A. JABBAR DENTAL CLINIC

Sadia Khan

Discover why leg blood pressure measurements are essential in some cases, and how they differ from arm readings. Learn more on Meri Sehat.

Why You Might Need Your Blood Pressure Taken In The Leg

Online Consultation

Ismail Munir

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

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

Madeeha Syed

Heart Health

Overview

Heart diseases are the number one cause of death in many countries.&nbsp;We all know someone in our circles who has or had a heart disease, or a really bad scare related to the condition of their heart. What has made this illness so serious and widespread?&nbsp;The answer is simple: our ‘modern’ lifestyle has made life more convenient, but in the process has also made us unhealthy.&nbsp;Heart issues were not as prevalent in previous generations due to those generations adopting a more active lifestyle. This, however, has been completely transformed in the new age of technology, digitisation and the ease with which we can access everything, including food, now.&nbsp; There’s still hope. We can live a modern lifestyle while also being healthy. Read on to find out how:&nbsp;

The Do's

<h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;"> </h4><h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;">Nutritional food and supplements:</h4> A well-balanced diet is going to be your friend in targeting all kinds of problems, but we know that that maintaining one, purely through food, is not always possible.&nbsp;So, the easiest thing that you can do is to opt for supplements to make up for the nutrients that do not make it to your diet in concentrations required by our body.&nbsp;A Dash (Dietary Approaches to Stop Hypertension) diet — one rich in potassium, calcium and magnesium — may just provide all the guidelines that you may need to create a heart-healthy nutritional plan. You will need to consume ample fruits, vegetables, whole grains, fat-free or low-fat dairy products, fish, poultry, beans and nuts — the latter in limited quantities.&nbsp; Even with a healthy diet, you need to monitor your intake, count your calories, macros and nutrients.&nbsp;

Daily exercise

<h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;">Daily Exercise:</h4> Exercise is the elixir of a healthy life. It can fix half of your potential health issues. Our bodies were created for work. This is the best kind of maintenance that your body can have. A good dose of physical activity not only gets your endorphins going but they also increase your stamina while improving your heart health and circulation.&nbsp;

Get enough sleep

<h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;">Get enough sleep: </h4> This seemingly simple aspect of life can be very complex. Good sleep is not just limited to the number of hours you are getting but has a lot more to do with your REM (Rapid eye movement) cycle. A good duration of the REM cycle leaves you waking up well-rested. Improper sleep increases your risk of developing high blood pressure, mental health issues, trouble losing weight, diabetes and may even risk heart attack.

Stop Smoking

<h5 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;"> </h5><h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;">Say goodbye to smoking: </h4> Smoking is one of the leading causes of increasing heart issues. This is because the particles that enter your system with the smoke that you inhale tend to build up and form plaque in your blood vessels that may eventually lead to its blockage. However, the damage is not only done to smokers but also to the people who hang around smokers. Second-hand smoke is just as much of a culprit for causing heart diseases.

Maintain your health

<h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;">Maintain your blood pressure and cholesterol levels:</h4> Certain levels of dietary restrictions will aid you in maintaining your blood pressure. This includes limiting your sodium intake. The maximum limit of sodium intake is 2,300mg (around one teaspoon) but an ideal amount for a lower sodium intake is an average of 1,500mg a day.Cholesterol is best targeted by reducing the intake of saturated fat in your diet and completely eradicating the consumption of trans fats. Saturated fats are mostly found in red meat and dairy products whereas trans fats are normally found in your vegetable oil, margarine or store-bought cookies. Another great way to control your cholesterol is through the intake of soluble fiber. It tends to reduce the absorption of cholesterol into your bloodstream.

Reduce Stress

<h4 style="line-height:1.2;margin-top:0pt;margin-bottom:10pt;">Reduce stress: </h4> Stress has been the underlying reason for causing and worsening of many diseases. Heart diseases are greatly affected by increased stress levels. This can be combatted by breathing practices, ensuring that your teeth stay unclenched, relaxing your muscles through stretching, massaging etc. Determining your triggers and eliminating them is a great long-term approach for reducing your stress levels.Your heart health is heavily dependent on you. The biggest choice that you have to make is if you would transform your lifestyle or let your cardiologist do it for you in the form of restrictions. Your current healthy lifestyle decisions will not only reflect well on your heart health but will also have a vital impact on your mental wellbeing.&nbsp;

user

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

This article or video has been viewed by many visitors, and is popular.

Don’t Lose Heart!

<a href="https://www.merisehat.pk/disease/coronary-artery-disease">Coronary Artery Disease (CAD)</a> is a leading cause of death globally. While there are some factors, such as family history, age and sex, that cannot be modified to prevent heart diseases, many lifestyle changes can decrease your risk of heart disease.

&nbsp;

Understanding measures for better cardiac health

The chemicals in tobacco can often cause irreversible damage to the heart and blood vessels. In addition, because of the damaged vessels, your heart will work harder to supply oxygen to the body and brain, causing an increase in blood pressure and heart rate. However, the good news is that the risk of heart disease starts to drop a day after quitting. Moreover, the risk of heart disease drops to almost half, a year after quitting cigarettes.

A healthy diet is low-fat, high in fiber, and includes plenty of fish, fresh fruits, vegetables, and whole grains. Also, limit the amount of salt you are eating in a day to no more than 6g, which is about a teaspoonful. Too much salt in your diet can cause an unhealthy spike in blood pressure.

There are 2 types of fats: saturated and unsaturated. Avoid foods with saturated fats since they increase the levels of bad cholesterol in your blood.

Below is a list of foods that are high in saturated fats:&nbsp;

<ul>
	<li>Fatty-cut meat&nbsp;</li>
	<li>Butter&nbsp;</li>
	<li>Ghee&nbsp;</li>
	<li>Cream&nbsp;</li>
	<li>Cheese&nbsp;</li>
	<li>Biscuits and cakes&nbsp;</li>
</ul>

A balanced diet should include unsaturated fats since they increase the levels of good cholesterol in your blood, and reduce any blockages in the arteries. Below is a list of foods high in unsaturated fats:&nbsp;

<ul>
	<li>Oily fish&nbsp;</li>
	<li>Avocados&nbsp;</li>
	<li>Sunflower, vegetable, and olive oils&nbsp;</li>
	<li>Nuts&nbsp;</li>
</ul>

You should also eliminate sugar from your diet and have carbohydrates in moderation, as this puts you at a higher risk of developing diabetes. Furthermore, this has proven to increase your risk of developing heart disease.&nbsp;

&nbsp;

A healthy diet with regular exercise is the best way to reduce your chances of developing high blood pressure. Regularly exercise will lower your cholesterol and make your heart and blood circulatory system more efficient. Exercise will also keep your blood pressure at healthy levels.&nbsp;Exercising regularly reduces your risk of heart attacks because, like any other muscle, the heart muscle will also benefit from exercise. A strong heart will be able to pump blood around your body without much effort. Aerobic exercises, for example, walking, dancing, and swimming will also help keep your heart healthy. However, if you’ve not been active for a while, slowly work your way up from moderate-intensity to high-intensity exercises. You can start with:&nbsp;<ul><li>Regularly walking at a brisk pace, or 150 minutes of aerobic exercises every day.&nbsp;</li><li>75 minutes of more strenuous aerobic activity, for example, running.&nbsp;</li><li>You can also sign up for strength training sessions once a week.</li></ul>

Being overweight increases the risk of developing heart disease, high blood pressure, type 2 diabetes, and high cholesterol. A body mass index (BMI) of 25 or higher is overweight. Moreover, unhealthy weight gain is also associated with higher blood pressure and high cholesterol which increases the risk of heart disease and stroke. Excess weight around the middle of the body also increases the chances of developing heart disease.&nbsp;

However, a mere reduction in your weight by 3% to 5% can be beneficial in decreasing certain fats in the blood, lowering blood glucose, lowering blood cholesterol, and reducing the risk of diabetes type 2.&nbsp;

&nbsp;

People who don’t get enough sleep are at a higher risk of developing obesity, depression, diabetes, high blood pressure, and heart disease. Thus, make sleep a priority. You need to set a sleep schedule and prioritise it by going to bed and waking up at the same time every day. Keeping your bedroom dark and quiet will also help you get a good night’s sleep.

Some people tend to manage stress with unhealthy habits, such as drinking or smoking, and overeating. The key is to look for alternative ways to manage stress. For example, meditation, relaxation exercises, and physical activities are great ways to manage stress and improve your overall health.&nbsp; 
&nbsp;

<ul>
	<li>Coronary artery disease is a leading cause of death globally, and while there are some factors such as family history, age and sex that cannot be modified to prevent heart diseases, many lifestyle changes can decrease your risk of heart disease.&nbsp;</li>
	<li>Eating a healthy diet, regular physical activity, and managing stress can have a positive impact on your overall health.&nbsp;</li>
	<li>However, if you feel unwell after any physical activity, speak with your doctor and they will run some tests to rule out underlying health conditions.&nbsp;</li>
	<li>If you have a family history of heart diseases, you can always speak with your doctor about regular checkups to help pick on any health concerns early on.&nbsp;</li>
</ul>

&nbsp;

Staff Writer

Know Your Blood Pressure Numbers

Blood pressure refers to the force applied by the flowing blood against the walls of the body&#39;s arteries<a href="#accordion">[1]</a>.&nbsp;Not only does this force help supply organs with oxygen and nutrients but also white blood cells and antibodies for immunity, and hormones like insulin<a href="#accordion">[2]</a>. Moreover, along with transporting oxygen and nutrients, blood pressure also plays a role in removing harmful metabolic end products, including carbon dioxide and other toxins cleared from the liver and kidneys.&nbsp; 
&nbsp;

Understanding blood pressure readings

When blood pressure exceeds the normal range, it is called <a href="https://www.merisehat.pk/disease/hypertension-57">hypertension</a>. Blood pressure is composed of a pair of numbers. The first (systolic) number represents the blood vessels&#39; pressure when the heart contracts. The second (diastolic) number is associated with the pressure in the vessels when the heart rests in between the beats<a href="#accordion">[1]</a>.&nbsp;The combination of the two allows doctors and health professionals to gauge the overall well-being of an individual. 
&nbsp;

Mild and temporary fluctuations in blood pressure are normal and can be triggered due to a myriad of reasons. However, if an individual deviates from the normal range for a chronic period, then that may indicate a deeper and more complex medical condition, and should be further explored by a licensed practitioner. To analyze quantitively, blood pressure has been categorized into five categories<a href="#accordion">[3]</a>. 
&nbsp;

<h5>Normal Range</h5>

The first range of blood pressure is defined as the normal range and is expected from every healthy individual. Numbers under 120/80mmHg are viewed as normal<a href="#accordion">[4].</a>&nbsp;Activities that encourage and support the heart&rsquo;s rhythmic motions, such as a well-balanced healthy diet and physical activity can help maintain the blood pressure in the normal range<a href="#accordion">[4]</a>. 
&nbsp;

At birth, the blood pressure stays at 64/40mmHg and then rises to 120/80mmHg as one reaches adulthood<a href="#accordion">[3]</a>. Several factors, both natural and human-induced, can then cause the blood pressure to fluctuate. For example, checking the blood pressure after delivering a fervent speech or running a marathon will likely give a high reading. This is perfectly normal as the increased adrenaline levels cause the body to increase the blood pressure, and supply the heart with more oxygen for fight or flight events<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

<h5>Elevated Levels</h5>

This is a warning stage to alarm patients and usher them into hypertension treatment before it is exacerbated. Elevated levels are denoted by persistent high blood pressure readings. A doctor is likely to investigate for differential diagnosis if the systolic blood pressure is in the range of 120-129mmHg and the diastolic is less than 80mmHg<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Individuals who constantly have elevated levels of blood pressure are more vulnerable and at risk of developing various coronary diseases early in their life<a href="#accordion">[5]</a>. An aneurysm is an abnormal bulge in the blood vessel wall that can result from prolonged and unattended elevated levels of blood pressure. Elevated blood pressure levels also increase the risk of cardiovascular failure. Moreover, damage to the renal vessels can affect healthy kidney functioning. Since little veins in the eyes are particularly defenseless against harm, hypertension can also prompt vision issues and even visual impairment<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<h5>Hypertension Stage I</h5>

If not addressed, then elevated levels can deteriorate to advanced stages of hypertension. Stage 1 is defined by consistently high blood pressure levels of systolic 130-139mmHg and diastolic 80-89mmHg<a href="#accordion">[3]</a>. At this phase of hypertension, specialists endorse and stress a reconsideration of routine activities and life changes. They may also prescribe blood pressure medications based on the individual&#39;s risk of developing an atherosclerotic cardiovascular disease (ASCVD), such as a heart attack or a stroke<a href="#accordion">[3]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>Hypertension Stage II</h5>

If treatment for hypertension stage 1 does not prove to be successful, then the individual is likely to progress to hypertension stage 2. Hypertension stage 2 is defined as blood pressure readings of 140/90mmHg or higher<a href="#accordion">[3]</a>. At this stage, specialists will probably recommend lifestyle changes and alternatives to the previously prescribed blood pressure prescriptions While treating a patient with stage 2 hypertension, the clinician should decide on the proper blood pressure (BP) objective, select the underlying anti-hypertensive routine, and change that routine, as required, to accomplish the objective BP. Likewise, the clinician ought to think about the effect of the treatment routine on both the patient&#39;s consistency with treatment and long-term risk for cardiovascular disease (CVD)<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

If an individual has a history of high blood pressure, then they may be more likely to develop a hypertensive crisis. This phase of hypertension necessitates immediate and proper medical assistance. Therefore, it is important not to delay treatment. If during a routine blood pressure check, the readings out of nowhere surpass 180/120mmHg, try not to panic. Take a deep breath, wait for five minutes, and afterwards test the blood pressure once more. However, if the readings are bizarrely high twice in a row, immediately contact a hospital or a doctor<a href="#accordion">[3]</a>. Such high levels could indicate that the person is going through a hypertensive crisis.&nbsp; 
&nbsp;

Moreover, with the blood pressure reading being higher than 180/120mmHg the individual might witness other alarming and distressing symptoms. These suggest signs of conceivable organ harm<a href="#accordion">[7]</a>. They may range from chest pain to difficulty in breathing, body numbness and pain (especially in the back), visible change in vision, and communication problems. If these accompany the blood pressure readings, then an individual should not hesitate or wait for the shortness of breath to pass away, and immediately call for medical help<a href="#accordion">[7]</a>.

&nbsp;

<h4>"Stay on top of your blood pressure reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

To maintain the blood pressure (BP) goal according to the individual&rsquo;s age, health, and stage, the patient must regularly monitor their readings for comparison and to confirm if the advised treatment is leading to any progress or not. Realistically, it is neither economical nor feasible to expect an individual to travel great lengths, and pay hefty consultation fees for a quotidian blood pressure reading. Therefore, a doctor may suggest investing in a home blood pressure monitor. 
&nbsp;

A home blood pressure apparatus is a more accessible and economical alternative than rushing to the hospital each day. Moreover, a patient does not require a doctor&#39;s prescription to purchase one. Thus, increasing its prevalence in every home. However, it should be stated that home blood pressure observation is not a substitute for visits to the primary care physician for more serious concerns and complications that might arise due to hypertension. Additionally, home blood pressure apparatuses might have a few shortcomings of their own<a href="#accordion">[7].</a> However, these can be avoided if the individual makes an informed purchase.&nbsp; 
&nbsp;

Don&#39;t hesitate to venture onto the world wide web and gather all necessary specifications before buying a home blood pressure monitor. You can even bother a doctor for suggestions for a reliable and approved gadget. Make sure to be diligent with the yearly check-ups of the apparatus. For the inauguration, bring it to the doctor&#39;s office and request a doctor or nursing staff to teach you the proper method of checking blood pressure at home. This will help guarantee correct readings<a href="#accordion">[7]</a>.&nbsp;

&nbsp;

Hypertension is a gateway to permanent damage and life-long complications. Therefore, it is important to understand the different stages of high blood pressure and the method to monitor it. The predominance of hypertension with increasing age is a result of the gradual rise in systolic blood pressure. 
&nbsp;

Systolic hypertension is the most common type of hypertension in people older than 50 years and reflects the pathologic decline in the blood vessel and arterial compliance<a href="#accordion">[6]</a>. The increase in systolic blood pressure is a more significant risk factor for cardiovascular disease than diastolic blood pressure rise. However, both should be regulated through prescribed treatments and lifestyle changes.

&nbsp;

While hypertension covers a range of sub-topics, it is important to remember that: 
&nbsp;

<ul>
	<li>Hypertension results from the normal blood pressure rising consistently. Blood pressure is measured through a pair of readings: systolic and diastolic.</li>
	<li>Systolic blood pressure results from the heart contracting, while diastolic pressure develops when the heart relaxes.</li>
	<li>The normal range of blood pressure is less than 120mmHg for systolic, and less than 80mmHg for diastolic.</li>
	<li>Elevated levels are defined as a systolic reading of 120-129mmHg and diastolic pressures of less than 80mmHg.</li>
	<li>Hypertension Stage 1 has blood pressure readings of 130-139mmHg and 80-89mmHg for systolic and diastolic respectively.&nbsp;</li>
	<li>Hypertension Stage 2 has blood pressure readings of 140mmHg or higher for systolic and 90mmHg or higher for diastolic.&nbsp;</li>
	<li>During a hypertensive crisis, systolic readings soar above 180mmHg while diastolic readings are higher than 120mmHg. This requires immediate medical attention.</li>
</ul>

&nbsp;

[1].World Health Organization (WHO). (2021, August 25). Hypertension. Retrieved from World Health Organization (WHO)

[2].Weatherspoon, D. (2022, March 20). What is a normal blood pressure reading? Retrieved from Medical News Today:

[3].American Heart Association. (2022). Understanding Blood Pressure Readings. Retrieved from American Heart Association:

[4].Jaret, P. (2021, September 17). High Blood Pressure. Retrieved from WebMD:

[5].Chobani, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., IzzoJr, J. L., . . . Rocella, E. J. (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, Vol. 42, No. 6, 1206-1252

[6].Giles, T. D., & Materson, B. J. (2005). Treating stage 2 hypertension. Journal of clinical hypertension (Greenwich, Conn.), 7(8), 464–470.

[7].Mayo Clinic. (2021, July 1). High blood pressure (hypertension). Retrieved from Mayo Clinic:

Zarlish Kazmi

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.

Humza Khizer

The Nation’s Stance Against TB

Pakistan, with around 510,000 new <a href="https://www.merisehat.pk/disease/tuberculosis">Tuberculosis (TB)</a> cases reported every year and around 15,000 transitioning to drug-resistant TB cases consistently, is positioned 5th among high-burden nations overall. It represents 61% of the TB burden in the WHO Eastern Mediterranean Region. The nation is assessed to have the 4th most elevated predominance of multidrug-resistant TB (MDR-TB) worldwide.&nbsp; 
&nbsp;

Key explanations behind the development of the medication-resistant types of TB range from untimely and late diagnosis; unadministered, improper, and insufficient medication regimens; poor development and absence of a social help program for high-risk populaces<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Understanding Pakistan's Fight Against TB

The Pakistan National Tuberculosis Program (NTP) has accomplished a momentous and consistent improvement in the staggering number of TB cases identified from 11,050 in 2000 to 248,115 in 2008. Likewise, treatment achievement rates recorded were an impressive 91% in 2007<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

This has been accomplished through robust responsibility and monetary contributions by the Government along with well-being advancement offered by supporters. 
&nbsp;

The World Health Organization (WHO) Directly Observed Treatment Short-course (DOTS) technique for TB was embraced and guided by Pakistan from 1995 onwards. However, significant advancement in TB control was accomplished after the recovery of the NTP in 2001 when TB had been proclaimed a public general health crisis through the Islamabad Declaration<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

The NTP operates under the Ministry of Health and is answerable for general coordination, strategy course, and specialized direction for TB control, while realistic execution is the obligation of the Provincial TB Programs (PTPs) and specialists within each region. The NTP focal unit connects elaborately with PTP chiefs and regional TB facilitators<a href="#accordion">[6]</a>. 
&nbsp;

The TB administrations are incorporated into the essential general medical care framework at the district level<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

A 2003 study led by the NTP and PTPs in Lahore and Rawalpindi locale saw that under 3% of general practitioners (GPs) were strictly abiding by the public rules for active contact tracing and the management of TB, while 90% of GPs were depending on chest radiography for confirmed diagnosis<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

Parastatal health administration&rsquo;s structure is one more place of entry outside the general medical care framework and NTP guidelines. In general, 32 government services and the federal bureau secretariat, with 208 independent (parastatal) bodies, give well-being administrations to 389,923 representatives and their dependents<a href="#accordion">[4]</a>. Excluding the Ministry of Defense, which has its own monetary cost for wellbeing administrations.&nbsp; 
&nbsp;

Lately, though, a high need has been given to creating practical organizations with medical care suppliers in the private domain, taking on a deliberate methodology following the WHO rules. Extra drives, like a better reconnaissance and research center organization, and improved follow-up and treatment modalities subsidized by international and public sources, have added to the huge improvement in recognition and treatment achievement rates framed previously.&nbsp; 
&nbsp;

The target of the survey was to feature the accomplishments of Pakistan&#39;s NTP throughout the last 10 years and to frame the exceptional needs and difficulties for what&#39;s to come. Moreover, the NTP has become more inclusive and has strived to work against discrimination of any sort while providing treatment and care for TB. This has been achieved by systematically drafting a communication manual through collaborative efforts to become more accessible to the people in Pakistan<a href="#accordion">[8]</a>.

&nbsp;

The PPM model was established to function through a typical and unanimous decision [memorandum of understanding, (MOU)] between the NTP (public arm) and the partaking wellbeing office proprietors (private arm) while adhering to the pertinent and important public TB rules<a href="#accordion">[13]</a>.&nbsp; 
&nbsp;

The NTP support component (material stockpile, monetary help, and specialized help) to the private supplier was, likewise, something very similar and uniformly disseminated in all TB offices working through the PPM model (PPM-1, 2, 3, and 4). It was provided by the Provincial TB control program (NTP provincial wing) via the area TB control program (NTP district wing) in all existing PPM approaches.&nbsp; 
&nbsp;

Nonetheless, the PPM enrolled cases were notified by private suppliers to the district TB control program (DTB), then to the Provincial TB control program (PTP), and lastly refreshed into the NTP data set. The four PPM approaches were following a specific arrangement of patient assessment, demonstrative diagnostics, and follow-up methods<a href="#accordion">[13]</a>. 
&nbsp;

First and foremost, the principal strength of the PPM mediation study (various methodologies of the customary PPM model) is that the data was gathered from regularly updated and revised program information, so the discoveries are theoretically going to mirror the program&#39;s real factors<a href="#accordion">[13]</a>. Second, the review and target population have an enormously appropriate sample size, which correspondingly allows the gauge to be a closer and more accurate representation of the truth. Third, the STROBE rules were adhered to for unparalleled concentration on the plan, procedure, and announcement of results which limits the gamble of systemic predispositions<a href="#accordion">[14]</a>. And fourth, the review gives proof and a graphic outline of all the TB case notifications (PPM and non-PPM) from all TB treatment offices accessible for 97% of Pakistani DOTS residents living in 4 regions in the review period<a href="#accordion">[13]</a>. 
&nbsp;

From the 4 PPM approaches (PPM-1, - 2, - 3, and&minus;4), increase in GP facilities ought to be centered more toward their PPM coverage result, as well as changing the PPM-1 procedure for consideration of GPs that are only practicing TB care in the private sector. On the other hand, NGO facilities should focus on an expansion in their PPM coverage, whereas private clinics should upgrade their PPM coverage proficiency, alongside broadening the treatment achievement rate up to 85%<a href="#accordion">[13]</a>.&nbsp; 
&nbsp;

However, changes in Parastatal offices cannot just be pointed toward redesigning the Parastatal commitment toward PPM TB case notification. They should also be working on their subsequent systems to prevent the default of Parastatal notified TB cases as well as holding the number of Parastatal offices offering TB administrations<a href="#accordion">[13]</a>. 
&nbsp;

The Integrated Health System Strengthening and Service Delivery (IHSS-SD) Activity is a United States Agency for International Development (USAID) subsidized drive in Pakistan. Integrated in 2018, it has been working intimately with the government and district well-being specialists to reform, change, and reinforce the well-being framework that has been implemented at the provincial level<a href="#accordion">[11]</a>. 
&nbsp;

The general objective of this specialized forum was to help the Provincial TB Control Programs in Sindh and Khyber Pakhtunkhwa in further developing the dynamic contact tracing of bacteriologic positive TB cases and decentralizing the administration of drug-resistant TB cases. 
&nbsp;

The definitive goals of this technical and international action were to accumulate sufficient proof for demonstrating the viability of active contact tracing and screening as a major strategy to work on the detection of bacteriologic positive instances of TB within the networks, and to improve the testing limit of the provincial TB programs. The program began on January 1, 2021, and finished on September 30, 2021<a href="#accordion">[11]</a>. 
&nbsp;

Diagnosing and proving the necessary care for TB cases in refugee camps and new settlements is a challenging task as many individuals are unregistered and undocumented. Besides, the societal stigma revolving around TB acts as a silent suppressor. Additionally, everyday environments, financial status, and restricted admittance to medical care are boundaries to TB services<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

There are a lot of instances where healthcare agents missed out TB among the refugees of Afghan populations in the three states covered by the Global Fund award.&nbsp; 
&nbsp;

Tracing TB cases and contact tracing is an effective way to stop the spread of the disease, including the epidemic of drug-resistant strains.&nbsp; 
&nbsp;

The Global Fund is a grant that functions under UNDP&#39;s attempts to reinforce joint effort and data sharing between Afghanistan, Iran, and Pakistan to guarantee quality care for patients who are relocating<a href="#accordion">[9]</a>. 
&nbsp;

UNDP introduced a cross-country computerized platform for recording and detailing TB cases among displaced people, returnees, and mobile communities. It was planned in association with public TB programs, the Global Fund, the United Nations High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM), and others.&nbsp; 
&nbsp;

The online application was created by Dure Tech and uses the WHO Prevent TB Digital Platform. It depends on open-source technology and incorporates a patient-focused module, as well as interoperability with well-being data frameworks. Hence, empowering the screening of TB patients across the continuum of medical services, transcending borders and nationalities<a href="#accordion">[9]</a>. 
&nbsp;

The PMDT model of care in Pakistan comprises 3 connected systems of hierarchies<a href="#accordion">[7]</a>. At the highest point of the order is a full-scale framework that could be referred to as the macro system, which contains the majority of global wellbeing organizations. These include the WHO and the Global Fund, which give direction and monetary help to the PMDT model of care. 
&nbsp;

At the national level, the public and provincial TB programs work collaboratively with the non-legislative associations forming a mesosystem that gets the necessary assistance from global offices, and subsequently interprets and adjusts rules for nearby settings and districts. Together, the two frameworks build a microsystem &mdash; i.e., the PMDT facilities, which work as per universally accepted norms of care and are rooted in a former, more extensive wellbeing system<a href="#accordion">[7]</a>.&nbsp; 
&nbsp;

The PMDT model focuses on materials. For example, foundation, medications, and quantities of individuals tested and screened. Initially, there wasn&rsquo;t much emphasis on developing competencies of the PMDT staff; hence, they were incapable of giving responsive care. 
&nbsp;

Later the PMDT staff suggested prioritizing medical services connected to responsiveness which, when implemented, proved to be fruitful for patients<a href="#accordion">[1]</a>.

&nbsp;

Significant steps have been made to provide accessible and effective medical services and care for TB. However, more efforts are needed since ailing health, unfortunate lodging, and sterilization, for instance, intensified by other risk factors, like tobacco, liquor use and diabetes aggravate the condition which are still prevalent in the society.&nbsp; 
&nbsp;

The Minister pledged and vowed Pakistan&#39;s continuous and unwavering stance with the global community in the fight to eradicate TB and is undoubtedly dedicated to ending the TB pestilence by 2030 as visualized in the agenda 2030 for Sustainable Development and its Sustainable Development Goals, World Health Organization End TB Strategy, Stop TB Partnership Global Plan to End TB<a href="#accordion">[12]</a>. 
&nbsp;

<ul>
	<li>Pakistan has a high prevalence of TB cases; it stands 5th in the world.</li>
	<li>Pakistan has made significant contributions to reducing the global burden of TB.</li>
	<li>The National TB Control Program (NTB) works at the central level to draft and implement national policies for TB care.</li>
	<li>NTB caters to the growing TB population through models such as the Public-Private Mix (PPM) Model or the Programmatic Management of Drug-Resistant Tuberculosis (PMDT).</li>
	<li>Global organisations such as WHO and the Global Fund assist Pakistan in fighting against TB.</li>
	<li>The Integrated Health System Strengthening and Service Delivery (IHSS-SD) Activity by USAID has allowed smooth provincial administration for TB.</li>
	<li>Tuberculosis is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately.</li>
	<li>In 2018, Federal Minister for National Health Services Saira Afzal Tarar said Pakistan&#39;s committed to eradicate TB by 2030 as visualised in the agenda 2030 for Sustainable Development and its Sustainable Development Goals, World Health Organization End TB Strategy, Stop TB Partnership Global Plan to End TB.</li>
</ul>

&nbsp;

[1] Abbas, S., Kermode, M., & Kane, S. (2020). Strengthening the response to drug-resistant TB in Pakistan: a practice theory-informed approach. Public health action, 10(4), 147–156.

[2] Federal Bureau of Statistics. (2009). National health accounts Pakistan 2005–06. Islamabad: Federal Bureau of Statistics, Statistics Division.

[3] Khan, J. A., Irfan, M., Zaki, A., Beg, M., Hussain, S. F., & Rizvi, N. (2006). Knowledge, attitude, and misconceptions regarding tuberculosis in Pakistani patients. Journal of Pakistan Medical Association, 56(5), 211–214.

[4] Metzger, P., Baloch, N., Kazi, G., & Bile, K. (2010). Tuberculosis control in Pakistan: reviewing a decade of success and challenges. Eastern Mediterranean Health Journal, Volume 16, 47-53.

[6] National TB Control Programme (NTP). (2014). National TB Control Programme Reach, treat, cure everyone: Annual report, 2014. Islamabad, Pakistan: Ministry of National Health Services Regulations & Coordination.

[6] National Tuberculosis Programme (NTP). (2008). Advocacy, communication and social mobilization: national strategy and operational guidelines. Islamabad: Ministry of Health.

[7] Ostby, K., & Burton, T. (2022, March 29). Tracking the 'missing cases' of TB as it moves across borders.

[8] Shah, S., Sadiq, H., Khalil, M., & Noor, A. (2003). Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan? Eastern Mediterranean Health Journal, 9(4), 776–788.

[9] Shaikh, B. T., Laghari, A. K., Durrani, S., Chaudhry, A., & Ali, N. (2022). Supporting tuberculosis program in active contact tracing: a case study from Pakistan. Infectious Diseases of Poverty volume 11, 42.

[10] The Frontier Post. (2018, March 27). All resources to be mobilized to fight against TB says Saira.

[11] Ullah, W., Ahmad, W., Haq, M. U., Yaqoob, A., Fatima, R., & Khan, G. M. (2021, August 10). Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Retrieved from Frontiers Public Health:

[12] Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., . . . Initiative., S. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Annals of internal medicine, 147(8), W-163.

[13] World Health Organization (WHO). (2006). Engaging all health care providers in TB control: guidance on implementing public-private mix approaches. Retrieved from World Health Organization (WHO):

[14] World Health Organization (WHO). (2022). Tuberculosis.

What Does Your Blood Type Have To Do With Your Risk Of Stroke?

Did you know that your blood type has a significant say in your susceptibility to <a href="https://www.merisehat.pk/disease/stroke">stroke</a>? Well, yes that&#39;s true, and, as surprising as it may sound, recent research has proven that individuals with type A blood group have a 16% higher risk of early-onset stroke, whereas individuals with blood type O have a 12% reduced risk of early onset stroke<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

A study was conducted and data was collected from 48 genetic studies on the incidence of ischemic stroke in the adult population (aged 18-59 years). Ischemic stroke is caused by a clot in the blood vessel supplying the brain, thus, disrupting the blood flow to the brain tissue. The study revolved around 17,000 patients who have had a stroke in the past and 600,000 healthy individuals as controls who had no previous history of stroke 
.&nbsp;

The purpose of the study was to determine the genetic causes behind stroke since it was not known earlier and the results showed a significant correlation between an individual&#39;s blood type and the risk of early-onset stroke<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Understanding the Association Between Blood Groups and Risk of a Stroke

It is imperative to know about the different blood groups before discussing their linkage with stroke. 4 blood groups are known to exist in humans &ndash; A, B, AB, and O. The blood group O is the commonest while the blood group AB is the rarest blood type. Individuals inherit their blood group from their parents<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

These blood groups are determined based on the presence of antigen (a protein) on the surface of our red blood cells.&nbsp; 
&nbsp;

<ul>
	<li>Type A: The A antigen is present on the surface of the red blood cell while the B antigen is present in the plasma.</li>
	<li>Type B: The B antigen is present on the surface of the red blood cell while the A antigen is present in the plasma.</li>
	<li>Type AB: Both A and B antigens are present on the surface of red blood cells and no antibody is present in the plasma.</li>
	<li>Type O: No antigen is present on the surface of the red blood cell; however, both A and B antigens are present in the plasma<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

Individuals with blood type O are known as universal donors because they can donate blood to anyone, while individuals with blood type AB are known as universal recipients because they can receive any and all blood types<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

According to the study, early stroke is more common in individuals with type A blood and less common in individuals with type O blood as compared to individuals who have had late onset stroke and those who had no previous history of stroke. Moreover, individuals with type B blood group are more likely to have both early and late onset of strokes<a href="#accordion">[4]</a>. 
&nbsp;

Now, you might be wondering how serious a stroke is? So, let&#39;s take a look into what stroke is and how serious it can be.&nbsp; 
&nbsp;

Stroke is referred to as a medical emergency since it can result in lifelong disability if prompt medical actions aren&#39;t taken<a href="#accordion">[5]</a>. Strokes are mostly ischemic, but they can be hemorrhagic as well.&nbsp; 
&nbsp;

In an ischemic stroke, there is blockage in a blood vessel supplying the brain. This disruption in the blood flow starves the brain tissue of oxygen and consequently results in the death of brain cells.&nbsp; 
&nbsp;

Since the brain is the control center of the body, any damage to the brain results in long-term consequences. For instance, after a stroke, people may experience blindness and problems with speech and memory. Individuals may also develop paralysis on the side of the body that is contralateral (opposite) to the site of stroke. That is, if an individual had a stroke in the right side of their brain, then the left side of their body would be paralyzed<a href="#accordion">[2]</a>. 
&nbsp;

According to the Center of Disease Control and Prevention (CDC), every 40 seconds someone in the U.S. experiences a stroke and every 3.5 minutes someone dies because of it. It is regarded as one of the leading causes of mortality (death) in the U.S<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

Stroke may present as<a href="#accordion">[7]</a>:&nbsp; 
&nbsp;

<ul>
	<li>Sudden weakness in the face, arm, or leg&nbsp;</li>
	<li>Sudden numbness in face, arm, or leg&nbsp;</li>
	<li>Sudden blindness&nbsp;</li>
	<li>Sudden confusion&nbsp;</li>
	<li>Sudden difficulty with understanding speech</li>
	<li>Sudden trouble with speaking&nbsp;</li>
	<li>Sudden dizziness</li>
	<li>Sudden loss of balance&nbsp; 
	&nbsp;</li>
</ul>

<h5>What Is An Early And Late Onset Stroke?</h5>

Stroke that occurs in individuals younger than 60 years of age is known as early onset stroke, whereas stroke that happens after 60 years of age is late onset stroke.&nbsp; 
&nbsp;

<h5>How Does Type A Blood Increase The Risk Of Early Onset Stroke?</h5>

Type A blood group increases the risk of having early onset stroke by 16% while the risk of having a late onset stroke is estimated to be 5% in individuals with type A blood<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Unfortunately, researchers don&#39;t have the answer as to why type A blood confers a higher risk of stroke in individuals less than 60 years of age, but it is believed that it has something to do with the clotting mechanism. There are studies that suggest that people with type A blood are slightly prone to developing blood clots in the leg &ndash; a condition known as deep vein thrombosis<a href="#accordion">[1]</a>. This signals towards the pro-clotting nature of type A blood group that paves way to the formation of other clotting-related diseases, including stroke<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Should I worry If I Have Type A Blood?</h5>

Researchers emphasize that the risk associated with type A blood and early onset stroke is not that significant, hence, individuals with this blood type need not to worry about it nor do they need to engage in additional screening or medical testing. If you have Type A blood, you can simply take it as a reminder to be cautious and to take steps to manage any risk factors you might have. 
&nbsp;

Additionally, stroke risk doubles every decade after 55 years of age and CDC has warned about the risk of stroke increasing with age. Most strokes occur in individuals after 50 years of age, but it has been reported that early onset stroke incidences are increasing, too. Every 1 in 7 strokes happen in individuals aged between 15 and 49 years<a href="#accordion">[6]</a>. 
&nbsp;

Yes, strokes can be prevented. As a matter of fact, 80% of strokes are preventable<a href="#accordion">[6]</a>. 
&nbsp;

While you cannot alter your blood type or stop your age from progressing, there are certain risk factors of stroke that you can control through lifestyle modifications. To do so, you first need to know the modifiable risk factors for stroke. This include<a href="#accordion">[5]</a>:&nbsp; 
&nbsp;

<ul>
	<li><a href="https://www.merisehat.pk/disease/hypertension-57">Hypertension </a>(high blood pressure)&nbsp;</li>
	<li>High cholesterol levels</li>
	<li><a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">Diabetes mellitus</a>&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/obesity">Obesity&nbsp;</a> 
	&nbsp;</li>
</ul>

Taking steps, such as quitting smoking and alcohol, incorporating exercise in your routine, managing your blood pressure and cholesterol levels, and eating a diet that is rich in fruits, vegetables and fibers can significantly reduce your stroke risk. 
&nbsp;

In a nutshell, even though blood type A is associated with increased risk of early onset stroke as proven by recent research, the risk for stroke is modest. Instead of worrying and finding ways to screen stroke, you should take it as a reason to be mindful about your health and work on other modifiable risk factors to reduce your chances of stroke.&nbsp; 
&nbsp;

<ul>
	<li>Stroke is a medical emergency that can result in life-long disability.&nbsp;</li>
	<li>Certain genetic factors, such as blood type, have been discovered through research to influence the risk of stroke.</li>
	<li>Blood type A is found to be associated with increased risk of early onset stroke, while individuals with blood type O are associated with decreased risk of early onset stroke.&nbsp;</li>
	<li>Early onset stroke occurs in individuals before the age of 60 years.&nbsp;</li>
	<li>The risk of stroke with blood type A is modest. Instead of getting involved in screening for stroke, individuals with blood type A should adopt healthier practices to manage the modifiable risk factors of stroke.&nbsp;</li>
</ul>

[1] Chang N.  Published 2022. Accessed September 23, 2022.

Norris J. Type A vs. O: Does blood type influence stroke risk?. Medicalnewstoday.com. Accessed September 23, 2022. https://www.medicalnewstoday.com/articles/is-there-a-link-between-your-blood-type-and-risk-of-stroke. Published 2022.

[2] Bailey E. Blood Type Linked to Risk of Stroke Before Age 60. Healthline.

[3] What Is A Universal Blood Type?. Redcrossblood.org.

[4] Conditions H, Risk S, Haase M. This Blood Type May Mean You’re at a Higher Risk of Early Stroke, New Study Finds. Prevention.

[5] Norris J. Type A vs. O: Does blood type influence stroke risk?. Medicalnewstoday.com.

[6] Solis-Moriera J. Your Blood Type May Influence Your Stroke Risk, Study Shows. Health.Published 2022.

[7] CDC.

Can Laughter Really Lower Blood Pressure?

High blood pressure, or hypertension, is a common health issue that affects around 1.28 billion people worldwide. It is often referred to as the &quot;silent killer&quot; because it can cause serious health problems, including heart disease, kidney failure, and stroke, without obvious symptoms.<a href="#accordion">[1]</a>

While medications and lifestyle changes are standard treatments, laughter therapy, quite surprisingly, is gaining attention as one of the natural ways to lower blood pressure.

Several studies demonstrate the long-term benefits of laughter therapy for blood pressure, for e.g. participants who engaged in regular laughter exercises had sustained reductions in their blood pressure levels over several months and could be&nbsp; a useful complementary treatment for hypertension.<a href="#accordion">[2]</a> 
&nbsp;

Understanding benefits of laughter therapy

This therapy can include watching funny movies, participating in laughter <a href="https://merisehat.pk/article/yoga-a-life-changing-approach">yoga</a>, attending humor workshops, or simply engaging in activities that make you laugh. The premise is simple: laughter can have a positive impact on your physical and mental health. 
&nbsp;

Laughter therapy works by triggering several physiological changes in your body:<a href="#accordion">[3]</a> 
&nbsp;

<ul>
	<li>
	<h5>Release Of Endorphins</h5>
	</li>
</ul>

Endorphins are the body&rsquo;s natural feel-good chemicals. They promote a sense of general well-being and can provide temporary pain relief. 
&nbsp;

<ul>
	<li>
	<h5>Reduction Of Stress Hormones</h5>
	</li>
</ul>

Stress hormones like cortisol and adrenaline can lead to stress and anxiety. 
&nbsp;

<ul>
	<li>
	<h5>Improved Blood Circulation</h5>
	</li>
</ul>

A healthy blood flow can help protect against heart attacks and other cardiovascular problems. According to a study, laughter expands the inner lining of blood vessels, called the endothelium, which increases blood flow and reduces blood pressure.<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>
	<h5>Muscle Relaxation</h5>
	</li>
</ul>

The whole body feels relaxed for up to 45 minutes after laughing. 
&nbsp;

While laughter therapy should not replace traditional medical treatments, it can be a valuable complementary approach to managing hypertension. It can effectively reduce stress and potentially lower your blood pressure. So, go ahead and find something that makes you laugh &ndash; it&#39;s good for your heart! 
&nbsp;

<ul>
	<li>Laughter therapy involves laughter to promote overall health and well-being.</li>
	<li>It can include activities like watching funny movies, participating in laughter yoga, or attending humor workshops.</li>
	<li>Laughter is one of the most effective stress management techniques; it decreases stress and anxiety while improving mental well-being and mood.</li>
	<li>Laughter therapy can help lower blood pressure and can be used as a complementary approach alongside traditional medical treatments for managing high blood pressure.</li>
</ul>

[1] Hypertension. World Health Organization. Accessed June 24, 2024.

[2] View of effectiveness of laughter therapy on blood pressure among patients with hypertension. Accessed June 24, 2024.

[3] Stress relief from laughter? it’s no joke. Mayo Clinic. September 22, 2023. Accessed June 24, 2024.

[4] Laughter has a positive impact on vascular function. European Society of Cardiology. Accessed June 24, 2024.

This method is typically reserved for specific medical conditions, such as peripheral artery disease (PAD), lymphedema, and aortic coarctation, or for individuals with certain injuries, burns, multiple IV lines, or those who have undergone surgeries like mastectomy or arm amputations.&nbsp;

It may also be preferred in scenarios where arm measurements are not feasible or accurate. 
&nbsp;

Understanding Leg Blood Pressure Measurements

While it is possible to measure blood pressure at home with the correct equipment, it is generally recommended to have it done in a clinical setting for several reasons:

<ul>
	<li>Accuracy-&nbsp;Healthcare professionals are trained to ensure proper technique and interpretation of the readings</li>
	<li>Special Equipment-&nbsp;Most home blood pressure monitors are designed for arm use; leg BP measurements require a larger cuff and sometimes specific settings</li>
	<li>Monitoring Conditions-&nbsp;Conditions like PAD or aortic coarctation require professional evaluation and ongoing monitoring</li>
</ul>

When measuring blood pressure in the leg, it&#39;s crucial to account for factors that can influence readings. Temperature, stress levels, and recent physical activity can all impact blood pressure readings, potentially leading to inaccurate results.&nbsp;

For instance, several studies show that temperature variations could significantly affect blood pressure measurements, necessitating controlled environments for consistency. Ensuring the person is calm and has been resting for at least 5 minutes before taking the measurement can help improve accuracy.<a href="#accordion">[1]</a><a href="#accordion">[2]</a>

Note: It&rsquo;s best to check the blood pressure at the same time every day. Keep a log and discuss it with the healthcare professional at every visit.&nbsp; 
&nbsp;

A sphygmomanometer or an automatic blood pressure monitor with a leg cuff setting is mostly used to measure blood pressure in the leg.&nbsp; 
Make sure:<a href="#accordion">[4]</a>

<ul>
	<li>The blood pressure cuff is appropriately sized for the thigh.</li>
	<li>The person is lying down on their back. They should be relaxed, with the leg slightly bent at the knee and the thigh properly supported.</li>
	<li>The cuff is placed around the thigh, about the midpoint between the hip and knee, and is snug but not too tight.</li>
	<li>Find the popliteal artery pulse at the back of the knee. This is where the stethoscope will be placed in case of a manual sphygmomanometer.</li>
	<li>Inflate the cuff until the pulse can no longer be heard or felt, then slowly release the pressure. For manual measurement, use the stethoscope to listen for the return of the pulse as the cuff deflates.</li>
	<li>The first sound heard is the systolic BP, and the point where the sound disappears is the diastolic BP. 
	&nbsp;</li>
</ul>

To measure BP at the ankle:<a href="#accordion">[4]</a>

<ul>
	<li>Use an appropriately sized cuff for the ankle.</li>
	<li>Place the cuff just above the malleolus (the bony prominence on each side of the ankle).</li>
	<li>Locate the posterior tibial artery or dorsalis pedis artery using palpation.</li>
	<li>Inflate the cuff until the pulse can no longer be felt, then slowly release the pressure.</li>
	<li>Record the systolic and diastolic BP as described for the thigh method. 
	&nbsp;</li>
</ul>

It&rsquo;s also important to first determine the best site for BP measurement.

<ul>
	<li>Avoid leg measurements if there is an underlying condition or infection, trauma, or a bulky bandage covering the leg.&nbsp;</li>
	<li>It is recommended to rotate the BP sites in the elderly more frequently compared to pediatrics or even young adults because their skin is more fragile and, therefore, can be damaged more easily. 
	&nbsp;</li>
</ul>

In some cases, ABI is used alongside leg BP measurements to assess peripheral artery disease. ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressure at the arm. A low ABI can indicate blockages or narrowing in the arteries, which is crucial for diagnosing PAD. 
&nbsp;

While the normal blood pressure range for arm measurements is typically less than 120/80 mmHg, leg BP measurements can vary slightly.&nbsp;

Typically, systolic BP in the leg is 10-40 mmHg higher than in the arm due to the larger muscle mass and artery size. Diastolic BP remains relatively similar. Based on the NICE threshold for BP in the arm, the normal range would be 155/90 mmHg.<a href="#accordion">[3]</a>

Any significant deviations from these ranges should be discussed with a healthcare provider to rule out vascular issues. 
&nbsp;

Leg BP measurements are not typically part of routine checks unless specific conditions warrant it. Regular monitoring is essential for those diagnosed with conditions affecting leg arteries. 
&nbsp;

Always consult with a healthcare provider before attempting to measure leg BP at home.&nbsp;

Symptoms like occipital headache, fatigue, nosebleeds, and facial flushing indicate a risk of hypertension.&nbsp;

On the other hand, mental confusion, dizziness, restlessness, cool or mottled skin over extremities, and pale or dusky mucous membranes mean a risk of low BP.<a href="#accordion">[4]</a> 
&nbsp;

While leg BP measurements are less common, they are crucial for diagnosing and managing certain medical conditions. Proper technique and equipment are essential for accurate readings, and it is usually best to have these measurements done in a clinical setting. 
&nbsp;

<ul>
	<li>Indications for leg BP measurements include peripheral artery disease (PAD), lymphedema, aortic coarctation, injuries, burns, and surgeries like mastectomy.</li>
	<li>Home measurement is possible but generally not recommended.</li>
	<li>Properly using a blood pressure monitor and following recommended techniques are key to controlling blood pressure effectively.</li>
	<li>Understanding the normal blood pressure range and being aware of high blood pressure symptoms are crucial for effective monitoring.</li>
	<li>Always consult your doctor for guidance.</li>
</ul>

[1] The influence of the ambient temperature on blood pressure and how it will affect the epidemiology of hypertension in Asia - Park - 2020 - the journal of clinical hypertension - wiley online library. Accessed July 17, 2024.

[2] How to accurately measure blood pressure at home. www.heart.org. January 24, 2023. Accessed July 17, 2024.

[3] E040749.full.pdf. Arm Based on LEg blood pressures (ABLE-BP). Accessed July 17, 2024.

[4] Blood pressure: Auscultation of lower extremity (ambulatory). Blood Pressure: Auscultation of Lower Extremity (Ambulatory). Accessed July 17, 2024.