*Angina* ☝ *All about*☝ is chest pain, discomfort, or tightness that occurs when an area of the heart muscle receives decreased blood oxygen supply. It is not a disease itself, but rather a likely symptom of coronary artery disease, the most common type of heart disease. The lack of oxygen-rich blood to the heart is usually a result of narrower coronary arteries due to plaque build-up; a condition called atherosclerosis. History The condition was named “hritshoola” in ancient India and was described by Sushruta (6th century BC). Types Stable (or chronic) angina Stable angina occurs when the heart is working harder than usual, for instance, during exercise. It has a regular pattern and can be predicted to happen over months or even years. Rest or medication relieves symptoms. Unstable angina Unstable angina does not follow a regular pattern. It can occur when at rest and is considered less common and more serious because rest and medication does not relieve it. This version can signal a future heart attack within a short time – hours or weeks. Variant and microvascular angina Variant (Prinzmetal’s) angina and microvascular (smallest vessels) angina are rare and can occur at rest without any underlying coronary artery disease. This angina is usually due to abnormal narrowing or relaxation (spasm) of the blood vessels, reducing blood flow to the heart. It is relieved by medicine. Risk factors The following risk factors increase your risk of coronary artery disease and angina: Tobacco use. Chewing tobacco, smoking and long-term exposure to second-hand smoke damage the interior walls of arteries including arteries to your heart allowing deposits of cholesterol to collect and block blood flow. Diabetes. Diabetes is the inability of your body to produce enough insulin or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis. High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries. High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. History of heart disease. If you have coronary artery disease or if you’ve had a heart attack, you’re at a greater risk of developing angina. Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults. Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program. Obesity. Obesity raises the risk of angina and heart disease because it’s associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue. Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina. Causes Angina is usually caused by coronary heart disease. When the arteries that supply your heart muscle with blood and oxygen become narrowed, the blood supply to your heart muscle is restricted. This can cause the symptoms of angina. Angina symptoms are often brought on by physical activity, an emotional upset, cold weather or after a meal. The episodes usually subside after a few minutes. Symptoms Symptoms associated with angina include: Chest pain or discomfort Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness of breath Sweating Dizziness The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion. Diagnosis and test A correct diagnosis for chest pain is important because it can predict the likelihood of having a heart attack. The process will start with a physical exam as well as a discussion of symptoms, risk factors, and family medical history. A physician who is suspicious of angina will order one or more of the following tests: Electrocardiogram (EKG) – records electrical activity of the heart and can detect when the heart is starved of oxygen. Stress test – blood pressure readings and an EKG while the patient is increasing physical activity. Chest X-ray – to see structures inside the chest. Coronary angiography – dye and special X-rays to show the inside of coronary arteries (dye is inserted using cardiac catheterization). Blood tests – to check levels of fats, cholesterol, sugar, and proteins. Treatment and medications Angina treatments aim to reduce pain, prevent symptoms, and prevent or lower the risk of heart attack. Medicines, lifestyle changes, and medical procedures may all be employed. Lifestyle changes recommended to treat angina include: stopping smoking controlling weight regularly checking cholesterol levels resting and slowing down avoiding large meals learning how to handle or avoid stress eating fruits, vegetables, whole grains, low-fat or no-fat dairy products, and lean meat and fish Medicines called nitrates (like nitroglycerin) are most often prescribed for angina. Nitrates prevent or reduce the intensity of angina attacks by relaxing and widening blood vessels. Other medicines may be used such as: Beta blockers Calcium channel blockers ACE (angiotensin-covering enzyme) inhibitors Oral anti-platelet medicines Anticoagulants High blood pressure medications may also be prescribed to treat angina. These medicines are designed to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming. In some cases, surgical medical procedures are necessary to treat angina. A heart specialist may recommend angioplasty. Coronary artery bypass grafting is another standard procedure; this is surgery where the narrowed arteries in the heart are bypassed using a healthy artery or vein from another part of the body. Prevention Unfortunately you can’t reverse coronary heart disease, which causes angina, but you can delay your arteries narrowing. To do this it’s important to: Stop smoking Control high blood pressure Reduce your cholesterol level Be physically active Achieve and maintain a healthy weight Control your blood glucose if you have diabetes Eat a healthy, balanced dietand only drink moderate amounts of alcohol. Some medications can also be used to help prevent angina episodes

Heart attack: A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscles A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call ambulance or emergency medical help if you think you might be having a heart attack. Symptoms Common heart attack signs and symptoms include: Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back Nausea, indigestion, heartburn or abdominal pain Shortness of breath Cold sweat Fatigue Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call ambulance or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. What to do if you see someone who might be having a heart attack If you see someone who's unconscious and you believe is having a heart attack, first call for emergency medical help. Then check if the person is breathing and has a pulse. If the person isn't breathing or you don't find a pulse, only then should you begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm — about 100 to 120 compressions a minute. If you haven't been trained in CPR, doctors recommend performing only chest compressions. If you have been trained in CPR, you can go on to opening the airway and rescue breathing. Causes A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can block the flow of blood through the coronary artery, starving the heart muscle of oxygen and nutrients (ischemia). You might have a complete blockage or partial. A complete blockage means you've had an ST elevation myocardial infarction (STEMI). A partial blockage means you've had a non-ST elevation myocardial infarction (NSTEMI). Diagnostic steps and treatment might be different depending on which you've had. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Using tobacco and illicit drugs, such as cocaine, can cause a life-threatening spasm. Risk factors Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or another heart attack. Heart attack risk factors include: Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. Tobacco. This includes smoking and long-term exposure to secondhand smoke. High blood pressure. Over time, high blood pressure can damage arteries that feed your heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases your risk even more. High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) lowers your risk of heart attack. Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. Diabetes. Not producing enough of a hormone secreted by your pancreas (insulin) or not responding to insulin properly causes your body's blood sugar levels to rise, increasing your risk of heart attack. Metabolic syndrome. This occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it. Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you might be at increased risk. Lack of physical activity. Being inactive contributes to high blood cholesterol levels and obesity. People who exercise regularly have better cardiovascular fitness, including lower high blood pressure. Stress. You might respond to stress in ways that can increase your risk of a heart attack. Illicit drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can increase your risk of heart attack. Complications Complications are often related to the damage done to your heart during an attack, which can lead to: Abnormal heart rhythms (arrhythmias).Electrical "short circuits" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. Heart failure. An attack might damage so much heart tissue that the remaining heart muscle can't pump enough blood out of your heart. Heart failure can be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. Sudden cardiac arrest. Without warning, your heart stops due to an electrical disturbance that causes an arrhythmia. Heart attacks increase the risk of sudden cardiac arrest, which can be fatal without immediate treatment. Prevention It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack. Medications. Taking medications can reduce your risk of a subsequent heart attack and help your damaged heart function better. Continue to take what your doctor prescribes, and ask your doctor how often you need to be monitored. Lifestyle factors. You know the drill: Maintain a healthy weight with a heart-healthy diet, don't smoke, exercise regularly, manage stress and control conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes.  Some common homoeopathic remedies that can prevent and treat heart attacks are: Arnica: One of the first symptoms of a heart attack is radiating pain from the chest to the left arm. The moment a person experiences such a symptom, he or she should be given arnica. Arnica helps calm the mind and treats the physical and mental shock of this experience. Arnica can also stem the internal bleeding and reduce internal bruising. Aconite: Sudden chest pain and a high heart rate are other common symptoms of a heart attack. As soon as such symptoms are experienced, aconite should be given to the patient. This treats the anxiety and mental anguish being experienced and lowers the heart rate. Aconite should ideally be given along with arnica. Nux Vomica: Nux vomica is often prescribed in cases where the patient complains of fatigue, chest pain and heaviness in the chest. This is often experienced after eating a heavy meal or triggered by exposure to stress. Stimulants such as coffee, alcohol and drugs can also stimulate such symptoms. Arsenicum: Arsenicum may be used to treat burning, chest pain that worsens at night. The patient may also complain of suffocation that worsens when lying on his back and may feel excessively thirsty. However, because of the chest pain, he may not be able to drink enough water to satiate his thirst. Arsenicum also helps calm restlessness and anxiety.

45m diabetic on OHA,controlled,bp normal rarely upto140/90 has no any complaints ecg after 5killometer walking routine checkup…… plz expert opinion if there is any future warning…………… history only genetical diabetics

53/M c/o Severe chest pain (squeezing in nature) radiating to left arm and upper back a/w profuse sweating since 1 hr. k/c/o T2DM x 3 yrs on RX k/c/o smoker - 20 beedi / day x 25 yrs ECG taken Diagnosis and treatment??

Association Between the Frank Sign and Cardiovascular Events Saleh Nazzal, MD; Arnon Blum, MD DISCLOSURES South Med J. 2018;111(8): Abstract Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was to summarize the clinical trials and observational studies that had examined the association between the Frank sign and cardiovascular diseases. Summarizing the 57 studies we found showed that this association could be used for early diagnosis of coronary and vascular diseases in the preclinical stage and that they were found in different populations around the world. Autopsy studies also found a strong association between the Frank sign and cardiovascular causes of death in both sexes. Cardiovascular causes of death included ischemic and hypertensive heart disease, calcific valvular stenosis, ruptured dissecting aneurysm of the thoracic aorta, and ruptured atheromatous aneurysm of the abdominal aorta. The Frank sign was correlated with increased intima-media thickness and stroke and was found in patients with peripheral vascular disease and with cardiovascular risk factors. The Frank sign could serve as a physical sign to help clinicians diagnose cardiovascular diseases. Introduction In the last decade physicians have learned to rely on advanced technology to detect subclinical stages of atherosclerosis. Cardiovascular diseases are among the most common causes of morbidity and mortality worldwide. They constitute approximately 31% of all deaths globally every year, or 17.5 million individuals annually.[1] Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time.[2] There remains, however, great debate about the accuracy and reliability of such "natural" means. An interesting example is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. It is a diagonal earlobe crease at a 45° angle, in varying depths, that starts from the tragus and extends to the edge of the auricle. Frank made a clinical observation that 19 of 20 patients with the crease had at least one of the known cardiovascular risk factors.[3] The Frank sign can be classified by the length of the crease. It is considered complete when it crosses the entire earlobe, whereas it is considered incomplete when it is visible only partly through the earlobe (Figure 1). The Frank sign also can be evaluated by its depth. Mild is graded when it is visible as a superficial wrinkling on the earlobe, moderate when it is seen as a sulcus with visible base, and severe when the sulcus is so deep that the base is not visible (Figure 2).[4] In addition, a stronger association between the Frank sign and coronary heart disease was found when the sign existed in both ears, not only in one ear.[5–7] Figure 1. The Frank sign classification according to length: complete (A) and incomplete (B). Figure 2. The Frank sign classification according to depth: (A) mild is graded when it is visible as a superficial wrinkling on the earlobe, (B) moderate is graded when it is seen as a sulcus with visible base, and (C) severe is graded when the sulcus is so deep that the base is not visible. The Frank sign has been documented in sculptures from the time of ancient Rome. The earliest work of art is believed to date to the Roman emperor Hadrian (76–138 CE; Figure 3); it was described by Patrakis, who found an association between the Frank sign in this ancient statue and the medical history of Hadrian, who experienced recurrent events of epistaxis and hypertension.[8] Recently, Charlier and Deo[9] identified bilateral earlobe creases in the 1880 death mask of French novelist Gustave Flaubert (1821–1880), who died at age 59 years from brain hemorrhagic stroke, and Galassi et al identified numerous instances of the Frank sign in Renaissance art.[10] Figure 3. Roman emperor Hadrian (76–138 CE). The arrow points to the Frank sign. Our goal was to summarize the clinical trials and observational studies that had examined the association between the physical sign, the Frank sign, and cardiovascular diseases. We searched PubMed and MEDLINE from 1973 to July 2017 using combinations of the following key words: earlobe crease, ear lobe crease, ear-lobe, crease, ear crease, ear creases, and Frank's sign. Randomized controlled trials, original papers, review articles, and case reports were included in the present review. We found 57 papers that summarized clinical observations and clinical retrospective and prospective studies that looked into this interesting association between a physical sign detected during a medical physical examination and the clinical events that follow. In a study that examined 215 Indian patients from different communities, the bilateral Frank sign was significantly associated in patients with documented coronary artery disease (CAD; P < 0.001). The prevalence of the Frank sign increased with advancing age. The combined presence of the Frank sign and ear canal hair represented a more sensitive index of CAD.[5,6] The association between the Frank sign and CAD was studied prospectively among 956 patients with ischemic heart disease who underwent coronary intervention. The Frank sign was associated with ischemic heart disease mainly in patients with more than four cardiovascular risk factors. An increased rate of cardiovascular complications was found following coronary intervention in patients who had a bilateral Frank sign.[7] The first controlled study that examined the relation between the Frank sign and cardiovascular disease found that 47% of 531 patients who had acute myocardial infarction also had the Frank sign (unilateral or bilateral), which is significantly greater than the 30% rate of the Frank sign observed among 305 age-matched control subjects with no clinical evidence of CAD (P < 0.001).[11] A Spanish study found that the association between the Frank sign and CAD was mainly positive and relevant among subjects between the ages of 30 and 60 years.[12] A prospective study that examined 222 patients with CAD found that the prevalence of the Frank sign among patients with coronary disease was significantly higher than those without (82% vs 38.5%). Patients with the Frank sign were prone to develop intraoperative cardiovascular complications (42.6% with vs 4.9% without) and postoperative cardiovascular complications (24.9% with vs 4.9% without).[13] Another prospective study of 286 patients with CAD who underwent coronary angiography because they demonstrated typical symptoms of angina pectoris found that of the 286 patients, 200 had critical stenosis in at least one coronary artery (>50% stenosis). There was a significant higher prevalence of the Frank sign in patients with CAD (72% vs 21%, P < 0.001). The Frank sign was detected in older patients and patients with an increased severity of coronary disease but not with other classic risk factors of coronary disease such as diabetes mellitus, hypertension, smoking, obesity, and hyperlipidemia.[14] Prospective cohort studies found that the Frank sign was associated with increased all-cause and cardiac morbidity and mortality. Patients with the Frank sign had more coronary events and were cautioned to reduce cardiac risk factors, even if they did not have any diagnostic evidence of CAD at the time of examination.[15] The Copenhagen City Heart Study tested the hypothesis that visible age-related signs may be associated with risk of coronary disease, myocardial infarction, and death independent of chronological age. Male pattern baldness, the Frank sign, and xanthelasmata predicted an increased risk of ischemic heart disease and myocardial infarction independent of chronological age and other well-known cardiovascular risk factors.[16] In a Brazilian study of 1464 patients, Tranchesi Júnior et al found that the Frank sign was present in 220 of 338 patients (65%) with CAD (>70% stenosis of ≥1 coronary artery documented by angiography) and that this prevalence was significantly greater compared with patients with the Frank sign but without coronary disease (28% of 1086 patients, P < 0.0001).[17] Both the Frank sign and CAD increased with advanced age (P < 0.0001 for both). This association remained statistically significant in all decades, except for patients older than 70 years. The presence of the Frank sign also was associated with the extent of coronary disease as measured by the number of narrowed major arteries (P = 0.015). The observed sensitivity of the sign for the diagnosis of coronary disease was 65%, with a specificity of 72%, a positive predictive value of 42%, and a negative predictive value of 87%. The Frank sign also was related to the severity of CAD. In stenosis in one to three coronary arteries, the prevalence of the Frank sign increased from 55% (when patients had 1-vessel CAD) to 78% (when patients had 3-vessel CAD, P = 0.015).[17] This association was found in different populations around the world; a significant association between the Frank sign and CAD was found in populations in Croatia,[18] Japan,[19] and Turkey.[20,21] In 2011 an Israeli review described the diagonal earlobe crease as an indicator of ischemic heart disease,[22] and similar results were found by a Chinese group 1 year later.[23] The association between CAD and the Frank sign was studied in 430 individuals without a history of coronary heart disease using coronary computed tomography. The Frank sign was present in 71% of the patients with documented CAD (a 50% stenosis at least in one of the coronary arteries). The prevalence of coronary significant lesions in 307 patients with the Frank sign was 77%, significantly greater compared with 55% of 123 patients without the Frank sign (P < 0.001). The sensitivity, specificity, and positive and negative predictive values for the Frank sign to diagnose any CAD were 78%, 43%, 77%, and 45%, respectively.[24] Adding the Frank sign to the cardiovascular risk assessment of patients with angina pectoris improved the prediction of CAD beyond the Diamond-Forrester classification