A sensation of pain in the chest is almost automatically associated with having a heart attack. While it is true that it is one of the best indicators of a heart attack, there are quite a few other things which can cause one s chest to pain and not all need to necessarily be as time critical as a heart attack. So, what are the various things one should be aware of when it comes to pain in the chest? In order to understand chest pain better, it is first very important to understand the various types of chest pain better! So, there is a sharp pain, its opposite which happens to be a dull pain, burning, aching, stabbing pain, as well as a crushing sensation.

Let s start with the elephant in the room, which is medically known as myocardial infarction or referred to as the infamous heart attack. This occurs when the muscle cells, which are located in the heart die on account of not enough blood flowing through the heart. In simple terms, the best way to get to know that one is having a heart attack is when the person feels a seriously crushing pain in the centre or the left side of the chest. What could be said to be unique about this type of pain is that resting does not make it better.

Another condition of the heart which is often mistaken by the layman for a heart attack happens to be myocarditis. Inflammation of the heart muscle leads to fatigue and a fast beating of the heart. The person would also experience some difficulty breathing.
Heart disease can come in multiple forms and one of those is known as CAD or Coronary Artery Disease. When there is a blockage in the blood vessels of the heart, the pain [which is known as angina] is caused by this blockage. The probably solitary source of good news is that permanent damage to the heart is not caused by CAD!
That being said, a heart attack is a greater possibility. The pain in the chest could spread to the jaw or the back, or even the arm. The sensation is that of the body part being squeezed. The first thing to be done when angina occurs is to rest in order to lower the pain.
While these conditions have focused on the heart, pneumonia affecting the lungs can cause deep chest ache. It causes a cough and chills. There is also likely to be pus from the respiratory tract which is coughed up!
Asthma is yet another respiratory issue which could cause chest pain!

Chest Pain - Reasons Behind It!

For a long time cholesterol in totality was seen as a bad thing for your body although the truth was a little more complicated than that. Cholesterol primarily is divided into two types, one of which can be categorized as bad cholesterol and the other as good cholesterol. Let's have an in-depth look at both the categories.

LDL or Low Density Lipoprotein aka bad cholesterol: Cholesterol is a wax like chemical, which is found all over the body and it has important functions to perform. Cholesterol is carried all over the body by Lipoproteins. The low density lipoproteins are denoted as bad cholesterol as they can accumulate on the walls of the blood vessels and cause blockages resulting in many ailments. LDL levels of 190 and above are considered dangerous. 

Some of the risks associated with it are:
1. Heart disease
2. Stroke
3. Atherosclerosis
4. peripheral artery disease among many others

HDL or High Density Lipoprotein aka good cholesterol: This is a form of cholesterol which is usually desired in higher quantities as it removes LDL from the system by dislodging it from the arteries and then carrying it through the blood stream into the liver. The liver then breaks it down and removes it from the body. Thus, higher number of HDL cholesterol is always desirable. 

Some of the ideal numbers for HDL cholesterol within the body are:

Women - Ideal: 60 mg/dl, dangerous: 50 mg/dl or lower
Men - Ideal: 60 mg/dl, dangerous: 50 mg/dl lower

The role of triglycerides
Good and bad cholesterol levels also depend on the levels of triglycerides within the body and not just LDL or HDL cholesterol. Triglycerides are another type of fat which are used to store energy within the body but can also affect your health. It is most associated with atherosclerosis when the levels of triglycerides are high within the body. 

Some habits that contribute to high levels of it are:
a. Lack of physical activity
b. Obesity or being overweight
c. Excesses in alcohol consumption
d. Smoking
e. Bad diet and others

Thus the good cholesterol versus bad cholesterol war also includes other factors, most of which can be easily changed by making subtle changes in lifestyle and incorporating healthier habits. This will increase the good cholesterol and the other relevant elements and reduce the bad.

Good Cholesterol Vs Bad Cholesterol and Factor involved in It

Automatic Implantable Cardioverter Defibrillator is an electronic device that is located in the chest of the patient suffering from arrhythmia. Arrhythmia is a condition which causes abnormal rhythm of heartbeat in the patients. It is a life-threatening condition. The device is located in the chest to correct the rhythm of a heartbeat.

AICD device works in two ways:

Firstly, it tries to correct the abnormal heartbeat rhythm and release high- speed heartbeat pace. This is called cardioversion. Patients with AICD generally do not feel the process.

However, if the effect of cardioversion is null then the device will give a mild electric shock to the patient's heart to correct arrhythmia and reset the rhythm.

This second method is called defibrillation. The patient can feel the defibrillation.

The modern-day AICD device is programmed to store the data about the patient s heart rhythm. Doctors use the programmed device which contains your condition and provides medically correct therapy.

Preparation for AICD Implantation

The patient is required to fast six hours before undergoing the surgery. On admission, prescribed medicine is given to the patient and the latest heart condition is measured by an ECG test. If the patient is on blood-thinning medication, then it will be stopped 24 hours before the surgery.

The procedure will be carried out by a cardiologist. The patient will remain under observation in the hospital for at least two days.

Procedure

The entire process of setting up the device in the chest of the patient takes about 2 hours. The patient is sedated, and the area below the collarbone is numbed for the operation. A small incision is made in the chest area. With the help of imaging techniques, cardiologist sets up the device in the chest. The device is then connected to the veins and the heart. After the surgery, the patient is kept under observation. Heart rate, blood pressure, and overall health condition are observed by the doctors to determine successful implantation of Automatic Implantable Cardioverter Defibrillator (AICD). Post Procedure After the successful recovery of the patient, doctors usually discharge the patient with AICD attached. The doctors give complete care instructions of the device along with health. Doctors also guide the patient through the list of activities that one can and cannot perform. AICD is a life-saving device. Hence, proper care and regular check-ups are recommended by the doctors. The regular check-up of the device is also essential since the device runs on a battery. The doctors also train the patient about the workings of the device. They will also explain about the mild shocks of the device one may receive to correct the arrhythmia. Before leaving, make sure the site of the surgery is dry and healing, and you do not have a fever for the past 24 hours.

AICD Implantation - Know Procedure Of It!

What is Palpitation?
Palpitation is a feeling of awareness of your own heart beat. It is usually described as heart rate being either too fast (racing), too slow or a sensation of missing a beat.

Types of palpitations?
Normal (Benign)
- These palpitations occur as a response to physical or mental stress like exercise, fever, pain, fear, anxiety etc. 
- They are harmless and settle on their own once the precipitating factors disappear. They do not require any medical treatment.

Abnormal
- These palpitations occur due to some underlying abnormality in either the structure of heart or the beating of heart. 
- These can be dangerous and at times life threatening. They may or may not settle on their own and require some medical treatment.

Warning signs that suggest palpitations are abnormal?
Palpitations are abnormal, if they are associated with chest heaviness, chest pain, uneasiness, sweating, weakness, giddiness, feeling of black out, fainting, nausea, vomiting, seizures. Palpitations are more likely to be abnormal in people who have some existing heart disease and these patients should report to their doctor at the earliest.

What to do during palpitations?
1. Stay calm. 
2. Call for help. If u are alone avoid driving, use a taxi or auto, go to your nearest hospital/doctor and try to get an ECG during the palpitations. If you are helping someone having palpitations, if they faint, call for help, start CPR if they remain unresponsive and take them to the nearest hospital. 

Which doctor can treat palpitations?
Doctors who specialise in the treatment of palpitations are called Electrophysiologists. They specialise in heart rhythm and are capable of performing a variety of complex tests to identify and treat different types of palpitations.

Which investigations are used to diagnose palpitations?
ECG: Taken during palpitations and when the patient is normal is a very helpful tool. 
Holter: Externally applied recorder, which continuously records heart rhythm for 24 hrs. 
ELR: Extended loop recorder, is like holter, but it records rhythm for longer durations. 
ILR:  Internal loop recorder is attached within the body for recording rhythm for long duration. 
EPS: Electrophysiology study, is the most sure shot test to diagnose, identify and treat 
Palpitations.

What is EPS?
EPS stands for Electrophysiology study. By this test a trained Electrophysiologist studies the conduction and formation system of heart beat, to understand the source, cause and type of palpitation. It is a simple and safe procedure of 2 to 3 hours and can be done as a day care procedure (by admitting the patient for a few hours in hospital, with discharge on same day).

It requires fasting for 4 hrs, some standard blood investigations and is done with local anaesthesia and if required it can be combined with treatment like ablation in the same sitting.In the procedure Electrophysiologist take catheters into your heart to study and stimulate the palpitations and understand them. Once found they can use various techniques to stop the palpitations, the techniques are called Ablation.

What are the treatment options available for palpitations?
There are many options depending upon the nature of palpitations and condition of the patient: 
- Drug therapy 
- Cardioversion where either a drug or electric shock is given to stop palpitations immediately. 

Ablations using many sophisticated computer softwares 
Device Therapy like ICD (Internal cardiac defibrillator) 
Combination of all the above therapies.

Your Electrophysiologist and you as a team can make a choice about the options that will be best for you.

Palpitations - Everything You Need to Know

Stroke is a medical condition in which the flow of blood towards the brain is poor and causes the death of certain cells. There are two common types of stroke: 

1. Ischemic- due to lack of blood flow
2. Hemorrhagic- due to bleeding

Signs and symptoms of stroke 

Problems with movement
Inability to feel  on one side of the body
Problems understanding or in speech
Vertigo
Loss of vision
Difficulty in carrying out everyday activities
Role of Physiotherapy for Patients with Stroke

The main focus of physiotherapy is to help you use your arms and legs to regain as much strength and movement as possible. 
If you have one-sided paralysis, correct positioning is important to prevent spasm or injury.
It helps you to sit up as this will help you avoid blood clots in your legs, improve your breathing and help you recover quickly.
If you are unable to move, you may be given chest physiotherapy to keep your lungs free of infection.
What does a Physiotherapist do?

A physiotherapist advises you on how you should be positioned when lying or sitting, and how often you need to be moved.
Motivates you to be actively involved in your physiotherapy sessions to help you relearn normal patterns of movement
Decides when you should begin to start walking and what equipment is needed to move or support you
Provides therapy to strengthen your limbs and teach you how to move again as independently as possible
Takes care of the fact that no complications should arise and you have a smooth recovery.
Treatment Techniques:

Strength Training: It is evident that strength training can improve upper-limb strength and function without increasing tone or pain in individuals with stroke.
Gaming: Goal orientated computer gaming has proven to significantly reduce upper limb impairment in stroke survivors.
Virtual Reality: Virtual reality training has been shown to be effective in restoring upper limb motor impairments and motor-related functional abilities.
Mirror Therapy: Mirror therapy has been shown to have a beneficial effect on motor control and function compared to conventional therapy.
Robot-Assisted Therapy: It has been shown to have a beneficial effect on motor recovery and function.
In the upper extremity with severe impairment and/or poor prognosis for recovery, Chedoke McMaster Stroke Assessment (CMSA) of Arm and Hand < Stage 4) treatment should focus on maintaining a comfortable, pain-free, mobile arm and hand. Engage in repetitive and intense use of novel tasks that challenge the stroke survivor to acquire necessary motor skills to use the involved upper limb during functional tasks and activities. Engage in motor-learning training including the use of imagery.

Stroke - How Physiotherapy Can Help With It?

The coronary arteries supply the heart with oxygen-enriched blood and nutrients. If these arteries become damaged or diseased; they could cause Coronary artery disease or CAD. Plaque deposits on the walls of the arteries are the most common cause of this disease. This plaque is usually the result of high cholesterol levels. As the plaque builds up, the passage of blood flow is reduced. This reduces the amount of blood that reaches the heart. In cases of a complete blockage, CAD can even cause a heart attack. Because of its slow progression, this disease is often not diagnosed until it reaches a dangerous stage. However, it can be prevented and treated if diagnosed in time.

In the early stages of CAD, symptoms are not very noticeable. Symptoms become visible only when blood flow to the heart reduces and the heart has to pump harder than normal. The most common symptoms experienced include:

Chest Pain: This is also referred to as angina. It may feel like a tightening of the chest or pressure on the chest as though someone is pressing against it. This type of chest pain may be triggered by emotional or physical stress. It is usually relieved within a few minutes of stopping the activity. Women may experience this pain as a sharp, fleeting pain in the back, arm or neck.
Breathlessness: When the heart does not receive enough blood, it has to work harder to pump blood through the body. This may be translated to breathlessness of shortness of breath when performing any type of physical activity. It can also cause extreme fatigue.
Heart Attack: A heart attack is the most severe symptom of coronary artery disease. This is caused by the complete blockage of a coronary artery. A heart attack can occur without any symptoms or be preceded by slight symptoms. The signs of an impending heart attack include pain in the chest and shoulder, shortness of breath and extreme sweating. The chest pain may also travel to the lower jaw. These symptoms are more pronounced in men as compared to women. Women have a higher tendency of experiencing atypical signs such as extreme fatigue.
Other symptoms that might indicate coronary artery disease are dizziness, nausea and an irregular heartbeat. The good news is that this disease can be prevented. Staying physically active, maintaining a healthy weight, reducing stress and eating a low fat and low salt diet can help reduce the risk of CAD.

Coronary Artery Disease (CAD) - What Are The Symptoms?

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