Top Homeopathic Remedies for Angina pectoris

# Referred_pain , also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in the neck, shoulders, and back rather than in the thorax (chest), the site of the injury.

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??

THYROID DISORDERS -EVERYTHING YOU SHOULD KNOW - by Dr Sunil kumar Dear friends and Curofians here's an brief information about thyroid disorders. Thyroid gland is a butterfly shaped gland in the front of the neck. It encircles the windpipe or the trachea. It is about 4 cms in height and weighs about 18 gms. This gland is responsible for the secretion of thyroid hormones. Hormones are chemicals produced by special glands like thyroid, adrenals, ovaries etc. They act as messengers and are carried by the blood to the various target organs. Thyroid disorders are conditions that affect the thyroid glands. It plays an important role in regulating numerous metabolic processes throughout the body. The Thyroid gland is located below the adam’s apple wrapped around the trachea. Thyroid disease is a common problem that can cause symptoms because of over- or under-function of the thyroid gland. The thyroid gland is an essential organ for producing thyroid hormones, which maintain our body metabolism. The thyroid gland is located in the front of the neck below the Adam's apple. Thyroid disease can also sometimes lead to enlargement of the thyroid gland in the neck, which can cause symptoms that are directly related to the increase in the size of the organ (such as difficulty swallowing and discomfort in front of the neck). Thyroxine T4 is the primary hormone developed by the Thyroid gland. A small portion of the T4 released from the gland is converted to Triiodothyronine (T3) which is the most active hormone. Hyperthyroidism: Too much thyroid hormone results in a condition known as hyperthyroidism. Affects about 1 percent of women. It's less common in men. Grave’s disease is the most common cause of hyperthyroidism. Symptoms: RestlessnessNervousnessIrritabilityracing heartIncreased sweatingShakingRestlessnessTrouble sleepingThin skinBrittle hairNailsWeight lossMuscle weakness Causes: Toxic adenomas: Nodules develop in the thyroid glands and begin to secrete thyroid hormones upsetting the body's chemical balance.Subacute thyroiditis: Inflammation of the thyroid that causes the gland to leak excess hormones, resulting in temporary hyperthyroidism that lasts a few weeks but may persist for months.Pituitary gland: Malfunctions or cancerous growths in the thyroid gland. Although rare, hyperthyroidism can also develop from these causes. Treatments for hyperthyroidism: destroy the thyroid gland or block it from producing its hormones. Antithyroid drugs: such as methimazole (Tapazole) prevent the thyroid from producing its hormones.Radioactive iodine: a large dose of it damages the thyroid gland. A pill is given by mouth. As thyroid gland takes in iodine, it also pulls in the radioactive iodine, which damages the gland.Surgery: Surgery can be performed to remove your thyroid gland. Hypothyroidism: Inadequate production of hormones by the thyroid gland is termed as hypothyroidism. This is also called Underactive thyroid state. Hypothyroidism can make the body’s development to slow down and reduces metabolism rates. Since the body needs some amount of thyroid for energy production and drop in hormone production leads to lower energy levels. Symptoms: FatigueDry skinIncreased sensitivity to coldMemory problemsConstipationDepressionWeight gainSlow heart rateComa What are the causes of Hypothyroidism? Hypothyroidism can be caused by a number of factors: Hashimoto's thyroiditis: This is the commonest cause. This is an autoimmune disorder (normally body’s defence system fight against external infections. In autoimmune disorder the defence system attacks the healthy cells of the body by mistake). In Hashimoto’s thyroiditis the immune system/defence system produces antibodies that attack the thyroid gland and destroy it.Iodine deficiency in diet: For the production of thyroid hormones iodine is very important. The body does not produce iodine normally, so it needs to be supplemented from outside. Iodine is mainly present in the food we eat. It is mainly present in shellfish, salt-water fish, eggs, dairy products. If a person does not eat iodine rich foods, he may end up with iodine deficiency leading to hypothyroidism. Currently, this causative factor is on the decline due to government initiative of table salt with iodine.Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.Treatment with radioactive iodine: This treatment is used for managing hyperthyroidism/overactive thyroid, where the thyroid gland produces excessive thyroid hormones. One of the treatment modalities is by radioactive iodine. Sometimes this radiotherapy destroys normal functioning cells which lead to hypothyroidism.Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc. – for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery – this is called Postpartum thyroiditis.Damage to the pituitary gland: Pituitary gland is a gland which is present in the brain. It produces a hormone called TSH (Thyroxine-Stimulating hormone).The TSH tells the thyroid gland how much thyroid hormone it should make. If the levels of thyroid hormone in the blood are low, then the TSH will stimulate the thyroid gland to produce more Thyroid hormone.Hypothalamus disorders: This is an organ in the brain. This produces a hormone called TRH (Thyrotropin Releasing Hormone) which acts on the Pituitary gland to secrete TSH. So any disorder of Pituitary gland will indirectly effect the production and secretion of Thyroid hormones. These are very rare disorders.Congenital thyroid defects: Some babies are born with thyroid problems. This is due to the thyroid not being developed normally during pregnancy. Sometimes the thyroid gland does not function normal. This can be identified by screening for thyroid disorders in the first week after delivery. This is usually by a blood test using a small drop of blood from the baby’s heel. Who are at risk of developing Hypothyroidism? Women have a higher risk of suffering from hypothyroidism than men.Older people are at increased risk.People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison’s disease etc.People with psychiatric conditions such as bipolar disorderPeople with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism. How to diagnose hypothyroidism? Blood tests: TSH: This hormone is made in the pituitary gland and it stimulates the thyroid gland to produce thyroxine. If the thyroxine levels are low in the blood, the pituitary gland produces and secretes more TSH into the blood to act on the thyroid gland to produce more thyroxine. A raised TSH level indicates hypothyroidism. Other tests are not usually necessary unless a rare cause of hypothyroidism.T4: A low level of thyroxine indicates hypothyroidism.T3: these levels are generally not needed to diagnose hypothyroidismAnti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.Ultrasound of the neck is done if the patient presents with a thyroid swelling. What is the treatment of hypothyroidism? Overt hypothyroidism is treated by synthetic Thyroxin hormone which should be taken every day on an empty stomach at least 30 – 45 minutes before breakfast. The treatment is continued for the rest of the patient’s life. Regular thyroid function tests are done once every 8 weeks-12 weeks to adjust the dose of the thyroxine in the initial period of diagnosis. Once the thyroxine dose is stabilised, the tests can be done even once a year. This treatment is quite effective. Sub-clinical hypothyroidism is only treated if the patient is a woman and is contemplating pregnancy, in patients with symptoms or if the TSH is quite high. What are the side-effects of thyroxine medication? There are few side effects if any. Most people tolerate these medications quite well. An important consideration before starting medication is to check if the patient has chest pain/angina. These people are started on the least available dose. If these patients are started on a higher dose they notice a worsening of their angina pains. Side effects mainly occur if the thyroxine dose is high which leads to hyperthyroidism. The symptoms of this could be palpitations 9increased heart beat), weight loss, profuse sweating, anxiety, irritability etc. There are some tablets which increase with thyroxine tablets. These include carbamazepine, iron supplements, calcium supplements, rifampicin, phenytoin, warfarin etc. What are the complications of hypothyroidism? If untreated hypothyroidism can lead to: heart problems like heart attack due to increased levels of bad cholesterol like LDL, or heart failure due to fluid retentionobesityinfertilityjoint painsdepressionA pregnant woman with hypothyroidism is at increased risk of giving birth to a baby with congenital hypothyroidism, also known as cretinism. Further, the woman may have pregnancy related complications like pre-eclampsia, premature delivery, low birth weight baby, anemia, post-partum haemorrhage (bleeding after delivery) etc.Myxoedema is another complication where the patient has extremely low levels of thyroid hormone. The body temperature drops drastically making the person lose consciousness or go into a coma. If you wish to discuss about any specific problem, you can consult an Endocrinologist. Regards Dr Sunil kumar

NEW STENTING TOOL COULD MAKE HEART PROCEDURES CHEAPER AND LESS PAINFUL. March 20, 2017 by Caroline Brogan. New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1700445 A NEW TOOL for assessing the narrowing of the heart's arteries was FOUND TO BE AS EFFECTIVE AS CURRENT METHODS AND LESS PAINFUL FOR PATIENTS. The tool is similar to current techniques in telling surgeons whether a patient needs a STENT – a type of mesh tube used to hold open clogged arteries and increase blood flow. However, THIS NEW TECHNIQUE, KNOWN AS instantaneous wave-free ratio (iFR), is MUCH MORE PLEASANT FOR the PATIENT, and could be CHEAPER and LESS TIME-CONSUMING for healthcare providers. CORONARY STENOSIS OCCURS WHEN VARIOUS FACTORS CAUSE NARROWING OF THE CORONARY ARTERIES, WHICH DELIVER OXYGEN-RICH BLOOD TO THE MUSCLE OF THE HEART. WHEN THESE blood VESSELS become BLOCKED or are narrowed, this CAN AFFECT how the heart functions, potentially LEADING TO CHEST PAIN, HEART ATTACKS and HEART FAILURE. Now, DR JUSTIN DAVIES and his team from the National Heart and Lung Institute at Imperial College London have DEVELOPED iFR to measure the pressure loss caused by the narrowing in these important blood vessels without the need for drugs with sometimes unpleasant side effects. This novel technology was licensed to Volcano-Philips by Imperial Innovations, the College's technology transfer partner. THE TECHNIQUE RECEIVED FDA APPROVAL IN 2013 and is ALREADY USED IN 4,500 LABS WORLDWIDE, BUT the LATEST STUDY is the biggest yet to PROVE ITS EFFECTIVENESS COMPARED WITH THE CURRENT MOST WIDELY ESTABLISHED TECHNIQUE. "We have already seen iFR ADOPTED INTO THE LATEST 2017 appropriate use criteria (AUC) GUIDELINES and expect this will lead to further changes in guidelines, which would have HUGE IMPLICATIONS FOR CARDIOLOGISTS AND THEIR PATIENTS," said Dr Davies. "iFR technology is already used widely worldwide, and this is the study we've been waiting for to show that our TECHNIQUE IS JUST AS ACCURATE AS OLD ONES, BUT FAR BETTER FOR PATIENTS." DECIDING ON STENTS : Measuring pressure in the coronary artery is important when deciding whether patients need to have a stent fitted – a procedure known as ANGIOPLASTY. This helps to improve the blood supply to the heart muscle by widening the narrowed coronary arteries. However, before patients can undergo angioplasty, CARDIOLOGISTS MUST TEST THE PRESSURE OF THE ARTERY TO MAKE SURE IT IS NARROW ENOUGH FOR A STENT TO BE USEFUL. The first line technique in CURRENT GUIDELINES, known as fractional flow reserve (FFR), requires using powerful drugs such as adenosine to open the blood vessels for easier measurement. However, it can cause severe crushing pain, low blood pressure and breathing difficulties, and adds more time and costs on to the procedure. THE LATEST STUDY HAS SHOWN THAT using the NEW TECHNIQUE (iFR) is just as ACCURATE, causes LESS DISCOMFORT, is LESS TIME-CONSUMING, and might be CHEAPER, than FFR. Click here for a live case demonstration of iFR, courtesy of Imperial College Healthcare NHS Trust. LIKE FFR, iFR measures pressure using a thin wire in the coronary artery, BUT UNLIKE FFR, it uses a mathematical algorithm to take measurements only when the heart is relaxed and the coronary blood flow is high, negating the need for adenosine. IN THIS STUDY, THE RESEARCHERS ENROLLED 2,492 PATIENTS IN 17 COUNTRIES who suffered with chest pain or acute coronary syndrome (heart attack). They RANDOMLY ASSIGNED participants to undergo iFR or FFR, and either inserted a stent or not, depending on the measurements. Patients were followed up for 12 months after the procedure. BY MEASURING subsequent heart attack and mortality after FFR and iFR, the researchers were able to tell whether the type of technique used had any association with higher mortality or other OUTCOMES. Although there were no significant differences in rates of death or subsequent heart attack between the two techniques, PATIENT EXPERIENCE WAS MUCH IMPROVED WITH THE iFR TECHNIQUE. The researchers found that ADVERSE EVENTS occurred in 31 PER CENT OF FFR patients AND THREE PER CENT OF iFR PATIENTS OVERALL. FFR was also associated with a HIGHER RATE OF SHORTNESS OF BREATH (reported in one per cent of iFR patients and 20 per cent of FFR patients); CHEST PAIN (nearly two percent in iFR and seven per cent in FFR); HEART RHYTHM disturbances (nearly ZERO per cent in iFR and nearly five per cent in FFR); ABNORMALLY LOW BLOOD PRESSURE (nearly zero per cent in iFR and one per cent in FFR); and SERIOUS ADVERSE EVENTS, which included severe shortness of breath or disturbance of normal heart rhythm (nearly zero per cent in iFR and nearly one per cent in FFR). They also found that iFR reduced the overall length of the PROCEDURE, from an average of 45 MINUTES FOR FFR to 40 MINUTES FOR iFR. The results from this trial, known as DEFINE-FLAIR, are published in the New England Journal of Medicine, and are presented today at the American College of Cardiology's 66th Annual Scientific Session in Washington. LEAD AUTHOR DR DAVIES SAID: "As our technique ELIMINATES the NEED FOR ADENOSINE and REDUCES the LENGTH OF the PROCEDURE, it could mean that iFR SAVES HEALTHCARE PROVIDERS MONEY. The study also provides a very good, REAL-WORLD SNAPSHOT OF THE TIME it takes to actually get a patient in, do the physiological assessment, do the stenting if necessary, and finish." CO-AUTHOR of the study, Dr Sayan Sen, SAID: "'CARDIOLOGISTS HAVE BEEN WAITING FOR SOMEONE TO PROVE THAT THIS NEW TECHNIQUE IS JUST AS EFFECTIVE AS THE CURRENT ONE." "Many of our physician colleagues have been waiting for these results, and for them to be incorporated fully into the guidelines they use. DEFINE-FLAIR gives guideline makers the evidence they need to go ahead and suggest the technique that's BETTER TOLERATED BY PATIENTS, and MORE COST EFFECTIVE for the health service." Next, Dr Davies and co-investigator Professor Javier Escaned will further analyse this data to fully compare the costs of iFR and FFR. They will also work to combine data from another study testing iFR outcomes, SWEDEHEART, with their own. The two groups of researchers will work together to conduct a follow-up analysis combining the data from the two studies in a META-ANALYSIS of primary outcomes that will include approximately 4,500 patients. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ £££££££££££££££££££££££££££££££££££££££££££££ MORE INFORMATION: Justin E. Davies et al. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI, New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1700445 _______________________________________ PROVIDED BY: Imperial College London. _______________________________________ IMAGE : A STENT HOLDING OPEN A CLOGGED ARTERY. ====================×========================

55yrs old male came with c/c of chest pain which rafiates left arm from last 2days. no significant medical history. his B/P 110/70, pulse 84/min. ECG done. please suggest managment