Kirjahaku

This is a practical textbook of adult cardiology aimed at medical students, junior doctors, and those more senior who need to know more about cardiac trial results and recent research advances. It represents a digest of 50 years of practical clinical experience, much of which will be valuable to nurses and paramedics engaged with heart problems. The book covers basic topics through to advanced ones. Many medical professionals find diagnosing and managing cardiac conditions harder than most other specialties. Only those who study the mechanical and electrical functions of the heart will gain a facility for accurate diagnosis and management. The aim of this book has been to define and explain all the key information about cardiac problems and to provide the evidence needed for sound cardiac diagnosis and management. Knowing and understanding all this book has to offer will not a cardiologist make; especially one capable of complex assessment, judgement, and invasive intervention. It will, however, provide a foundation. Managing a disturbed cardiovascular system from every physical, emotional, and functional point of view requires some talent. Through the knowledge gained within and hands-on experience, a cardiologist with enough clinical wisdom to achieve patient benefit should emerge.I have summarised the history of cardiology, modern advances in cardiac intervention, and key references to many important therapeutic trials. All are necessary for an appreciation of current cardiac management. An area of difficulty for many students and doctors is cardiac examination, especially auscultation of the heart. Another area of difficulty is 'reading' ECGs. Few now appreciate that it was over seven decades ago that cardiologists first developed the skills needed to detect and assess congenital and valvular abnormalities using only their eyes, ears, and hands. Using feedback from cardiac catheterisation and surgery, these skills developed further. Except for those working on desert islands and in impoverished third world countries, the highly specialised skills of cardiologist doyens like Paul Wood and Aubrey Leatham might now seem antiquated. Echocardiography, MRI, CT, and PET scanning are now seen as more useful and reliable. ECG interpretation is difficult because it requires not only experience with true abnormalities but also an acquaintance with the many variations of normal. I hope to impart a better understanding by including details of how ECGs are generated and how abnormalities arise. The two commonest causes of cardiac morbidity are atherosclerosis and arteriosclerosis. To understand how atherosclerosis affects the coronary and other arteries and how arteriosclerosis relates to left ventricular hypertrophy and hypertension, I have included information about these processes at a clinical, histological, and molecular level.Patients are most troubled by shortness of breath, angina, heart attacks, and rhythm problems. To understand them fully, one must consider valvular and adult congenital heart disease, together with the reasons for heart failure and its optimal management. Also included are less common conditions like myocarditis, cardiomyopathy, cardiac tumours, and heart disease in pregnancy.Cardiologists like to quote relevant trials as acronyms, so some of the game-changing and controversial ones will be found throughout the text. The bibliography provided will enable dedicated students to take their study of cardiology further, to an expert level, should they wish. Those who want details of cardiac surgery will not find enough detail here. They should consult dedicated surgical textbooks on the subject.

This is a practical textbook of adult cardiology aimed at medical students, junior doctors, and those more senior who need to know more about cardiac trial results and recent research advances. It represents a digest of 50 years of practical clinical experience, much of which will be valuable to nurses and paramedics engaged with heart problems. The book covers basic topics through to advanced ones. Many medical professionals find diagnosing and managing cardiac conditions harder than most other specialties. Only those who study the mechanical and electrical functions of the heart will gain a facility for accurate diagnosis and management. The aim of this book has been to define and explain all the key information about cardiac problems and to provide the evidence needed for sound cardiac diagnosis and management. There are too many clinical variations. Knowing and understanding all this book has to offer will not a cardiologist make; especially one capable of complex assessment, judgement, and invasive intervention. It will, however, provide a foundation. Managing a disturbed cardiovascular system from every physical, emotional, and functional point of view requires some talent. Through the knowledge gained within and hands-on experience, a cardiologist with enough clinical wisdom to achieve patient benefit should emerge.I have summarised the history of cardiology, modern advances in cardiac intervention, and key references to many important therapeutic trials. All are necessary for an appreciation of current cardiac management. An area of difficulty for many students and doctors is cardiac examination, especially auscultation of the heart. Another area of difficulty is 'reading' ECGs. Few now appreciate that it was over seven decades ago that cardiologists first developed the skills needed to detect and assess congenital and valvular abnormalities using only their eyes, ears, and hands. Using feedback from cardiac catheterisation and surgery, these skills developed further. Except for those working on desert islands and in impoverished third world countries, the highly specialised skills of cardiologist doyens like Paul Wood and Aubrey Leatham might now seem antiquated. Echocardiography, MRI, CT, and PET scanning are now seen as more useful and reliable. ECG interpretation is difficult because it requires not only experience with true abnormalities but also an acquaintance with the many variations of normal. I hope to impart a better understanding by including details of how ECGs are generated and how abnormalities arise. The two commonest causes of cardiac morbidity are atherosclerosis and arteriosclerosis. To understand how atherosclerosis affects the coronary and other arteries and how arteriosclerosis relates to left ventricular hypertrophy and hypertension, I have included information about these processes at a clinical, histological, and molecular level.Patients are most troubled by shortness of breath, angina, heart attacks, and rhythm problems. To understand them fully, one must consider valvular and adult congenital heart disease, together with the reasons for heart failure and its optimal management. Also included are less common conditions like myocarditis, cardiomyopathy, cardiac tumours, and heart disease in pregnancy.Cardiologists like to quote relevant trials as acronyms, so some of the game-changing and controversial ones will be found throughout the text. The bibliography provided will enable dedicated students to take their study of cardiology further, to an expert level, should they wish. Those who want details of cardiac surgery will not find enough detail here. They should consult dedicated surgical textbooks on the subject.

Why do we get tired from time to time? Why are some 'Tired All the Time'? Why do some progress further - to fatigue and exhaustion, and suffer medical consequences? For 50-years I have dealt with medical and cardiac patients complaining of these problems, and within I explain: The Causes: Few have a medical cause, so is it stress, strain, constitution or our mental energy spending that affects us? I have introduced two concepts - 'The Life Equation' and the 'Traffic Analysis Theory of Tiredness' - to aid understanding. The Consequences: From trivial to catastrophic (from worsening eczema to sudden heart attacks and strokes). The 'Health Divide' is a major problem in all societies. Why are the rich healthier than the poor, and why do they live longer? Find many reasons within. The Cures: Restorative sleep, sleep therapy, medication, meditation, yoga and prayer. Energy is essential for healthy survival and for achieving success in life. In this book, I reveal the detailed reasons why most people suffer tiredness, fatigue and exhaustion, and how they can be overcome. As a cardiologist I have seen both chronic fatigue ruin lives, and ruined lives cause fatigue. By considering tiredness, fatigue and exhaustion as potentially serious, doctors can limit clinical risk, reduce the frequency and severity of symptoms, improve angina and blood pressure, blood coagulation and immune responses - and sometimes save a life Unfortunately, few doctors now have the time or inclination to explore the reasons why their patients get tired all the time - especially given causes that mostly lie beyond their remit - to diagnose and treat physical and mental illness.

Why do we get tired from time to time? Why are some 'Tired All the Time'? Why do some progress further - to fatigue and exhaustion, and suffer medical consequences? For 50-years I have dealt with medical and cardiac patients complaining of these problems, and within I explain: The Causes: Few have a medical cause, so is it stress, strain, constitution or our mental energy spending that affects us? I have introduced two concepts - 'The Life Equation' and the 'Traffic Analysis Theory of Tiredness' - to aid understanding. The Consequences: From trivial to catastrophic (from worsening eczema to sudden heart attacks and strokes). The 'Health Divide' is a major problem in all societies. Why are the rich healthier than the poor, and why do they live longer? Find many reasons within. The Cures: Restorative sleep, sleep therapy, medication, meditation, yoga and prayer. Energy is essential for healthy survival and for achieving success in life. In this book, I reveal the detailed reasons why most people suffer tiredness, fatigue and exhaustion, and how they can be overcome. As a cardiologist I have seen both chronic fatigue ruin lives, and ruined lives cause fatigue. By considering tiredness, fatigue and exhaustion as potentially serious, doctors can limit clinical risk, reduce the frequency and severity of symptoms, improve angina and blood pressure, blood coagulation and immune responses - and sometimes save a life Unfortunately, few doctors now have the time or inclination to explore the reasons why their patients get tired all the time - especially given causes that mostly lie beyond their remit - to diagnose and treat physical and mental illness. We are all aware of our personal energy balance: the misery of feeling depleted and fatigued, and the exhilaration of boundless vitality. There is a direct financial equivalent - wealth, when money is in excess; poverty, when it is lacking. Some handle both their money and energy with ease; others spend their life worrying about both. One can learn to balance them, but only those with the ability to learn, a willingness to practise, and a mind happy to embrace change, have any chance. Have you ever wondered why some people suffer from a sudden - 'out-of-the-blue' - medical condition? Many who have lived more than a few decades, will have lost a friend or family member from a sudden heart attack or stroke. They might then have wondered why. Some will have watched a friend or relative slowly deteriorate, without any apparent cause. Others will have seen a friend age rapidly, get tired-out and frightened, for no obvious reason. They may have previously consulted their doctor without being given a diagnosis. Although not all, many such patients will have experienced prolonged tiredness before the event. Could there be a connection between progressive fatigue and illness? Does the brain have a battery that runs down, to leave us tired and short of energy or is blocked brain traffic the answer?

The calories we eat, and the calories we use while exercising, are the focus of every book on dieting and slimming, but typically, one key topic is missing - mentality. What drives some of us to become overweight and to fail repeatedly to lose weight, and what drives others to be slim, fit and athletic. Without suppressing our 'Fat Mentality', every weight-loss strategy is bound to last only a short time.Psychologically, we all have a 'Fat Mentality' and 'Fit Mentality'. These two components of our eating and exercise mindset co-exist, and are forever in opposition. The 'Fat Mentality' promotes our inactivity, self-indulgence and weight gain; our 'Fit Mentality' drives our desire for activity and the disciplined control of everything we do. Because they direct what we eat, and what exercise we choose to do, they will affect our body weight.A better understanding of the 'Fat Mentality' is crucial to everyone who has repeatedly failed to lose weight. Because it can so easily overwhelm whatever strategy we adopt, ignoring it is not an option for those who wish to succeed. In matters of weight control, we must consider our attitude to food and exercise, alongside food calories, portion sizes, carbohydrates in food, and the latest information about our genes, gut hormones and gut biome. A discussion of all the long-known, and new weight loss interventions, will enable individuals to choose the strategies that suit them best.Given the liability of overweight people to diabetes and heart disease, I have added something new to the weight loss debate. Which foods are best for the heart and circulation.Explore within -- How to break free from a 'Fat Mentality' mindset.- How to cultivate a 'Fit Mentality' mindset.- About calories and portion sizes.- About appetite control.- About carbohydrates.- About food that can be good or bad for your arteries.- About your metabolism.- About ketones.- About your hormones.- About your genes.- About gut hormones.- About the gut biome.- About exercise.- About medical and psychological help.- About appetite suppressants.- About bariatric surgery.- About dieting myths.

This book contains many practical tips about how to practise medicine, judged as successful by patients. These tips result from 55-years of medical practice experience, using both its art and science; its judgement tools, methods and creative processes, rather than anonymous, check-box ticking algorithmic processing. Everyday medical practices save lives and reduce suffering, but with problematic cases both independent thought and creativity are often necessary. Scientific medicine has provided us with many indispensable tools, but it is the art of medicine that defines how best to use them to fulfil our patient's needs. Applying the science of medicine can be as effective as a bowl of cold soup served to stranded, freezing and frightened mountaineers. Even though it contains every ingredient necessary to sustain life, the soup alone might not uplift their spirits enough for the journey ahead. For that, knowing how to handle people is the essential art. Only the art of medical practice serves this purpose for patients.No matter how much science we apply to a clinical situation, someone, sometime, will need to draw a line between what is 'normal' and 'abnormal'; between what is acceptable and the unacceptable, and between what is clinically advisable, risky or ineffective. Science has provided doctors with the means to draw such lines of distinction, but not the ability to know where best to draw them for each patient. That remains a medical art.Some controversial medical topics discussed are: The relative importance of scientific medicine and the art of medicine. The challenge of cultural diversity and our personal biases.Why the poor suffer five times more disease than the wealthy. The statistical paradox, informed consent and patient agreement. The merit of doctors and nurses performing in 'attached' and 'detached' modes.The relative merits of medical training rather the education of experience. The sovereignty of medical learning, ability, and practice and the duties it imposes. Why doctors in the UK are leaving the medical profession ('Drexit')?The contents will be most pertinent to all medical students, doctors, nurses, paramedics, and anyone unfortunate enough to be a patient. It could also be pertinent to those still at school, considering a career in medicine.Only those with a strong interest in their fellow man should attempt to practise the art of medicine. They will need to be brave enough, and irreverent enough of regulatory bureaucracy, to practise it in the future. The reason is simple. Medical science alone is used to define the regulatory high ground. While the progressive impenetrability and detached nature of scientific knowledge helps to grow its mystique, the art of medicine is being simultaneously derided and undervalued. This is because the art of medical practice is impossible to regulate and there are no means to measure its indispensable merits.

Doctors, nurses and patients need to understand one another. With that in mind, this book describes the many characters they can each portray. In the first chapter, I describe 120 caricatures of doctors and nurses, together with many pertinent and amusing anecdotes, some of which are deadly serious.In the second chapter, I describe 70 patient types of patient, together with many illustrative anecdotes.In the third chapter, I explore the interrelationship between patients, doctors and nurses, and how they relate to medical bureaucracy. This is important now that it affects the morbidity and mortality of patients and the working conditions of nurses and doctors in the UK.When considered as characters, doctors, nurses and patients each play their role in different ways. How each doctor and nurse behaves can affect a patient's quality of life and also their morbidity and mortality. Doctors and nurses gain an advantage when they understand their patients well, and patients will benefit when they understand the difference, various types of doctor and nurse can make to their life. Doctors and nurses are not all equally effective when treating people, and patients deserve to know why this is. This book will not only enable doctors and nurses to better understand those they treat, it will also help patients decide who they should allow to treat them. Some doctors and nurses prefer to treat patients as numbers, others insist on treating patients as sentient human beings. Most specialist doctors now only treat specific problems, whereas once we had general physicians and surgeons capable of much more. Only GPs have kept their ability to treat all-comers. Although I refer mainly to doctors and nurses, I must acknowledge that many others care for patients. They include pharmacists, hairdressers, carers, counsellors, social workers, paramedics and friends. They should assume that they are all included in my descriptions. In the 1960s when I first worked as a junior doctor, patients had relationships with doctors that were more formal than today. Doctors then came from rich educated families, and many had experienced the work doctors did as members of their family. Those who practiced medicine had a vocation and were middle-class. Those who became nurses and doctors represented those given to public duty, and not to business. Their aim was to serve. Many would have pursued their vocation, even if their work had been unpaid. Things have changed considerably, but has it been for the better?The media and medical bureaucrats have made patients aware that every doctor is a potential Dr. Harold Shipman, and every nurse a potential Lucy Letby, until proven otherwise. The result has been that doctors and nurses have changed their approach to patients. Some now see patients as potential litigants. Everything doctors and nurses do now has a medico-legal dimension, with everything that is said or done, recorded and audited for the satisfaction of managers with MBAs and law degrees, many of whom should run baked-bean factories, not medical facilities. One unfortunate result has been that the focus of some nurses and doctors has had to move from patient care to consider the needs of the corporate management system controlling them. The actions of doctors and nurses has thus changed, and with it the doctor-patient and nurse-patient relationship, but not for the better. Bureaucracy has raised patient expectations, while the services they can access in the UK have become less. My hope is for patients, doctors and nurses to better understand one another. I have aimed to make the information provided both useful and amusing.

The medical students and doctors who read this book will learn many practical tips about how to practise medicine, judged as successful by patients. These tips result from 55-years of medical practice experience, using both its art and science; its judgement tools, methods and creative processes, rather than anonymous, check-box ticking algorithmic processing. Everyday medical practices save lives and reduce suffering, but with problematic cases both independent thought and creativity are often necessary. Scientific medicine has provided us with many indispensable tools, but it is the art of medicine that defines how best to use them to fulfil our patient's needs. Applying the science of medicine can be as effective as a bowl of cold soup served to stranded, freezing and frightened mountaineers. Even though it contains every ingredient necessary to sustain life, the soup alone might not uplift their spirits enough for the journey ahead. For that, knowing how to handle people is the essential art. Only the art of medical practice serves this purpose for patients.No matter how much science we apply to a clinical situation, someone, sometime, will need to draw a line between what is 'normal' and 'abnormal'; between what is acceptable and the unacceptable, and between what is clinically advisable, risky or ineffective. Science has provided doctors with the means to draw such lines of distinction, but not the ability to know where best to draw them for each patient. That remains a medical art.Some controversial medical topics discussed are: The relative importance of scientific medicine and the art of medicine. The challenge of cultural diversity and our personal biases.Why the poor suffer five times more disease than the wealthy. The statistical paradox, informed consent and patient agreement. The merit of doctors and nurses performing in 'attached' and 'detached' modes.The relative merits of medical training rather the education of experience. The sovereignty of medical learning, ability, and practice and the duties it imposes. Why doctors in the UK are leaving the medical profession ('Drexit')?The contents will be most pertinent to all medical students, doctors, nurses, paramedics, and anyone unfortunate enough to be a patient. It could also be pertinent to those still at school, considering a career in medicine.Only those with a strong interest in their fellow man should attempt to practise the art of medicine. They will need to be brave enough, and irreverent enough of regulatory bureaucracy, to practise it in the future. The reason is simple. Medical science alone is used to define the regulatory high ground. While the progressive impenetrability and detached nature of scientific knowledge helps to grow its mystique, the art of medicine is being simultaneously derided and undervalued. This is because the art of medical practice is impossible to regulate and there are no means to measure its indispensable merits.

1.Senryu for Life, 2.Poetic Thoughts of Love, Life & LossWithin are many haiku (senryu) and longer poetic forms. All express common life relationship situations, but in particular the judgement biases which affect our thoughts, feelings and decisions in matters of love and its loss.As a physician with five decades of experience, I depart here from my usual role and attempt to go where poetic content lives: beyond the peaks of exact meaning, through the valleys of essence and personal interpretation, into the realms of the spiritual; the all-accepting, non-judgmental frames of mind so few have time for. From what other aspect of consciousness can one express feelings of love, beauty, stress and loss, all of which lack explicit definition, but all of which have their serious individual implications? In any collection of thoughts like this, only a few will resonate with each person. Our search for knowledge and direction is always a similar quest. My aim is for each reader to find at least one item they regard as a gem; one that speaks to them and enables a better understanding of life and its commonest source of happiness and stress -relationships.

Natural food was not designed for humans. The plants and animals we regard as food, has long had its own raison d' tre. So, who knows what food is best for our heart and circulation, when most of it is compromised by too many calories, detrimental fats, few protective substances, by taste and cost? How are we to make scientifically informed food choices? Most people have fixed ideas about food - especially, what is 'bad for them' (fats in 'junk food', they think). Far fewer know what might be positively good for their heart and arteries (rather than just 'not so bad'). Most believe that fresh fruit and vegetables, nuts, fish, olive oil and salads are best. Are these myths based on hearsay or is there a scientific basis for them? Nobody has yet devised a readily usable index for 'how good' or 'how bad' any particular food, food group or diet is for our arteries, heart and circulation. Can certain foods protect us from heart attacks and strokes? If so, how strong might each protective nutrient be? Perhaps, only drugs like 'statins' can be relied on to do the job. I was once asked by a heart patient of mine (who had just had a heart by-pass), what he should eat to help protect his arteries. I had to admit I wasn't sure. So, I undertook some research. Some animal experiments have observed artery 'furring' in relationship to various nutrients. There were those that caused 'furring', while others had a protective effect. Although, I did manage to collect together a few damaging nutrients, like saturated fat, I was only able to find sixteen protective ones. Soon, other questions arose. Where are these nutrients to be found in food? And, how much does each food contain? How bad are the damaging nutrients, and how good the protective ones? Few books list the full nutrient content of natural foods; that of prepared foods often remaining secret. Even then, not every known protective nutrient will be listed. Nutrients like allicin (in garlic), resveratrol and flavonoids in wine and deep colored fruit - all likely to be of importance - but rarely mentioned. We have long needed a usable index for both potential effects; alternatively, one could use their ratio - the Cardiac Value of Food. But wait Perhaps it's not the ratio that counts most. Perhaps the 'good' nutrients easily overwhelm the dangerous effects of the 'bad' ones. That vital question has yet to be answered. This book introduces an index for each food, food group and diet, based not on hearsay, but on actual nutrient content. This is a new approach to food choice, especially for those with a family history of coronary heart disease and those who already have it. As a cardiologist with almost 60-years of experience, I have always had doubts about the role food plays in the generation of artery 'furring' (atherosclerosis), coronary artery disease, heart attacks and strokes. I don't believe those who carry strong artery 'furring' genes will completely overcome their problem, just by choosing what I think is best to eat. But since we must all eat, there will be best and worst food choices to consider. I believe those with no trace of 'furring' genes can probably eat what they like, regardless of any best or worst food concept, taken from either animal experiments or population studies. If we are to get the maximum nutrient benefit for the heart and circulation, taking supplements might be the answer. At least, there should not be any damaging nutrients or too many calories. In the meantime, most of us have one prominent desire - to enjoy the food we eat; foods that hopefully help us to survive healthily within our social and cultural groups.