The heart has four chambers in a series, which pump the blood collected from the body to the lungs and then receive the purified blood (filled with oxygen) from the lungs and again pump the same to the whole body. These chambers are called right atrium (RA), right ventricle (RV), left atrium (LA) and left ventricle (LV). For a better understanding let’s call them chambers 1, 2, 3 and 4.
‘Chamber 1′ gets about 70 millilitres of blood almost every second from the entire body through two major veins (tubes carrying blood to the heart). This blood accumulates and is passed on to ‘chamber 2′ through a valve which opens only in one direction allowing the collected blood to pass in that direction. ‘Chamber 2′ contracts, thereby closing the valve between the first and second chambers, but opening another valve which pushes 70 ml. blood to both the lungs.
The blood now reaches the lungs for purification i.e. removal of carbon dioxide and filling up with oxygen. The lungs collect oxygen from the air that we breathe in through the nose.
Once the blood is purified it is sent to ‘chamber 3′ through some tubes and accumulates there. Then this blood is pushed to ‘chamber 4′ through another valve which only opens in the direction of ‘chamber 4′. No sooner the blood reaches ‘chamber 4′ this valve closes.
‘Chamber 4′ is the strongest and the most useful chamber of the heart as it has to pump blood to the entire body. Once the 70 ml. of blood comes to ‘chamber 4′, it contracts vigorously resulting in building a high pressure (above 120 mm of mercury). This opens another valve and pushes the blood to the main artery of the body called the aorta. Since the blood pressure inside the aorta is about 120 mm of mercury (mmHg), ‘chamber 4′ has to create a pressure of more than 120 mmHg to push the blood into this tube. The aorta now branches and re-branches to supply this blood to the entire body.
The first branch that the aorta gives blood goes to the heart, Usually two branches are available to the heart - one on the right and another on the left to supply blood to the heart muscles, especially the muscles of ‘chamber 4′. These two branches – the right coronary artery and the left coronary artery (more popularly called left main) divide and re-divide to supply the blood that they get from the aorta to the heart muscles. Immediately after its origin, the left main divides into two branches called left anterior descending (LAD) and left circumflex (LCx) to supply to the left part of the heart.
The condition of the heart is like that of a cashier in the bank. The cashier handles crores (one crore is equal to 10 million) of money everyday, but he cannot use it for himself or for his personal requirements. He has to depend on his own salary which forms a small part of the cash that he is handling. Likewise the heart also handles so much blood everyday through its chambers but can utilize only a fraction of it for its own use.
One must remember that once all the chambers of the heart contract a round, 70 ml. of blood is pushed. Since the heart chambers contract 72 times in a minute, a total of about 5000 ml. of blood is pushed to the whole body in 72 installments.
The aorta, supplying blood, first circulates the blood to the entire body. It immediately gives a branch on the right side to supply blood to the whole of the right hand. The next branches are to the brain and left hand. It takes a turn below, and gives a series of branches, called arteries to the chest walls. Once it enters the abdomen it supplies blood to the liver, kidneys, spleen and intestines (both large and small). Finally it divides into two branches to supply blood to the legs.
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Alcohol intake is also a known risk factor of coronary heart disease – directly or indirectly. It has become associated with heart disease in many ways. Alcohol leads to increased triglycerides, owing to its similarity of structure with glycerol, a component of triglycerides. Many good laboratories do not take blood samples for lipid profile test (which includes triglycerides) if the patients have consumed alcohol in the last 12 hours.
Alcohol also adds huge calories to the patients. Many people eat a lot of fried items while drinking. This also adds to fat, cholesterol and calories. Alcohol is often associated with increased stress and bad interpersonal relationships in the family. Alcohol is also one of the major causes of liver disease and failure, besides gastritis and neurological damages.
There has been some confusion about recommending of alcohol in some newspapers and medical journals. It has been shown that alcohol can increase the HDL levels in the blood, but it also increases the triglycerides – it does more harm than benefit to the patients. One must see all the effects rather than one isolated parameter.
Moreover, many of these research studies are carried out in countries where the temperature is very low and alcohol is used in considerable quantities. The extrapolations are not justified with regard to alcohol. Many studies have also shown that alcohol also leads to an increased incidence of heart disease.
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INTAKE OF ALCOHOL AS A MODIFIABLE RISK FACTOR FOR CORONARY HEART DISEASE DEVELOPMENTAlcohol intake is also a known risk factor of coronary heart disease – directly or indirectly. It has become associated with heart disease in many ways. Alcohol leads to increased triglycerides, owing to its similarity of structure with glycerol, a component of triglycerides. Many good laboratories do not take blood samples for lipid profile test (which includes triglycerides) if the patients have consumed alcohol in the last 12 hours.Alcohol also adds huge calories to the patients. Many people eat a lot of fried items while drinking. This also adds to fat, cholesterol and calories. Alcohol is often associated with increased stress and bad interpersonal relationships in the family. Alcohol is also one of the major causes of liver disease and failure, besides gastritis and neurological damages.There has been some confusion about recommending of alcohol in some newspapers and medical journals. It has been shown that alcohol can increase the HDL levels in the blood, but it also increases the triglycerides – it does more harm than benefit to the patients. One must see all the effects rather than one isolated parameter.Moreover, many of these research studies are carried out in countries where the temperature is very low and alcohol is used in considerable quantities. The extrapolations are not justified with regard to alcohol. Many studies have also shown that alcohol also leads to an increased incidence of heart disease.*18/283/5*
The problem of unnecessary surgery has been the subject of study for nearly a decade by the Rand Corporation, a policy research center in Santa Monica, California. In the early 1980s, Rand researchers checked the records of patients in one western state who’d had coronary bypass surgery. They found that, of 386 coronary surgeries performed there, 14 percent were unnecessary.
Given estimated average costs of 20,000 dollars per heart-related operation, it seems safe to project that Americans paid 1 billion dollars in taxes and insurance premiums just to cover those costs.
In the early 1990s, however, the Rand Corporation studied bypass surgery in New York State. The scene appears to have changed dramatically: It was found that among 1,500 operations, only 2.4 percent were unneeded. And, reports the New York State Department of Health Cardiac Survey, the death rate also dropped on the operating table- from 3.53 percent in 1990 to 2.51 percent in 1992.
The indications are that doctors keep acquiring skills and that the newer drugs and technology are gaining in their power to heal without injury. Some states keep track of cardiac surgeries. Through New York State Health Department data, in fact, you can discover a heart surgeon’s batting average-how many surgeries he or she performed and their outcomes.
At Columbia-Presbyterian Medical Center physicians have opened a new Heart Failure Center. Here, the doctors turn first to drugs to heal damaged hearts and reduce the battered heart’s workload. Dr. Milton Packer, the center’s chief, says that this approach has:
• taken 40 percent of heart failure patients off the transplant waiting list,
• improved the conditions of 70 percent of people with heart failure, and
• cut the mortality rate by 25 percent.
“Drugs are not as exciting as transplants or mechanical hearts,” Dr. Packer says, “but we have got to give drugs a chance to work.”
A growing number of patients seem to be opting for the drug-treatment-first approach.
One of them is Howard Mills, 48, a British citizen living in Redondo Beach, California. In November 1992, a viral infection had attacked his heart muscle, leaving it weak and flabby. Mr. Mills opted for medication over surgery. He became a patient at the UCLA Cardiomyopathy Center.
“I was taking a lot of different drugs,” says Mr. Mills, recalling the start of his treatment. “I could barely walk. But my heart and body came back. Now I can walk 4 miles an hour, I can swim, and I can ride a bike. I’m glad I escaped the transplant.”
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HEART SURGERY: WHEN IT IS REALLY NECESSARYThe problem of unnecessary surgery has been the subject of study for nearly a decade by the Rand Corporation, a policy research center in Santa Monica, California. In the early 1980s, Rand researchers checked the records of patients in one western state who’d had coronary bypass surgery. They found that, of 386 coronary surgeries performed there, 14 percent were unnecessary.Given estimated average costs of 20,000 dollars per heart-related operation, it seems safe to project that Americans paid 1 billion dollars in taxes and insurance premiums just to cover those costs.In the early 1990s, however, the Rand Corporation studied bypass surgery in New York State. The scene appears to have changed dramatically: It was found that among 1,500 operations, only 2.4 percent were unneeded. And, reports the New York State Department of Health Cardiac Survey, the death rate also dropped on the operating table- from 3.53 percent in 1990 to 2.51 percent in 1992.The indications are that doctors keep acquiring skills and that the newer drugs and technology are gaining in their power to heal without injury. Some states keep track of cardiac surgeries. Through New York State Health Department data, in fact, you can discover a heart surgeon’s batting average-how many surgeries he or she performed and their outcomes.At Columbia-Presbyterian Medical Center physicians have opened a new Heart Failure Center. Here, the doctors turn first to drugs to heal damaged hearts and reduce the battered heart’s workload. Dr. Milton Packer, the center’s chief, says that this approach has:• taken 40 percent of heart failure patients off the transplant waiting list,• improved the conditions of 70 percent of people with heart failure, and• cut the mortality rate by 25 percent.”Drugs are not as exciting as transplants or mechanical hearts,” Dr. Packer says, “but we have got to give drugs a chance to work.”A growing number of patients seem to be opting for the drug-treatment-first approach.One of them is Howard Mills, 48, a British citizen living in Redondo Beach, California. In November 1992, a viral infection had attacked his heart muscle, leaving it weak and flabby. Mr. Mills opted for medication over surgery. He became a patient at the UCLA Cardiomyopathy Center.”I was taking a lot of different drugs,” says Mr. Mills, recalling the start of his treatment. “I could barely walk. But my heart and body came back. Now I can walk 4 miles an hour, I can swim, and I can ride a bike. I’m glad I escaped the transplant.”*14/266/5*