Madeeha Syed

Understand the intensity of a panic attack and explore its causes. Meri Sehat provides insights for navigating and managing panic attacks.

Understanding The Intensity Of A Panic Attack And Its Causes

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

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Ismail Munir

Help! I Think I’M Having An Angina Attack

Introduction

Angina, or chest pain, is not a disease but rather a sign of heart disease. There are different types of angina: stable, unstable, microvascular, and variant. 
&nbsp;

Whether we talk about the first wheel from 4000 B.C or the Roomba of the 21st century, all human inventions are focused on making our lives easier. As inventors, we tend to create things that can help us do the same work more efficiently, and with less effort. Even something as simple as getting up to switch off the lights can now be done with a single tap on the phone, all from the comfort of your bed.&nbsp; 
&nbsp;

While the evolution of technology has significantly helped the field of transportation, medicine, communication, and business, it has also led to some &#39;bad&#39; behaviours in society. Over the years, there has been a marked increase in sedentary behavior among children, teens, and adults. The reduction in physical activity, coupled with poor lifestyle choices, has led to an obesity epidemic worldwide, even in low- and middle-income countries<a href="#accordion">[1]</a>. Obesity not only increases the risk of diabetes and hypertension but also cardiovascular diseases (CVDs) which are the leading cause of death globally. 
&nbsp;

In 2019, approximately 17.9 million people died due to CVDs; 85% of these deaths resulted from stroke and heart attack<a href="#accordion">[2]</a>. The Global Burden of Disease&nbsp; study in 2019 predicts that we will experience a further increase in the prevalence of CVDs because of the increasing population and rising obesity<a href="#accordion">[2]</a>. With this rise, it will be no surprise to see more and more people complaining of <a href="https://www.merisehat.pk/disease/angina">angina</a>, one of the most common clinical symptoms of coronary artery disease (CAD). As per a Lancet study, in 2010, more than 100 million people worldwide suffered from angina<a href="#accordion">[3]</a>.

&nbsp;

Angina, or chest pain, is not a disease but rather a sign of heart disease. There are different types of angina: stable, unstable, microvascular, and variant. Unstable angina is a medical emergency as it increases the risk of a heart attack. 
&nbsp;

Atherosclerotic changes in the coronary arteries result in hardening and narrowing of the vessels. The reduced blood supply is unable to meet the increased oxygen demand of the heart muscles. As a result, the cardiac muscles face an oxygen shortage and myocardial ischemia occurs. Physical exertion, smoking, stress, and exposure to cold can trigger angina by causing vasoconstriction and reducing blood supply to the muscles.&nbsp; 
&nbsp;

The chest pain in angina is often described as pressure, discomfort, heaviness, or tightness in the chest. This discomfort can also travel to the jaw, neck, shoulders, arms, and back. Moreover, the chest pain typically lasts 1-5 minutes and is relieved by rest or nitroglycerin pills. Other than chest pain, people with angina may also complain of: 
&nbsp;

<ul>
	<li>shortness of breath</li>
	<li>anxiety</li>
	<li>sudden and extreme tiredness</li>
	<li>nausea and vomiting</li>
	<li>light-headedness or fainting</li>
	<li>sweating</li>
	<li>cold, clammy skin</li>
</ul>

&nbsp;

Understanding first aid measures for an angina attack

If you see someone having angina, follow the following steps: 
&nbsp;

<h5>1.Help the patient rest</h5>

Ask the person to stop what they are doing and make them sit in a comfortable position. A half-sitting position with the back and head supported is mostly preferred. Use a cushion to support the head. If there are no chairs or cushions available, the person can sit on the floor and lean their head against a wall. Or you can kneel behind them and support their head with your hands or arms.&nbsp;

&nbsp;

<h5>2. Give medication</h5>

If the patient has their angina medication like a sublingual nitroglycerin pill or spray, then ask them to take it as instructed by their doctor. Help the person take the medication if they are unable to do so themselves. These medications relax and widen the blood vessels. Thus, improving blood flow to the heart and providing pain relief.&nbsp; 
&nbsp;

Another dose can be taken if the pain lasts longer than 5 minutes. Assess the patient for a further 5 minutes and if the second dose also fails to relieve their pain, then take them to the hospital immediately. Moreover, people experiencing angina for the first time might not have any medications and should immediately be taken to the hospital.&nbsp;

&nbsp;

<h5>3. Calm the patient down</h5>

Stress and anxiety can worsen the pain and lead to complications. Therefore, it is important to keep the patient calm. Furthermore, open shirt buttons and loosen any tight clothing to help the person breathe better. Ask the person to take slow, deep breaths through the nose and exhale slowly through the mouth.&nbsp;

&nbsp;

<h5>4. Assess the patient</h5>

If the pain is relieved within 15 minutes of resting or taking medication, the person should be able to return to what they were doing, provided it&rsquo;s not strenuous.&nbsp;

It is important to assess the patient&#39;s breathing and circulation. In case of sudden collapse, immediately start CPR and call for an ambulance.&nbsp;

&nbsp;

<h5>5. Call the ambulance</h5>

If the pain returns, worsens or lasts for more than 15 minutes despite rest and medication, then you should call an ambulance.&nbsp; 
&nbsp;

Following are the emergency/ambulance number for the various provinces in Pakistan: 
&nbsp;

<ul>
	<li>Sindh - 115 (Edhi ambulance), 1020 (Chhipa), +92 (21) 1021 (Aman Foundation)</li>
	<li>Punjab - 115 (Ambulance)&nbsp;</li>
	<li>Khyber Pakhtunkhwa (KPK) - 091-2590846 (Emergency ambulance), 091-2214575 (Edhi ambulance), 091-2210836 (Red Crescent ambulance)</li>
	<li>Baluchistan&nbsp;- 1122 (Medical Emergency Response Centers) 
	&nbsp;</li>
</ul>

<ul>
	<li>Never leave a person having chest pain alone.&nbsp;</li>
	<li>Avoid giving any food, fluids, cigarette, coffee, or tea.</li>
	<li>Do not make the person walk or do any physical activity.</li>
	<li>Do not delay in calling for medical help.</li>
	<li>Do not wait for the symptoms to go away.</li>
	<li>Never transport a patient with chest pain in a car as it can cause additional exertion to the heart and worsen their condition.&nbsp;</li>
</ul>

&nbsp;

<h4>"All that chest pain can increase blood pressure. Check yours today with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

Angina is not a heart attack, but unstable angina can increase one&#39;s risk of a heart attack. Therefore, if someone is having angina, it is important to look out for the following warning signs: 
&nbsp;

<ul>
	<li>A heaviness, discomfort, or squeezing pressure in the chest, or below the sternum (breastbone)</li>
	<li>The pain may radiate to the jaw, neck, arm, or back</li>
	<li>Sweating</li>
	<li>Nausea or vomiting</li>
	<li>Dizziness</li>
	<li>Shortness of breath</li>
	<li>Weakness</li>
	<li>A rapid or irregular heartbeat</li>
	<li>Chest pain typically lasts longer than 5 minutes 
	&nbsp;</li>
</ul>

Unlike angina, symptoms of a heart attack are not relieved by rest or medications and can last for 30 minutes or longer. If a heart attack is suspected, take the person to the hospital immediately. Moreover, the person can be given 250mg of aspirin to chew while they wait for the ambulance. Before administering aspirin, make sure the person is not allergic to the medicine or suffers from any bleeding disorder. 
&nbsp;

Conclusion

In women, angina often presents with non-specific symptoms such as abdominal pain, stabbing chest pain instead of pressure, and discomfort in the teeth, jaw, and back. Moreover, chest pain, in both genders, can result from a variety of conditions. These include gastroesophageal reflux disease (GERD), indigestion, stomach ulcers, pneumonia, emotional stress, pulmonary embolism, and several more. However, it is not easy to determine the exact cause. Therefore, it is always best to contact an emergency healthcare service if you have unexplained chest pain. 
&nbsp;

Although angina is not a life-threatening condition, it can increase the risk of myocardial infarction (MI). Therefore, it is important to practice healthy lifestyle modifications, stay compliant with medications, and avoid risk factors associated with angina. Maintaining a healthy weight, quitting smoking, keeping blood glucose levels within range, exercising regularly, and eating a healthy diet can prevent angina and complications.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Angina is a sign of heart disease and typically results from atherosclerotic changes in the coronary arteries. The chest pain can radiate to the jaw, neck, shoulders, arm, and back. It is often described as a heaviness, tightness, pressure, discomfort, or squeezing in the chest.&nbsp;</li>
	<li>If someone is having angina, you can help them by placing them in a comfortable position and calming them down. A semi-seated position is preferred. Moreover, patients can be administered medications such as sublingual nitroglycerin pills or sprays.&nbsp;</li>
	<li>If the chest pain is not relieved from rest or medications, recurs, worsens, or lasts longer than 15 minutes, it is important to seek emergency medical care.</li>
	<li>Unstable angina can increase one&#39;s risk of a heart attack. Therefore, always look out for warning signs in someone suffering from angina. These include sweating, nausea, vomiting, shortness of breath, rapid or irregular heartbeat, light-headedness, or pain in the jaw, neck, arm, shoulder, or back.</li>
	<li>These emergency/ambulance number for the various provinces in Pakistan:</li>
</ul>

1.&nbsp;Sindh - 115 (Edhi ambulance), 1020 (Chhipa), +92 (21) 1021 (Aman Foundation)

2.&nbsp;Punjab - 115 (Ambulance)&nbsp;

3.&nbsp;Khyber Pakhtunkhwa (KPK) - 091-2590846 (Emergency ambulance), 091-2214575 (Edhi ambulance), 091-2210836 (Red Crescent ambulance)

4.&nbsp;Baluchistan - 1122 (Medical Emergency Response Centers)

&nbsp;

[1].Roth, G. A. et al., 2020. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), pp. 2982-3021.

[2].World Health Organization, 2021. Cardiovascular diseases.

[3].Vos, T. et al., 2012. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859).

Nimrah H. Sattar

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

A Guide To CPR

CPR or Cardiopulmonary resuscitation is a lifesaving technique that aims to keep the blood flowing when the heart ceases to beat.

&nbsp;

The heart usually stops functioning due to an electrical disturbance during a cardiac arrest. CPR has a pivotal role in managing a patient who has collapsed due to cardiac arrest. 
&nbsp;

Understanding How To Perform CPR

A cardiac arrest is different from a heart attack. So, what is the difference between the two?

&nbsp;

Well, heart attack refers to the disruption in blood supply to the heart due to a blockage in the vessel(s) that nourishes the heart muscles.

&nbsp;

In a heart attack, the person is mostly conscious, whereas in a cardiac arrest, the person suddenly collapses due to disturbance in the electrical conductivity of the heart due to which the heart comes to a standstill. Heart attack can progress to cardiac arrest in the absence of timely intervention.

&nbsp;

According to the American Health Association, CPR can double or even triple the chances of survival, if performed immediately after cardiac arrest<a href="#accordion">[1]</a>.

&nbsp;

The primary goal of CPR is to keep the blood flowing to the vital organs until medical professionals are available to intervene. Therefore, it is vital to learn this lifesaving technique to help someone in an emergency<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Yes, anyone can perform CPR since it is basically the delivery of compressions to the chest. It doesn&rsquo;t matter whether you&#39;re a bystander or a trained first responder, you can deliver CPR in either case.

&nbsp;

However, the protocol of performing CPR differs for trained and untrained individuals (see below).

&nbsp;

A recent study shows that even children can perform CPR. The study was conducted on 6th-graders and it was tested if they can do hands-only CPR. The results revealed that these children can actually give adequate compressions with the correct rate. This makes children a valuable group to deliver CPR in emergency situations.

&nbsp;

The American Health Association is currently working on training young individuals to become a viable group for the community<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

Before starting CPR, check the following things<a href="#accordion">[3]</a>:&nbsp;

<ul>
	<li>Make sure that the environment is safe for the person.</li>
	<li>Check if the person is conscious or unconscious. </li>
	<li>If the person appears unconscious, call them loudly asking if they are okay or tap on their shoulder.</li>
	<li>Call an ambulance service or any local emergency service.</li>
	<li>Start doing CPR and continue doing it until emergency help arrives. 
	&nbsp;</li>
</ul>

There are 2 types of CPR<a href="#accordion">[1]</a>:

<ul>
	<li>
	Hands-only CPR&nbsp;
	</li>
	<li>
	Traditional CPR with rescue breaths&nbsp;
	</li>
</ul>

&nbsp;

Hands only CPR is used by individuals who are not trained or whose skills have become rusty due to lack of practice. These individuals can easily perform hands-only compressions that do not involve the delivery of rescue breaths.

&nbsp;

On the other hand, traditional CPR consists of 30 chest compressions followed by 2 rescue breaths. It is the right technique for individuals who are trained in CPR.&nbsp; 
&nbsp;

To perform a hands-only CPR on an adult, follow these steps<a href="#accordion">[4]</a>.

&nbsp;

Sit next to the person who has collapsed and place the lower part of your hand (the heel) on the breastbone, right at the center of the chest. Place the palm of your other hand over the hand already placed on the chest and interlock your fingers.

&nbsp;

Position yourself in such a way that your shoulders are directly above your hands. Your hands should be straight, being perpendicular to the chest or making a 90&deg; angle with the chest.

&nbsp;

Use your entire body weight to give compressions to the chest, each compression being 5-6cm (2-2.5 inches) deep.

&nbsp;

After 1 compression is delivered, release the compression while keeping your hand on the chest and allow the heart to recoil and return to its original position.

&nbsp;

Repeat these chest compressions at a rate of 100-120 in a minute and continue giving them until an ambulance arrives.&nbsp; 
&nbsp;

Following steps constitute a traditional CPR in an adult<a href="#accordion">[4]</a>:

<ul>
	<li>Sit beside the collapsed person and place the heel of your hand on the center of their chest. Place the palm of your other hand over the hand already placed over the chest and interlock your fingers.</li>
	<li>Deliver chest compressions and make sure that the compressions are 5-6cm (2-2.5 inches) deep and given at the rate of 100 to 120 compressions in a minute.</li>
	<li>After delivering 30 chest compressions, give 2 rescue breaths in every cycle.</li>
	<li>To deliver the rescue breaths, the airway of the patient should be maintained. Tilt the patient&rsquo;s head gently with one hand over the forehead of the person and use the other hand to lift the chin with 2 fingers.</li>
	<li>Pinch the nose of the person and bring your mouth over the person&#39;s mouth and blow in air for a period of about 1 second. Position your head in a way that you can check for the rise in their chest level and deliver 2 rescue breaths.</li>
	<li>Repeat the cycle by giving 30 chest compressions followed by 2 rescue breaths and keep doing it until the person regains consciousness or an ambulance arrives.&nbsp; 
	&nbsp;</li>
</ul>

Children are more likely to experience respiratory or airway problems rather than a cardiac arrest. If it&rsquo;s a cardiac arrest, they are likely to collapse, hence CPR with rescue breaths should always be prioritized for children<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<ul>
	<li>Open the airway of the child by tilting their head, placing one hand on the forehead and using the other to lift their chin with 2 fingers. </li>
	<li>Remember to remove any obstruction from the mouth if present.</li>
	<li>Pinch the nose of the child and place your mouth over their mouth. In this position, deliver 5 rescue breaths steadily. While blowing the air into the mouth also keep checking for their chest to rise.</li>
	<li>Place the heel of your 1 hand at the center of the child&rsquo;s chest and give compressions such that the chest goes down by 5 cm (2 inches). If you are not able to give effective compressions with 1 hand, use your other hand, too, to achieve the depth of 5 cm while giving compressions.</li>
	<li>After every 30 chest compressions, give 2 rescue breaths besides giving compressions at the rate of 100-120 in a minute.</li>
	<li>Repeat the cycle of 30 chest compressions and 2 rescue breaths until the child gains consciousness or emergency medical help arrives<a href="#accordion">[4]</a>.&nbsp; 
	&nbsp;</li>
</ul>

Tilt the head of the infant gently while lifting their chin. Remove any obstruction present in their mouth or nose.

&nbsp;

Place your mouth near the infant&#39;s mouth and blow air firmly into their mouth. Keep checking for the rise in their chest levels. Administer 5 rescue breaths to the infant initially.

&nbsp;

Place 2 fingers at the center of the infant&#39;s chest and compress their chest such that the chest goes down by 4 cm. It is imperative to ensure the quality of chest compressions and if you&#39;re unable to achieve it by 2 fingers, then use the heel of your hand to deliver chest compressions.

&nbsp;

After every 30-chest compression, give 2 rescue breaths. The rate of compressions should be 100-120 compressions in a minute. Continue this cycle until the infant regains consciousness or emergency help arrives<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

It is important to mention that with CPR administration, there is a possibility of a broken rib(s) but this occurrence is unlikely to happen in every case. Only 30% of individuals ended with broken ribs after surviving due to CPR. It is important to continue administering CPR, regardless of broken bones. 

&nbsp;

CPR is a lifesaving technique and considered a part of first aid. Everyone should learn how to perform effective CPR. Even if you are not trained to give CPR, it is better to intervene and try giving any compression instead of none. Any CPR is better than no CPR. So next time you see a person collapse, ensure the safety of that patient and get into action!&nbsp; 
&nbsp;

<ul>
	<li>Cardiopulmonary resuscitation or CPR is a lifesaving technique and a crucial part of<a href="https://merisehat.pk/article/first-aid-for-heat-stroke"> first aid</a>.</li>
	<li>Immediate CPR increases the chances of survival by two to three folds for a person who has had a cardiac arrest.&nbsp; </li>
	<li>CPR maintains the blood flow to the vital organs of the body.</li>
	<li>An ambulance should be called before starting CPR.</li>
	<li>Any individual whether trained or untrained can perform a CPR, the protocols however, vary for each category.</li>
	<li>Individuals who are trained and confident of their skills should perform traditional CPR which includes chest compressions and rescue breaths. </li>
	<li>However, individuals who aren&#39;t trained should perform hands-only CPR and shouldn&#39;t give rescue breaths.</li>
	<li>The method of giving CPR is slightly different in adults (use 2 hands), children over 1 year (use 1 hand), and in infants under 1 year of age (use 2 fingers). Details on each have been provided in this article. </li>
</ul>

&nbsp;

<ul>
	<li>CPR administration might lead to breaking a rib but that is a very unlikely occurrence, and it is important to continue administering CPR, regardless of broken bones.&nbsp;</li>
</ul>

[1] Hepler L. How to Perform CPR: Hands-Only and Mouth-to-Mouth. Healthline.

[2] What is CPR? American Heart Association.

[3] Cardiopulmonary resuscitation (CPR): First aid. Mayo Clinic.

[4] First aid - CPR. NHS UK.

Nawal Adnan

Is It A Heart Attack Or A Heart Failure? Know The Difference

<ul>
	<li>Over 2.3 million patients in Pakistan are treated every year in the whole system of the NICVD network free of cost<a href="#accordion">[1]</a>.</li>
	<li>Chest pain or difficulty breathing that lasts more than 10 minutes is an emergency. Call an ambulance or consult a doctor immediately<a href="#accordion">[2]</a>! 
	&nbsp;</li>
</ul>

Three things that are common to almost all desi households are the Angised tablet, disprin, and Deponit NTS skin patch. There&rsquo;s usually one person in the family with a heart condition. The good part is you&rsquo;re familiar with these products. The bad part is you lack a basic understanding of heart conditions, including heart attack and heart failure.

The terms are often used synonymously to refer to the same thing &ndash; chest pain. Suddenly, everyone is a doctor. Chest pain? Chew a disprin. Pain radiating down your left arm? Maybe an Angised tablet under the tongue or a patch to stick on the left side of your chest. 
&nbsp;

While these are good options, self-medication is NOT a good idea. It&rsquo;s better to understand why you need them in the first place. What is a heart attack? How is it different from heart failure? Why are these conditions on the rise? Read on to find out. 
&nbsp;

Your heart pumps blood in your body. If your heart is not functioning effectively, the cells in your body are deprived of essential nutrients and oxygen and die. This leads to serious heart diseases, including heart attack and heart failure.

Given that the symptoms of these conditions in real life are not exactly like what you see in the movies, it&rsquo;s no wonder that you may not take them seriously. It also doesn&rsquo;t help that these symptoms are so similar and only adds to the confusion. 
&nbsp;

However, incorrect or late diagnosis and treatment can prove fatal. According to the CDC, heart disease is the leading cause of death in the US, responsible for 1 in 5 deaths in 2021<a href="#accordion">[3]</a>.

Nearly 800,000 Americans have a heart attack annually, with 1 in 5 being silent, making them all the more dangerous<a href="#accordion">[3]</a>. The CDC also estimates that 6.2 million US adults have heart failure<a href="#accordion">[4]</a>. 
&nbsp;

But, according to a recent study, it&rsquo;s South Asian countries that account for nearly 60% of the global burden of heart disease, with an increased risk of heart failure at an earlier age than other ethnic groups<a href="#accordion">[5]</a>.

In Pakistan, 16.49% of all fatalities in 2020 were due to coronary heart disease. Individuals as young as 30-40 years are developing heart disease due to junk food consumption, sedentary lifestyle, excessive smoking, hypertension, and lack of sleep. Additionally, the heart attack ratio is higher in females in the country than in males due to underdiagnosis and under-treatment<a href="#accordion">[6]</a>. 
&nbsp;

Understanding Heart Attack and Heart Failure

Simply put, a heart attack means a sudden reduction or loss of blood supply to your heart. A heart attack may lead to heart failure. 
&nbsp;

<ol>
	<li>
	<h5>Causes Of Heart Attack</h5>
	</li>
</ol>

A heart attack is usually caused due to a blockage in blood vessels that prevent normal flow. 
&nbsp;

<ul>
	<li>Plaque buildup can narrow down or block the coronary arteries, also known as coronary artery disease.</li>
	<li>If there&rsquo;s a severe tightening in the coronary artery, it can cause a spasm and result in a heart attack.</li>
	<li>Another reason could be that your body&rsquo;s demands increase suddenly and your heart could not keep up with them.</li>
</ul>

When the blood flow isn&rsquo;t normal and your heart muscle is deprived of oxygen, it will start to deteriorate. 
&nbsp;

<ol start="2">
	<li>
	<h5>Symptoms Of Heart Attack</h5>
	</li>
</ol>

Symptoms include:

<ul>
	<li>Shortness of breath</li>
	<li>Chest pain or discomfort (can be mild or severe and may come and go or last for several minutes at a stretch)</li>
	<li>Cold sweat</li>
	<li>Upper body discomfort (in the jaw, neck, shoulders, arms, stomach, and back)</li>
	<li>Nausea or vomiting</li>
	<li>Fatigue</li>
	<li>Dizziness 
	&nbsp;</li>
</ul>

Women are more likely to have unexplained or unusual tiredness and nausea or vomiting during a heart attack. Men are more likely to have chest pain, which worsens during physical activity and improves during rest. Diabetics are less likely to have the typical symptoms of a heart attack and more of the other symptoms like lightheadedness<a href="#accordion">[7]</a>.

Symptoms of a heart attack vary from person to person, and even for the same person, they may be different for different episodes. Sometimes, an individual can have a silent heart attack. Then there will be no noticeable symptoms. At other times, it can be mistaken for toothache or indigestion when the person feels pain in these places instead of their chest. 
&nbsp;

Note: If you or someone you know is experiencing these symptoms, consult a doctor immediately! The longer you wait, the more your heart muscle will be damaged 
&nbsp;

<ol start="3">
	<li>
	<h5>Treatment Of Heart Attack</h5>
	</li>
</ol>

Early treatment can prevent or minimize damage to your heart muscle. Doctors usually prescribe aspirin, oxygen therapy, nitroglycerin, and beta-blockers before diagnosis. Once diagnosed, other interventions like coronary angioplasty are suggested<a href="#accordion">[4]</a>. 
&nbsp;

In contrast to a heart attack, heart failure means your heart is unable to pump blood efficiently around your body. It usually develops gradually. Sometimes, the onset can be sudden following a heart attack. 
&nbsp;

<ol>
	<li>
	<h5>Causes Of Heart Failure</h5>
	</li>
</ol>

A popular misconception is that by &lsquo;failure&rsquo; it means your heart has stopped. That is not true.

Heart failure arises if your heart is too weak to correctly pump blood or your heart is not filling with enough blood.

It is usually a complication of other medical issues (e.g., obesity and diabetes), an infection (e.g., HIV), illegal drug use, certain chemo medications, or an injury that causes your heart to overwork or damages it. 
&nbsp;

Unhealthy behaviors like eating foods high in cholesterol and sodium, smoking, drinking alcohol, and not getting enough physical activity also increase your risk of heart failure.

A major difference between heart attack and heart failure is that the latter can affect either the right and the left sides of your heart or both. That is, the right side which collects oxygen-low blood and pumps it out to your lungs to get oxygen is affected. Likewise, the left side which collects oxygen-rich blood and pumps it throughout your body is affected.

Often, it&rsquo;s the left side. This type of heart failure can be further divided into preserved ejection fraction (diastolic heart failure) and reduced ejection fraction (systolic heart failure). 
&nbsp;

Ejection fraction is how much blood your left ventricle is pumping out with each contraction.

<ul>
	<li>Diastolic Heart Failure &ndash; The heart muscle is stiff and unable to relax normally. The lower left chamber of the heart doesn&rsquo;t fill properly with blood during the resting period between each beat, reducing the amount of blood pumped out to the rest of the body. 
	It may occur because of obesity, high blood pressure, and diabetes. 
	&nbsp;</li>
	<li>Systolic Heart Failure &ndash; The heart muscle in the left ventricle is weak and unable to contract normally. The heart cannot pump with enough force to push required blood into circulation. 
	It may occur because of coronary artery disease, irregular heartbeat, genetic cardiomyopathy, acquired heart disease, faulty heart valves, alcohol, and toxins like meth or cocaine. 
	&nbsp;</li>
</ul>

It&rsquo;s important to note here that you can have a normal ejection fraction measurement (55-70%) and still experience heart failure, and you can have an unhealthy ejection fraction (41-49%) and not have heart failure. An ejection fraction of under 40% may indicate heart failure, but it can also be due to another heart condition like cardiomyopathy.

Right-sided heart failure usually happens when you have left-sided heart failure. When the left side weakens, the right side has to work harder. Other than that, chronic obtrusive pulmonary disorder, congenital heart conditions, and pulmonary embolism can also cause right-sided heart failure. 
&nbsp;

Biventricular heart failure means both sides of your heart are impacted by heart failure at the same time. 
&nbsp;

<ol start="2">
	<li>
	<h5>Symptoms Of Heart Failure</h5>
	</li>
</ol>

Symptoms usually depend on the type and severity of the condition, worsening as the heart grows weaker. A common symptom of both right and left-sided heart failure is shortness of breath during daily activities. 
&nbsp;

Generally, symptoms of right-sided heart failure include:

<ul>
	<li>Unexplained weight gain</li>
	<li>Swelling around the stomach, legs, or ankles</li>
	<li>Frequent urination, especially at night</li>
	<li>Loss of appetite</li>
	<li>Nausea</li>
	<li>Abdominal pain 
	&nbsp;</li>
</ul>

Generally, symptoms of left-sided heart failure include:

<ul>
	<li>Weakness</li>
	<li>Sleepiness</li>
	<li>Fatigue</li>
	<li>Difficulty breathing, especially when lying down</li>
	<li>Difficulty concentrating</li>
	<li>Difficulty sleeping in a flat position</li>
	<li>Bluish lips and fingers</li>
	<li>Coughing or wheezing 
	&nbsp;</li>
</ul>

Note: If you or someone you know is experiencing these symptoms, consult a doctor immediately! The longer you wait, the more your heart muscle will be damaged 
&nbsp;

<ol start="3">
	<li>
	<h5>Treatment Of Heart Failure</h5>
	</li>
</ol>

There is no cure for heart failure. Any treatment will aim to help alleviate symptoms and improve life expectancy. 
&nbsp;

It will depend on the type of heart failure but usually includes:

<ul>
	<li>Medications (e.g., ACE inhibitors, ARBs, beta-blockers, SGLT2 inhibitors, diuretics)</li>
	<li>Lifestyle Changes (e.g., regular physical activity, regular check-ups)</li>
	<li>Heart Transplants and other surgeries (in some cases) 
	&nbsp;</li>
</ul>

Note: Some medicines that can worsen your heart failure include Naproxen (Aleve and Naprosyn) and Ibuprofen (Advil and Motrin), tricyclics and SSRIs, and some antiarrhythmic medications, and calcium-channel blockers<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>Heart attack and heart failure are two different conditions. If left untreated, they can seriously affect your health.</li>
	<li>A partial or complete blockage of the coronary arteries can lead to a heart attack.</li>
	<li>Causes of heart attack include atherosclerosis and, in rare cases, spasms of the coronary arteries.</li>
	<li>Any condition that either forces your heart to work harder to pump blood or damages the muscular organ can lead to heart failure.</li>
	<li>Causes of heart failure include arrhythmias, coronary artery disease, damage from a previous heart attack, hypertension, heart valve disease, myocarditis, obesity, overactive/underactive thyroid, diabetes, and congenital heart conditions.</li>
	<li>Heart attack is characterized by chest pain, pain in the upper body (arms, jaw, neck, shoulders, and back), nausea or vomiting, shortness of breath, fatigue, cold sweats, and lightheadedness.</li>
	<li>Heart failure can be identified by shortness of breath, difficulty breathing, bluish lips or fingernails, trouble concentrating, cough, and not being able to sleep while lying flat. Other symptoms include loss of appetite, nausea, unexplained weight gain, abdominal pain, swelling in the abdomen or lower extremities, and frequent urination.</li>
	<li>Treatment for heart attack aims to restore blood flow and prevent additional damage with medications (e.g., blood thinners), coronary artery bypass surgery, and percutaneous coronary intervention.</li>
	<li>Treatment for heart failure aims to reduce the strain and manage the underlying health conditions with medications (e.g., diuretics), medical devices (e.g., pacemakers), and surgery (e.g., heart transplant).</li>
	<li>Keep your blood pressure, diabetes, and cholesterol under control. A heart-healthy lifestyle, including a healthy diet, stress management, regular exercise, and quitting smoking and drinking can help reduce the risk of heart attack as well as heart failure.</li>
	<li>DO NOT self-medicate. Take your medicines as directed by your doctor. 
	&nbsp;</li>
</ul>

[1] Azfar SM. NICVD. National Institute of Cardiovascular Diseases (NICVD) | National Institute of Cardiovascular Diseases (NICVD).

[2] Heart failure. Healthdirect.

[3] Heart disease facts. Centers for Disease Control and Prevention

[4] What is the difference between heart failure and a heart attack? Medical News Today

[5] The upcoming epidemic of heart failure in South Asia

[6] Hassan O. Heart attack cases in Pakistan: MMI. Memon Medical Institute Hospital

[7] Here are the major differences between a heart attack and heart failure. GoodRx

[8] Heart failure. JHM.

Shermeen Zuberi

Hypertension And Heart Attack

Your heart is responsible for pumping blood around your body. The pressure with which your blood pushes against the walls of the blood vessels continually changes. When your heart is relaxed, this pressure will be low. When your heart is squeezing the blood into arteries, this pressure will increase.

Your blood pressure reading is a measurement of the highest (systolic) and lowest (diastolic) recorded pressure. Normal blood pressure is less than 120/80 mmHg<a href="#accordion">[1]</a>. 
&nbsp;

High blood pressure or hypertension occurs when:

<ul>
	<li>Either the first number (systolic pressure) is above 140 mmHg</li>
	<li>Or the second number (diastolic pressure) is above 90 mmHg</li>
	<li>Or both 
	&nbsp;</li>
</ul>

Your blood pressure may vary at different times of the day depending on your activity and general health. Generally, high blood pressure is diagnosed if your readings on two separate days are higher than 140/90 mmHg.

It&rsquo;s important to monitor your blood pressure on a regular basis as high blood pressure can affect your blood flow to the organs. The higher the pressure, the greater the risk of complications. Often, it continues to damage the body quietly, without any symptoms. 
&nbsp;

Note: This limit (140/90 mmHg or higher) is based on 2003 guidelines. Some doctors diagnose high blood pressure when a patient consistently presents a reading of 130/80 mmHg or higher, as per the 2017 Guideline For The Prevention, Detection, Evaluation, And Management Of High Blood Pressure In Adults by the American College of Cardiology/American Heart Association<a href="#accordion">[1]</a>. 
&nbsp;

Understanding Hypertension and its risks

A heart attack occurs when the blood supply to your heart is blocked. The lack of oxygen causes the heart muscle to die. The longer the blood flow is blocked, the more damage it causes to your heart.

And where does hypertension fit in the picture? 
&nbsp;

A heart attack is basically a medical emergency due to high blood pressure. If your blood pressure is consistently high, you&rsquo;re at a higher risk of developing cardiovascular problems than those who don&rsquo;t.

<ul>
	<li>Additional Strain: Hypertension forces your heart to work harder to pump blood throughout your body. It weakens the heart muscle, contributing to the development of multiple heart-related conditions, including heart attack. 
	&nbsp;</li>
	<li>Atherosclerosis: Hypertension also causes the thickening of the walls of your blood vessels. The damage makes them more susceptible to blockages. A buildup of plaque (composed of cholesterol, fat, and other substances) in the artery causes the hardening or thickening of the arteries. This puts you at a higher risk of developing conditions like vascular dementia, kidney failure, heart attack, and stroke. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/aortic-aneurysm">Aneurysm</a>: The increased pressure of the blood causes a section of the artery wall to enlarge and bulge out. While aneurysms can develop in any artery, they usually develop in the aorta. 
	&nbsp;</li>
	<li>Coronary Thrombosis: When the plaque ruptures, it can cause blood clots to form and block the blood flow. If it blocks the coronary arteries, it can trigger a heart attack. 
	&nbsp;</li>
</ul>

A heart attack is a life-threatening emergency. While symptoms vary from person to person, common warning signs include:

<ul>
	<li>Unexplained shortness of breath, with or without chest discomfort</li>
	<li>Chest discomfort (angina)</li>
	<li>Pain and discomfort extending beyond the chest to one or both arms, neck, jaw, teeth, stomach, and back</li>
	<li>Nausea or vomiting</li>
	<li>Anxiety</li>
	<li>Lightheadedness</li>
	<li>Cold sweats</li>
	<li>Indigestion</li>
	<li>Unexplained fatigue</li>
	<li>Coughing or wheezing</li>
	<li>Swelling in hands or feet 
	&nbsp;</li>
</ul>

Note: Seek medical attention immediately if you or a loved one has any of these symptoms. 
&nbsp;

Not all people who have a heart attack will experience intense pressure or pain to think they&rsquo;re having an episode and show due concern. In fact, some people have no symptoms at all. According to the American Heart Association, silent heart attacks make up about 20% of all heart attacks<a href="#accordion">[5]</a>.

They&rsquo;re pretty much the same as a heart attack, i.e., the heart muscle is deprived of oxygen and nutrients due to blockage, causing the person to feel pressure or pain, except that this time the problem goes unnoticed. 
&nbsp;

A general feeling of unease, for instance, that causes sleep disturbance at night should not be overlooked. Similarly, pain in the arm or shoulder should not be mistaken for simply an orthopedic issue. Sometimes, a pacemaker can disguise a heart attack as chest pain as well.

Rule of the thumb here is to see if this pain can be manipulated in some way. For instance, do you feel better if you change your position? If you experienced discomfort while you were sitting in a chair, does getting up and walking around improve or aggravate it? 
&nbsp;

The earlier this condition is identified and targeted, the better. According to a study, a silent heart attack is connected to a greater risk of heart failure<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>Gender &ndash; Women have a greater risk because of high blood pressure during pregnancy, birth control pills containing estrogen, and depression. Women are thrice at risk of heart failure due to high blood pressure while men are twice as likely to get it<a href="#accordion">[3]</a>.</li>
	<li>Age &ndash; Men aged 45 or above and women aged 55 or above are at risk of having a high attack.</li>
	<li>Ethnicity &ndash; At least 3 out of 5 African American women have high blood pressure (&ge; 130/80 mmHg).</li>
	<li>Diet &ndash; Consuming more than the recommended amounts of salt and unhealthy fat raises blood pressure.</li>
	<li>Lifestyle &ndash; An unhealthy lifestyle choice, like not getting enough physical activity every day or smoking, also increases the risk of developing high blood pressure.</li>
	<li>Health &ndash; Certain health conditions, like obesity, sleep apnea, and diabetes, are major risk factors. A family history of heart disease may cause it, too. 
	&nbsp;</li>
</ul>

To reduce your risk of heart attack, you need to prevent and/or manage hypertension. This includes lifestyle changes mainly:

<ul>
	<li>Not smoking</li>
	<li>Relieve stress through meditation or yoga</li>
	<li>Quitting alcohol and smoking</li>
	<li>Maintaining a healthy weight</li>
	<li>Getting at least 30 minutes of physical activity every day</li>
	<li>Eating a healthy diet</li>
	<li>Monitoring cholesterol and diabetes closely and keeping their levels under control 
	&nbsp;</li>
</ul>

Your doctor may prescribe some medication (e.g., diuretics, vasodilators, beta-blockers, and calcium channel blockers) depending on your condition to help you control your blood pressure<a href="#accordion">[3]</a>. Do not change or stop medications without talking to your doctor. 
&nbsp;

Important!

All adults aged 18 and above should get their blood pressure checked every year. In case of the presence of risk factors, more frequent checkups may be needed<a href="#accordion">[2]</a>. 
&nbsp;

The global prevalence of hypertension is 26.4%. In particular, 1 in 3 US adults have hypertension with only 54% of these patients having adequate blood pressure control<a href="#accordion">[4]</a>. It requires constant surveillance to identify and slow the development of complications.

Always consult a healthcare professional if you think you have high blood pressure or a heart-related condition. They can recommend the appropriate preventive measures and treatment options to reduce your risk of heart attack. 
&nbsp;

[1] High blood pressure symptoms and causes. Centers for Disease Control and Prevention. May 18, 2021

[2] Hypertensive Heart Disease. Pennmedicine.

[3] Hypertensive heart disease: Symptoms, causes &amp; treatment. Cleveland Clinic.

[4] Tackling G, Borhade MB. Hypertensive Heart Disease.

[5] Nania R. How to recognize the signs of a silent heart attack. AARP.

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How To Manage Anxiety

Overview

Anxiety is the persistent feeling of dread and fear over future events. It also might happen when the person misconstrues a situation as being more negative or harmful than it really is, leading to them being constantly agitated and worried.&nbsp;This is what we call cognitive anxiety — where feelings are limited to a thought patterns and rumination. Once this starts manifesting physically, we call is somatic anxiety or somatisation. Some of the things the anxious individual might experience include muscle tension, stomach aches, chest pain, dizziness, headaches, insomnia, restlessness, muscle tension, nausea, vomiting, sweaty palms and difficulty focusing.&nbsp;Panic attacks are essentially a paroxysm of anxiety. The person experiences a sudden feeling of terror and stress. This is disproportionate to the situation at hand and some people even experience this while sleeping. People experiencing panic attacks report that it feels like having a heart attack. This makes sense since panic attacks are accompanied by a rapid heart rate, hyperventilation and severe, constricting chest pain.&nbsp;These feelings of overwhelm can happen for something as minor as public speaking or something as major as the death of a beloved pet.

Dealing Measures

Thanks to the world we currently inhabit, almost all of us have been through situations where we have experienced these feelings and symptoms. Most of the time we have no other option but to wait for them to pass. However, if you know that you are prone to such intense consternation and worry then it might help to have a toolbox of strategies you can employ to feel better. We can&rsquo;t completely eradicate these feelings, but we can definitely manage them.&nbsp;

Some of the ways you can go about this are as follows: 
&nbsp;

<ul>
	<li>Breathe Slowly: Taking a minute to take slow deep breaths helps calm down your entire body. A great method is to take a deep belly breath for four seconds, hold it in for seven seconds and slowly exhale over a period of eight seconds. Just a few of these breaths tend to make a considerable difference.&nbsp;&nbsp;</li>
</ul>

<ul>
	<li>Muscle Relaxation: Get yourself in a nice and quiet place and progressively tense and relax your muscles starting from your toes and ending at your face. This helps release the muscle tension that is accompanied by anxiety.</li>
</ul>

<ul>
	<li>Grounding: Since anxiety is usually due to apprehension about the future, it helps to root yourself in the present moment. One of the most effective ways to do this is to employ grounding techniques. This requires you to sit up straight wherever you are with your feet on the ground, now look around an acknowledge five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. It&rsquo;s also called the &lsquo;5-4-3-2-1 technique for anxiety&rsquo;.</li>
</ul>

<ul>
	<li>Improve Self-talk: A lot of the times the little voice in our head that talks to us isn&rsquo;t our own. We have internalised the voice of a parent or a caregiver we had gotten used to while growing up. Many of us haven&rsquo;t received the best of care in certain situations. Hence it helps to question what your brain is telling you about yourself in a certain situation. Working on the way you talk to yourself, being kind and compassionate and extending yourself the same grace that you do to others goes a long way. Similarly, you might be stuck in some negative thought patterns and might need to challenge those to arrive at better conclusions.&nbsp;</li>
</ul>

<ul>
	<li>Take Time Out To Worry: Many people who <a href="https://merisehat.pk/disease/anxiety">suffer from anxiety</a> are just taking time to prepare for all the possible outcomes in a situation, or that is what they tell themselves. If you&rsquo;re one of these people then it would be highly beneficial to allot yourself 10 minutes every few hours to sit and go over all your worries. This way you can get it out of the way instead of having your entire day be tinged with anxiety.&nbsp;</li>
</ul>

<ul>
	<li>Journal: This works on the same principle as above. Writing down your anxious thoughts and reasons behind them can help you externalise and understand them. This way you can not only gain control over them but also identify patterns. You can also chart out when your anxiety is at its worst and when you are having a calmer, more peaceful day.&nbsp;</li>
</ul>

<ul>
	<li>Identify Your Triggers: This doesn&rsquo;t just help you attain control of your emotions in the short term, it can also eventually be a long-term solution. Is it a certain situation? A person? A scent or even a song? Identifying what triggers you into feelings of overwhelm helps you reduce your exposure to it or eradicate it entirely. It can also help you assess what other strategies of stress management will work best on you.</li>
</ul>

<ul>
	<li>Aromatherapy: Certain scents have been identified as having a calming effect on the nerves. These could be lavender, chamomile, sandalwood, rosemary, jasmine etc. Surrounding yourself with these could effectively set your mind at ease. These could be used in the form of essential oils, candles, incense, air fresheners etc.&nbsp;</li>
</ul>

<ul>
	<li>Mild Physical Activity: A light brisk walk or some yoga can greatly improve your mood and ameliorate any negativity. It works to give your body a time out from stressful situations and then dissipate all the excess energy through gentle movement. 
	&nbsp;</li>
</ul>

Bottom Line

Some of these strategies might work for you and some might not. It&rsquo;s important to note that everyone is different hence everyone responds differently to these tactics. Trial and error will teach you a lot about what is effective in your case. However, if nothing is working out and your anxiety and panic attacks are having a tangible impact on your social, occupational and personal life then it&rsquo;s a sign to seek professional help.&nbsp;

It&rsquo;s important to note that there is no shame in experiencing psychological distress and seeking help doesn&rsquo;t make you weak. Men, especially, carry this shame around this but there&rsquo;s no need to do so anymore. The human body just requires maintenance and upkeep and we are all more than capable of taking care of ourselves and procuring help.&nbsp;

Dr. Safia Mehmood

A <a href="https://merisehat.pk/disease/panic-attack">panic attack </a>can be a terrifying and bewildering experience, leaving individuals feeling as though they are caught in a relentless storm of fear and discomfort. Understanding what a panic attack feels like is crucial to recognize the signs, provide support, and seek appropriate help. In this article, we explore the intricate nature of panic attacks, delving into the emotional and physical sensations that accompany them, as well as the underlying causes that trigger these distressing episodes. 
&nbsp;

Panic Attack and Its Causes

A panic attack is a sudden and intense surge of fear or anxiety that arises without warning and reaches its peak within minutes. These episodes are typically brief but can feel overwhelming and can occur repeatedly, creating a sense of fear about future attacks. Panic attacks can be symptomatic of panic disorder, a type of anxiety disorder, but can also occur in individuals with other anxiety conditions. 
&nbsp;

<ol>
	<li>Intense Fear And Dread: A panic attack is characterized by an overwhelming sense of fear and impending doom. Individuals may feel like they are in grave danger, even when there is no identifiable threat.</li>
	<li>Heart Palpitations And Chest Pain: Panic attacks often trigger a rapid and pounding heartbeat. Chest pain or discomfort is also common, which can mimic heart-related issues, causing additional distress.</li>
	<li>Shortness Of Breath And Hyperventilation: Breathing may become rapid and shallow, leading to a feeling of breathlessness and suffocation. This can further intensify feelings of anxiety and panic.</li>
	<li>Dizziness And Nausea: A panic attack can cause dizziness and lightheadedness, which may be accompanied by nausea or stomach discomfort.</li>
	<li>Sweating And Chills: Profuse sweating, even in a cool environment, is a common physical response during a panic attack. Conversely, some individuals may experience chills or shivering.</li>
	<li>Trembling And Shaking: Involuntary trembling or shaking of the hands, legs, or voice may occur during a panic attack due to the release of adrenaline.</li>
	<li>Numbness And Tingling: Some individuals may experience tingling sensations or numbness, often in the extremities, as a result of heightened arousal.</li>
	<li>Feeling Of Unreality Or Detachment: Panic attacks can lead to a sense of detachment from oneself or the surrounding environment, as if experiencing the world through a fog or a dream.</li>
	<li>Fear Of Losing Control Or Going Crazy: A common fear during panic attacks is losing control over one&#39;s thoughts, actions, or emotions, or the fear of going crazy.</li>
	<li>Fear Of Death: Many individuals experiencing a panic attack report fearing that they may die during the episode, even though panic attacks are not physically harmful. 
	&nbsp;</li>
</ol>

The exact causes of panic attacks are not fully understood, but they are believed to be a complex interplay of biological, psychological, and environmental factors. Some contributing factors include:

<ol>
	<li>Genetics: Family history of anxiety disorders or panic attacks may increase an individual&#39;s susceptibility to experiencing panic attacks.</li>
	<li>Brain Chemistry: Imbalances in neurotransmitters, such as serotonin and norepinephrine, which play a role in regulating mood and anxiety, may contribute to panic attacks.</li>
	<li>Stressful Life Events: Traumatic experiences or significant life changes can trigger heightened anxiety levels, leading to panic attacks.</li>
	<li>Phobias And Avoidance: Fear of certain situations or places, coupled with avoidance behaviors, can lead to the development of panic attacks.</li>
	<li>Sensitivity To Physical Sensations: Some individuals are more sensitive to bodily sensations, and when they experience physical symptoms of anxiety, it can escalate into a full-blown panic attack. 
	&nbsp;</li>
</ol>

Experiencing a panic attack can be an overwhelming and distressing ordeal. The physical and emotional symptoms can be all-consuming, leaving individuals feeling vulnerable and frightened. Recognizing the signs of a panic attack is essential for supporting those who are affected and encouraging them to seek appropriate help. With the right guidance, coping strategies, and, if necessary, professional treatment, individuals can learn to navigate the storm of panic attacks and find a path towards healing and emotional resilience.