truly painfree,
or sometimes the pain is mild and you may think it is just heartburn or 'wind'.
Some people collapse and die suddenly if they have a large or severe MI.
What should I do if I suspect I am having a myocardial infarction?
Call for an ambulance immediately. Then, if you have some, take one aspirin tablet (see
below for the reason for this). You will normally be admitted straight to hospital.
How is myocardial infarction diagnosed and assessed?
Many people develop chest pains that are not due to an MI. For example, you can have
quite bad chest pains with heartburn, gallbladder problems, or with pains from conditions of
the muscles in the chest wall. However, tests can usually confirm MI. These are:
A heart tracing called an ECG (electrocardiograph). There are typical changes to the
normal pattern of the heart tracing if you have an MI. Patterns that occur with an MI
include things called 'pathological Q waves' and 'ST elevation'. However, it is
possible to have a normal ECG even if you have had an MI.
Blood tests. A blood test that measures a chemical called troponin is the usual test
that confirms an MI. This chemical is present in heart muscle cells and damage to
heart muscle cells releases troponin into the bloodstream. The blood level of troponin
increases within 3-12 hours from the onset of chest pain, peaks at 24-48 hours, and
returns to a normal level over 5-14 days.
A rough idea as to the severity of the MI (the amount of heart muscle that is damaged) can
be gauged by the degree of abnormality of the ECG and the level of troponin in the blood.
Another chemical that may be measured in a blood test is called creatinine kinase. This too
is released from heart muscle cells during an MI.
Your heart tracing will be monitored for a few days to check on the heart rhythm. Various
blood tests will be done to check on your general wellbeing.
Other tests may be done in some cases. This may be to clarify the diagnosis (if the
diagnosis is not certain) or to diagnose complications such as heart failure if this is
suspected. For example, an echocardiogram (an ultrasound scan of the heart) or a test
called myocardial perfusion scintigraphy may be done.
Also, before discharge from hospital, you may be advised to have tests to assess the
severity of atheroma in the coronary arteries. For example, an ECG taken whilst you
exercise on a treadmill or bike ('exercise-ECG'). Or, angiography of the coronary arteries. In
this test a dye is injected into the coronary arteries. The dye can be seen by special X-ray
equipment. This shows up the structure of the arteries (like a road map) and can show the
location and severity of any atheroma.
What is the treatment for myocardial infarction?
The following is a 'typical' situation and mentions the common treatments offered. Each
case is different and treatments may vary depending on your situation.
Aspirin and other antiplatelet drugs
As soon as possible after an MI is suspected you will be given a dose of aspirin. Aspirin
reduces the 'stickiness' of platelets. Platelets are tiny particles in the blood that trigger the
Page 3 of 7
blood to clot. It is the platelets that become stuck onto a patch of atheroma inside an artery
that go on to form the clot (thrombosis) of an MI. Another antiplatelet drug called clopidogrel
is also usually given as soon as possible. This works in a different way to aspirin and adds
to the action of reducing platelet stickiness.
Pain relief
A strong pain killer given by injection into a vein will ease the pain.
Treatment to restore blood flow in the blocked coronary artery
The part of the heart muscle starved of blood does not die ('infarct') immediately. If blood
flow is restored within a few hours, much of the heart muscle that would have been
damaged will survive. This is why an MI is a medical emergency, and treatment is given
urgently. The quicker the blood flow is restored, the better the outlook. There are two
treatments that can be done to restore blood flow back through the blocked artery.
Emergency angioplasty is, ideally, the best treatment if it is available and can be done within
a few hours of symptoms starting. In this procedure a tiny wire with a balloon at the end is
put into a large artery in the groin or arm. It is then passed up to the heart and into the
blocked section of a coronary artery using special x-ray guidance. The balloon is blown up
inside the blocked part of the artery to open it wide again. A stent may be left in the widened
section of the artery. A stent is like a wire mesh tube which gives support to the artery and
helps to keep the artery widened. See leaflet called 'Angioplasty' for details.
An injection of a 'clot busting' drug is an alternative to emergency angioplasty. In reality, this
is the more common treatment as it can be given easily and quickly in most situations.
Some ambulance crews are trained to give this treatment. Note: the common 'clot buster'
drug used in the UK is called streptokinase. If you are given this drug you should not be
given it again if you have another MI in the future. This is because antibodies develop to it
and it will not work so well a second time. An alternative 'clot buster' drug should be given if
you have another MI in the future.
Both the above treatments usually work well to restore blood flow and greatly improve the
outlook. The most crucial factor is the quickness in which one or other treatment is given
after symptoms have developed.
A betablocker drug
Beta-blockers 'block' the action of certain hormones such as adrenaline. These hormones
increase the rate and force of the heartbeat. Beta-blockers have some protective effect on
the heart muscle and they also help to prevent abnormal heart rhythms from developing.
Injections of heparin or a similar drug
These are usually given for a few days to help prevent further blood clots.
Treatment after you have had a myocardial infarction
Once you have had an MI, you will normally be advised to take regular medication for the
rest of your life. Medication after an MI is discussed more fully in another leaflet called
'Medication After a Myocardial Infarction'. Briefly, the following four drugs are commonly
prescribed to prevent a further MI, and to help prevent complications.
Aspirin - to reduce the 'stickiness' of platelets in the blood which helps to prevent
blood clots forming. If you are not be able to take aspirin then an alternative antiplatelet
drug such as clopidogrel may be advised.
A beta-blocker - to slow the heart rate, and to reduce the chance of abnormal heart
rhythms developing.
An ACE inhibitor (angiotensin converting enzyme inhibitor). ACE inhibitors have a
number of actions including having a protective effect on the heart.
A statin drug to lower the cholesterol level in your blood. This helps to prevent the
build-up of atheroma.
Page 4 of 7
Also, you will normally be advised to take the antiplatelet drug clopidogrel in addition to
aspirin. However, this is usually only advised for a certain number of weeks or months,
depending on the type and severity of the MI.
Many people recover well from an MI and have no complications. Before discharge from
hospital it is common for a doctor or nurse to advise you how to reduce any risk factors (see
below). This advice aims to reduce your risk of a future MI as much as possible.
Other drugs or treatments may be needed if you develop complications. For example,
treatments for heart failure may be needed if you develop heart failure as a complication
after an MI.
How serious is a myocardial infarction?
This often depends on the amount of heart muscle that is damaged. In many cases only a
small part of the heart muscle is damaged (infarcts or dies) which heals as a small patch of
scar tissue. The heart can usually function normally with a small patch of scar tissue. A
larger MI is more likely to be life-threatening or cause complications.
Even before treatments became available to restore blood flow such as 'clot busting' drugs
and angioplasty, many people made a full recovery as many MIs are small. With the help of
modern treatment, particularly if you are given treatment within a few hours to restore blood
flow, a higher percentage of people now make a full recovery.
Some possible complications that may occur after an MI include the following.
Heart failure. If a large area of the heart muscle is damaged, then the pumping
ability of the heart may be reduced. Less blood than usual is then pumped around
the body, especially when extra blood is needed when you exercise. Symptoms such
as breathlessness, tiredness, and swollen ankles may develop. Mild heart failure can
often be treated with medication. Severe heart failure can be serious and lifethreatening.
Abnormal heart rhythms may occur if the electrical activity of the heart is affected.
The main risk of this happening is within the first few hours after an MI. Sudden,
chaotic, fast heart beats may occur. This is called ventricular fibrillation and is the
common cause of 'cardiac arrest'. This needs immediate treatment with an electrical
shock given by a defibrillator. Otherwise, collapse and sudden death is likely.
A further MI may occur sometime in the future. This is more likely if the coronary
arteries are badly affected with atheroma, or further build up of atheroma continues.
If the risk of this is thought to be high then surgery may be advised to bypass or
widen severely narrowed coronary arteries.
The most crucial time is during the first day or so. If no complications arise, and you are well
after a couple weeks, then you have a good chance of making a full recovery. A main
objective then is to get back into normal life, and to minimise the risk of a further MI.
After having a myocardial infarction
After recovering from an MI, it is natural to wonder if there are any 'dos and don'ts'. In the
past, well-meaning but bad advice to "rest and take it easy from now on" caused some
people to become over-anxious about their hearts. Some people gave up their jobs,
hobbies, and any activity that caused exertion for fear of 'straining the heart'.
However, quite the opposite is true for most people who recover from an MI. Regular
exercise and getting back to normal work and life is usually advised. Much can be done to
reduce the risk of a further MI. This is discussed more fully in another leaflet called 'After a
Myocardial Infarction'.
Page 5 of 7
Can myocardial infarction be prevented?
Everybody has a risk of developing atheroma which can lead to an MI. However, certain
'risk factors' increase the risk and include:
Preventable or treatable risk factors:
smoking
hypertension (high blood pressure)
high cholesterol level
lack of exercise
a poor diet
obesity
excess alcohol
Having diabetes. But if you have diabetes, the increased risk of heart disease is
minimised by good control of the blood sugar level, and reducing blood pressure if it
is high.
Risk factors that are fixed and you cannot change:
a family history of heart disease or a stroke that occurred in a father or brother
aged below 55, or in a mother or sister aged below 65
being male.
ethnic group (for example, British Asians have an increased risk).
Risk factors are discussed more fully in another leaflet called 'Preventing Heart Disease'.
Briefly, if you can reduce any risk factors, it reduces your risk of having an MI (or of having a
further MI if you have already had one). Some risk factors are fixed and you cannot change
them. However, if you have a fixed risk factor, you may want to make extra effort to reduce
preventable risk factors such as smoking or lack of exercise.
Appendix: What is 'acute coronary syndrome'?
The term 'acute coronary syndrome' is a term that is used more and more by doctors. It
covers a range of disorders (including MI) that are caused by the same underlying problem.
The underlying problem is a sudden reduction of blood flow to part of the heart muscle. This
is caused by a blood clot that forms on a patch of atheroma within a coronary artery (which
is described earlier). If the blood clot causes a reduced blood flow, but not a total blockage
then the heart muscle supplied by the affected artery does not infarct (die). This situation
causes 'acute coronary syndrome with unstable angina' - and typically leads to a sudden
worsening of angina pains. If there is death of heart tissue then this is called an 'acute
coronary syndrome with MI' (the subject of this leaflet). There is a third 'in between' category
where just a very small amount of heart tissue infarcts. This is called 'acute coronary
syndrome with myocyte necrosis'. In effect, this is like having a mild MI.
One test that is used to distinguish between these three acute coronary syndromes is the
blood test for troponin. This test is described earlier. If the level of troponin is normal, then
there is no death of heart tissue. If the level is high, then it is classed as an MI. If there is
just a slight rise in the level of troponin then this diagnoses 'acute coronary syndrome with
myocyte necrosis'.
What is a myocardial infarction?
Myocardial infarction (MI) means that part of the heart muscle suddenly loses its blood
supply. Without prompt treatment, this can lead to damage to the affected part of the heart.
An MI is sometimes called a heart attack or a coronary thrombosis. An MI is part of a range
or disorders called 'acute coronary syndromes'. There is a brief explanation of the term
'acute coronary syndrome' at the end of this leaflet.
Understanding the heart and coronary arteries
The heart is mainly made of special muscle. The heart pumps blood into arteries (blood
vessels) which take the blood to every part of the body.
Like any other muscle, the heart muscle needs a good blood supply. The coronary arteries
take blood to the heart muscle. The main coronary arteries branch off from the aorta. (The
aorta is the large artery which takes oxygen-rich blood from the heart chambers to the
body.) The main coronary arteries divide into smaller branches which take blood to all parts
of the heart muscle.
What happens when you have a myocardial infarction?
Myocardial infarction (MI) is usually caused by a blood clot that stops blood flow in a
heart (coronary) artery. Call for an ambulance immediately if you develop severe chest
pain. Treatment with a 'clot busting' drug or an emergency procedure to restore blood
flow through the blocked artery are usually done as soon as possible to prevent
damage to heart muscle. Other treatments help to ease the pain and prevent
complications. Reducing risk factors can help to prevent an MI.
If you have an MI, a coronary artery or one of its smaller branches is suddenly blocked. The
part of the heart muscle supplied by this artery loses its blood (and oxygen) supply. This
part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word
'infarction' means death of some tissue due to a blocked artery which stops blood from
getting past.)
If one of the main coronary arteries is blocked, a large part of the heart muscle is affected. If
a smaller branch artery is blocked, a smaller amount of heart muscle is affected. In people
who survive an MI, the part of the heart muscle that dies ('infarcts') is replaced by scar
tissue over the next few weeks.
What causes myocardial infarction?
Thrombosis - the cause in most cases
The common cause of an MI is a blood clot (thrombosis) that forms inside a coronary artery,
or one of its branches. This blocks the blood flow to a part of the heart.
Blood clots do not usually form in normal arteries. However, a clot may form if there is some
atheroma within the lining of the artery. Atheroma is like fatty patches or 'plaques' that
develop within the inside lining of arteries. (This is similar to water pipes that get 'furred up'.)
Plaques of atheroma may gradually form over a number of years in one or more places in
the coronary arteries. Each plaque has an outer firm shell with a soft inner fatty core.
What happens is that a 'crack' develops in the outer shell of the atheroma plaque. This is
called 'plaque rupture'. This exposes the softer inner core of the plaque to blood. This can
trigger the clotting mechanism in the blood to form a blood clot. Therefore, a build up of
atheroma is the root problem that leads to most cases of MI. (The diagram above shows
four patches of atheroma as an example. However, atheroma may develop in any section of
the coronary arteries.)
Treatment with 'clot busting' drugs or a procedure called angioplasty (see below) can break
up the clot and restore blood flow through the artery. If treatment is given quickly enough
this prevents damage to the heart muscle, or limits the extent of the damage.
Uncommon causes
Various other uncommon conditions can block a coronary artery and cause an MI. For
example: inflammation of the coronary arteries (rare); a stab wound to the heart; a blood
clot forming elsewhere in the body (for example, in a heart chamber) and travelling to a
coronary artery where it gets stuck; cocaine abuse which can cause a coronary artery to go
into spasm; complications from heart surgery; and some other rare heart problems. There
are not dealt with further.
The rest of this leaflet deals only with the common cause - thrombosis over an atheroma
plaque.
Who has a myocardial infarction?
MI is common. About 180,000 people in the UK are admitted to hospital each year with an
MI. Most MIs occur in people over 50, and become more common with increasing age.
Sometimes younger people are affected. An MI is three times more common in men than
women. An MI may occur in people known to have heart disease such as angina. It can also
happen 'out of the blue' in people with no previous symptoms of heart disease. (Atheroma
often develops without any symptoms at first.)
What are the symptoms of a myocardial infarction?
Severe chest pain is the usual main symptom. The pain may also travel up into your jaw,
and down your left arm, or down both arms. You may also sweat, feel sick, and feel faint.
Page 2 of 7
The pain may be similar to angina, but it is usually more severe and lasts longer. (Angina
usually goes off after a few minutes. MI pain usually lasts more than 15 minutes -
sometimes several hours.)
A small MI occasionally happens without causing pain (a 'silent MI'). It may be truly painfree,
or sometimes the pain is mild and you may think it is just heartburn or 'wind'.
Some people collapse and die suddenly if they have a large or severe MI.
What should I do if I suspect I am having a myocardial infarction?
Call for an ambulance immediately. Then, if you have some, take one aspirin tablet (see
below for the reason for this). You will normally be admitted straight to hospital.
How is myocardial infarction diagnosed and assessed?
Many people develop chest pains that are not due to an MI. For example, you can have
quite bad chest pains with heartburn, gallbladder problems, or with pains from conditions of
the muscles in the chest wall. However, tests can usually confirm MI. These are:
A heart tracing called an ECG (electrocardiograph). There are typical changes to the
normal pattern of the heart tracing if you have an MI. Patterns that occur with an MI
include things called 'pathological Q waves' and 'ST elevation'. However, it is
possible to have a normal ECG even if you have had an MI.
Blood tests. A blood test that measures a chemical called troponin is the usual test
that confirms an MI. This chemical is present in heart muscle cells and damage to
heart muscle cells releases troponin into the bloodstream. The blood level of troponin
increases within 3-12 hours from the onset of chest pain, peaks at 24-48 hours, and
returns to a normal level over 5-14 days.
A rough idea as to the severity of the MI (the amount of heart muscle that is damaged) can
be gauged by the degree of abnormality of the ECG and the level of troponin in the blood.
Another chemical that may be measured in a blood test is called creatinine kinase. This too
is released from heart muscle cells during an MI.
Your heart tracing will be monitored for a few days to check on the heart rhythm. Various
blood tests will be done to check on your general wellbeing.
Other tests may be done in some cases. This may be to clarify the diagnosis (if the
diagnosis is not certain) or to diagnose complications such as heart failure if this is
suspected. For example, an echocardiogram (an ultrasound scan of the heart) or a test
called myocardial perfusion scintigraphy may be done.
Also, before discharge from hospital, you may be advised to have tests to assess the
severity of atheroma in the coronary arteries. For example, an ECG taken whilst you
exercise on a treadmill or bike ('exercise-ECG'). Or, angiography of the coronary arteries. In
this test a dye is injected into the coronary arteries. The dye can be seen by special X-ray
equipment. This shows up the structure of the arteries (like a road map) and can show the
location and severity of any atheroma.
What is the treatment for myocardial infarction?
The following is a 'typical' situation and mentions the common treatments offered. Each
case is different and treatments may vary depending on your situation.
Aspirin and other antiplatelet drugs
As soon as possible after an MI is suspected you will be given a dose of aspirin. Aspirin
reduces the 'stickiness' of platelets. Platelets are tiny particles in the blood that trigger the
Page 3 of 7
blood to clot. It is the platelets that become stuck onto a patch of atheroma inside an artery
that go on to form the clot (thrombosis) of an MI. Another antiplatelet drug called clopidogrel
is also usually given as soon as possible. This works in a different way to aspirin and adds
to the action of reducing platelet stickiness.
Pain relief
A strong pain killer given by injection into a vein will ease the pain.
Treatment to restore blood flow in the blocked coronary artery
The part of the heart muscle starved of blood does not die ('infarct') immediately. If blood
flow is restored within a few hours, much of the heart muscle that would have been
damaged will survive. This is why an MI is a medical emergency, and treatment is given
urgently. The quicker the blood flow is restored, the better the outlook. There are two
treatments that can be done to restore blood flow back through the blocked artery.
Emergency angioplasty is, ideally, the best treatment if it is available and can be done within
a few hours of symptoms starting. In this procedure a tiny wire with a balloon at the end is
put into a large artery in the groin or arm. It is then passed up to the heart and into the
blocked section of a coronary artery using special x-ray guidance. The balloon is blown up
inside the blocked part of the artery to open it wide again. A stent may be left in the widened
section of the artery. A stent is like a wire mesh tube which gives support to the artery and
helps to keep the artery widened. See leaflet called 'Angioplasty' for details.
An injection of a 'clot busting' drug is an alternative to emergency angioplasty. In reality, this
is the more common treatment as it can be given easily and quickly in most situations.
Some ambulance crews are trained to give this treatment. Note: the common 'clot buster'
drug used in the UK is called streptokinase. If you are given this drug you should not be
given it again if you have another MI in the future. This is because antibodies develop to it
and it will not work so well a second time. An alternative 'clot buster' drug should be given if
you have another MI in the future.
Both the above treatments usually work well to restore blood flow and greatly improve the
outlook. The most crucial factor is the quickness in which one or other treatment is given
after symptoms have developed.
A betablocker drug
Beta-blockers 'block' the action of certain hormones such as adrenaline. These hormones
increase the rate and force of the heartbeat. Beta-blockers have some protective effect on
the heart muscle and they also help to prevent abnormal heart rhythms from developing.
Injections of heparin or a similar drug
These are usually given for a few days to help prevent further blood clots.
Treatment after you have had a myocardial infarction
Once you have had an MI, you will normally be advised to take regular medication for the
rest of your life. Medication after an MI is discussed more fully in another leaflet called
'Medication After a Myocardial Infarction'. Briefly, the following four drugs are commonly
prescribed to prevent a further MI, and to help prevent complications.
Aspirin - to reduce the 'stickiness' of platelets in the blood which helps to prevent
blood clots forming. If you are not be able to take aspirin then an alternative antiplatelet
drug such as clopidogrel may be advised.
A beta-blocker - to slow the heart rate, and to reduce the chance of abnormal heart
rhythms developing.
An ACE inhibitor (angiotensin converting enzyme inhibitor). ACE inhibitors have a
number of actions including having a protective effect on the heart.
A statin drug to lower the cholesterol level in your blood. This helps to prevent the
build-up of atheroma.
Page 4 of 7
Also, you will normally be advised to take the antiplatelet drug clopidogrel in addition to
aspirin. However, this is usually only advised for a certain number of weeks or months,
depending on the type and severity of the MI.
Many people recover well from an MI and have no complications. Before discharge from
hospital it is common for a doctor or nurse to advise you how to reduce any risk factors (see
below). This advice aims to reduce your risk of a future MI as much as possible.
Other drugs or treatments may be needed if you develop complications. For example,
treatments for heart failure may be needed if you develop heart failure as a complication
after an MI.
How serious is a myocardial infarction?
This often depends on the amount of heart muscle that is damaged. In many cases only a
small part of the heart muscle is damaged (infarcts or dies) which heals as a small patch of
scar tissue. The heart can usually function normally with a small patch of scar tissue. A
larger MI is more likely to be life-threatening or cause complications.
Even before treatments became available to restore blood flow such as 'clot busting' drugs
and angioplasty, many people made a full recovery as many MIs are small. With the help of
modern treatment, particularly if you are given treatment within a few hours to restore blood
flow, a higher percentage of people now make a full recovery.
Some possible complications that may occur after an MI include the following.
Heart failure. If a large area of the heart muscle is damaged, then the pumping
ability of the heart may be reduced. Less blood than usual is then pumped around
the body, especially when extra blood is needed when you exercise. Symptoms such
as breathlessness, tiredness, and swollen ankles may develop. Mild heart failure can
often be treated with medication. Severe heart failure can be serious and lifethreatening.
Abnormal heart rhythms may occur if the electrical activity of the heart is affected.
The main risk of this happening is within the first few hours after an MI. Sudden,
chaotic, fast heart beats may occur. This is called ventricular fibrillation and is the
common cause of 'cardiac arrest'. This needs immediate treatment with an electrical
shock given by a defibrillator. Otherwise, collapse and sudden death is likely.
A further MI may occur sometime in the future. This is more likely if the coronary
arteries are badly affected with atheroma, or further build up of atheroma continues.
If the risk of this is thought to be high then surgery may be advised to bypass or
widen severely narrowed coronary arteries.
The most crucial time is during the first day or so. If no complications arise, and you are well
after a couple weeks, then you have a good chance of making a full recovery. A main
objective then is to get back into normal life, and to minimise the risk of a further MI.
After having a myocardial infarction
After recovering from an MI, it is natural to wonder if there are any 'dos and don'ts'. In the
past, well-meaning but bad advice to "rest and take it easy from now on" caused some
people to become over-anxious about their hearts. Some people gave up their jobs,
hobbies, and any activity that caused exertion for fear of 'straining the heart'.
However, quite the opposite is true for most people who recover from an MI. Regular
exercise and getting back to normal work and life is usually advised. Much can be done to
reduce the risk of a further MI. This is discussed more fully in another leaflet called 'After a
Myocardial Infarction'.
Page 5 of 7
Can myocardial infarction be prevented?
Everybody has a risk of developing atheroma which can lead to an MI. However, certain
'risk factors' increase the risk and include:
Preventable or treatable risk factors:
smoking
hypertension (high blood pressure)
high cholesterol level
lack of exercise
a poor diet
obesity
excess alcohol
Having diabetes. But if you have diabetes, the increased risk of heart disease is
minimised by good control of the blood sugar level, and reducing blood pressure if it
is high.
Risk factors that are fixed and you cannot change:
a family history of heart disease or a stroke that occurred in a father or brother
aged below 55, or in a mother or sister aged below 65
being male.
ethnic group (for example, British Asians have an increased risk).
Risk factors are discussed more fully in another leaflet called 'Preventing Heart Disease'.
Briefly, if you can reduce any risk factors, it reduces your risk of having an MI (or of having a
further MI if you have already had one). Some risk factors are fixed and you cannot change
them. However, if you have a fixed risk factor, you may want to make extra effort to reduce
preventable risk factors such as smoking or lack of exercise.
Appendix: What is 'acute coronary syndrome'?
The term 'acute coronary syndrome' is a term that is used more and more by doctors. It
covers a range of disorders (including MI) that are caused by the same underlying problem.
The underlying problem is a sudden reduction of blood flow to part of the heart muscle. This
is caused by a blood clot that forms on a patch of atheroma within a coronary artery (which
is described earlier). If the blood clot causes a reduced blood flow, but not a total blockage
then the heart muscle supplied by the affected artery does not infarct (die). This situation
causes 'acute coronary syndrome with unstable angina' - and typically leads to a sudden
worsening of angina pains. If there is death of heart tissue then this is called an 'acute
coronary syndrome with MI' (the subject of this leaflet). There is a third 'in between' category
where just a very small amount of heart tissue infarcts. This is called 'acute coronary
syndrome with myocyte necrosis'. In effect, this is like having a mild MI.
One test that is used to distinguish between these three acute coronary syndromes is the
blood test for troponin. This test is described earlier. If the level of troponin is normal, then
there is no death of heart tissue. If the level is high, then it is classed as an MI. If there is
just a slight rise in the level of troponin then this diagnoses 'acute coronary syndrome with
myocyte necrosis'.
Get your stomach flat
Here are the 5 things you MUST learn if you ever want a chance to lose your belly fat and get a flat stomach:
1. Many foods sold as "healthy foods" will only make you gain more belly fat. All this time we thought we were doing the right thing! It turns out that the one key ingredient, "that every fitness source told us was right", was in fact making us fatter.
2. Ab exercises like crunches, sit-ups, and ab machines are the LEAST effective method for getting flat six pack abs. Before we found the answer, we would literally work for hours on end doing excruciating ab exercises, yet we were still left with no definition and a blanket of fat on our stomachs.
3. Boring repetitive cardio exercises like running, the stairmaster or the stationary bike are NOT the best way to lose body fat and uncover your six pack abs.
4. Don't even get me started about "fat burner pills" or "weight loss supplements." The internet is littered with these scams - stay away!
5. Ab belts, ab-rockers, ab-loungers, and ab-gimmicks... are a COMPLETE waste of your time and money.
1. Many foods sold as "healthy foods" will only make you gain more belly fat. All this time we thought we were doing the right thing! It turns out that the one key ingredient, "that every fitness source told us was right", was in fact making us fatter.
2. Ab exercises like crunches, sit-ups, and ab machines are the LEAST effective method for getting flat six pack abs. Before we found the answer, we would literally work for hours on end doing excruciating ab exercises, yet we were still left with no definition and a blanket of fat on our stomachs.
3. Boring repetitive cardio exercises like running, the stairmaster or the stationary bike are NOT the best way to lose body fat and uncover your six pack abs.
4. Don't even get me started about "fat burner pills" or "weight loss supplements." The internet is littered with these scams - stay away!
5. Ab belts, ab-rockers, ab-loungers, and ab-gimmicks... are a COMPLETE waste of your time and money.
simple ways to live a healthy life
ou hear a lot about living a healthy lifestyle, but what does that mean? In general, a healthy person doesn't smoke, is at a healthy weight, eats healthy and exercises. Sounds simple, doesn't it?
The trick to healthy living is making small changes...taking more steps, adding fruit to your cereal, having an extra glass of water...these are just a few ways you can start living healthy without drastic changes.
Exercise
One of the biggest problems in America today is lack of activity. We know it's good for us but avoid it like the plague either because we're used to being sedentary or afraid that exercise has to be vigorous to be worth our time. The truth is, movement is movement and the more you do, the healthier you'll be. Even moderate activities like chores, gardening and walking can make a difference.
Just adding a little movement to your life can:
Reduce the risk of heart disease, stroke and diabetes
Improve joint stability
Increase and improve range of movement
Help maintain flexibility as you age
Maintain bone mass
Prevent osteoporosis and fractures
Improve mood and reduce symptoms of anxiety and depression
Enhance self esteem
Improve memory in elderly people
Reduce stress
So, even if you opt for small changes and a more modest weight loss, you can see the benefits are still pretty good. One study has found that just a 10% weight reduction helped obese patients reduce blood pressure, cholesterol and increase longevity.
Simple Ways to Move Your Body
You can start the process of weight loss now by adding a little more activity to your life. If you're not ready for a structured program, start small. Every little bit counts and it all adds up to burning more calories.
Turn off the TV. Once a week, turn off the TV and do something a little more physical with your family. Play games, take a walk...almost anything will be more active than sitting on the couch.
Walk more. Look for small ways to walk more. When you get the mail, take a walk around the block, take the dog for an extra outing each day or walk on your treadmill for 5 minutes before getting ready for work.
Do some chores. Shoveling snow, working in the garden, raking leaves, sweeping the floor...these kinds of activities may not be 'vigorous' exercise, but they can keep you moving while getting your house in order.
Pace while you talk. When you're on the phone, pace around or even do some cleaning while gabbing. This is a great way to stay moving while doing something you enjoy.
Be aware. Make a list of all the physical activities you do on a typical day. If you find that the bulk of your time is spent sitting, make another list of all the ways you could move more--getting up each hour to stretch or walk, walk the stairs at work, etc.
Eating Well
Eating a healthy diet is another part of the healthy lifestyle. Not only can a clean diet help with weight management, it can also improve your health and quality of life as you get older. You can use the new Food Guide Pyramid to determine how many calories you need and what food groups you should focus on or, if you're looking for smaller changes, you can use these tips for simple ways to change how you eat:
Eat more fruit. Add it to your cereal, your salads or even your dinners
Sneak in more veggies. Add them wherever you can--a tomato on your sandwich, peppers on your pizza, or extra veggies in your pasta sauce. Keep pre-cut or canned/frozen veggies ready for quick snacks.
Switch your salad dressing. If you eat full-fat dressing, switch to something lighter and you'll automatically eat less calories.
Eat low-fat or fat-free dairy. Switching to skim milk or fat free yogurt is another simple way to eat less calories without having to change too much in your diet.
Make some substitutes. Look through your cabinets or fridge and pick 3 foods you eat every day. Write down the nutritional content and, the next time you're at the store, find lower-calorie substitutes for just those 3 items.
Creating a healthy lifestyle doesn't have to mean drastic changes. In fact, drastic changes almost always lead to failure. Making small changes in how you live each day can lead to big rewards, so figure out what you can to be healthy today.
The trick to healthy living is making small changes...taking more steps, adding fruit to your cereal, having an extra glass of water...these are just a few ways you can start living healthy without drastic changes.
Exercise
One of the biggest problems in America today is lack of activity. We know it's good for us but avoid it like the plague either because we're used to being sedentary or afraid that exercise has to be vigorous to be worth our time. The truth is, movement is movement and the more you do, the healthier you'll be. Even moderate activities like chores, gardening and walking can make a difference.
Just adding a little movement to your life can:
Reduce the risk of heart disease, stroke and diabetes
Improve joint stability
Increase and improve range of movement
Help maintain flexibility as you age
Maintain bone mass
Prevent osteoporosis and fractures
Improve mood and reduce symptoms of anxiety and depression
Enhance self esteem
Improve memory in elderly people
Reduce stress
So, even if you opt for small changes and a more modest weight loss, you can see the benefits are still pretty good. One study has found that just a 10% weight reduction helped obese patients reduce blood pressure, cholesterol and increase longevity.
Simple Ways to Move Your Body
You can start the process of weight loss now by adding a little more activity to your life. If you're not ready for a structured program, start small. Every little bit counts and it all adds up to burning more calories.
Turn off the TV. Once a week, turn off the TV and do something a little more physical with your family. Play games, take a walk...almost anything will be more active than sitting on the couch.
Walk more. Look for small ways to walk more. When you get the mail, take a walk around the block, take the dog for an extra outing each day or walk on your treadmill for 5 minutes before getting ready for work.
Do some chores. Shoveling snow, working in the garden, raking leaves, sweeping the floor...these kinds of activities may not be 'vigorous' exercise, but they can keep you moving while getting your house in order.
Pace while you talk. When you're on the phone, pace around or even do some cleaning while gabbing. This is a great way to stay moving while doing something you enjoy.
Be aware. Make a list of all the physical activities you do on a typical day. If you find that the bulk of your time is spent sitting, make another list of all the ways you could move more--getting up each hour to stretch or walk, walk the stairs at work, etc.
Eating Well
Eating a healthy diet is another part of the healthy lifestyle. Not only can a clean diet help with weight management, it can also improve your health and quality of life as you get older. You can use the new Food Guide Pyramid to determine how many calories you need and what food groups you should focus on or, if you're looking for smaller changes, you can use these tips for simple ways to change how you eat:
Eat more fruit. Add it to your cereal, your salads or even your dinners
Sneak in more veggies. Add them wherever you can--a tomato on your sandwich, peppers on your pizza, or extra veggies in your pasta sauce. Keep pre-cut or canned/frozen veggies ready for quick snacks.
Switch your salad dressing. If you eat full-fat dressing, switch to something lighter and you'll automatically eat less calories.
Eat low-fat or fat-free dairy. Switching to skim milk or fat free yogurt is another simple way to eat less calories without having to change too much in your diet.
Make some substitutes. Look through your cabinets or fridge and pick 3 foods you eat every day. Write down the nutritional content and, the next time you're at the store, find lower-calorie substitutes for just those 3 items.
Creating a healthy lifestyle doesn't have to mean drastic changes. In fact, drastic changes almost always lead to failure. Making small changes in how you live each day can lead to big rewards, so figure out what you can to be healthy today.
Wednesday, November 26, 2008
Human interaction with biosphere
HUMAN INTERACTION WITH BIOSPHERE
Ecology:
Ecology was first proposed by a zoologist named H.Reiter in 1885.
It is derived from Greek words, Oikos meaning the discourse or study, thus ecology is the branch of biology which deals with the study of the relationship of living organism to each other and with their environment.
Ecologist regards these as the living part of a system called ecosystem. The different ecosystem are united to form the ‘’Biosphere.’’
Biosphere:
Biosphere I derived from German word ‘’biosphere’’ which means the region of the earth’s crust and atmosphere occupied by living organism.
It is the highest level of organization which forms the largest biological system. It is a part of earth including air, water, soil within which life occurs and biotic processes in turn alter or transform.
Man and Biosphere:
Human beings depend on natural resources such as plants and animals to meet their basic needs and wants.
These needs are obtained from plants and animals.
1. Foods:All animals require energy for the vital activities as well as physical activities. The energy is fulfilled by food.
2. Shelter:Human beings need shelter to protect themselves from various climatic factors such as extreme cold and hot temperature, wind, rain, and others disaster. For this we build a house on land. The material for the construction of house is provided by plants.
3. Cloth:We wear the clothes to protect our body from heat and cold. Plants and animals provide raw materials for manufacturing various types of cloth
Bio-geochemical cycles
The circulation of chemical nutrients like carbon, nitrogen, oxygen, phosphorus, calcium and water through the biological and physical work or biosphere is known as bio-geochemical cycle.
The four important biogeochemical cycles in nature are:
1. Water cycle
2. Oxygen cycle
3. Carbon cycle
4. Nitrogen cycle
1. Water cycle
• The most abundant compound present in all organisms is water.
• Water covers more than three fourth of earth’s surface. It is also found within the crust of earth.
• Heat of sunlight evaporates the water on the earth and forms vapour. The water vapour being lighter than air rises up and goes into atmosphere.
• The unutilized water absorbed by plants from soil is given off into atmosphere by transpiration.
• The water vapour produced due to respiration of living organism also goes into atmosphere.
• As the water vapour rises up into atmosphere, gets cooled and condensed to form tiny droplets of water and form cloud and finally falls down as rain. The rain water passes into soil and some part is absorbed in soil and utilized by plants.
2. Oxygen cycle:
• It represents about 21% of atmospheric gases. It is available in free molecular form and in combined state like carbon-dioxide, water etc.
• All living organism take oxygen from atmosphere for respiration and is converted it into carbon dioxide and water and is released in to atmosphere.
• The burning of fuels also requires oxygen from atmosphere and releases carbon dioxide and water vapour into atmosphere.
• The carbon dioxide and water vapour released in atmosphere are utilized by photosynthesis and oxygen gas formed in this process is released into atmosphere. In this way oxygen cycle is completed in nature.
3. Carbon cycle
• Carbon is the basic constituents of living organism.
• It is the most essential constituents of all the major organic compounds of the carbohydrate, fats, protein and nucleic acids.
• The atmospheric carbon dioxide serves as the source of carbon for the synthesis of organic compound in green plants. Most of the carbon dioxide enters into the living world through photosynthesis.
• The major process by which carbon dioxide is removed from atmosphere is photosynthesis by green plants.
• The green plants and their products are eaten by animals as food.
• During respiration, plants and animals give off carbon dioxide into atmosphere. Dead and decayed plants and animals also release carbon dioxide into atmosphere.
• Some dead plants and animals are changed into fossils fuel which when burnt, produce carbon dioxide.
• Volcanic eruption also releases carbon dioxide formed from decomposition of carbonate minerals.
• Carbon dioxide is also released into atmosphere when acid rain falls on carbonate rocks such as limestone. In this way the carbon cycle in nature is completed.
5. Nitrogen cycle
• Nitrogen comprises 78% of the earth’s atmosphere.
• The nitrogen forms the structural and functional component of the cell protoplasm and its organelles.
• The atmospheric nitrogen can be used only when it is converted into nitrates and nitrites by nitrogen fixation. There are 3 kinds of nitrogen fixation: atmospheric, biological and industrial fixation.
• In atmospheric fixation, nitrogen combines with oxygen during lightening and form oxides of nitrogen which dissolves in rain water, gets soaked into soil and forms nitrate.
• In biological fixation, nitrogen fixing bacteria called rhizobium present in nodules of certain leguminous plant directly fixes atmospheric nitrogen into nitrogen compounds. Some blue green algae also fix atmospheric nitrogen.
• In industrial fixation, the nitrogen gas is made to combine with hydrogen gas to form ammonia which can be oxidized to form nitrates or made to react with acid to form ammonium salt. The nitrates of ammonium salt which contain fixed nitrogen are used as fertilizers.
• The nitrates and nitrites absorbed by plants converted into plant protein.
• The purifying bacteria and fungi convert nitrogenous substance of dead plant and animals into ammonia by ammonification.
• By nitrification, nitrate salts present in soil are converted into free nitrogen gas. In this way nitrogen cycle is completed.
Ecology:
Ecology was first proposed by a zoologist named H.Reiter in 1885.
It is derived from Greek words, Oikos meaning the discourse or study, thus ecology is the branch of biology which deals with the study of the relationship of living organism to each other and with their environment.
Ecologist regards these as the living part of a system called ecosystem. The different ecosystem are united to form the ‘’Biosphere.’’
Biosphere:
Biosphere I derived from German word ‘’biosphere’’ which means the region of the earth’s crust and atmosphere occupied by living organism.
It is the highest level of organization which forms the largest biological system. It is a part of earth including air, water, soil within which life occurs and biotic processes in turn alter or transform.
Man and Biosphere:
Human beings depend on natural resources such as plants and animals to meet their basic needs and wants.
These needs are obtained from plants and animals.
1. Foods:All animals require energy for the vital activities as well as physical activities. The energy is fulfilled by food.
2. Shelter:Human beings need shelter to protect themselves from various climatic factors such as extreme cold and hot temperature, wind, rain, and others disaster. For this we build a house on land. The material for the construction of house is provided by plants.
3. Cloth:We wear the clothes to protect our body from heat and cold. Plants and animals provide raw materials for manufacturing various types of cloth
Bio-geochemical cycles
The circulation of chemical nutrients like carbon, nitrogen, oxygen, phosphorus, calcium and water through the biological and physical work or biosphere is known as bio-geochemical cycle.
The four important biogeochemical cycles in nature are:
1. Water cycle
2. Oxygen cycle
3. Carbon cycle
4. Nitrogen cycle
1. Water cycle
• The most abundant compound present in all organisms is water.
• Water covers more than three fourth of earth’s surface. It is also found within the crust of earth.
• Heat of sunlight evaporates the water on the earth and forms vapour. The water vapour being lighter than air rises up and goes into atmosphere.
• The unutilized water absorbed by plants from soil is given off into atmosphere by transpiration.
• The water vapour produced due to respiration of living organism also goes into atmosphere.
• As the water vapour rises up into atmosphere, gets cooled and condensed to form tiny droplets of water and form cloud and finally falls down as rain. The rain water passes into soil and some part is absorbed in soil and utilized by plants.
2. Oxygen cycle:
• It represents about 21% of atmospheric gases. It is available in free molecular form and in combined state like carbon-dioxide, water etc.
• All living organism take oxygen from atmosphere for respiration and is converted it into carbon dioxide and water and is released in to atmosphere.
• The burning of fuels also requires oxygen from atmosphere and releases carbon dioxide and water vapour into atmosphere.
• The carbon dioxide and water vapour released in atmosphere are utilized by photosynthesis and oxygen gas formed in this process is released into atmosphere. In this way oxygen cycle is completed in nature.
3. Carbon cycle
• Carbon is the basic constituents of living organism.
• It is the most essential constituents of all the major organic compounds of the carbohydrate, fats, protein and nucleic acids.
• The atmospheric carbon dioxide serves as the source of carbon for the synthesis of organic compound in green plants. Most of the carbon dioxide enters into the living world through photosynthesis.
• The major process by which carbon dioxide is removed from atmosphere is photosynthesis by green plants.
• The green plants and their products are eaten by animals as food.
• During respiration, plants and animals give off carbon dioxide into atmosphere. Dead and decayed plants and animals also release carbon dioxide into atmosphere.
• Some dead plants and animals are changed into fossils fuel which when burnt, produce carbon dioxide.
• Volcanic eruption also releases carbon dioxide formed from decomposition of carbonate minerals.
• Carbon dioxide is also released into atmosphere when acid rain falls on carbonate rocks such as limestone. In this way the carbon cycle in nature is completed.
5. Nitrogen cycle
• Nitrogen comprises 78% of the earth’s atmosphere.
• The nitrogen forms the structural and functional component of the cell protoplasm and its organelles.
• The atmospheric nitrogen can be used only when it is converted into nitrates and nitrites by nitrogen fixation. There are 3 kinds of nitrogen fixation: atmospheric, biological and industrial fixation.
• In atmospheric fixation, nitrogen combines with oxygen during lightening and form oxides of nitrogen which dissolves in rain water, gets soaked into soil and forms nitrate.
• In biological fixation, nitrogen fixing bacteria called rhizobium present in nodules of certain leguminous plant directly fixes atmospheric nitrogen into nitrogen compounds. Some blue green algae also fix atmospheric nitrogen.
• In industrial fixation, the nitrogen gas is made to combine with hydrogen gas to form ammonia which can be oxidized to form nitrates or made to react with acid to form ammonium salt. The nitrates of ammonium salt which contain fixed nitrogen are used as fertilizers.
• The nitrates and nitrites absorbed by plants converted into plant protein.
• The purifying bacteria and fungi convert nitrogenous substance of dead plant and animals into ammonia by ammonification.
• By nitrification, nitrate salts present in soil are converted into free nitrogen gas. In this way nitrogen cycle is completed.
Friday, November 7, 2008
breast cancer
Breast Cancer
Also called: Breast carcinoma
Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include
Age - the chance of getting breast cancer rises as a woman gets older
Genes - there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
Personal factors - beginning periods before age 12 or going through menopause after age 55
Other risks include being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.
Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.
Men can have breast cancer, too, but the number of cases is small.
Also called: Breast carcinoma
Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include
Age - the chance of getting breast cancer rises as a woman gets older
Genes - there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
Personal factors - beginning periods before age 12 or going through menopause after age 55
Other risks include being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.
Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.
Men can have breast cancer, too, but the number of cases is small.
Adolescence
Adolescence:
Adolescence is characterized by the time period between 12-20yrs.
It is a period of transition between childhood and adulthood and a time of profound biological, intellectual, psychological and economic change.
During this period individuals reach physical and sexual maturity, develop more sophisticated reasoning abilities and make educational and occupational decisions that will shape their adult careers.
Adolescence period is subdivided into 3 stages:
Early adolescence: 12-14yrs
Middle adolescence: 15-17yrs
Late adolescence: 18-20yrs
The different changes in adolescents also differ during these subphases:
Early adolescence is characterized primarily by the changes of puberty and responses to these changes.
Middle adolescence is characterized by transition to a dominant peer orientation, music, dress, appearance, language and behaviour.
Late adolescence involves transition into adulthood including talking on adult work roles and developing adult relationships.
Physical development of adolescents:
The major milestone of development in the adolescence period are the onset of puberty and the cessation of body growth.
Most girls are 2.4-5cm taller than boys coming into adolescence and generally stop growing within 3 yrs from menarche.
Boys grow about 10-30cm in ht. and gain 7-30kg wt. during adolescence.
Girls grow 5-20cm in ht. and gain wt. 7-25kg.
Growth stops with the closure of epiphyseal line of long bones which occurs at about 16-17yrs in female and about 18-20yrs in male.
Physical growth during adolescence is greatly influenced by heredity, nutrition, medical care, illness, physical and emotional environment, family size and culture.
Musculo-skeletal changes:
The head, hand, feet grows first. Extremities grows before the trunk because of which they look ‘leggy’.
After trunk grows to full size the shoulder chest and hip grows.
Skull, facial bone and jaw bone develop and forehead becomes more prominent.
Skeletal differences:
Shoulder wide in boys and broader hip in girls.
Under the influence of ‘testosterone’ muscle increases steadily and remerkably well developed in boy.
In both sexes fat deposition on trunk increases which is more pronounced on girls particularly in the region over the thighs, hip, buttocks and around the breast tissue.
Skin changes:
Androgenic hormones produce increased thickness and some darkening of the skin.
Voice changes:
Girls’ voice become slightly deeper and considerably full.
In boys, voice shifts uncontrollably from deep to high tone.
Hair:
Pubic and axillary hair appears in both sexes, although its more extensive in male than females.
In boys body hair appears on chest, back and shoulder and moustache and beard line also appears.
Sweat gland:
Formation of apocrine sweat glands (glands present in axilla and genital area) occurs shortly after puberty.
These glands produce a strong odour.
Teeth:
Adolescents gain 2nd molar at about 13yrs and 3rd molar (wisdom teeth) between 18 and 21yrs.
Sexual changes/secondary sex characteristics:
Boy
Begins enlargement of testes, scrotum and penis.
Scrotal skin becomes darkly pigmented and rugated.
The first noticeable sign of puberty is appearance of pubic hair.
Facial and axillary hair also appear.
Milestone of male puberty is ejaculation that occurs at 14yrs of age.
Girl:
First noticeable sign of puberty is appearance of breast bud.
Pubic and axillary hair appears
Milestone of female puberty is menarche which usually occur after 2yrs of thelarche.
Female internal reproductive organ reach about adult size in about 18-20yrs sequential order in which development occurs in adolescent girl is:
Thelarche->pubarche->further develpoment of breast and pubic hair->menarche->maturation of breast and adult female distribution of pubic hair.
Physiological changes in adolescents:
Cardiovascular system:
The size and strength of heart, blood volume and systolic blood pressure increase and pulse rate decrease.
Pulse rate is slightly high in girls than in boys.
Blood volume and hematocrit level are high in boys.
Respiratory system:
Respiratory rate decrease but volume and tidal capacity increase.
Fluid and electrolyte:
Body fluid volume reaches adult level and is higher in girls than in boys.
Intellectual change:
The ability to respond to physical stress and strain develops and performance improves.
Integumentary change:
Due to extreme activities of sebaceous gland acne appears on face.
Sweating present especially in the axilla and becomes odoriferous.
Pubic and axillary hair develops in both sexes
In boys moustache, beard, long hair on extrimities, in chest and even in shoulder and back.
Reproductive system:
Production and release of gonads.
Secretion of sex appropriate hormones like estrogen and progesterone from ovaries and testosterone from testes.
Psychological and emotional development in adolescents
It is a transition period of life beginning with the appearance of secondary sex characteristics and ending with cessation of growth.
Their ability to reason, assess, evaluate, thinking and new ideas increase during this period so they can go following psychological and emotional development:
a) Cognitive development:
It is the development in the thinking capacity of a person. The adolescents become capable of scientific reasoning and formal logic.
b) Self concept and body image development:
- In adolescence, physical and psychological alteration, new sensation and feelings, are experienced .
- Factors influencing their self-concept are age of maturation, degree of attractiveness, nane or nickname, size and physique appropriate to their gender.
- Rapid body growth during adolescence results in revision of individual’s body image. To integrate these changing body image they spend lot of time in body hygiene, selecting clothing and staying in front of mirror.
c) Moral development:
- Adolescents are conscious about existing moral values. They try to establish their own moral codes.
- Their decision based on an internalized set of moral principle provide them a source to evaluate the situation and plan of the course of action that is consistence with their values and ideas.
d) Idealism:
- With the capacity of abstract thinking adolescents become concerned about gaining a clear understanding of life and its purposes.
e) Search for identity:
- Identity formation is enhanced by having support not only from parents but also from other person who has a stable identity.
- During this period they develop personal identity, group identity and sex role identity.
Adolescence is characterized by the time period between 12-20yrs.
It is a period of transition between childhood and adulthood and a time of profound biological, intellectual, psychological and economic change.
During this period individuals reach physical and sexual maturity, develop more sophisticated reasoning abilities and make educational and occupational decisions that will shape their adult careers.
Adolescence period is subdivided into 3 stages:
Early adolescence: 12-14yrs
Middle adolescence: 15-17yrs
Late adolescence: 18-20yrs
The different changes in adolescents also differ during these subphases:
Early adolescence is characterized primarily by the changes of puberty and responses to these changes.
Middle adolescence is characterized by transition to a dominant peer orientation, music, dress, appearance, language and behaviour.
Late adolescence involves transition into adulthood including talking on adult work roles and developing adult relationships.
Physical development of adolescents:
The major milestone of development in the adolescence period are the onset of puberty and the cessation of body growth.
Most girls are 2.4-5cm taller than boys coming into adolescence and generally stop growing within 3 yrs from menarche.
Boys grow about 10-30cm in ht. and gain 7-30kg wt. during adolescence.
Girls grow 5-20cm in ht. and gain wt. 7-25kg.
Growth stops with the closure of epiphyseal line of long bones which occurs at about 16-17yrs in female and about 18-20yrs in male.
Physical growth during adolescence is greatly influenced by heredity, nutrition, medical care, illness, physical and emotional environment, family size and culture.
Musculo-skeletal changes:
The head, hand, feet grows first. Extremities grows before the trunk because of which they look ‘leggy’.
After trunk grows to full size the shoulder chest and hip grows.
Skull, facial bone and jaw bone develop and forehead becomes more prominent.
Skeletal differences:
Shoulder wide in boys and broader hip in girls.
Under the influence of ‘testosterone’ muscle increases steadily and remerkably well developed in boy.
In both sexes fat deposition on trunk increases which is more pronounced on girls particularly in the region over the thighs, hip, buttocks and around the breast tissue.
Skin changes:
Androgenic hormones produce increased thickness and some darkening of the skin.
Voice changes:
Girls’ voice become slightly deeper and considerably full.
In boys, voice shifts uncontrollably from deep to high tone.
Hair:
Pubic and axillary hair appears in both sexes, although its more extensive in male than females.
In boys body hair appears on chest, back and shoulder and moustache and beard line also appears.
Sweat gland:
Formation of apocrine sweat glands (glands present in axilla and genital area) occurs shortly after puberty.
These glands produce a strong odour.
Teeth:
Adolescents gain 2nd molar at about 13yrs and 3rd molar (wisdom teeth) between 18 and 21yrs.
Sexual changes/secondary sex characteristics:
Boy
Begins enlargement of testes, scrotum and penis.
Scrotal skin becomes darkly pigmented and rugated.
The first noticeable sign of puberty is appearance of pubic hair.
Facial and axillary hair also appear.
Milestone of male puberty is ejaculation that occurs at 14yrs of age.
Girl:
First noticeable sign of puberty is appearance of breast bud.
Pubic and axillary hair appears
Milestone of female puberty is menarche which usually occur after 2yrs of thelarche.
Female internal reproductive organ reach about adult size in about 18-20yrs sequential order in which development occurs in adolescent girl is:
Thelarche->pubarche->further develpoment of breast and pubic hair->menarche->maturation of breast and adult female distribution of pubic hair.
Physiological changes in adolescents:
Cardiovascular system:
The size and strength of heart, blood volume and systolic blood pressure increase and pulse rate decrease.
Pulse rate is slightly high in girls than in boys.
Blood volume and hematocrit level are high in boys.
Respiratory system:
Respiratory rate decrease but volume and tidal capacity increase.
Fluid and electrolyte:
Body fluid volume reaches adult level and is higher in girls than in boys.
Intellectual change:
The ability to respond to physical stress and strain develops and performance improves.
Integumentary change:
Due to extreme activities of sebaceous gland acne appears on face.
Sweating present especially in the axilla and becomes odoriferous.
Pubic and axillary hair develops in both sexes
In boys moustache, beard, long hair on extrimities, in chest and even in shoulder and back.
Reproductive system:
Production and release of gonads.
Secretion of sex appropriate hormones like estrogen and progesterone from ovaries and testosterone from testes.
Psychological and emotional development in adolescents
It is a transition period of life beginning with the appearance of secondary sex characteristics and ending with cessation of growth.
Their ability to reason, assess, evaluate, thinking and new ideas increase during this period so they can go following psychological and emotional development:
a) Cognitive development:
It is the development in the thinking capacity of a person. The adolescents become capable of scientific reasoning and formal logic.
b) Self concept and body image development:
- In adolescence, physical and psychological alteration, new sensation and feelings, are experienced .
- Factors influencing their self-concept are age of maturation, degree of attractiveness, nane or nickname, size and physique appropriate to their gender.
- Rapid body growth during adolescence results in revision of individual’s body image. To integrate these changing body image they spend lot of time in body hygiene, selecting clothing and staying in front of mirror.
c) Moral development:
- Adolescents are conscious about existing moral values. They try to establish their own moral codes.
- Their decision based on an internalized set of moral principle provide them a source to evaluate the situation and plan of the course of action that is consistence with their values and ideas.
d) Idealism:
- With the capacity of abstract thinking adolescents become concerned about gaining a clear understanding of life and its purposes.
e) Search for identity:
- Identity formation is enhanced by having support not only from parents but also from other person who has a stable identity.
- During this period they develop personal identity, group identity and sex role identity.
Tuesday, October 28, 2008
Indication for oxygen therapy
Indication for oxygen therapy:
- Oxygen therapy is indicated in any acute condition causing inadequate tissue oxygenation like pulmonary embolism, severe pneumonia, pneumothorax, acute severe asthma, MI
- Cyanosis and acute dyspnea are obvious signs of severe hypoxia but, in many patients requiring oxygen, the signs, if any, may be much less specific, e.g. tachycardia or mild confusion.
- If the arterial oxygen saturation, as measured by pulse oximetry (SpO2) is less than 90%.
- Prophylactic oxygen therapy is required postoperatively (at least 4 hours following major surgery and following minor surgery until the patient is stable.).
- Hypoxemia is common during heavy sedation: If verbal contact with the patient is lost due to sedation, the airway must be protected and oxygen should be administered.
- Oxygen therapy is indicated in any acute condition causing inadequate tissue oxygenation like pulmonary embolism, severe pneumonia, pneumothorax, acute severe asthma, MI
- Cyanosis and acute dyspnea are obvious signs of severe hypoxia but, in many patients requiring oxygen, the signs, if any, may be much less specific, e.g. tachycardia or mild confusion.
- If the arterial oxygen saturation, as measured by pulse oximetry (SpO2) is less than 90%.
- Prophylactic oxygen therapy is required postoperatively (at least 4 hours following major surgery and following minor surgery until the patient is stable.).
- Hypoxemia is common during heavy sedation: If verbal contact with the patient is lost due to sedation, the airway must be protected and oxygen should be administered.
congestive cardiac failure
Definition: Heart failure is a clinical syndrome that results from the progressive process of remodeling, in which mechanical and biochemical factors alter the size, shape, and function of the ventricle’s ability to pump enough oxygenated blood to meet the metabolic demands of the body.
Pathophysiology:
Heart failure results from a variety of cardiovascular conditions including chronic HTN, coronary artery disease and valvular disease. These conditions can result in decreased contraction (systole), decreased filling (diastole) or both. Significant myocardial dysfunction most often occurs before the patient experiences the signs and symptoms of heart failure such as shortness of breath, edema and fatigue.
As heart failure develops, the body activates neurohormonal compensatory mechanisms. Systolic heart failure results in decreased blood volume being ejected from the ventricles. The decreased ventricular stretch is sensed by baroreceptors in the aortic and carotid bodies. The sympathetic nervous system is then stimulated to release epinephrine and nor epinephrine. The purpose of this initial response is to increase heart rate and contractility and support the failing myocardium, but the continued response had multiple negative effects. Sympathetic stimulation causes vasoconstriction to the skin, GI tract and the kidneys. A decrease in renal perfusion causes the release of rennin. Rennin promotes the formation of angiotensin I.Angiotensin converting enzyme in the lumen of pulmonary blood vessels converts the angiotensin I to angiotensin II, a potent vasoconstrictor, which then increases the blood pressure and afterload. Angiotensin II also stimulates the aldosterone from the adrenal cortex, resulting in sodium and fluid retention by renal tubules and stimulating the thirst centre. This leads to the fluid over load commonly seen in heart failure.
As heart workload increases, contractility of the myocardial muscle fibers decreases. Decreased contractility results in an increase in an end diastolic blood volume in the ventricle, stretching the myocardial muscle fibers and increasing the size of the ventricles. The increased size of the ventricles further increases the stress on the ventricular wall, adding to the workload of the heart. One way the heart compensates the workload is by increasing the thickness of the heart muscles. However this hypertrophy results in an abnormal proliferation of myocardial cells, a process known as ventricular remodeling.
Diastolic heart failure results because of continued increased workload in the heart, which responds by increasing the number and size of myocardial cells. The responses cause resistance to ventricular filling, which increases ventricular filling pressures despite a normal or reduced blood volume.
Etiology:
Caused by disorders of heart muscles resulting in decreased contractile properties of the heart; MI, HTN, valvular heart disease; congenital heart disease; cardiomyopathies; dysarrythmias.
Other causes include:
a) Pulmonary embolism, chronic lung disease
b) Hemorrhage and anemia
c) Anesthesia and surgery
d) Transfusions or infusions
e) Increased body demands( fever, infection, pregnancy)
f) Drug induced
g) Physical and emotional stress
h) Excessive sodium intake
Risk factors:
a) Hypertension
b) Hyprelipidemia
c) diabetes
d) CAD
e) Family history
f) Smoking
g) Alcohol consumption
h) Use of cardio toxic drugs
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