Helicobacter pylori

Helicobacter pylori is a bacterium that is only found in humans in the lower part of the stomach and according to the World Health Organization, half of humanity is infected with this bacterium. If left untreated, helicoid bacteria can cause more serious medical conditions.

Helicobacter causes local inflammation of the gastric mucosa, that is, gastritis, and some people infected with this type of bacterium may develop ulcers on the duodenum and stomach. The bacterium thrives in the acidic environment of the stomach because it secretes the enzyme urease that breaks down urea and thus releases ammonia, which neutralizes gastric acid with its basic properties.

How is helicobacter transmitted?

Helicobacter is transmitted through dirty hands, which is why it is most prevalent in those parts of the world where there are unhygienic living conditions and are socially and economically underdeveloped. In these countries, it is estimated that up to 80% of the population is infected with this bacterium, while the percentage of infected persons in developed parts of the world is smaller and ranges between 20% and 50%. In addition, the channels through which this bacterium can be transmitted are contaminated food, ie unwashed fruits and vegetables, defective water. And it can also be transmitted by the mouth-to-mouth method from a person infected to a healthy person.

Helicobacter symptoms

Symptoms in some people who are infected with the bacterium are almost not manifested, so the bacterium can stay in the body for decades, even throughout life. In some people, certain symptoms may develop over time. However, this also depends on the immune properties of the organism. The most common symptoms are bloating, stomach pain, nausea, and indigestion, bad breath, and heartburn. Persons suffering from chronic gastritis do not feel anxious, but this changes if a stomach ulcer occurs. Appetite is reduced, which causes weight loss, and in some cases, blood in the stool may occur.

Chronic fatigue, insomnia, anxiety, depression can all be indirect indications that helicobacter has formed in the body. In some people, gastric disorders are much more pronounced, while in some people the intensity of indirect problems is higher.

Pain caused by Helicobacter

Proper nutrition

One of the basic things for eliminating helicobacter from the body is proper and reduced diet and changing lifestyle. It is necessary to have breakfast, lunch, and dinner at about the same time. The interval between meals should not be less than 3 hours and ideally around 4 hours. Avoid carbonated beverages, alcohol, especially white wine, coffee, sweets and sugars, refined foods (eg white flour products…), cooked, roasted and heavily spicy food. Consume green or black tea instead of coffee.

Against the increased secretion of acid, drink at least half an hour before breakfast unsweetened chamomile tea, flax seeds, thyme, sage, nettle, flacon (not hot at all). Strictly avoid tobacco smoke as it stimulates the secretion of gastric acid. Consume integral colostrum, oats and barley. Avoid fresh, white, wheat, cornbread.

Integral or red rice is recommended for lunch until 3 pm in combination with grilled vegetables or low-fat fish. Do not season soups or stews and cooked meals with strong spices that contain additives and flavor enhancers. Do not waste food. From dairy products, sour milk, young cheese and sometimes butter are recommended. Cow’s milk is prohibited. Legumes (beans, peas) should be consumed as a puree, but in principle be careful and limited bring them in.

Recommended vegetables are cabbage, broccoli, spinach, artichokes, kale, currant, arugula, beets, cauliflower. Tomatoes and tomato products, onions, cucumbers, green peppers, mushrooms should be avoided, or at least restricted, as they enhance the secretion of gastric acid. Consumption of fruits rich in raspberry, pear and plum fiber is advised. Cranberries and apples contain flavonoids – chemicals that can stop the growth of helicobacter. Cranberry juice is also rich in flavonoids. Consume fruits between 4 pm and 6 pm, every third or fourth day. Meat (veal, beef, chicken, rabbit…) or fish (sea or river) should be cooked or grilled. Avoid greasy and stronger types of meat or fish. The use of fresh and fried eggs is prohibited. Soft boiled eggs are recommended. Meals should be moderately warm and beverages moderately cold. Eat slowly and cook well.

Iker Casillas is the champion!

Iker Casillas, 5 times World’s Best Goalkeeper, achieved the greatest victory of his life. On the opposite side was a heart attack, a ruthless enemy who takes millions of lives a year, but once again, “San Iker” shows us that he is a true champion, he survived that fight and took the biggest victory of his astonishing career.

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How did all start?

The day was May 20, 1981. On lazy, sunny, Wednesday afternoon, in the second-largest city in population belonging to the autonomous community of Madrid, 18 kilometers southwest from central, in Mostoles, the legend was born.

Just 16 years later, he was first called up to the senior team squad to face Rosenborg in the UEFA Champions League. In starting the 1999-2000 UEFA Champions League group stage fixture against Olympiakos on 15 September 1999, he became the youngest goalkeeper ever to feature in the competition at the time, aged 18 years and 177 days. Casillas had made his La Liga debut in a 2–2 draw against Athletic Bilbao at San Memes Stadium. In May 2000, he became the youngest ever goalkeeper to play in and win a Champions League final when Real Madrid defeated Valencia 3-0, just four days after his 19th birthday.

Real Madrid – the biggest chapter

Casillas began his career in Real Madrid’s youth system, during 1990 – 91 season. For the next 16 years he was the central part of the team. During his time in Real, Iker has won literally everything that football goalkeeper can win.

  • 5x Spanish champion (00/01, 02/03, 06/07, 07/08, 11/12)
  • 3x Champions League winner (99/00, 01/02, 13/14)
  • 2x Spanish cup winner (10/11, 13/14)
  • 4x Spanish Super Cup winner (01/02, 03/04, 08/09, 12/13)
  • 2x FIFA Club World Cup winner (2014, 2015)
  • 3x Intercontinental Cup winner (1998, 2002, 2003)
  • 2x Uefa Supercup winner (02/03, 14/15)
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Honestly, I don’t have to use up many words to say how good he is, the results are there for all to see. He has won everything there is to win and has been on the same great level for so many years now, which is possibly hardest of all for a goalkeeper. Spain almost never concede goals and Casillas is the main reason for that.

Gianluigi Buffon on Casillas prior to the UEFA EURO 2012 Final
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International career

Casillas debuted for Spain at the under-17 level. At age 16, he was the youngest player in the Spanish squad that placed third at the 1997 FIFA U-17 World Championship in Egypt. Two years later, he went on to win the FIFA World Youth Championship and the UEFA-CAF Meridian Cup that same year. As a senior, he debuts for Spain national team on EURO 2000.

Casillas is currently the most capped player in the history of the Spain national team. Following his full international debut at the senior level on 3 June 2000 against Sweden (at 19 years and 14 days), Casillas was an unused substitute at UEFA Euro 2000. He was part of the roster for the 2002 FIFA World Cup, initially as the understudy to Santiago Cañizares. Coincidentally, he became first-choice when Cañizares had to withdraw from the tournament due to injury from a freak accident. At 21, Casillas was one of the youngest first-choice goalkeepers in the tournament. He played an instrumental role in Spanish progression when he saved two penalties in the shoot-out during the round of 16 match against the Republic of Ireland, earning him the nickname “The Saint”. One of his saves during the quarter-final against South Korea during the 2002 World Cup was rated by Fifa as one of the top ten saves of all time.

Unfortunatlly for Iker and Spain, on Euro 2004 and World Cup 2006, they did not well. They lost their matches in the Round of 16. After that, the beast has been awakened. From 2008. to 2012. Iker Casillas was the best goalkeeper in the world. He won that title 5 years in a row and in that period, Spain has won 2008 European Championship, 2010 FIFA World Cup and 2012 EURO. In June 2014, Casillas was selected to represent Spain in his fourth World Cup. On 5 September 2015, Casillas kept a clean sheet in his 100th game as Spain’s captain. On 31 May, Casillas was named to Vicente del Bosque’s final 23-man Spain squad for Euro 2016. The following day, he became the most-capped European player by earning his 167th cap in a 6–1 friendly win over South Korea.

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After finishing his career in Real Madrid, in 2015, Iker moved to FC Porto and won Portuguese champion in 2017/18 and 2 times Portuguese Super Cup in 2018. and 2019. 1

But on the first may we were all witnesses of a terrible event.

The 37-year-old goalkeeper suffered the heart attack during training on Wednesday morning and he was immediately escorted to a local hospital.

Iker Casillas suffered an acute heart attack during Wednesday morning’s training session,” Porto said in a statement.

“The training session was promptly interrupted to provide assistance to the Porto goalkeeper, who is currently at the Hospital CUF Porto.

“Casillas is doing well, he’s stable and his heart problem has been resolved.”

Let’s take closer look what actually happened.

Sudden death in people younger than 35, often due to undiscovered heart defects or overlooked heart abnormalities, is rare. When these sudden deaths occur, it’s often during physical activity, such as playing a sport, and more often occurs in males than in females.1

Millions of elementary, high school and college athletes compete yearly without incident. If you or your child is at risk of sudden death, talk to your doctor about precautions you can take.

How common is sudden cardiac death in young athletes?

Most deaths due to cardiac arrest are in older adults, particularly those with coronary artery disease. Cardiac arrest is the leading cause of death in young athletes, but the incidence of it is unclear. Perhaps 1 in every 50,000 sudden cardiac deaths a year occurs in young athletes.

What can cause sudden cardiac death in young people?

The causes of sudden cardiac death in young people vary. Most often, death is due to a heart abnormality.

For a variety of reasons, something causes the heart to beat out of control. This abnormal heart rhythm is known as ventricular fibrillation.

Some specific causes of sudden cardiac death in young people include:

  • Hypertrophic cardiomyopathy (HCM). In this usually inherited condition, the walls of the heart muscle thicken. The thickened muscle can disrupt the heart’s electrical system, leading to fast or irregular heartbeats (arrhythmias), which can lead to sudden cardiac death.Hypertrophic cardiomyopathy, although not usually fatal, is the most common cause of heart-related sudden death in people under 30. It’s the most common identifiable cause of sudden death in athletes. HCM often goes undetected.
  • Coronary artery abnormalities. Sometimes people are born with heart arteries (coronary arteries) that are connected abnormally. The arteries can become compressed during exercise and not provide proper blood flow to the heart.
  • Long QT syndrome. This inherited heart rhythm disorder can cause fast, chaotic heartbeats, often leading to fainting. Young people with long QT syndrome have an increased risk of sudden death.


Other causes of sudden cardiac death in young people include structural abnormalities of the heart, such as undetected heart disease that was present at birth (congenital) and heart muscle abnormalities.

Other causes include inflammation of the heart muscle, which can be caused by viruses and other illnesses. Besides long QT syndrome, other abnormalities of the heart’s electrical system, such as Brugada syndrome, can cause sudden death.

Commotio cordis, another rare cause of sudden cardiac death that can occur in anyone, occurs as the result of a blunt blow to the chest, such as being hit by a hockey puck or another player. The blow to the chest can trigger ventricular fibrillation if the blow strikes at exactly the wrong time in the heart’s electrical cycle.

Are there symptoms or red flags parents, coaches and others should be on the lookout for that signal a young person is at high risk of sudden cardiac death?

Many times these deaths occur with no warning, indications to watch for include:

  • Unexplained fainting (syncope). If this occurs during physical activity, it could be a sign that there’s a problem with your heart.
  • Family history of sudden cardiac death. The other major warning sign is a family history of unexplained deaths before the age of 50. If this has occurred in your family, talk with your doctor about screening options.

Shortness of breath or chest pain could indicate that you’re at risk of sudden cardiac death. They could also indicate other health problems in young people, such as asthma.

Can sudden death in young people be prevented?

Sometimes. If you’re at high risk of sudden cardiac death, your doctor will usually suggest that you avoid competitive sports. Depending on your underlying condition, medical or surgical treatments might be appropriate to reduce your risk of sudden death.

Another option for some, such as those with hypertrophic cardiomyopathy, is an implantable cardioverter-defibrillator (ICD). This pager-sized device implanted in your chest like a pacemaker continuously monitors your heartbeat. If a life-threatening arrhythmia occurs, the ICD delivers electrical shocks to restore a normal heart rhythm.

Who should be screened for sudden death risk factors?

There’s debate in the medical community about screening young athletes to attempt to identify those at high risk of sudden death.

Some countries such as Italy screen young people with an electrocardiogram (ECG or EKG), which records the electrical signals in the heart. However, this type of screening is expensive and can produce false-positive results — indications that an abnormality or disease is present when it isn’t — which can cause unnecessary worry and additional tests.

It’s not clear that routine exams given before athletes are cleared to play competitive sports can prevent sudden cardiac death. However, they might help identify some who are at increased risk.Paragraph

For anyone with a family history or risk factors for conditions that cause sudden cardiac death, further screening is recommended. Repeat screening of family members is recommended over time, even if the first heart evaluation was normal.

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Interview with Yoni Freedhoff

Our interest is to talk with successful colleagues. Our interview was done with Yoni Freedhoff, MD, CCF. He is an associate professor of family medicine at the University of Ottawa. In 2004, he became the founder and medical director of the Bariatric Medical Institute.
He is one of Canada’s most outspoken obesity experts.  He is also a popular video blogger; his YouTube channel is The Diet Fix: Why Diets Fail and How to Make Yours Work. In 2014, he published a book under the same title. Read this interesting interview :

1. Why did you chose to become a doctor?

Honestly for me it was a bit of an accident. I was on a path to getting a PhD in genetics, but after a few years of bench work during my undergrad I realized I don’t particularly like bench work, and all my friends were taking their MCATs and applying to medical school – and so I did too.

2. Why have you chosen this field of speciality?

Again, an accident. I hadn’t been taught pretty much anything about nutrition or obesity medicine in medical school or residency and decided that learning more about both might be a good excuse to go to Las Vegas for a conference. Turned out I really enjoyed it and have made it the focus of my practice since 2004.

3. What does your typical work day look like?

I see patients every day for 8-10 hours. During down times I write and am pathologically attached to Twitter.

4. What are your achievements till date?

I’ve had the fortune of affecting a fair bit of change over the years. From shutting down a fat shaming exhibit in Epcot, to helping put an end to a terrible front of package food labeling program, to writing a book, being featured in a documentary, shining a light on Coca-Cola’s efforts to fund bad science, and more. It’s been a fun ride that’s for sure.

5. What’s the most common misconception about what you do?

That it’s especially lucrative! At least here in Canada, if you want to be a physician working in the delivery of ethical, evidence-based obesity medicine, don’t go in it for the money. If you’re lucky you’ll earn as much as your family physician friends, but you probably won’t earn more.

6. How do you feel about your job?

Love my job.

7. What is the most interesting part of your job?

Probably the ability to influence public policy. I realize that it’s not a direct part of my day to day with patients, but I do believe that as physicians, we should also be advocating for patients and the public as a whole.

8. What are your plans about the future?

Going to keep on doing what I’m doing and hope that by this fall, our office’s digital tool will be ready for launch (currently just finishing with coding, then in office beta testing, then distance beta testing, and then launch)

Effects of hyperthyroidism on cardiac function

Diseases of the thyroid gland can directly modify the normal function of the heart, cause symptoms and lead to serious complications. To understand how they affect the heart, it is important to first understand how the heart works.

The heart is a muscle made of cavities whose walls contract and circulate the blood all over the body. Because of the valves inside the heart, blood flows ordinarily only in one direction. The oxygen-poor blood returns to the heart by the veins, the inferior and superior vena cava into the right atrium and the right ventricle of the heart pump the blood into the lungs. From there, the oxygen-rich blood returns to the left atrium within pulmonary vein and the left ventricle from which it is ejected into the arteries which distribute the blood to the various organs of the body.


With regard to thyroid diseases, it is important to understand two principles. First, because the heart itself is a muscle, it needs oxygen to function and receives oxygen through special arteries called coronary arteries. If these coronary arteries have a disease that causes an obstruction in the lumen of the vessel (atherosclerosis), resulting in reduced blood flow to the coronary artery, the heart muscle then functions with insufficient oxygen supply and that can cause heart pain, or “angina pectoris”. Second, in order for the heart to beat in a coordinated fashion and expel blood evenly and efficiently, the heart muscle is stimulated to contract in a synchronized manner by specialized tissue inside the heart that emits electrical impulses.  The impulse normally starts from the top of the right atrium and descends as it spreads through the heart.

Symptoms and signs of hyperthyroidism


An increase in the level of thyroxine (T4) secreted by the thyroid gland stimulates the heart, which then beats faster and stronger. Almost all of the T4 (and T3) found in the blood is bound to protein, but only free T4 and T3 can bind to receptors. At first, higher levels of FT4 and FT3 can cause a rapid heartbeat, called tachycardia. A nurse or doctor will detect this condition, but usually the patient will not even notice it. However, if the accelerated heart rate get worse, the patient may feel palpitations, which means that he will be aware of the heartbeat in his chest. But sometimes even healthy people can experience this as a result of excessive exercise or after consuming too much caffeine (coffee, tea, energy drinks). However, if this occurs at rest and it is a prolonged fast heart rate, then it can be result of abnormal thyroid function. On the other side, palpitations can occur in other types of heart disease, but if they are caused by hyperactivity of the thyroid gland, that does not necessarily mean that there is a serious underlying heart disease. In some patients prolonged heart stimulation with thyroxine may cause a lack of coordination of conduction of electrical impulses within the heart which can lead to an episode of atrial fibrillation may result. This occurs when pulses from the right atrium, instead of being routed normally into the ventricles, short-circuit the atria and turn rapidly in circles, causing an inadequate atrial contraction, a loss of regular stimulation of ventricles and irregular heartbeats. Prolonged stimulation of the heart’s contraction can cause a rise in blood pressure called systolic hypertension. Normally, the diastolic blood pressure is not higher in these patients. The accelerated contraction of the heart, which results in increased cardiac output, makes it easy to feel the pulse on the wrist and contributes to the moist heat of the hands.

Complications of hyperthyroidism

 Prolonged untreated stimulation of heart rate and contractions can lead to the following two complications: angina pectoris and heart failure. Angina occurs when the heart muscle does not get enough oxygen, which causes discomfort in the center of the chest, which can also be felt in the throat, neck or jaw, and in the arms (often the arm left). In severe cases, the individual does not feel a simple discomfort but a real pain. If this pain is not treated, it can result in a true heart attack or myocardial infarction, which damages an area of ​​the heart muscle in an irreversible way and it can be fatal. Heart failure can occur when the increased effort required of the heart by rapid electrical stimulations and increased contractions causes a weakening of the heart muscle which then can no longer efficiently pump blood from the lungs to the rest of the body. The usual symptom is therefore shortness of breath due to congestion of blood in the lungs. One of symptoms also can be a swelling of the ankles. Usually, angina pectoris and congestive heart failure do not occur in young hyperthyroid patients whose heart is healthy and strong. However, in older patients with underlying heart disease, the presence of an overactive thyroid gland may be sufficient to unmask the underlying heart disease and worsen the symptoms that are already present.

Effects of alcohol consumption on cardiovascular system

Light to moderate alcohol consumption – up to one drink per day for a woman and 1-2 glasses per day for a man – would be expected to reduce mortality, risk of coronary heart disease, diabetes or stroke prevalence. Is alcohol good or bad for your health and how much should you drink?

 American researchers who publish an article on this subject in Mayo Clinic Proceedings confirm that cardiovascular benefits are observed with a light to moderate consumption of alcohol, ideally of red wine taken before or during the evening meal. But the most important thing in their research is dose of alcohol that people consume and serious toxic effect in an exposed individual. The overconsumption of alcohol is in fact is linked to serious pathologies: cirrhosis, stroke, cancers of the colon/rectum, breast, larynx and liver. Alcohol also increases violence and the risk of traffic accidents.

Regarding general mortality, a meta-analysis involving 1,2 million people found that small amounts of alcohol to moderate alcohol consumption was associated with decreased mortality: the maximum protection was raised with half to one drink per day for women and 1 to 2 glasses a day for men. But 2.5 glasses a day for women and 4 a day for men increased the risk of death.

The benefits do NOT outweigh the risks

alcohol consumption impact on cardiovascular health

Chronic consumption of alcohol in large amounts can lead to a condition called alcoholic cardiomyopathy. Consume a lot of alcohol (four to five drinks a day for several years) leads to weakening of the heart muscle.  This weakening becomes even more important when a person consumes alcohol in excessive amounts.  Excessive consumption of alcohol (on the same occasion, four or more drinks for women, and five or more drinks for men) and heavy alcohol consumption can increase blood pressure and the risk of developing arrhythmias (irregular heartbeat), such as atrial fibrillation. Such alcohol consumption can increase the risk of death, whether or not the person has heart disease. People who survive a heart attack and report excessive alcohol use are twice as likely to die of any condition, including heart disease, as those who do not consume alcohol excessively. There is no doubt that excessive alcohol consumption, even once a week, puts you at higher risk for heart disease or stroke.  We tend to minimize this point, but if you are trying to lose weight healthily, reducing your alcohol intake can save you a lot of calories. Light and non-alcoholic beers are a better choice than standard beers when it comes to caloric and alcohol content.

Summary and conclusions

If you do not consume alcohol, you do not deprive yourself of any benefit and it is not recommended that you change your good habits. The risk of cancer, liver disease, pancreatitis, accidents, suicide and exposure to violence are also important negative effects of alcohol. 

There are better ways to reduce the risk associated with heart disease, such as exercising, eating a balanced diet, and quitting smoking and alcohol at the same time. All of these methods offer benefits without the added risks associated with alcohol consumption. However, consuming a small amount of alcohol from time to time is not necessarily detrimental to your health, ergo, moderation is the solution.  As there are some exceptions, it is important to talk to your doctor and pharmacist about your use of alcohol. Some people should avoid taking it to avoid aggravating their condition. Mixing alcohol and certain medications can also cause dangerous side effects that can be fatal.

Modifying alcohol consumption

Limit your alcohol consumption in the following ways:  two drinks a day most days, for a maximum of 10 per week for women and three drinks a day most days, for a maximum of 15 per week for men.  Consumption is:  341 ml or 1 bottle of beer at normal alcohol level (5%), 142 ml or 5 oz of wine (12% alcohol) 43 ml or 1½ oz of spirits (40% alcohol content). Chronic consumption of alcohol can raise blood pressure and contribute to the development of heart disease and stroke.  If you drink alcohol, avoid taking more than:  two drinks a day for up to 10 drinks a week for women  and three drinks per day for up to 15 drinks per week for men

Take care of your health and safety. If you are worried about the effects of alcohol on your health, consult your doctor or pharmacist.

Effects of nicotine on cardiovascular system

It is clearly established that tobacco and nicotine has increased mortality and cardiovascular events (CV), however, the price of smoking is often neglected. Behavioral interventions and stop assisting treatments are effective and do not increase the risk of CV events when used over a specified period. E-cigarettes (or vaporettes) contain potentially cardiotoxic substances but lower concentrations than those of cigarettes. The CV effect of vaping is difficult today to evaluate and depends on the type of device used and its mode of consumption. Consumers have been advised to quit using sprays and it is recommended that they be discontinued as soon as they are stabilized.

nicotine structure

Smoking is one of the major cardiovascular (CV) risk factors. Despite the fact that the link between smoking and cardiovascular disease (CVD) has been known for more than 60 years, 1 tobacco still kills nearly 5 million people every year according to WHO. According to estimates by the Federal Statistical Office, 9,500 deaths in Switzerland in 2012 are attributable to diseases caused by tobacco, which represents 1 out of 7.3 deaths CVD accounts for 39% of the causes of tobacco-related deaths (15 % of ischemic heart disease, 24% of other CVD). Despite this, the prevalence of smoking remains high even among people with a CV event. Smoking cessation is one of the recommendations for primary and secondary prevention.  In this article, we will consider the CV effects of smoking, the CV benefits of stopping as well as the effectiveness and possible risks of some cessation aid treatments.

What are the health effects of cigarette smoking?

 Smoking has 5 main adverse effects on your cardiovascular system: 

  • Cigarettes significally reduces the concetration of oxygen in the blood, causing shortness of breath and impaired functioning of your muscles.
  •  It hurts your arteries, which lose their ability to expand normally. It also causes spasms (sudden narrowing of the caliber of the artery) that potentially can be fatal.
  • It can cause blood clotting and promotes, among other things, the formation of clots and thus the potential release of an infarct, a phlebitis or a stroke (stroke). 
  • It causes inflammation of the blood vessels, a phenomenon that also promotes the formation of clots and atherosclerosis.
  • It lowers the level of good cholesterol, which is an additional risk factor for your cardiovascular system in the long term. In fact, the good cholesterol or HDL-cholesterol acts as a “scavenger of the arteries” by cleaning the plaque that forms there. 

Smoking also has an indirect effect: the relative loss of taste and smell associated with tobacco promotes smoker’s attraction to more tasty foods, usually much richer in saturated (bad) fats and more salty. However, a diet high in salt and saturated fat further increases the risk of developing cardiovascular disease.

The pathophysiology of cigarette smoking and cardiovascular disease

Nicotine is naturally occurring liquid alkaloid. An alkaloid is an organic compound made out of carbon, hydrogen, nitrogen and sometimes oxygen, and it can have potent effects on human body. Nicotine is a major addictive ingredient found in all tobacco products. Nicotine primarily binds to nicotinic cholinergic receptors in the brain and acts as a sympathomimetic substance. As a result, it stimulates the release of catecholamines (epinephrine, norepinephrine), which lead to an increase in heart rate, blood pressure and myocardial contractility, which in turn increases myocardial work  and oxygen requirements. Nicotine has a toxic effect on the endothelium and, acting also on alpha-adrenergic receptors, causes vasoconstriction. This leads to a decrease in arterial, coronary and cerebral flows. The harmful effects of nicotine are mainly due to long-term consumption and affect the overall health of the body.

As nicotine narrows the blood vessels and also lower the temperature of the skin (it also leads to increased sweating). The increased blood pressure permanently increases the risk of clot formation. Indirectly, nicotine also promotes the development of arteriosclerosis. Thus, there are numerous gases and substances (for example nitrogen monoxide) in tobacco smoke, which are deposited in the vessels and harden them. This reduces the oxygen supply to the vessels and leads to loss of function. In the further course it can come to a complete stop of the blood supply of individual body regions, which can cause sometimes the death of body parts. As arteriosclerosis also affects the heart, it increases the risk of heart attack. A lack of blood flow in the brain increases the risk of stroke and has a negative effect on the health of the brain. Overall, the cardiovascular system also suffers from red blood cells taking up carbon monoxide instead of oxygen. Thus, there is a shortage of oxygen throughout the body, which among other things accelerates cell death.

The chemical process of burning tobacco creates high levels of harmful chemicals, CO is one among them. It binds to hemoglobin more easily than oxygen, thus decreasing the oxygenation of different organs resulting in moderate hypoxemia that can lead to ischemic events. Erythrocyte production is stimulated by hypoxemia, causing hyperviscosity that contributes to hypercoagulability.  The smoke contains a considerable number of oxidizing gases. These lead to inflammation, endothelial dysfunction and lipid oxidation, which contributes to the pathogenesis of CVD. Oxidizing gases also participate in platelet activation and thermogenesis and increase coagulability. Other components of the smoke, such as heavy metals and polycyclic aromatic hydrocarbons, destroy endothelial cells and contribute to the progression of atherosclerosis.

Nicotine substitutuion

The cardiovascular effects of cigarettes are well known and preventable. They are caused by nicotine, CO, heavy metals on the other side nicotine substitutes contain low dose nicotine and are relatively safe to use even in people with CV risk. Precautions are required during a severe acute cardiac event, but even in these situations, the use of nicotine replacement therapy remains preferable to smoking. Data on the efficacy and safety of varenicline in CVs are favorable. With respect to vaping, the exposure to nicotine and other compounds in the vapor differs with respect to the type and generation of the device and its use. It is therefore extremely difficult to generalize the results of the studies. In addition to nicotine, other substances in the liquid may have a CV effect. The CV toxicity of the vapote nevertheless seems to be lower compared to cigarettes but medium and long term data on the CV safety of the current devices are necessary. In the meantime, it is recommended that people who have quit smoking by vaporettes stop using them as soon as the cessation of smoking is consolidated and that they feel confident enough not to relapse.


Retinopathy refers to any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to a retinal vascular disease, or the damage to the vessels of the retina caused by abnormal blood flow. Retinopathy can be broadly categorized into proliferative and non-proliferative types. By examining the retina, the light-sensitive layer at the back of the eyes, a doctor can detect early signs of complications of diabetes or high blood pressure, as well as other diseases (such as sickle cell disease, anemia, lupus).

Types of the damage that can occur in the retina are hypertensive retinopathy, a complication of high blood pressure (hypertension), and diabetic retinopathy, a complication of long-term diabetes. Hypertensive retinopathy can lead to blockage of retinal arteries or veins, which in turn may eventually result in the loss of vision. Smoking and diabetes increase the risk of developing hypertensive retinopathy. Diabetic retinopathy is a deterioration of the blood vessels in the retina that usually affects both eyes. Diabetes is the most common cause of retinopathy in the U.S. Diabetic retinopathy is the leading cause of blindness in working-aged people. Almost all people with diabetes show signs of retinal damage after about 20 years of living with the condition. Retinopathy can also be seen in premature newborns.


Causes of retinopathy

Retinopathy is usually a sign of another medical condition. Although several medical conditions (sickle cell disease, lupus) can cause retinopathy, the most common causes are diabetes and hypertension.

Diabetic retinopathy is one of the most common complications of diabetes. Diabetes causes high blood sugar levels, which can damage blood vessels around the retina, that then leak protein and fats, forming deposits. The damaged blood vessels are also not as efficient at carrying oxygen to the retina. Diabetic retinopathy can be proliferative (growing abnormal blood vessels in the retina) or non-proliferative (not growing). Non-proliferative retinopathy is much more common and may not require treatment. In the advanced stage, called proliferative retinopathy, new blood vessels grow, when the existing vessels close off. However, they are weak and often burst, causing bleeding, which can cause scarring and damage vision. Regular eye examinations are important to check for progression of retinopathy from non-proliferative to proliferative stages. Diabetic retinopathy usually affects both eyes.

Hypertensive retinopathy is a complication of high blood pressure that usually takes many years to develop. High blood pressure damages the blood vessel walls, causing them to thicken and narrow, which then reduces the blood supply available to the retina, leading to retinal damage. Visual changes sometimes develop because of advanced retinopathy and may be a sign of undiagnosed or poorly controlled hypertension.

Signs and symptoms

Many people often do not have symptoms until there is irreversible damage. Symptoms are usually not painful and can include:

•    Spots or dark strings floating in your vision (floaters)

•    Blurred vision

•    Fluctuating vision

•    Impaired color vision

•    Eye pain and redness that does not resolve

•    Decreased peripheral vision

•    Changes in color perception

•    Headaches

The earliest sign of diabetic retinopathy that can be detected is the formation of microaneurysms. A more advanced form of diabetic retinopathy, called proliferative diabetic retinopathy, may lead to scars that decrease vision. In proliferative retinopathy, new blood vessels grow over the retina, these blood vessels may swell and burst, causing bleeding and damage to the eye.

Diagnosis and treatment

Retinopathy is diagnosed by an ophthalmologist during a comprehensive dilated eye exam that usually includes: visual acuity testing, tonometry, pupil dilation and optical coherence tomography (OCT). If severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damage or leakage in blood vessels. In the case of hypertensive retinopathy, an ophthalmologist will look for tiny cholesterol plaques as well as narrowing and thickening of the blood vessels.

The key to treating retinopathy is managing the underlying causes behind this condition. Controlling blood sugar levels in diabetes is critical in delaying the progression of diabetic retinopathy. Keeping blood pressure under control will help prevent hypertensive retinopathy. Regular exercise, proper diet, supplements and other lifestyle changes such as quitting smoking will reduce the risk of developing retinopathy. Once retinopathy is detected, early treatment is essential to prevent blindness.

Today, many retinal problems are treated with lasers. Evidence shows that laser therapy is generally safe and improves visual symptoms. If a blood vessel has already leaked and scarring has occurred, your doctor may advise you to have a vitrectomy, which involves removing a part of the vitreous humour along with the scar tissue. Treatment for hypertensive retinopathy includes medications to control blood pressure, laser treatment, and medications injected into the eye (corticosteroids).

Foods to avoid for high cholesterol

Foods to avoid for high cholesterol

Cholesterol is a substance found in our body and in animal products such as meat, eggs and dairy products. It plays important role in the production of hormones, vitamin D and the bile which is necessary for digesting fats. Cholesterol is an essential component of every cell in our body as a part of cell membranes, giving them strength and flexibility. The liver produces cholesterol that our body needs to function, but cholesterol can also be introduced through the consumption of food, and this takes about 25% of the cholesterol in our body. Through the body, cholesterol is transported by particles called lipoproteins, including low-density (LDL) and high-density lipoproteins (HDL). LDL is often referred to as “bad cholesterol,” as it’s associated with atherosclerosis, while HDL (“good cholesterol”) helps collect bad cholesterol from the arteries and bring it back to the liver for disposal.

When you consume a lot of cholesterol-rich foods, your body compensates by reducing the amount of cholesterol that the liver produces. In contrast, when cholesterol intake is low, the liver increases the production to ensure there is always enough cholesterol for functioning. There are a lot of cholesterol-rich foods that are important to consummate, but there are also foods to avoid for high cholesterol.

Types of fat

Fat intake affects the production of cholesterol in the liver because fatty acids bind to liver cells and through them regulate this process. The most effective dietary approach for lowering blood cholesterol is choosing foods that contain unsaturated fats over those that contain saturated or trans fats. Each form of fat influences cholesterol levels differently:

•  Saturated fats: You can find them mostly in meat and dairy products, and they instruct the liver to produce more bad cholesterol (LDL).

•  Unsaturated fats: These are more common in fish, plants, nuts, seeds, beans, and vegetable oils. Some of them may help increase the rate of reabsorbing and breaking down bad cholesterol (LDL).

•  Trans fats: These are found in hardened vegetable oils, manufactured through an artificial process called hydrogenation. Usually, fried food, baked goods and packaged foods contain them.

Foods to Avoid

Foods to avoid for high cholesterol

While certain cholesterol-rich foods are highly nutritious and beneficial to your health, others can be harmful. Here are some foods to avoid for high cholesterol:

•    Fried Foods: Such as deep-fried meats and cheese sticks or any of commercially fried foods should be avoided whenever possible. They’re loaded with calories and usually contain a lot of trans fats, which increase heart disease risk. Trans fats not only increase levels of bad cholesterol, but they can also lower levels of good cholesterol. Also, consumption of fried foods has been linked to an increased risk of obesity and diabetes.

•    Fast Food: Fast food consumption is a major risk factor for heart disease, diabetes and obesity. Those who frequently consume fast food tend to have higher cholesterol, higher levels of inflammation and imbalance in blood sugar levels. Sandwiches, pizza, hamburgers, pasta are some of the fast foods to avoid for high cholesterol. Cooking more meals at home is associated with lower body weight and reductions in heart disease risk factors like high LDL cholesterol.

•    Processed Meats: Such as sausages, bacon and hot dogs, are foods to avoid for high cholesterol. High consumption of this kind of meats has been linked to increased rates of heart disease and colon cancer.

•    Desserts: Cookies, cakes, ice cream, pastries, packaged cookies, soda, donuts and other sweets are unhealthy foods rich in added sugars, unhealthy fats and calories. Frequent consumption of these foods can negatively impact overall health and lead to obesity, heart disease, cognitive decline and certain cancers. These foods also lack nutrients your body needs to thrive, like vitamins, minerals, protein and healthy fats.

•    Salt: Usually found in canned soups, salty snacks, bread and rolls, pizza, some chicken, microwave popcorn. Too much sodium can raise your blood pressure, and because of that, it is recommended not to take more than 2,300 to 2,400 milligrams per day.

•    Saturated vegetable oils: Such as hydrogenated or partly hydrogenated coconut oil, palm oil and palm kernel oil.

Lowering cholesterol levels

While avoiding some of the previously mentioned foods there are some more ways of lowering cholesterol levels. They consist of: eating more fiber, increasing physical activity, losing weight, increasing dietary omega-3, eating more vegetables and fruits. If you follow these tips along with lowering cholesterol levels you will manage to decrease your heart disease risk, diabetes risk and obesity.

Essential hypertension

Essential hypertension (called idiopathic hypertension or primary hypertension) is the form of hypertension that has no identifiable cause. It is usually familial and is likely to be the consequence of a complex interaction between genetic and environmental factors. The other type of hypertension is secondary hypertension. Secondary hypertension is high blood pressure that has an identifiable cause, with a prevalence of 5% of patients with hypertension.

Blood pressure is the force of the blood against the artery walls as the heart pumps blood through the body. Hypertension occurs when the force of blood is stronger than usual. Hypertension can increase the risk of cerebral, cardiac and renal events.    

Risk factors

By the definition essential hypertension has no identifiable cause, however, several risk factors were identified. The list of risk factors:

  • Age: The risk of high blood pressure increases by aging. Until about the age of 64, essential hypertension is more common in men. Women are more likely to develop essential hypertension after the age of 65.
  • Race: Essential hypertension is four times more common among people of African heritage. It accelerates more rapidly and with a higher rate of serious complications in people of African heritage.
  • Family history: A personal family history of hypertension increases the likelihood that an individual would develop it.
  • Being overweight or obese:  Obesity can increase the risk of hypertension as compared with normal weight. More than 85% of cases occur in patients with a Body Mass Index (BMI) greater than 25. The mechanisms could include the activation of the sympathetic nervous system or the activation of the renin–angiotensin–aldosterone system.
  • Lack of exercise: Regular physical exercise reduces blood pressure, and at the same time increases the risk of being overweight.
  • Smoking:  Smoking doesn`t directly cause high blood pressure but it is a known risk factor for serious cardiovascular disease. Secondhand smoke also can increase the risk of developing heart disease.
  • Salt:  When sodium intake exceeds the capacity of the body to excrete it through the kidneys, vascular volume expands and this leads to an increase of blood pressure.
  • Alcohol: Over time, excessive alcohol consumption can damage the heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
  • Stress: High levels of stress can lead to a temporary increase in blood pressure.


The most recent classification recommends blood pressure criteria for defining normal blood pressure, prehypertension, hypertension (stages I and II), and isolated systolic hypertension. Blood pressure readings are described with two numbers, usually written this way: 120/80. The first number is systolic pressure. Systolic pressure measures the force of blood against artery walls as the heart pumps blood to the body. The second number measures diastolic pressure, which is the force of the blood against the artery walls between heartbeats, as the heart muscle relaxes.

Normal blood pressure is measured less than 120/80 millimeters of mercury (mmHg). Elevated blood pressure is higher than normal, but not quite high enough to be hypertension. Elevated blood pressure is a systolic pressure of 120 to 129 mmHg, a diastolic pressure less than 80 mmHg. Stage 1 hypertension is a systolic pressure of 130 to 139 mmHg, or a diastolic pressure of 80 to 89 mmHg. Stage 2 hypertension is a systolic pressure higher than 140 mmHg, or a diastolic pressure higher than 90 mmHg.


For most patients, high blood pressure is diagnosed when blood pressure readings are consistently 130/90 mmHg or above. A blood pressure reading can be done in the doctor`s office or at the clinic. To track blood pressure readings over a period of time, the doctor may ask the patient to come on different days and at different times. If the blood pressure is high, the doctor may want from a patient to check his blood pressure at home during regular intervals. It usually takes 2–3 readings at several medical appointments to diagnose high blood pressure.

The doctor can perform a physical exam to check for signs of heart disease, and may also order the following test to detect organ damage:

  • Cholesterol test
  • Echocardiogram
  • Electrocardiogram (EKG or ECG)
  • Kidney and other organ function tests


There’s no cure for essential hypertension, but there are treatments that can help manage high blood pressure and keep it under control. The treatment consists of lifestyle changes and medication. Recommended lifestyle changes are the following: exercising at least 30 minutes a day, losing weight, quit smoking, reducing stress levels, limiting alcohol intake, eating a low-sodium, heart-healthy diet (recommended DASH diet). If these lifestyle changes don’t lower the blood pressure levels enough, the doctor may prescribe one or more antihypertension medications, such as: beta-blockers, calcium channel blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers.


The excessive pressure on the artery walls caused by high blood pressure can damage the blood vessels, as well as the organs. Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke
  • An aneurysm
  • Heart failure
  • Weakened and narrowed blood vessels in the kidneys
  • Thickened, narrowed or torn blood vessels in the eyes
  • Metabolic syndrome
  • Dementia

With a healthy lifestyle and medication, there’s a good chance that you can control your blood pressure. Controlling essential hypertension reduces the risk of a heart attack, stroke, heart failure, damage to the eyes or kidneys. If you already have organ damage the treatment would help limit further damaging.

Cardiac tamponade

Cardiac tamponade, also known as pericardial tamponade, is a serious medical condition caused by the accumulation of fluid or blood in the pericardium (the sac around the heart), resulting in the reduced ventricular filling which keeps your heart from functioning properly. Because of this, your heart can`t pump enough blood to the rest of the body, which makes this condition a medical emergency. If not treated it can lead to complications such as pulmonary edema, organ failure, shock, cardiac arrest, and even death.

cardiac tamponade

Cardiac tamponade is usually the result of penetration of the pericardium, which is double-walled, thin sac that surrounds the heart. Common causes of pericardial penetration or fluid accumulation might be gunshot or stab wounds, trauma to the chest from a car accident, a ruptured aortic aneurysm, cancer that has spread to the pericardial sac, accidental perforation after cardiac catheterization or angiography, pericarditis, heart attack, kidney failure, hypothyroidism and many more. Other possible causes include leukemia, radiation therapy to the chest, systemic lupus erythematosus, dermatomyositis, and heart tumors.

Symptoms and diagnosis of cardiac tamponade

Symptoms of cardiac tamponade may vary with the acuteness and underlying cause of the tamponade. Patients with acute cardiac tamponade show signs like tachycardia, dyspnea, and tachypnea. Other symptoms and signs may include: low blood pressure, weakness, chest pressure, anxiety, fainting, dizziness or even loss of consciousness, decreased urine output, trouble breathing, cold and clammy extremities.


Prompt diagnosis is key to reducing the mortality risk for patients with this condition. There are often three signs any doctor can recognize, they are commonly known as Beck`s triad. They include:

  • Low blood pressure and weak pulse, because of reduced blood pumping by your heart
  • Extended neck veins
  • A rapid heartbeat combined with muffled heart sounds, due to the increasing level of fluids in the pericardium

Tests that need to be done for the diagnosis are firstly echocardiogram, an ultrasound of the heart, then chest X-rays, a thoracic CT scan, a magnetic resonance angiogram, and an electrocardiogram.

Pathophysiology of cardiac tamponade

The pericardium, which is the membrane surrounding the heart is composed of 2 layers. The ticker parietal which is an outer fibrous layer and the thinner visceral which is an inner serous layer. Normally the pericardial space contains 20-50mL of fluid. During cardiac tamponade there are 3 phases of hemodynamic changes, as follows:

  • Phase I – The accumulation of pericardial fluid impairs relaxation and filling of the ventricles, which leads to a higher filling pressure. At this point, the left and right ventricular filling pressures are higher than the intrapericardial pressure
  • Phase II – As fluid continues to accumulate, the pericardial pressure increases above the ventricular filling pressure, this leads to resulting in reduced cardiac pressure
  • Phase III – A further decrease in cardiac output occurs, which is due to the equilibration of pericardial and left ventricular filling pressures

The underlying process in the development of tamponade is a reduction in a diastolic filling, which occurs when transmural distending pressure becomes insufficient to overcome increased intrapericardial pressure. To maintain the cardiac output heart rate grows rapidly, which leads to tachycardia. Systemic venous return is also altered during cardiac tamponade because the heart is compressed due to the increased intrapericardial pressure.

Treatment of cardiac tamponade


Cardiac tamponade is a medical emergency that requires urgent hospitalization and drainage of pericardial fluid. The treatment has two purposes, firstly it should relieve pressure on your heart and then treat the underlying condition. Preferably, patients should be monitored in an intensive care unit, and the doctor needs to make sure that the patient is stabilized. Initial management in the hospital is by pericardiocentesis, this is a procedure that involves the insertion of a needle through the skin and into the pericardium, and then under ultrasound guidance aspirating fluid. Almost every time, a cannula is left in place for 1-2 days, so that the procedure can be performed again if the need arises. If a patient has penetrating wound the doctor can perform a more invasive procedure called a thoracotomy to drain blood.

During hospitalization, all patients should receive: oxygen, fluids, and medications to raise blood pressure. It is strongly recommended to be rested in bed with leg elevation because that can help increase venous return. Once the tamponade is under control and the patient`s condition stabilizes, the doctor may perform additional tests to determine the underlying cause of cardiac tamponade.

The long-term outlook depends on how quickly the diagnosis was made, the underlying cause of the tamponade, and any subsequent complications. The outlook is really good if the cardiac tamponade was quickly diagnosed and treated. So it`s important to seek medical help as soon as you notice any of the signs of symptoms.