Cardiologic Tracings: AT HEART

Readers might like to start off by reading about a particular group of heart disorders known as the cardiac arrhythmias. You can review that collection (syncopated verses about cardiac arrhythmias) by clicking HERE.

CURRENT CONTENTS

Arteriopath

Bypass Grafts

Dipyridamole stress

Dobutamine stress

Ejection fraction

Hyperlipidemia

Hypertension
Myocardial ischemia

Authors' Note: Statins are drugs in frequent use for patients with arterial disease that reduce the body's manufacture of cholesterol. A small proportion of patients are intolerant of this class of oral medication, most commonly due to muscle cramps.

The most common site of symptomatic arterial blockage is the coronary arteries, which provide nutrient blood flow to the heart muscle. Surgical bypass grafting of multiple sites of obstruction is a common treatment for this disease. Following such surgery, patients such as Jack need to remain attentive to risk factors including dietary fats.

Authors' Note: 

 (dye-puh-RIH-duh-mawl)

(Puhr-SANT-in)

Tests of myocardial flow in the Nuclear laboratory, e.g. gated SPECT, require a stimulus so that the specific radiotracer can be injected at peak blood flow to image the state of heart muscle. Ideally, exercise stress, as with a submaximal treadmill procedure, provides this stimulus, with a high attained heart rate reflecting success. As a backup in those unable to exercise sufficiently, (musculoskeletal or breathing problems, reduced fitness), pharmacologic stress may be used. Dipyridamole, tradename Persantine, is a commonly used agent for this purpose, increasing blood flow optimally, but with little change in heart rate or blood pressure. 

Authors' Note:   The verse above is a companion verse to ”dipyridamole”. 

When doctors want to check whether all areas of heart muscle can increase their blood flow appropriately, they may use certain drugs as helpers; this is particularly true when the patient is unable to perform a submaximal exercise test, often called a Bruce treadmill test, after its inventor. Dobutamine (doh-BYOO-ta-meen), relative of adrenaline, raises heart rate and blood pressure. It's the only drug available for tests which use echocardiography to picture the heart while it is 'under stress', but is a second-choice drug for the nuclear imaging test called gated SPECT. The preferred drug for those tests is one whose primary effect is to dilate arterial blood vessels, increasing the flow to normal heart muscle. Such drugs include dipyridamole and adenosine.

Authors' Note:  In disease states, including those producing congestive heart failure, the ejection fraction of the left ventricle, a measure indicating the strength of contraction, provides important information concerning prognosis (potential outcome) and the need for treatment. 

   The ejection fraction can be measured by echocardiography, magnetic resonance imaging, or several different nuclear (radio-isotope) techniques. These techniques measure the volume of the ventricle at the end of diastolic (relaxation) and systolic (contraction) phases of the cardiac cycle. Despite the name, the change during systole is generally given in medical jargon as the percent relative change, rather than as a true fraction; e.g. 60% is good, 30% is bad.

Authors' Note: Jealousy at the flight of birds has apparently resulted in expressions suggesting that human social responsibility is analogous to having one's wings clipped, or flying straight, as here.

Hyperlipemia (also known in America as hyperlipidemia), is a medical condition in which high blood levels of fats (lipids), particularly cholesterol, portend cardiac disease, including deadly heart attacks. Hyperlipemia is one of a number of such asymptomatic risk factors including hypertension and diabetes. Fortunately, change in lifestyle including diet and exercise, and judicious prescription of pharmaceutical drugs, such as statins, can reduce risk.

 Authors' Note: High blood pressure, or hypertension, a chronic condition generally of unknown cause, is one of the major cardiovascular risk factors playing a role in the development of adult heart disease. It is also of particular importance in the causation of stroke, accounting for up to 50% of the risk for that condition. 

Authors' Note: There is variability in patients' response to the development of blockages in the coronary arteries. Part of this is due to the gradual development of collateral arteries or side branches, which may mitigate the effect of the obstructions to produce chronic symptoms or acute severe damage to heart muscle. The net impact on flow can be assessed through imaging showing blood flow to heart muscle at rest and stress, with nuclear or other studies of myocardial perfusion (‘gated SPECT’).

               

Here's a LIST OF LINKS to collections of intriguing poems (over 200 of these!) on medical/dental topics, updated to December 2024. 

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