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The ‘broken heart’ syndrome
Immunotherapy for allergic disorders
Regular exercise when young makes old age less painful How to get a trim waistline
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The ‘broken heart’ syndrome It has been found that patients with psychological problems are prone to heart disease — and vice versa! In fact, in a study done by the Psychology Department, Panjab University, Chandigarh, on people, including some of the cardiac patients operated upon by this writer, it was noticed that one of the main causes for heart disease was a high incidence of anger, frustration, depression, stress, loneliness, a negative outlook, guilt and repressed feelings. In terms of their contribution to heart attacks, psycho-social factors are on a par with smoking, high blood pressure, obesity and cholesterol problems. It has also been shown that stress as such can cause a syndrome of a “broken heart” — all symptoms of heart disease without any organic damage to the heart. What was very surprising was that in a study carried in the New England Journal of Medicine none of the patients actually had a heart attack. In fact, few had any signs of heart disease and none had clogged arteries — the usual cause of heart attacks. Yet at least five of the 19 patients (18 women and one man) studied would have died without treatment. To find out the cause, the investigating physicians measured the levels of catecholamines — stress hormones that include adrenaline — in the patients. They found raised levels among all — up to 34 times as high as normal levels, and 2-3 times as high as those seen typically during a severe heart attack. Unlike a heart attack, “broken heart” syndrome doesn’t cause parts of the heart muscle to die. It has been known for eons that emotions can affect the body. This gives us a physiological reason as to why stress can cause heart attack. The brain sends signals to the sympathetic nervous system to release stress hormones like adrenaline. A little bit of stress is necessary for the fight-or-flight response that enables survival when a person is physically threatened. But some people, for reasons not yet well understood, seem to have severe cardiac reactions to stress hormones. What happens is that a sudden surge of stress hormones set off by the brain stuns the heart. This appears to be a good thing gone bad. There’s a huge amount of adrenaline stunning the heart — just like emotions are stunned. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to those of a typical heart attack: chest pain, fluid in the lungs, shortness of breath and heart failure. There is impaired pumping of the heart. It bulges out, doesn’t contract. The heart muscle works at 20 per cent instead of 60 per cent. All this indicates the mind and the heart are two sides of the same coin. But the similarities with a “traditional” heart attack end here. Closer inspection using blood tests and magnetic resonance imaging scans failed to show the typical heart attack signs, such as irreversible muscle damage, elevated levels of certain enzymes or clogged arteries. The good news is that this condition is reversible — provided the initial shock is not too great. However, even a stress-induced heart attack can’t go untreated. The heart has to be supported in some cases with drugs or machines till recovery is complete. Also there may be underlying heart disease that must be addressed, and the symptoms of broken heart syndrome, if severe enough, must be dealt with quickly. The incidence may be more than reported as most cases could be labelled as organic heart disease. Doctors believe that these heart attacks happen more often than they realise because they normally mistake them for an attack related to poor health, not emotional trauma. Anxiety or panic attacks with symptoms of hyperventilating and sometimes chest pain may relate to the broken heart syndrome. Maybe, shortness of breath associated with an anxiety attack is a subclinical form of this syndrome that just gets better fairly quickly. Though at present nobody can do much to stop these life-threatening heart spasms, it is helpful to know that as doctors become more aware of the phenomenon, they can take steps to avoid long-term damage and at least mend the physical aspects of a “broken heart.” Not surprisingly, these non-traditional heart attacks occur more in women than men. Women react differently to stress, particularly emotional stress. A woman’s heart seems to be more vulnerable than a man’s to this problem-the reason for this is not known as, paradoxically, women produce lower levels of catecholamines than men to a stressful event. A happy marriage may provide women some protection against heart disease and stroke. Perhaps, it acts as a “buffer” against stress. The connection between psycho-social factors and heart disease is so strong that today’s cardiologists must ask their patients about moods, stress and social support, and how to deal with adverse events. All the findings underscore the importance of learning to cope with stress as a way of protecting one’s heart. Traditional ways like yoga and meditation and non-traditional ways like laughter clubs go a long way in reducing stress and the threat to the heart. A number of detailed scientific studies have proved beyond doubt that these methods work by documenting better control of blood pressure, lesser stress hormone release and halting of atherosclerosis (blockage of arteries). The happy person is more likely to be “heart healthy,”and “heart smart”. The writer, a former senior consultant, Escorts Heart Institute, New Delhi, and Fortis, Mohali, is based at Ludhiana.
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Immunotherapy for allergic disorders Successful treatment of allergic disorders is based on three principles: avoidance of the allergen if possible,
pharmacotherapy, and immunotherapy (desensitisation).
In spite of the identification of the relevant allergen, avoidance may not be feasible due to many reasons. Pharmacological treatment is effective for symptom control. Immunotherapy (IT) is useful only for allergic disorders mediated by IgE antibody mechanism. Immunotherapy for the treatment of allergic respiratory diseases with orally administered pollen extract was introduced in 1890. The basic principle of IT is to inject the patient with increasing doses of allergen to which he is sensitive until a maintenance level is reached, where his symptoms are effectively controlled. Thereafter regular maintenance injections are given. Band T cells mount the immune response to antigens and other extrinsic agents and their subsets to produce specific antibodies. According to one well-accepted hypothesis, patients develop IgG antibodies, which have high avidity for the antigen than do the IgE antibodies and are able to compete successfully for the antigen sites on the allergen. These IgG antibodies are referred as blocking antibodies. The exact mechanism is yet to be known. IT may induce many other suppressive mechanisms that ultimately down-regulate IgE biosynthesis. Thus there is almost a defence barrier, which does not allow allergen to come in contact with most cells and release of vasoactive amines. The benefits from immunotherapy depend on several factors such as accuracy in allergy tests, allergen selection for the IT, its specificity, purity, storage, dosage and modification of IT schedule based upon patient’s condition. Representation of allergenic fraction in allergenic extract is very important and therefore, purified allergens should be proffered. When an individual is more sensitive to a minor allergen, which may not be present in an adequate amount in the extract, the IT with routine allergens will not be beneficial. Thus, the diagnostic criterion for the detection of the allergen and knowledge of the person practicing IT are most critical factors. It is common to see in practice that people with inadequate knowledge do allergy tests and IT, putting this science in disrepute. IT has documented clinical efficacy in allergic rhinitis and, to a certain degree, in bronchial asthma, particularly induced by house dust mite, grass pollens, etc. The possibility of the prevention of the late phase of IgE production in the lung by IT provides further rationale for its use. In a convincing double blind trial, IT with bee venom in patients with anaphylactic sensitivity to bee venom antigen has shown to protect them against anaphylaxis upon subsequent sting. IT is not indicated in food allergy and skin allergy. Recent advances in IT are many. It is mainly directed towards the purification of allergens, isolation of allergenic fractions and modified polymerised allergenic preparations. Properly conducted immunotherapy by a qualified physician after an accurate allergy diagnosis, based upon in-vitro and in-vivo tests, is safe and beneficial for the patients of respiratory allergies. Except for the local reactions, no short or long-term adverse reactions are known. The writer is a consultant paediatrician and allergy specialist.
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Regular exercise when young makes
Washington: A recent study carried out by researchers of Stanford University, USA, claims that people who regularly perform a daily routine of
exercises during their lives experience 25 per cent less muscle and joint pain in their old age as compared to those who are less active. The study reveals that people who regularly participate in brisk aerobic exercise, such as running, experience less pain than non-runners even though they are more likely to suffer from pain from injuries. Researcher Bonnie Bruce and colleagues compared the level of pain in a group of runners and a group of community-based individuals who acted as controls. They followed the participants, who were on average in their mid-sixties when the study started, for 14 years. Each year they completed a questionnaire about their
health status, exercise habits and history of injuries. In total, the study included 866 subjects: 492 Runners’ Association members and 374 controls. The results show that the greater majority of physically active participants did, on average, between 355 and 2,119 minutes of exercise per week over the course of the study, while controls exercised significantly less. After adjusting for confounding factors such as gender, age, weight and health status the results show that pain increased in both groups over time.
But members of the Runners’ Association experienced 25 per cent less musculoskeletal pain than controls. This reduction persisted throughout the study period, until the subjects reached an age of 62 to 76 years. “Exercise was associated with a substantial and significant reduction in pain even [...] despite the fact that fractures, a significant predictor of pain, were slightly
more common among runners,” said the authors. — ANI |
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How to get a trim waistline Everybody wants to have a flat abdomen. An obese standing in front of a mirror squeezes the stomach and always wishes that he could look like this. Therefore, the important question is: What exercises should one do to flatten the abdominal area? Secondly, how often should the abdominal workout be done? The abdominal cavity consists of abdominal muscles. Therefore, the abdominal exercises in the form of sit-ups can only tone up the muscles but cannot get rid of the fat that lies above the abdominal muscles. The only way to lose fat is to do vigorous aerobic activities. The main purpose of sit-ups is to strengthen the abdominal muscles which help in improving the posture and stability of the lumbar spine, assist in breathing and holding organs of digestion. Sit-ups are an important aspect of any fitness programme when done properly. When done wrongly, sit-ups can be a waste of time or may be harmful. Abdominal muscles should be toned like a yoga teacher does it — developing the perfect balance of abdominal strength, suppleness and relaxation but not being tense like a soldier. It is advisable to perform “crunches” in a manner so as to achieve the best results and avoid low back pain, neck stiffness, etc. l Crunches should be done after aerobic and weight training exercises. l Bend your knees so as to flatten the lower back. It helps in neutralising the action of hip flexors and avoids low back pain. l Hands should be placed lightly on the ears or then cross your arms over the chest. It is better to avoid locking hands behind the neck to avoid any pull on the neck muscles. l Inhale before the start to crunch. Hold your breath during the upward movement and forcefully exhale at the top. As you return to the initial position, start inhaling. Lungs should be full by the time of starting the next repetition. l Shoulders, upper back and the neck should be in a straight line while lifting the body up. Rounding the shoulders forward can strain the neck and upper back muscles. l It is advisable to lift the upper back for not more than 45 degrees, otherwise one can strain the lower back. l The speed of the crunches is very important. Crunches should be done slowly in the upward and downward movement. One should do two or three sets of 15 to 20 repetitions. Doing 50 to 100 repetitions in a fast speed may cause backache. l To get the best results, focus by closing your eyes and visualising the movement of the abdominal muscles. Crunches are performed in different angles. When one bends forward, the work is done in sagittal plane. Bending to the side relates to the frontal plane. Twisting your torso relates to the transverse plane. Therefore, it is important to incorporate abdominal exercises in all the planes to get better results. Upper abdominal muscles — Lying on the back with knees bent at about 90 degrees and the feet flat on the floor. Place your hands at the opposite shoulder or at the sides of ears. Raise the shoulders and head 6” to 12”. Tense your abdominal muscles and hold this position for a few seconds. Return slowly to the floor and repeat. Lower abdominal — Lie on your back, legs extended towards the ceiling. Bend elbows over the shoulders and grab underneath the edge of the bed or sofa for support. Tighten the abdomen and slowly move the feet towards the ceiling by lifting the hips off the floor. After a pause, return to the original position. This completes one repetition. Do it 10 times. Exercise for oblique muscle — Lie sideways on your left hip with the legs together and the knees bent. The left elbow stays close to the body for support and the right hand is placed behind the upper ear. Raise the top of the leg along with the elbow simultaneously so that the elbow and the knee meet each other. Lower it back. Do it 10 times and repeat on the other side. It is not possible to strengthen the abdominal muscles within a short span. Therefore, patience and determination are a must . The writer is a former doctor/physiotherapist, Indian cricket team
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“broken heart” is not just a cliche from Mills and Boons novels and Bollywood tear-jerkers. Nor is it just a metaphor. Broken hearts aren’t limited to the domain of literature and art. Recent studies have shown that it is a real medical event — one that can kill.