Heart pain

Types of Heart pain

Doctors usually divide the heart pain (angina pectoris) into two categories:a.     Stable angina
b.     Unstable angina

Stable refers to the predictable appearance of chest discomfort with a certain amount of exertion. For example, walking fast or up a slight incline usually produces symptoms, but they never occur when you are walking at a slow pace on level ground. It disappears promptly with rest, and its severity, duration, and precipitating causes do not usually change over a period of years. In contrast unstable angina is alarming. Sometimes it is the harbinger of death  So it requires immediate attention. In layman term unstable angina means when the patient gets chest pain at rest.

          Canadian cardiac society (CCS) classifies heart pain into 4 categories:

1.    CCS class-1 angina- This means the patient gets chest pain only during marked physical exertion and promptly relieved by rest.

2.    CCS class-2 angina- It occurs after moderate exertion and relieved by rest.

3.    CCS class-3 angina- Chest pain occurs after mild physical exertion. Even routine household activities may precipitate such type of angina.

4.    CCS class-4 angina- Class 4 angina means pain at rest.

Unstable angina is class 4 angina. Unstable angina describes two situations. In one, pain occurs in patients with no background of prior symptoms. In the other case of unstable angina, individuals with previously stable angina will experience changes in their symptoms, the pain may be more severe, lasting longer, or it may appear with less exertion than before.

Except these types of angina there are some special varieties of chest pain. If patient gets pain just after taking food, it is called postprandial angina. Chest pain after taking food is very suggestive of significant ischaemic heart disease (IHD). Some patients awake from sleep at night due to chest pain, this type of pain is called nocturnal angina. Patient may experience pain in lying condition, which is termed as angina decubitus. Emotional stress may precipitate heart pain, called variant or Prinzmetal angina.

Stable angina does not require urgent medical attention; however, unstable angina needs immediate care. Furthermore, the circumstances under which angina takes place also will govern how the problem should be treated. For example, chest discomfort that is noted only rarely, and then only with extremes of exertion, need not be handled with the same urgency as angina triggered by walking across a room.

Coronary Artery disease

How to predict risk of heart attack

Risk factors of coronary artery disease

You are at a greater risk for angina pectoris (heart pain) and Myocardial infarction (heart attack) if you/your

1.    are male

2.    smoke cigarettes

3.    have high blood pressure

4.    have diabetes

5.    are inactive

6.    are overweight

7.    have high blood cholesterol

8.    father/mother have coronary heart disease

9.    are of Type A personality (very ambitious and competitive).

 

What is risk factor?

A risk factor may be defined broadly as any habit or trait that can be used to predict an individual’s probability of developing coronary heart disease (1). A rise factor so defined may be a causative agent of the disease. A more limited and specific definition is that a risk factor is a causative agent or condition that can be used to predict an individual’s probability of developing disease. In most instances, a risk factor is the trait that predicts of development of clinically significant disease within a population. In most of the cases, it is involved in the causation of the disease. There are four very important risk factors for the causation of heart attack. These are cigarette smoking, high blood pressure, diabetes mellitus and high blood cholesterol level (2-5).

Risk factors of heart attack?

Increasing knowledge of risk factors in coronary artery disease has enabled us to identify them in individuals and in communities. It is therefore possible and desirable to correct or modify them so as to reduce the incidence of heart attack. There are two types of coronary risk factors; non modifiable risk factors and modifiable risk factors. Those risk factors which you can not reverse are called non-modifiable risk factors or in other words, you are born with some of those risks. Those risk factors which you can correct by drugs or by changing lifestyle are called modifiable risk factors.

A.   Non-modifiable risk factors include:

1.    Masculine gender

2.    Increasing age

3.    Family history of heart attack

B.   Modifiable risk factors include :

1.    High blood pressure

2.    Diabetes mellitus

3.    Smoking

4.    High blood fat

5.    Overweight

6.    Physical inactivity

7.    Stressful life

The effect of combined factors is not an additive but a multiplying one. For example a person with untreated high blood pressure is twice as likely to get heart attack compared with someone with normal pressure. If he also suffers from diabetes his chances of developing heart attack is five fold; and if he is also a heavy smoker, her is nine times more likely to get ischaemic heart disease (6). Modification of risk factors has already been proven to be effective in reducing the incidence of coronary heart disease in population studies. For an individual, preventive measures must be targeted towards modifying his risk factors in a manner which is practical and acceptable. If he has high blood pressure, is a heavy smoker and has high blood fat, all three factors can be tackled all together. For the community the approach must be multifactor and sustained.

Blood supply of the heart

Blood supply of the heart

The heart is located in the chest just behind the breast bone and between the two lungs. It is composed of muscle called myocardium (heart Muscle). Myo- means muscle and cardium means heart. The heart is externally covered by a sheath called pericardium. Two third of heart is in the left side of the chest and one third on the right. Heart is a muscular organ about the size of a fist. The heart is a compact, hollow, muscular organ of a some what conical or pyramidal form possessing, therefore a base, apex, and a series of surfaces and borders. An average adult heart measures about 12 cm from base to apex, 8 to 9 cm transversely at its broadest part, and 6 cm from base to backwards. Its weight, in the male, varies from 280 to 340 gm (average 300gm), while in the female, from 230 to 280 gm (average 250gm). The adult weight is achieved between 17 and 20 years (1). The heart is divided by vertical septa into four chambers, the right and left atria and the right and left ventricles. In simple way, atrium means blood receiving chambers and ventricles means pumping chambers. Right heart chambers (both right atria and right ventricle deal with deoxygenated impure) blood and left sided chambers (both left atrium and ventricle) deal with oxygenated (pure) blood. The impure blood arrives in right ventricle by way of right atrium and right ventricle pumps the blood in the lung circulation through pulmonary artery. The impure blood gets pure in the lungs and comeback to left ventricle through left atrium. Then left heart pumps the pure blood through out the body.
          Heart also have four values, they are mistral value or bicuspid valve (bicuspid means two doors), tricuspid valve, aortic valve and pulmonary valve. Valves are not affected by coronary artery disease. Heart disease may involve coronary artery or it may involve the valves. But one should not confuse coronary artery disease with valvular heart disease. They are two separate entities. Valvular heart disease is the end result of rheumatic heart disease but coronary artery disease means the obstruction in the coronary blood flow.

     Though the heart supply the nutrition of the whole body but it also needs nutrition (food) for its own survival. Heart needs food in the form of oxygen. Oxygen is supplied to the heart’s own muscle through coronary arteries. When these arteries are blocked by some means heart itself does not get enough energy to supply whole body. This situation is called ischemic heart disease or coronary artery disease. When doctor talks about ischemic heart disease (heart attack), he usually specifies the disease of left ventricle. Right and left atrium's are usually not affected by the ischemic heart disease and right ventricle is very rate victim. Left ventricle has thicker wall (8-11mm). If left ventricle does not get enough blood then patients feel pain particularly during exercise.

Blood supply of the heart

There are two coronary arteries which supply blood (nutrition) to heart muscle. They are right coronary artery and left coronary artery. Left coronary artery is further divided into two big branches, Left anterior descending artery and left circumflex artery (LCX). So, in reality heart is supplied by three big arteries, right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCX). When your doctor tells about IHD he means that some of your coronary artery is not functioning well due to blockage. All the three big arteries are equally important for all person. Even a significant block in one artery may cause severe symptoms. When patients visit his doctor for consultation, doctor off and on uses the terms single, double and triple vessel disease. What does it mean? If one of your artery is significantly blocked it is called single vessel disease (SVD), if two of your arteries are blocked it is called double vessel disease (DVD) and if all of your three arteries are blocked then it is called triple vessel disease (TVD).          Left ventricular ejection is very important for the longevity of the patients with heart disease. What does ejection fraction actually mean? In a simple way it implies the strength of the left ventricle. During each heart beat left ventricle pumps certain amount of blood to other parts of the body. This is called ejection fraction. Ejection fraction indicates the strength of your heart, how efficiently your heart can pump blood. During diastole (when ventricle relaxes) blood collects inside the ventricle. The amount of blood that collects inside the ventricle at the end of diastole is about 130 ml. During heart contraction heart pumps about 65% of this incoming volume. Normal ejection fraction (EF) varies from 55% to 75%. If EF is less than 50% it indicates early impairment of heart muscle strength. If EF is in between 35 to 45%, heart function is moderately impaired and if EF is less than 35%, it means that heart pumping is severely impaired.Does all chest pain come from heart?If you get chest pain, it is not always true that you are having heart disease. Your chest does not only contain heart. In fact chest comprises a number of structures other than heart and all of them may cause pain. Some of them mimic heart pain. A number of different conditions may cause chest pain; some are harmless while others are serious. Pain that is not originating from the heart the heart is called no cardiac chest pain. The source of pain may be from any structure within the chest cavity such as the esophagus (food cannal; through which food from the mouth enters into the stomach), lungs of airways.          The most common source of chest pain is the chest wall. Typically such pains are transient, lasting form few minutes to few days, reaching peak intensity within few hours, are often produced by certain positions of the body, relieved or intensified by movement of the chest such as breathing, and tender (painful to touch) and this type of pain is usually sharply localized (1). This type of pain is not associated with significant breathlessness, sweating or vomiting. Sometimes viral infection may cause chest pain. Such pain is usually accompanied by low grade fever, dry cough and prostration, which are unusual in heart pain. Ischaemic heart pains usually do not produce fever at its inception. Some times pain usually do not esophagus mimics cardiac pain. Esophagus pain is one of the important causes of chest pain. But this type of pain is burning in nature, has got relation with food intake, typically occurs while the subject is at rest rather than during exercise and is usually relieved by antacid. In addition, the patient often has accompanying symptoms such as gas and acid eructation (2-4). Chest pain originating from within the chest may be from the lungs or from the pleura (covering membrane of the lungs) (5). Breathing deeply intensifies such type of pain. If patient holds breathing pain disappears. Usually there are other clues that it is coming from the lungs; often the patient has a cough or an illness with fever. Chest muscle pain is also some times confused with heart pain. If pain originates from the muscle it is called myalgia chest. This type of pain is localized without any radiation, intensifies with change of body posture and surrounding area is painful to touch. Such pain promptly respond to simple analgesic like paraectamol, aspirin or other NSAID eg  indomethacin, diclofenac , ketoprofen etc. Some times pain may be felt in the area where rib bone meets with the cartilage. This is called costochondritis (1). It is much localized pain and the overlying skin sometimes becomes reddish. Chest pain also may originate from the nerve roots coming out of the spinal cord.          Each of these sources of chest pain has its own characteristics; however some general features of non cardiac chest should be brought to your attention. So the doctor must exclude the possibilities of no cardiac pain during evaluation of a patient with chest pain.

Mental Doctor in Bangladesh

This Post is important mental doctor in Bangladesh. Pabna Famous of the metal Doctor and metal hospital in Bangladesh. Have Many Mental doctor in Bangladesh.

  

Metal Doctor ‘s Name		Qualifications	Address	Phone Number
Dr. Abdus Sobhan		MBBS, DPM, Fellow -WHO	MUKTI , House-2, Road- 49, Gulshan-2, Dhaka-1212, Bangladesh ngladesh he metal Doctor and metal hospital in bangladesh	02-9889044, 02-9883991
Prof. Dr. A. A. Quoreshi		MBBS, PGT, (USA)	MUKTI, House-2, Road- 49, Gulshan-2, Dhaka-1212, Bangladesh	02-9896165, 02-9883991
Dr. MD. Nurul Haque		MBBS, FRSH, London	MUKTI, House-2, Road- 49, Gulshan-2, Dhaka-1212, Bangladesh	02-9896165, 02-9883991
Dr. A. H. M Mohammad Firoj		MBBS, FCPS, MRCP, FRCP	Monojagat Centre, (Kasba Centre), House-5, Road-4, Dhanmondi, Dhaka	02-8629565
Dr. A. H. M Mostafizur Rahman		MBBS, FCPS	Kalyani Diagnostic Centre, 346, Elephant Road, Dhaka	02-8613975, 02-8626650,
Dr. Tarikul Alam		MBBS, MCPS (psyche)	Popular Diagnostic Center Ltd. House-29, Bir Uttam A. N. M Nuruzzaman Road, Mohammadpur, Dhaka.
Dr. A. K. M. Nazimuddola Choudhury		MBBS, DPM, FRC Psyche, FCPS.	152/2-F, Green Road Pantha Path, Dhaka	02-8121608 (C), 02-8011722,
Dr. A. K. Moyeenuddin Ahmmed		MBBS, MCPS (Psyche) PhD	Brain & Mind Hospital (Pvt) Ltd, 149/A, Airport Road, Farm gate, Dhaka	02-8120710
Dr. Dean Abdur Rahim		MBBS, DPM, MCPS, Fellow-HO (India)	Modern Diagnostic Centre Ltd, House-14, Road-7, Dhanmondi	02-9661240, 02-8613883 (C),
Dr. Fahmid-ur-Rahman		MBBS, FCPS, M- Phil	Islami Bank Central Hospital, Kakrail. 30, VIP Road, Dhaka	02-9355801-2. 9360331-2 (C)
Dr. Hidayetul Islam		MBBS, DPM (London)	Concord Arcadia, House-1 & 2, Road-4/A, DRA	8610770 (C),)
Dr. Jhuna Shamsun Nahar		MBBS, FCPS (Psyche)	New Mukti Clinic, 22/10, B-Block, Babar Road, Dhaka	02-9136376, 8151002 (C),
Dr. M. A Bari		MBBS, MCPS, FRSH (London)	Bari Clinic, 103 Elephant Road, Dhaka.	8614298, 9669681
Dr. Mahmood Hasan		MBBS, FCPS (Psyche), FIPS (India).	Ibn Sina Consultation Centre, House-58, Road-2/A, DRA	02-8610420, 8618262 (C), 9122276 (R),
Dr. M. A Mohit Kamal		MBBS, M. Phil (Psyche), EMDR Training & Training in Psychotherapy (USA)	Central Hospital H-2, Rd-5, Green Road, Dhonmondi, Dhaka	02-9660015-19 (C), 8825753 (R)
Dr. Masuda Khanom		Prof. of Psychiatry, BSMMU	Medinova, H-54/1, Rd-4/A, DRA, Dhaka	8618583, 8620353-7
Dr. Md. Farooque Alam		MBBS, FCPS (Psyche).	Lab Aid Ltd, House-1, Road-4, Dhanmondi, Dhaka.	02-8610793-8 (C), 9143163
Capt. Dr. A.S.M. Anusuzzaman		MBBS, D- psyche,	Northern international Medical College, H-48, R-9/A, Satmasjid Raod, Dhanmondhi, Dhaka-1209	02-8156914, 9133505
Dr. Md. Golam Rabbani		MBBS, FCPS (Psyche)	Medinova, H-71/A, Rd-5/A, Dhanmondi R/A, Dhaka	9144280 (O), 8624907-10 (C)
Dr. (Lt. Col) Md. Habibur Rahman)		MBBS, FCPS (Psyche	Al-Rajhi Hospital, 12 Farmgate, Dhaka	02-8119229, 8121172 (C),
Dr. Md. Najmul Ahsan)		MBBS, FCPS (Psyche), MCS (Psyche), Special Training in Child Psychiatry (Australia)	Motijheel Nursing Home, 30 Naya Paltan, Dhaka	02-9337685, 02-8617816
Dr. Md. Tazul Islam		MBBS, FCPS (Psyche)	Sheba Drug Abuse Mental Treatment & Rehabilitation Centre, 364, Elephant Road, Dhanmondi, Dhaka	028610257
Dr. Mohammad Samir Hossain		MBBS, DP (USA), MS (USA), CMEP  (USA), PhD (Spain)	Proshanti Hospital/Diagnostic Ltd. Malibag more, Dhaka	02-8318699, 9348728 (C)
Dr. Mohsin Ali Shah		MBBS, FCPS, M Phil (Psyche)	Dhaka Hospital, 17, D.C Roy Road, Mitford	7310750, 7320212 (C),
Dr. Sayedul Islam Mullic		MBBS, FCPS (Psyche)	Lab Aid Ltd, House-1, Road-4, Dhanmondi, Dhaka.	8610793-8 (C), 9669775