Category Archives: Reviews

Heart Disease: Thoracic Aortic Aneurysm Risks

A thoracic aortic aneurysm is a weak spot in the aorta, the main pipeline for blood from the heart to the body. The weak spot has the potential to dissect or rupture, cutting off the supply of life-sustaining blood to the rest of the body. Thoracic aortic aneurysms are often harder to detect and diagnose compared to the more common abdominal aortic aneurysms. 

December 14, 2022

The aorta begins deep in the heart. It emerges from the top of the powerful left ventricle, curves up and over the heart in a gentle arch, then descends into the chest and through the muscular diaphragm into the abdomen (see “Thoracic aorta”). It ends around the belly button, where it splits into two smaller arteries, one for each leg.

THORACIC AORTA

From start to end, arteries branch off to nourish the heart, brain, arms, kidneys, liver, stomach, intestines, and every other part of the body. The stretch of the aorta from its start in the heart to the top of the diaphragm is called the thoracic aorta; the section below the diaphragm is the abdominal aorta.

Some aneurysms are relatively harmless. Others can lead to the catastrophic problems known as dissection or rupture. For now, size is the best and only guide to the health threat posed by an aneurysm.

Dissection. The most common consequence of an aortic aneurysm, dissection occurs when a tear develops in the inner lining of the aortic wall. The inner and outer layers peel apart, creating an extra channel for blood inside the aorta. It may do no harm, or it may allow blood to bypass the outflow to certain organs or tissues, leaving them without a blood supply. This can cause a heart attack, stroke, kidney damage, and other problems.

Rupture. A break in all three layers of the aortic wall is termed a rupture. Blood pours from the aorta into the chest. This massive internal bleeding can quickly lead to shock and death.

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Heart Health: Function & Benefits Of Pacemakers

“The likelihood of needing a pacemaker increases with age,” says Dr. Sunil Kapur, a cardiologist at the Heart and Vascular Center at Harvard-affiliated Brigham and Women’s Hospital. “The good news is that today’s pacemakers have evolved from fixing irregular heartbeats to helping the heart maintain its normal function, which allows many men with certain heart conditions to stay active longer.”

December 1, 2022

A pacemaker monitors the heart’s rhythm and, when necessary, generates a painless electrical impulse that triggers a heartbeat.

The most common use for a pacemaker is when the heart beats too slowly or pauses, which triggers dizziness, shortness of breath, or fainting. (You should see your doctor immediately if you have any of these symptoms.) A pacemaker also can help your heart chambers beat in sync and improve blood flow if your heart isn’t pumping enough blood. In some cases, a pacemaker may be needed to treat a heartbeat that is too fast or irregular.

These issues can stem from problems with the heart’s electrical signaling, a heart defect, an enlarged or thick heart muscle, heart failure, or a heart attack.

Several tests can help your doctor determine if you need a pacemaker: an electrocardiogram, which measures the heart’s electrical activity; Holter monitoring, in which you wear a small device to track your heart’s rhythm; or an echocardiogram, which uses sound waves to produce images showing your heart’s size, structure, and motion.

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Technology: ‘Low-Field MRI’ Stroke Detection

Recently, low-field MRI scanners have become available that are portable, are cryogen-free, are easy to use, provide rapid patient loading and unloading, have minimal power requirements, and have relatively low purchase prices and maintenance costs. For some indications, including ischemic stroke, these MRI scanners are a welcomed addition to the clinical armamentarium, as they have the potential to improve some aspects of clinical care over the current standard of care.

For one, they offer rapid “point-of-care” imaging diagnosis. Owing to their reduced cost and portability, these scanners could be deployed in a myriad of new settings, such as at-large public gatherings (e.g., sporting events or rock concerts), rural health care centers, emergency rooms, and assisted living facilities. Future innovations in motion correction, noise remediation, and image data upload capabilities suggest the eventual use of these scanners in ambulances or even on the battlefield.

Reviews: New Shoulder Replacement Surgeries

Shoulder replacement is a major surgery where all or part of the shoulder joint is replaced. In the past, it would take weeks for the patient to gain mobility, but new technology is changing all that.

Laura Britt has degenerative joint disease and as a result has had several surgeries, including shoulder replacements.

Reviews: The Top 5 Articles On Healthy Aging In 2022

National Institute on Aging – As 2022 comes to a close, NIA invites you to explore some of the most popular health information topics from this past year:

High Blood Pressure and Older Adults

— High blood pressure, or hypertension, is common in older adults. The good news is that blood pressure can be controlled in most people.

What Is Menopause?

 — Menopause is a normal part of aging for women, but it affects every woman differently.

Memory, Forgetfulness, and Aging: What’s Normal and What’s Not?

 — As you age, you may wonder about the difference between normal, age-related forgetfulness and a serious memory problem, such as dementia.

Shingles 

— Shingles is a disease that triggers a painful skin rash. About one in three people will get shingles, but there is a vaccine for older adults to help prevent the disease.

Vitamins and Minerals for Older Adults

 — Vitamins and minerals are types of nutrients that your body needs to survive and stay healthy.

Reports: Tufts Health & Nutrition – December 2022

December 2022 Issue:

Beware of “Health-Washing”

Front-of-package health claims can be helpful—but they can also be misleading. Learn how to tell the difference.

Habitual Coffee Consumption Associated with Health Benefits

A study that followed nearly 400,000 middle-aged individuals in the U.K. for a median of over 10 years found that, compared to individuals who reported drinking less than one cup of coffee a day, drinking four or more eight-ounce cups a day was associated with lower risk of 30 medical conditions.

FDA Proposes New Definition of “Healthy” on Food Packages

The U.S. Food and Drug Administration (FDA) recently proposed new draft guidelines for food manufacturers who want to label their products as “healthy.” This term was last defined in the 1990s. According to the FDA, “our current definition permits manufacturers to use the claim ‘healthy’ on some foods that, based on the most up-to-date nutrition.

C. diff Bacteria: What Is Clostridioides difficile

“C. diff is a severe, difficult-to-treat infection,” says family medicine specialist Daniel Allan, MD.
Studies show that you’re seven to 10 times more likely to get C. diff while you’re taking antibiotics or right after.”

Cleveland Clinic – Clostridioides difficile (C. diff) is a type of harmful bacteria that causes inflammation in your large intestine (also known as pseudomembranous colitis). The main symptom of a C. diff infection is frequent, watery and sometimes bloody diarrhea. If diarrhea persists, it can lead to:

  • Dehydration.
  • Weight loss.
  • Sepsis.
  • Death.

C. diff is common in the environment. Some people even carry C. diff in their gut but don’t have any signs of illness. Most of the time, the “good” bacteria in your gut prevent a C. diff infection. But certain antibiotics can wipe out your gut bacteria. If you encounter C. diff while taking antibiotics, the bacteria can flourish and grow and make you sick.

“Think about your colon as a plush green lawn. The thick grass crowds out the weeds,” illustrates Dr. Allan. “But if your yard is mostly dirt, all kinds of weeds will grow. Antibiotics reduce the rich collection of bacteria in your gut (the thick grass). This gives C. diff (the weeds) an opportunity to take hold.”

C. diff is most dangerous for people age 65 or older or with a weakened immune system. People who are healthy can also develop life-threatening complications if they don’t receive prompt care.

Hearing Aids: Over-The-Counter vs Prescription

Hearing aids are not one-size-fits all. “While OTC devices may help many people with mild or moderate hearing loss, they might not be appropriate for all types of hearing loss,” says Dr. Naples.

Harvard Health Publishing – A change in FDA regulations has cleared the way for over-the-counter (OTC) hearing aids. What does this mean for you if you’re among the approximately 48 million Americans with some degree of hearing loss? We asked Dr. James Naples, assistant professor of otolaryngology/head and neck surgery at Harvard-affiliated Beth Israel Deaconess Medical Center, to help explain potential pros and cons.

The basics: Hearing aids versus amplification products

There are various types of hearing aids that largely work in the same way. Whether the style is behind the ear or in the ear canal, they amplify sounds to make them louder. They also help filter out certain types of noise. “All hearing aids use a combination of signal processing and directional microphones to filter out some unwanted noise and to improve our ability to hear sounds,” says Dr. Naples.

Don’t confuse prescription or OTC hearing aids with personal sound amplification products (PSAPs) sold at most drug stores. Such products merely amplify nearby sounds. They’re not tailored to an individual’s hearing loss, and aren’t regulated by the FDA or intended to treat hearing loss.

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COMMENTARY:

Humans and their mammalian cousins have lost the ability to regenerate the hair cells in the inner ear. In preindustrial society(how could they know?) people apparently didn’t lose hearing as they aged. However, in the Industrial Age, the prevalence of noise has been increasing along with our power consumption,  and loss of hearing consequently occurs along with Aging.

High frequency loss is the most prominent, and this leads to inability to hear consonants, and have more difficulty with the voices of children and women which tend to be of a higher frequency. The ability of young people to hear high frequencies better than older people has led to various ringtones and songs favoring high frequencies, which the children can hear and older people cannot.

There are a number of things that can add to this hearing loss, such as chronic exposure to loud sounds (such as rock concerts), exposure to drugs that damage hearing, such as certain antibiotics and even aspirin. Otosclerosis and repeated middle ear infections can also accentuate the problem by interfering with sound conduction.

Ringing in the ears, tinnitus, is also associated with accelerated hearing loss.

I have had tinnitus for a long time, and at the age of 90, I have definite hearing loss. Even a couple of decades ago my high frequency loss was quite demonstrable by audiogram. I am resisting the temptation to get it corrected, since the louder sounds from the device would probably gradually reduce my baseline hearing ability. Also  I am now forced to pay strict attention when listening to people. This may slow down the tendency of older people to have a greater difficulty in “decoding” the  spoken word, due to decreased brain processing.

With the passage of a new law permitting people to access hearing aids without a prescription, the price of hearing aids is bound to go down, another reason for waiting.

If you are considering getting a hearing aid, an audiologist would prepare one that is tuned to your specific hearing loss.

The best is none too good.

—Dr. C.

Aging: ‘Healthy Longevity’ Journal – November 2022

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Inside the November 2022 Issue:

Research & review on #Alzheimers, global burden of benign prostatic hyperplasia, #WHO def of vitality capacity, IPD meta on social connection & #cognition, #oralhealth for older people & more.


Hope on the horizon for Alzheimer’s disease treatment?

Social connectedness and cognitive decline

Time to take oral health seriously

Heart Disease: The Best Ways To Lower High LDL Cholesterol Levels

November 1, 2022

What is a healthy target for LDL cholesterol?

Target LDL depends on many factors, including your age, family history, and personal history of cardiovascular disease. For people at intermediate risk, LDL should be lowered by 30% to 50%. For those who have already had a heart attack, target LDL is no more than 70 mg/dl (note: automatic download).

Which non-statin therapies are recommended first?

Five non-statin therapies described in this post aim to help people achieve target LDL goals while minimizing side effects. They may be combined with a statin or given instead of statins.

Each helps lower LDL cholesterol when diet and statins are not sufficient, such as when there is a family history of high cholesterol (familial hypercholesterolemia). But so far, only two options are proven to reduce cardiovascular risk — the risk for heart attack, stroke, heart failure, and other issues affecting the heart and blood vessels.

Ezetimibe (Zetia)

What it does: Lowers LDL and cardiovascular risk by reducing cholesterol absorption.

How it’s given: A daily pill

Relatively inexpensive and often given with statins.

PCSK9 inhibitors, alirocumab (Praluent) and evolocumab (Repatha)

What it does: A protein called PCSK9 controls the number of LDL receptors on cells. These medicines are monoclonal antibodies against PCSK9 that increase LDL receptors on the liver, helping to clear circulating LDL from the bloodstream.

How it’s given: A shot every two to four weeks

Highly effective for lowering LDL, but expensive and may not be covered by insurance.

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