Summary of American Heart Association Dietary Guidelines

To Achieve An Overall Healthy Eating Pattern

Choose an overall balanced diet with foods from all major food groups, emphasizing fruits, vegetables and grains. Consume a variety of fruits, vegetables and grain products.

• At least 5 daily servings of fruits and vegetables.
• At least 6 daily servings of grain products, including whole grains.
• Include fat-free and low-fat dairy products, fish, legumes, poultry and lean meats.
• Eat at least two servings of fish per week. 

To Achieve A Healthy Body Weight

• Avoid excess intake of calories.
• Maintain a level of physical activity that achieves fitness and balances energy expenditure with caloric intake; for weight reduction, expenditure should exceed intake.
• Limit foods that are high in calories and/or low in nutritional quality, including those with a high amount of added sugar. 

To Achieve A Desirable Cholesterol Level

• Limit foods with a high content of saturated fat and cholesterol. Substitute with grains and unsaturated fat from vegetables, fish, legumes and nuts.
• Limit cholesterol to 300 milligrams (mg) a day for the general population, and 200 mg a day for those with heart disease or its risk factors.
• Limit trans fatty acids. Trans fatty acids are found in foods containing partially hydrogenated vegetable oils such as packaged cookies, crackers and other baked goods; commercially prepared fried foods and some margarines. 

To Achieve A Desirable Blood Pressure Level

• Limit salt intake to less than 6 grams (2,400 mg sodium) per day, slightly more than one teaspoon a day.
• If you drink, limit alcohol consumption to no more than one drink per day for women and two drinks per day for men.

Heart Attack Symptoms

Classic symptoms of a heart attack may include:

• Chest pain associated with shortness of breath
• Profuse sweating
• Nausea

The chest pain may be described as tightness, fullness, a pressure, or an ache.

Unfortunately, many people do not have these classic signs. Other presentations of heart attack may include:

• Indigestion
• Jaw ache
• Pain, only in the shoulders or arms
• Shortness of breath
• Nausea
• Vomiting.

This list is not complete, since many times people can experience a heart attack with minimal symptoms. In women and the elderly, heart attack symptoms can be atypical and sometimes so vague as to be easily missed. The only complaint may be extreme weakness or fatigue.

Heart Attack Risk Factors

Heart attack is most often caused by narrowing of the arteries by cholesterol plaque and their subsequent rupture. This is known as atherosclerotic heart disease (AHSD) orcoronary artery disease (CAD).

The risk factors for ASHD are the same as those for stroke (cerebrovascular disease) orperipheral vascular disease:

• Family history or heredity 
• Smoking 
• High blood pressure 
• High cholesterol 
• Diabetes

While heredity is beyond a patient's control, all other risk factors can be addressed to minimize the risk of developing coronary artery disease or decreasing its progression if already present.

Non-coronary artery disease causes of heart attack may also occur, these include:

• Cocaine use. This drug can cause the coronary arteries to go into enoughspasm to cause a heart attack. As well, because of the irritant effect on the heart's electrical system, cocaine can also cause fatal heart rhythms. 
• Prinzmetal angina or coronary artery vasospasm. Coronary arteries can go into spasm and cause angina without specific cause known as Prinzmetal angina. There can be EKG changes associated with this situation, and the diagnosis is made by heart catheterization showing normal coronary arteries that go into spasm when challenged with a medication injected in the cath lab. Approximately 2%-3% of patients with heart disease have coronary artery vasospasm. 
• Anomalous coronary artery. In their normal position, the coronary arteries lie on the surface of the heart. On occasion, the course of part the artery can dive into the heart muscle itself. When the heart muscle contracts, it can temporarily kink the artery and cause angina. Again, diagnosis is made by heart catheterization. 
• Inadequate oxygenation. Just like any other muscle, heart muscle requires adequate oxygen supply for it to work. If there isn't adequate oxygen delivery, angina and heart attack can occur. This means that an adequate number of red blood cells and normal lung function are required to deliver oxygen to the cells of the heart. Profound anemia from bleeding or bone marrow failure can lead to lack of red blood cells. Lack of oxygen in the bloodstream can occur due to a variety of causes including respiratory failure or carbon monoxide poisoning.

Shoulder and Neck Pain Prevention

Timely follow-up visits to your doctor plus following his or her recommendations will enable you to recover faster. The preventions from shoulder and neck pains are:

• To prevent injuries, examine your home for potential hazards and correct them to reduce the chance of accidental injury.
• Proper exercise of the shoulders and neck can reduce the risk of injury.
• When performing hazardous tasks, have someone present to reduce the likelihood of injury. For example, when climbing a ladder, have someone hold the base of the ladder to keep it from sliding to either side.
• Know your limitations. Do not perform activities that you do not have the training, skills, tools, or strength to accomplish.
• Wear seat belts and use other safety equipment to reduce injuries.

Shoulder and Neck Pain Treatment

Minor injuries that have only slight pain can be treated at home. If the source of the pain and the cause of the pain are not known, or if symptoms suggest you might have a more serious condition, you should contact your doctor while initiating basic care measures.

• Rest: Use the injured area as little as possible for the first two to three days, then slowly begin to exercise the injured area. This speeds recovery.
• Ice: Place the ice in a plastic bag, wrap the bag with a towel, and then apply to the injured area for 15-20 minutes every hour. Directly applying ice can damage the skin.
• Elevation: Elevation of the injured area above your heart helps the swelling go down. This reduces your pain. Use pillows to prop yourself up.
• Pain control: Acetaminophen (Tylenol) oribuprofen (Advil, Motrin) can help control swelling and pain.
• Heat: Do not apply heat in the first week because it can increase the swelling in the injured area and worsen your pain.

Women Suffering from Fatigue May Have Sleep Apnea.

Sleep apnea is not uncommon in women, but women's sleep apnea symptoms are different than men's. Women with daytime sleepiness may have sleep apnea.

Many people assume that sleep apnea affects only older, overweight men. Yet medical studies show that sleep apnea affects women and children as well. Doctors estimate that for every two to three men with sleep apnea, one woman has the condition.

A woman is less likely to receive a sleep apnea diagnosis than a man, however. For every woman diagnosed with obstructive sleep apnea (OSA), eight to nine men receive a diagnosis. Women should learn about sleep apnea symptoms and be aware that the disorder can affect them too.

Sleep Apnea Diagnosis Challenges for Women

When women suffer from excessive sleepiness (fatigue even after sleeping seven to eight hours) doctors are likely to overlook the possibility of a sleeping disorder, according to Dr. Barbara Philips of the National Sleep Foundation. Female sleep apnea sufferers are often misdiagnosed with disorders such as the following:

• anemia
• cardiac or pulmonary illnesses
• depression
• diabetes
• fatigue from overwork
• fibromyalgia
• hypertension
• hypochondria
• hypothyroidism
• insomnia
• menopausal changes
• obesity

One challenge of diagnosing women's sleep disorders is that women tend to sleep more lightly than men. As a result, women hear their male bed partners snoring and express concern. This prompts many men to see doctors about sleep disorders. Men may sleep more soundly than their female bed partners, and so fail to notice female nighttime breathing problems, according to Dr. Nancy A. Collop of Johns Hopkins University Sleep Disorders Center. Women are thus often unaware that they have sleep apnea symptoms.

Sleep Apnea Effects in Women

Another challenge for diagnosing sleep apnea in women is that sleep apnea causes additional conditions that complicate diagnosis. One such condition that arises from sleep apnea is depression. Women are more open to taking anti-depressants for depression than men are. Men suffering from depression may request a sleep study rather than take anti-depressants, while women leave the doctor's office with a prescription.

One of the primary effects of sleep apnea is daytime sleepiness. Men are less likely than women to have other reasons for fatigue, such as anemia or an exhausting schedule of work and family responsibilities, according to Dr. Anita L. Blosser. It is thus easier for doctors to quickly recognize a possible sleep disorder in male patients. Women patients who complain of fatigue are more likely to receive blood tests for anemia or thyroid problems than a referral for a sleep study.

Sleep Apnea Symptoms in Women

Sleep apnea affects women differently than men. The "classic" symptoms that affect men include loud snoring, long breathing pauses at night and excessive daytime sleepiness. Women, however, may instead report symptoms such as lack of energy, insomnia, morning headaches, restless legs and depression.

Since men tend to sleep more soundly than women, a female patient may not have a bed partner who can report on her nighttime breathing patterns. Researchers are also discovering that women experience sleep apnea differently than men. According to Dr. Barbara Philips, female patients suffer from "more subtle breathing disturbances" and more REM-related apneas.

In sleep studies, women may have lower scores for AHI (apnea-hypopnea index) than men, indicating fewer full-blown apneas (10-second pauses in breathing). This lower AHI may indicate a form of sleep apnea known as UARS (upper airway resistance syndrome), which is more common in women, according to some doctors.

Sleep apnea symptoms in women include the following:

• "tossing and turning," feeling that it's difficult to stay asleep (some women report this as insomnia)
• waking up feeling tired and poorly rested
• chronic fatigue or lack of energy
• snoring or choking
• frequent nighttime urination
• awakening gasping
• excessive daytime sleepiness
• morning headaches
• dry mouth upon waking up
• edema (swelling) of the feet
• hypertension
• high blood pressure that does not respond well to medication
• unexplained weight gain.

Women are at greater risk of sleep apnea if they are overweight, obese, or past menopause.

Sleep Apnea Treatment for Women

The most effective treatment for sleep apnea is CPAP (continuous positive airway pressure). The good news is that although women may find it somewhat harder than men to find out they have sleep apnea, women are more likely than men to comply with CPAP treatment, according to Dr. Blosser.

CPAP treatment requires wearing a breathing mask over the mouth at night, which provides pressurized air to hold the airway open. Women who suspect sleep apnea should talk to a doctor about a sleep study to find out if CPAP treatment would help them.

Obstructive Sleep Apnea - OSA

Diagnosis and Treatment of a Nocturnal Breathing Disorder

Obstructive sleep apnea is a problem with breathing and sleeping that can have serious consequences.

Obstructive sleep apnea (OSA) is the cessation of breathing during sleep due to a partial or complete collapse of the upper airway. It is an increasing problem that occurs in approximately 2 to 10% of adults. Fortunately, it can be evaluated and treated to prevent further complications.

Causes

A common factor for OSA is obesity, because the accumulation of fat in the neck makes the upper airway flabby and prone to collapse. A variety of other anatomical factors can lead to OSA, including but not limited to a posteriorly displaced jaw (retrognathia), a small jaw (micrognathia), an enlarged tongue base, an elongated palate, tumors, and swollen tonsils. Other causes are nonanatomical, such as alcohol and sedatives that relax upper airway muscles.

Clinical Manifestations

While asleep, a patient with OSA may have loud snoring, breathing cessation (apnea), and/or sudden awakening due to choking or gasping. He or she may often be unaware of these symptoms unless a bed partner is present to witness them. After waking up, the patient may experience excessive daytime sleepiness, impaired concentration, and fatigue, which increase the risk of serious and fatal accidents, especially those involving motor vehicles.

In the long term, OSA leads to increased blood pressure in the lung circulation (pulmonary hypertension) because small lung arteries clamp down in the absence of oxygen. OSA also causes right-sided congestive heart failure and high blood pressure in the rest of the circulatory system (systemic hypertension).

Diagnosis

A clinician considers the diagnosis of OSA when a patient history reveals the characteristic symptoms of OSA and a physical exam presents possible risk factors for OSA. The diagnosis is confirmed with a sleep study, also known as a polysomnography. This procedure involves the patient sleeping overnight at a clinical facility with collection of various data, including but not limited to apnea, slow breathing (hypopnea), rapid eye movements, seizures, and blood oxygen saturation.

OSA is measured by the apnea-hypopnea index (AHI), which is the total number of episodes of apnea and hypopnea divided by the number of hours of sleep. OSA occurs when the AHI is at least 5. Moderate OSA is defined as an AHI of at least 15, and severe OSA is characterized by an AHI of at least 30.

Treatment

To correct disordered breathing during sleep, the patient wears a nasal mask connected to a continuous positive airway pressure (CPAP) machine. The CPAP machine works by constantly delivering air into the upper airway to keep it open and prevent apneic episodes. Oral appliances to keep the jaw and tongue forward are another option.

In the long term, however, these options are not a substitute for addressing the underlying cause. The patient must still refrain from alcohol and sedatives, lose weight if he or she is obese, undergo surgical uvulopalatopharyngoplasty (UPPP) for anatomical abnormalities of the airway, and have other treatments as needed.

Sleep Apnea BiPAP and AVS Machines

Alternatives to Continuous Positive Airway Pressure (CPAP) Treatment

CPAP (continuous positive airway pressure)

CPAP (continuous positive airway pressure) is the gold standard for sleep apnea treatment. New treatment options are beginning to challenge the unquestioned supremacy of the CPAP machine however, including the BiPAP (bilevel positive airway pressure) machine and the ASV (adaptive servo-ventilation.

A CPAP machine prevents apneas by blowing a constant stream of air through a tube and face mask and into the patient's lungs. As the air pressure is constant, when the patient breathes out the lungs must work against the air flow in order to exhale. For many people this aspect of CPAP treatment is not a problem. Some CPAP users, however, cannot adapt to breathing against the CPAP airflow. Health complications such as heart failure may also make CPAP airflow difficult to breathe against. For people in these categories a BiPAP or ASV machine may provide more effective apnea relief.

The BiPAP (Bilevel Positive Airway Pressure)

The BiPAP, or bilevel positive airway pressure machine, is very similar to the CPAP. While a CPAP machine treats sleep apnea with one continuous air pressure, a BiPAP uses two different air pressures.

When the sleeper inhales, the BiPAP uses air pressure similar to that produced by a CPAP. As the sleeper exhales, however, the air pressure drops, making it easier to empty the lungs. The two air pressures alternate on a set timer.

A more complicated version of the BiPAP goes by the long and intimidating name of the bilevel continuous airway pressure spontaneous timed machine, or BiPAP ST (thank goodness for acronyms!). The BiPAP ST works like a regular BiPAP machine, but has a back-up response if the user stops breathing. If an apnea occurs and breathing stops for a predetermined amount of time the BiPAP responds with a higher pressure airflow to stimulate breathing. It is important to remember, however, that the BiPAP does not actually breathe for you.

ASV (Adaptive Servo-Ventilation)

The adaptive servo-ventilation machine (ASV) is one of the most recent sleep apnea treatment options, and certainly one of the most complex. A CPAP machine provides a continuous flow of air. A BiPAP has two alternating air pressures. The ASV, however, monitors and responds to every breath you take.

Rather than providing the same air pressure (or mixture of air pressures) the adaptive servo-ventilator adjusts air pressure as needed. When sleep apnea occurs, the ASV responds with air pressure that mimics approximately ninety percent of the patient's normal breathing. As the apnea ends, the ASV slowly stops providing breathing support. The result is a sleep apnea treatment that is more in tune with the sleeper's normal breathing pattern.

BiPAP, CPAP and Complex Sleep Apnea

Adaptive servo-ventilators are most often used with central sleep apnea. Unlike obstructive sleep apnea, central sleep apnea occurs due to neurological abnormalities. Patients with both heart failure and central sleep apnea often respond well to an ASV.

CPAP and BiPAP treatment for obstructive sleep apnea sometimes results in complex sleep apnea. Complex sleep apnea appears to occur when CPAP and BiPAP treatments trigger previously dormant central sleep apnea. Even though the sleeper uses a BiPAP or CPAP machine to prevent obstructive sleep apnea, the newly developed central sleep apnea causes sleep apnea symptoms. In such cases, it is often beneficial to switch the user from a CPAP machine or BiPAP to an AVS machine.

World's tallest building stars in world's biggest blockbuster.

Fourth installment of $2bn franchise being shot in the UAE to be called 'Mission Impossible: Ghost Protocol'

Dubai’s efforts to be taken seriously as a venue for film production have received a shot in the arm as filming begins on the fourth installment of the $2 billion Hollywood franchise “Mission Impossible” this week.

The film is to be called "Mission Impossible: Ghost Protocol", producer and lead actor Tom Cruise told a press conference at the emirate’s Armani Hotel on Thursday. "All I wanted is not to have a number ... I always thought we should have a title aside from 'Mission Impossible'," he said.

As a producer, Cruise said it was hard to find places that appeared fresh on screen but that Dubai offered exactly that opportunity.

"Dubai is very cinematic. We are looking forward to present that on film," he said.

"Dubai is a city I always wanted to shoot in. It's a very challenging film and people here have been extraordinary in helping us get this project going. I would like to thank Sheikh Mohammed," he added, referring to His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai.

Shooting is expected to take place all around the city and definitely in the Burj Khalifa, the world's tallest building. Vital action scenes would be shot at the iconic tower and the Armani Hotel, which occupies eight floors of the building. Filming began on Thursday.

The cast include Jeremy Renner, nominated for an Oscar for his role in the 2009 war film "The Hurt Locker". Other actors include Simon Pegg and Paula Patton.

ICC uphold suspensions on Pakistani duo

Pakistani cricketers Salman Butt and Mohammad Amir had their provisional suspensions over allegations of spot-fixing upheld by the International Cricket Council (ICC) on Sunday.

"I have decided to dismiss the application... players accordingly are still for the time being unable to participate in cricketing activities," Michael Beloff, the head of the ICC's code of conduct commission told reporters in Dubai on Sunday after a two-day hearing.

The innocence or guilt of the players, who have denied any wrongdoing, will be judged at an independent tribunal, the date of which has yet to be set.