All posts by amdoctorsblog

US Cancer Survival

The survival rate for most cancers has seen promising improvement.  5 year relative survival for 18 of the top 20 most common cancers has increased from 50% in 1975-1977 to 66% in 2006-2012. Cancers that still have poor prognosis are those of the Pancreas, Liver, Lung, Esophagus, and Brain.
One of the factors quoted is that of poor accessibility. AM Doctors mission is to help cancer patients connect with leading US cancer doctors.

Source – National Cancer Institute (NCI) website (https://www.cancer.gov)

Difference between Cardiac arrest and Heart attack

Many people confuse the two terms as being the same. Here are the essential differences.

American Heart Association published an infographic to help understand the difference between Cardiac arrest and Heart attack.

The heart has a conducting system that can be thought of as an internal electrical system. This ‘electric system’ maintains the normal rhythm of the heart. A problem in this system can cause abnormal beating which could be slow, fast, skip beats or abnormal in its rhythm. This is called as arrhythmias.
When an arrhythmia causes the heart to stop beating it results in a Cardiac arrest.

In addition to the electrical system that causes the heart to beat, there is a blood vessel system in the heart. These vessels supply blood and oxygen to the heart muscles.
A blockage in the blood vessels is what causes a Heart attack.

A Cardiac arrest is a medical emergency – Without medical attention, a person can die in a few minutes. A defibrillator can save a life if readily available.  The defibrillator works by sending an electrical stimulus to restore the rhythm. In case a defibrillator is not available,  a cardiopulmonary resuscitation (CPR) should be attempted.

The symptoms of a heart attack mostly start slowly. It is possible for a heart attack to result in immediate death as well. A heart attack does not cause the heart to stop but rather limits its ability to pump enough blood. Because of this weak pumping – There is a backflow of blood and fluid to the lungs causing shortness of breath. This also results in the fluid accumulating in other dependent parts of the body causing swelling of the feet and ankles.

Post a free question to ask our doctors how you can help yourself to a healthier tomorrow.

 

 

 

Update on Blood Pressure control – What should be the target value?

Latest updates from American Medical association on Hypertension target.

Hypertension – commonly referred as high blood pressure is one of the commonest chronic conditions worldwide. Hypertension is referred to as the ‘silent killer’. This is because it may not manifest with usual signs and symptoms. If not controlled properly, this can lead to harmful effects. These include – heart diseases (Coronary artery disease, enlarged left heart or left ventricular hypertrophy and heart failure), effects on brain (Dementia, memory loss and stroke) and damage to kidneys (Kidney failure, glomerulosclerosis and kidney artery aneurysm).
Hypertension affecst 1 of every 3 Americans. Yet only over half (54%) of those affected have their pressure under control.

High blood pressure is preventable with active monitoring and timely treatment.

What is the optimal blood pressure and when should you seek help

Till date, (Based on JNC 7 report) the target BP was set at 140/90 for most people regardless of age except those with certain conditions. These conditions include diabetes, chronic kidney diseases and some heart conditions where it was recommended to keep blood pressure lower than 130/80.

JAMA (Journal of the American Medical Association) recently published its viewpoint on this supported by recent studies.
This table summarizes Blood Pressure goal recommended by JAMA

JAMA recommendations

Note that the target for general population is set at 120/80 as many studies have shown a tremendous increase in heart conditions above these levels. One should not start with medications in this age group as lifestyle changes are the first choice of control in this age group. These changes include weight loss, proper diet, reduction in salt intake, limiting alcohol and smoking and reducing your stress levels.

For the age group of 50-74, the goal is set at 130 for systolic blood pressure but JAMA notes that a target of less than 140 is reasonable. One should aim for less than 130 if treatment is well tolerated.

For the higher age bracket (more than 74) it is recommended to set the goal at 140. Again treatment should be adjusted based on tolerance including orthostatic hypotension, renal function and cognitive changes.

Hypertension and Mobility

While many studies looked at the effect of blood pressure control on cardiovascular and renal conditions, a recent study looked at the effect of intensive control on mobility. The authors followed 2636 patients over 3 years. They looked at limitation in mobility – defined as a walking speed less than 0.6 meters per second (m/s) or self assessed limitation in walking and climbing stairs. The result was that ‘Intensive blood pressure control does not appear to have an important effect on short-term gait speed decline among older adults.’

Recommendation for Physicians

American medical association recommends physicians to use the M.A.P framework as an approach to control blood pressure.
M – Measure Blood pressure accurately
A  – Act rapidly to address high BP
P  – Partner with patients and families to encourage self management.

Controlling your blood pressure starts with taking control of your lifestyle and can control many other diseases. Post a free question to ask our doctors how you can help yourself to a healthier tomorrow.

References
Hypertension in 2017—What Is the Right Target?Aram V. Chobanian, MD -JAMA.  Published online January 30, 2017. doi:10.1001/jama.2017.0105

Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or OlderA Randomized Clinical Trial Michelle C. Odden, PhD et al Published online February 6, 2017. doi:10.1001/jamainternmed.2016.9104