In The Heart Of The Sea Isaimini

[Amaia Novara]

Thesite is secure.

The ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Acute mesenteric ischemia is a rare but severe complication after open heart surgery. Its incidence (0.2-0.4%) is quite low, but mortality rates are ranging between 70% and 100%. From October 1992 to December 1996, 4,640 patients underwent open heart surgery with cardiopulmonary bypass: 74.6% coronary artery bypass graft (CABG) operations, 23.2% valve replacement including aortic repairs, and 2.2% corrections of congenital heart diseases or tumors of the heart. The overall mortality rate (30 days) was 3.4%, and after CABG, 2.9%. Twelve patients (0.26%), following CABG (one combined with aortic valve replacement, one with mitral reconstruction, and one with carotid disobliteration) developed signs of acute mesenteric ischemia in the early postoperative period (day 1 to 5). In all patients various abdominal symptoms, leukocytosis, acidosis, hyperlactatemia, hyperosmolality, renal failure, and, finally, hemodynamic instability were observed. Eleven patients underwent emergency laparotomy. Mesenteric angiography was done if possible in still stable patients (n=7); it showed severe stenosis or occlusion prior to the operation in each case. Other diagnostic methods were not reliable. In six patients (55%) during the first look, extensive bowel necrosis was found and in five patients an ischemic intestine but no necrosis was detected. Of these, three patients were affected by extensive bowel gangrene at the second look. In the fourth patient a disseminated peripheral ischemia of the entire small intestine was found intraoperatively. After mechanical release and stimulation normal bowel function could be reestablished. One patient underwent percutaneous transluminal angioplasty prior to the laparotomy. Bowel perfusion was still deteriorated but no necrosis was found intraoperatively. These patients were the only survivors in the investigated group; 10 of 12 patients (83.3%) died in the early postoperative period (day 1 to day 6). Predisposing factors for mesenteric ischemia are: arteriosclerotic patients after CABG (100%), age >70 years (91.7%), hyperosmotic dehydration (100%), and cardiac ischemia in 25%. Mesenteric ischemia is a fatal complication with high mortality rates after open heart surgery, especially in older, dehydrated patients with generalized atherosclerotic vessel disease. As the acute mesenteric ischemia usually starts during anesthesia or in the early postoperative period, setting of immediate diagnosis is very difficult. With the occurrence of typical symptoms diagnostic and therapeutic procedures (angiography and laparotomy) must be done very urgently owing to the life-threatening mesenteric process. When mesenteric gangrene already has taken place, the prognosis is very poor, despite extensive resection. Prevention can be exercised by avoiding perioperative hyperosmotic dehydration of patients at high risk.

An occluded coronary artery causes an inadequate supply of blood to the heart and produces angina pectoris or a heart attack. For both men and women, coronary heart disease or ischemic heart disease is one of the leading causes of death in the world. It is usually asymptomatic and can be prevented.

Ischaemic Heart Disease, also known as coronary heart disease, occurs when the blood flow to the heart muscle is reduced because of a partial or complete blockage of the arteries supplying it with blood.

If we consider the coronary arteries to be a system of tubes, as they progressively become blocked it means that the liquid flowing through them, in this case blood, does not reach its destination, the heart, correctly.

The prevalence of ischaemic heart disease increases with age and is greater in men than women, even in the elderly. Studies show that coronary heart disease affects twice as many men and three times as many women when aged 65 to 94 years compared to those aged between 35 and 64 years old.

In developed countries the prevalence of ischaemic heart disease is currently tending to decrease, thanks to improved treatments and healthier lifestyles; nevertheless, the prevalence continues to increase in developing nations.

Ischaemic heart disease is caused by arteriosclerosis. Arteriosclerosis is chronic inflammation of the arteries that causes them to harden and accumulate cholesterol plaques (atheromatous plaques) on their walls. This leads to an increased risk of thrombus formation (stationary blood clots attached to blood vessel linings).

Arteriosclerosis can affect any of the arteries in the body and produces different symptoms depending on which organ is affected. If it occurs in arteries that carry blood to the brain, then it may cause a stroke or cerebrovascular accident; if it occurs in arteries supplying the legs, then it could translate into pain when walking; if it happens in arteries that deliver blood to the heart itself it may cause angina pectoris (chest pain) or a myocardial infarction (heart attack).

Angina pectoris (chest pain). Whenever a coronary artery is severely obstructed, normally when its passageway is reduced by over 75%, then secondary symptoms often start to appear due to the lack of oxygen reaching the heart muscle cells. This lack of blood supply manifests as chest pain, which usually arises upon making an effort. If the ischaemia is mild or short-lived, then the myocardium cells can survive the event.

Electrocardiogram. For most cases of angina, an electrocardiogram only reveals any abnormalities if it is performed while the patient experiences chest pain. By contrast, in the case of an infarction, it is very likely that electrocardiogram results will include abnormal patterns, to varying degrees.

Blood analysis. Troponins are proteins found inside heart muscle cells. When the cells die (necrosis) their walls break open and these proteins are released into the blood stream. In the event of a heart attack a straightforward, rapid analytical test can be used to identify the presence of any troponins in the blood and confirm the diagnosis.

Stable angina. Chest pain is chronic and appears regularly, is always brought on by the same amount of exercise and does not change as the months pass by. Patients tend to be very familiar with the symptoms. While Ischaemic Heart Disease always requires full attention, stable angina is less serious and can be treated effectively with medicines.

Acute coronary syndrome. This corresponds to irregular episodes of chest pain; they appear suddenly, when resting; the pain is much more intense or appears after increasingly less effort. This condition is more serious than stable angina and always requires a hospital stay and intensive treatment.

Dr. Angela Ryan Lee is an ABMS board certified internal medicine physician specializing in cardiology. She is a fellow of the American College of Cardiology and a member of the National Lipid Association and the American Society for Echocardiography. She lives in Dallas, Texas and provides consulting services related to cardiovascular disease and health communication.

While having this type of heart disease increases your risk of a heart attack in the future, it is possible to take steps to partially reverse coronary artery disease. This involves a combination of recommended medical interventions, as well as diet and lifestyle changes.

Once you have been diagnosed with coronary artery disease (CAD), you may be focused on making changes to help prevent worsening heart disease and possible related complications, such as heart attack and heart failure.

On its own, exercise has a role in preventing CAD from developing, as well as preventing future cardiac events in people with a diagnosis of CAD. While studies have shown conflicting results on whether exercise directly leads to plaque regression, physical activity appears to have beneficial effects on the coronary arteries.

Diet is critical in helping to prevent heart disease, as well as to help manage CAD. Some researchers advocate for a plant-based diet, arguing that the typical western diet of meat, dairy, and oils, is a major contribution to CAD development.

When discussing medication, be sure to let your care team know about any other over-the-counter or prescription medications you take, including supplements and vitamins. This can help to prevent potential drug interactions.

I mention this, not just to remind everyone that I think Dorothy Wordsworth was the poet in that family, (ha!) but also because Raifteir was blind from the age of six, and in both poems, sensation is the key to the escape, not the literal viewing of the landscape, but the feelings that they can inspire.

I like this low-key observation from the poet, because again, there is a reversal of a common idea that the city is the sophisticated or civilized space. There is a Kavanagh-esque rejection of Dublin here, preferring the established, understood ritual of neighbourly trade.

To digress a little, you must remember that Ireland was first written about by Christians. Our earliest literature was penned by monks and abbots, for whom it was essential to express Irish tradition in a Christian framework. Even the old pagan mythology, a sturdy part of the oral tradition, was articulated from Christian perspectives. It was these monks and priests who literally expressed Ireland, in the Irish language, and embedded into it almost indelible Christian ideology. Thankfully, however, they did incorporate much of the folklore and superstition of the pre-Christian world. It seems contradictory, and yet we can still see plenty of evidence of the pagan and the Christian co-existing comfortably in much of the literature of Ireland.

3a8082e126