Tag: heart

Posted in Psychology & Medicine

Lazarus

Posted on by Jinavie

In the New Testament of the Bible, there is a scene where Jesus resurrects a man by the name of Lazarus back four days after his death. This “miracle” is of course a fictitious event, but nonetheless, the name Lazarus has come to symbolise resurrection after death. For example, there are two actual medical conditions named after Lazarus, both related to death.

The first is called Lazarus phenomenon, where a person who is declared to be clinically dead spontaneously returns to life. This is an extremely rare event that has only been recorded in about 30 cases. In most of these cases, the patients had suffered a cardiac arrest, with all attempts at resuscitation (e.g. CPR, adrenaline) had failed. Sometime after the person was declared clinically dead (usually around 5~10 minutes), the person’s circulatory system would suddenly start on its own and the person would be “resurrected” (quite literally). In one case, a 61 year-old woman was declared officially dead after her heart stopped and her vitals did not return after continuous resuscitation. At the morgue, however, she was found to have a pulse and breathing on her own. She later sued the hospital for the neurological and physical injury caused by oxygen deprivation during her death. There is even a case report of a patient who returned to life two and a half hours after dying (although he died again 3 weeks later).

Of course, the Lazarus phenomenon is not a miracle. In most cases, it is hypothesised that when resuscitation is attempted then stopped, there is a rare chance of the relieving of pressure causing blood to fill the heart, causing a sudden expansion and kickstarting the electrical circuit. Other factors that may influence this is hyperkalaemia resulting from ischaemia and high doses of adrenaline given to the patient during resuscitation having a delayed effect.
Because of this rare “complication” of death, doctors are advised to observe the patient for about 10 minutes after declaring them dead. Just in case.

The second is called Lazarus sign and it occurs not in dead patients, but brain-dead patients. Brain-dead patients are immobile as their higher functions such as cognition and motor functions are destroyed. However, there are rare cases where the brainstem is somehow stimulated, triggering a reflex arc from the spinal cord. This reflex is seen as the patient suddenly raising their arms and dropping them on their chest in a crossed position, much like Egyptian mummies. As the spinal cord is not usually damaged in brain-dead patients, this reflex arc is possible, similar to a knee jerk reflex. The Lazarus sign should not be misinterpreted as a sign that a brain-dead patient is conscious, as it is an involuntary movement. However, it has been mistaken for the resuscitation of a patient, or in some cases, as a miracle.

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Posted in History & Literature

Valentine’s Day

Posted on by Jinavie

Valentine’s day is the one day put aside every year, on the 14th of February, to celebrate the love between a couple. It is a rather controversial(?) holiday with many people contesting that it is the result of chocolate and flower companies conspiring to increase sales and that people should love equally on every day. The day is full of hearts and cupids and chocolate, making it the perfect day for couples to show off to the world just how much they adore each other, while single people put up a nonchalant face while desperately trying to distract themselves from the fact that they alone (there is also a statistic that states suicide rates peak during Valentine’s day).

February 14th was not always associated with romantic love. Originally it was a day honouring Saint Valentine of Rome (it is debated whether day honours him or another Saint Valentine – Valentine of Terni). In 1st century Rome, it was illegal for Christians to marry. Saint Valentine secretly performed weddings for Christians under threat of death (helping Christians was illegal too). He was eventually caught, imprisoned, tortured and killed.

As one can see, the story (and its ending) is not the most romantic one and Valentine was honoured for helping Christians rather than being involved in marrying people. It appears that the romantic association started around the 14th century in Parlement of Foules by Chaucer. Up until the 19th century, the only custom for Valentine’s Day was the giving of cards (or “valentines”) between loved ones. It was in the mid-1900’s when the practice of giving roses and chocolates arose (most likely due to advertising campaigns by companies for the commercialisation of the day), with the diamond industry promoting a custom of giving jewellery on Valentine’s Day.

Another not-so-lovely story related to Valentine’s Day is the infamous Saint Valentine’s Day Massacre of Chicago in 1929. In a conflict related to gangs and bootlegging, the South Side Italian gang led by Al Capone initiated a deadly attack resulting in the death of seven deaths.

Posted in Psychology & Medicine

How To Feign Death

Posted on by Jinavie

Usually to check if a person is dead, one checks their pulse and breathing. If you want to fake your death properly, you must be able to stop both of these. You can easily hold your breath, but how can one stop their own heart? The answer lies in a ball.

If you wedge a tennis ball, squash ball, baseball or any small but firm ball in each of your armpits and squeeze tightly, the pulse at your wrist will disappear. This pulse is the radial pulse, and the radial artery is a branch of the brachial artery further up the arm. If a ball is squeezed in the armpit, it compresses the brachial artery, stopping the blood flow to the radial artery and obliterating the radial pulse. Most people who are not medical professionals tend to use the radial pulse for taking a pulse, so this method can be used to make it look like you do not have a pulse. But as this trick only causes the radial pulse to disappear, it is ineffective if the other person takes the pulse at another site such as the carotid artery or femoral artery. However, if you can control the situation and the person checking to see if you are alive is not a doctor or nurse, then it is quite a useful trick to use.

Posted in Psychology & Medicine

Clubbing

Posted on by Jinavie

Among the thousands of signs and symptoms in the field of medicine, there is one that every doctor and medical student knows since the development of medicine. Clubbing is an easily noticeable sign in a patient’s fingers that can have wide implications on their health.

Clubbing is essentially when the angle (gap) between the fingernail bed and finger disappears. The formal definition is much more complicated, such as “the loss of the normal <165° angle, or Lovibond angle between the nailbed and the fold”, but for all intents and purposes the simple definition is sufficient.

To see if a patient has clubbing, the physician carefully studies the fingers against light. There are a few ways to check for clubbing but the most popular methods are holding the fingers out straight and holding them parallel to the ground, checking the angle between the nailbed and finger, or the Schamroth’s window test. The latter test is done by holding two opposing fingers (such as the left and right index fingers) against each other nail to nail. The fingers are then held against the light so that the light can shine through the “window” that is made. If the window is not seen, the test is positive and the patient has clubbing.

What does clubbing suggest? Clubbing was first noticed by Hippocrates, the father of Western medicine, who observed that people with clubbing tended to grab their chest and fall dead. This is one of the most common associations to clubbing – a congenital cyanotic heart defect such as tetralogy of Fallot or patent ductus arteriosus. Other common associations are related to the lungs, such as lung cancer (one of the most common causes) and various other lung diseases such as interstitial lung disease, tuberculosis and other chronic infections. There are also a myriad of other diseases associated to clubbing, including but not limited to: Crohn’s disease, ulcerative colitis, cirrhosis, celiac disease, Graves disease and certain types of cancers (lung, gastrointestinal and Hodgkin’s lymphoma mainly). Clubbing can also be idiopathic, where there is no apparent cause for the clubbing and the person just has it (possibly just born with it).

Despite knowing about clubbing for over 2000 years, we still do not know the exact reasons for clubbing. There are theories that it is related to a fall in blood oxygen content leading to vasodilation in the peripheries. As the pathophysiology is not clear and so many diseases are associated with it, when clubbing is found in the patient the physician should investigate the related organ systems (heart, lungs, GI mainly) to narrow down the possible cause of it. As many of the causes (such as lung cancer) carry a rather morbid prognosis, it is quite important to notice whether the patient has clubbing when doing a physical examination.

Posted in Psychology & Medicine

Pulse

Posted on by Jinavie

Blood, which supplies all the cells in the human body with nutrients and oxygen, flows through the vessels due to the pumping of the heart. Thus, blood flow directly transmits the force generated by every heartbeat. As the blood ejected by the heart causes the arteries to “pulse” by stretching and relaxing. As some pulses can be felt over the skin, they are very useful in patient examinations, especially a clinical exam of the cardiovascular system. Although people commonly know how to take a pulse from the wrist or neck, there are many more places a pulse can be taken from.

  • Radial pulse: Taken from the inside of the wrist on the side of the thumb.
  • Brachial pulse: Taken from the inside of the elbow.
  • Carotid pulse: Taken from where the neck meets the jawline, or 2~3cm either side of the Adam’s apple to be precise.
  • Apex beat: This measures the heartbeats directly, taken on the left chest between the 4th and 6th ribs (around the left nipple).
  • Abdominal pulse: Taken from above the belly button of a lying patient, may be able to see the pulse.
  • Femoral pulse: Taken from the middle of the groin. 
  • Popliteal pulse: Taken from the inside of the knee.
  • Posterior tibial pulse: Taken from the inside of the ankle behind the bone.
  • Dorsalis pedis pulse: Taken from the back (upper side) of the foot along the middle.

When taking a pulse, you use your second and third fingers (and the fourth if you want) and press lightly on the pulse point. If you press too hard, you may stop the blood flow and obliterate the pulse. As a pulse is measured per-minute, it is often taken for 10 or 15 seconds and multiplied by 6 or 4 respectively. Also, it should be noted whether the pulse has a regular rhythm, and if it is irregular, whether it is regularly irregular or irregularly irregular. If the pulse is over 100 beats per minute, it is called tachycardia, while less than 60 beats per minute is referred to as bradycardia. If it is irregular, it is called an arrhythmia.

An experienced doctor can diagnose different conditions such as an aortic stenosis or atrial fibrillation just from taking the pulse of the patient. Taking a pulse is also a crucial diagnostic tool in traditional Korean and Chinese medicine.

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Posted in Psychology & Medicine

Sudden Death

Posted on by Jinavie

Unlike diseases such as tuberculosis or cancer, some disease processes are known to kill a human being within an hour of onset. Other than the obvious causes such as decapitation, massive bleeding or any other trauma-related injuries, these diseases tend to be cardiac or respiratory in origin.

A common example is coronary artery disease, where the blood vessel providing blood to an area of the heart becomes completely blocked by stenosis (narrowing, often by atherosclerosis) or a clot. This results in immediate ischaemia (lack of oxygen) to heart muscles, which causes cell death. This produces scar tissue which disrupts the electrical activity of the heart, which may lead to a condition called ventricular fibrillation where the heart beats in an uncontrolled, erratic manner. When in VF, the heart effectively becomes useless as it cannot coordinate proper pumping function. Blood circulation stops and the patient goes in to multiple organ failure (the brain goes first) within a very short time. Although it can kill within a short time, early identification and treatment may be able to prevent VF from occurring and save the patient’s life. If VF does occur, it is crucial to begin CPR or use a defibrillator if available.

VF can also occur in other situations. For example, there is a genetic condition called long QT syndrome which predisposes the patient to spontaneous arrhythmias (electrical abnormalities in the heart). Even becoming too excited can sometimes set off a VF in some LQTS patients, thus they require an implantable cardioverter-defibrillator (ICD) to shock their heart back in to normal rhythm every time they develop an arrhythmia.

Some other causes of sudden death include: aortic dissection (tearing of the aorta that may cause massive internal bleeding), pulmonary embolism (a clot obstructs blood flow in the lung, stopping circulation), commotio cordis (a blow to the heart at a certain moment in the heart rhythm triggers VF), ruptured brain aneurysm (ballooning of an artery in the brain), anaphylaxis (severe allergic reaction that cuts off airflow to the lungs) and poisoning (various mechanisms, mainly related to disrupting cellular function).

Death can strike swiftly, even from within your body.

Posted in History & Literature

Buttons

Posted on by Jinavie

There is an extremely simple way to tell if a shirt or jacket is designed for a man or a woman – buttons. A male garment traditionally has buttons on the right side while female garments have them on the left side.

The reason for the male garment is that having the button on the right side is easier to button up when dressing oneself (given that he is right-handed). So why is this not the case for female garments? This is because during Victorian times, women were usually dressed by a maid or servant so it would be easier for them to button up a dress if it was on the left side. This theory is very plausible as zippers were not available then and dresses were mostly buttoned from the back. Even when women’s clothing started having buttons in the front, tailors were already accustomed to the traditional convention.

Alternate theories are quite interesting too. It is hypothesised that buttons on male clothing were modelled after a knight’s armour that would be latched on so that a right-handed opponent could not jam their pike through a seam. Contrary to the military origin of the male buttons, female buttons may be placed in such a way to allow the lady to easily expose her left breast – which is closer to her heart – to nurse her baby.

(Source: http://j-jm-m.deviantart.com/art/Button-66176952)

Posted in Psychology & Medicine

Broken Heart Syndrome

Posted on by Jinavie

Countless novels and films depict a character, heartbroken from the loss of a loved one or due to a break-up, suddenly clutch their chest and collapse. Although this may seem like a dramatic plot device, it is actually possible to die from stress.

The condition, colloquially termed broken heart syndrome for obvious reasons, is known as takotsubo cardiomyopathy or stress-induced cardiomyopathy. As the name suggests, the heart suddenly goes into congestive heart failure after sudden emotional stress. In simpler words, the heart’s ability to pump blood is sharply reduced due to muscle weakness and blood is not circulated properly. This causes blood to dam up and cause symptoms such as chest pain, breathlessness, fluid overload and much more.

The characteristics of this disease is that the heart temporarily enlarges so that the tip (apex) bulges out while the function of the base (upper part of the heart) is normal. The muscles in the apex is thinned while the base has hypertrophied and thickened. This gives the appearance of a thin pocket with a thick entrance, thus giving the name takotsubo cardiomyopathy, which means “octopus trap” in Japanese.
Given the patient survives the initial heart failure, their condition improves over the course of two months. The patient may also need psychiatric help or antidepressants and sedatives to ease the stress that led to the heart failure. 

As the presentation is very similar to a normal myocardial infarction (“heart attack”), the diagnosis may be difficult. The cause has not been identified yet, but researchers believe it to be due to a combination of blood vessel spasms disrupting blood supply to the heart and high levels of catecholamines. As catecholamines (adrenaline/noradrenaline) are released in great quantities in times of stress, this theory has some plausibility. A similar thing happens when patients with heart problems are exposed to significant levels of fear – their heart goes into overdrive and develop cardiac arrest due to an exacerbation of their condition.

The concept of dying from intense emotions such as anger and stress is found in almost every culture, where a person collapses and falls deathly ill after shocking news or a particularly stressful experience. But modern medicine has only just begun to understand the scientific reasoning behind this strange phenomenon.

It has also been noted that takotsubo cardiomyopathy tends to affect post-menopausal women, especially widows. Interestingly, most of these patients are not considered “at risk” for a heart attack and generally healthy. 
Thus, stress alone can be enough to “break” someone’s heart and cause sudden death.

(Source: http://sndr.deviantart.com/art/Broken-Heart-7445432?q=boost%3Apopular%20broken%20heart&qo=0)

Posted in Science & Nature

Shrew

Posted on by Jinavie

A shrew is a small rodent, similar in size to a rat, that has many fascinating characteristics.

Funnily enough, this animal has a notorious name in history. Ancient Egyptians considered shrews the spirits of darkness and the English believed that if a shrew ran over a lying animal, the animal would suffer great pain. The name shrew comes from the Middle Age English word shrewe, which meant “evil” or “scolding person”.
This is probably attributable to the putrid smell a shrew makes when threatened, and its poisonous bite.

Despite its tiny figure, the shrew has the greatest surface-area-to-weight ratio out of any mammal on the face of the Earth. Because of this, they also have a high heat expenditure, meaning they have to eat constantly to replenish the energy. This means that they sometimes die from starvation during prolonged naps.
Also, they have an extremely high heart rate, averaging about 700 beats per minute. When they are frightened, the heart rate can spike leading to cardiac arrest. For example, shrews are known to die from being frightened by the sound of thunder.

An animal that dies if it naps too much or when thunder strikes – the shrew is a very sad animal.

Posted in Psychology & Medicine

CPR

Posted on by Jinavie

CPR stands for cardiopulmonary resuscitation – or in plain English, artificially (and partially) restoring the function of the heart and lungs of an unconscious, pulseless person. As blood flow (perfusion) is critical in the survival of major organs such as the brain, this procedure can save lives by prolonging a victim’s life until the paramedics arrive to provide professional medical care.

When the heart stops beating, or becomes inefficient due to erratic beating, blood flow stops. In the case of the brain, this means that the cells will start dying after 4~5 minutes if perfusion is not restored. CPR can restore about 30% of perfusion, delaying the onset of brain death.

This may be critical when someone suffers a heart attack (myocardial infarction) and paramedics will not arrive for over 10 minutes. Ergo, this is one of the most important emergency skills one should know to help people in need as soon as possible.

There are different guidelines for CPR in many countries, but here is a standard procedure guideline (NZ).
It is summarised into the acronym: DR’S ABCD (doctor’s ABCD), and is a flowchart that goes from one step to the next (detailed explanation after summary).

  1. Danger: check that area is safe and risk-free
  2. Response: check for patient response by shouting, shaking, pain
  3. Send for help: pick one person to call emergency services
  4. Airway: check airway, remove obstruction, tilt head back and lift chin
  5. Breathing: check for breathing, go to CPR if no breathing
  6. Circulation: check for pulse if breathing, if no pulse, start CPR (30 chest compressions : 2 breaths)
  7. (Defibrillation): follow AED instructions

The first rule of first aid is that you must not put yourself in danger. For example, if the patient is on the road, pull them to a safe area to minimise the risk to your own health.

Then, check for a response. The easiest way is to call loudly to them such as “Can you hear me”, and inflicting pain (such as rapping on their chest or shaking their shoulders) and see if they become conscious.

If they remain unconscious, immediately designate a person around you by pointing to them (otherwise they will be less likely to be responsible) to call the emergency service (111, 911, 119 etc.), alerting them the location and state of the patient.

This is the point when clinical skills come in.

Airway: An unconscious person may have their airway obstructed by vomit or their own tongue (which falls back by gravity into the throat). You must secure the airway by scooping out any material, and clearing the tongue out of the way. This is done by tilting the head back far (as if they are looking up), then using one hand to pull their chin out. This opens the airway up so that mouth-to-mouth becomes effective.

Breathing: Put one ear right next to the person’s nose and mouth and check for any breathing sounds or air flow. If they are breathing, check the pulse to see if they are pumping blood. If not, go straight to CPR.

Circulation: It is best to check the central pulses such as the carotid (side of neck, next to the Adam’s apple), brachial (squeeze inner side of biceps) or femoral pulses. The carotid is often the easiest as most people know how to take it. If you feel a pulse, put the patient in recovery position as they are just unconscious, breathing and has blood flowing. If not, proceed to CPR (as you do with when the patient is not breathing).

CPR is composed of two actions: chest compressions and mouth-to-mouth breathing. The former is the strong compression of the chest wall to squeeze blood in and out of the heart; the latter is breathing air into the patient’s lungs and letting exhalation come out naturally.

Chest compressions are often misrepresented in medical dramas, and is extremely important that you do it correctly. First find where the sternum is (centre of ribcage, between the nipples) and place the heel of your left palm on it, then spread your fingers out. Put your right hand over your left and close your fingers around it for a good grip. If the patient is lying flat on the ground (with head tilted back), kneel beside them and stoop over their chest with straight, locked arms (bent arms exert much less pressure).

You are now ready to begin chest compressions. Press down hard, until the chest wall is compressed to about 1/3~½ depth (the chest wall is a springy structure, and do not worry about broken ribs, as being alive is more important for the person), then ease pressure to let it bounce back up. Ideally the time pushing and the time letting it bounce back should be the same, giving a good rhythm. Repeat this 30 times at the beat of 100/min, or in easier terms: to the beats of the Bee Gee’s song Stayin’ Alive (scientifically proven).

After 30 compressions, tilt the patient’s head back, lift their chin up, and lock your mouth over their mouth and nose to make an airtight seal. It is crucial that you use a face shield to prevent the spread of disease. Be aware that breaths are less important than the compressions, so if you do not have a face shield, let someone else do the breathing and focus on chest compressions. Pinch the nose closed to ensure air does not escape.
Forcefully breathe into them and look for the chest rising. Let go of the nose and pull away so that they can breathe out. Repeat once, then return to chest compressions.

After 2 minutes of CPR (30 compressions : 2 breaths, repeat 4 times), change places with another person capable of CPR, as otherwise you will tire out and become inefficient.

Defibrillation is only possible if you are near an AED (automated external defibrillator). Nowadays, AEDs are designed to be completely user-friendly so simply follow the instructions on the machine.

It is important to note that not all abnormal heart rhythms are “shockable” (see Flatline). Follow the AED’s instruction, as it will state whether shock is advised or not. Make sure that CPR is still happening continuously.

Repeat until help arrives.

As a final note, remember that the patient is dead whether you do CPR or not, so there is nothing to lose. Believe it or not, this will be of incredible help in calming your mind when struck with such an emergency. Even with CPR, there is a maximum 30% chance the patient will survive, 10% if it occurs outside the hospital. But if you do nothing, their survival chance will be 0%, so put all your energy into resuscitating them, and you may just save a life.