Fainting or syncope occurs when insufficient oxygen reaches the brain. A person can either suddenly lose consciousness without warning or may develop symptoms before hand such as feeling light headed, sweaty or nauseous. The person then falls unconscious and in most cases after a few moments recovers and may feel nauseous or can vomit.

Treatment:

The best position for fainting is lying down. Often a person who has fainted ends up on the floor and this helps to improve oxygen supply to the brain. Leave the person in the recovery position and do some basic checks. You should check that the person is breathing and there is a pulse.

After a simple faint a person should wake up without any deficit but there are other reasons why a person can faint (have syncope) and the person may remain unconscious or have difficulties when recovered. This depends on the cause.

Causes of Syncope.

Vasovagal Syncope: This is due to an over stimulation of the Vagus Nerve. This results in heart slowing down and less blood reaching the brain. This can result from

1. Severe pain or fear. A fellow Medical Student fainted when I tried to take a drop of blood from his finger by pin prick.

2. Acute Blood loss. This can be a haemorrhage or serous loss from burns.

3. Postural Hypotension. Blood Pressure drops when standing up quickly.

4. Drugs. Some drugs such as nitrates can do this.

Cardiac Cause:

1. Asystole: More commonly know as Flatline. No cardiac output.

2. Sudden irregular heart beat such as ventricular fibrillation.

3. Aortic Stenosis. When the valve allowing flow of blood to the Aorta from the heart is restricted. Increase effort may produce syncope.

4. Cardiac Shock: This can occur after a massive Infarct (heart attack).

5. Pulmonary Embolism. This is a clot in the lungs.

6. Myocardial Infarction.
   

State of the Blood:

1. Hypoxia: Low level of oxygen in the blood either due to low percentage of oxygen in the lungs or poor transfer of oxygen from the lungs to the circulation.

2. Anaemia: Low Haemoglobin level means less oxygen can be transported from the lungs to other parts of the body.

3. Hypoglycaemia: This is low blood sugars level. Glucose is needed to produce energy in the body. In the presence of oxygen, glucose is broken down to release energy.

Cerebral problems.

1. Ischaemic attacks: This is when blood supply is temporarily restricted. This is often due to clogged up arteries supplying the brain. Commonly know as Vertebro-Basilar Insufficiency.

2. Stroke: This can be cerebral thrombosis (clot) or Cerebral Haemorrhage (bleed).

What to look for when deciding cause:

1. May be just a simple faint with sweating, pallor and desire to pass urine.

2. Epilepsy. May have obvious pattern of a seizure.

3. May be following a bout of cough. Cough Syncope.

4. May be following Meniere’s Disease. This is a disease of the ears causing vertigo, nausea or even vomiting.

5. Hysteria.

If you see a person who you suspect has fainted, put the person in a recovery position and keep checking the stats e.g. pulse and breathing while you wait for assistance or the person recovers.

Your heart is made up of two ventricles and two atria. There is a left and right side of the heart. The left side pumps oxygenated blood to the rest of the body. The right side collects deoxygenated blood from the veins and sends it to the lungs and then returns it to the left heart.

If your heart rate is regular and normal, it is estimated it will beat 2700 million times by the age of 75 years.  So look after this precious organ. Coronary Artery Disease is the commonest cause of death in UK. There are several things you can do to avoid heart disease. This Blog will go through them all.

Blood pressure.:Low blood pressure will make you light headed when you stand up quickly. You can become dizzy or even pass out. High blood pressure can cause heart disease and conditions such as stroke. It is therefore important that you have your blood pressure checked. If  high then you may need medication.

High blood pressure or hypertension is a chronic condition and you should be prepared to be on medication for the rest of your life. The gold standard for blood pressure is 120/80 and 140/90 and above will need scrutiny. Your blood pressure increases with age as the arteries become less elastic. Statistics show that men are at a higher risk of developing high blood pressure in their 30s and early 40s but the risk equalises between 44 and 55 and after that, women have a greater risk.

Research show that alcohol in moderation is beneficial to the heart. This is because it increases the level of the good high-density cholesterol (HDL). It also makes the blood less sticky reducing the risk of stroke and heart attacks.

Smoking affect the heart and giving up smoking reduces your risk of coronary artery disease by 36%. Childhood obesity is an good indicator of later in life heart disease. The statistic show that between the ages of five and 17  years, one in ten are obese ~ approximately 155 million globally. A bit scary.

Genetic factors must be taken into considering when assessing risk and this can be as high as 50%. In addition a person who has coronary event or stroke is a greater risk of having further problems and preventative medication are given.

Heart failure is a serious disease and results in fluid leaving the circulation and diffusing into tissues of the body. This leads to swelling of the legs, back etc. Shortness of breath on exertion or at rest can be due to fluid in the lungs. At rest a person with heart failure needs to be propped up with several pillows to avoid breathlessness. There can be fatigue, light headedness, weight gain due to fluid retention or even chest pain.

Coffee contains caffeine. This can increase the heart rate or even make the heart skip a beat. Caffeine is also found in tea and chocolate. If you have a healthy heart this is not a problem , but if you have coronary heart disease it is best to cut out coffee.

Dr. Phil Hariram.

Angina is a constrictive pain in the chest due to Ischaemic heart disease. It is also known as Angina pectoris.

There are two types. Stable Angina is of short duration brought on by physical exertions or mental stress. Unstable Angina is of longer duration lasting between 30 to 60 minutes and can be brought on by stress but may occur at rest e.g. at night.

What is Angina pectoris?

Angina is a pain in the chest and it is caused by a progressive obstruction of the Coronary Artery tree usually from arteriosclerosis. It can be aggravated by conditions such as anaemia, thyrotoxicosis and hypertension. It is more common is diabetics.

Signs and Symptoms.

Angina is a crushing heavy pain in the chest lasting 2 to 10 minutes. The pain is not sharp. The pain can radiate to the left arm, occasionally to the right side or into the neck or abdomen. It is triggered by increased cardiac demand from exertion, cold, heavy eating, smoking, anger and fear. If examinaed by a doctor no abnormality will be detected  but an ECG will show typical changes during an angina attack.

Diagnosis.

This is usually from a careful history and where the pain presents and where it spreads to. A provocative ECG (Exercise ECG) using a threadmill or exercise bike will display characteristic changes. Cardiac Angiography will hone in on the specific site and distribution of the Coronary Artery.

Some times Angina symptoms can be confused with symptoms of anxiety, indigestion, peptic ulcer, oesophageal spasm, hiatus hernia, gall bladder disease, pleurisy and pancreatitis.

If you suspect you have angina, it is vitally important that you seek medical help at the earliest opportunity. Treatment today is excellent.

There are some general measures you must adopt. You should stop smoking. Lose weight if indicated. Have you blood pressure checked and if high and you are on medication, not only must you take your tablets but have regular BP checks to ensure good BP control. If you are anaemic or your cholesterol is high, you will be given treatment by your GP.

If you have chest pains and you are not sure, check it out. See your GP. Either way it is better to know. Reassurance from your GP goes a long way and if it is heart related, you have started the process of investigation and treatment.

Dr. Phil Hariram.

An HGH test will help one to know about the level of the human growth hormone in their body. Any deficiency can be cured thereby with the help of the report from the test. It is a useful tool in the field which helps in taking the correct supplement for the deficiency.

The level of the growth hormone in the body can be performed with the help of the blood or urine sample and analyzed with the help of HGH test. They are mainly used in the field of sport for testing the positive ness of the banned drug which will increase the performance of the person by increasing the human growth hormone.

The purpose of the HGH tests is,

- To find the growth deficiency

- To find the cause of gigantism and acremogaly.

- To identify pituitary tumor

- Done before HGH therapy.

Let us educate ourselves about the various available tests in this field and the purpose of those tests.

Somatotropin test

This test is performed in order to identify the growth deficiency. The deficiency may include low height and low and late level of sexual desire. This test will also help in recording the level of the growth hormone which can also help in identifying the reason for acromegaly and gigantism. The blood for the test is drawn after sleep or after exercise, because the hormone level will be high at these times.

Growth Hormone Stimulation Test

It is a HGH stimulation test that is also known as the Arginine test. This is used to find the growth hormone stimulating level of the person. It give the value about mans capacity in stimulating the growth hormone. It is also a test for hypoglycemia, a condition in which the level of the insulin is high. This method is more accurate in the values produced by it.

Somatomedin C

This is another type of HGH test that will detect the abnormality in the pituitary gland, if any. This is a test for the Insulin like growth factor level in the blood. The low level of Somatomedin C test will confirm the low level of growth hormone or an deficient condition of growth hormone. This Somatomedin C is a group of peptides that are found circulating in the blood stream.

Growth Hormone Suppression test

In this test the level of the growth hormone is measured in order to detect acromegaly in adults and gigantism in children. The test is done in the following way. A blood sample is taken from the patient by giving him 100gm of glucose through mouth. Then another sample is taken after two hours. The technology behind this test is that the glucose will suppress the HGH level. If the HGH level is high, then there is no suppression and it is identified as there is a problem in the pituitary gland.

The entire above HGH test is very much useful in determining the growth hormone level in the body. This will also help the doctor to administrate proper HGH supplement for increasing the level of the human growth hormone.

Hyperuricaemia is a higher than normal blood level of uric acid. There are individuals with high blood uric acid levels and have never had an attack of gout. Are these people at risk of arthritis of the joints and kidney stones from urate crystals deposits? Yes they are.

Firstly the diagnosis of asymptomatic hyperuricaemia is made more frequently because of more screening, and blood tests for insurance purposes. Secondly you can break it down to primary and secondary types. In the primary type there may be a genetic link. In this case there is a deficiency of an important enzyme leading to excess production of uric acid. When this is severe (Lesch-Nyhan Syndrome), there are severe problems.

Secondary hyperuricaemia results from factors affecting the production and/or elimination of uric acid. These include medical conditions, drugs, metabolic conditions, obesity and alcohol consumption.

Sometimes hyperuricaemia is suspected when patients present to the doctor with tophi. These can be acute or chronic. An acute tophus is usually small and later soften when it becomes chronic. They look like small nodules and as they grow bigger, the skin overlying them looks shiny and feels smooth. Sometimes they can ulcerate and release white chalky stuff. If the patient is treated with allopurinol the tophi usually becomes smaller.

Dr. Phil Hariram

Arthritis Guide.

In the days before adequate treatment controlled the blood level of uric acid, chronic gout presented with multiple joint involvement and chronic poly-arthritis. Today this is rare and only found in patients who refuse medication, have poor compliance or unable to take suitable medication.

Here the acute gout attack will become more frequent. Then other joints become involved. The crystals deposited in and around the joints are needle shaped and I suspect this is why acute gout is so painful.

I had an elderly patient who had heart failure and was on large doses of diuretics and ace inhibitors. She developed acute gout. Her medication was looked at and altered. Unfortunately her uric acid level remained very high. She was started on allopurinol.

She developed an allergic rash to allopurinol. In fact everything the consultant prescribed gave her problems. In the end she had no medication and refused any attempt to try anything for her gout because she was worried about side effects.

She was put on a specific diet. Eventually she developed poly-arthritis. Her fingers had big nobbles for joints and she had problems walking around her ground floor flat. Tophi developed first on the ear then elsewhere.

A joint badly damaged by chronic gout will on x-ray show erosions, secondary calcium deposits and soft tissue swelling.

Allopurinol is the drug of choice in chronic gout. By maintaining the blood level of uric acid within the normal range, separation of urate crystals into joints and kidneys are prevented.

Dr. Phil Hariram.

Arthritis Guide.

The first explanation of podagra was in the sixteenth century by Burgamer, a German Physician. He said podagra is a pain in the feet with or without swelling which comes from dampness or drought.

Podagra is acute gout affecting the big toe and typically the first metatarso-phalangeal joint. It is as a result of higher than normal uric acid in the blood. Uric acid is mainly excreted by the kidneys.

Diuretics and other drugs can affect the function of the kidneys and reduce excretion of uric acid. This can cause elevated level of uric acid in the blood and acute gout.

Over indulgence in alcohol can trigger acute gout. Beer is the worse alcoholic beverage for gout. Port was linked to gout in the eighteenth century. At the time, port was stored in lead lined casks and lead diffused into the port.

Lead in the consumed port accumulated in the body and in the kidneys, it affected the ability of the kidneys to excrete uric acid. The imbalance caused high uric acid in the blood. This condition is called Saturine gout.

Sometimes podagra can develop following initiating treatment with allopurinol. Gross over eating especially seafoods and red meat can trigger podagra.

No one knows exactly why podagra is the commonest manifestation of acute gout. Some suggested that the first metatarso-phalangeal is used a lot and takes a lot of the body’s weight when walking.

Dr. Phil Hariram,

Arthritis Guide.

Gout develops when the level of uric acid in the blood stream is higher than normal. When this happens urate crystal are deposited in and around the joints.
There are two types of gout, primary and secondary. The body eliminates uric acid from the blood naturally and most of this (66%) is done by the kidneys. In primary gout the process of elimination is slow and as a result the uric acid level in blood remains higher than normal. This is called hyperuricaemia.

In this condition the level of uric acid in the blood gradually increases over several years and during this time there are no gout symptoms. In addition it is estimated that only 5% of people with high blood level of uric acid develop gout.

Secondary gout is as a result of other diseases or factors that can elevate the level of uric acid. Often it is the case that these diseases or drugs make the body produce uric acid faster than the body can eliminate it.

Drugs that can raise uric acid level are diuretics especially thiazides,low dose aspirin,pyrazinamide and cytotoxic drugs.

Medical conditions that can trigger gout include kidney disease, myxoedema, psoriasis, lead poisoning, sarcoidosis, obesity, myeloproliferative disorders and polycythaemia.

People on very strict (almost starvation) diet can have high uric acid levels. Hyperlipidaemia is associated with high uric acid level.

Urates are eliminated mainly by the kidneys. The renal tubules are the important part of the kidneys for excretion of uric acid. So anything that can affect the efficient functioning of the renal tubules can affect the level of serum uric acid.

Dr. Phil Hariram,

Arthritis Guide

Gout is a form of inflammatory arthritis. In gout, crystals of uric acid is deposited in and around the joints. For this deposit of urate to occur, the circulating level of uric acid in the blood must be higher than normal.

Gout has been recorded through the centuries. Hippocrates wrote about it and urate crystals were found in the big toe of an Egyptian mummy.

Gout is more prevalent in males and high in affluent societies. This may be a dietary factor. In the old days the rich ate the expensive red meat while the poor could only afford grain. Guess who developed gout?
Acute gout is rare in pre-menopausal women and it is predominantly a male disease up to the age of 50. It usually starts after 30 years of age and more commonly between 40 and 50 in males. In women the first attack is usually between 50-60 years.

The first attack of gout is usually in the big toe and this is called Podagra. 70-90% of first attacks present this way.

Pain often develops at night and within a few hours the pain level can escalate to severe and throbbing. The big toe will become red, hot, swollen and very tender to the touch. This acute attack will resolve spontaneously but can take weeks. Medical intervention often shorten this episode.

After this first attack your doctor is not likely to start you off on long term medication because you may not get another attack for years. On the other hand, you could have another attack in days.

Dr. Phil Hariram,

Arthritis Guide.

Magnets were discovered in China and Greece. In China it was used in fortune telling and as a guide to building. By 1200 AD they were used in ships as compasses. Ever since, sailors and navigators have used compasses and the earth’s magnetic field to guide them in their journeys, whether on land or at sea.

Legends have it that Magnes, the Greek shepherd discovered the magnetic properties of lodestone when his iron staff was stuck to the lodestone and he was unable to dislodge it. Another legend has it that magnets were discovered in Magnesia, a place in Turkey.

Traditional Chinese Medicine which dates back to 2600 BC used magnetic stones on certain areas of the body to correct imbalance. The Vedas, dating back to 1500 BC, mentioned the use of lodestone in healing. The dead were buried with the head facing north to create harmony between the body and the earth.

Thales, a Greek philosopher, described the magnetic effects of lodestone in the seventh century BC. When St. Augustine arrived in Britain in the sixth century, he noted that lodestone was being used.

Compasses were developed where the lodestone was suspended by a piece of string, then later by a piece of wood in water. This was subsequently replaced by the dry suspension magnets.

In 1269, Pierre de Maricourt mapped the magnetic field around the lodestone. William Gilbert in the sixteenth century recognised the two poles, north and south. He also described the healing properties of magnets. Gilbert realised that iron rods left in a north south direction in alignment with the earth’s magnetic field, became weakly magnetised after 20 years. He suggested that lightning could magnetise iron. He also found that if a blacksmith heated an iron rod, and cooled with the rod lying in a north south direction, it becomes magnetised if the blacksmith hammered it while it is cooling.

The horseshoe magnet was developed by bending a straight iron magnet into the shape of a horseshoe. With the north and south poles so near to each other, the power of the magnet was doubled.

Iron magnets were heavy. Lightweight powerful magnets were soon developed. In the eighteenth century, carbon steel magnets were developed. It retained its magnetism better than beaten iron.

The first alloy containing magnet was developed in the early twentieth century and contained cobalt, tungsten, molybdenum or chromium. The next development was in the 1930s when iron was alloyed with aluminium, nickel and cobalt. These magnets were called Alnico magnets. These magnets were still metal based and therefore heavy to use.

In 1980s, magnets incorporating cobalt and samarium were used. They were the rare earth magnets. They were lighter and were used in industry. They were, however, expensive. In 1983, magnets using iron, boron and neodymium were produced. They were called Neodymium Magnets. They are very difficult to demagnetise and will remain magnetised for several decades. The process by which neodymium magnets were developed is called sintering. High temperature and pressure are applied to the powdered metals. This, however, means the magnets are brittle but this can be overcome by using a strong metal casing. A Neodymium magnet of say 8000 gauss weighs 20 gm while the comparable strength Alnico magnet weighs 90kg.

In the nineteenth century, Hans Christian Oersted, professor of physics at Copenhagen discovered that an electric current developed a magnetic field. In 1830s Michael Faraday and Joseph Henry independently discovered that a magnetic field produced electricity.

James Clerk Maxwell, a British physicist developed the Cork Screw Rule for calculating the direction of electrical flow when an object is moved in a magnetic field. In 1820 Andre Marie produced a mathematical relationship between electricity and the strength of the magnetic field.

Franz Anton Mesmer was the eponymous Viennese psychiatrist who developed the theory of animal magnetism. In his magnetic seances, Mesmer placed individuals in a magnetic tub, and made them relax. He then touched them, sending them into a trance. When they woke up, they were cured.

Pierre Curie discovered that magnets lose their magnetism above a specific temperature. This is now known as the Curie point. Edward Purcell & Flix Bloch developed a way to measure the magnetic field of nuclei. This led to the development of the MRI (Magnetic Resonance Imaging) scan.

In the 1960-1970 superconductors were developed. Magnets were cooled to absolute zero. These magnets can generate fields up to 200,000 gauss. It is used today in nuclear research.
Dr. Phil Hariram.

Arthritis Guide.