CARDIAC NEUROSIS

Da Costa Syndrome or Cardiac neurosis is a condition in which cardiovascular symptoms are caused by physical or emotional stress but may also be caused by conditions such as mitral valve prolapse and autonomic hyperactivity. The syndrome is often seen in soldiers during times of stress or in young adults who suffer emotional stress.

Cardiac neurosis is an anxiety reaction characterized by quick fatigue, shortness of breath, rapid heartbeat, dizziness, and other cardiac symptoms, but not caused by disease of the heart. Some people complain of pain over the heart, or the heart area, who do not have the slightest sign of any real disturbance of the heart.

Doctors call this a cardiac neurosis, and credit it to abnormal anxiety about the heart. Such pains are not related to effort or work of the heart. They are usually accentuated by fatigue and emotional stresses. There various drug treatments available for this condition. But Systematic desensitization, a type of behavioural therapy, may be more effective than drugs, especially if it includes encouragement, instruction, and suggestion.

Systemic Desensitisation: In this procedure, events which cause anxiety are recalled in imagination, and then a relaxation technique is used to dissipate the anxiety. With sufficient repetition through practice, the imagined event loses its anxiety-provoking power. At the end of training, when you actually face the real event, you will find that it too, just like the imagined event, has lost its power to make you anxious.
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BLOOD PRESSURE ON STANDING

 

 Understanding How The Nervous System Regulates Blood Pressure :

Our blood pressure is regulated from minute to minute by nerves. At specific locations in the walls of the large arteries, special sensors "measure" blood pressure by responding to the amount of stretch in the walls of the arteries. An important location of these sensors is the carotid sinus, which is in the arteries that run up the neck to supply the head with blood.

When you suddenly sit or stand up after lying down. Gravity pulls the blood downward, lowering the blood pressure in the carotid sinus in your neck. If the carotid sinus reflex didn't act promptly, sending out nerve impulses (over sympathetic nerves) to increase heart output and constrict the arterioles, you would faint from the decreased flow of blood to your head.

Located along portions of the carotid artery and the aorta are several hundred pressure detectors called baroreceptors. These specialized cells operate like ‘stretch’ detectors that respond to alterations in blood pressure in the arteries and send neural signals to the brainstem to inform the brain which component of the autonomic nervous system should fire. Inadequate blood pressure should result in a signal to increase either heart rate or vasoconstriction via the sympathetic nervous system.

# Your blood pressure changes when you change position.

# When your heart contracts, it pushes blood into the arteries causing an increase in blood pressure (systolic pressure). When your heart relaxes and refills with blood, the pressure in the arteries decreases (diastolic pressure).

# Standing causes 500 to 700 ml of blood to pool in the legs, so there is less blood for the heart to pump. This results in a decrease in blood pressure.

# Special cells called baroreceptors (located close to the neck arteries) sense this decrease in blood pressure. They counteract by triggering the heart to beat faster and pump more blood in order to stabilize the blood pressure.
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CAUSES OF STROKE

A stroke occurs when there's a problem with the amount of blood in your brain. The cause of the main type of stroke — ischemic stroke — is too little blood in the brain. The cause of the other type of stroke — hemorrhagic stroke — is too much blood within the skull.

1) Ischemic stroke:

About 80 percent of strokes are ischemic strokes. They occur when the arteries to your brain are narrowed or blocked, causing severely reduced blood flow (ischemia).

a) Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot usually forms in areas damaged by atherosclerosis.

b) Embolic stroke.
An embolic stroke occurs when a blood clot or other particle forms in a blood vessel away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. It's often caused by irregular beating in the heart's two upper chambers (atrial fibrillation). This abnormal heart rhythm can lead to poor blood flow and the formation of a blood clot.

2) Hemorrhagic stroke

"Hemorrhage" is the medical word for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures.

a) Intracerebral hemorrhage: In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells.

b) Subarachnoid hemorrhage. In this type of stroke, bleeding starts in a large artery on or near the surface of the brain and spills into the space between the surfaces of your brain and your skull.
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B P AFTER EXERCISE

Normally, blood pressure increases from resting level with exercise. Based on criteria used for exercise treadmill tests, any decrease in blood pressure during exercise might be a sign of heart disease. The same is true, to a lesser extent, if there is a failure of the blood pressure to increase with exercise.

Once exercise has stopped, blood pressure should return to resting levels and may even drop to slightly below pre-exercise levels for a while based on a number of factors, like any medications one might be taking, overall fitness level, and the type and duration of exercise.

The whole question of what your fall in blood pressure really means depends on its timing. If it occurs during exercise or soon after stopping, talk to your doctor about having some sort of stress test (an exercise treadmill test or a stress echocardiogram), because, even though you feel well, this could be a warning sign of early heart disease. It may not be, but the exercise testing will help sort this out.

If you have any risk factors for heart disease (smoking, high blood pressure, diabetes, high blood cholesterol levels, or close relatives with heart disease before age 45), then a treadmill test might be an even better idea.
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ANTI-OXIDANTS

Antioxidants are substances that may protect your cells against the effects of free radicals. Free radicals are molecules produced when your body breaks down food, or by environmental exposures like tobacco smoke and radiation. Free radicals can damage cells, and may play a role in heart disease, cancer and other diseases.

Antioxidant substances include

* Beta-carotene                                                                  
* Lutein
* Lycopene
* Selenium
* Vitamin A
* Vitamin C
* Vitamin E

Antioxidants are found in many foods. These include fruits and vegetables, nuts, grains, and some meats, poultry and fish.

NOTE:

Oxidation of low-density lipoprotein (LDL or "bad") cholesterol is important in the development of fatty buildups in the arteries. This process, called atherosclerosis, can lead to heart attacks and strokes. Until recently, it was thought that LDL cholesterol lipoprotein oxidation and its biological effects could be prevented by using antioxidant supplements. However, more recent clinical trials have failed to demonstrate a beneficial effect of antioxidant supplements.

DETECTING HEART DEFECTS BEFORE BIRTH

A heart defect can be detected in your baby using an ultrasound study or echocardiography, which is the name used for a specialized cardiac ultrasound. Diagnosis of a serious heart defect before your baby is born enables doctors to further examine the defect, closely monitor your child's overall health, carefully plan for your baby's delivery and ensure a smooth transition to the necessary specialized care after birth. In some cases, your baby may be a candidate for in utero treatment.

The common practice is for heart defects to be detected between 16 and 22 weeks. This is the usual age at which most pregnant women undergo a screening obstetric ultrasound. Some serious heart defects can be detected as early as 14 weeks.

Fetal ultrasounds are performed in most pregnant women to monitor fetal growth and to detect abnormalities. Serious congenital heart defects can be found during routine fetal ultrasounds. If your baby has potential risk factors, like a family history of heart disease, the Fetal Cardiology Program at Children's offers ultrasound by experienced cardiologists who will carefully examine your baby's heart.
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