Incessant noise can disrupt the body at a cellular level

Health Care, Heart Care Foundation of India, Medicine Comments Off

Noise is recognized environmental stressor and can exacerbate certain existing health conditions

New Delhi, 16 May 2018: According to a review of the underlying mechanisms that lead to noise-induced heart disease, environmental noise from traffic and aircraft disrupts the body on the cellular level to raise heart disease risk factors. Sound pollution can cause metabolic abnormalities and autonomic imbalance, characterized by dizziness and exercise intolerance. Exposure to this noise can also lead to behavioral issues in children.

Dust mixed with toxic fumes from vehicular exhausts can exacerbate lung and heart diseases and trigger death from heart attack, stroke, chronic obstructive pulmonary disease, lung infections like pneumonia, and cancers of the lung and respiratory tract.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, ” Noise is an unwanted intrusive sound. A loud noise is 85 db or higher, or if a person has to raise his/her voice to speak with someone standing at a distance of 3 feet. Noise is a recognized environmental stressor, which has both physiological and psychological effects. It is associated with anxiety, high blood pressure, increased heart rate, insomnia, annoyance, stress. Progressive hearing loss may result from continuous and repeated exposure to loud noise. The safe limit for sounds at 85 db or less is 8 hours of exposure. Loud noise affects speech intelligibility and consequently work performance and increases chances of errors. Conversation has to be conducted at higher dbs for clear speech communication because of noise interference.”

People living in areas with high traffic noise are also 25% more likely than those in quieter neighborhoods to have symptoms of depression such as sadness, loneliness and trouble concentrating.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Hospitals are noisy work places. Control of noise levels is very important in hospitals for patient well-being and healing. Noise creates an unhealthy work environment for doctors. It affects concentration and increases the chances of mistakes, which can be costly for the doctors and hospitals. Inability to hear the warning patient monitoring alarm over the general background noise in an ICU may have potentially disastrous outcome. Moreover, doctors too are prone to develop high BP and other negative effects on health.”
Some HCFI tips to reduce noise pollution.
• Traffic flow around schools and hospitals should be minimized as much as possible.
• Signboards displaying ‘Silence zone’, ‘No honking’ must be placed near these areas.
• Efforts should be made to ban the use of horns with jarring sounds, motorbikes with damaged exhaust pipes, and noisy trucks.
• The use of loudspeakers in parties and discos, as well as public announcements systems should be checked and discouraged.
• Noise rules must be stringent and strictly enforced near such silence zones.
• Planting trees along roads and in residential areas is a good way to reduce noise pollution as they absorb sound.

Heart attack with normal angiography or normal post mortem

Health Care Comments Off

Dr KK Aggarwal

Recipient of Padma Shri

The death of actress Sridevi was due to accidental drowning in a bath tub following loss of consciousness in a hotel in Dubai. This was the conclusion of the post-mortem report and foul play has been ruled out. Dubai police said that the case has been closed.

However, the cause of unconsciousness has not yet been conclusively found. Traces of alcohol were found in blood, and it has been suggested that this may have led to the accidental drowning.

Though the post mortem has ruled out heart attack, it still remains the most likely initiating event for loss of unconsciousness or gasping, which may have been due to ventricular tachycardia/fibrillation.

So, can one have a normal angiography or normal post-mortem after a heart attack? The answer is yes.

There are two types of heart attacks: Type I versus type II heart attack.

Most patients with acute heart attack will have obstructive (blockages) atherosclerotic (cholesterol deposition) coronary artery stenoses (narrowing) with acute thrombosis (clot) as the underlying pathology.

However, some patients (up to 28%) will not have significant epicardial coronary artery disease when coronary angiography is performed or post mortem is done. These patients are defined as having a type 2 heart attack, which is defined as a heart attack consequent to increased oxygen demand or decreased supply (coronary endothelial dysfunction, coronary artery spasm, coronary artery embolus, tachy / bradyarrhythmias, anemia, respiratory failure, hypertension, or hypotension).

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Can accidental drowning occur medically?

Health Care Comments Off

Dr KK Aggarwal

Recipient of Padma Shri

Actor Sridevi died of accidental drowning in her hotel bath tub after losing consciousness, according to the forensic report by the Dubai govt. on Monday. However, the report, which carries the stamp of the “Ministry of Health UAE” and the director of preventive medicine, Dubai, Dr Sami Wadie, does not state the cause of unconsciousness.

Can accidental drowning occur medically? Yes. Medical conditions can cause accidental drowning. Seizure disorders, which can be first-onset episode, can cause accidental drowning. Alcohol and/or use of illicit drugs increases risk of accidental drowning as it may affect balance, coordination and judgment. Stroke, syncopal attack (heart attack) or undetected primary cardiac arrhythmia are other factors that can cause accidental drowning. A gasping patient with ventricular arrhythmia will end up with drowning.

If there are no signs of struggle, then ‘accidental drowning’ can be a medical opinion. It is up to the police to accept this opinion or find it as a case of ‘homicidal drowning’ and investigate any foul play.

Some salient facts on accidental drowning

Drowning is the third most common cause of accidental death. A victim of drowning can be revived by cardiopulmonary resuscitation (CPR) with rescue breathing. Prolonged resuscitation, up to many hours, has been known to revive patients with hypothermia and cardiac arrest.

Antemortem drowning can be identified by the presence of fine, white, leathery, copious froth or foam tinged with blood at the mouth and nostrils (Froth is of lasting nature and large in quantity), cadaveric spasms in hands, diatoms in tissues from brain, liver and bone marrow of long bones, presence of water in stomach and intestines, voluminous water logged lungs along with fine froth in lungs and air passages.

A bathtub drowning is a major cause of death in a bathtub. The bathtub is the most common site of seizure-induced drowning; hence, patients with epilepsy should be advised to take showers instead of baths. Heart attack leading to syncope and subsequent falling in the tub can cause drowning. Besides the causes discussed above, mutations in the cardiac ryanodine receptor (RyR)-2 gene, which is associated with familial polymorphic VT in the absence of structural heart disease or QT prolongation, have been identified in some individuals with unexplained drowning. Concomitant trauma, paralysis, heart attack or hypothermia, which can lead to rapid exhaustion or cardiac arrhythmias are other factors for accidental drowning. Duration of submersion >5 minutes is the most critical factor.

Several studies have reported incidents of bath tub drowning with varying medical histories as follows:

  • A total of 268 victims were found unconscious or dead during tub bathing. After postmortem examination, the manner of death was judged as natural cause in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Drowning water inhalation, which was confirmed in 72% of victims, was absent in the others. Whereas, inhalational findings were more frequent in victims with other backgrounds such as alcohol intake, mobility disturbance, and history of epilepsy (Am J Forensic Med Pathol. 2013 Jun;34(2):164-8).
  • In a series of 14 cases of suicide by drowning in the bath in the Bristol area, England between 1974 and 1996, six cases had evidence of concomitant alcohol or substance use. Seven cases had a past psychiatric history and a history of previous deliberate self-harm. Most drowned at home, face down, fully clothed (Med Sci Law. 1999 Oct;39(4):349-53).
  • A retrospective review of 92 deaths in the bathtub in Maryland found 71.7% incidence of bathtub drowning; 28.3% were the absence of bathtub drowning. Three leading contributory causes of death were cardiovascular disease, drug/alcohol-related death, and seizure disorder in both groups More than triple overlapped drowning-related signs (history of recovery from the water, foam in the air way, watery fluid in the sphenoid sinuses, hyperinflated lungs and watery fluid in the stomach contents) could be beneficial for the diagnosis of a bathtub drowning. (Forensic Sci Int. 2015 Aug;253:64-70).
  • In a retrospective analysis of 245 bathtub death cases between 1971 and 1988 carried out in the Institute of Legal Medicine in Hamburg, 66 cases proved to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as homicides, while 51 fatalities remained unclear with respect to one of these groups. About 50% of the victims were alcoholized.  (Arch Kriminol. 1991 Jul-Aug;188(1-2):35-46).

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

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