UHS Medical Times 1
Newsletter | May 2018
HYPERTENSION THE SILENT KILLER
WHAT IS HYPERTENSION? Each time your heart beats, blood is pumped through your arteries and veins, the blood vessels of your circulatory system. Arterial blood pressure is created by the force exerted by the blood against the artery walls, as they carry blood around your body. Hypertension refers to a persistent elevation of arterial blood pressure. Hypertension, also known as high blood pressure, is when the pressure of the blood being pumped through your arteries is higher than it should be. High blood pressure, or hypertension has been called the "silent killer", because it often has no warning signs or symptoms, and many people do not even know they have it. Over time, the constant pressure overload causes accumulating damage that eventually becomes more than your circulatory system can handle, often leading to serious health problems.
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Newsletter | May 2018
Hypertension is a major risk factor for MI, stroke and chronic kidney disease (CKD). It is classified into ‘stages’ to help guide management.
Categories of BP in Adults* BP Category
SBP
DBP
<120 mm Hg
and
<80 mm Hg
120–129 mm Hg
and
<80 mm Hg
Stage 1
130–139 mm Hg
or
80–89 mm Hg
Stage 2
≥140 mm Hg
or
≥90 mm Hg
Normal Elevated Hypertension
*Individuals with SBP and DBP in 2 categories should be designated to the higher BP category.
HYPERTENSION IN UAE Hypertension as well as the associated risk factors, are now abundant in the UAE and its neighboring Gulf states there is no doubt of the impact and burden this is placing public health and the healthcare system. The consequences of hypertension, such as cardiovascular complications, chronic kidney disease and stroke are on the rise, this is, in part because hypertension is often neither correctly diagnosed nor appropriately treated.
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e-newsletter September Newsletter || May 2018 2016
THE CIRCULATORY SYSTEM HOW IT WORKS AND WHAT CAN GO WRONG Your circulatory system is made up of three main parts: blood, which carries substances such as nutrients, oxygen and waste products around your body; your blood vessels, a network of tubes that carry the blood; and your heart, a muscular organ, located in the centre of your chest, whose job is to pump your blood throughout the circulatory system. Blood is made of a pale yellow fluid, called plasma that contains red and white blood cells, and platelets. The red blood cells contain hemoglobin, a chemical that can combine with oxygen. You have different types of blood vessels, the tubes through which your blood travels, with different jobs. Blood flows away from your heart through strong, thick-walled vessels, called arteries, which branch into networks of tiny, thin-walled tubes, called capillaries. Oxygen and other substances can easily diffuse out of your capillaries into the cells of your tissues and organs, where they are needed, while carbon dioxide and waste products can easily diffuse back into the bloodstream, for disposal. The capillaries eventually join up again to form veins, which are the tubes that transport blood back to your heart. Your heart is divided into four chambers. The two upper chambers are the atria (singular atrium) and the two lower chambers are the ventricles. As your heart pumps, one way valves between the chambers keep the blood flowing in a specific direction. Blood passes through your heart twice as it makes a complete tour of your body. Starting from your heart, it is pumped from the right ventricle to your lungs, where it picks up oxygen. It then returns to the left atrium, flows into the left ventricle, and is pumped out of there to the rest of your body. With this done, the blood returns to the right atrium, flows into the right ventricle, and the cycle starts again.
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Newsletter | May 2018
Blood pressure is set by: â&#x20AC;˘ Cardiac Output - the amount of blood pumped by each ventricle in one minute; and â&#x20AC;˘ Peripheral Resistance - the resistance that the heart has to overcome to make the blood flow through the blood vessels of your circulatory system. Your body uses multiple complicated, overlapping processes to control blood pressure. Together, these systems do this by regulating vasodilatation and vasoconstriction, the widening and narrowing of blood vessels, as well as rates of excretion of salt and water, which is how your body adjusts blood volume. Around 5-10% of people have a specific underlying medical condition that causes a malfunction in one or more of the physiological processes that maintain blood pressure; for example, chronic kidney disease or thyroid disease. However, the majority of people with high blood pressure have what is known as essential hypertension, meaning the cause is unknown.
Regardless of whether you have essential hypertension, or hypertension due to an underlying condition, it can increase cardiac output, the resistance to blood flow caused by the muscle tone and diameter of the blood vessels, known as peripheral resistance, or both. High blood pressure is dangerous because the higher your blood pressure gets, the harder your heart has to work to pump blood around your body, and the more likely your heart and blood vessels will be damaged. Without treatment, hypertension can cause a heart attack, enlargement of your heart, and/or heart failure. Your blood vessels may start to bulge, burst, or clog, and excessive pressure inside the vessels in your brain may cause a brain bleed leading to a stroke. In some cases, high blood pressure can also bring on kidney failure, blindness, and even cognitive impairment.
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e-newsletter September Newsletter ||May 2018 2016
DOES HAVING HIGH BLOOD PRESSURE GIVE YOU ANY SYMPTOMS? Most commonly high blood pressure is only picked up as part of a routine check. Occasionally if it is very high, you can get headaches, some people feel a bit dizzy, or their vision can be affected. It is known as a “silent killer’’ as you may not experience many symptoms until you develop a serious complication which is why it is important to have your blood pressure checked regularly.
HOW IS IT BLOOD PRESSURE MEASURED?
A blood pressure machine (sphygmomanometer) is used. A cuff is placed around your upper arm and is then tightened by pumping air into the cuff. It is then gradually let down (deflated) while the pressure readings are taken. This is usually done two or three times over a few minutes. If you get consistently high readings, you may be asked to have this done with a special machine which measures blood pressure regularly over a 24-hour period.
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Newsletter | May 2018
WHAT DO THE BLOOD PRESSURE NUMBERS MEAN? There are two numbers to blood pressure, a top number and a bottom number. Both are important. Ideally, for most people, you want your top number to be 130 or less, and you want your bottom number to be no more than 80. Your doctor may want your blood pressure lower if you have other medical conditions.
LOW
IDEAL
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STAGE I
STAGE II
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e-newsletter September 2016 Newsletter | September Newsletter || May 2018 2017
RISK FACTORS FOR HYPERTENSION Although for most people there is no identifiable cause of hypertension, there are known risk factors that increase the likelihood that you will become hypertensive. Several of these are things that you can’t do anything about, including:
•
Genetics - having family members with hypertension increases the likelihood that you will too.
•
Race - high blood pressure is more common in people with dark skin than in people with pale skin.
•
Age - your blood vessels become more rigid as you age, preventing them from opening as effectively as when you were younger, which increases peripheral resistance. Other risk factors are known as modifiable risk factors, because many people can reduce their blood pressure by changing their diet and lifestyle. The most common risk factors include being overweight and inactive, eating a high salt diet, and smoking.
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e-newsletter September Newsletter ||May 2018 2016
HOW LIKELY ARE YOU TO BECOME HYPERTENSIVE? If you have high blood pressure, you are certainly not alone. More than one in three adults worldwide have high blood pressure, and it is credited with contributing to half of all deaths due to heart disease and stroke. High blood pressure is more common in men during middle-age, around 45 years, with women catching up after age 65. Worryingly, children can also become hypertensive for many of the same reasons as adults - inactivity, unhealthy diet, and obesity. Although it is common in both economically developed and developing countries and regions, many people in developing countries go undiagnosed, and miss out on treatment that could significantly reduce cardiovascular problems.
STEPS YOU CAN TAKE TO LOWER YOUR BLOOD PRESSURE Lifestyle changes can really help to lower your blood pressure. For example, you can work on eating a healthy diet with lots of fruits and vegetables to take care of any nutritional deficiencies, and to eat less salt. This, together with reducing high fat, and calorie laden foods can help you reach and maintain a healthy weight. Another way to lower your blood pressure is to increase the amount of exercise you do. Routinely exercising not only helps to lower your blood pressure, but may give you more energy, and is a great way to reduce stress. Finally, reducing or better still quitting smoking, and limiting your daily amounts of alcohol (2 drinks for men, 1 drink for women), are also great ways to get your blood pressure heading into the healthy range. As an adult, it is a good idea to ask your doctor to check your blood pressure one or two times a year if you think you may be at increased risk for any of the reasons described above. That way, you will know early on in the course of the disease, and be able to take steps to minimize your risk for other illnesses.
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e-newsletter September Newsletter || May 2018 2016
DIAGNOSE AND TREAT HYPERTENSION DIAGNOSE HYPERTENSION Blood pressure is usually measured using a pressure cuff or an electronic device placed on your upper arm. A blood pressure reading is written as two numbers, representing the maximum pressure in the circulatory system when the heart pumps blood out (systolic pressure), and the minimum pressure when the heart refills (diastolic pressure). Blood pressure is measured in millimeters of mercury (mm Hg). Normal resting blood pressure in an adult is approximately 120 / 80 mm Hg. However, your blood pressure can fluctuate from minute to minute, and readings are generally higher in the afternoon and lower at night.
Doctors often classify blood pressure into four categories: Normal Blood Pressure - below 120 / 80 mm Hg. Prehypertension - 120-129 / Below 80 mm Hg. Stage 1 Hypertension - 130-139 / 80-89 mm Hg. Stage 2 Hypertension - 140 / 90 mm Hg or higher. Both numbers in a blood pressure reading are important, and an increase in either number (systolic or diastolic pressure) indicates you are hypertensive. It is worth noting that a blood pressure below 90 / 60 mm Hg is considered outside the normal range, and is known as hypotension, or low blood pressure.
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e-newsletter September Newsletter || May 2018 2016
TREATING HYPERTENSION Treatment typically involves lifestyle changes and medications when necessary. If you are prehypertensive, but otherwise healthy, your doctor is most likely going to encourage lifestyle changes, such as eating a healthier diet, quitting smoking, getting more exercise, and managing stress, as a first step to lowering your blood pressure. However, if this doesnâ&#x20AC;&#x2122;t work, or you are already hypertensive, you may need medications.
If you are healthy, blood pressure medications are recommended when your blood pressure is 140 / 90 mm Hg or higher, but if you have other cardiovascular risk factors such as atherosclerosis, diabetes, or obesity, your doctor is likely to recommend medication earlier so as to protect your kidneys, heart, and other organs from potential damage. Generally, the treatment goal is to lower blood pressure to less than 130 / 80 mm Hg in people younger than 60, and less than 140 / 90 in people older than 60.
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e-newsletter September Newsletter || May 2018 2016
TREATING HYPERTENSION Many different classes of drugs are used to treat high blood pressure. The most common ones are: Diuretics - these promote the production of urine, which removes excess fluid from the bloodstream. This reduces the volume of blood in your circulatory system, and your blood pressure. Beta-blockers - these make your heart beat slower and with less force, and your blood vessels open up. This reduces blood pressure, and improves blood flow.
Angiotensin - converting enzyme inhibitors, (ACE inhibitors) - these block the action of a hormone that causes your blood vessels to constrict and that thickens and stiffens the walls of your blood vessels and heart, as well as triggering the release of another hormone that increases the amount of sodium and water in your body. Together, this has the effect of lowering blood pressure.
Angiotensin II Receptor Blockers - these affect similar biochemical pathways as ACE inhibitors, for similar effects.
Alpha Blockers - these block the action of hormones that trigger vasoconstriction of the smaller arteries and veins, improving blood flow and lowering blood pressure.
Calcium Channel Blockers - these relax and widen blood vessels by preventing calcium from entering heart cells and the muscle cells within the blood vessel walls. This slows your heart rate and vasodilates your arteries, resulting in lower blood pressure.
Diuretics are often recommended as the first line of therapy for most people who have high blood pressure, and no other medical conditions. If you do have a medical condition, then your doctor may choose a medication from one of the other drug classes to suit your individual needs. For example, if you have diabetes, your doctor may prescribe an ACE inhibitor rather than a diuretic, as diuretics sometimes interfere with blood sugar levels. The good thing is that if one drug doesnâ&#x20AC;&#x2122;t work, there are plenty more to choose from. And, if your blood pressure is extremely high, your doctor may prescribe combinations of two or more medications to bring it under control. After you start antihypertensive medication, your doctor will want to follow your blood pressure regularly for a few months to make sure you reach your treatment goal. You may also need blood tests to check the health of your kidneys, which are sometimes affected as a side effect of blood pressure medicine.
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e-newsletter September Newsletter || May 2018 2016
CONTROLLING HYPERTENSION EAT A HEALTHY DIET Briefly, this means:
At least five portions of a variety of fruit and vegetables per day.
A third of most meals should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables. Not much fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low-fat, mono-unsaturated or polyunsaturated spreads. Include 2-3 portions of fish per week. At least one of these should be 'oily', such as herring, mackerel, sardines, kippers, pilchards, salmon, or fresh (not tinned) tuna. If you eat meat it is best to eat lean meat, or eat poultry such as chicken (without the skin, which is full of saturated fat!).
If you do fry, choose a vegetable oil such as rapeseed or olive oil.
Limit salt in your diet (see below).
Use wholegrain versions of starchy foods (such as rice and pasta). A healthy diet provides benefits in different ways. For example, it can lower cholesterol, help control your weight, and provide plenty of vitamins, fibre and other nutrients which help to prevent certain diseases. Some aspects of a healthy diet also directly affect blood pressure. For example, if you have a poor diet and change to a diet which is low-fat, low-salt and high in fruit and vegetables, it can significantly lower systolic blood pressure.
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e-newsletter September Newsletter || May 2018 2016
HAVE A LOW SALT INTAKE The amount of salt that we eat can have a major effect on our blood pressure. Government guidelines recommend that we should have no more than 5-6 grams of salt per day. On average, we eat just over 8 grams a day. About 3/4 of the salt we eat comes from processed food, where it's often not obvious for instance, packet soups and sauces and even breakfast cereals can be high in salt. Please check the food labels. Tips on how to reduce salt include: Use herbs and spices rather than salt to flavour food. Limit the amount of salt used in cooking. Do not add salt to food at the table. Choose foods labelled 'no added salt'. Avoid processed foods as much as possible If you want the flavour of salt, consider using a reduced sodium salt alternative. It's the sodium in salt that puts your blood pressure up, and using a version where some of the sodium has been replaced with potassium may lower blood pressure
ADVICE ON EXERCISE Adults (aged 19-64 years) Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate-intensity activity in bouts of 10 minutes or more. For example, 30 minutes on at least five days a week. Comparable benefits can be achieved by 75 minutes of vigorous-intensity activity spread across the week or combinations of moderate-intensity and vigorous-intensity activity. Older adults (aged 65 years and older) Older adults who participate in any amount of physical activity gain some health benefits. Some physical activity is better than none and more physical activity provides greater health benefits. Older adults should aim to be active daily and, if possible, aim for the same amount of physical activity as younger adults.
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EXERCISE
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Newsletter || May February Newsletter 20182018
AEROBIC ACTIVITIES Aerobic activities are any activity that makes your heart and lungs work harder. To gain health benefits, government experts suggest that you should do at least 30 minutes of moderate-intensity physical activity on most days of the week. 30 minutes is probably the minimum but you do not have to do this all at once. For example, cycling to work and back for 15 minutes each way adds up to 30 minutes. A recent study showed that even less time may have some health benefits. Moderate-intensity physical activity means that you get warm, mildly out of breath and mildly sweaty. For example, brisk walking, jogging, swimming, cycling, dancing, badminton, tennis, etc. However, as mentioned above, normal activities that are part of your daily routine (everyday activities) may make up some of the 30 minutes. For example, fairly heavy housework, DIY, climbing the stairs, or gardening can make you mildly out of breath and mildly sweaty. On most days means that you cannot store up the benefits of physical activity. You need to do it regularly. Being physically active on at least five days a week is recommended.
TEAM AT UHS
QUALIFICATIONS Dr Seif is trained at Alexandria University, Egypt, from where he also achieved his MSc in Cardiology. He had obtained his MRCP from Royal College of Physicians (Edinburg University, UK), Saudi Board in Cardiology, Arab Board in Cardiology, American Board certified in Echocardiography after completed his Echocardiography training from National Board of Echocardiography, USA in 2009 and lastly FRCP (Edinburg University, UK).
EXPERIENCE
Dr Seif expertise extends for more than 28 years of medical experience and worked in several eminent hospitals in Egypt and Saudi Arabia like Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. He joined University Hospital Sharjah (UHS) from North West Armed Forces Hospital Saudi Arabia, were he was associated as Consultant Non Invasive Cardiologist.
Dr. Mohamed Seif FRCP (UK), Arab Board, American Board Consultant Cardiologist
Dr Seif has extensive experience in the management of various cardiovascular diseases such as hypertension, dyslipidemia, coronary artery disease, congenital heart diseases, heart failure, rheumatic heart diseases, ischemic heart disease, valvular heart diseases and preoperative risk evaluation. His clinical practice focuses on cardiac imaging, his interests include all aspects of Adult Cardiology and he takes an active role in providing advice and treatment for the entire range of cardiology conditions as well as skilled procedures.
diagnostic maneuvers, he is fully trained in Echocardiography including transthoracic ,transesophageal and Dobutamine stress echocardiography, Treadmill exercise stress test, Holter monitoring, Ambulatory 24 hours BP monitoring, CT Coronary Angiography as well as invasive diagnostic tools including coronary angiography and cardiac catheterization. Dr Seif has presented scientific papers in various national and international forum.
SPECIAL INTEREST Coronary Artery Disease and Heart Failure Cardiac Imaging (Echocardiography, Toe, Cardiac CT Exercise Stress Testing and Dobutamine Stress Echo cardiography Management of Hypertension Assessing Diabetic Patients for Heart Disease Heart Valve Disease Pregnancy and Heart Disease Interdisciplinary Care of Patients with Risk Factors for Heart Disease
LANGUAGE KNOWN Arabic and English
Dr. Seif has gained experience in dealing with various
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Newsletter || May February Newsletter 20182018
TEAM AT UHS
QUALIFICATIONS Dr. Guella gained his MD degree at the Faculty of Medicine, University of Oran, Algeria and completed his French Board in Nephrology (C.E.S; Certificat d’ Etudes Speciales de Nephrologie) from the Faculty of Medicine of Lille, France.
EXPERIENCE Dr. Adnane has 28 years’ experience in the diagnosis and treatment of acute and chronic kidney diseases, follow-up and care of dialysis patients as well as preparation, evaluation and follow-up of kidney transplant patients. His expertise includes also acute dialysis (CRRT) in intensive care unit, vascular access catheter insertions, and renal biopsy. He has special interest and expertise in all Apheresis techniques (plasmapheresis, cascade filtration, LDL – Apheresis, Red cell apheresis, platelet apheresis, leukapheresis and photopheresis). He performed the first LDL-Apheresis (1998) in the Arab World, using Cobe ultracentrifugation machine in two patients with familial hypercholesterolemia and the first red cell apheresis (2004) in a patient with sickle cell crisis.
Dr. Adnane Guella
Dr. Adnane got his initial training in France and was associated with various hospitals in France including Amiens University Hospital, Lille University Hospital and Roubaix General Hospital.He has authored several scientific papers in peer reviewed journals in the field of nephrology and transplantation and is widely published in medical journals. He is also reviewer for the American Journal of Kidney Diseases. He received an award from the International Society of Nephrology in Sydney for young first author of a poster.
SPECIAL INTEREST
Kidney Diseases Acute Dialysis Chronic Dialysis Kidney Transplantation Hypertension
Apheresis
LANGUAGE KNOWN Arabic, English & French
Prior to joining UHS, Dr. Adnane was Consultant Nephrologist and Head of the Nephrology division of King Fahd Military Medical Complex, Dhahran, Saudi Arabia, where he was also involved in renal transplantation from living and cadaveric donors.
MD, CES/French Board in Nephrology Consultant Nephrologist
ARISE NEWSLETTER ISSUE 14 | MAY 2018
Don’t Forget To Check May Edition of
ARISE Nursing Newsletter Edition of ARISE Nursing Newsletter is dedicated to World No Tobacco May
INSIDE THIS ISSUE
INTRODUCTION
CAMPAIGN AIM
HELPING PATIENTS TO QUIT
ROLE OF
SMOKING NURSES
INTRODUCTION A dirham for a stick, a minute to relax, one puff at a time. However, even just one puff of tobacco is harmful to the body; just one puff can be enough to get a person hooked. This addictive habit can put a person at risk of coronary heart disease, stroke, and peripheral vascular disease. Every year, on 31 May, WHO and partners mark World No Tobacco Day (WNTD), highlighting the health and other risks associated with tobacco use, and advocating for effective policies to reduce tobacco consumption. The focus of World No Tobacco Day 2018 is "Tobacco and heart disease”.
ARISE Nursing Newsletter from University Hospital Sharjah
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Newsletter from University Hospital Sharjah
Day.
This edition contains guidance to assist a person quit smoking. Nurses can use the points discussed in the newsletter to highlight the harmful effects of smoking tobacco as well as the impact it has on an individual and then steps to help them to quit smoking.
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Newsletter | May 2018
SCOPE OF SERVICES AT UHS MEDICAL SERVICES
SURGICAL SERVICES
CARDIOLOGY
NEUROPHYSIOLOGY
Anesthesiology
Bariatric Surgery
24-Hour BP Monitoring
Electroencephalogram (EEG)
Aviation Medicine
Ears, Nose and Throat Surgery
24-Hour Holter Monitoring
Electromyography (EMG)
Cardiology
General Surgery
2D/3D Echo
Evoked Potential Test
Critical Care
Neurological Surgery
3D Transesophageal Echo
Brain Auditory Evoked Potential
Dermatology
Obstetrics and Gynecologic Surgery
CT coronary Angiography
(BAEP)
Emergency Medicine
Ophthalmic Surgery
Somato Sensory Evoked Potential
Endocrinology
Orthopedic Surgery
Dobutamine Stress Echo for Ischemia and Viability Studies
Family Medicine
Pediatric Surgery
Gastroenterology
Plastic and Reconstructive Surgery
Internal Medicine
Urologic Surgery
Medical Oncology
Vascular Surgery
Neonatology Nephrology Neurology Pediatrics Psychiatry Pulmonology Rheumatology MEDICAL DIAGNOSTICS IMAGING (MDI) 128 Channel CT Scan with Coronary and Cardiac Facility
PATHOLOGY & LABORATORY MEDICINE
Interventional Cardiology Stress Test Treadmill Stress Test
AUDIOLOGY
(SSEP) Visual Evoked Potential ( VEP) Nerve Conduction Studies (NCS)
OTHER SPECIALTY SERVICES
Biochemistry
Acoustic Reflex Threshold
24/7 Emergency Services
Blood Transfusion Medicine
Auditory Brainstem Response
Ambulance
Cytology
Auditory Steady State Response
Hemodialysis
Hematology
Cochlear Implant Mapping
Physiotherapy
Histology
Electrocochleography
Pharmacy
Immunology
Free Field Audiometry
Sharjah Breast Centre
Microbiology
Hearing Aid Fitting and Programming
Phlebotomy
Newborn Hearing Screening
Bone Densitometry
Otoacoustic Emission
Digital X-Ray and Fluoroscopy
Pure Tone Audiometry (PTA)
Mammography and Guided Breast Intervention
Speech Audiometry
MRI 1.5 TESLA
Tinnitus Evaluation
Ultrasound
Tympanometry
Vascular Interventional Lab
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