is Cardiomyopathy ("weak heart muscle"),and How it is Classified

The cardiomyopathies are a group of diseases in which the primary feature is direct involvement and weakening of the heart muscle (myocardium only). Cardiomyopathies are increasing in incidence and are a significant cause of death. Dilated cardiomyopathy, the most common type of cardiomyopathy, is reported to occur in 5 to 8 people per 100,000 population per year.

Cardiomyopathies occur more frequently in blacks than whites and more commonly in men than women. Factors that are associated with increased death rates in cardiomyopathy patients include the following:

Weak heart function (left ventricular ejection fraction:

• Aging (age greater than 55 years)

• Reduced functional capacity

• Electrical abnormalities

• Low blood sodium level (hyponatremia)

• Worsening kidney function.

Cardiomyopathy can be classified as primary, which is heart muscle disease of unknown cause, or secondary, which is heart muscle disease due to specific causes (such as narrowing of the heart arteries [coronary artery disease], heart valve disease, high blood pressure).

The World Health Organization (WHO) classifies cardiomyopathy into 3 major groups:

• Dilated

• Hypertrophic

• Restrictive.

What are the features and causes of dilated cardiomyopathy (DCM)?

Dilated cardiomyopathy (DCM) is typically characterized by significant enlargement of the 2 pumping chambers of the heart—the left ventricle (which pumps blood to the body) and the right ventricle (which pumps blood to the lungs). As a result of the chamber enlargement, there is some degree of reduction in the pumping power of the ventricle (reduced ejection fraction).

While there are many causes of DCM (nearly 80 specific diseases have been associated with DCM), a clear cause is often not identified in many individuals, and these cases are described as idiopathic. Alcohol abuse is a common cause of DCM, as long-term ingestion leads to cardiac cell (myocyte) damage with subsequent heart dysfunction. Many patients can see significant improvement if they stop drinking. Cocaine abuse can lead to DCM in some individuals; in 1 large study, more than 10% of cocaine users had at least mild left ventricular dysfunction.

Infectious causes can also lead to DCM. Viral infections can attack the heart muscle and lead to significant cardiac dysfunction; in many cases, the damage can be irreversible and severe. In young adults, severe viral-related DCM is the top reason to be "listed" for heart transplantation. Human immunodeficiency virus (HIV), the cause of AIDS, can also lead to DCM in a minority of causes. Vitamin deficiencies (such as thiamine) can lead to DCM, though such cases occur more commonly in Third World countries.

Metabolic disorders can lead to DCM. A relatively common example is hemochromatosis, a disease of iron metabolism, which is often familial and more common in men, in whom iron is deposited in the liver and heart muscle.
Peripartum cardiomyopathy is a form of DCM that typically occurs during the last 3 months of pregnancy and up to 6 months after delivery. It occurs in about 1 in every 5,000 pregnancies. The incidence is higher in women older than 30 years old and those with high blood pressure, multiple previous pregnancies, and twin pregnancies. Note that those who experience this condition are strongly discouraged from subsequent pregnancies, as the recurrence rate is high and death can even occur due to heart failure.

Chemotherapy drugs can lead to DCM in some individuals.
Drugs most commonly associated with DCM are doxorubicin, cyclophosphamide, amsacrine, and interferon. Neuromuscular disorders (disorders of the muscles and nervous system) are also associated with DCM.

Does therapy for DCM differ from that for congestive heart failure due to coronary artery disease (narrowing of the heart arteries)?

Treatment is similar for heart failure due to either DCM or coronary artery disease and includes:

• Salt restriction and diuretics (drugs that reduce lung and leg fluid via increased urine output)

• Beta-blockers (drugs that slow the heart rate and take stress off the heart)

• Angiotensin-converting enzyme (ACE) inhibitors (drugs that reduce the load on the heart by relaxing the body's major blood vessels)

• A combination of hydralazine and isosorbide nitrates (a drug option in those who cannot tolerate ACE inhibitors due to kidney function problems)

• Digoxin (a drug that helps improve the squeezing power of the heart).

What is hypertrophic cardiomyopathy (HCM)?

Hypertrophic cardiomyopathy (HCM) is a primary disorder of the heart muscle characterized by inappropriate hypertrophy (excessive growth) of the left ventricle, which is the chamber that pumps blood to the body's organs and tissues. In many individuals, hypertrophy predominantly involves the septum, which is the intracardiac wall that separates the left ventricle and right ventricle.

In at least one-quarter of cases, this variant leads to obstruction of blood flow out of the left ventricle and into the aorta and, hence, is called hypertrophic obstructive cardiomyopathy (HOCM). Overall annual death rates in HCM individuals are approximately 3% per year in adults, while the rates are higher in those with HOCM.

What are the causes of hypertrophic cardiomyopathy (HCM)?

In more than 50% of cases, HCM is genetically transmitted.

Most experts think that some if not all of the sporadic forms of HCM are due to spontaneous mutations (a sudden change in the genetic code of the developing fetus). At least 8 different genes have been associated with HCM. Note that genetic testing is not currently indicated (except in research settings), even in families in which HCM occurs, because knowing the type of gene defect does not impact subsequent treatment.

What are the most frequent symptoms in patients with HCM?

Shortness of breath (dyspnea) occurs in approximately 90% of symptomatic individuals with HCM. It occurs due to a combination of abnormalities, including poor relaxation of the stiff, thickened heart muscle (diastolic dysfunction), reduced blood flow into the main heart pumping chamber (impaired ventricular filling), and increased pressures in the left atrium and pulmonary veins.

Fainting and near-fainting (syncope and near-syncope) can occur in HCM patients due to inadequate cardiac output during times of increased demand (such as physical exertion or severe stress). Serious arrhythmias can also result in fainting episodes; in fact, such arrhythmias are a top cause of sudden death in otherwise healthy children and young adults.

Chest pain (angina pectoris) occurs in up to three-fourths of symptomatic patients.The discomfort is a result of an imbalance between a reduced oxygen supply to the heart (because of thickened and narrowed heart arteries) and increased demand (due to greater heart muscle).
What noninvasive testing can be used to evaluate patients with suspected DCM or HCM?


Useful tests include electrocardiography (ECG), chest x-ray, and ultrasound (echocardiography).
In symptomatic individuals, the ECG is usually abnormal, but no specific findings are diagnostic of either DCM or HCM.

A chest x-ray will demonstrate an enlarged cardiac silhouette in DCM patients and in some HCM patients.

An echocardiogram provides the most useful and specific information. In DCM patients, severe dilatation of the ventricles is demonstrated, and an accurate estimation can be made of the impairment of heart function. In HCM patients, thickening of the left ventricle is the cardinal feature. Other findings include narrowing of the outflow tract through which blood flows from the left ventricle and out through the aortic valve and into the aorta, a small left ventricular cavity size, and abnormal motion of the mitral valve.

What medical and invasive therapies are available to treat HCM patients?

Beta-blockers (examples include metoprolol and atenolol), which are drugs that slow down the heart rate, are the cornerstone of medical therapy for HCM. In up to two-thirds of patients, they reduce the frequency of chest pain, shortness of breath, and near fainting.
Calcium channel blockers, such as verapamil, have also been utilized with good success; they appear to help the thick heart muscle relax better (decreased diastolic dysfunction) and can reduce the outflow tract obstruction.

Insertion of a pacemaker may be useful in some patients with an outflow gradient and severe symptoms.

In high-risk patients, especially in those who have had serious ventricular arrhythmias or aborted sudden death, an implantable cardiac defibrillator (ICD) should be inserted.

Surgical and invasive options exist for severely symptomatic patients. A surgical myomectomy, or excision of excess heart muscle, has a mortality rate of 3% or less in large centers. Surgery results in long-term improvement in symptoms and exercise capacity in most patients.

A nonsurgical invasive approach involves injection of alcohol into 1 of the arteries supplying the excessively thickened septal wall; this is done via left catheterization (a small incision is made in a leg or arm artery to allow delivery of a catheter into the specific artery under x-ray guidance). Short-term results in experienced centers have been promising, but long-term results are still not available.

What is restrictive cardiomyopathy (RCM), and what are the most common forms?

Restrictive cardiomyopathy (RCM)—the least common of the cardiomyopathies—is characterized by abnormal relaxation of the heart muscle in the presence of normal ejection fraction. RCM is often classified into myocardial (throughout the heart muscle) and endocardial (from inside the ventricle).

The most common myocardial forms are amyloidosis and sarcoidosis (infiltrative diseases); scleroderma or idiopathic (noninfiltrative diseases); and hemochromatosis, glycogen storage diseases, and Fabry's disease (storage diseases).

Infiltrative diseases refer to abnormal proteins and cells generated by certain disease states that penetrate the heart muscle. Noninfiltrative diseases are typically diseases related to activation of the autoimmune system or due to a genetic abnormality that activates abnormal cardiac muscle growth, where the storage diseases refer to genetic abnormalities that lead to abnormal storage of sugars and other substances inside the heart muscle cells.

The most common endocardial forms of RCM are carcinoid, metastatic malignancy (spread of cancer), and endomyocardial fibrosis.

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The Use of Antibiotics To Pregnant Women

Health - Antibiotics to pregnant women may harm babies

Antibiotics administered indiscriminately to pregnant women to delay premature birth may cause long-term harm to babies, a research has suggested.

The study, published in The Lancet, found that among women whose waters had not broken, giving antibiotics was associated with increased risk of cerebral palsy in the children and problems such as poor eyesight or hearing not only at birth but for decades beyond.
Britain has issued a warning about the indiscriminate prescribing of antibiotics to pregnant women to delay premature labour after research revealed that the practice may cause long-term harm to their babies, the Independent newspaper said today.



According to the British daily, Liam Donaldson, UK's chief medical officer, warned that the antibiotics should "not routinely be given" to women in premature labour where there was no sign of infection and whose waters had not broken, in line with "existing good clinical practice".

A clinical trial involving 12,000 women in the UK and around the world, published in 2001, found antibiotics delayed labour and improved outcomes for mother and babies at risk of giving birth prematurely.

According to the UK medical journal, a follow-up study seven years later of more than 8,000 of the women in the UK showed that among women whose waters had not broken, giving antibiotics was associated with up to a threefold rise in cerebral palsy, from 1.6 per cent in those given placebo to 4.4 per cent in those on two antibiotics, and a small increase in "mild" functional impairment such as poor co-ordination and poor eyesight.

However, among women whose waters had broken, giving antibiotics caused no long-term benefit or harm to their children, despite the improved outcome at birth revealed in the first study, the study showed.


Antibiotic Use in Pregnant Women Increases Risk of Functional Impairment in Their Children NEW YORK -- September 17, 2008 -- Long-term follow-up data on a trial to assess the effects of antibiotics given to pregnant women experiencing premature labour, with intact membranes and no obvious infection, has revealed an unexpected increased risk of functional impairment and/or cerebral palsy in some children.

This is among the conclusions of the Overview of the Role of Antibiotics in Curtailing Labour and Early Delivery (ORACLE) Children's Study, published early online in 2 articles and in an upcoming edition of The Lancet.

Both studies are authored by Sara Kenyon, MD, University of Leicester, Leicester, United Kingdom, and colleagues from the ORACLE study group.
The ORACLE Children Study I and II were carried out in the UK to discover whether erythromycin and co-amoxiclav had any long-term effects on the children at 7 years of age born to these mothers.

The ORACLE Children Study II looked at mothers in spontaneous premature labour with intact membranes surrounding their unborn child and no obvious sign of infection.

The children were born to the 4,221 women who had completed the study, and were followed-up after 7 years using a structured parental questionnaire to assess the child's health status. Data for 3,196 (71%) of eligible children was available.

The researchers found that functional impairment was increased in children of mothers who received erythromycin (42.3%, 658 children) compared with no erythromycin (38.3%, 574 children) -- an increase in relative risk of 18% for receiving erythromycin. Co-amoxiclav (with or without erythromycin) had no effect of the proportion of children with any functional impairment.

The researchers also made the unexpected discovery that more children whose mothers had received the antibiotics developed cerebral palsy than those who did not.

For mothers receiving erythromycin (with or without co-amoxiclav), 53 (3.3%) children had cerebral palsy compared with 27 (1.7%) receiving no erythromycin. For mothers given co-amoxiclav (with or without erythromycin), 50 (3.2%) children had cerebral palsy versus 30 (1.9%) receiving no co-amoxiclav.

The risk was clearest for mothers given both antibiotics: 35 (4.4%) of children had cerebral palsy compared with 12 (1.6%) of mothers receiving double placebo.
No effects were seen with either antibiotic on the number of deaths, other medical conditions, behavioural patterns, or educational attainment.

"The prescription of erythromycin for women in spontaneous preterm labour with intact membranes was associated with an increase in functional impairment among their children at 7 years of age. The risk of cerebral palsy was increased by either antibiotic, although the overall risk of this condition was low," the authors concluded.

The ORACLE Children Study I followed up 4,148 eligible children whose mothers joined the trial with preterm rupture of the membranes without obvious signs of infection.

The original trial reported that prescription of erythromycin to these women resulted in reductions in short-term neonatal morbidity and erythromycin is now recommended treatment.

The Children Study, which assessed data from 3,298 (75%) eligible children, found no differences in functional impairment with either antibiotic, and no differences in behavioural difficulties, medical conditions, or educational achievement.

In relation to this part of the study, the authors said that "the prescription of antibiotics for women with preterm rupture of the membranes seems to have little effect on the health of children at 7 years of age."

In an accompanying comment, Philip J. Steer, Chelsea and Westminster Hospital, London, United Kingdom, and Alison Bedford Russell, Warwick Medical School, Coventry, and Heart of England NHS Trust, Birmingham, United Kingdom said: "The lessons to be learned seem clear; contrary to popular opinion, antibiotics are not risk-free. There are good reasons not to give them in association with threatened preterm labour unless there is clear evidence of infection. It is vital the practice is not extended by stealth beyond that which is justified by the evidence, and interventions given in pregnancy should always be evaluated with proper long-term follow-up."

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Honey as Medicine Benefits

Ayurvedic as well as Yunani medicine have been using honey as a vital medicine for centuries.

Today’s western scientists also accept honey as a "Ram Ban" (very effective) medicine for all kinds of diseases without producing any side effects. Today, honey is produced in most of the countries of the world and is therefore available worldwide. Modern science maintains that although honey is sweet, if ingested in the right dosages as a medication, diabetic patients will also be able to intake it.

According to Ayurvedic medicine, a mixture of Honey and Cinnamon can be beneficial to many ailments and diseases and on 17th January 1995, ‘Weekly World News’ - Canada, published a list of ailments/diseases that can be helped / treated with a Honey/Cinnamon mixture. Some of the important details of that information are as below:

* HEART DISEASES

Make a paste of honey and cinnamon powder, spread it on bread or chapatti instead of jelly and jam and eat it regularly for breakfast. This can help to reduce the cholesterol in the arteries and maybe reduce the possibility of a heart patient from suffering a heart attack. Patients, who have already suffered attacks, are also advised to ingest the honey/cinnamon mixture to ward off further attacks.

Regular use of the mixture relieves loss of breath and strengthens the heartbeat. In USA and Canada, various nursing homes have treated patients successfully and have found that due to increasing age, the arteries and veins, which lose their flexibility and become clogged, are revitalized.

* ARTHRITIS

Mix one part honey to two parts of lukewarm water and add a small level teaspoon of cinnamon powder. Make a paste and massage slowly onto the itching area of the body. It has been found that the pain can recede within a minute or two. Arthritic patients can also benefit from the daily intake morning and evening, of one cup of hot water with two spoons of honey and one small teaspoon of cinnamon powder mixed together. In a recent research program conducted at Copenhagen University, it was found that when the doctors treated their patients with a mixture of one tablespoon honey and half a teaspoon cinnamon powder before breakfast; within a week, out of 200 patients who underwent the treatment, 73 patients were relieved of pain, and within a month most of the patients who could not walk or who had limited mobility due to their arthritis, started walking without pain.

* HAIR LOSS

For people suffering from hair loss or baldness the following paste has been found to be effective: In warm olive oil, mix one tablespoon of honey, one teaspoon cinnamon powder, make a paste and apply before taking a bath. Leave on the scalp /hair for around 5 ―15 minutes, and then wash the hair.

* BLADDER INFECTIONS

Stir two tablespoons of cinnamon powder and one teaspoon of honey in a glass of lukewarm water and ingest. This can destroy the bacteria in the bladder that are the cause of the infection.

* TOOTHACHE

Make a paste of one teaspoon of cinnamon powder and five teaspoons of honey and apply to the aching tooth. This may be applied 3 times a day until the tooth stops aching.

* CHOLESTEROL

Two tablespoons of honey and three teaspoons of cinnamon powder mixed into 16 ounces of tea water, can aid in the reduction of cholesterol levels in the blood by 10% within a two hour period. As mentioned above for arthritic patients, if this mixture is ingested 3 times day, chronic cholesterol can be lowered. Pure honey, also ingested daily without cinnamon, taken together with food, is an aid in lowering cholesterol levels.

* COLDS

Those suffering from common or severe colds should take one tablespoon lukewarm honey mixed with 1/4 spoon cinnamon powder daily for 3 days. This will cure most chronic coughs, colds and clear the sinuses.

* INFERTILITY

Yunani and Ayurvedic medicine have been using honey for thousands of years to strengthen the semen of men and improve impotence. Through the regular ingestion of two tablespoons of honey, prior to sleep, impotence can be greatly reduced. In China, Japan and Far-Eastern countries, women, who do not conceive and need to strengthen the uterus, have been taking cinnamon powder for centuries. Women, who are unable to conceive, may take a pinch of cinnamon powder in half teaspoon of honey and apply it on the gums frequently throughout the day, so that it slowly mixes with the saliva and can therefore enter the body. There is a story about a couple in Maryland, USA who were unable to produce children for 14 years and had lost hope of having a child of their own. When told about the honey cinnamon mixture both the husband and wife started ingesting the mixture and the wife conceived after a few months, giving birth to healthy twins.

* UPSET STOMACH

Honey taken with cinnamon powder cures stomachache and can also clear stomach ulcers.

* GAS

According to studies done in India & Japan, honey, taken together with cinnamon powder can relieve the stomach of gas.

* IMMUNE SYSTEM

Daily use of honey and cinnamon powder strengthens the immune system and protects the body from bacteria and viral attacks. Scientists have found that honey has various vitamins and iron in large amounts. Constant use of honey strengthens the white blood corpuscles to fight bacteria and viral diseases.

INDIGESTION Cinnamon powder sprinkled onto two tablespoons of honey taken before eating, relieves acidity and aids in the digestion of the heaviest of meals.

INFLUENZA A scientist in Spain has proven that honey contains a natural ingredient, which kills influenza germs.

* LONGEVITY

Tea made with honey and cinnamon powder, when taken regularly, arrests the ravages of old age. Take 4 spoons of honey, 1 spoon of cinnamon powder and 3 cups of water and boil as if making tea. Drink 1/4cup, 3 to 4 times a day. It keeps the skin fresh and soft and arrests old age. Life spans also increases and even a 100 year old, starts performing the chores of a 20-year-old.

* PIMPLES

Make a paste from three tablespoons of honey and one teaspoon of cinnamon powder. Apply this paste on the pimples before sleep and wash it off the next morning with warm water. If applied daily for two weeks, the paste can remove pimples.

* SKIN INFECTIONS

Applying honey and cinnamon powder in equal parts on the affected parts can cure eczema, ringworm and all types of skin infections.

* WEIGHT LOSS

Drink daily in the morning on an empty stomach, 1/2 hour before breakfast and at night before sleeping, a honey and cinnamon powder mixture boiled in one cup of water. If taken regularly, it is said to reduce the weight of even the most obese person. Also by drinking this mixture regularly, fat does not accumulate in the body even though the person maybe eating a high calorie diet.

* CANCER

Recent research in Japan and Australia has reveled that advanced cancer of the stomach and bones have been cured successfully. Patients suffering from these kinds of cancer should take one tablespoon of honey with one teaspoon of cinnamon powder, 3 times a day for one month.

* FATIGUE

Recent studies have shown that the sugar content of honey is more helpful than detrimental to the strength of the body. Senior citizens, who take honey and cinnamon power in equal parts, are more alert and flexible. Half a tablespoon of honey stirred into in a glass of water and sprinkled with cinnamon powder, taken daily n the afternoon at about 3.00PM when the vitality of the body starts to decrease, can help the body to have more vitality within a week.

* BAD BREATH

In order to maintain fresh breath throughout the day, the people of South America, gargle with one teaspoon of honey and cinnamon powder mixed in hot water first thing upon awakening.

* HEARING LOSS

Taken daily, morning and evening, honey and cinnamon powder taken in equal parts can restore hearing.

I hope honey can be utilized for the overall health

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