Wednesday, May 8, 2019

Managing Heart Disease (JR 168)











Managing Heart Disease (JR168)

Introduction

Whether you want to better understand your high blood pressure symptoms or you want to know the signs of heart attack, better heart health begins with better information. When you experience tightness in your chest or a pain in your left arm, your first thought may be, “Am I having a heart attack?”
 Heart disease is still the leading cause of death for men and women. In most cases, a heart attack is the result of a long process in which the arteries that supply blood to the heart muscle become blocked. When blood stops flowing to that hard-working muscle, it stops beating and the result is a heart attack. The sooner blood flow can be restored, the greater the chances of minimizing heart damage and having a healthier outcome. That’s why it’s so important to recognize the signs of a heart attack and to can get help quickly. 



Reversal claims

Making simple changes in what you eat, how often you exercise, how much you weigh, and how you manage stress can help put the brakes on heart disease. Dean Ornish, MD, founder and president of the Preventive Medicine Research Institute, has written six best-selling books, including Dr. Dean Ornish's Program for Reversing Heart Disease.

In his book The Spectrum, Ornish describes patients waiting to undergo a heart transplant -- those with the worst possible damage -- who enrolled in his program while on a transplant list. Some of them, he says, improved so much; they no longer needed a transplant.

“Our studies show that with significant lifestyle changes, blood flow to the heart and its ability to pump normally improve in less than a month, and the frequency of chest pains fell by 90% in that time,” Ornish says.

“Within a year on our program, even severely blocked arteries in the heart became less blocked, and there was even more reversal after 5 years. That’s compared with ... other patients in our study, in which the heart just got worse and worse.”

Ornish's plan includes walking at least half an hour a day, or for an hour three times a week. Yoga, meditation, and stress reduction are also involved. Diet may be the biggest thing you'd change. The shift will be drastic if you're used to a typical  diet.

“Just making moderate changes in your diet may be enough to prevent heart disease, but it won’t be enough to reverse it,” Ornish says. He puts foods in five groups, ranging from healthiest to least healthy. To reverse heart disease, he says, means becoming a vegetarian. You'll fill your plate with fruits and vegetables, whole grains, legumes, soy products, nonfat dairy, and egg whites, and you'll avoid fats, refined sugar, and processed carbs.

“You want to eat foods in their natural form as much as possible," Ornish says. Of course, eating a healthy diet and being active are part of any heart health plan. You’ll also need to:

·         Stick to a healthy weight

·         Take all your medications

·         Keep up with your doctor visits

·         Not smoke or be around secondhand smoke








·         Stick to a healthy weight
·         Take all your medications
·         Keep up with your doctor visits
·         Not smoke or be around secondhand smoke
Height                                                                       Weight
Normal
Overweight
Obesity
Severe obesity
4ft 10"
(58")
91 to 115 lbs.
119 to 138 lbs.
143 to 186 lbs.
191 to 258 lbs.
4ft 11"
(59")
94 to 119 lbs.
124 to 143 lbs.
148 to 193 lbs.
198 to 267 lbs.
5ft
(60")
97 to 123 lbs.
128 to 148 lbs.
153 to 199 lbs.
204 to 276 lbs.
5ft 1"
(61")
100 to 127 lbs.
132 to 153 lbs.
158 to 206 lbs.
211 to 285 lbs.
5ft 2"
(62")
104 to 131 lbs.
136 to 158 lbs.
164 to 213 lbs.
218 to 295 lbs.
5ft 3"
(63")
107 to 135 lbs.
141 to 163 lbs.
169 to 220 lbs.
225 to 304 lbs.
5ft 4"
(64")
110 to 140 lbs.
145 to 169 lbs.
174 to 227 lbs.
232 to 314 lbs.
5ft 5"
(65")
114 to 144 lbs.
150 to 174 lbs.
180 to 234 lbs.
240 to 324 lbs.
5ft 6"
(66")
118 to 148 lbs.
155 to 179 lbs.
186 to 241 lbs.
247 to 334 lbs.
5ft 7"
(67")
121 to 153 lbs.
159 to 185 lbs.
191 to 249 lbs.
255 to 344 lbs.
5ft 8"
(68")
125 to 158 lbs.
164 to 190 lbs.
197 to 256 lbs.
262 to 354 lbs.
5ft 9"
(69")
128 to 162 lbs.
169 to 196 lbs.
203 to 263 lbs.
270 to 365 lbs.
5ft 10"
(70")
132 to 167 lbs.
174 to 202 lbs.
209 to 271 lbs.
278 to 376 lbs.
5ft 11"
(71")
136 to 172 lbs.
179 to 208 lbs.
215 to 279 lbs.
286 to 386 lbs.
6ft
(72")
140 to 177 lbs.
184 to 213 lbs.
221 to 287 lbs.
294 to 397 lbs.
6ft 1"
(73")
144 to 182 lbs.
189 to 219 lbs.
227 to 295 lbs.
302 to 408 lbs.
6ft 2"
(74")
148 to 186 lbs.
194 to 225 lbs.
233 to 303 lbs.
311 to 420 lbs.
6ft 3"
(75")
152 to 192 lbs.
200 to 232 lbs.
240 to 311 lbs.
319 to 431 lbs.
6ft 4"
(76")
156 to 197 lbs.
205 to 238 lbs.
246 to 320 lbs.
328 to 443 lbs.
BMI
19 to 24
25 to 29
30 to 39
40 to 54
Lori Mosca
You’ll need to be really motivated to make those changes, and to make them last. "You have to live a very strict lifestyle," says Lori Mosca, MD, director of preventive cardiology at New York-Presbyterian Hospital.
If you already have heart disease, Mosca emphasizes slowing it down through a healthy lifestyle that allows for more variety than Ornish's "reversal" plan. “I don’t think that dietary approaches that are highly restrictive are sustainable," Mosca says. She also avoids using the word "reversal." "I wouldn’t say you can ‘reverse’ heart disease, because that implies you had something and now you don’t," she says. "You can’t cure heart disease, but you can slow its progression.”
Ornish agrees that if you're just trying to slow heart disease, you might have more freedom with your diet. “If you need to reverse a life-threatening illness, you’re well-advised to live as much as you can on the healthiest end of the spectrum,” he says. “But if you’re just trying to stay healthy, it’s [unrealistic] to say, ‘Never eat certain foods.’ It’s much more sustainable to just move in a healthier direction.”    

Overview: How the Heart Works

In simplest terms, the heart is a pump, and one that’s powered by electrical energy. Therefore most heart problems are either plumbing or electrical. The plumbing system includes arteries that carry blood from the heart to all the organs, muscles and tissues, as well as veins that bring blood back to the heart from the rest of the body.
Inside the heart are four chambers: two upper chambers (atria) and two lower chambers (ventricles). The atria fill with blood during each heartbeat. In between the beats, valves open up between the atria and ventricles and the ventricles fill with blood. During the next contraction of the heart muscle, the heart pumps blood out to the rest of the body.
Blood is fed to the heart muscle by the coronary arteries. Veins return blood to the heart from the extremities. Blood is then pumped to the lungs to become oxygenated, and then back to the heart to be pumped out again– multiple thousands of times a day.
Controlling all this circulation is a complex electrical system that triggers each heartbeat, as well as the opening and closing of the valves. Blood that leaves the heart travels quickly throughout the body’s cardiovascular system, which includes a vast network of veins and arteries. Problems with any of your blood vessels can affect the heart, while heart disease can also impact the function of the arteries and veins throughout the body.

CORONARY ARTERY DISEASE

Coronary artery disease (CAD), also known as coronary heart disease (CHD) or just heart disease is a progressive medical condition that reduces or even halts blood flow through the arteries that supply blood to the heart muscle. When blood doesn’t reach the muscle, the result is a heart attack and permanent damage to some heart tissue.
CAD is slightly more common in men than women, but it’s definitely a major health concern for both sexes. And a woman’s risk of heart disease increases after menopause—so much so that among older adults, more women die of heart disease than men. CAD claims the lives of more than 370,000 Americans annually, but the numbers of people dying of CAD have diminished in recent years as more people adopt healthier lifestyles and CAD treatment continues to improve.

Causes of CAD

Cad occurs because of: High blood pressure (hypertension); sedentary lifestyle; Diabetes; Smoking; Advancing age; Family history of heart disease What causes CAD and heart attacks is a process called atherosclerosis. Often described as, “hardening of the arteries.” That’s because cholesterol, fats and other substances, such as white blood cells, collect in the walls of the blood vessels that keep the heart supplied with blood—the coronary arteries. The cholesterol and other materials form plaques. This can create two problems for the heart.
When plaques are first forming, they’re soft. But they can rupture, releasing the “junk” inside. The rupture can also lead to the production of enzymes that cause blood to clot. If the clot is big enough it can block the flow of blood. Older plaques present a different danger. After a while, soft plaques turn hard and narrow the affected arteries. If the plaque build-up is too great, blood can no longer flow through a blocked artery. No matter what causes the stoppage of circulation in the coronary artery, the result is a heart attack.

Symptoms of CAD

Before you get to the stage of CAD that ends up with a heart attack, you should learn about these symptoms of CAD, the signs that suggest heart disease is developing and a heart attack could be in your future:
  • Angina Symptoms: The most noticeable and serious symptom of CAD is angina, the clinical term for chest pain caused by reduced blood flow to the heart. When your heart muscle isn’t getting quite enough oxygenated blood from the coronary arteries, you may feel pressure or tightness in your chest. You can have angina for years without ever having a heart attack. But it’s important to pay attention to the frequency and intensity of angina episodes because they can signal a change in your condition. Angina exists in two forms: stable and unstable angina. Stable angina is pain that is fairly predictable. If your chest starts to feel tight after you do some yard work or exercise, but you seldom if ever feel pain when you’re resting, it’s probably stable angina. Unstable angina can appear at any time. You might be sitting in your favorite chair watching TV and suddenly feel a smothering sensation in your chest. That’s unstable angina and it’s much more dangerous than stable angina. Unstable angina puts you at a higher risk for a heart attack, so it’s vital that you discuss your symptoms with your doctor.
  • Shortness of breath: Shortness of breath may also indicate CAD. If you’re having trouble catching your breath after walking up a flight of stairs or doing any kind of exertion, don’t hesitate to tell your health care provider. This can also indicate respiratory problems, not just CAD, so it’s especially important not to ignore.
  • Heart attack: Of course, the most obvious symptom of CAD is a heart attack. You’ve no doubt seen movies or television shows in which a character clutches his or her chest for a moment and then collapses because of a heart attack.
Signs of a heart attack vary from person to person. And the symptoms you had during one heart attack may not be the same ones you experience if you’re unfortunate enough to have a second. Typical symptoms also differ somewhat between men and women. Men, for instance, are more likely to feel a sudden pressure in the chest, while a woman’s symptoms of a heart attack may be more likely to include pain in the upper back and dizziness.
Signs of a Heart Attack: Pressure or pain in the back, neck, or jaw; Shortness of breath; Nausea, sometimes to the point of vomiting; Discomfort in the upper abdomen; Heartburn or indigestion; Headache; And Arm pain, often in the left arm, but could be in either or both arms
Another atypical symptom of a heart attack is a vague feeling that you’re not quite right. You feel ill, but without specific pains or other complaints. This can make it difficult to know how to react, but if this feeling persists, trust your instinct. If you sense that something is wrong, see a doctor.
And even if the signs of a heart attack you’re experiencing are mild or hard to define, the heart attack itself may be quite serious. Your heart can experience just as much injury from a heart attack with no chest pain as one with that “elephant sitting on your chest” feeling.
If you are at high risk for a heart attack, it’s vital that you take your risks seriously and respond quickly when symptoms appear. The sooner you respond to signs of a heart attack, the more likely it is that you can receive treatment that will minimize damage to the heart muscle and give you a greater chance of having a healthy recovery.
Heart Attack Risks:  Advancing age; High cholesterol; Smoking; Obesity; Diabetes; Inactive lifestyle; Family history of heart disease; Previous heart attack or stroke; Autoimmune disease, such as rheumatoid arthritis; Stress
If you experience one or more of those risk factors, then you should memorize the symptoms of a heart attack and make sure those who live and work with you know them, too. If a heart attack occurs, you may be able to explain your symptoms and call emergency or a family member or someone else close to you may be the one who has to call the paramedics. In general, it’s best to call emergency rather than be driven to the hospital. And under no circumstances should you try to drive yourself to the hospital if you suspect you’re having a heart attack.

Diagnosing CAD

If you experience angina or shortness of breath, or if you have serious risk factors, such as high cholesterol, hypertension, obesity, smoking or a family history of heart trouble, you should talk with your doctor about a screening for CAD. If you have no symptoms, your doctor may do a routine exam that includes listening to your heart. But you may be advised to make lifestyle changes to help lower your risks of CAD.If your physician suspects CAD or some other kind of heart disease you may be advised to undergo one or more of the following tests:
  • Electrocardiogram (EKG), which measures the heart’s electrical activity. An EKG may help detect an arrhythmia or if parts of the heart are working too hard.
  • Echocardiogram (echo), which uses sound waves to create a picture of the heart. It can reveal information about how the heart’s valves are working, how well the heart is pumping, the presence of any blood clots and the health of the heart’s outer lining and the large arteries that exit the heart.
  • Exercise stress test, which measures how well the heart handles exertion. In this test, you’ll walk on a treadmill or ride a stationary bicycle while hooked up to monitors that measure your blood pressure and your heart function. During exercise, the body demands more oxygenated blood, so the heart has to pump harder. If blood flow is limited during a stress test, that can help the doctor make a diagnosis of CAD.

Treating CAD

As with most heart conditions, lifestyle changes are often necessary with a CAD diagnosis. Regular exercise, losing weight, and quitting cigarettes are among the most important changes you can make. Along with making healthier choices, you may also be advised to follow a medication regimen that involves several different types of medications. Some of the more common meds for CAD include:
  • Statins to help control cholesterol. Statins are taken daily, and are generally well-tolerated, along with being very effective for most people. Some side effects may include muscle soreness and a slight increase in blood sugar levels.
  • Anti hypertensives to help lower blood pressure. Among the most widely used blood pressure-lowering medications are ACE inhibitors, ARBs, diuretics, beta blockers, alpha blockers, and calcium channel blockers. The type of antihypertensive that’s right for you depends on the underlying cause of your hypertension (if that can be determined), as well as any other health problems you might have, such as diabetes, heart failure or kidney disease.
  • Aspirin to help prevent blood clots. Daily aspirin therapy is a somewhat controversial issue. Most doctors agree that it’s helpful for people who have already had one heart attack and want to avoid a second. But medical experts are split about whether an aspirin a day is right to prevent a first heart attack, primarily due to the risk of internal bleeding or gastrointestinal irritation that can accompany aspirin use.
  • Blood thinners to help prevent blood clots. In addition to aspirin, other antiplatelet and anticoagulant medications are prescribed to patients at high risk for heart attack or stroke.
  • Nitroglycerin to relieve angina by opening the coronary arteries and veins throughout the body. Blood flow to the heart muscle increases. At the same time the heart’s workload diminishes. This can help bring an angina episode to an end.

Stenting and Surgery

Sometimes medications aren’t enough. Serious cases of CAD require interventional procedures to help restore blood flow in blocked arteries. Depending on the severity of the blockage and its location, your doctor may recommend stenting or bypass surgery.
A stent is a flexible mesh scaffold-like device, which can fit inside a coronary artery. A stent is usually placed at the site of the blockage with a catheter that is inserted into an artery in the leg or wrist and then guided to the heart. Once at the narrowed or blocked part of the blood vessel, the collapsed stent is opened from within by inflating a tiny balloon. The stent pushes the plaque against the inner wall of the artery, and blood flow resumes in a much healthier manner.
Sometimes, however, a stent is not the answer. This could be because the blockage is so severe, or because it’s in a Y-shaped part of an artery that can’t easily be helped with a stent. In these situations, you may need to undergo coronary artery bypass grafting (CABG).
CABG is usually done with open-heart surgery. A blood vessel is taken from another part of the body and grafted on to the blocked artery so that blood can move through the newly attached artery, bypassing the blockage altogether.
Both procedures have their risks and benefits, but in any event, a healthy lifestyle is essential for anyone following stenting or CABG. And those same healthy choices may also help lower the risk of developing CAD in the first place.

Preventing CAD

Because you can’t control advancing age or the genes you inherit, some CAD risk factors are unavoidable. However, most risk factors are manageable. Following your doctor’s advice may help you avoid the need for interventions or a long list of medications.
Preventing CAD: stop smoking:  Talk with your doctor about programs and products that can help you quit. Remember, too, that most people need several tries before they can quit permanently; Weight loss, Getting down to a healthy weight does several things, including reducing the burden on the heart, lowering your blood pressure, reducing diabetes risk, giving you more energy to exercise, helping you sleep better and lowering your cholesterol; Regular exercise: Exercising 30 to 40 minutes a day will go a long way in improving your heart health. If necessary, you may need to break up your workouts into 10-minute routines; Healthy diet: Lowering your sodium intake may help improve your blood pressure, and reducing your intake of simple carbohydrates and unhealthy fats will help you lose weight and manage your blood sugar levels.
Heart Rate whilst walking: Your walking heart rate will go up or down depending on how quickly you’re moving. In general, however, walking is a low- to moderate-intensity activity. Exercising at a moderate intensity (i.e. walking or jogging), your heart rate will fall somewhere between 50 to 70 percent of your maximum heart rate.  Whereas vigorous exercise will fall somewhere between 70 to 85 percent of your maximum heart rate.
To figure out your target heart rate zone while walking, you first need to determine your maximum heart rate, or the maximum number of times your heart beats per minute. The standard formula for calculating maximum heart rate is to subtract your age from 220. To determine your target heart rate for various exercise intensities, take your maximum heart rate and multiply it by a percentage. For example, to figure out what 50 percent of your maximum heart rate equals, take your maximum heart and multiply it by 0.5.
However, these numbers are by no means definitive, so use them only as a general guide. Wearable technology — such as heart rate monitors and fitness trackers — offer an easy way to track your heart rate during exercise. Otherwise, you’ll have to check your pulse manually while walking, which can be tricky.
                                                                                   
Blood sugar or glucose control is essential, because too much of it circulating in your bloodstream indicates diabetes. Your risk of heart disease and other heart complications rises dramatically if you have diabetes. If you ever get a diagnosis of pre-diabetes, you should be especially mindful of losing weight and adjusting your diet and exercise levels to keep your condition from advancing to diabetes. Pre-diabetes is diagnosed, in part, with a special type of blood test called an A1C test. An A1C result between 5.7 and 6.4 percent indicates pre-diabetes.
CAD prevention also depends on keeping your blood pressure and cholesterol levels under control. Discussing your target levels with your doctor and developing a strategy for managing your blood pressure and cholesterol.

Summary

While coronary artery disease can lead to fatal heart attacks or major surgery, CAD is also a very treatable condition. The keys to surviving and thriving with CAD include:
  • Recognize heart attack symptoms and know how to respond.
  • See your physician regularly and follow his or her advice about diet, exercise, and medications.
  • Remember that CABG or stenting are not “cures,” but treatments that require ongoing monitoring and a heart-healthy lifestyle.

 HEART FAILURE

One of the possible results of a serious heart attack is heart failure. It sounds like a condition in which the heart fails to work. But in reality, heart failure simply means the heart has weakened and can’t pump as efficiently as it once did. The result, however, is that blood doesn’t circulate as vigorously as it should throughout the organs, tissue and other parts of the body. It can also mean that proteins and other substances can build up in the blood. These can damage the heart and other organs. A weakened heart also tries to work harder to meet the body’s demand for oxygenated blood, and all that additional work can make heart even weaker.  While heart failure treatment has improved in recent years, the prognosis for people with the condition can be grim. About half of the people with heart failure die within five years of diagnosis.

Types of Heart Failure

There are actually a few different types of heart failure. The most common is left-sided heart failure. That’s because the left ventricle has the biggest pumping job, sending blood through the aorta and out to most of the body. Within left-sided heart failure, there are two kinds of heart failure: systolic and diastolic.
Systolic heart failure means the left ventricle can’t contract properly, so a reduced amount of blood is pumped with every heartbeat. Diastolic heart failure means the left ventricle no longer relaxes properly in between heartbeats. As a result, less blood fills the left ventricle, so less blood is pumped out of the heart.
You can also have right-sided heart failure, though it often develops after left-sided heart failure. When the left ventricle can no longer pump enough blood throughout the body, blood and fluid can back up into the veins. This puts more pressure on the right side of the heart, which accepts blood (into the right atrium) and pumps it to the lungs (from the right ventricle) to become oxygenated. All that added pressure makes the right side of the heart work harder, resulting in right-sided heart failure.

About Congestive Heart Failure

You may have heard the phrase “congestive heart failure” used interchangeably with “heart failure.” That’s because the symptoms of heart failure usually involve congestion throughout the body. Less blood being constantly circulated means less excess fluid being filtered by the kidneys into urine. That additional fluid is known as congestion, and it can start to collect in the lungs and other tissues of the body. You may notice swelling in the legs, feet and even around the eyes. This kind of swelling is called edema, and it’s serious. If swelling increases—this is often noticed by weighing yourself daily—it’s usually a sign your heart failure is worsening and immediate treatment is needed.
What is Congestive Heart Failure? Heart failure can develop without their having been a heart attack, though that is often a cause. The damage done to the heart muscle by the heart attack can leave it weaker than before. But there are many other causes, too. High blood pressure, for example, can lead to heart failure. Elevated pressure in the arteries forces the heart to work extra hard to keep blood moving. The heart must also pump harder if the valves don’t open and close properly. Valve disease often means a reduced amount of blood is circulating throughout the heart, so less blood is being pumped to the body. In an effort to keep up with demand, the heart works harder… and grows weaker.
Diseases of the heart muscle, such as cardiomyopathy or myocarditis, can also injure the heart and leave it unable to pump as it once did. The bottom line with all these causes is that any damage to the heart, even if you don’t notice any symptoms, can make the heart weaker.
One other cause of heart failure that isn’t related to a heart condition you develop over time is a congenital heart problem. If the structure of the heart isn’t normal and healthy at birth, the heart muscle may have to work harder to compensate.

Congestive Heart Failure Symptoms

Unlike a heart attack, which can present suddenly and with obvious symptoms, heart failure usually develops slowly. However, a condition called acute decompensated heart failure (ADHF) includes a sudden worsening of symptoms.
You may have had heart failure and not been aware of the condition until ADHF appears. Suddenly, you may have difficulty breathing and experience sudden edema, or fluid buildup in chronic heart failure, unlike ADHF, symptoms tend to get worse over a period of months or years.
Heart Failure Symptoms
Shortness of breath:  usually with exertion but even when lying down in some instances. If theres congestion in the lungs, lying flat will cause the fluid to spread out across the lungs (think of laying a bottle of water on its side as opposed to standing it upright). When more of the lungs are wet, it becomes harder to breathe.
Swelling (edema):  especially in the legs and feet. Swelling may also lead to weight gain.
Persistent cough: sometime with pink-tinged phlegm.
Fatigue : and less energy for exercise.
Racing : or abnormal heartbeat.
Nausea:  sometimes with vomiting.
Difficulty: concentrating and staying alert.
If the coughing or shortness of breath worsens or you notice an abnormal heartbeat, you should see a doctor soon. And if any of these symptoms are accompanied by chest pain, you should definitely seek emergency medical care.

Diagnosing Heart Failure

A combination of tests and an evaluation of symptoms will help a physician diagnose heart failure. It starts with a standard physical exam. Your doctor should listen to your heart and lungs with a stethoscope to pick up indications of an irregular heartbeat or congestion in the lungs. A chest X-ray can also provide a doctor a picture of what’s going on in the heart and lungs.
If heart failure is suspected, a blood test will likely be ordered to check for certain indicators, such as the chemical N-terminal pro-B-type natriuretic peptide. It’s a substance produced by the heart when it is being overworked.
Another helpful screening is an echocardiogram, which uses sound waves to create a picture of the heart’s shape, size and the functioning of its valves. An echocardiogram can be particularly helpful in discerning between systolic and diastolic heart failure. The test also helps your doctor measure your ejection fraction, which is the percentage of blood from the left ventricle that is actually pumped out of the heart with each contraction. A diminishing ejection fraction usually indicates worsening heart failure.

Treating Heart Failure

Depending on the severity and cause of your heart failure, treatment can range from medications and lifestyle adjustments to artificial pumps implanted in the chest to compensate for the heart’s declining pumping ability. A heart that has grown too weak may need to be removed in favor of a transplanted heart.
In its early stages, heart failure is usually treated with medications, including angiotensin-converting enzyme (ACE) inhibitors. These drugs widen arteries to make blood flow easier. This helps reduce blood pressure and lessens the heart’s workload.
Beta blockers, which slow the heart down, can also be helpful. Diuretics, which help the body reduce fluid levels to lower blood pressure, are also commonly prescribed to heart failure patients. A powerful drug called Digoxin is also a mainstay of heart failure treatment. It strengthens each heart contraction, and is often used when the source of heart failure is an arrhythmia.
Treating the underlying cause of heart failure can sometimes be enough to halt symptoms and essentially reverse the heart failure. But for many people heart failure is a chronic condition that can’t be cured. Medications are part of an effective treatment, but certain procedures may also be necessary.
For example, coronary artery bypass graft (CABG) may help improve heart failure symptoms if CAD is the problem. Heart valve repair or replacement may also be helpful. Certain cardiac devices, including a pacemaker and an implantable cardioverter device (ICD), may be needed to help keep the heart in a healthy rhythm and make sure it pumps as efficiently as possible. And when these treatments are no longer enough to keep blood circulating sufficiently, the next step is a ventricular assist device (VAD)—an artificial pump that takes over for the left ventricle. A VAD is surgically implanted in either the abdomen or the chest, and is attached to the heart to circulate blood throughout the body. VADs used to be temporary measures to help patients get by while they waited for a heart transplant. But with improvements in technology, some heart failure patients are relying on VADs for long-term use.
A heart transplant is still a possibility for some people, but there are restrictions. These include the availability of donor hearts and the overall health of the recipient. Patients who are too frail to handle a heart transplant may not be eligible for this dramatic procedure.

June 7,2019:

The heart  patches could one day help people manage and recover from debilitating heart failure, a condition which affects an estimated 920,000 people in the UK alone, and is on the rise worldwide, say researchers from the BHF. The patches are thumb-sized bits of heart tissue measuring 3cm by 2cm and containing up to 50 million human stem cells. These cells have the ability to turn into fully-functional heart tissue, and are meant to be applied to the heart of someone after they’ve had a heart attack. Used in this fashion, they can limit, and even reverse, the loss of the heart’s pumping ability.

Preventing Heart Failure

Because heart failure can develop from any of several heart conditions, the key to prevention is to strive for the best cardiovascular health possible. This means controlling risk factors, such as quitting smoking, maintaining a healthy weight, exercising most days of the week, eating a low-fat and low-sodium diet, reducing stress, getting enough sleep, and managing blood pressure, cholesterol and blood sugar levels.
It’s also important to see your doctor on a regular basis and follow his or her instructions when it comes to screenings, medications and other healthcare maintenance. If you have had a heart attack or you have a heart condition of any kind, it’s vital that you work with your doctor to try to keep heart failure from developing.
Heart failure can be a treatable condition. Medications and medical devices are helping people with heart failure live longer and with a greater quality of life. But if your heart grows weaker, it’s up to you to take a strong and optimistic approach to your treatment.

  CARDIOMYOPATHY

Along with heart failure, cardiomyopathy is another potential outcome of a heart attack. Cardiomyopathy is sometimes referred to as an “enlarged heart,” because the main sign of cardiomyopathy is a heart muscle that has become thicker and more rigid.
Bigger muscles might be what athletes want in their arms and legs. But a bigger heart isn’t a good thing, as it actually becomes weaker rather than stronger. And as you just read, a weaker heart leads to heart failure. There are actually several different types of cardiomyopathy. They include:
  • Hypertrophic cardiomyopathy: An enlargement of the heart muscle without an obvious cause.
  • Dilated cardiomyopathy: An enlargement and weakening of the ventricles, which can lead to heart failure, arrhythmias and blood clots.
  • Restrictive cardiomyopathy: Reduced blood volume filling the ventricles, which become stiff but not thick.
  • Arrhythmogenic right ventricular dysplasia: A rare, but serious disease, in which the right ventricle’s muscle is replaced with more fibrous and fatty tissue. It often leads to arrhythmias.
There are other types of cardiomyopathy, usually categorized under “unclassified cardiomyopathy.” Some people with mild cardiomyopathy may never experience any symptoms, while others develop very serious complications. Typically, the cause of your cardiomyopathy determines the severity of symptoms and the type of treatment that you’ll need.

Causes of Cardiomyopathy

There are two basic origins of cardiomyopathy. It can either be inherited or acquired. Inherited, as you might surmise, means the condition is part of the genes you inherit from your parents. Hypertrophic cardiomyopathy is often inherited, though it can develop in older adults.
Dilated cardiomyopathy is sometimes inherited, but is usually the result of CAD, high blood pressure, a heart attack or other heart condition. A viral infection that causes inflammation of the heart can also lead to dilated cardiomyopathy. The condition in women is also sometimes related to complications during the last months of pregnancy.
The causes of restrictive cardiomyopathy range from connective tissue disorders, such as Marfan syndrome and cellulitis, to cancer treatments, such as chemotherapy and radiation. Other health problems, such as amyloidosis (a buildup of certain proteins in the heart and other organs), can also result in restrictive cardiomyopathy. Arrhythmogenic right ventricular dysplasia is thought to be an inherited condition.

Symptoms of Cardiomyopathy

In the early stages of cardiomyopathy, you may not notice any symptoms. But as the condition develops, you may experience heart failure-like symptoms, such as shortness of breath, fatigue, and swelling in the legs and feet (and possibly in the neck and abdomen). Dizziness or lightheadedness may also occur, and arrhythmias may also develop over time.

Diagnosing Cardiomyopathy

The tests and evaluations used to diagnose cardiomyopathy are similar to those used to identify heart failure. But sometimes using a stethoscope to listen to the heart can help diagnose particular types of cardiomyopathy. Certain kinds of heart murmurs may suggest hypertrophic cardiomyopathy. A rattling sound in the lungs could indicate cardiomyopathy has also brought on heart failure.
Screenings including a chest X-ray and an echocardiogram can show changes in the heart’s structure. An electrocardiogram (EKG) measures the heart’s electrical activity, and is helpful if an arrhythmia is also suspected.
In addition to an evaluation of your symptoms, one other very important aspect of cardiomyopathy diagnosis is a look at your family history. Because cardiomyopathy can be an inherited condition, a detailed knowledge of your family’s heart health history can be very helpful to your health care provider.

Treating Cardiomyopathy

If you’re not experiencing any symptoms, you may not need any treatment for your cardiomyopathy. You should, however, strive for a heart-healthy lifestyle. This includes:
  • A heart-healthy diet, such as the Mediterranean-style eating plan or the Dietary Approaches to Stop Hypertension (DASH) diet.
  • At least 150 minutes of exercise a week.
  • Smoking cessation.
  • Reducing stress through meditation, breathing techniques and other methods.
  • Maintaining a healthy weight.
This advice also applies whether you have been diagnosed with cardiomyopathy or not. If a healthy lifestyle isn’t enough, you may be prescribed medications. These includes medicines to help balance electrolytes in the body, maintain a healthy heart rhythm, lower your blood pressure (including diuretics to also help remove excess fluid from the body), prevent blood clot formation, lower inflammation, and slow your heart rate (beta blocks, calcium channel blockers and digoxin are among the drugs that work on the speed and strength of your heartbeat).

Nonsurgical and Surgical Procedures

When cardiomyopathy symptoms begin to severely interfere with your quality of life and your overall health, some type of interventional therapy may be necessary. One nonsurgical procedure that is sometimes effective is alcohol septal ablation. In this treatment, your doctor will inject a type of alcohol into a tube connected to an artery that supplies blood to the enlarged or thickened part of the heart muscle. The alcohol destroys some of the cells, which helps shrink that portion of the muscle back to a more normal thickness.
Sometimes, however, surgery is necessary. But the options are limited. For some hypertrophic cardiomyopathy patients a procedure called septal myectomy may be helpful. In this operation, a surgeon will remove part of the tissue of the enlarged septum—the wall that separates the two ventricles. This can make it easier for the ventricles to fill with blood and pump it out.
Another surgical procedure that helps certain patients is the implantation of a cardiac device. If you have cardiomyopathy and an arrhythmia, an implantable cardioverter defibrillator (ICD) may be placed in the chest or abdomen to help keep the heart’s rhythm steady. A left ventricular assist device may also be implanted if cardiomyopathy has led to heart failure and a heart too weak to pump on its own.

Prevention

The steps needed to prevent cardiomyopathy are similar to that needed to prevent heart failure or any heart condition. These include a healthy diet, regular exercise, no smoking and management of your weight, blood pressure, cholesterol and blood sugar. And, of course, there’s nothing you can do to prevent inherited cardiomyopathy.

Summary

Cardiomyopathy affects an estimated 1 in 500 people, but many never notice symptoms because their condition is mild. It tends to be more common in men than in women, but it can affect anyone at any age. Because of that, cardiomyopathy can be viewed as yet another reminder to follow a heart-healthy lifestyle for as long as you can.

HIGH BLOOD PRESSURE

 High blood pressure (hypertension) can be a factor in CAD, heart failure and cardiomyopathy. And as you’ll learn, hypertension is also a major risk factor for stroke. .But what is hypertension? Well, blood pressure is just the force of blood against the inside walls of the arteries. It’s measured in two parts: systolic and diastolic pressure. Systolic pressure is the force of blood against the artery walls when the heart contracts. Diastolic pressure measures that force when the heart relaxes and fills with blood for the next contraction.
Your blood pressure is given as the systolic pressure over the diastolic pressure. For example, a blood pressure of 120 mmHg/70 mmHg is considered normal blood pressure. The mmHg measurement refers to millimeters of mercury.
Hypertension is a condition in which that force is greater than normal. According to the American Heart Association rates hypertension by stages: prehypertension, Stage 1 hypertension, and Stage 2 hypertension.
Prehypertension is, of course, the stage just below the level at which a person is considered to have high blood pressure. It should be looked at as a warning sign that steps should be taken to avoid advancing into Stage 1 high blood pressure. Prehypertension is defined as having a systolic pressure of 120 to 139 mmHg and a diastolic pressure of 80 to 89 mmHg.
Stage 1 hypertension is defined as systolic blood pressure of 140 to 159 mmHg and a diastolic pressure of 90 to 99 mmHg. Stage 2 hypertension is a systolic pressure of 160 mmHg or higher, or a diastolic pressure of 100 mmHg or higher.

Causes of High Blood Pressure

Blood pressure is dependent on several bodily processes. The kidneys, for example, must maintain the proper balance of sodium and fluid in the body for blood pressure to remain normal. If the kidneys don’t excrete enough fluid, the volume of blood expands and places more pressure on the arteries.
Another cause of hypertension is due to a change in the renin-angiotensin-aldosterone system. The hormone angiotensin helps widen or narrow blood vessels. Constricted blood vessels lead to higher blood pressure. Aldosterone affects the kidneys’ ability to balance fluid and sodium levels.
Researchers are also looking at whether high blood pressure might be caused by the sympathetic nervous system, the “fight or flight” part of the nervous system that controls things like blood pressure, heart rate, breathing rate and other processes. There also appears to be a genetic component to hypertension, but that’s not entirely understood. Research continues in that area, too.
An unhealthy lifestyle is also a major risk factor for high blood pressure. Obesity and a diet high in sodium are common culprits, as are smoking and drinking alcohol to excess. A lack of regular physical activity can also lead to high blood pressure.

Symptoms of High Blood Pressure

You can’t count on high blood pressure symptoms to alert you to this serious cardiovascular problem. You may have heard high blood pressure described as “the silent killer.” That sounds ominous, but it simply refers to the fact that hypertension can lead to deadly complications while never presenting with any symptoms.
In fact, unless your high blood pressure is well into Stage 2 you probably won’t notice anything except the numbers on your blood pressure reading. That’s why it’s important to have your blood pressure checked regularly. Hypertension can sneak up on you. One year your numbers may be fine. At your next annual physical, you’ve got high blood pressure.
If, however, your blood pressure is severely high (usually well above 160/100 mmHg), you may experience symptoms such as a headache, nosebleed and fatigue. It’s possible you could experience those high blood pressure symptoms at an earlier stage. It’s also possible that you may not even notice any signs, even in a hypertensive emergency.

Diagnosing High Blood Pressure

So if there are no symptoms to respond to, how do you know if you should be tested for possible high blood pressure? Hypertension can be identified with a simple check of your blood pressure. If a blood pressure check reveals hypertension, you’ll likely be checked again to confirm your numbers. You may have two or three separate checks on different days to confirm the diagnosis.
You will probably have your blood pressure checked in both arms to rule out any problems specific to the blood vessels in one arm. Your doctor may also order a 24-hour blood pressure monitor to note changes. Blood pressure changes throughout the day and night, depending on your sleep stages, when you eat, when and how much you exercise, and various other stimuli.
If high blood pressure is diagnosed, there should be further tests to get a comprehensive look at your cardiovascular health. Your cholesterol levels should be checked, as well as your blood sugar levels. You may also be advised to undergo screenings such as an echocardiogram and electrocardiogram to reveal more about the structure and function of your heart.

Treating High Blood Pressure                                                                                 

Hypertension treatment almost always includes medications. The usual approach is to be conservative, starting with one medication at a moderate dose. But a higher dose may be necessary. Or multiple drugs may be required to get your blood pressure under control. You should also know that the drug or drugs that help you manage your blood pressure at first may need to change over time as your cardiovascular health changes.
Drugs for High Blood Pressure:
Diuretics;
Angiotensin-converting enzyme (ACE) inhibitors;
Angiotensin II receptor blockers;
Beta blockers;
Calcium channel blockers’
And Renin inhibitors
But along with taking medications, successful hypertension treatment depends on lifestyle adjustments. And among the most important steps you can take are regular exercise and weight management. If you’re overweight or obese, dropping even 10 pounds can bring down your blood pressure by a few mmHg. You can also help lower your blood pressure by exercising daily, or at least most days of the week.
Follow a heart-healthy diet that focuses on fruits, vegetables, whole grains, lean proteins and low-fat or nonfat dairy, and you should be on your way to lower blood pressure. It also goes without saying, though we’ll say it here, that you should stop smoking immediately. Smoking damages the blood vessels, and that injury increases blood pressure.

Preventing High Blood Pressure

Following the heart-healthy behaviors above may also help prevent you from developing high blood pressure. And if you are ever diagnosed with pre hypertension, you should discuss with your doctor all steps necessary to bring your blood pressure back down. Medications usually aren’t prescribed for prehypertension, but a healthy lifestyle may be enough.
The key with hypertension is to prevent it from getting worse. That means following the advice of your healthcare provider and not assuming that once medications and a healthy lifestyle bring your numbers under control that you are “cured.” High blood pressure is a chronic problem, so if you’re being treated, figure that you’re going to be on antihypertensive medications for life.
Weight loss, smoking cessation and other positive changes may reduce the number of medications you need. But taking some drugs to control blood pressure may be necessary to prevent a worsening of your condition.

Summary

High blood pressure affects about one out of every three adult. Many of those with hypertension don’t know it. And even many of the individuals who know they have high blood pressure don’t have it under control. Your odds of developing hypertension increase with age, but it can develop at any time. That’s why it’s essential to keep track of your blood pressure with regular doctor visits (and with a home monitor if you’re at risk for hypertension) and to take steps now to minimize your odds of developing high blood pressure:
  • Cut back on the salt,
  •  Lose those extra pounds.
  • Walk (or swim or bike or…) more. Walking is by far the best exercise
  • Get enough sleep.
Poor quality sleep and too much stress can also raise your blood pressure, so relax and talk with your doctor about a blood pressure target that’s right for you.

Recommendations 

Following a heart-healthy lifestyle starting now and following your doctor’s advice are two of the most important preventive steps you can take to avoid a heart attack or other medical problem. Arming yourself with information is the third important aspect of cardiovascular health. Be Heart-smart; to live a long, healthy life. It’s not complicated, but it means you have to make good choices every day.

 
We are only born with one heart. For our entire life, our heart needs to work for us in order to survive. Because of this, it is important to take care of your one and only heart. However, many people in the United States suffer from heart disease due to poor diet and lack of activity. Generally, cardiovascular health problems have to do with when the blood vessels become diseased, resulting in coronary artery disease (CAD), arrhythmias (or heart rhythm problems), and heart defects, to name a few possible problems. • Statistics About Heart Disease • Cardiovascular Health Statistics • Stroke Association Information • Heart Disease Facts and Statistics • Heart Health Information for Women • Statistics on Common Cardiovascular Diseases • Fact Sheets Regarding Heart Disease Each of these vary in their degree of seriousness, but each is important to address right away. While physical activity is vital to maintaining a healthy lifestyle, that does not mean that you need to be an Olympic athlete. A simple exercise routine that is done daily can be enough to keep your body active and in good working condition. • Exercise and Cardiovascular Health • Exercise Tips for a Healthier Lifestyle • Promoting Cardiovascular Health in Children • Exercise Tips for Improved Cardiovascular Health • Exercise Recommendations for a Lifestyle That is Healthy On average, you should get one to two hours a week of exercise to improve your cardiovascular health. This can include activities as simple as walking, jogging, or running. One of the best activities that most everyone can participate in is a brisk walk. Doing so will increase your heart rate and improve blood flow and your ability to burn calories. All you have to do is wear comfortable walking shoes and then get moving! If you are able, running is another great way to keep your body happy and healthy. This activity is a bit more challenging, but it is a great way to burn calories and reduce your risk of heart disease. If running or walking are not really your style, there are plenty of other options. Swimming is another great way to work cardio into your routine. Swimming laps helps to raise your heart rate, while the water provides you with resistance, so you are also working on your muscle strength at the same time. Swimming is a great workout for older people because it puts a minimal strain on the joints, unlike more high-impact activities such as running. Another great cardiovascular exercise is biking. A nice leisurely ride on a bicycle can give your heart a good workout without taxing your system. People can ride on the road, bike paths or anywhere you can find a safe route. While biking is a heart-friendly activity, make sure you wear a helmet and follow all safety rules! • Heart Friendly Health to Prevent Stroke • ?Leading a Healthy Life Through Exercise • Daily Exercise Can Help the Body • Types of Exercise to Boost Your Health • Benefits of Having Regular Physical Activity • Ways to Promote a Healthy Life • Preventing Heart and Coronary Disease Before you get started on any new healthcare regimen, be sure to consult a doctor first. They will tell you how your health is currently and what activities it is safe for you to participate in. Once your doctor gives you the OK, get out there and work on your heart health! After all, your heart is what keeps your body running. Put in a bit of effort to keep your heart in good shape by getting plenty of exercise, maintain a healthy diet and you'll raise your odds of living a long, healthy life. • Tips for Reducing Heart Disease Risk • Poor Sleep Habits and Your Heart • Managing Heart Failure Risk Factors • Smoking and the Problems of the Heart • Heart Failure Warning Signs and Resources • Healthy and Happy Heart Resources • Heart Attack Prevention Tools and Resources • Resources and Prevention of Diseases of the Heart • Heart Disease Information and Resources https://www.uscareerinstitute.edu/library/avoid-a-medical-emergency

Monday, May 6, 2019

Yaum-e-Shuhda: Pak Army’s Role in War and Peace Times By Sajjad Shaukat (JR167SS45)












Yaum-e-Shuhda: Pak Army’s Role in War and Peace Times By Sajjad Shaukat (JR167SS45)

Every year, Pakistan Army celebrates Youm-e-Shuhada (Martyrs Day) on April 30 and the whole nation joins it to pay tribute to the departed souls of those valiant army officials who sacrificed their lives for the safety and security of the country and its people.

Several ceremonies are being held at the Garrisons all over the country, but the main ceremony is being held at Yadqar-e-Shuhada, General Headquarters (GHQ) Rawalpindi. The families and relatives of the martyrs (Shuhada), serving and retired officers including people, belonging to various segments of society are invited to attend a function at the GHQ to pay tribute to the national heroes. Similarly, a sizeable number of near and dear ones of the martyrs are invited to attend the functions at the Corps Headquarters.

This time, Youm-e-Shuhada has come at a time when Pakistan and its armed forces have been facing internal and external challenges and threats to the national security of the country, which are worrying all the citizens.

Particularly, war-like situation which started between India and Pakistan in the aftermath of the false flag Pulwama terror attack in the Indian Occupied Kashmir (IOK),
still exists, as the extremist government of the BJP led by the Indian fundamentalist Prime Minister Narendra Modi has refused the mediatory role of any country, while continuing war hysteria against Pakistan in wake of acceleration of shelling across the Line of Control (LoC), which has resulted into many casualties in the Pakistani side of Kashmir. On the other side, Pakistan’s armed forces are on high alert to give a matching response to any Indian prospective aggression or war. Earlier, Indian Air Force conducted pre-emptive air strike near the town of Balakot, close to the border with Pakistan’s sector of Kashmir on February 27, 2018, claiming that Indian fighter jets targeted the camp of Jaish-e-Mohammad (JeM) and killed 350 militants—the group whom New Delhi blamed for the Pulwama attack. Next day, in response, Pakistan Air Force launched aerial strikes at six targets in the IOK and shot down two Indian fighter jets and captured Indian pilot Wing Commander Abhinandan Varthaman who was released as a gesture of peace and handed over to the Indian authorities. It resulted into diplomatic victory of Islamabad over India. Prime Minister Modi who has directed the Indian security forces to accelerate atrocities in the IOK, wants to obtain various nefarious designs, especially to suppress the Kashmiris’ war of liberation and to win the general elections 2019 at the cost of Pakistan. On the other side, Western media and their high officials are insisting upon the settlement of the Kashmir issue. 

In this regard, unlike India, Pakistan’s ruling party Pakistan Tehreek-e-Insaf (PTI), opposition parties, members of civil societies and military are on one page regarding Indian aggression, as they are standing shoulder to shoulder to the armed forces of Pakistan.

It is notable that Pakistan’s armed forces have successfully broken the backbone of the foreign-backed terrorists through the military operations Zarb-e-Azb and Radd-ul-Fasaad. Army and top intelligence agency ISI have broken the network of these terrorist groups by capturing several militants, while thwarting a number of terror attempts. Peace has been restored in various regions of Pakistan, including Karachi and Balochistan province.

Although Pakistan’s forces have eliminated terrorism, yet, in the recent past and during the election-campaign of 2019, blasts in Balochistan and other regions of the country showed that the US-led India, Afghanistan and Israel have again started acts of sabotage especially to weaken Pakistan and to damage the China-Pakistan Economic Corridor (CPEC) which is part of China’s One Belt, One Road (OBOR) initiative or BRI. Washington and New Delhi has already opposed this project. Foiled terror attack on the Chinese consulate in Karachi on November 23, last year was part of the same scheme. Likewise, bomb blast in Quetta-the capital of Balochistan on April 12, this year killed at least 20 people and injured 48 individuals. On the same day, at least two persons were killed and 13 others wounded in an explosion on Mall Road in Balochistan’ Chaman city. Balochistan is the focus of projects in the $57 billion CPEC, a transport and energy link planned to run from western China to Pakistan’s southern deepwater port of Gwadar which is located in Balochistan. Therefore, well-entrenched in Afghanistan, America CIA, India RAW and Israeli Mossad are assisting the separatist elements of the Balochistan province to thwart the CPEC project.

Besides Pakistan is the only nuclear country in the Islamic World. Hence, the US, India, Israel and some Western countries are acting upon a secret strategy to ‘denuclearize’ Pakistan. In order to destabilize Pakistan, their intelligence agencies are assisting the terrorist’s outfits like the Islamic State group (Also known as Daesh, ISIS, ISIL) and the affiliated faction of the Tehreek-e-Taliban Pakistan (TTP), the Tehreek-e-Taliban Pakistan Jamaat-ur-Ahrar (TTP-JA also known as JuA).

Apart from fighting the ‘different war’ against the different enemy-terrorism and giving a matching response to Indian shelling across LoC, the role of Pakistan Army in the peace times is also commendable. In these terms, services of Pak Army cannot be explained in words. They always make us proud. They stood first in the time of national crisis and natural calamities.

Undoubtedly, we always remember the innumerable services and sacrifices of the Pakistan’s armed forces, especially Army in relation to the resettlement of the Internally Displaced Persons (IDPs), floods, desilting of canals (Bhal Safai) etc., entailing restoration of law and order on many occasions. In the recent past, armed forces were in the frontline for people-salvage from areas of earthquake which hit Balochistan. Particularly, 8th October reminds the tragedy which Pakistan faced due the earthquake in 2005 and Pakistan’s armed forces again rose to the occasion to meet the aftermath courageously by contributing to the relief efforts. However, during any natural calamity, the personnel of the armed forces coped with situation boldly.  Their untiring sincere efforts mark the defence of Pakistan with an ultimate assurance to safeguard the country at all heads.

We are proud to have such great sons, because these are the heroes who really make history— the martyrs. The sacrifices of our Shuhada are what make our defence unconquerable.

Pakistan’s armed forces are our strategic assets and first line of defence. Whether it be frustrating enemy’s nefarious designs on the borders and fighting off internal enemies, horrifying the state or it may be the difficult times of natural catastrophes, these bold soldiers have strengthened and fortified the motherland by leaving no stone unturned. Every Pakistani salutes to those brave sons of the soil, who always ensure our safety by keeping the frontiers safe. The alertness and resolve of our soldiers in looking out—day and night for all internal and external enemies, and who are always ready to confront the mayhem of severe conditions from the scorching deserts to the icy glaciers in the face of death with no fear—help the persons in tiring times of calamities, leaving their families behind in their determination to provide protection to all the families of our country, and thus make them real national heroes.

Today, the whole nation stands by our soldiers who are guarding our borders and days will prove that the war against terrorism will not finish us, while the terrorists themselves will be eliminated by our valiant soldiers who desire to be martyrs and are not afraid of death. Caravans of Shuhada will continue forever. We salute all the soldiers of Pakistan, who are sacrificing their today for our tomorrow. Nevertheless, surely martyrs are gladly giving up their bodies to torture and death-the trustworthy heroes of our history.

Nonetheless, the importance of the Youm-e-Shuhada, this year has been increased, as the nation stood by forces when they have also been made target of malevolent campaign, being launched by the anti-Pakistan foreign entities in wake of Indian aggressive designs against Pakistan.

In this respect, while playing national songs on the occasion, the TV channels must also give a matching response to the hostile forces which are working against the integrity of the country, and are distorting the image of Pak Army.

Sajjad Shaukat writes on international affairs and is author of the book: US vs Islamic Militants, Invisible Balance of Power: Dangerous Shift in International Relations

Email: sajjad_logic@yahoo.com

Yaum-e-Shuhda: Pak Army’s Role in War and Peace Times By Sajjad Shaukat, Abhinandan Varthaman, Internally Displaced Persons, flood relief, disaster management,