Letter 3 - Difficulty to Breathe due to a problem in the Heart

Semmals Letters 

Dated 28012014

Letter 3 

              Difficulty to Breathe due to a problem in the Heart

Dear Daughter,

The greatest gift in Life is Life itself.

Now I would like to place to u a question – R u aware of u r breathing at all times of the day?

U would answer “No”

If anyone wishes to feel 24 X 7 then life would become a misery

But for some, it’s a reality

U r there to study medicine only to save them and make then as fit as U

The uncomfortable awareness of breathing is called as Dyspnea.

It may b due to problems in 2 systems in the body – CVS and RS and can b of 2 types – Acute and Sub acute or chronic

U can use u r logic to reason out that Subacute or chronic Dyspnea can be a symptom of some problem with the Lungs as it is a common presenting or accompanying symptom in patients with pulmonary disease

Still it b due to various other reasons, Lets c them 

Acute Dyspnea can be due to –

[1] Ischemia of the Heart 

[2] Failure of the Heart

[3] Severe hypertension

[4] Pericardial tamponade – Heart is encircled by fluid at an increased pressure

[5] Pulmonary Embolism – Air bubble placed within a pulmonary vessel

[6] Pneumothorax – Air in a space in the chest where it is not expected to enter

[7] Upper airway obstruction

[8] Acute bronchitis or pneumonia

[9] Drug overdoses (e.g., salicylates)

Apart from the Lungs and the Heart can any other system lead to dyspnoea, think deeply – S u r right the blood circulates between them – If that is inefficient as in Severe Anemia it can as well lead to dyspnoea.

Be careful a Pt with Neurological or muscle disease can confuse you with Fatigue and Dyspnoea.

Now I will teach u how to fix the cause for dyspnoea between the Heart and the Lungs.

When the Dyspnoea is experienced as a hunger for air and a need or an urge to breathe – then the cause can b with the Heart

When the Dyspnoea is experienced as a requirement for increased work or effort the problem can be an obstruction in the pathway for the air to move (the Lungs) or the problem can be with the movement of the chest wall in its muscles.

If the Pt says to u that he has a feeling that something is constricting his chest during breathing- then it may b due to bronchoconstriction caused by obstructive airway disease or edema in the Lungs.

How can a problem in the left ventricle lead to chronic dyspnea?

Simple explanation – Failure of the Left Ventricle → ↑ in pulmonary venous pressure → Back Pressure → Traffic jam in Pulmonary vein → Dyspnoea.

How can a problem in the Cardiac Valves lead to chronic dyspnea?

Now the check post is not clearing the crowd properly!!!

No big deal, the same mechanism as above.

Now finally for this small letter,
When a Pt, going for a peaceful sleep suddenly wakes up in the middle of the night and feels comfortable on assuming a sitting or standing position, what to call it?

It is called as – PND - Paroxysmal Nocturnal Dyspnea

The comfort experience by the Pt is due to achieving of gravitational redistribution of fluid.

Okay May God Bless U for a Lifetime of peaceful and graceful sleep.

Good Night.  

Dr.Semmals Letters related to Psychosomatic Medicine to his Daughter - Letter 1

Letter – 1

Dear Daughter,

As u were crossing the wards and interacting with real patients u r mind is ought to get a lot of intriguing questions related to the Basic Sciences, I am always there to help u to clarify them then and there. 

The other day u have been asking to me about a question, Why is Chest Pain so serious of a problem?

I would like to answer u about it now.

Its serious b’cos it can kill u r patient, but all pain  in the chest r not always from the heart, u need to know this.

Pain, u may even call it as discomfort in the chest is a cardinal  manifestation of ischemia involving the myocardium.

Now u need to know what does the word Cardinal means ?

The Word Cardinal means – of Foremost Importance – of paramount importance

Just wait – do u know that is the non medical meaning of the word Cardinal ?

It means sanctae romanae ecclesiae cardinalis( Latin) an ordained Bishop in the Roman Catholic Church.

Coming back to the problem of chest pain, it is quiet serious when it arises due to a reason involving the Myocardium. It can b due to dis ease in the coronary artery. Even when the arteries are fine as u believe yours to be – still there can be an imbalance which could lead to Myocardial Ischemia.

What is the Imbalance? - this imbalance is related to myocardial oxygen demand, when the supply is less compared to the need for myocardial oxygen, something akin to the status of the money balance tagged to u r ATM card at the end of the month, still  God has blessed u with many collateral's.

I mean u r good friends, who could give u the extra feed in times of need. 

When a patient comes to u with chest pain – First rule out it’s not from the heart, as it’s very dangerous.

Now u may ask me, can there be any reason beyond the heart to get it?

Lot may b there,

Apart from the Myocardium, It can b due to 

Dissection of the Aorta

From the Lungs (Pulmonary embolism - Pleural irritation)

Musculoskeletal origin from the chest wall, thorax, or shoulder

Gastrointestinal abnormality as due to reflux (stomach contents moving in reverse towards the esophagus – quiet horrible isn’t it)

Spasm of the Esophagus

Peptic ulcer disease

Cholecystitis

Now, what is Cholecystitis ?

“Chole” – means Gall Bladder

“Itis” – denotes Inflammation  

What is this site?

This site is the portal via which Dr.Semmal would b communicating to all his students across boundaries about the reverberating world of Psychoendoimmunoneurology. 

Subject: Brain Functions across Parturition – We have found it Sir!!!!

From,

Srinivasan  Venkataraman

Second year MBBS 

SRMC & RI

To

Dr.Semmal 

Director,Scientific Tamil Foundation 

Dear Semmal Sir,

Subject: Brain Functions across Parturition – We have found it Sir!!!!

        I am happy to inform you that today I have submitted the report of our ICMR research work to the Central Government of India. This is my first research work done by collecting data and doing an original study. The findings that we were able to obtain were very impressive and thought provoking, It has paved the way for the origin of still more questions in my psyche as to know about how the results actually resulted. I am sure that you would clarify the questions one by one.  

        It was a great feeling to be a researcher, the purpose of being educated can be better appreciated by these kinds of efforts. As discussed previously now we need to proceed on to the next levels.

(1)        To present the findings of our research at various national and International conferences.

(2)        To create scientific Books in English and in Tamil for the general public to be briefed about the frontiers in Science.

Thanks you very much for your guidance.

I am ready for the ventures.     

Thanking You,

Yours Sincerely

Srinivasan  Venkataraman 

பாஸ் நாமெல்லாம் இனி எப்பவுமே Pass !!!

பெறுனர்

திரு குமரன் 

முதலாம் ஆண்டு 

MBBS மாணவர்

தஞ்சை மருத்துவக் கல்லூரி 

விடுனர்

டாக்டர் மு. செம்மல்

நிர்வாக இயக்குனர் அறிவியல் தமிழ் அறக்கட்டளை

சைபர் தமிழ் சங்கம் (முதல் உறுப்பினர்)

    

தம்பி வணக்கம் 

தேர்வு காலம் நெருங்கும் நேரம் இது 

கவலைப்படாதே 

கவனமாக படி தம்பி 

உன்னால் வெற்றி  பெற முடியும் 

இப்ப இதற்கு முன்னர் நடைப்பெற்ற தேர்வுகளில் பல 

மருத்துவப் பல்கலைக்கழகங்களில் கேட்கப்பட்டுள்ள 

கேள்விகளை உள்வாங்கி அன்புடன் உனக்காக

நான் செதுக்கும் கடிதம் இது. 

இன்று General Physiology சார்ந்த கேள்விகளை ஒன்றின் 

பின் ஒன்றாக காண்போம் தம்பி.

General Physiology  என்றாலே நம்ம பசங்க , அப்பறம் பார்க்கலாம் என்று விடுவது எதார்த்தம்தான் - அப்பறம் என்பது எப்பரம் தம்பி ?

தள்ளிபோட கூடாதவைகளை தள்ளிப்போடகூடாது தம்பி 

தமிழ் மீடியத்துல படித்து வந்த நாம் எந்த வகையிலும் மற்றவர்களை விட குறைந்தவர்கள் அல்ல - இந்த வருட தேர்வில் அதனை நிரூபிக்க வேண்டும் 

சரியாதம்பி , super  - கலக்க துவங்குவோம் பாஸ் !!!

 schoolலயே சொல்லிக்கொடுத்த செய்திதான் இங்கும் வரும் , ஓர் அளவிற்கு - Mitochondria to Microtubule , Cell cycles and Types of Cell Division  கொஞ்சம் பார்த்துக்கொள்ள வேண்டும்.

          Sodium potassium pump என்றால் என்ன? , Functions of Na K ATP ase என்ன ? என்று தெரிந்துகொள்; regarding the transport of molecules பற்றி தெரிந்திகோல் தம்பி ; the difference between the primary and secondary active transport mechanisms , Facilitated diffusion மாற்றும இந்த அறிவை எப்படி மருத்துவத்தில் பயன்பற்றுவது (பாஸ், அதுதான்  clinical applications)  பற்றி அறிந்துகொள்.        

         The various intercellular junctions and their uses must b known to u, Resting Membrane Potential (RMP) what is it? How is that maintained? பற்றி தெரிந்துகொள்.

       தம்பி , u must know about the Refractory period - both absolute and relative ; பல்வேறு வகையான Cytosis ( Endo) (Exo) (Trans) (Phago) பற்றி கொஞ்சம் தெரிந்துகொள்.  

          Plasma tonicity, உடலில் உள்ள Fluid Compartments அவற்றின் வகைகள் பெயர்கள் – அளவுகள் – அளவை மதிப்பிடும் முறைகள் என அனைத்தையும் தெரிந்துகொள் ; Idea about the Ionic composition of ECF and ICF will help u to answer many MCQs; applied physiology about Edema and Dehydration பற்றி தெரிந்துகொள்.  

        General physiology பற்றி   கேள்விகள் பொதுவாக short notes வடிவில்தான் வரும் இருப்பினும் சில நேரங்களில் பெரிய கேள்வியாகவும் அது வரும்,  Homeostasis (Definition - Feedback Types) ; Axon Reflex and the Triple Response of Lewis is a fine question ; Regarding Electrical activity in the Nerves.

        Nerve Action potential Basics, Slatatory Conduction பற்றி கொஞ்சம் தெரிந்துகொள். ; Temperature Physiology பற்றி இப்பொழுது நிறைய கேட்கிறார்கள் question in it may be as “Body Temperature Regulation Mechanisms, Heat loss mechanisms,Body response to cold Environment.

சரி தம்பி

மற்ற chapters பற்றி பிறகு காண்போம்

நன்றி

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