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