Treatments and drugs

By Mayo Clinic staff

What to do if you see someone having a heart attack
If you encounter someone who is unconscious from a presumed heart attack, call for emergency medical help. If you have received training in emergency procedures, begin cardiopulmonary resuscitation (CPR). This helps deliver oxygen to the body and brain.
Regardless of whether you've been trained, you should begin CPR with chest compressions. Press down about two inches (about five centimeters) on the person's chest for each compression at a rate of about 100 a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions. If you haven't been trained, continue doing compressions only.
Heart attack treatment at a hospital
If you have a heart attack, your heart attack treatment at a hospital varies depending on the situation. You may be treated with medications, undergo an invasive procedure or both — depending on the severity of your condition and the amount of damage to your heart.
Medications
With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly.
Medications given to treat a heart attack include:

Aspirin. You may be given aspirin by emergency medical personnel soon after they arrive or as soon as you get to the hospital. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug following a heart attack, the greater the chance you will survive and lessen the damage to your heart.
Superaspirins. Doctors in the emergency room may give you other drugs that are somewhat similar to aspirin to help prevent new clots from forming. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors.
Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less "sticky" and less likely to form more dangerous clots. Heparin is given intravenously or by an injection under your skin and is usually used during the first few days after a heart attack.
Pain relievers. If your chest pain or associated pain is great, you may receive a pain reliever, such as morphine, to reduce your discomfort.
Nitroglycerin. This medication, used to treat chest pain (angina), temporarily opens arterial blood vessels, improving blood flow to and from your heart.
Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks.
Cholesterol-lowering medications. Examples include statins, niacin, fibrates and bile acid sequestrants. These drugs help lower levels of unwanted blood cholesterol and may be helpful if given soon after a heart attack to improve survival.

Surgical and other procedures
In addition to medications, you may undergo one of the following procedures to treat your heart attack:

Coronary angioplasty and stenting. Emergency angioplasty opens blocked coronary arteries, letting blood flow more freely to your heart. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. This catheter is equipped with a special balloon. Once in position, the balloon is briefly inflated to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open.
Coronary angioplasty is done at the same time as a coronary catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart. When getting an angioplasty for heart attack treatment, the sooner the better to limit the damage to your heart.
Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. Usually, your doctor may suggest that you have bypass surgery after your heart has had time to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section), restoring blood flow to the heart.

Once blood flow to your heart is restored and your condition is stable following your heart attack, you may be hospitalized for observation.

Obat stroke

Penyakit Stroke adalah berciri terjadinya kelumpuhan sebagai akibat dari rusaknya pembuluh darah di otak.Penyebab stroke ini antara lain karena tekanan darah tinggi, gula darah tinggi atau kolesterol tinggi.
Stroke termasuk penyakit serebrovaskuler (pembuluh darah otak) yang ditandai dengan kematian jaringan otak (infark serebral) yang terjadi karena berkurangnya aliran darah dan oksigen ke otak. Berkurangnya aliran darah dan oksigen ini bisa dikarenakan adanya sumbatan,penyempitan atau pecahnya pembuluh darah.

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What is the treatment of a stroke?

Tissue plasminogen activator (TPA)
There is opportunity to use alteplase (TPA) as a clot-buster drug to dissolve the blood clot that is causing the stroke. There is a narrow window of opportunity to use this drug. The earlier that it is given, the better the result and the less potential for the complication of bleeding into the brain.
Present American Heart Association guidelines recommend that if used, TPA must be given within 4 1/2 hours after the onset of symptoms. for patients who waken from sleep with symptoms of stroke, the clock starts when they were last seen in a normal state.
TPA is injected into a vein in the arm but, the time frame for its use may be extended to six hours if it is dripped directly into the blood vessel that is blocked requiring angiography, which is performed by an interventional radiologist. Not all hospitals have access to this technology.
TPA may reverse stroke symptoms in more than one-third of patients, but may also cause bleeding in 6% patients, potentially making the stroke worse.
For posterior circulation strokes that involve the vertebrobasilar system, the time frame for treatment with TPA may be extended even further to 18 hours.
Heparin and aspirin
Drugs to thin the blood (anticoagulation; for example, heparin) are also sometimes used in treating stroke patients in the hopes of improving the patient's recovery. It is unclear, however, whether the use of anticoagulation improves the outcome from the current stroke or simply helps to prevent subsequent strokes (see below). In certain patients, aspirin given after the onset of a stroke does have a small, but measurable effect on recovery. The treating doctor will determine the medications to be used based upon a patient's specific needs.
Managing other Medical Problems
Blood pressure will be tightly controlled often using intravenous medication to prevent stroke symptoms from progressing. This is true whether the stroke is ischemic or hemorrhagic.
Supplemental oxygen is often provided.
In patients with diabetes, the blood sugar (glucose) level is often elevated after a stroke. Controlling the glucose level in these patients may minimize the size of a stroke.
Patients who have suffered a transient ischemic attacks, the patient may be discharged with blood pressure and cholesterol medications even if the blood pressure and cholesterol levels are within acceptable levels. Smoking cessation is mandatory.
Rehabilitation
When a patient is no longer acutely ill after a stroke, the health care staff focuses on maximizing the individuals functional abilities. This is most often done in an inpatient rehabilitation hospital or in a special area of a general hospital. Rehabilitation can also take place at a nursing facility.
The rehabilitation process can include some or all of the following:

speech therapy to relearn talking and swallowing;
occupational therapy to regain as much function dexterity in the arms and hands as possible;
physical therapy to improve strength and walking; and
family education to orient them in caring for their loved one at home and the challenges they will face.

The goal is for the patient to resume as many, if not all, of their pre-stroke activities and functions. Since a stroke involves the permanent loss of brain cells, a total return to the patient's pre-stroke status is not necessarily a realistic goal in many cases. However, many stroke patients can return to vibrant independent lives.
Depending upon the severity of the stroke, some patients are transferred from the acute care hospital setting to a skilled nursing facility to be monitored and continue physical and occupational therapy.
Many times, home health providers can assess the home living situation and make recommendations to ease the transition home. Unfortunately, some stroke patients have such significant nursing needs that they cannot be met by relatives and friends and long-term nursing home care may be required.

What is a stroke?

Brain cell function requires a constant delivery of oxygen and glucose from the bloodstream. A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. Blood flow can be compromised by a variety of mechanisms.
Blockage of an artery

Narrowing of the small arteries within the brain can cause a lacunar stroke, (lacune means "empty space"). Blockage of a single arteriole can affect a tiny area of brain causing that tissue to die (infarct).
Hardening of the arteries (atherosclerosis) leading to the brain. There are four major blood vessels that supply the brain with blood. The anterior circulation of the brain that controls most motor activity, sensation, thought, speech, and emotion is supplied by the carotid arteries. The posterior circulation, which supplies the brainstem and the cerebellum, controlling the automatic parts of brain function and coordination, is supplied by the vertebrobasilar arteries.

If these arteries become narrow as a result of atherosclerosis, plaque or cholesterol, debris can break off and float downstream, clogging the blood supply to a part of the brain. As opposed to lacunar strokes, larger parts of the brain can lose blood supply, and this may produce more symptoms than a lacunar stroke.

Embolism to the brain from the heart. In some instances blood clots can form within the heart and the potential exists for them to break off and travel (embolize) to the arteries in the brain and cause a stroke.

Rupture of an artery (hemorrhage)

Cerebral hemorrhage (bleeding within the brain substance). The most common reason to have bleeding within the brain is uncontrolled high blood pressure. Other situations include aneurysms that leak or rupture or arteriovenous malformations (AVM) in which there is an abnormal collection of blood vessels that are fragile and can bleed.

What causes a stroke?

Blockage of an artery
The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die and the part of the body that it controls stops working. Typically, a cholesterol plaque in a small blood vessel within the brain that has gradually caused blood vessel narrowing ruptures and starts the process of forming a small blood clot.
Risk factors for narrowed blood vessels in the brain are the same as those that cause narrowing blood vessels in the heart and heart attack (myocardial infarction). These risk factors include:

high blood pressure (hypertension),
high cholesterol,
diabetes, and
smoking.

Embolic stroke
Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose, travels through the bloodstream and lodges in an artery in the brain. When blood flow stops, brain cells do not receive the oxygen and glucose they require to function and a stroke occurs. This type of stroke is referred to as an embolic stroke. For example, a blood clot might originally form in the heart chamber as a result of an irregular heart rhythm, such as occurs in atrial fibrillation. Usually, these clots remain attached to the inner lining of the heart, but occasionally they can break off, travel through the blood stream, form a plug (embolism) in a brain artery, and cause a stroke. An embolism can also originate in a large artery (for example, the carotid artery, a major artery in the neck that supplies blood to the brain) and then travel downstream to clog a small artery within the brain.
Cerebral hemorrhage
A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes stroke symptoms by depriving blood and oxygen to parts of the brain in a variety of ways. Blood flow is lost to some cells. As well, blood is very irritating and can cause swelling of brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increases pressure within the skull and causes further damage by squeezing the brain against the bony skull further decreasing blood flow to brain tissue and cells.
Subarachnoid hemorrhage
In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid membrane that lines the brain. The blood originates from an abnormal blood vessel that leaks or ruptures. Often this is from an aneurysm (an abnormal ballooning out of the wall of the vessel). Subarachnoid hemorrhages usually cause a sudden, severe headache, nausea, vomiting, light intolerance, and a stiff neck. If not recognized and treated, major neurological consequences, such as coma, and brain death may occur.
Vasculitis
Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed causing decreased blood flow to brain tissue.
Migraine headache
There appears to be a very slight increased occurrence of stroke in people with migraine headache. The mechanism for migraine or vascular headaches includes narrowing of the brain blood vessels. Some migraine headache episodes can even mimic stroke with loss of function of one side of the body or vision or speech problems. Usually, the symptoms resolve as the headache resolves.

Atrial Fibrillation and Cardioembolic Stroke

Atrial fibrillation and the need for antithrombotic therapy

Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice, affecting more than 6 million people in Europe, up to 5.1 million people in the US and more than 800,000 people in Japan.^{289, 290, 291} Atrial fibrillation is associated with a major risk of stroke, caused by a thrombus that forms within the left atrium and embolises to block a cerebral artery. The degree of stroke risk and the need for anticoagulant therapy to lower this risk varies among patients with AF.

AF — the most common arrhythmia

AF, the most common type of sustained cardiac arrhythmia, is primarily a problem of the elderly. The prevalence is less than 1% in those under 60 and almost 10% in those over 80.⁷⁹

AF is often classified based on the temporal pattern of presentation⁴:

Recurrent AF: two or more episodes of AF
Paroxysmal AF: episodes end spontaneously within seven days
Persistent AF: pharmacologic or electrical cardioversion is required to terminate the arrhythmia
Permanent AF: sustained AF despite treatment to end the arrhythmia or when cardioversion is inappropriate

Paroxysmal and persistent AF are referred to as recurrent AF based on the pattern of the arrhythmia.

AF — rhythm control vs rate control

The objectives of treating AF are to relieve symptoms (when present) and to optimise cardiac function. This can be accomplished with either a rhythm-control or a rate-control approach. Rhythm control involves efforts — electrical cardioversion or drug therapy, or both — to restore and maintain normal sinus rhythm. In addition, interventional approaches designed to ablate the source of the abnormal rhythm — known as catheter ablation procedures — have proven successful in some patients with paroxysmal AF.⁴

Rate control involves using medications to maintain a ventricular rate under 100 beats per minute without attempting to terminate the arrhythmia.⁴ Generally, studies have shown that there is no survival advantage with rhythm control as opposed to rate control.⁸⁰

AF — the role of antithrombotic therapy

Regardless of which treatment approach is pursued, antithrombotic therapy is essential, according to AF guidelines. This is because cardioembolic stroke is one of the main complications of AF.⁴ Cardioembolic stroke (or thromboembolic stroke) occurs when stagnant blood in the fibrillating atrium forms a thrombus that then embolises to the cerebral circulation, blocking arterial blood flow and causing ischaemic injury.

The incidence of stroke in patients with nonvalvular AF (ie, AF not caused by damage to the mitral valve) is between two- and seven-fold greater than in the general population. For patients with AF caused by valvular disease, the risk of stroke increases 17-fold.²²

Thrombus in right atrial appendage

AF — the risk of stroke

The risk of stroke is age-dependent. In the Framingham study, the annual risk was 1.5% in those 50 to 59 years old and 23.5% in those 80 to 89 years old.²² A systematic review of six cohorts of AF patients identified three other independent risk factors in addition to age: prior history of stroke or transient ischaemic attack (TIA), history of hypertension, and diabetes.⁸¹

Several scoring systems are available to help clinicians estimate the stroke risk in AF. One popular, well-validated risk assessment tool is the "CHADS₂". This system assigns single points for Congestive heart failure, Hypertension, Age ≥75, and Diabetes and prior Stroke or/transient ischemic attack”. The scale assigns 2 points if there is a history of prior stroke or TIA and 1 point for each of the other factors.⁸² This scoring system is a commonly used schema for stroke risk assessment. Patients with a CHADS₂ score of ≥2 have a high risk and merit anticoagulation therapy.²²⁶

The CHADS₂ score, however, has limitations, as it does not incorporate a number of documented stroke risk factors. To expand the CHADS₂ score — especially where patients have a CHADS₂ score of 0-1 or where a more comprehensive stroke risk assessment is needed — the CHA₂DS₂-VASc score has been developed. This score identifies “major” risk factors, including stroke/TIA/thromboembolism and age ≥75, and “clinically relevant non-major” risk factors, which are congestive heart failure, hypertension, diabetes, age 65-74, female gender and vascular disease (see table below). Single points are assigned for all risk factors, with the exception of age ≥75 and stroke/TIA/systemic thromboembolism, which are assigned 2 points each. Patients with a CHA₂DS₂-VASc score of ≥2 are considered at high risk and should receive oral anticoagulation therapy. Those with a score of 1 can be offered antithrombotic therapy with oral anticoagulation or aspirin, although oral anticoagulation is preferred. Subjects with a score of 0 are truly at low risk, and while they can be offered antithrombotic therapy or aspirin, no therapy would generally be needed.²³⁰

5 Effective Stretches for Walkers

Hey guys - Jonathon Stewart here for About.com. Walking is a great form of exercise for everyone - fat burning and low-impact, it's about as natural for your body as it gets. So why the need for stretching? How about longer joint life, increased flexibility, and a reduced risk of injury? And it actually feels good, too. Check it out.

Warm Up Before Stretching

Before you get going, it's important to allow your muscles to relax and warm up before stretching to avoid debilitating pulls or tears. Start by walking at a very gentle pace for about 5-10 minutes, then stop near a wall or pole for balance.

Warm UP Ankle Roll

Bend one knee at a 90-degree angle and roll your foot clockwise 10 times, then counter-clockwise another 10. Switch legs and repeat.

Twist Walking Warm Up

Standing with your legs shoulder-width apart, hold your arms out to the side, parallel to the ground. Turn your torso so you twist your spine gently to the right, then the left, about 20 times total.

Arm Circle Warm Up

With your arms still extended, roll your arms forward in a small, circular motion, rotating from your shoulders. Count to 10 slowly, then reverse the direction of your circles for another count to 10.

Walking Warm Up Reach Stretches

Next, lift your right arm straight up, and reach over slowly to the left side of your body, bending at the hips. Keep your left hand at your waist, and once you begin to feel a little tension, hold the stretch for a count of ten. Relax, and repeat with the other side.

Warm Up Neck Stretches

Standing tall, bend your neck slowly to the side and hold it for a count of 10. Switch to the other side for another 10, then back, then forward. Be gentle, move slowly, and avoid rolling your neck in a full circle.

5 Stretches for Walkers

Now, you walk on your legs, so why all the upper body stuff? Well, walking actually exercises your whole body, from your toes to the top of your spine, and the more relaxed your whole body is, the better it's going to perform. And, now that you're loosened up, let's stretch the rest of you!

Thigh Walking Stretch

Start in a seated position on the floor or ground with one leg extended out in front of you and the other bent and tucked in. With a very straight spine, slowly bend at the hips, bringing your torso forward. Do not let your back round or slouch, even if it allows you to get closer to your toe. Hold, and repeat with your other leg.

Abs and Glutes Walking Stretch

With one leg extended in front of you, cross the other leg over and place the sole of your foot on the ground. Keep your glutes solidly balanced on the ground, and twist toward your bent leg, keeping your spine long and straight. Hold, and repeat with your legs reversed.

Calves Walking Stretch

Next, stand next to a wall or pole and place one foot in front of the other, bend your front leg and keep your back leg straight, and lean forward slightly, always keeping your spine straight. After holding for 30 seconds, slowly bend your back knee slightly to stretch your Achilles' tendon.

Walking Stretches for Shins

Stay Standing, bend your right leg and point your toes, then bring your foot down, toenails to the ground, roll your foot forward slowly, bending at the ankle. Hold the stretch for about 30 seconds, then switch to your left shin.

Quad Walking Stretches

Finally, grab your left foot with your left hand and slowly bring your foot up behind you. Keep your thighs close together and your hips level, and don't push further if you feel any pain in your knees. Hold, and repeat with your other leg.

Some folks recommend stretching after your walk, and it doesn't matter too much when you do it, as long as you always allow yourself the time to warm up, and don't forget to stretch at some point. Personally, when I'm done exercising, I'm most interested grabbing some food and stretching my belly.

How Bad is Obesity, Really?

We all know that America is in the throes of an obesity epidemic. Over two-thirds of Americans are officially overweight or obese; obesity in children is on the rise; and type II diabetes (almost always associated with obesity) is being seen in great numbers, including in young Americans for the first time. And it's something you can see with your own eyes: anyone who has traveled to Europe in the past few years can tell you how striking a contrast it is to see large numbers of trim people.

There's no question that obesity greatly increases one's risk of developing diabetes and cardiovascular disease. Obesity is not a problem to be ignored.

Yet, we are increasingly hearing the faint sound of dissenting voices: Obesity is a growing medical problem, but really, how significant is it? They point out the following:

At least a substantial part of the obesity epidemic can be accounted for by a change in the definition of "obesity." When the CDC changed the definition in 1997, 30 million Americans who had been of normal weight now found themselves to be obese, all without gaining a pound.
A 2007 report in the Journal of the American Medical Association showed that one's level of physical fitness correlated with long-term survival better than one's level of obesity. That is, overweight people who were fit had a lower risk of death than non-overweight people who were sedentary. Read more here about being "fat and fit."
While Americans are fatter, they have made other changes in health behavior -- chiefly, smoking reduction and better management of cholesterol and hypertension -- that have more than offset the health risk incurred by the increase in population obesity, according to a 2007 National Bureau of Economic Research report.
A 2006 report in The Lancet suggested that individuals who were overweight but not obese (BMI of 25 to 29.9), actually had a slightly lower risk of dying than patients who were of "normal" weight (BMI 20 to 24.9).
A 2009 review paper in the Journal of the American College of Cardiology describes a somewhat puzzling relationship between obesity and heart disease that is now emerging: While obesity increases the risk for heart disease, obese patients who develop heart failure or coronary artery disease may actually have better survival than thin people who develop the same cardiac conditions. Do overweight people develop less severe forms of heart disease than thin people, or does fat tissue somehow mitigate the severity of heart conditions once they develop? Nobody knows.

Calculate your BMI

So far, the backlash to the anti-obesity movement is fairly muted, but it promises to become louder. As the obesity controversy begins to spread, here are three things you should keep in mind to avoid becoming confused by the hyperbole that is sure to arise from both sides:

1) Being very obese (BMI 30 or greater) is very bad for you, as it tremendously increases your risk of cardiovascular disease. No controversy here whatsoever.

2) On a population basis, being merely overweight (BMI between 25 and 29.9) is also associated with increased risk. But on an individual basis, the level of risk really does depend on several other factors, including your fitness levels, the amount of "excess" weight accounted for by muscle mass rather than fat, and your waist-to-hip ratio. (Your waist size should be less than your hip size.)

Importance of Your Waist-to-Hip Ratio

3) If you are overweight and sedentary, you need to exercise. For one thing, it is difficult to achieve sustained weight loss without regular exercise. But more importantly, even if you do not get down to your ideal weight, the increase in fitness will offset -- at least partially -- the increase in risk posed by the excess pounds.

_Sources:

Cutler DM, Glaeser EL, Rosen AB. Is the US Population Behaving Healthier? NBER Working Paper No. 13013. April, 2007. http://www.nber.org/digest/dec07/w13013.html

Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007; 298:2507-2516.

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease. Risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-1932.

Keeping Your Heart Clean

While heart disease kills more men and women than any other disease in developed countries, it turns out there's a lot you can do to keep your heart healthy.

We have learned a tremendous amount in recent years about the risk factors that predispose us to heart disease. One of the important things we have learned is that each of us has significant control over most of these risk factors. And therefore, to a large extent, each of us holds our cardiac fate in our own hands. Even people who have strong a genetic predisposition to heart disease can often significantly delay the onset of heart problems by adopting healthy lifestyles.

There are at least eight categories of lifestyle choices that can substantially impact your odds of developing heart disease. The following is a list of resources that will help you understand the kinds of lifestyle changes you can make, in each of these eight categories, to help prevent heart disease and keep your heart healthy.

1) Manage Your Diet and Weight

A poor diet often leads to obesity, and obesity can be very damaging to the heart and vascular system (especially when it is accompanied by a sedentary lifestyle). These articles will help you understand the risk, and what you can do about it.

2) Get Plenty of Exercise

A sedentary lifestyle is very bad for the entire cardiovascular system, and it can also contribute to metabolic problems, such as high cholesterol and high blood sugar. Getting plenty of exercise is one of the best things you can do for your heart. Here is some important information on preventing heart disease with exercise.

How much exercise do you really need?
Heart healthy exercise guidelines
Exercise and HDL cholesterol
Exercise for beginners
Cardiac rehabilitation

3) Don't Smoke

Of all the things you can do to ruin your health, smoking is the most ruinous. If you smoke you are likely to develop heart disease decades earlier than you otherwise might. Even if you don't develop premature heart disease, you will likely suffer from one of the other scourges of smoking - cancer, lung disease, premature aging, and other conditions that make you sickly, or wrinkly and old, before your time. Here is some important information for smokers.

4) Manage Your Cholesterol Levels

Blood lipids - cholesterol and triglycerides - are important determinants of cardiac risk. Here's what you should know about bad cholesterol, good cholesterol, and the things you can do - diet, lifestyle and medications - to keep your cardiac risk as low as possible.

5) Manage Your Blood Pressure

Hypertension (high blood pressure) is extremely common, and is often poorly treated. Unfortunately, inadequately-treated hypertension can lead to both heart attacks and especially strokes. Here is some basic information you should know about blood pressure.

6) Learn to Manage Stress

Does stress really cause heart disease? What kind of stress? And what can you do about it? The following articles will help answer these questions.

7) Control Your Blood Sugar

Insulin resistance - which can manifest as either diabetes of metabolic syndrome - leads to high blood sugar and a host of other metabolic problems that greatly increase your risk of heart disease. Here is some important information on diabetes, metabolic syndrome and heart disease.

8) Other Things You Should Know To Keep Your Heart Healthy

In addition to all of the above, there are several other risk factors and lifestyle choices that may impact on your chances of getting heart disease. Some of these are listed here.

"Keeping Your Heart Clean and Your Hands Dirty"

The Apostle Paul is perhaps one of the best examples of a person striving for purity, keeping his heart clean, and not afraid of getting in the trenches of sharing the gospel. Many Christians and churches are afraid to get their hands dirty; afraid to do the grunt work in the trenches of everyday ministry. The Word of God instructs us to keep our hearts clean and our hands dirty. The Apostle Paul is an excellent model of a person with a passion for ministry. He applied himself to every good work for the glory of God.

I. How to Minister With Fervor (v.1).

We see here that the Apostle Paul is committed to the message of the gospel. His heart was completely on fire for God. His passion for souls had driven him through beatings, shipwreck, poverty, hunger, stonings and imprisonments. Never did a man preach as Paul preached. God used him to alter Asia and rile the Romans. He preached with a fervor, with passion, and with heart. There was thunder and lightening in his soul. He had a heart for sharing the gospel as he said in I Corinthians 9:16 “Woe to me if I do not preach the gospel.” A man who understands the gospel and who has experienced the life changing power of Jesus in his heart cannot avoid the passion that is involved in the gospel witness.

1. Paul used a simple strategy (v.1).

The Corinthians were accustomed to eloquence. As we see in this context, Paul did not come to add to their culture. He did not come to be a sightseer, but a soul winner. He did not use a method of communication that was lined with eloquence. He refused to speak in beautiful words, flowing rhetoric or superiority of language. Paul could easily have swept them off their feet with his phenomenal mind and impressive education, but he chose not to. No display of rhetoric--just a message of profound simplicity. Paul was extremely qualified. He understood that the gospel had its own inherent power. The single story of Jesus dying on the cross of Calvary could grip the hearts of men and women and change their lives. He made it as simple as he could.

When the National Cemetery in Gettysburg was dedicated in 1863, public officials asked Edward Everett, a great orator, to deliver the oration. It was a masterpiece. When the oration was over, the crowd clapped and shouted because of Everett’s tremendous message. Later, with apologies, President Lincoln delivered a very simple and direct address at Gettysburg. Today, few of us are familiar with Everett’s message. This illustrates the fact that when we preach the gospel, we must have the passion in our hearts to preach it as simply as we know how. The witness of Paul to these people says to us that a worthy witness is one motivated by love, one who employs methods of simplicity, and one who speaks a message of urgency.

2. Paul was determined (v.2).

Paul must have wrestled with this decision. He had been beaten and imprisoned at Phillipi, and run out of Thessalonica and Berea. Although a few responded when he preached on Mars Hill in Athens, others mocked him. Paul walked two or three days to Corinth and he must have reflected on the prior days of difficulty and challenge. When he arrived in Corinth he had decided, thus in v.2 “I have determined...” which means a “settled conviction.” Paul had considered the options and made up his mind to continue to preach only one message: Jesus Christ and Him crucified. The message of the cross should dominate our witness and our preaching. The only message that can comfort broken hearts, that can mend broken families, and that can turn a sinner into a saint is the simple message of the gospel.

3. Paul was humble (v.3).

Physically Paul was weak. He was emotionally trembling, mentally fearful, and filled with anxiety and a sense of inadequacy. Every time I stand to preach or go into a home to make an evangelistic visit, I have some of the same anxiety. Paul knew that the task was bigger than he was. The population of Corinth at this time was at least 700,000. Perhaps Priscilla and Aquilla were the only Christians besides Paul. God often gives us assignments greater than our ability to accomplish them.

“When I am weak, then I am strong”(2 Cor. 12:10). Many churches and Christians need to learn this lesson. So often pastors and congregations want to do only the things they feel comfortable doing; adopt budgets they can afford, start only those programs they know will succeed. It is time we get out of our comfort zones.

Paul possessed not an inner fear due to inferiority, but a fear and trembling anxiety that he might not perform his duty to the very best of his ability. The result was that whatever was accomplished was because God intervened and demonstrated His power, His might. God wants us to see our weakness. We are absolute failures without His presence. John Stott said, “It seems that the only preaching God honors, through which His wisdom and power are expressed, is the preaching of a man who is willing in himself to be both the weakling and the fool.”

II. How to Minister with Power (v.4).

Paul now shares how he communicated the message. The Corinthians were mesmerized by great oration, but little action resulted. They were used to just listening and doing nothing. We are messengers. The power of the message is not in human persuasion; it is a divine persuasion. James writes about being only hearers of the word and not doers. Many love the eloquence of a speaker, but do not change. Paul says that our power is not found in human persuasion. Divine persuasion is a demonstration of the Holy Spirit moving in His power. The Spirit of God can take the weakest words of a preacher, a witnessing school girl, or a well dressed businessman and use them to bring conviction to the hearts of lost people.

III. How to Share your Faith with Purpose v.5.

Paul's motive was that their faith would not “rest on the wisdom of men, but on the power of God.” Paul made it clear to the Corinthians that they could not rest their faith in Peter, Apollos, or himself. Faith placed in anyone but Christ, the only worthy object of our faith, is misplaced faith. Paul preached the simple message of Christ crucified passionately and humbly. He depended on God’s supply of power, not his own strength. He had great purpose and so do we.

Charles Spurgeon once said, “The power that is in the Gospel does not lie in the eloquence of the preacher; otherwise, men would be the converters of souls. Nor does it lie in the preacher’s learning; otherwise, it would consist of the wisdom of men. We could preach until our tongues rot, until we would exhaust our lungs and die, but never a soul would be converted unless the Holy Spirit be with the Word of God to give it the power to convert the soul.”

If the Corinthians had come to have faith in the wisdom of men, even in Paul’s wisdom, they might have changed intellectually, but they would not have changed spiritually. The faithful hymn of old is so true,

“My faith is built on nothing less,
Than Jesus’ love and righteousness.
On Christ the solid rock I stand,
All other ground is sinking sand.”

What type of witness are you? How do your family, your friends, and those you work with view you and your relationship to the Lord? The story is told of a young father and husband who became seriously ill and died leaving behind his young wife and a five-year-old son. The young mother tried to explain to the little fellow that Jesus needed to take his daddy home to heaven, but the boy couldn’t seem to understand. Finally one night, when he knelt down to pray he said, “Dear Jesus, mommy told me that daddy was going to come to live with you now. She said that you needed him to help you in heaven. But, you know, I need him too. But mommy said the other day that in heaven daddy would not be sick anymore. I’m so glad about that because he used to hurt so bad down here. Now there are a few things that you need to know about my daddy. He can’t preach, he can’t sing in the choir, and he doesn’t have much education because he had to work all of his life. When they called on him to pray at church, he used to always mess it up and it used to embarrass me and my mommy so bad that we just could hardly stand it. But there is one thing, Jesus, he thought a lot about you. He loved you a lot. He used to tell everyone what a fine fellow you are. And when you get to know my daddy, you will really like him. The kids in the neighborhood just love him to death. When a toy broke down, they would bring it to my daddy. He would go get that old black toolbox and he knew exactly what to do to make those toys just like brand new. Mommy told me the other day that there are children in heaven. And where there are children, there are toys--golden toys. I think that is why you want my daddy in heaven. You need someone to help you, somebody to help you fix those golden toys. Well, I’ve got to go now and I’ve enjoyed talking to you. Tell my daddy that me and my mommy miss him and that we love him a lot. One day we will be in heaven and we will see my daddy again.” What would your son or daughter say about your relationship with Christ? If they were praying to the Lord and said, “There is one thing, Jesus,....” what would be that one dominating characteristic that they see?

Gypsy Smith was asked how to start a revival. He said, “It is very simple. Go into a room all by yourself. Take a piece of chalk and draw a circle. Get down on your knees in that circle and ask God to start a revival in that circle.” My prayer is that God will bring revival to our hearts that we might minister with the fervor, power, and purpose that only comes from Him.

Written by: Dr. Kevin Ezell
Pastor, Highview Baptist Church
Louisville, KY

Physical Exercise

The hardest part of an exercise routine is getting started. Once you've established a regular pattern of exercise, you'll find yourself following it. So, how do you get started? Well, first of all, consult your doctor. Your doctor can recommend the specific kinds of exercise for your own individual needs. Generally, however, these guidelines should get you going.
First of all, exercise will only become a habit if it's fun! Pick something you will enjoy doing. If you like being with a group of people, try a team sport like basketball or soccer. You don't have to be a super athlete. Anyone can exercise. Social activities like dancing and mall-walking are also good. If you're more of a loner, try bicycling or swimming.
Don't kid yourself. Be honest about what you realistically think you can do. If you have always hated to climb stairs, step aerobics probably isn't for you. Maybe a walk around the neighborhood would be more pleasant. Many people today are walking toward fitness.
Consider your current state of physical fitness. If you haven't exercised in years, you'll definitely want to start with some modest activities. As you get adjusted, you can increase your activity.
Consider your schedule. Are you a morning person? Then plan to exercise in the morning. If you're addicted to your snooze button, plan to exercise in the evening. Start with just a small block of time, maybe fifteen minutes. As you get into your routine, you probably won't mind increasing to twenty, and then thirty, minutes. In order to be effective, you'll need to repeat your exercise routine 3 or 4 times per week.
Will you exercise at home or at a fitness center? Selecting a fitness center can be a challenge, but you may find the community support motivational. Will you need any special equipment? The variety of exercise equipment available for purchase today can be overwhelming. Be sure to buy the proper equipment.
Finally, take it easy. Make sure that you exercise intelligently and cautiously. Follow some guidelines for beginners. Exercise should improve your health, not risk it.
If you're still making excuses, at least try some of the Healthy Heart Tips for today. These simple, realistic activities can become the first step toward a healthier tomorrow.

Heart Attacks: An Explosive Situation

A heart attack is sudden. The causes of the heart attack are not. Years of unhealthy heart habits suddenly, unexpectedly, catch up with you. Anywhere. Anytime. A diseased heart is like a ticking timebomb. The heart attack is its explosion.
Technically, a heart attack occurs when the supply of nutrient-rich blood to the heart muscle is reduced or stopped. If the blood supply is shut down for a long time, muscle cells die from a lack of oxygen. If enough cells die, the victim will also die. Often, only a small part of the heart muscle is deprived of oxygen so the victim can recover.
Why does the blood supply reduce or stop? There are many possibilities. One of the most common is arteriosclerosis, an arterial disease. If blood is unable to flow through the blood vessels, it cannot nourish the body and heart.
Is there a way to predict a heart attack? Angina pectoris, or chest pain, is a warning sign of a possible heart attack. Any chest pain should be taken seriously and investigated.
Heart attacks are frightening for both the victim and for the victim's companions. Be a Heart Saver by learning the best ways to help a heart attack victim.

Hypertension

There is no "ideal" blood pressure reading. However, there is a range of "normal" blood pressure readings. Generally, a reading that is less than 120 over 80 indicates that you don't need to worry. If either or both numbers are equal to or greater than 120 over 80 for an extended period of time, you have high blood pressure, or hypertension.
Hypertension is dangerous because it causes the heart to work extra hard. This strain contributes to heart attacks and stroke. When the heart is forced to work extra hard for an extended period of time, it tends to enlarge. A slightly enlarged heart can function well, but a significantly enlarged heart cannot. High blood pressure also causes damage to the arteries, causing arterial disease.
Hypertension can be treated. Mild cases of hypertension can be treated through behavior modification like changing diet and increasing exercise. More severe cases of hypertension require medications like diuretics, beta blockers, ACE inhibitors, and calcium channel blockers. Each type of chemical works differently in an attempt to bring blood pressure back into a normal range. For example, diuretics rid the body of excess fluids and salt while beta blockers reduce the heart rate and the heart's output of blood.
Please note that these are general statements about hypertension. For individualized information, it is essential that you consult with a medical professional.

Diabetes: Can You Beat It?

While diabetes is not actually a form of heart disease, it often contributes to heart disease. Diabetes occurs when a body is unable to produce or respond properly to insulin which is needed to regulate glucose (sugar). Besides contributing to heart disease, diabetes also increases the risks of developing kidney disease, blindness, nerve damage, and blood vessel damage. More than 80 percent of people with diabetes die from some form of heart or blood vessel disease.

CLICK to enlarge: Shown above is a woman using a blood glucose monitor and a needle used for injecting insulin.

There are two forms of diabetes: juvenile diabetes and adult-onset diabetes. Adult-onset diabetes is associated with obesity and can be delayed or controlled with proper diet and exercise.
There is no cure for diabetes. However, diabetes can be controlled through changing eating habits and exercise programs. Drugs are also available. However, even if diabetes is under control, it still contributes to heart disease.

Keeping the Heart Clean

The human heart's job is to pump nutrient-rich blood throughout your body. If you smoke, take drugs, or drink alcohol excessively, you are giving your heart extra work. How do you feel when you have too much work to do? Your heart cannot handle too much extra work over a long period of time. Over time, the health of your heart will suffer.
Scientists have proven that smoking doubles your risk of having a heart attack and doubles, triples, or quadruples your risk of sudden cardiac death. Each year, over 300,000 Americans die of smoking-related heart disease. So, don't smoke. If you do, quit. The sooner you quit, the sooner your risk will start to decline. There is hope. Former smokers can completely lower their risk of sudden cardiac death within ten years of quitting.
Because they are foreign substances, any drug can effect your heart. Even prescribed medications can. However, since prescribed medications are legal, doctors are able to control the effect a drug will have on your heart by controlling the dosage. With illegal drugs (cocaine, heroin, marijuana, amphetamines, etc.), YOU have to control the effect on your heart. Can you do that? Only if you don't take any. Even a small amount of a drug can be potentially fatal. So, don't use illegal drugs. If you do, quit.
While drinking alcohol in moderation may not pose a risk, drinking excessively does pose a serious hazard to your heart. While alcohol flows in your blood stream, the nutrient-rich blood is less able to nourish the heart. If the alcohol content is excessive, your heart will be in danger. So, don't drink alcohol excessively. If you do, quit.

How to Keep Your Computer Safe, Clean, and Backed Up in 2011

Those important computer tasks—like securing, cleaning, and backing up—are like any other resolution: we all say we're going to do them but rarely keep up with them all year. Here's our simple guide to staying on track in 2011.
Keeping your computer in good shape gets to be tedious and annoying when you have to try to fit it in to your busy schedule. Rather than letting things slip through the cracks and watch your computer slow to a crawl, fall victim to a nasty virus, or crash and burn with no backups, we've put together everything you need to tackle to stay on top of all your computer maintenance tasks. Here are the four things we're going to look at (feel free to click to skip to any of the sections):

Back Up Automatically

Resolved: How to Keep Your Computer Safe, Clean, and Backed Up in 2011

Backing up our data is something we all know is important but many of us do not do. In the past you might've been able to get away with the excuse of inconvenience, but nowadays it's so effortless that if you're not backing up, you should make it your first order of business for the new year.
A good backup system will duplicate your important data in three places. One of them can be your computer, another can be an external hard drive that you keep in your house, but one of those three places should exist outside of your home. Local backups (like backing up to an external USB drive) protect you if a hard drive dies, but not if your house is robbed, catches fire, or you fall victim to any other incredibly fun disaster you can imagine. While these are rare circumstances, the effects are devastating. Since backup is so easy, there's really no sense in taking the risk. First we'll take a look at backing up to the cloud, which requires essentially no effort at all, and then we'll consider your options for each specific operating system so you can have a local copy on an external drive as well.

Backing Up to the Cloud

As long as your work doesn't consist of serious data creation, I'm of the opinion that you can use Dropbox for all your backup needs, especially now that it includes selective sync. I used Dropbox toorganize my home folder and sync my iTunes library to multiple computers and it works great. While Dropbox can take care of just about everything I want backed up and synced, it can't handle your applications and system files without causing problems. Also, for reasons I don't entirely understand (aside from the cost), not everyone wants to keep the majority of their stuff in their Dropbox. So, for those of you who aren't sold on Dropbox being the golden egg of cloud backup, your other best bet for off-site backup is Mozy.
Resolved: How to Keep Your Computer Safe, Clean, and Backed Up in 2011

Mozy has become a Lifehacker favorite, especially with the speed boosts and its ability to also back up to external drives. In fact, its external drive backup options make it a cross-platform tool that can pretty much handle every one of your backup needs (cloud + local drive). While I wasn't in love with Mozy when it first came about, it's now considerably faster than it was in its early days and can handle everything from one application. That's pretty tough to beat. For a full walkthrough, check out our guide to setting up a foolproof and fireproof automatic backup plan with Mozy.

Backing Up to a Local Drive

NOTE: While we're not going to get picky about the brand of drive you use, make sure you get one that's a bit bigger than your computer's drive if you want to save multiple backups.

While Mozy can back up to an external drive nicely, you may prefer a backup tool with a larger feature-set that's more tailored to your operating system. Fortunately, there is no shortage of backup software available for every operating system. We've narrowed down the pool and have a few options for Windows, Mac OS X, and Linux, that should cover all your local backup needs.

Windows

Built into Windows 7 is the Backup and Restore Center, which Microsoft debuted in Windows Vista and has since improved in Windows 7. While it'll take more than a few clicks to set up, you're given a good number of options to control how your data is backed up. You can choose what you want to backup, where you want to back it up (including network locations), and how often you want the backup to occur. While it may not be the perfect solution for all users, it's built into Windows and pretty easy to set up.
Alternatively, you have the classic SyncBack. The SE version is free but you can pay for additional features. Nearly five years ago, Gina used SyncBack SE to set up an automatic backup plan that still works today. If Windows Backup Center doesn't quite cut it for you, SyncBack SE is a great alternative.

Mac OS X

One nice feature of Mac OS X 10.5 and 10.6 is Time Machine, which lets you plug in a drive and just back up with no effort at all. Once it has a full copy of all your data, it will only backup the files that have changed since that original copy was made. If you want a file you lost, you can activate Time Machine and go back in time to retrieve an earlier copy of that file. Your Time Machine backup drive can also be used to restore lost data and set up a brand new Mac with all your files.
Time Machine pretty much does what it wants to do and that's that, so if you're looking for more control I'd suggest picking up Carbon Copy Cloner. It's a free backup utility that makes a bootable copy of your drive (which Time Machine does not). I use it all the time and love it. It can be as simple as selecting the drive you want to copy, but you can also selectively copy certain files. Carbon Copy Cloner is very straightforward backup software, so you're not going to find the bells and whistles you might with paid software, but if you want something simple that also offers quite a bit of control over your backup, it's an ideal choice.

Linux

For easy backups on Linux machines, Back In Time is a good solution. You can get your backup plan set up pretty quickly, and it backs up using space-saving snapshots (much like Apple's Time Machine). As far as Linux backup apps go, it's pretty easy to understand and runs great on GNOME and KDE-based Linux systems.

Secure Your Computer and Your Life Online

There are a number of ways your computer can get into trouble. Whether you're dealing with viruses, online threats, or physical theft, here are some great tools to help keep you safe.

Antivirus Software

For Windows, however, you don't have to look much further than Microsoft Security Essentials. There once was a day when relying on third-party antivirus software was necessary, but Microsoft put those days behind us. MSE is great at ferreting out malware, performs very well, and is free. Mac OS X and Linux users generally don't have to worry too much about viruses, so you get a pass on antivirus software. But you don't get a pass on the next category.

Online Security

We've take a pretty extensive look at how to stay secure online, so read through that and you should be in pretty good shape. Additionally, you'll want to take a look at how to combat spam email, learn how to prevent someone from breaking into your Mac or Windows PC, and invade your own privacy to make sure your private information is secure.

Preventing (and Preparing for) Computer Theft

Prey is a wonderful, free, open-source tool that can help you track down and (potentially) recover your stolen Mac, Windows PC, or smartphone. If you're like me and you've had your laptop stolen before, you know how devastating it can be. When you lose technology with personal data, the thief doesn't only have access to your expensive hardware but a lot of information about you as well. Coming to this realization is not fun, so be smart and take the necessary steps to protect yourself from a potential theft.
For those of you with iPhones (or other iOS devices), you're lucky enough to have free access to find my iPhone. Set it up and use it! If you're don't have a recent iOS device, we've got you covered. Here's how to set up Find My iPhone on older iOS devices.

Run Regular Maintenance

With your data backed up and protected, you're going to want a computer that runs smoothly. Performing regular maintenance can play a big role in keeping your machine in tip-top shape. Mac OS X and Windows 7/Vista will take care of defragmenting your drive for you—so no need to take care of it yourself—but if you're running earlier versions of Windows you should check out our guides on setting up a self-repairing hard drive and setting up scheduled tasks to run your favorite cleaning tasks in the background. If you're a fan of CCleaner (the all-in-one crap cleaner for Windows), check out this guide to automating your CCleaner sessions.
For Mac users, maintenance tasks are regularly scheduled by OS X and so, technically, you don't have to do anything yourself. Nonetheless, it's in your best interest to play a hand in your system's upkeep. If you want a look at every possible option you have, definitely check out our guide on cleaning up and reviving your bloated, sluggish Mac. Alternatively, if you want to do a bit less, you can just schedule maintenance tasks in the Terminal and repair disk permissions. If you're not familiar with repairing your disk permissions, all you have to do is go into your Applications —> Utilities folder and open up Disk Utility. Inside of Disk Utility, choose the First Aid tab and then click the Repair Disk Permissions button. It'll take a few minutes and slow down the system a bit, but running this operation will help prevent little errors here and there. Running this once a month (and after any major software installation) will keep your Mac a bit happier and less prone to preventable issues.
Last, if you have a bad habit of letting your Downloads folder or Desktop get out of control, check out our guide to automatically cleaning and organizing your folders with Belvedere (or with Hazel if you're on a Mac).

Create a Tidy, Attractive Desktop

Once your computer is backed up, safe, clean, and running smoothly, you ought to finish up with a little fun. Your machine is, ultimately, going to be more fun to use if it's easy to navigate and looks just the way you want it to look. We've taken an extensive look at customizing your desktop, so be sure to check out those options to take on some serious customizations. Need inspiration? Check out our most popular featured desktops from 2010. If you're just looking for some simple customizations, however, you can find some excellent, distraction-free wallpaper over at Simple Desktops and great free icons at the Iconfactory.

Hopefully now you've got a good plan to keep your computer in good shape this year. Is there anything you'd add to this list? Let's hear about it in the comments.