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The patient may become completely normal, without any symptoms and require only a low dose of aspirin. Some patients and require only a low dose of aspirin. Some patients may have a stable angina after the heart attack, they require only medical treatment.

Some patients may have unstable angina i.e. angina coming at an increasing frequency with increasing severity and sometimes even at rest. Such patients may not respond to medical treatment adequately and may require surgical intervention.

To differentiate between these three categories of patients, we have a battery of tests available. These include :

1. Treadmill Test (TMT). This is also known as Stress Test. It is done 3 weeks after heart attack under the supervision of a cardiologist. Some people have a misconception that one may even die after undergoing the test. But on the contrary, this test is absolutely safe. Complications,if any, are only a coincidence and could have occurred otherwise also. This test is not done in patients with unstable angina. Exercise in this test is graded and limited to a particular heart rate or symptoms of the patients. Here person on a fasting state is asked to walk on a moving belt, the speed of which increase gradually. Changes in the ECG, if any, are recorded on to the monitor. If you can walk half to one km without any problem, if you are having normal sex with your partner or if you are climbing stairs, then why be afraid of a treadmill.
2. Holter Monitoring. Holter is a small Walkman like machine that you can carry along with yourself. It gives us a continuous 24 hours beat to beat monitoring. It is particularly useful to pick up any disturbance in pulse rhythm and painless or painful episodes of lack of blood supply to the heart.
3. Colour Doppler Echocardiography- This is another simple and non-invasive test in which we can pick up the function of various chambers, valves and walls of the heart by placing a transducer on patients chest wall.
4. Transesophageal Colour Droppler Echocardiography. This is a few innovative test in which a transducer is placed in the food pipe of the patient where it lies just next to the heart. It gives a much better and clearer view of the heart than the conventional echocardiography. We can also see the main blood vessel supplying blood to the heart, the obstruction of which can lead to sudden death.
5. Late Potential. This is a special type of ECG which can predict dangerous irregularity of pulse which otherwise can lead to sudden death if not treated properly and in time. This test is simple and can be done any time just like an ECG.
6. Angiography-  This is an invasive procedure and is, indicated only in patients who have failed to respond to adequate medical treatment and lead a desirable quality of life.
7. MUGA- It gives the same information given by TMT and echocardiography.

Thalium Scan- Thalium gives us the same though better information as given by TMT and echocardiography.

DRUGS AFTER DISCHARGE

If you have suffered a mild heart attack, it is quite possible that you will be discharged without any drugs, and with only advice on diet, exercise and test. On the other hand, there may have been a slight complication that your doctor wants to treat with drugs, in which case, you may be prescribed one of the drugs described on the following pages.

ANTOCOAGULANTS

These drugs thin the blood and, at least in theory, prevent further thrombosis either in the veins or in the coronary arteries; they may be given for a few weeks or months. They will normally be given to prevent deep-vein thrombosis in the legs. Unfortunately, however, they do not always succeed in preventing a further heart attack. The disadvantages are that you are required to have frequent blood tests- maybe as often as two or three times a week to start with and then at weekly intervals. If you are on long-term anticoagulants, you will have a blood test once a month after the first few weeks of stabilization. A possible danger is that of serious bruises and internal or external bleeding if the blood is thinned too much.

The most commonly prescribed anti-coagulant is coumarin. If you are prescribed an anti-coagulant, you must not take any other drugs without consulting your doctor.

ANTI-THROMBOTIC DRUGS

Aspirin and other drugs, such as persantin, which reduce the stickiness of blood platelets and thus the tendency for the blood to coagulate,may also be prescribed.

The advantages of this kind of treatment for heart attack patients are not, as yet, very clear and there may be problems of gastro-intestinal upsets and, less commonly, the formation of stomach ulcers and internal bleeding. Aspirin is never prescribed with Warfarin because the two drugs can react with each other, causing internal or external bleeding.

OTHER DRUGS

The other types of treatment which may be prescribed are those of angina,heart failure, rhythm disturbance, and high blood pressure and those prescribed in the hope of preventing a further heart attack. These medications are all long term, sometimes for the rest of your life and it is essential that you know exactly what their purpose is, how much and how often they have to be taken and in what quantity, and for how long they are to continue. It is important that you raise this last point with your doctor from time to time. Although you must continue to take your drugs exactly as they have been prescribed for you, you must also realize that they are not the be all and end all : what they can do is limited and the self-help measures which are probably just as if not more important.

ANTI-HYPERTENSIVES

There is no conclusive evidence The drugs used to control high blood pressure prevent further heart attacks and they may not be without their dangers. In a large trial in the United States called MRFIT, it was shown that among those people with ECG abnormality at the start of the trial, more died in the group who were on drugs for high blood pressure than in the group who were not on such medications.

BLOOD-FAT REDUCING DRUGS

Since a raised level of fats in the blood is associated with an increased chance of having a heart attack, it follows that drugs that can reduce fat levels are used in the hope of preventing a recurrence. It should be remembered, though, that the first step is to make every effort to reduce fat levels by changing to a diet low in saturated  and high in polyunsaturated fats. The drugs will be given only if the levels remain dangerously high.

One such drug, in fuse for several years, was Clofiabrate; then an international trial was carried out too see if its use could be further extended to healthy people with raised blood cholesterol levels. Fifteen thousand people from Edinburgh, Budapest and Prague took part and after five years, some rather surprising truths were revealed : the drug certainly reduced the risk of having a heart attack, but overall, it killed more people than it saved. Most of these deaths were from disease of the gall bladder, liver and bowel, including cancer. The trail was described in the medical journal The Lancet thus : The treatment was beneficial but the patient died The drug is no longer in use.

There are other drugs which can reduce fat levels in the blood. It is true that they may reduce the chances of future heart attacks, but their benefits are not impressive and are likely to be wiped out by their side-effects. In 1985, two scientists, Doctor Joseph Goldstein and Doctor Micheal Brown, won the Nobel Prize for their research on the structure and function of an enzyme whose activity is vital in the synthesis of cholesterol by the body. This gives new hope that one day soon researchers will find a new drug that will block production of cholesterol by the body.

BETA- BLOCKERS

There has recently been a tendency for some doctors to prescribe long-term beta-blockers to prevent a recurrence. They may be useful for some people but their wholesale use is to be discouraged for the following reasons. In the first place, they can cause a number of side-effects, including wheeziness, fatigue, depression, weight gain, hallucinations, nightmares, insomnia, cold extremities and psoriasis-like skin rashes.

Secondly, they may interfere with your self-healing ability by masking physical warning signs and emotional over-arousal. Thirdly, you may come to rely on them to such an extent that those problems that may have caused the heart attack in the first place are pushed to one side and remain unresolved. In addition, they tend to have an adverse effect on the level of blood fats and so tend to counteract some of their benefits. And finally, their benefits may not last longer than one year.

If you have been prescribed them, however, you must continue to take them regularly as an abrupt stoppage can have serious or even fatal results.

SURGICAL TREATMENT

If drug treatment fails to relieve you of angina or if you are believed to be at risk of further heart damage, you may be recommended to have a coronary bypass operation. Other possible surgical treatment includes a heart transplant or the use of an artificial pacemaker.

FOLLOW-UP TREATMENT 

In the early stages after having a pace-maker fitted, you will attend the pace-maker clinic at frequent intervals say, a month after discharge and again at the end of a further three months. Thereafter a regular six-monthly check is usual. The pacemaker rate is tested electronically and the device is replaced well before the batteries run out.

Obviously, if a major fault develops suddenly, your original symptoms will develop and you must contact your doctor or clinic immediately. It is wise to carry a medical card at all times, giving essential details about yourself, your cardiac condition and your pacemaker so that, in the unlikely event of your needing emergency treatment, the doctor will have all the details he needs to help you.

ELECTROMAGNETIC INTERFERENCE 

Fixed-rate pacemakers do not contain any sensing circuits and are influenced neither by biological signals nor by outside electromagnetic interference. A demand pacemaker, however, has to be sensitive to the natural heart rhythm and contains sensing circuits. External electromagnetic signals, some of which closely mimic the heart own signal, may therefore suppress the pacemaker electrical impulse.

In practice this rarely happens, since the pacemakers are well shielded from such signals, but in theory at least, spot-welding machines, anti-theft devices, metal detectors, electromagnets, radio and TV transmitters, metal detectors used in airports and libraries, and faulty microwave opens can all occasionally influence the working of a pacemaker. Manufacturers of pacemakers give detailed instructions as to exactly which sources of electromagnetic interference must be avoided.

CARING FOR THE PATIENT AT HOME 

When someone you love has a heart attack, the experience can be alarming, confusing and emotionally draining. Many of the financial, psychological and social problems that both you and the patient are likely to face can be resolved, or at least their burden can be reduced, if you can learn to share them between you and to discuss them openly and constructively with each other. You can also help the patient to recover by maintaining a positive, cheerful and optimistic attitude. Discuss the information you and the patient are given and plan a sensible programme of rehabilitation.

It is particularly important that you appreciate the difference between instructions you are given which are merely intended as guidelines, and those which must be adhered to strictly. Advice regarding medication must be strictly followed, but some of the other recommendations can be given greater latitude. There is nothing more annoying for a patient than your trying to follow every piece of advice you have been given to the letter by throwing away favourite foods, recording every sip of alcohol, or timing every minute exercise with a stopwatch.

Let the patient know his recovery is important to you and that you are there to assist in every possible way. Offer sympathy and understanding but do not take over over his life completely.

What is Prana ? 

The word Prana comes from Prayana or movement. Prana is the fundamental energy, course or fire, thick or thin, big or small which is present in the universe. It is the sum total of all energy that is present in Nature. All physical and mental force and power are the result of Prana. Whatever and mental force and powers are the result of Prana. Whatever moves or works or has life is the manifestation of Prana. It vibrates though all life from the tiny flowers to colossol trees; from creatures and animals to human beings. Prana is that energy which is the basis of all life. Where there is life, physical, intellectual, mental, psychic, spiritual, higher life or lower life there is prana. It is in the air but it is not air. It is the spirit of life. Prana can reach which is beyond the reach of air.

The word Prana is often confused with breathing. When prana is present breathing takes place. The word prana means energy which is the basis of all life. Breath goes directly to the lungs while prana goes directly to the nadis. Prana is inside the blood, inside the air, inside the bones. This energy can be psychic or astral in nature. The meaning of prana goes much deeper than the breath. In one of the ancient scriptures it is mentioned; once upon a time the organs of the body debated as to which among them was the greatest. Sir, which is the best of us? They asked the lord of creatures. The one which leaves the body the worst off, when it goes away. The different sense organs went away one by one, only to find that those remaining had managed without them. For example, without speech, the others were dumb, but yet they carried on. Finally, the breath of life prepared to go away. As a great house might pull up the pegs that tether it to the ground so that Breath of life prepared to pull away all the other organs. But they unitedly said, Sir, do not go away, for we cannot live without you. You are the best of us.

Prana is related to mind and through mind to will and through will to the individual soul and through this to the Supreme Being. If one knows how to control the little waves of prana working through the mind, then the secret of universal prana will become easy for him. The working of prana is seen in the systolic and diastolic actions of the heart, when it pumps the blood into arteries, in the action of exhalation, inhalation and retention during the course of breathing, in the digestion of food, in the manufacture of semen, chyle, chyme, gastric juice, bile, intestinal juice, saliva, in closing and opening of the eye lids, in walking, playing, talking, thinking, and feeling. Prana is the link between the astral and physical body. When this link is cut off, death takes place.

The seat of Prana

According to Swami Sivananda, the seat of prana is heart. Though the Antahkarana is one, yet it assumes four forms viz. (1) Manas, (2) Buddhi, (3) Chitta, ( 4) Ahankar. Likewise, through prana is one, it assumes five forms viz. (1) Prana, (2) Apana, (3) Samana, (4) Udana, (5) Vyana. According to the different functions, it performs this is called as Vritti Bheda. The principal prana is called Mukhya Prana. The prana joined with Ahankara, lives in the heart. The seat of prana is heart, of Apana, the anus of Samana, the region of the naval, of Udana the throat. While Vyana is all pervading it moves all over the body.

Respiration and Breathing 

The terms respiration and breathing are often confused and sometime used as synonymus, but there is a fundamental difference between the two. Breathing is the mechanical act of inhaling air into and exhaling it from the body. A baby starts breathing immediately after its birth, the moment placenta is cut from its body. Respiration, however, takes place in the embryonic stage long before birth. Respiration, life and energy giving process goes on non-stop from the womb to the tomb. Prana is much more than mere breath. Prana is the power behind and within breath. It is the vital force in everything. It is cosmic energy that pervades the whole universe. It is present in all forms, from the lowest to the highest, from the ant to the elephant. Prana is force, magnetism and electricity. It is due to prana that digestion, excretion and seczetion take place. The prana in the air performs a number of functions in the human body. Each of these has a specific name and aim:

1. Prana : It circulates in the area around the heart and controls breathing.
2. Apana : It circulates in the lower regions of the abdomen and controls excretory functions.
3. Udana : It reamins in the thoractic cage and controls the absorbtion of air and food.
4. Vyana : It spreads throughout the body and distributes the energy from food and breath.
5. Naga : It relieves abdominal pressure by provoking excretion.
6. Kurma : It controls the eyelids to prevent foreign bodies from entering and dazzling light from harming the eyes.
7. Krkara : It prevents certain substances from rising into the nasal cavities or descending into the throat causing sneezing and coughing.
8. Devadutta : It ensures the absorption of extra oxygen into a tired body and causes yawning.
9. Dhananjaya : It remains in the body even after death and sometimes causes the corpse to swell.

The Five Sheaths

Prana is the vital force present in animal, plant and all other forms of life. Cosmic Prana infuses all life forms, although it may appear to be a separate entity or take a different form. In the human being, there are five separate planes of existence which are contained within the form of human being and which co-exist. They are known as five sheaths; annamaya kosha, pranamaya kosha, manomaya kosta, vigyanamaya kosha, and anandamaya kosha. These are associated with vital, mental, intutitive and blissful planes by western mystics. The astral body is attributed to both manomaya and vigyanamaya koshas. Just as a machine is operated in action by a generator. Similarly, the five sheaths are able to function by the cosmic prana, even in the absence of continued conscious awareness. In most human beings, conscious awareness exists only on the physical plane. Awareness of the other planes can be developed through the knowledge of prana. The annamya sheath or the food sheath depends on the gross prana in the form of food, water and air. But its existence is more dependent on subtle prana. Life seizes if the subtle prana seizes. The vital sheath of the body is called the pranamaya Kosha or pranic body. The basic structure or the man consists of the physical and the pranic body. It is proper for one to learn all about gross body, the constructon, the physiology and anatomy of the physical and pranic body. The eight chakras and nine gates are the means of awakening. The pranic body which is more subtle that the physical body provides energy and infuses life into the physical body. It is divided into five main sections collectively known ass Panch Pranas prana, apana, samana, udana and vyana. They perform five different function. The pranic body and physical body are inseparably bound with one another. The prana which sustains the pranic body is drawn from the more subtle sheaths of the manomaya, vigyanamaya and anandmaya koshas. Prana exists as light and energy in the pranamaya kosha. In its gores form it is like the flame of fire that flickers, waxes and wanes. As the practitioner develops and purifies body and mind, the pranic body takes on a golden colour which becomes finally a luminous transparent glow. Manomaya kosha, the mental sheath is more subtle than pranamaya kosha. It performs multifarious functions and keeps annamaya and pranamaya kosha together as an integrated whole. It acts as a messanger between each body conveying the experiences and sensations of the external world to the intuitive body. Prana is the source or energy of mind and meditation. Vigyanamaya kosha, the sheath of intuition, is more subtle than the manomaya kosha. When this sheath is awakened, one begins to experience life intuitively to see deeper reasons behind all seen and unseen things. This leads to wisdom. Anandamaya kosha, the sheath of bliss is the last sheath of individual being. This is the causal body.

All the five sheaths are nourished, pervaded, and sustained by prana. In every human body, there is only oneprana. To become conscious of one own prana is to become conscious of prana in other living beings. By gaining control over one own prana, one can influence the prana of others. This is possible when one purifies prana with the yoga techniques. When prana is awakend, one can experience its flow, form, colour and quality. The annamaya kosha or physical sheath can be perceived through the physical leyes. The first stage of the science of prana is transcending awareness of the gross body by inducing pratyahara, sense withdrawal. When this stage is achieved, one can see prana like stars shining in the night. Then one enters the plane of mental sheath, manomaya kosha. The subtle aspect of the mind can be visualised as the abode of light. The quality of the light depended on the purity of mind. Some Yogis have visualised the monomaya kosha having shape and form; others as light emanating from a central source. It is in state of deep meditation that one can perceive the intuitive sheath o vigyanamaya kosha. In this state of awakening one can get vision and intutions of all things. After this stage, one enters into the last sheath known as anandamaya kosha or the ocean of bliss. This is the stage of Samadhi, the abode of paramatma, cosmic self. This sheath may appear in the form of luminous egg, a luminous Shiv-linga or any shining symbol. Each symbol can be used as a means to absorb one awareness. The five sheaths can be perceived and visualised and awakened through the practice of the science of prana. Like a ladder, when one ascends all the five sheaths, one can enter into the state of Samadhi, a blissful union with the Supreme Self. This stage leads to the direct intutive realisation of the Infinite. It is an inner divine experience beyond the reach of speech and mind.

               Observance of Rules

Place : The place selected for doing pranayama should be neither high nor low and it should be lonely, neat, even dry, free from dust, dirt, smoke, flies, insects and other disturbing factors. If the place of practice is a room it should be airy and well ventilated. During the hours of pranayama, no incense should burn. The place should not be in a forest, river bed, sandy or grassy area or near a waterfall. If the place selected is open, it should not be crowded or conjested. All such surroundings and factors induce anxiety and disturb the mind and are therefore inimical to practice of pranayama. To be beneficial pranayama must be practised with due care and attention, otherwise it becomes harmful and dangerous.

Food : Avoid unclean, unbalanced and improperly cooked food. Let the place of cooking be neat and tidy and free from flies. Unclean and unwholesome food would first cause different aliments like drowsiness, idleness, sinful, wicked and lustful desires and through and finally to spiritual fall and degeneration. Impure food retards one spirtitual growth. Food becomes impure when it comes into contact with dust, dirt, flies etc. Cold food should be avoided. One should take food that is simple, nutritious, easily digested and easily obtained. In selecting food, must know its suitability according to one physical build up and the climate in which one lives. And one kind of food, however good, simple and nutritious may not suit all people living in different climates. Avoid taking too much of sour, sweet or pungent things. People living in exterme cold climates must take heat producing food as a necessity but those living in hot climates must take cold-producing food; and people living the tempreate climate, should select food and drinks, the effect of which may be moderate.

LOW ASPIRIN FOR HEART PATIENTS 

Major new research shows that people at high risk of heart attack or stroke should be given one or two baby aspirins a day, instead of the standard maximum strength adult aspirin. The study also concluded that the aspirin can help a wider range of people with potential heart trouble. Aspirin is the cornerstone of blood thinning treatment for people who have had a heart-attack or stroke, but is not normally used for those who have not had a heart attack or stroke but suffer from risky conditions like diabetes, chest pain, irregular heart beat and diseased leg arteries.

The research found that aspirin reduced the risk of heart attack or stroke, or death from those, by 25 per cent whether or not the patients had already had a heart attack or stroke previously.

The findings come from an analysis that combines the evidence accumulated over the years on the effectiveness of aspirin and its alternatives in staving off heart trouble.

Coordinated by scientists at Oxford University in England it encompassed 287 studies involving more than 2000000 people.

The most crucial advance offered by the study is in defining the appropriate dose of aspirin for long-term therapy, said Dr. Eric Topol, cardiology chief at the Cleveland Clinic who was not involved in the analysis.

Most doctors and heart specialists use a dose of 325 mg of aspirin per day when applying it as a blood thinner. That the dose in a maximum strength adult aspirin tablet. The latest analysis shows that between 75 mg and 150 mg works just as well, with less internal bleeding.

TEA GOODS FOR HEARTS

Heavy tea drinking could reduce the risk of dying after a heart attack, a study suggests.

The study of 1900 heart attack victims found that those patients who drank the most tea before their heart attacks about 19 cups a week were 44 per cent less likely than nondrinkers to die in the three to four years latter.

Moderate drinkers, or those who had fewer than 14 cups, had a 28 per cent lower death rate. The study looked at death from all causes, not just heart disease. The study was published in the American Heart Association Journal Circulation.

Researched involved in the latest study suspect the finding are linked to flavonoids, antioxidants found naturally in various foods derived from plants. Tea is a major source of flavonoids in our diets.

HOLE IN HEART A STROKE RISK

In as many as 10 per cent of people, a hole formed in foetal life to allow blood to bypass the lungs remains open, increasing the risk of strokes.

During foetal life, this small tunnel, the foramen ovale, allows blood to bypass the lungs, which are not yet functioning, and go to the placenta. But in newborns, the hole is supposed to close, routing the blood through the lungs.

An open foramen ovale can go unnoticed for decades, but evidence is mounting that the opening, often no wider than a pencil, can cause strokes and mini-strokes in younger people. Small clots entering the heart are normally routed to the lunge, where they are harmlessly eliminated. But if a clot slips through a foramen ovale, it will bypass the lungs and may end up in the brain.

But those who have the opening and experience strokes or mini-stroke also have sharply increased risks of other strokes, as high as 10 percent a year.

WHITE WINE FOR LUNGS

Red wine may be best for your heart, but researchers reported that white wine beat red at preserving aging lungs.

People who drank white wine had greater lung function than those who consumed red wine, but both groups of wine drinkers had greater lung function than non-wine drinkers, say Holger Schuemann of the State University of New York in Buffalo.

Both red and white wine have high concentrations of flavor compounds called polyphenols and flavonoids. Some experts believe that these antioxidants may protect lung tissue from minute atomic particles called free radicals that, over time, damage tissues.

The study, involving 1555 adults, is the latest of several studies showing that moderate drinking may be good for your health.

Red wine has been shown to guard against clogged arteries and to boost blood levels of HDL cholesterol, the good cholesterol that ushers fats out of the blood-stream. Another study showed that a few drinks a weeks a week whether wine, beer or liquor may help women avoid high blood pressure.

In the study, white-wine drinkers had 3 per cent better lung function and red-wine drinkers had 1.5 per cent better lung function than non-drinkers.

HEART CHECKS MUST START AT 20

Doctor should start screening patients for their risk of developing heart disease or strokes as early as age 20, says the American Heart Association.

That calculation is based on factors such as age, smoking status, gender, blood pressure and cholesterol.

Heart disease can be prevented, and we have to start at a young age to do it, says Sidney Smith, professor of medicine at the University of North Carolina-Chapel Hill, who was member of the panel that framed the guidelines.

The panel recommended :

• Weight loss for those with a body mass index over 25 or waist measurement over 40 inches for men and 35 inches for women.
• Moderate physical exercise 30 minutes per day, preferably every day.
• Low-dose aspirin for patients with a 10 per cent risk of developing heart disease within 10 years.
• No exposure to tobacco smoke, including second-hand smoke.
• Control of blood pressure and blood fats.
• Regular pulse checks and treatment for irregular heartbeat associated with blood clot formation, which could lead to stroke.

COATED STENTS KEEP ARTERIES OPEN

A new approach to keeping heart arteries flowing smoothly after angioplasty shows astonishing success in early testing, apparently solving a major shortcoming of this common procedure.

Doctor released the new technique the drug-coated stent. In testing on 43 patients over two years, they found it to be 100 per cent effective, an accomplishment almost unheard of in medicine.

The new approach is likely to be used on most new operations if these promising early results hold up in further testing. They could be on the market very soon.

During angioplasty, doctors fish tiny balloons through clogged heart arteries, then inflate them briefly to open up blood flow. Frequently, though, the arteries squeeze shut again. In recent years, doctors have often left behind tiny wire coils, called stents, to prop the arteries open.

However, about one-quarter of the time, reopened artery closes off, a condition called restenosis. It usually occurs when fast-growth scar-like tissue fills the artery, and must be fixed with a repeat angioplasty or coronary bypass.

The solution to this dilemma appears to be a new kind of stent coated with medicines that gradually ooze into the artery. The drugs keep cells from growing.

Dr. J. Eduardo Sousa of the Dante Pazzanese Institute of Cardiology in Sao Paulo presented two year of follow-up with 43 patients. While three of them needed heart procedures for worsening disease in other parts of their hearts, all areas treated with the cordis stents are flowing freely.

LOWER CHOLESTEROL, THE GRAZING WAY

The first large study into the benefits of snacking found that people who spread their food across many meals had lower cholesterol levels people who ate one or two big meals a day.

The study, published in The British Medical Journal, compared the results of a survey of eating habits of 14666 residents of Norfolk, England, ages 45 to 75. The study also looked at their cholesterol levels, which had been recorded as part of a large study on cancer risks.

The researchers, from the Institute of Public Health at the University of Cambridge, found that the more often people ate, the lower their total cholesterol levels tended to be, particularly their levels of the harmful LDL  cholesterol.

People who ate six meals a day had an average cholesterol level 5 per cent lower than people who ate one or two meals a day, the article said.

People who snacked more consumed more calories and exercised more, but the difference in cholesterol levels remained even when those differences were accounted for, said one of the researchers, Dr. Kay-Tee Khaw.

The authors said the link had turned up in animal studies and smaller human studies. Researchers have speculated that some mechanism lets animals store more of the fat they eat when they gorge than when they nibble more regularly.

Dr. Khaw said the standard recommendations for healthy hearts exercise, eating fruits and vegetables, quitting smoking were still the most important steps.

ORIGIN OF HEART DISEASE QUESTION 

Worse than cholesterol ? Hard to believe, perhaps, but the top heath concern of millions of Americans is about to be trumped by what doctor say is an even bigger trigger of heart attacks.

The condition is low-grade inflammation, Which may originate in a variety of unlikely places throughout the body, including even excess fat. New federal recommendations are being written that will urge doctors to test millions of middleaged Americans for it.

The discovery of its surprising ill effects is causing a top to bottom rethinking of the origins and prevention of heart trouble. Doctors call it a revolutionary departure from viewing the world top killer as largely a plumbing problem blamed on cholesterol clogged arteries, the standard theory through the modern era of cardiology.

In the past year or two, experts say, the evidence has become overwhelming that inflammation hidden deep in the body is a common trigger of heart attacks, even when clogging in the arteries is minimal. Now the main question is : How aggressively should otherwise healthy people be tested to find and treat it ? The new recommendations are still being drawn up and the first formal answer will be available, probably some time later. Inflammation can be measured with a generic $10 test that looks for high levels of a chemical called C-reactive protein. Experts expect it to quickly become a standard part of physical exams. As a result, many people ordinarily considered at low risk will probably be put on stain drugs, which lower inflammation as well as cholesterol.

ASPIRIN AND THE HEART 

A new study suggest that some people who take aspirin to ward off heart attack may not be getting all the benefits they through they were. The study published in the journal Circulation found that a many as 75 per cent of patients showed some resistance to the blood-thinning effects  of aspirin.

Aspirin works by blocking the formation of thromboxane A2,  a chemical in the body that makes platelets sticky and promotes blood clotting. Heart attack are caused by clots. The study found that taking aspirin did not adequately block thromboxane in some people, making them 3.5 time more likely to die of a heart attack than those in whom aspirin works.

WHY INDIANS SUFFER MORE HEART ATTACKS

More and more Indians are getting heart attack and succumbing to them because they do not live with nature, eat bad food and eat at the wrong hour.

It is no wonder, then, that Indians start getting heart disease 10 years before Americans, although the latter are known to take more junk food. Then there are Indian who pass off good food to their servants thinking it cheap food but end up dining at expensive restaurants whose fare is not good for healthy hearts. That is one of the major reasons why so many people die of heart attacks in India, said cardiologist K.K Agarwal of Mool Chand Hospital. Of the 30 million heart patients in India, 250,000 die of heart attacks every year and 180,000 die before reaching the hospital, which means within an hour of the attack, Agarwal said.

We in India give our servants cheap vegetables and we eat expensive vegetables ourselves. We give the servant ration rice and er eat polished rice. We give the servant lemon water and we drink Coke and Pepsi. What we do not realise is that the cheap food we are giving to be servant is natural food and what we eat is unnatural. This is what increase the risk factors. The food we eat is absolutely unnatural and most of it is eaten at night. In the U.S. people eat dinner by 7 p.m. and that is the best time to eat. Eating unnatural food, which we do, after 7 p.m. is most harmful.

Mind does show her three faces. Sometimes Rajas running wild; sometimes Tamas with dark despair; sometimes with sweet serenity

It was Budha who had declared more than 25 centuries ago, What we think, we become. This philosophy of incomparable India Royal Saint found expression once again, a few centuries later in I think, therefore, I am wisely spoken by Descartes in his Principles de la philosophic. These two meaningful statements representing two distinguished schools of through highlight the importance of Mind in unmistakable terms. The human mind is a powerful instruments with which we can solve most of our problems. It is a suitable instrument that enables us to wage of our problems. It is a suitable instrument that enables us to wage our unique battle against our huge ignorance.

It is our sacred duty to use the mind in a positive way, with the help of positive thinking. We can turn any situation howsoever bad to advantage. It prevents mental and physical inertia. There is no room for pessimism and boredom in positive attitude. It was the great artist Rambrandt who said that man could find more beauty in his own village than could reasonably be enjoyed in one normal life span. Although he had as sad a life as one could imagine yet never made the mistake of indulging in self-pity. It goes to his credit that he faced life as a fighting optimist. The result of positive thinking of this celebrated artist is before us. His paintings are now an inexhaustible source of delight, aesthetic pleasure and inspiration to the lowers of art.

Now let us see what negative thinking does to man. It gives rise to unsocial behaviour patterns. This kind of attitude betrays the absence of any real purpose in and affirmation of life. A person yoked to negative thinking refuses to accept social responsibility. Such a mind develops the habit of talking in terms of Ifs and Buts. Inferiority complex is the main characteristic of such a mind. He is unable to meet the obligations of life, and to my mind a person who cannot be of any use to society is worse than a stone. A state may arrive when such a person will be at the mercy of inner disharmony. Psychiatric help will be the only way out in such a situation. The denial of the fact that man is a social animal is clearly a misuse of mind. Love is the highest law of human life. There are two more ingredients necessary for the correct use of mind, namely knowledge and organisation. Without knowledge there is no starting point and in the absence of organisation, knowledge cannot be lasting. Prejudices and thinking in extreme should be abjured as they run counter to knowledge and organisation. Fear, frustration and egotism are the plants that grow fast in soil of negative thinking which is clearly a misuse of mind. So it is essential to discard our defective thought patterns. If we want to cultivate the correct use of mind, we must not take anything on its face value. The pitfall of being dogmatic should be avoided at all costs because it stunts the mind. Curiosity is one of the main springs of the correct use of mind. All our great achievements and dizzy heights that we have achieved in various spheres of human activity, have been possible due to curiosity. Famous philosopher and populariser of Scientific ideas, load has rightly remarked that without this quality of the human mind, our civilisation as we know it today, would have come to naught.

Mind is the wildest, fastest wanderer as mischievous as a monkey, as cunning as a fox, fickle, whimsical, slippery, oscillating, easy to fall into the net of temptations and allurements. If left uncontrolled, it becomes a source of evil thought, morbid feelings, malicious intentions, sinister motives, sensual desires, pervert ideas, ignoble actions and lands man to doom and destruction.

Happiness, sorrows, realisation,  hallucination, liberation, bondage, depends on one mind. For a person whose mind is under his control, there is no need for a mantra or a tantra. In a small ashram in India a Guru had a few disciples. When pleased with one of the disciples who had devotedly served him for ten years, he said, son, choose anything you like, I will confer it on you. The disciple jumped with joy and asked, Master bless me with a mantra that can fetch me anything I desire. Surprised, the Guru asked him to ask instead for spiritual blessings. When the disciple insisted, the master reluctantly gave him the mantra, on his way back to his house, when the disciple chanted the mantra, the power appeared before him and asked for orders. On the disciples request, the power built a palatial house and filled it with rich food, wine and women. The disciple satisfied with these said that it would suffice. But the power said, anything you desire, I will do, but the moment, you stop giving me work, I will devour you; Frightened the disciple ran back to the master. As per the master advice, the disciple ordered for an iron pole of five thousand feet to be fixed and asked the power to keep moving up and down the pole. The power did so. Human mind is like the power in the story. Tuned properly, the mind can achieve anything and everything. Once it is kept idle, it will not only create problems for one but also literally behour one with its worries. It is said as our desires, so our thoughts; as our thoughts, so our experience. The mind is to be constantly guarded and carefully protected from its own inherent negative tendencies. Cultivation of higher values of life, like forgiveness, compassion, love charity, ahimsa, help in this regard. The mind is a huge catalogue of conception and it uses these to create a philosophy of its own. The brain is only a distribution centre. It is the a power house but not the power. The mind is both mysterious and unique. Sometime man, in ingorance struggles to control the mind but misses it completely because the very struggle sometimes brings conflict, feeds the mind and makes it strong. Swami chanmayananda in his commentag on ashtavakra gita says mind can never control the mind. By rising above the mind intellect alone can the mind controlled without trenscending the mind, the experience of the self is impossible. Some people continue their meditation throughout their lives yet ever remain unhappy, bound as they are with the mind intellect  entanglements. Man tries in the beginning to turn his mind away from sense objects, but sense objects  are everywhere. One should lift oneself above the mind. Both father and child walk into the toy shop, the child is tempted and excited but not the father because he has risen above the level of toys. The sense objects can entrap only a mind, that is seduced with its desires. The quietened mind, after eliminating the desire and ego, becomes the pure intellect namely sudha budhi.

According to yogic philosophy human being in his journey to self awakening passes through the stages of evolution and involution. In the first stage one becomes completely identified with the external world. In the second stage one turns inwards in which he rediscovers the subtle experiences and subtle aspects of his being and finally comes to realise himself as pure consciousness. A mind either runs after the world or away from it, both reflect the weakness of the mind. A mind that does from it, both reflect the weakness of the mind. A mind that does not enjoy objectivity and tends to project its own conceptions on men and matters becomes mechanical and thus unhappy. When the mind is turned outward, as it usually done, the mind becomes the subject and the whole outerworld becomes the object. When such a mind is turned inwards, it divide itself into both the subject and the object. Most of the people are ignorant about mind. It is this ignorance which makes the mind a jungle full of poisonous weeds of tension, anxiety, Worry, fears and phobias. Mind is the cause of three states of experience waking, dream and deep sleep. In waking state of experience waking, dream and deep sleep. In waking state there is disharmony and confusion of through. In dream state, the stored up memories of waking state are projected. In deep sleep state there is peace and happiness because of continuous single through I do not Know.

Whether one lives in heaven or hell, in the house or moves to the forest, the mind will continue to haunt. sometimes change of surroundings, even a forest, the mind will continue to haunt. Sometimes change of surroundings, even a forest, can increase the thought of the mind. In Amrta-Bindopanishad, the mind had indeed been described as two-fold, the pure and the impures, the impure as affected with desire and the pure as devoid of desire. One colouredness is the quality of milk of cows of various colours. The wise man looks upon the knowledge of the Brahman as on milk, and on the people with various garbs as on the cows. Vijnava abides hidden in being after being, even as butter does in milk. Hence should churning be constantly made in the mind by every being with the churning- stick of the mind

In the Tejo-Bindopanished, it is mentioned, The mind alone is the universe. The mind alone is the great foe. The mind alone is worldly existence. The mind alone is the great misery. The mind alone is duration of time. The mind alone is impurity. The mind alone is desire. The mind alone is Jiva. The mind alone is Chitta. The guardians of the cardinal points, the Vasus, the Rudras, and the Adityas are the products of mind.

There appear many impediments, situations and difficulties in yogic way of life. Impediments and difficulties are of various types producing misery or Dukhas. In the Sankhaya Sutras, Kapila mentions Dukhas of three types : Adhiyatmika or that caused within ourselves in the body by illness and unhealthy living and in the mind by evil desires, anger, greed, folly, pride and envy. Adhibantika or that caused by other living beings such as thieves, beats, terrorists and evil minded persons. Adhidasvika as the misery brought about by natural phenomenon such as extreme temperature, floods, storms, tempests, earthquakes etc. as obstacles in yogic way of life.

We are all born with good impressions and tendencies brought from previous lives and we also acquire new ones in present life. While good tendencies help but evil tendencies obstruct our yogic progress. Yogic life is like stream and should move towards the ocean of sat-chit-Ananda or Infinite-Existence sometimes the yogic current does not move at all, sometimes it moves for a time and stops and sometimes it moves along wrong directions. The task in our yogic life is to make the current move steadily in the right direction till the aim is achieved. But in actual life there is no such things as movements in a straight line. There appear many ups and downs, breaks or stops, This has been experienced by many yoga aspirants.

Patanjali gives number of conditions which serve as distractors of mind and consequently make the successful practice of yoga impossible.

Vyadhi-styana-sannsaya-pramada

lasyavirati-bhranti-darsanala

badhabhumikatvanavasthitatvani

chitta-vaksepas te ntarayah.

Disease, languor, doubt, carelessness, laziness, worldly-mindedness, delusion, non-achievement of a stage, instability these cause of distraction of the mind and they are the obstacles.

This distracted condition of the mind is called viksepa. There are two general characteristics which we are likely to find in the large majority of people. First is the lack of purpose. They drift through life being carried along on its currents in a helpless manner. There is no directly force within them which can modify their circumstances and give a certain direction to their life. Even when they decide to pursue any particular objective, they are easily thrown off the track by any obstacles. They lack concentration of purpose. There are some exceptional people who have strong will and have the capacity to pursue  their aim till they achieve success. such people generally rise from the lowest rank and become great scientists, inventors, and leader. Now the yogi has neither any ambitions nor the pursuit of of any worldly aim still he needs concentration of purpose. The pursuit of yogic ideals requires more concentration of purpose because difficulties in his path are greater and his sphere of work is invisible and objective is unknown.

ABOUT NOW

While cardiovascular disease remains a major killer around the world (India alone accounts for nearly 40 million people diagnosed with heart disease) doctors are better equipped than ever to battle it thanks to breakthroughs in prevention, diagnosis and treatment. In fact, 70% of the drop in heart disease deaths over the past decade has come from innovations such as clot-busting drugs and bypass surgery. Given below are some of the most promising new medications, diagnostic methods and surgical techniques on the horizon.

PREVENTION

A NEW BLOOD TEST IDENTIFIED HIGH-RISK CANDIDATES 

Many people start down the road towards heart disease and do not even know it. Some suddenly gain weight around their midsection in their late 40s. In others blood pressure goes up for the first time. Some people may also silently develop insulin resistance, a precursor to diabetes and a contributor to the growth of artery-clogging plaque. A new blood test may help identify these candidates before they suffer permanent heart damage.

The test looks at the level of binding protein which is lower in people who do not process insulin properly.

In studies, When insulin-resistant women were given a drug that lowered blood sugar and put on a special diet, their blood pressure and insulin levels came down, the BP-1 marker their risk factors. Researchers believe that the BP-1 test could be available within five years.

BETTER CHOLESTEROL CONTROL

About a third of those who are had one heart attack will suffer another, so staving off will the second crisis is critical. A 1996 study found that people who had high cholesterol levels could prevent artery damage and cut their chances of a second attack or a stroke almost in half by taking cholesterol-lowering drug called statins.

Experts believe that such preventive drug therapy works best in those who have other risk factors such as hypertension or diabetes. In those who only have mildly elevated cholesterol, but no other risk factors, just a low fat diet and an exercise regimen coupled with regular monitoring can greatly reduce their risk of a further attack.

CAN ANTIBIOTICS STOP HEART DISEASE?

Many researchers believe that coronary artery disease develops when inflammation in blood vessel walls promotes the growth of plaque. Now some scientists think that herpes viruses such as cytomegalovirus, a cousin of the virus responsible for cold sores, or the bacterium Chlamydia pneumoniae, which causes respiratory infections, may trigger the initial inflammation.

There plenty of circumstantial evidence. Both organisms have been found in arterial plaque, say epidemiologists at the University of Washington School of Public Health in Seattle. A 1996 study conducted at the National Heart, Lung, and Blood Institute found that people who had CMV infections were 10 times as likely to have plaque grow back after it was cut away. And heart patients are likelier than others to have antibodies to C. pneumoniae in their blood.

If bacteria promote clogged arteries, then antibiotics might slow the process. Scientists are planning a study to test that idea, giving antibiotics to people who have had one heart attack to try to prevent a second one. As for the viral threat, vaccines could prevent infection in the first place, but shots are still several years away.

DETECTION

A HEART Mammogram 

Almost two-third of those who die suddenly of coronary disease have had no previous symptoms. Fortunately doctors now have a way to detect early signs of clogged arteries while there still time to intervene. Electron-beam computed tomography, better known as Ultrafast CT, has been dubbed a mammogram of the heart, because it picks up tiny calcium deposits in arteries, just as X-ray detect calcifications in breast tissue.

Among the potential uses for Ultrafast CT are determining whether heart attack candidates, for eg.,postmenopausal women, with average cholesterol levels might benefit from cholesterol-lowering drugs or estrogen therapy.

A MENTAL STRESS TEST

Exercise stress tests are notoriously bad at diagnosing heart disease in most people. Nor can they measure the effects of mental stress, which strains the entire cardiovascular system. Now researchers at Duke University Medical Center in Durham, N.C. have come up with a test to do just that.

Patients with heart disease were asked to give a speech, trace the outline of a star from its reflection in a mirror, and do complex math problems quickly all while researchers measured heart function. Two-thirds of the 126 patients studied showed cardiac abnoralities during both types of test. But those who turned up positive on the mental test were three times as likely to suffer a heart attack or need surgery in the next five years.

Mental stress tests not replace exercise tests, but they could become a valuable added diagnostic tool.

A MORE ACCURATE EXAM FOR WOMEN 

When a treadmill test turns up symptoms of heart disease, the next step is often a thallium test. The radioactive element is injected into the body, allowing special cameras to trace blood flow to the heart muscle. There one catch: In women, breast tissue often casts a shadow that can prompt a false diagnosis of ischemia (inadequate supply of blood to the heart). Cardiologists are increasingly turning to a technology that does not pose this problem; positron emission tomography scans.

PET uses elements such as rubidium, which are less prone to image distortion. It has therefore become the definitive test in women because it is more accurate and gives more detailed information. PET scan not only eliminates interference from breast tissue, but it can also better detect mild blockages, which my not produce symptoms in women. PET also takes only about an hour, compared with four or five hours for a thallium test.

A BLOOD TEST DETECTS HEART ATTACK

Even the most advances diagnostic technology is of little help when a man enters the emergency room with chest pain: Roughly one-third of the time, a heart attack does not show up on the ECG. But a new blood test can swiftly reveal if even a mild heart attack has occurred.

The test measures blood levels of cardiac troponin I, a protein released only by a damaged heart. In a 1966 study of more than 1,400 people by the Brigham and Women Hospital in Boston, researchers reported that 25% of patients with chest pain who might normally have been diagnosed with unstable angina (chest pain that is not immediately fatal) had elevated levels of protein, indicating they actually had mild heart attacks. The blood test allows researchers to quickly rule out or confirm a heart attack when other tests are in doubt, or to classify a patient as high risk.

TREATMENT

TINY TOOLS, GENTLER SURGERY 

Its called minimally invasive heart surgery, and some say it is the biggest advance in cardiac surgery in the last quarter century. Traditional bypass surgery involves sawing through the breastbone and prying open the rib cage, leaving a foot-long scar. Doctors practicing the new technique insert miniature surgical tools through small incisions in the chest, leaving only small scars.

The most widely used method, the Heart port Port-Access system, cuts the hospital stay in half, and recovery time to two to three weeks, compared with 12 weeks for open-chest surgery. A patients bill slightly lower than the one for a conventional bypass.

Because the technique is relatively new, long-term follow up results have not yet been published. Ultimately, though, half of those who undergo bypass surgery each year might be candidates for minimally invasive surgery.

LASERS SAVE HOPELESS CASES

When clogged arteries starve the heart of blood and oxygen over a long period, angina becomes chronic and the heart muscle can be seriously damaged. For people who are not helped by angioplasty or bypass, a technique called TMR can buy time.

The idea was inspired by snakes and alligators, whose heart soak up oxygen-rich blood like a sponge because they have dozens of little channels running into the heart muscle. TMR uses a laser to create 15 to 50 such channels in the human heart. When the heart contracts, blood is squeezed through the new channels into the heart muscle. In a few weeks, the channels branch out and new blood vessels grow. Although the procedure is not curative, most patients have significant angina relief.

KEEPING TIRED HEARTS TICKING

If a weakened heart can not pump fast enough to keep the body going, congestive heart failure develops. When medication does not help, the next step is a transplant. Each year less than one percent of those who need a donor heart actually get one; many die waiting. In the past few years, doctors have begun to use battery-powered implants called left ventricular assist devices to keep worn-out hearts pumping.

After the L-Vad, a bit larger than a mans fist, is implanted beneath the diaphragm, patients go home and can resume normal activities. In some patients the heart may even regain strength, and not need a transplant at all.

Researchers are now conducting a clinical trial in 130 patients to see if L-VADs could be used permanently. They are also developing smaller models that fit women more comfortably. Although the device is not any cheaper or better than a transplant, given the scarcity of donor hearts, L-VADs  can meet the shortfall.

THE WONDER DRUG

If it were half as effective, 10 times as expensive, and on prescription, maybe more people would take it seriously, lamented Dr. Charles Hennekens, Professor at Harvard Medical School. He was talking about aspirin, the world largest-selling drug, that has precious little hype built around it because it is so freely and cheaply available.

Yet doctors are now looking at aspirin as the 20th century wonder drug, one which does not just get rid of headaches and fevers, but also helps reduce chances of heart attacks and strokes, alleviates the pain of arthritis and is even being considered as a new line of defence against HIV.

HOW IT WORKS

The key compound in aspirin is salicin, found in the bark of the willow tree. Folk medicine has used it to treat all kinds of aches, pains, fevers and swellings. Clay tablets from the sumerian period describe the use of willow leaves to treat rheumatism and the Egyptians, used them too. Around 400 BC, Hippocrates used a brew of willow leaves to ease the pain of childbirth.

Aspirin was first marketed mainly as an anti-inflammatory drug, particularly for people suffering from rheumatism, but its popularity as a general purpose painkiller followed quickly.

The discovery, in 1971, of how aspirin actually works has led to its use in a number of new applications. The British pharmacologist and Nobel Prize awardee, Sir John Vane, showed that aspirin worked by suppressing the production of local hormones known as prostoglandins. Among other things, prostoglandins increase the sensitivity of pain receptors on nerve endings and dilate blood vessels.

Prostoglandins are found in most tissues of the body and they have a number of different functions, including regulating the contraction of the so-called smooth muscle that is found in the blood vessels, the stomach, the intestines and the bladder. But they also regulate the aggregation of platelets. Suppress the prostoglandins in platelets, therefore, and you suppress the formation of the sort of clots that trigger heart attacks and strokes.

Prostoglandins are released when cells are injured and trigger the typical symptoms of inflammation, including swelling and pain. This discovery confirmed why aspirin had been so effective in treating arthritis it eases the pain, controls the inflammation; and reduces fever which frequently plagues people with rheumatoid arthritis.

THE WORLD FIRST SYNTHETIC DRUG

When aspirin was invented on August 10, 1897, it become the world first truly synthetic drug and paved the way for the modern pharmaceuticals industry.

The newly-discovered drug become the first drug ever to be tested in clinical trials before registration. It was entered in the Patent Office at Berlin on February 1, 1899, under the trade name aspirin. The letter a stood for acetyl and spir was derived from spirea acid, which is chemically identical to salicylic acid. This was obtained from the sap of the plant, Spirea ulmaria, a shrub belonging to the rose family which usually grows abundantly in wet areas.

Over 40,000 tonnes of aspirin are consumed globally every year. In India, around 3,000 tonnes of aspirin is sold annually.

You Need Deep Relaxation to Meditation

A visual image may help you understand the process of deep relaxation. Imagine that you can see the energy patterns of the body. Muscles are luminescent, brightening when they contract and dimming as they relax. Every cell glows as it carries on its tasks. The heart flashes each time it beats, and organs shine brightly as they perform their various functions. You can see which muscles are tense by looking for hot spots.

The brain and nervous system are especially brights, and you can see constantly shifting waves of energy. A channel of light leads to the brain from each of the sense organs, especially the eyes and ears. Small flashes appear in the brain as information is received and processed, as decisions are made, and signals sent to various parts of the body. The spinal cord is nearly as bright as the brain, glowing as signals go back and forth to every area of the body. You can see circuits in the brain flashing over and over again as the brain thinks, as it remembers, and as it makes decisions.

Look at someone who is asleep. His body is relaxed and appears dim. The heart and respiratory system have slowed down but still flash as they feed the slumbering body. The senses have largely shut down, and their connection with the brain is only a dull glow. The brain itself is surprisingly active, but the patterns are different from those during the waking hours. Most of the sleeping person energy is centered in the spine and brain.

Now observe someone in the deep meditation. In many ways he seems similar to a person who is asleep. The yogi body is completely relaxed, perhaps even more so than that of a person sleeping. His senses, too, are shut down, but other parts are aglow. Energy has been completely withdrawn into the spine and forepart of the brain. A great master of yoga can withdraw his energy so completely that even the heart and autonomic nervous system are shut down. He has the ability to consciously bring all his energy into a laser-like focus which energizes the spiritual eye, uplifts his consciousness, and eventually raises him to the state of Self-realization.

The first step toward this profound state is relaxation. Relaxation is a result of withdrawing tension and energy from any area, a process normally only partly under our command. But for deep meditation we must learn deep relaxation, which requires conscious control of life-force. Later in this lesson we will learn a technique to completely relax the body, which gets us over the first big hurdle in meditation : physical tension. Keeping your body relaxed and motionless while you are meditating is the first step toward more profound states of consciousness.

Next we must relax the mind, because the biggest challenge is overcoming mental restlessness. When you try to meditate, you will find that your mind wanders, not because you are meditating, but simply because you are now quiet enough to finally see how the mind constantly skips from thought to thought in a free-association wonderland. The way to overcome mental restlessness is through concentration. There are a number of extremely effective yogic techniques to improve concentration. Among the most effective are techniques which work with the breath.

One of yoga great gifts to mankind is the discovery of the link that exists between energy, breath, and mind. As you change one, you also change the other two. If you excite one, the other two become excited and, conversely, if you calm one, the other two respond by becoming calm also. You will notice that if your mind becomes excited, from a sudden fright perhaps, your breath will also speed up. You might also notice that your muscles fill with energy in preparation for action. Observe yourself going through changes in this mind/breath/energy cycle the next time you see a film which plays on your emotions.

The breath is the most outward and, therefore, the easiest of these three linked elements to control. Control your breath and see how quickly it influences your thoughts. This is true in any situation, not just in meditation. A student of these teachings who was in charge of training for the San Francisco Police Department told his rookies that if they wanted to take control of a potentially dangerous confrontation, they had to learn to control themselves first. In order to help them achieve self-control, he taught them to monitor their breathing, to take slow deep breaths. They found it amazingly effective. Try it yourself the next time you are in a tense situation.

Control of the breath and breathing is central to yoga practice. During this course we will learn a number of techniques of breath-control, or pranayama as it is called in Sanskrit. Here are several simple but very effective techniques to help you become relaxed and calm for meditation.

Techniques for Relaxing the Body 

These techniques will help you relax the body. We teach them here as a preparation for meditation, but they can be used any time. They take only a few minutes.

Full Yogic Breath 

This techniques relaxes the spine and helps to increase and harmonize the energy in the body. It also oxygenates the brain.

Stand erect with feet slightly apart and hands at your sides. Concentrate first on standing with proper posture spine straight, chest up, and chin level with the floor the same posture you learned for meditation in the last lesson. Close your eyes and feel that you are centered in your spine. Now, without any strain, bend over as far as is comfortable, exhaling slowly as you do so. By the time the hands have reached the floor you should have exhaled all the air in the lungs. Let the hands rest on your ankles or, if you are flexible enough, touch the floor. Rest in this position for a few moments.

Now begin to inhale and come up gradually until you are fully erect. Bring your hands up slowly as you rise and extend them up over your head. Rise up on your toes as you complete this upward movements. You should inhale slowly during the whole rising motion, filling your lungs completely by the time your arms are above your head. Now, finish the movement by exhaling slowing and once again bringing the hands to the sides. Repeat this movement three to five times, trying to breathe more and more deeply each time. When you finish stand erect for a minute or two with your eyes closed. Feel that your body is completely relaxed and filled with energy.

In order to do the full yogic breath correctly you need to breathe very deeply. Begin the inhalation, as you rise, by breathing with your diaphragm. Then, as you rise farther, inhale more deeply, feeling the sides of your chest and rib cage expanding and filling the middle part of your lungs with air. Finally, as you stretch up, fill the upper part of the lungs. Feed that you are filling not only your lungs, but your whole body with air and vitality.

Diaphragmatic Breathing

It is important to learn how to breathe correctly, and this means diaphragmatic breathing. The diaphragm is a dome-shaped muscle between the lungs and the abdominal cavity. As we inhale, it contracts and flattens its curve, creating a vacuum into which the lungs can expand. As this happens the diaphragm pushes the abdominal muscles outward. Watch the stomach of a baby rise and fall as it breathes and you will see this natural process in action. Many adults, however, because of tension, illness, or the desire to have a thin waist, resist this natural movements and have to re-learn it.

Diaphragmatic breathing can, and should, be done in any position, but it is easiest to re-learn when you are most relaxed, lying on the floor. Lie on your back with your arms at your sides, palms upward. Many people find it easier to relax the diaphragm if they bend their knees, placing their feet flat on the floor. Relax completely, especially the stomach and abdomen. Now, breath deeply and slowly, concentrating on the diaphragm, and feeling your stomach rise as you inhale and fall as you exhale. Relax the abdominal muscles more and more completely, using the diaphragm, and not the stomach muscles, to create the rise and fall of the abdomen.

After several minutes of practice on the floor you can sit in a cross-legged position and continue diaphragmatic breathing. You may find this a little harder at first but you will soon catch on. It helps to close your eyes and concentrate on relaxing the stomach, allowing it to swell outward and relax back inward. Once you know how to breathe correctly you can practice diaphragmatic breathing wherever you are. It may take a couple of weeks to re-train yourself but you will find the results well worth the effort. Be sure to check to see that you are breathing diaphragmatically as you begin your meditations.

Poses to Stretch and Relax the Spine

It is very helpful for both meditation and overall health to increase flexibility in the spine. Here are two simple stretches to accomplish that goal. But first, a couple of cautions: 1) Never push past your comfort level when doing any stretch. Always relax into a pose, never force yourself. 2) Never hold a posture longer than is comfortable. A few seconds to a minute is sufficient to start with.

A wide variety of yoga postures are taught in detail in the next section of this course, The Art and Science of Yoga : 14 step to Higher Awareness, which goes much more deeply into the study of hatha yoga. But for now, here are some very simple stretches to help relax you in preparation for meditation. They will stretch the spine, helping to relax and energize you for meditation.

The Child Pose

It is always good to balance a stretch of the spine in one direction with another stretch in the opposite direction. Here is a very gentle forward stretch Sit on your calves with your legs underneath you. Your right big toe should be over your left big toe. If you feel a strain on your legs you can use a small cushion on top of or under your ankles to relieve the pressure. Now bend forward, exhaling as you do so,until your head touches the floor a few inches in front of your knees. Let your arms rest beside your legs. Hold this position for a few seconds, relaxing completely and breathing normally. Return slowly to an upright position and relax for a minute or so.

Tensing and Relaxing 

This technique was recommended by Paramhansa Yogananda and will help release subconscious tensions. It is especially valuable for meditation and should be used at the beginning of each session. But you can also use it at the beginning of deep relaxation or any time you feel tense. To begin, inhale fully through the nose with a double breath A double breath is a short inhalation followed immediately by a long inhalation huh, hhuuuuhh. When you have inhaled tense the whole body until it vibrates, holding the breath as you do so. Then throw the breath out and relax completely. This exhalation should be with a double breath through both the mouth and the nose. Do this three to six times after you sit to meditate.

Regular Breathing 

This technique will regularize and harmonize the breath, which, in turn, will produce the same result for your mind. Inhale slowly, counting to eight. Hold the breath for the same eight count while concentrating your attention at the point between the eyebrows. Now exhale slowly to the same count of eight. This is one round of regular breathing. Depending upon your capacity, you can go more slowly, counting mentally to 12 or use 16 count. It is essential, however, that the inhalation, holding, and exhalation be of equal length. Generally speaking, slower is better, but do not go so slowly that you get out of breath. That would be counterproductive. As you do this technique feel that you are becoming increasingly relaxed and focused.

FIFTY PLUS CHECKING HYPERTENSION

The incidence of hypertension increase with age. No exact cause has been determined for hypertension but it is associated with increased risk of stroke and coroary diseases.

The symptoms of hypertension are mostly headaches and heaviness in the head. But it is most commonly picked up during a general check up , says Dr. Ashwini Mehta, cardiologist, sir Ganga Ram Hospital. Ways to control hypertension in the elderly :

1: Decrease in salt intake

2: Regular eating habits

3: Daily walks

4: Regular check ups

5: Regular treatment

HEART ATTACK PREDICTOR

For the first time, researchers have shown that magnetic resonance imaging can predict the risk of heart attacks or cardiac death in coronary heart disease patients, according to a report in a rapid access issue of Circulation: Journal of the American Heart Association. MRI can be used to locate tissue damage in a heart attack or pinpoint blockages, but it has not been used to predict heart attacks.

simple test for heart failure

Researchers have revealed that a simple blood test is helping doctors to diagnose heart failure at the earliest instead of the cumbersome process that can take hours.

The new blood test can spot a hormone, called hormone B-type natriuretic peptide, present in elevated levels during heart failure. This means doctors can pinpoints who has heart disease, how sick they are and what treatment they need immediately.

The presence and level of the hormone gives you a precise measure of how high the risk is for heart failure, says San Diego cardiologist Dr. Alan S. Maisel, who developed the test. Conversely, if the levels of hormone is not high the change of heart failure is only one or two per cent.

The blood test takes 15 minutes to administer and records the levels of the hormone in the blood. A low levels means the heart is working well. But an elevated level proves the patient has heart trouble as the body releases the hormone when the heart is not pumping properly. If the blood test is added to the diagnostic methods, the accuracy of the diagnosis jumps to over 90 per cent.

NO PILLS, NO POKES, NO UNCALLED FOR PRESSURE

A new method of treating high blood pressure involves no injections or oral medicines

In the hurly-burly of what life today has come to represent, headaches, frustration, immense work pressures and sleepless night have become part and parcel of our daily regimen. As a result, the incidence of high blood pressure is increasing at an alarming rate.

Generally, any kind of tension increases this blood pressure and, interestingly, housewives and retired persons also attrack  this rather common malady. There are many medicines that meet requirements, but a new method called the transdermal therapeutic system or transdermal drug delivery system deserves focus. It involves no injections or oral medicine, and herein lies its uniqueness and growing popularity among high BP patients.

The transdermal therapeutic system is more reliable in that it has no side-effects that may result from oral drugs or injections. In this case, a strip or patch is stuck below the ear near the neck and the drug enters the blood through the skin. In medical terms, the drug enters through intravenous infusion and mixes with the blood. The medicine does not move through the liver so the chances of side-effects are reduced, as are the chances of overdose.

The transdermal therapeutic system has multifarious applications, but its fundamental use lies in reducing high blood pressure. Well known cardiologist Tarun Kumar Praharaj of the BM Birla Heart Research Centre describes hypertension as a common complication resulting in acute stroke and very poor outcomes. So Transdermal glyceryl trinitrate, a no donor, lowers BP by five to eight per cent. It is clinically significant and relevant. However, GTN has no effect on platelet aggregation. Since other no-donors increase cerebral blood flow in patients with acute ischaemic cerebral stroke, GTN is the appropriate drug for testing the effect of lowering BP on a functional outcome.

Pregnancy also induces hypertension. In this case, too, it has been found that administering Transdermal glyceryl trinitrate for 24 hours or 16 hours yields positive results by controlling systolic and diastolic BP. Further studies are being done to verify the possible use of Transdermal glyceryl trinitrate as an anti-hypertensive drug during pregnancy

Transdermal oestrogen reduces daytime BP in hypertensive women. Also transdermally administered 17 beta oestradiol produces a very positive effect on ambulatory BP in hypertensive post menopausal women. Recent treatment records reveal that transdermally administered oestrogen also help in reducing BP during daytime in hypertensive postmenopausal women.

A low does of transdermal scopalamine decrease blood pressure in mild hypertension and also increase cardiovascular parasympathetic activity.

Transdermal clonidine therapy reduces blood pressure in hypertensive male patients. In this regard, Dr. Praharaj explains, Transdermally administered clonidine lower both systole and diastole BP within 14 to 24 hours of application. The anti-hypertensive effect persists at the end of the first week, as well as after 14 days. The lowest values of systolic and diastolic BP documented were not better than the levels reported in normotensive men. Therefore, transdermal clonidine seems to act as an anti-hypertensive agent rather than a hypotensive one since it normalises BP without lowering it below physiological levels.

The transdermal therapeutic system has also opened up a new dimension in transdermal estrogen replacements therapy. This replacement therapy is associated with a reduction in mean ambulatory BP whereas oral treatments does not alter BP. Although the overall effect of estrogen is to lower BP, it varies from individual to individual. Therefore, long term monitoring of ambulatory measurements may be required.

BYPASS ON BEATING HEARTS HELPS ELDERS

For elderly heart patients, especially those above 80 years bypass surgery on a beating heart may help boost survival rates by cutting down on the number of strokes, says a new Canadian study published in the special surgery issue of circulation : Journal of the American Heart Association.

Since patients above 80 years of age are at a higher risk of complications after bypass surgery, some physicians have suggested that the less invasive surgery on a beating heart may be a better option for these patients.

PIG PARTS FOR PEOPLE?

It wont happen for years, but a new breakthrough puts an unlimited source of organs a step closer

If you or a loved one has a heart that falling or kidneys that are giving out, you already know the grim statistics on transplants. A new organ can turn a death sentence into a full healthy life but the supply of replacement body parts lags for behind the demand. According to the non-profit United Network for Organ sharing, which maintains America transplant waiting lists, nearly 80,000 patients in the U.S. alone are standing by for new organs and more than 5,000 people die each year before their turn comes.

Those dismal numbers have prompted scientists to consider organs from other mammals especially pigs, which are easily bred and whose physiology is similar to ours. But pig biology is different enough from human biology that rejection, a surmountable problem in human to human transplants, is disastrous in so-called xenotransplants.

But a solution may be on the horizen. Recently two research teams said they had removed the pig gene responsible for the most severe form of rejection. Not only that. Both teams one from PPL Therapeutics, which in 1996 helped make Dolly the sheep, the first mammal cloned from an adult animal, and the other from the University of Missouri-Columbia and Immerge Bio-Therapeutics, of Charlestown, Massachusetts then cloned their little pigs, producing five and four piglets, respectively.

By itself, this breakthrough wont lead directly to pig transplants. For one thing, pigs carry two copies of gene, called GGTA1; the scientists knocked out only one. Researchers expect to create double-knockout pigs within a year, but until they do, rejection will remain an insurmountable problem. And even if they do eliminate the most problematic form of inter species rejection, other exist, and they will have to be dealt with.

Another danger arises because animals carry viruses that are harmless to their hosts but can turn deadly in another species. If such a virus hitchhiked aboard transplanted tissue, it could not only infect its new host but also spread to other humans much as HIV did when it jumped from monkeys to man.

Finally, cloning often produces animals that are deformed or die young; they may age prematurely as well. Researchers at Scotland Roslin Institute, PPL  partner in the Dolly experiment, reported that their famous ewe has come down with arthritis at age 5 a condition that may be related to her cloning.

Still, interspecies transplantation is so promising that researchers are determined to tackle each hurdle as it comes. It could be a decade or more before clinical trials become routine and even longer for transplants. But they seem to be on their way.

HEART REPAIRS

Talk about a sign of acceptance. Researchers in the U.S. studying men who received heart transplants from women discovered male cells growing in the donated female hearts a surprising upheaval of the conventional wisdom that the heart cannot regenerate tissue the way other organs can. Doctors are now searching for cardiac stem cells that could repair hearts without a transplant.

TAKE HEART

Heart attacks sometimes do not spare even those who stay away from a risky lifestyle. About 3 per cent of reported heart conditions are caused by unexplained factors even though risk factors such as genetic predisposition play a major role, says Dr. Naresh Trehan

This happened in the case of 28 year old Madhav Verma, who suffered a heart attack even though he had none of the high risk factorr. The only positive thing on this jeopardy score a scoring procedure for risk factors was a positive C reactive protein

The New England Journal of Medicine reported recently that a chemical called C-reactive protein in the blood is a better predictor for a heart attack than low-density lipoprotein or bad cholesterol. Researchers are now linking heart disease with inflammation, the body first line of defence against infection and injury.

The American Heart Association and the US centers for Disease Control and prevention have also recommended that doctors use a test that measures inflammation when trying to decide how to treat patients as risk for cardiovascular disease.

In India, some doctors such as Purushottam Lal of the Metro Heart Centre are already doing the test. We have adopted a jeopardy score procedure that includes a CRP measure and an ankle brachial index, says Lal. While a positive CRP indicates inflammation and in turn a heart risk, an ankle branchial test indicates a stiffness of the branchial artery, which can be an early indicator of coronary artery disease.

WOMEN HEARTS

Coronary Artery disease are no longer a predominantly male disease. More and more doctor are reporting larger numbers of women patients coming in even in the pre- menopausal stage. Earlier, it was believed that women developed heart diseases only post-menopause as they were protected from the disease before that by the hormone oestrogen which reduces post-menopause.

There is a marked increase in the number of overweight and obese young women. This coupled with an upward trend in cigarette smoking among women, switching to potentially dangerous weight loss practices and crash diet has led to a steep rise in sudden cardiac deaths in women, says Dr. OP Yadava of Sir Ganga Ram Hospital. Dr. Ashwini mehta, cardiologist in the same hospital, says this increase is in keeping with the trend of rising incidence of coronary diseases.

Stress of urban life, sedentary lifestyle, bad eating habits and rise in cholesterol levels is affecting women heart too says Dr Mehta.

Dr. Yadava study of 1,500 patients in his hospital has shown that women constitute 25 percent of total bypass surgeries. Nearly 10 percents of the women needing needing bypass were in the relatively younger perimenopausal age group of 40-49 years. Moreover 65 percent of the women under going bypass surgeries were diabetic and 61 percent had high blood pressure, suggesting a high correlation between diabetes, high BP and heart attacks in women, says Dr. Yadava. He points out that nearly twice as many woman die of heart disease and related stroke as all forms of cancer, including breast cancer.

Doctor warn that 42 per cent of the women having a heart attack die within one years itself, as compared with just 24 per cent of the men.

The doctor said that you had a heart attack. This simple statement will be repeated over and over again in your mind in the months to follow. The important thing, however, is that you understand what this statement means. The terms that you hear will be confusing; heart attack, coronary occlusion, coronary thrombosis, and myocardial infarction are virtually synonymous. Angina pectoris is not synonymous with coronary occlusion. When a person has a heart attack, a portion of the heart muscle dies. In angina, there is a temporary insufficiency of blood flow to a part of the heart, and heart muscles death does not occur.

The heart is basically a pump that is composed primarily of muscle that expands and contracts to push blood through the body. This muscle, like all muscles in the body, must be fed with food and oxygen to function properly. If the muscle or part of the muscle is deprived of food and oxygen, serious consequences develop. Food and oxygen are carried to the heart muscle by blood flowing through the right and left coronary arteries. These are two blood vessels that arise from the aorta as soon as oxygen-rich blood has left the heart. In other words, the very first organ that the heart pumps blood to for nourishment is itself. Both coronary arteries supply a different part of the heart by way of their branches. If a main artery or one of its branches becomes obstructed for any reason, a portion of the heart muscle dies. This is a heart attack. The moment of blood vessel occlusion and heart muscles death is usually accompanied by profound symptoms such as severe chest pain, possibly, weakness, sweating, a sense of fear, and, in some instances, shortness of breath, palpitations, or fainting. If the rest of the heart can compensate during this initial phase of profound injury, the heart muscle will heal itself and the pump may again function in a near-normal fashion.

The common medical term used to describe this condition is myocardial infarction. Myo refers to muscle, cardial to heart, and infarction means an area of dead tissue that is caused by interruption in means an area of dead tissue that is caused by interruption in blood supply.. This point must be emphasized the fact that a portion of the heart muscle has died to help you understand and long term restrictions that this condition may impose upon you.

A great many people have the erroneous impression that a coronary thrombosis or coronary occlusion means only that an important blood vessel has been obstructed. That is correct, but it omits the consequences of heart muscle death. They have then heard that in time drugs will dissolve the blood clot that obstructs the vessel, and they then infer that they are back to normal again. Other people have the impression that, when a blood vessel is obstructed collateral blood vessels will supply the deprived tissue with an adequate blood flow. This again is a half-truth. Collateral circulation refers to the presence of small blood vessels which communicate with the large blood vessels. If a block occurs in a large vessel, these branches have the capacity to enlarge and shunt blood flow around the blockage to an area in need of blood. It is true that in time a blood clot may disappear, and it is also true that in time collateral blood vessels may supply with extra blood an area of the heart that lacks it. However, the diagnosis of myocardial infarction distinctly indicates that a portion of heart muscle has died before either of these two potential solutions have had time to become a reality.

In time, the area of dead muscle will be replaced by scar tissue. The time element is considered to be approximately six weeks. The reason that the patient activity should be greatly curtailed during the six-week period is that the heart should be given a chance to form an adequate scar. The function of the heart is to pump blood throughout the body. Working muscles of the body require a greater blood flow and, therefore, impose a greater load on the heart. A person at rest requires minimal blood flow to his body muscles and, therefore, minimal heart work. A distinct possibility in the person who does not rest after a myocardial infarction is that the area a dead muscle will soften and rupture before a scar has formed. The effect is the same as punching a hole in a gas tank. When the gasoline runs out, the engine will no longer run. In the case of the human being, he dies.

Restricted activity during this critical healing phase permits the formation of a tight, effective scar. Scar tissue is incapable of performing any work. Scar tissue cannot contract to make the heart a more effective pump. A good scar, however, will draw the living muscles as close together as possible so that they can function properly without the useless part. If the heart is overworked during this period, it will tend to enlarge and a loose, thin, bulging scar will form which will hamper the work to the adjacent muscles. This loose scar is called a ventricular aneurysm.

One of the potential early complications of the myocardial infarction is heart failure. This term means that the pump is unable to move an adequate amount of blood through the body. When one portion of the heart muscle suddenly dies, the rest of the heart must take on an additional burden. This is similar to one engine of a multiengine airplane suddenly quitting in flight. If the load is not too heavy and if the remaining engines are powerful enough, the plane will continue to be airborne; otherwise the plane will crash. If the pilot has sufficient time to act, he may be able to compensate for his loss of power by throwing cargo or fuel overboard to lighten his load. The burden on the heart muscle is eased by radically reducing the activity that the entire body undertakes. This is another reason for strict rest during the early phases of a heart attack. If the heart is unable to pump an adequate blood volume, the ensuing course of events results in an engorgement of blood in the vessels of the lungs. The increased back pressure eventually results in the water portion of the blood oozing into the air spaces of the lungs, which blocks normal gas exchange. The patient literally drowns in his own fluids. The clinical picture is called pulmonary edema, which is a form of heart failure. The patient experiences this chain of events as a rapidly increasing shortness of breath.

The blood pressure of the body is maintained by a certain quantity of blood flowing through blood vessels in a given period of time. When the heart is unable to pump an adequate amount of blood, the blood pressure in the entire body will fall and a state of shock will develop. The patient experiences this as a sensation of weakness, faintness, and possibly profuse perspiration. The physician recognizes this state by a low blood pressure and a weak pulse. If this state persists for a sufficient time, the brain and other vital organs will suffer from lack of blood and irreparable damage or death may occur.

The heart normally contracts 60 to 100 times a minute, propelling blood with each contraction. The stimulus for each contraction is a discharge from nervous tissue within the heart at the same rate. The origin of these stimuli is usually the sino-atrial node, which is known as the pacemaker of the heart. However, any portion of the heart has the potential capacity for initiating a nervous impulse that can result in contraction of the heart muscles. When a portion of heart muscles dies, the remaining muscles may become very irritable and multiple areas of discharge may compete with the pacemaker, resulting in a rapid or erratic heart beat. This rhythm may be a tachycardia or fibrillation. If the speed of contraction is not too fast or if the rhythm of contraction is not too erratic, the heart will still pump blood effectively. If, on the other hand the rate is too fast or the rhythm too irregular, the actual amount of blood pumped will greatly diminish and a shock-like picture will develop. The patient may experience these events as a palpitation or fluttering in his chest. The development of shock is accompanied by feelings of weakness, faintness or profuse sweating.

Physicians today are familiar with these events, and hospitals are equipped to combat many of these complicating factors. Therefore, the safest place for a person who has suffered a heart attack is in a hospital under close supervision of trained personnel. It is nostalgic to remember Grand-father heart attack as he remained in his comfortable bed at home, visited daily by his family doctor until it was felt safe for him to get out of bed. At that time, however, many of these serious complications were not known, and effective treatment for them was not available. Today doctor may very well recognise over the telephone that his patient has gone into shock the third day after his heart attack, but if the patient is at home it may be too late for the doctor to do anything effective about it by the time he reaches the bedside.

The current approach to the treatment of myocardial infarction is first to get the suffering patient to the hospital quickly. After a provisional diagnosis has been made, he is moved into a special area of the hospital called a Coronary Care Unit, which is staffed and equipped expressly for this type of illness. The patient is usually under the constant supervision of doctors, nurses,  and electronic machinery, all of which are focusing their attention on detecting the very first sign of any complication. If complications do develop, treatment is much more effective if it is begun early.

The development of the concept of coronary care units is of recent origin. It is the result of increasing medical knowledge and in particular of increasing knowledge about the natural history of coronary artery disease. To achieve a proper frame of reference, it is of interest that Dr. Paul White reports that in 1910 the diagnosis of a heart attack or myocardial infarct was seldom made in a general hospital. His explanation is that, first, the disease itself was much less common than it is today, and, second, that doctor were not aware of the disease itself. In other words, medicine had not advanced to the point where it was commonly recognised that there was such a thing as a myocardial infarct, or what the symptoms of this illness were. By the 1920 the disease pattern was established as a distinct entity, and by, World War II large number of patients were being treated for this condition.

By the 1960 statistics revealed that about 60 percent of the deaths of person with atherosclerotic heart disease were sudden deaths. Furthermore about 70 percent of these deaths accurred during the first seven days of the illness. Just before this period, the first human being was successfully defibrillated by an electrical shock across the chest. This is a common cause of sudden death in persons with heart attacks.

Shortly after this, the technique of closed-chest cardiac massage was devised. By this is meant the application of pressure repeatedly over the chest of a person whose heart has stopped beating. With the proper application of chest compression, blood is forced into and out of the heart in a near normal fashion. The efficiency does not approach that of the normally beating heart, but enough blood can be induced to circulate to the vital organs of the body to postpone death. Formerly, if the heart stopped beating or fibrillated, death of the brain occurred in four or five minutes as mentioned above. Other forms of heart stoppage cannot be treated by defibrillation, but sometimes drugs or other forms of treatment can be used to start the heart again if the patient can be kept alive until they have a chance to take effect.

John was a 50-year-old insurance broker. He had been hospitalized three years ago with a heart attack. It had been a frightening experience for him, but he had survived and after three months had been able gradually to resume work. Initially he had lost the 15 kg. of weight as his doctor had advised. He had also given up smoking and held his work down to 30 hour a week.  As time wore on, he gradually ate more, exercised less and slipped back into the cigarette habit. He was also grinding out 55 hours a week on the job. But after all, he had two children in collage and no one else was going to pay their bills.

He was more fatigued than usual and found himself stopping every few blocks to catch his breath when he was walking back to the office from lunch. I will have to start eating lunch in that restaurant around the corner. I hate the eating lunch in that restaurant around the corner. I hate the food, but he noticed that the elastic bands of his socks were leaving imprints on his lower legs, and his ankles were indented by the top edges of his shoes. As he undid his belt, he felt relief; his abdomen appeared slightly swollen and a vague discomfort in his upper abdomen was lessened without his tight pants.

His wife Janet noted how tired he looked and reminded him that he had skipped his four-month checkup with his doctor. John promised to make another appointment soon, but he was just too busy this week, to go. That night he fell asleep quickly, but about two a.m. he awoke feeling as though he needed more air. He got out of bed, went to the bathroom, and noted that lately he seemed to be getting up more at night to urinate. Last night it was three times, as a matter of fact. He went back to bed and after a while fell asleep again.

Three night later John awoke at two a.m. horrified. He was suffocating he could not get enough air. He was panting for breath and was making gurgling sound in his chest. He awakened Janet and told her to call the doctor. John went to the window and threw it open to get more air. He felt a tightness developing in his chest similar to the one he experienced when he had his original heart attack. He went to the bedside table and found the nitroglycerine that his doctor had insisted he have. After a tablet dissolved under his tongue, the chest tightness was relieved, but the shortness of breath persisted. The doctor told Janet that he would meet them at the hospital emergency room.

His diagnosis was congestive heart failure with pulmonary edema. He had warning signs of heart failure for days before the ultimate episode of pulmonary edema with fluid filling his lungs, but he had not recognized the impending danger.

Heart failure does not mean that the heart has stopped beating, and it does not mean that a person is heaving a heart attack or a myocardial infarction. It does mean that for a significant period of time the heart is not pumping enough blood. Heart failure may develop suddenly or gradually. It may occur immediately after a myocardial infarction or months or years later. The late development of heart failure is usually the result of the patients placing greater demands on his heart over a period of time than the heart is able to tolerate. In mechanical terms, the heart is able to run nicely at 30 miles an hour, but the patients keeps racing it at 60. Heart failure may also occur in other forms of heart diseases besides the type associated with atherosclerosis and myocardial infarction, if the heart is overworked.

A knowledge of some of the basic mechanisms involved in heart failure will help a person who has this problem to cope with the situation. The following is an explanation of some of the more important mechanisms.

The heart pumps a certain amount of blood per minute to the body. This amount of blood is called the cardiac output. The cardiac output for an average size man is five to six liters per minute when he is awake but not active. This can be increased in the normal person to 30 or 35 liters per minute with exercise. After a heart attack, the heart muscle is weakened and the cardiac output may fall, transiently or permanently, to two to three litters per minute at rest. If the cardiac output falls below a certain level, the body will not receive adequate blood flow and a state of heart failure will be present. This is made most dramatically evident by an abnormal collection of fluid in the body. Let us see how this fluid accumulation occurs.

Many people are surprised to learn that the human body is 65 percent fluid. Each individual body cell contains fluid, and fluid circulates around each cell. A small amount of the body fluid circulates in the blood vessels as blood. Sodium and potassium are two of the most important ingredients in body fluids. Sodium is found primarily outside of the body cells, and potassium is located within the cells. The body regulates its own fluid volume by adjusting the amount of sodium and water that is excreted by the kidneys as urine. If we drink an excess of water, the kidneys eliminate the excess to reestablish normal body content. If we eat excess salt, the kidneys get rid of the unneeded amount. If we are dehydrated, the kidneys conserve water.

About 25 percent of the blood that the heart pumps is directed to the kidneys. From this large volume of blood the kidneys are constantly filtering out waste products and producing different quantities of urine to adjust total body fluids.

If the blood flow to the kidneys is reduced, they will not function properly. Reduced blood flow could occur, for example, if the person were injured and had lost a lot of blood. The body attempts to make adjustments by the following mechanism. Kidney blood flow is monitored by special cells inside the arteries that feed the kidneys. If the flow falls below normal, these cells produce a substance which is released into the blood stream and eventually reaches the adrenal glands. The adrenal glands are triggered to produce certain hormones which are also released into the blood and eventually reach the kidneys again. Here the hormones tell the kidneys to conserve water and salt and therefore to reduce the volume of urine produced. The retained water and salt effectively increase the volume of blood contained in the blood vessel system (by expansion of the plasma, or fluid portion of the blood.) The result is an increase in the amount of blood reaching the kidneys, and these organs are again able to function.

The sensors that detect decreased kidney blood flow cannot differentiate between reduced flow caused by blood loss and reduced flow caused by poor heart function. In the latter case, the name protective mechanism operates. As a result, in the case of heart failure, an unnecessary increase in the blood volume occurs.

The excess blood inside the blood vessels is detected by the heart, which temporarily works harder to move the blood along. However, the weakened heart cannot respond beyond a certain point, and the result is a buildup of back pressure and engorgement of the blood vessels.

The fluid portion of the blood is constantly leaving the blood vessels and reentering them in the normal state of the body operation. The purpose of this movement of fluid is to bathe the body cells in needed water, chemicals, and foods. As the plasma reenters the blood vessels, it brings with it wastes from the cells which are eventually carried to the kidneys. This movement of fluid to and from the blood vessels is controlled by pressures inside the vessels and in the body tissue spaces. In heart failure, when the kidney mechanism described above results in increased blood volume and pressure, the net effect is that it is easier for fluid to leave the vessels than it is for it to return. As a consequence, excess fluid surrounds the body cells.

A person in heart failure may accumulate as little as two or three pounds of excess fluid or, if the process has persisted for a long time, as much as 20 or 30 pounds. The fluid obeys the law of gravity, and if the person in heart failure is sitting in a chair much of the time, the edema will accumulate in his feet, ankles, and legs; if lying in the bed on his back, it will tend to accumulate in the back and buttocks. The presence of edema can be detected by pressing into a soft area of tissue with a finger. If the pressure is maintained for a minute or two, and then the finger is removed, a pit or depression will persist in the tissue where pressure was applied. The accumulation of fluid can also be surmised if a patient is weight daily and if the weight is found to creep upward by a pound or two each day.

All person with edema do not have heart failure. A small amount of edema may be present in the feet or ankles of person with normal hearts who have been sitting or standing for long period of time, as is the case when traveling in a car or working as a sales person who stands up for hours at a time. Disease of the kidneys themselves and some forms of liver disease will also cause edema.

The person with heart failure and edema who has been standing or sitting much of the day may experience a strange development knows as nocturnal dyspnea when he lies down in bed at the end of the day. The fluid which has accumulated in the legs and feet is no longer held there by gravity, and the excess fluid gradually returns to the blood stream and overloads the circulation. Pressure rises in the blood vessels and starts to force excess amounts of plasma out of the small blood vessels into the tissue. The lungs, which were previously protected by gravity and their high location in the body when the person was erect, are now affected. The plasma oozes from the capillaries into the tiny air space in the lungs and blocks off the gas exchange that normally occurs there. If the person is still awake as this is happening, he may notice a gradually increasing shortness of breath and find that if he raise his head and shoulders higher by propping himself up on pillows, he is more comfortable. If asleep at this time, he may instead suddenly awaken and find himself gasping for breath. The normal reaction in this instance is to sit up or get out of bed and walk around, which again throws gravity into the situation and helps to correct the situation temporarily by drawing the excess fluid back down to the legs. Another medical term for this congestion of the lungs is pulmonary edema(pulmonary = lungs)

Pulmonary edema may occur in another circumstance in heart failure. The heart is basically a double pump. The right side of the heart receives blood from the body via the veins and pumps the blood through the lungs to receive oxygen. The left side of the heart now receives this blood from the lungs and pumps it back to the body. The left side of the heart has more work to do and is therefore equipped with large muscles which contain the majority of the blood vessels that feed the heart. In the event of a myocardial infarction, therefore, the left side is usually more severely, or exclusively, injured. The result is that one pump is now weaker than it should be. The right side of the heart will still be able to pump a normal amount of blood into the lungs, but the left side may not be able to accept the total volume and return it to the body. As a result, the blood vessels of the lungs become abnormally engorged, and the increased pressure inside the vessels can force plasma through the walls of the capillaries into the air spaces of the lungs.