THE RELATIONSHIP BETWEEN SODIUM INTAKE AND BLOOD PRESSURE HAS BEEN RECOGNIZED FOR MANY YEARS.
It was documented as early as 1904.There's a lot of data from epidemiologic, animal, and genetic studies to support the relationship between sodium intake and hypertension. The best evidence to date for this relationship comes from the Dietary Approaches to Stop Hypertension (DASH-sodium) study.
Subjects eating the DASH diet had a slightly better improvement in blood pressure at all levels of sodium intake. In fact, in subjects with hypertension, the blood pressure-lowering effect of the DASH diet plus low sodium intake was equal to or greater than what would be expected from a single antihypertensive drug. Systolic blood pressure was lowered by 11.5 mm Hg with the DASH diet plus low sodium compared to the typical diet plus high sodium (p<0.001) in the hypertensive group. But the DASH-sodium results did show that even without dietary changes, reduced sodium intake can lead to a reduction in blood pressure.
Besides actually lowering blood pressure, reducing sodium intake can be beneficial for patients whose hypertension is being treated. Excessive dietary sodium can blunt the blood pressure-lowering effect of most antihypertensive drugs. This is particularly true for individuals who are considered to be "salt-sensitive." This term refers to those whose blood pressure is especially responsive to their sodium intake. Factors predisposing individuals to salt sensitivity are chronic kidney disease, obesity, old or middle-aged, African American ethnicity, and metabolic syndrome or diabetes.
It's important to note that in most patients, potassium intake goes hand-in-hand with sodium intake. A diet low in potassium can cause sodium retention and a subsequent elevation of blood pressure.An increase in dietary potassium can actually reduce sodium sensitivity in people with normal or high blood pressure.
Benefits of Limiting Sodium Intake
Current guidelines for treating hypertension state that reducing sodium intake to less than 2400 mg daily can lower systolic blood pressure, on average, by 2 to 8 mm Hg.The DASH-sodium study backs this up. Without dietary changes other than sodium reduction, systolic blood pressure can be reduced by up to 7 mm Hg when sodium intake is limited to 1500 mg or 65 mmol/day.
Limiting sodium intake as a society could have a major impact on public health. Researchers say that reducing salt intake by 3 grams daily (1200 mg or 50 mmol of sodium) would have an impact on morbidity and mortality similar to the total elimination of cigarette smoking. New cases of heart disease would drop by 6%. There would be 8% fewer heart attacks, and 3% fewer deaths. These benefits would be even more profound for specific groups like African-Americans, whose blood pressure can be more sensitive to salt.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
*Tune in tomorrow for PART III OF IV SODIUM AND HIGH BLOOD PRESSURE
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Showing posts with label cardiac. Show all posts
Showing posts with label cardiac. Show all posts
Thursday, August 20, 2009
Saturday, June 20, 2009
STUDY INDICATES HOSPITAL RAPID RESPONSE TEAMS MAY NOT PREVENT CARDIAC ARRESTS, DEATHS.
It’s been reported that, "Hospital rapid response teams, created to prevent cardiac arrest and deaths in critically ill patients, do not seem to work," according to a study published in the Dec. 3,2008 issue of the Journal of the American Medical Association. Normally, rapid response teams are "made up of doctors, nurses and respiratory therapists, whose primary role is to care for patients in the intensive care unit (ICU)." The teams may also "help evaluate patients who are not in the ICU."
For the study, investigators analyzed "the use of rapid-response teams consisting of intensive-care unit nurses and respiratory therapists at 404-bed St. Luke's Hospital of Kansas City (Mo.), and their association with lower hospitalwide cardiopulmonary arrest and hospital mortality rates,"
It is also noted that the study revealed a four percent decline in mortality rates "after rapid-response teams were introduced in late 2005," and a 33 percent decline in "mean rates for hospital-wide cardiopulmonary arrest codes." But, "after accounting for other changes occurring in the same time frame, including hospital quality-improvement programs and improved technologies, the adjusted odds ratio of 0.76 failed to reach statistical significance."
A rapid response team, also known as a medical emergency team, is a multidisciplinary team of intensive care unit (ICU) personnel charged with the evaluation, triage, and treatment of non-ICU patients with signs of clinical deterioration to reduce the rates of in-hospital cardiopulmonary arrests (codes) and their attendant morbidity and mortality. Several studies have shown that rates of non-ICU codes decrease after rapid response team implementation,7-11 but these studies, which have focused on cardiopulmonary arrests outside of the ICU, may lead to a favorable bias for rapid response teams because cardiac arrests that occurred after transferring patients with physiological decline to the ICU were not included.
In-hospital cardiac arrests are common and delays in treatment are associated with lower survival and worse neurological outcomes. Prior studies have reported that adult patients often exhibit physiological deterioration hours before cardiopulmonary arrest. As a result, the Institute for Healthcare Improvement recommended in their 100 000 Lives Campaign that hospitals implement rapid response teams as 1 of 6 strategies to reduce preventable in-hospital deaths. In response, hundreds of hospitals around the country have invested significant financial and personnel resources in implementing rapid response teams, despite the fact that limited published data support their
effectiveness.
The authors found no differences in length of hospital stay (ie, median exposure time to codes) was seen across the study years. We found that implementation of a rapid response team was not associated with lower hospital-wide code rates. Similarly, rapid response team intervention was not associated with improvements in the clinically meaningful outcome of hospital-wide mortality. Importantly, only a small percentage of deaths after rapid response team intervention and cardiopulmonary arrests were categorized as potential rapid response team undertreatment or underuse and would not have plausibly altered these findings. We believe that this study provides important new insights regarding the effectiveness and limitations of rapid response team intervention and raises critical questions about whether recommendations to disseminate rapid response teams nationally are warranted without a demonstrable mortality benefit.
Implementation of a rapid response team in the author’s tertiary care adult hospital was not associated with lower rates of either hospital-wide cardiopulmonary arrests or mortality.
Because of the lack of robust outcomes after the rapid response team intervention, well-designed multicenter adequately powered randomized controlled trials with sufficiently long follow-up should be considered to rigorously evaluate the efficacy of rapid response teams prior to endorsing their widespread implementation.
Paul S. Chan et al. Hospital-wide Code Rates and Mortality Before and After Implementation of a Rapid Response Team. JAMA. 2008;300(21):2506-2513.
For the study, investigators analyzed "the use of rapid-response teams consisting of intensive-care unit nurses and respiratory therapists at 404-bed St. Luke's Hospital of Kansas City (Mo.), and their association with lower hospitalwide cardiopulmonary arrest and hospital mortality rates,"
It is also noted that the study revealed a four percent decline in mortality rates "after rapid-response teams were introduced in late 2005," and a 33 percent decline in "mean rates for hospital-wide cardiopulmonary arrest codes." But, "after accounting for other changes occurring in the same time frame, including hospital quality-improvement programs and improved technologies, the adjusted odds ratio of 0.76 failed to reach statistical significance."
A rapid response team, also known as a medical emergency team, is a multidisciplinary team of intensive care unit (ICU) personnel charged with the evaluation, triage, and treatment of non-ICU patients with signs of clinical deterioration to reduce the rates of in-hospital cardiopulmonary arrests (codes) and their attendant morbidity and mortality. Several studies have shown that rates of non-ICU codes decrease after rapid response team implementation,7-11 but these studies, which have focused on cardiopulmonary arrests outside of the ICU, may lead to a favorable bias for rapid response teams because cardiac arrests that occurred after transferring patients with physiological decline to the ICU were not included.
In-hospital cardiac arrests are common and delays in treatment are associated with lower survival and worse neurological outcomes. Prior studies have reported that adult patients often exhibit physiological deterioration hours before cardiopulmonary arrest. As a result, the Institute for Healthcare Improvement recommended in their 100 000 Lives Campaign that hospitals implement rapid response teams as 1 of 6 strategies to reduce preventable in-hospital deaths. In response, hundreds of hospitals around the country have invested significant financial and personnel resources in implementing rapid response teams, despite the fact that limited published data support their
effectiveness.
The authors found no differences in length of hospital stay (ie, median exposure time to codes) was seen across the study years. We found that implementation of a rapid response team was not associated with lower hospital-wide code rates. Similarly, rapid response team intervention was not associated with improvements in the clinically meaningful outcome of hospital-wide mortality. Importantly, only a small percentage of deaths after rapid response team intervention and cardiopulmonary arrests were categorized as potential rapid response team undertreatment or underuse and would not have plausibly altered these findings. We believe that this study provides important new insights regarding the effectiveness and limitations of rapid response team intervention and raises critical questions about whether recommendations to disseminate rapid response teams nationally are warranted without a demonstrable mortality benefit.
Implementation of a rapid response team in the author’s tertiary care adult hospital was not associated with lower rates of either hospital-wide cardiopulmonary arrests or mortality.
Because of the lack of robust outcomes after the rapid response team intervention, well-designed multicenter adequately powered randomized controlled trials with sufficiently long follow-up should be considered to rigorously evaluate the efficacy of rapid response teams prior to endorsing their widespread implementation.
Paul S. Chan et al. Hospital-wide Code Rates and Mortality Before and After Implementation of a Rapid Response Team. JAMA. 2008;300(21):2506-2513.
Monday, May 18, 2009
Is it Heartburn or a Heart Attack?
Part I of II :GERD
The experts say “It doesn’t often begins as a sharp, burning sensation in the chest. Many times it seems either like a pressure or burning or indigestion in the chest.”
Is the pain heartburn, or might it be a heart attack?
It's often difficult for people to tell the difference. Complicating the issue is that some people with diagnosed heart disease will also have heartburn, Those are the patients who want to say, 'Oh, this is just heartburn' and not worry about it. If, however, you have any heart history, a cardiologist should be consulted.
But even people without known heart disease who have heartburn shouldn't always just pop an over-the-counter antacid either. Overreacting in seeking medical help is always better than under-reacting.
In the common variety heartburn, or GERD [ gastro-esophageal reflux disorder] stomach acid moves up into the esophagus and causes irritation. It might require a doctor's intervention, to rule out that what a person is feeling stems from heartburn and not heart problems, which can have similar symptoms.
So what's a person to do?
Pay attention to the pattern of heartburn. If people have heartburn on a regular basis after eating specific foods -- every time they eat a greasy pepperoni pizza or drink a large glass of orange juice, for instance -- the food is generally the origin of the symptoms. If, however, if they start having “heartburn” and have not eaten any of the food or drinks that previously triggered a heartburn episode. That would merit a call for medical help.
Pay attention to when the heartburn occurs. If the heartburn follows consumption of a specific food, it's probably run-of-the-mill heartburn, which when it becomes severe will need prompt medical attention.
See a doctor if heartburn is severe and begins to affect quality of life. A medical visit in such an instance, though, would not be as urgently needed as it would be for those with pain and swallowing problems along with heartburn.
If heartburn is a new experience, have it checked out asap. That needs to be evaluated pretty quickly because people with first-time heartburn and risk factors for heart disease -- including high blood pressure, high cholesterol, diabetes, a family history of heart problems and active cigarette smoking -- should seek prompt medical help.
Other “red flag” reasons to quickly talk to a doctor or go to the emergency room.
• If heartburn accompanies exercise or other exertion.
• If a severe episode of heartburn does not get better with antacids. Garden-variety heartburn should subside fairly quickly. An episode might last up to a few hours, and then disappear in varying lengths of time, depending on the type of remedy used to combat it. "If you take an antacid, their effect is usually immediate," "If you take an H-2 blocker [such as Zantac or Tagamet], it may be 30 minutes.
• If heartburn comes with other symptoms, such as shortness of breath or arm pain.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
The experts say “It doesn’t often begins as a sharp, burning sensation in the chest. Many times it seems either like a pressure or burning or indigestion in the chest.”
Is the pain heartburn, or might it be a heart attack?
It's often difficult for people to tell the difference. Complicating the issue is that some people with diagnosed heart disease will also have heartburn, Those are the patients who want to say, 'Oh, this is just heartburn' and not worry about it. If, however, you have any heart history, a cardiologist should be consulted.
But even people without known heart disease who have heartburn shouldn't always just pop an over-the-counter antacid either. Overreacting in seeking medical help is always better than under-reacting.
In the common variety heartburn, or GERD [ gastro-esophageal reflux disorder] stomach acid moves up into the esophagus and causes irritation. It might require a doctor's intervention, to rule out that what a person is feeling stems from heartburn and not heart problems, which can have similar symptoms.
So what's a person to do?
Pay attention to the pattern of heartburn. If people have heartburn on a regular basis after eating specific foods -- every time they eat a greasy pepperoni pizza or drink a large glass of orange juice, for instance -- the food is generally the origin of the symptoms. If, however, if they start having “heartburn” and have not eaten any of the food or drinks that previously triggered a heartburn episode. That would merit a call for medical help.
Pay attention to when the heartburn occurs. If the heartburn follows consumption of a specific food, it's probably run-of-the-mill heartburn, which when it becomes severe will need prompt medical attention.
See a doctor if heartburn is severe and begins to affect quality of life. A medical visit in such an instance, though, would not be as urgently needed as it would be for those with pain and swallowing problems along with heartburn.
If heartburn is a new experience, have it checked out asap. That needs to be evaluated pretty quickly because people with first-time heartburn and risk factors for heart disease -- including high blood pressure, high cholesterol, diabetes, a family history of heart problems and active cigarette smoking -- should seek prompt medical help.
Other “red flag” reasons to quickly talk to a doctor or go to the emergency room.
• If heartburn accompanies exercise or other exertion.
• If a severe episode of heartburn does not get better with antacids. Garden-variety heartburn should subside fairly quickly. An episode might last up to a few hours, and then disappear in varying lengths of time, depending on the type of remedy used to combat it. "If you take an antacid, their effect is usually immediate," "If you take an H-2 blocker [such as Zantac or Tagamet], it may be 30 minutes.
• If heartburn comes with other symptoms, such as shortness of breath or arm pain.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Thursday, April 23, 2009
WHAT DOES AN AIRLINE PASSENGER DO DURING A HEART ATTACK?
In-flight medical emergencies are increasing, and this is partly due to more people with medical conditions traveling by air. It is very important to note that unique environmental and physiological changes occur as a result of changes in pressure during routine commercial air travel. These changes can exacerbate preexisting medical conditions, such as cardiac and lung conditions.
Passengers should always notify a flight attendant whenever they are having a health problem. Although the flight crew has only very basic training on responding to medical emergencies, they have the ability to communicate via satellite phones to physicians on the ground, and several tele-medical companies routinely assist flight crews during in-flight medical emergencies by providing instructions on what to do. Many times there are medically trained fellow passengers who also readily volunteer to assist whenever the flight crew broadcasts a call for help.
All U.S–based commercial aircraft that carry more than 85 passengers, and most international air carriers, carry an automated external defibrillator, as well as both a basic and enhanced emergency medical kit. Only medical professionals or flight crew instructed by on-ground physicians are allowed access to the enhanced medical kit, which carries various emergency medications to deal with serious in–flight medical emergencies. The captain of the aircraft has the ultimate authority as to whether or not to divert the aircraft, but they tend to side with caution and what is in the best interest of the stricken passenger.
Individuals with any cardiac, lung or blood diseases, diabetes or cancer, as well as those who have undergone any surgery within a 14-day period prior to travel, must check with their doctor to make sure they are fit for air travel. As a rule of thumb ,one should be able to walk a distance of 150 feet and climb one flight of stairs without developing any chest pain or severe shortness of breath.
Passengers should always notify a flight attendant whenever they are having a health problem. Although the flight crew has only very basic training on responding to medical emergencies, they have the ability to communicate via satellite phones to physicians on the ground, and several tele-medical companies routinely assist flight crews during in-flight medical emergencies by providing instructions on what to do. Many times there are medically trained fellow passengers who also readily volunteer to assist whenever the flight crew broadcasts a call for help.
All U.S–based commercial aircraft that carry more than 85 passengers, and most international air carriers, carry an automated external defibrillator, as well as both a basic and enhanced emergency medical kit. Only medical professionals or flight crew instructed by on-ground physicians are allowed access to the enhanced medical kit, which carries various emergency medications to deal with serious in–flight medical emergencies. The captain of the aircraft has the ultimate authority as to whether or not to divert the aircraft, but they tend to side with caution and what is in the best interest of the stricken passenger.
Individuals with any cardiac, lung or blood diseases, diabetes or cancer, as well as those who have undergone any surgery within a 14-day period prior to travel, must check with their doctor to make sure they are fit for air travel. As a rule of thumb ,one should be able to walk a distance of 150 feet and climb one flight of stairs without developing any chest pain or severe shortness of breath.
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