Stethoscope Health Dictionary

The method used by physicians to determine, by listening, the condition of certain internal organs. The ancient physicians appear to have practised a kind of auscultation, by which they were able to detect the presence of air or ?uids in the cavities of the chest and abdomen.

In 1819 the French physician, Laennec, introduced the method of auscultation by means of the STETHOSCOPE. Initially a wooden cylinder, the stethoscope has evolved into a binaural instrument consisting of a small expanded chest-piece and two ?exible tubes, the ends of which ?t into the ears of the observer. Various modi?cations of the binaural stethoscope have been introduced.

Conditions affecting the lungs can often be recognised by means of auscultation and the stethoscope. The same is true for the heart, in which disease can, by auscultation, often be identi?ed with striking accuracy. But auscultation is also helpful in the investigation of aneurysms (see ANEURYSM) and certain diseases of the OESOPHAGUS and STOMACH. The stethoscope is also a valuable aid in the detection of some forms of uterine tumours, especially in the diagnosis of pregnancy.... auscultation

The traditional device for measuring blood pressure in clinical practice, devised by Riva-Rocci and Korotko? about a century ago. Measurement depends on accurate transmission and interpretation of the pulse wave to an artery. The sphygmomanometer is of two types, mercury and aneroid. The former is more accurate. Both have some features in common – an in?ation-de?ation system, an occluding bladder encased in a cu?, and the use of AUSCULTATION with a STETHOSCOPE. The mercury sphygmomanometer consists of a pneumatic armlet which is connected via a rubber tube with an air-pressure pump and a measuring gauge comprising a glass column containing mercury. The armlet is bound around the upper arm and pumped up su?ciently to obliterate the pulse felt at the wrist or heard by auscultation of the artery at the bend of the elbow. The pressure, measured in millimetres of mercury (mm Hg), registered at this point on the gauge is regarded as the pressure of the blood at each heartbeat (ventricular contraction). This is called the systolic pressure. The cu? is then slowly de?ated by releasing the valve on the air pump and the pressure at which the sound heard in the artery suddenly changes its character marks the diastolic pressure. Aneroid sphygmomanometers register pressure through an intricate bellows and lever system which is more susceptible than the mercury type to the bumps and jolts of everyday use which reduce its inaccuracy.

While mercury sphygmomanometers are simple, accurate and easily serviced, there is concern about possible mercury toxicity for users, those servicing the devices and the environment. Use of them has already been banned in some European hospitals. Although it may be a few years before they are widely replaced, automated blood-pressure-measuring devices will increasingly be in routine use. A wide variety of ambulatory blood-pressuremeasuring devices are already available and may be ?tted in general practice or hospital settings, where the patient is advised on the technique. Blood-pressure readings can be taken half-hourly – or more often, if required – with little disturbance of the patient’s daily activities or sleep. (See also BLOOD PRESSURE; HYPERTENSION.)... sphygmomanometer

The uneven, rustling sound heard by AUSCULTATION over the HEART and various blood vessels in abnormal conditons. For example, murmurs heard when the stethoscope is applied over the heart are highly characteristic of valvular disease of this organ.... murmur

The transmitted sounds of breathing, heard when a stethoscope is applied to the chest. Normal breath sounds are described as vesicular. Abnormal sounds may be heard when there is increased ?uid in the lungs or ?brosis (crepitation or crackles), when there is bronchospasm (rhonchi or wheezes), or when the lung is airless (consolidated – bronchial breathing). Breath sounds are absent in people with pleural e?usion, pneumothorax, or after pneumonectomy.... breath sounds

Muscular contraction of the bronchi (air passages) in the LUNGS, causing narrowing. The cause is usually a stimulus, as in BRONCHITIS and ASTHMA. The result is that the patient can inhale air into the lungs but breathing out becomes di?cult and requires muscular e?ort of the chest. Exhalation is accompanied by audible noises in the airways which can be detected with a STETHOSCOPE. Reversible obstructive airways disease can be relieved with a BRONCHODILATOR drug; if the bronchospasm cannot be relieved by drugs it is called irreversible. (See CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD).)... bronchospasm

A crackling sound in the lungs (heard through a stethoscope) caused by abnormal build-up of fluid.

(See also auscultation.)... crepitation

The resonance of the voice, when spoken or whispered words can be clearly heard through the stethoscope placed on the chest wall. It is a sign of consolidation, or of a cavity, in the lung.... pectoriloquy

The bleating or punchinello tone given to the voice as heard by AUSCULTATION with a stethoscope, when there is a small amount of ?uid in the pleural cavity in the chest.... aegophony

Normal breath sounds heard in the lung by means of a stethoscope. These are soft regular sounds which become altered by disease; the changed characteristics may help the physician to diagnose a disease in the lung.... vesicular breathing

Sounds made by the passage of air and fluid through the intestine. Absent or abnormal bowel sounds may indicate a disorder. Those that are audible without a stethoscope are known as borborygmi and are a normal part of the digestive process, but they may be exaggerated by anxiety and some disorders of the intestine.... bowel sounds

The sounds made in the heart, arteries, or veins when blood circulation becomes turbulent or flows at an abnormal speed. This happens when blood vessels become narrowed by disease (as in arteriosclerosis), when heart valves are narrowed or damaged (as in endocarditis), or if blood vessels dilate (as in an aneurysm). Bruits are usually heard through a stethoscope.... bruits

a silent period in the knocking sounds heard with a stethoscope over an artery, between the systolic and diastolic blood pressures, when the blood pressure is measured with a *sphygmomanometer.... auscultatory gap

n. 1. a crackling sound or grating feeling produced by bone rubbing on bone or roughened cartilage, detected by palpation on movement of an arthritic joint. Crepitus in the knee joint is a common sign of *chondromalacia patellae in the young and *osteoarthritis in the elderly. 2. a similar sound heard with a stethoscope over an inflamed lung when the patient breathes in. 3. a similar sound heard over an inflamed extensor tendon in the hand in *scleroderma caused by thickening of the skin, or over a tendon injured by repetitive use in de Quervain’s *tendovaginitis.... crepitus

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

Heart disease can affect any of the structures of the HEART and may affect more than one at a time. Heart attack is an imprecise term and may refer to ANGINA PECTORIS (a symptom of pain originating in the heart) or to coronary artery thrombosis, also called myocardial infarction.

Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.

Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.

The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.

•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.

In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.

In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be

caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.

Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.

Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.

Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.

Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.

If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.

Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)

Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.

Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.

The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.

Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.

Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.

Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).

Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.

PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of

(friction rub) a scratching sound, heard over the heart with the aid of the stethoscope, in patients who have *pericarditis. It results from the two inflamed layers of the pericardium rubbing together during activity of the heart.... friction murmur

a crunching sound synchronous with the heartbeat heard with a stethoscope in 45–50% of patients with *pneumomediastinum. [L. V. Hamman (1877–1946), US physician]... hamman’s sign

Gmelina arborea

Verbenaceae

San: Gumbhari;

Hin:Gamari, Jugani-chukar;

Mal: Kumizhu, Kumpil;

Guj: Shewan; Pun:Gumbar; Mar: Shivanasal;

Kan: Kummuda;

Tam: Uni, Gumadi;

Tel: Gummadi;

Importance: Coomb teak, Candahar tree or Kashmeeri tree is a moderate sized, unarmed, deciduous tree which is a vital ingredient of the ”dasamula” (group of ten roots). The whole plant is medicinally very important. It promotes digestive power, improves memory, overcomes giddiness and is also used as an antidote for snake bite and scorpion sting. Roots are useful in hallucination, fever, dyspepsia, hyperdipsia, haemorrhoids, stomachalgia, heart diseases, nervous disorders, piles and burning sensation. Bark is used in fever and dyspepsia. Leaf paste is good for cephalagia and leaf juice is a good wash for foul ulcers and is also used in the treatment of gonorrhoea and cough. Flowers are recommended for leprosy, skin and blood diseases. The fruits are used for promoting the growth of hair and in anaemia, leprosy, ulcers, constipation, strangury, leucorrhoea, colpitis and lung disease.

Wood is one of the best and most reliable timber of India. It is used for making furniture, planks, carriages, printing boxes, musical instruments, shafts, axles, picture frames, jute bobbins, calipers, ship buildings, artificial limbs and stethoscopes.

In south India the bark of the tree is used by arrack manufacturers to regulate the fermentation of toddy. The plant is also grown in garden or avenues (Dey, 1988; Sivarajan and Indira, 1994).

Distribution: The plant is found wild throughout India from the foot of Himalayas to Kerala and Anadamans, in moist, semideciduous and open forests upto an altitude of 1500 m. It is also distributed in Sri Lanka and Philippines.

Botany: Gmelina arborea Roxb. Syn. Premna arborea Roth. belongs to Family Verbenaceae. It is an unarmed deciduous tree growing up to 20m height with whitish grey corky lenticellate bark, exfloliating in thin flakes. Branchlets and young parts are clothed with fine white mealy pubescence. Leaves are simple, opposite, broadly ovate, cordate, glandular, glabrous above when mature and fulvous-tomentose beneath. Flowers brownish yellow in terminal panicle. Calyx campanulate, pubescent outside and with 5 lobes. Corolla showy brownish yellow with short tube and oblique limbs. Stamens 4, didynamous and included. Ovary is 4 chambered with one ovule each; style slender ending in a bifid stigma. Fruits are fleshy ovoid drupes, orange yellow when ripe. Seeds 1 or 2, hard and oblong.

Agrotechnology: Coomb teak is a sun loving plant. It does not tolerate drought. But it grows in light frost. Rainfall higher than 2000mm and loose soil are ideal. The best method of propagation is by seeds but rarely propagated vegitatevely by stem cuttings also. Seed formation occurs in May-June. Seeds are dried well before use. They are soaked in water for 12 hours before sowing. Seed rate is 3kg/ha. Seeds are sown in nursery beds shortly before rains. Seeds germinate within one month. Seedlings are transplanted in the first rainy season when they are 7-10cm tall. Pits of size 50cm cube are made at a spacing of 3-4m and filled with sand, dried cowdung and surface soil, over which the seedlings are transplanted. 20kg organic manure is given once a year. Irrigation and weeding should be done on a regular basis. The common disease reported is sooty mould caused by Corticium salmonicolor which can be controlled by applying a suitable fungicide. The tree grows fast and may be ready for harvesting after 4 or 5 years. This plant is coppiced and traded. The roots are also used for medicinal purposes. The tree may stand up to 25 years.

Properties and activity: Roots and heart wood of Coomb teak are reported to contain gmelinol, hentriacontanol, n-octacosanol and -sitosterol. The roots contain sesquiterpenoid and apiosylskimmin, a coumarin characterised as umbelliferone-7-apiosyl glucoside and gmelofuran. The heart wood gives ceryl alcohol, cluytyl ferulate, lignans, arboreol, gmelonone, 6”-bromo isoarboreol, lignan hemiacetal and gummidiol. Leaves yield luteolin, apigenin, quercetin, hentriacontanol, -sitosterol, quercetogenin and other flavons. Fruits contain butyric acid, tartaric acid, and saccharine substances (Asolkar et al, 1992; Dey, 1988).

The roots are acrid, bitter, tonic, stomachic, laxative, galactogogue, demulcent, antibilious, febrifuge and anthelmintic. Bark is bitter, hypoglycaemic, antiviral, anticephalalgic and tonic. The leaves are demulcent, antigonorrhoeic and bechic. Flowers are sweet, refrigerant, astringent and acrid. Fruits are acrid, refrigerant, diuretic, astringent, aphrodisiac, trichogenous, alterant and tonic (Warrier et al; 1995).... coomb teak

n. a representation of the normal heart sounds as heard through the stethoscope. Lubb (the first heart sound) coincides with closure of the mitral and tricuspid valves; dupp (the second heart sound) is due to closure of the aortic and pulmonary valves.... lubb-dupp

n. inflammation of the *pleura, often due to pneumonia in the underlying lung. The normally shiny and slippery pleural surfaces lose their sheen and become slightly sticky, so that there is pain on deep breathing and a characteristic ‘rub’ can be heard through a stethoscope. Pleurisy is always associated with some other disease in the lung, chest wall, diaphragm, or abdomen.... pleurisy

n. (pl. rhonchi) an abnormal musical noise produced by air passing through narrowed bronchi. It is heard through a stethoscope, usually when the patient breathes out.... rhonchus

adj. whistling or hissing. The term is applied to certain high-pitched abnormal sounds heard through a stethoscope.... sibilant

n. a soft blowing sound heard through the stethoscope, usually produced by blood flowing in vessels.... souffle

the sounds heard through the stethoscope when the patient speaks (“ninety nine”). These are normally just audible but become much louder (bronchophony) if the lung under the stethoscope is consolidated, when they resemble the sounds heard over the trachea and main bronchi. Vocal resonance is lost over pleural fluid except at its upper surface, when it has a bleating quality and is called aegophony. See also pectoriloquy.... vocal resonance

There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.

The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.

In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)

Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of

Damage to bronchi when ballooned beyond normal limits, usually from chronic infection. May be a legacy from lung infections, whooping cough, measles, tuberculosis, foreign body or other bronchial troubles. Predisposing factors: smoking, working with asbestos and other industrial materials. Now known that some structural changes in bronchial epithelium caused by cigarette smoking are reversible by abstinence for over two years.

A plug of tenacious mucus may be clogged in the bronchial tree and gradually sucked into the smaller bronchi, blocking them. This prevents air from passing through to replace air that has been absorbed and precipitates cough, sputum, spitting of blood. A stethoscope reveals crepitations; chronic cases may be detected by clubbing of the fingers, which sign may be missing in bronchitis and other chest infections. Alternatives. Treatment. Bronchitics are most at risk and should never neglect a cold. Stimulating expectorants followed by postural drainage indicated. To control infection, plenty of Echinacea should be given. Where a localised area becomes septic a surgical lobectomy may be necessary. See: POSTURAL DRAINAGE. Cases of developed bronchiectasis can be maintained relatively well over a period of years by judicious use of herbs: Bayberry bark, Blood root, Elecampane root, Ephedra, Eucalyptus oil, Grindelia, Senega root, Mullein, Pleurisy root, Red Clover. Lobelia. Not Comfrey.

Tea. Formula. Equal parts: Yarrow, Mullein, Lungwort. 1 heaped teaspoon in each cup boiling water; infuse 5-15 minutes; 1 cup morning and evening and when necessary.

Powders. Mix: Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 500mg (two 00 capsules or one- third teaspoon) morning, evening and when necessary.

Tablets/capsules. Iceland Moss. Lobelia.

Tinctures. Formula. Ephedra 2; Echinacea 1; Elecampane root 1; Capsicum quarter. dose: 2-5ml teaspoons morning and evening and when necessary.

Practitioner. Liquid Extract Senega 1; Ephedra 1; Lungwort 2 (spitting of blood add: Blood root quarter). Dose: 2-5ml morning and evening and when necessary. In advanced cases there may be swollen ankles and kidney breakdown for which Parsley root, Buchu or Juniper may be indicated.

The sucking of a clove (or single drop of oil of Cloves in honey) has given temporary relief. Aromatherapy. Inhalants or chest-rub – Eucalyptus, Cajeput, Hyssop, Rosemary, Sandalwood.

Diet. Wholefoods. Low fat, low salt, high fibre. Avoid all dairy foods.

Supplementation. Vitamin B-complex. Vitamin E for increased oxygenation. Vitamins A, C, D, F. Outlook. Relief possible from regular herbal regime as dispensed by qualified practitioner. Requirements of each individual case may differ. ... bronchiectasis

n. an abnormal high-pitched (sibilant) or low-pitched sound heard – either by the unaided human ear or through the stethoscope – mainly during expiration. Wheezes occur as a result of narrowing of the airways, such as results from *bronchospasm or increased secretion and retention of sputum; they are commonly heard in patients with asthma or chronic bronchitis.... wheeze

Pneumonia is an in?ammation of the lung tissue (see LUNGS) caused by infection. It can occur without underlying lung or general disease, or in patients with an underlying condition that makes them susceptible.

Pneumonia with no predisposing cause – community-acquired pneumonia – is caused most often by Streptococcus pneumoniae (PNEUMOCOCCUS). The other most common causes are viruses, Mycoplasma pneumoniae and Legionella species (Legionnaire’s disease). Another cause, Chlamydia psittaci, may be associated with exposure to perching birds.

In patients with underlying lung disease, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) or BRONCHIECTASIS as in CYSTIC FIBROSIS, other organisms such as Haemophilus in?uenzae, Klebsiella, Escherichia coli and Pseudomonas aeruginosa are more prominent. In patients in hospital with severe underlying disease, pneumonia, often caused by gram-negative bacteria (see GRAM’S STAIN), is commonly the terminal event.

In patients with an immune system suppressed by pregnancy and labour, infection with HIV, CHEMOTHERAPY or immunosuppressive drugs after organ transplantation, a wider range of opportunistic organisms needs to be considered. Some of these organisms such as CYTOMEGALOVIRUS (CMV) or the fungus Pneumocystis carinii rarely cause disease in immunocompetent individuals – those whose body’s immune (defence) system is e?ective.

TUBERCULOSIS is another cause of pneumonia, although the pattern of lung involvement and the more chronic course usually di?erentiate it from other causes of pneumonia.

Symptoms The common symptoms of pneumonia are cough, fever (sometimes with RIGOR), pleuritic chest pain (see PLEURISY) and shortness of breath. SPUTUM may not be present at ?rst but later may be purulent or reddish (rusty).

Examination of the chest may show the typical signs of consolidation of an area of lung. The solid lung in which the alveoli are ?lled with in?ammatory exudate is dull to percussion but transmits sounds better than air-containing lung, giving rise to the signs of bronchial breathing and increased conduction of voice sounds to the stethoscope or palpating hand.

The chest X-ray in pneumonia shows opacities corresponding to the consolidated lung. This may have a lobar distribution ?tting with limitation to one area of the lung, or have a less con?uent scattered distribution in bronchopneumonia. Blood tests usually show a raised white cell (LEUCOCYTES) count. The organism responsible for the pneumonia can often be identi?ed from culture of the sputum or the blood, or from blood tests for the speci?c ANTIBODIES produced in response to the infection.

Treatment The treatment of pneumonia involves appropriate antibiotics together with oxygen, pain relief and management of any complications that may arise. When treatment is started, the causative organism has often not been identi?ed so that the antibiotic choice is made on the basis of the clinical features, prevalent organisms and their sensitivities. In severe cases of community-acquired pneumonia (see above), this will often be a PENICILLIN or one of the CEPHALOSPORINS to cover Strep. pneumoniae together with a macrolide such as ERYTHROMYCIN. Pleuritic pain will need analgesia to allow deep breathing and coughing; oxygen may be needed as judged by the oxygen saturation or blood gas measurement.

Possible complications of pneumonia are local changes such as lung abscess, pleural e?usion or EMPYEMA and general problems such as cardiovascular collapse and abnormalities of kidney or liver function. Appropriate treatment should result in complete resolution of the lung changes but some FIBROSIS in the lung may remain. Pneumonia can be a severe illness in previously ?t people and it may take some months to return to full ?tness.... pneumonia

In normal breathing the lungs spring back into their usual shape after expansion by the act of breathing-in. In emphysema, elasticity has lost its spring so the lungs become permanently expanded. Differs from chronic bronchitis by destroying walls of the air sacs. The chest is barrel-shaped through hyperinflation. Trumpeter’s lung; glass-blower’s disease, smoker’s disease. Stethoscope reveals ‘distant’ heart sounds of right heart failure, for which Hawthorn is indicated. Breathlessness on exertion. The victim cannot dispel the sensation of puffed-up lungs.

Through a lack of oxygen other muscles weaken. Rate of breathing may increase from 14-30 times per minute. Always ‘clearing the throat’. Overweight worsens.

Alternatives. Lobelia, Wild Thyme, Coltsfoot. Ephedra (practitioner only).

To loosen and thin tough mucus: Iceland Moss, Garlic, Coltsfoot, Gum ammoniac, Fenugreek seeds, Liquorice, Khella.

Decoction. Equal parts: Valerian, Liquorice root. 1-2 teaspoons to each cup boiling water; simmer 15 minutes. Dose: 1 cup once or twice daily and at bedtime.

Tablets/capsules. Lobelia, Iceland Moss, Garlic.

Formula. Equal parts: Elecampane, Iceland Moss, Wild Thyme. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. In water, honey or banana mash, thrice daily, and during the night if necessary.

Practitioner. Alternatives.

Formula (1). Liquid extracts: Ephedra 2; Elecampane 1; Lobelia 1. Dose – 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons in water etc as above.

Formula (2). Liquid extracts: Ephedra 2; Liquorice 1. Dosage same as Formula 1. The action of both formulae is improved when taken in cup of Fenugreek decoction.

Hyssop Wine. Good responses observed. 1oz herb macerated in 1 pint white wine or Vodka for 3-4 weeks; shake daily.

A. Barker FNIMH. Liquid extract Mouse Ear 60 drops; Liquid extract Pleurisy root 30 drops; Tincture Goldenseal 30 drops; Tincture Myrrh 20 drops; Tincture Ginger 20 drops. Pure bottled or distilled water to 8oz (240ml). Dose: 2 teaspoons every 3 hours.

Diet. Low salt. High fibre. Avoid all dairy products.

Supplements. Daily. Vitamin A 7500iu. Vitamin E 400iu. Folic acid 1mg. Vitamin C 200mg. Iodine, iron. Deep-breathing exercises. 2 Garlic tablets/capsules at night. For acute respiratory infections that irritate emphysema add Echinacea. ... emphysema

Atheroma is a name given to the disease where fatty and mineral deposits attach themselves to the walls of the arteries. Usually starts from a deposit of cholesterol which leaks into the inner surface of the artery causing a streak of fat to appear within the wall. As the fatty streak grows deeper tissue within the arterial wall is broken down and the mechanism for clotting blood is triggered. The result is formation of atheromatous plaque that may clog an artery, precipitate a clot (known as an embolism) and travel to a smaller artery which could become blocked. The end result of atherosclerosis is invariably arteriosclerosis in which thickening and hardening leads to loss of elasticity.

Atherosclerosis can be the forerunner of degenerative heart and kidney disease, with rise in blood pressure.

A study of Australian ’flu epidemic diseases revealed influenza as a major cause of cardiovascular disease and in particular, atherosclerosis.

Causes. Excessive smoking and alcohol, fatty foods, hereditary weakness, stress and emotional tension that release excessive adrenalin into the bloodstream. Toxic effects of environmental poisons (diesel fumes). Fevers.

Symptoms. Cold hands and feet, headache, giddiness. Diminished mental ability due to thickening of arteries in the brain. Pain on exertion, breathlessness and fatigue. Diagnosis of atheroma of main arteries: by placing stethoscope over second right intercostal space, half inch from the sternum, the second aortic sound will be pronounced.

Treatment. Surface vasodilators, Cardioactives. Anti-cholesterols.

Alternatives. Teas. To lower cholesterol levels and shrink hardened plaque: Alfalfa, Chamomile, Borage, Olive leaves, Mint, Nettles, Marigold, Garlic, Lime flowers, Yarrow, Horsetail, Hawthorn, Ginkgo, Orange Tree leaves, Meadowsweet, Eucalyptus leaves, Ispaghula, Bromelain. Rutin (Buckwheat tea).

Artichoke leaves. Spanish traditional. 2 teaspoons to each cup of water; simmer 2 minutes. Drink cold: 1 cup 2-3 times daily.

Mistletoe leaves. 1-2 teaspoons to each cup cold water steeped 8 hours (overnight). Half-1 cup thrice daily.

Tablets, or capsules. Garlic, Mistletoe, Poke root, Rutin, Hawthorn, Motherwort, Ginkgo, Bamboo gum. Liquid Extracts. Mix Hawthorn 2; Mistletoe 1; Barberry 1; Rutin 1; Poke root half. Dose: 30-60 drops thrice daily.

Tinctures. Mix: Hawthorn 2; Cactus flowers 2; Mistletoe 1; Capsicum half. Dose: 1-2 teaspoons thrice daily in water before meals.

Powders. Mix equal parts: Bamboo gum, Hawthorn, Mistletoe, Rutin, Ginger. Fill 00 capsules. Dose: 2-4 capsules, or quarter to half a teaspoon (375-750mg) thrice daily before meals.

Threatened stroke. Tincture Arnica BPC (1949): 3-5 drops in water morning and evening. Practitioner only.

Evening Primrose oil. Favourable results reported. (Maxepa)

Diet. Vegetarian. Low fat. Low salt. High fibre. Lecithin, polyunsaturated oils, artichokes, oily fish (see entry). Linseed on breakfast cereal. Garlic at meals, or Garlic tablets or capsules at night to reduce cholesterol.

Vitamins. A, B-complex, B6, B12, C (2g), E (400iu), daily.

Minerals. Chromium, Iodine, Potassium, Selenium, Magnesium, Manganese, Zinc.

“A man is as old as his arteries” – Thomas Sydenham, 17th century physician.

“A man’s arteries are as old as he makes them” – Robert Bell MD, 19th century physician. ... atherosclerosis

The use of an instrument to record and/or listen to an unborn baby’s heartbeat during pregnancy and labour. Monitoring is carried out at intervals throughout pregnancy if tests indicate that the placenta is not functioning normally or if the baby’s growth is slow. During labour, monitoring can detect fetal distress, in which oxygen deprivation causes abnormality in the fetal heart-rate.

The simplest form of fetal heart monitoring involves the use of a special fetal stethoscope. Cardiotocography, a more sophisticated electronic version, makes a continuous paper recording of the heartbeat together with a recording of the uterine contractions. The heartbeat is picked up either externally by an ultrasound transducer strapped to the mother’s abdomen or, as an alternative during labour, internally by an electrode attached to the baby’s scalp that passes through the vagina and cervix.... fetal heart monitoring

A machine that temporarily takes over the function of the heart and lungs to facilitate operations such as open heart surgery, heart transplants, and heart–lung transplants.

A heart–lung machine consists of a pump (to replace the heart’s function) and an oxygenator (to replace the lung’s function). It bypasses the heart and lungs, and the heart can be stopped.

Use of a heart–lung machine tends to damage red blood cells and to cause blood clotting. These problems can be minimized, however, by the administration of heparin, an anticoagulant drug, beforehand.heart–lung transplant A procedure in which the heart and lungs of a patient are removed, and replaced with donor organs. This surgery is used to treat diseases in which the lung damage has affected the heart, or vice versa. Such diseases include cystic fibrosis, fibrosing alveolitis, and some severe congenital heart defects (see heart disease, congenital). A heart–lung machine is used to take over the function of the patient’s heart and lungs during the operation, which is no more dangerous than a heart transplant.

heart-rate The rate at which the heart contracts to pump blood around the body. Most people have a heart-rate of between 60 and 100 beats per minute at rest. This rate tends to be faster in childhood and to slow slightly with age. Very fit people may have a resting rate below 60 beats per minute.

The heart muscle responds automatically to any increase in the amount of blood returned to it from active muscles by increasing its output. During extreme exercise, heart-rate may increase to 200 contractions per minute and the output to almost 250 ml per beat.

The heart-rate is also regulated by the autonomic nervous system. The parts of this system concerned with heart action are a nucleus of nerve cells, called the cardiac centre, in the brainstem, and 2 sets of nerves (the parasympathetic and sympathetic).

At rest, the parasympathetic nerves – particularly the vagus nerve – act on the sinoatrial node to maintain a slow heart-rate. During or in anticipation of muscular activity, this inhibition lessens and the heart-rate speeds up.

Sympathetic nerves release noradrenaline, which further increases the heart-rate and force of contraction. Sympathetic activity can be triggered by fear or anger, low blood pressure, or a reduction of oxygen in the blood.

Release of adrenaline and noradrenaline by the adrenal glands also acts to increase heart-rate.

The rate and rhythm of the heart can be measured by feeling the pulse or by listening with a stethoscope; a more accurate record is provided by an ECG.

A resting heart-rate above 100 beats per minute is termed a tachycardia, and a rate below 60 beats per minute a bradycardia. (See also arrhythmia, cardiac.)... heart–lung machine

Two types – simple and ulcerative. Inflammation of the membrane lining of the heart with the appearance of small fibrin accumulations on the valves. These may form during a specific fever – rheumatic, scarlet, etc, due to bacterial infection. In Bacterial Endocarditis, fragments of tissue may be shed from the main seat of infection and borne to other parts of the body, promoting inflammation or ischaemia elsewhere.

Affects more women than men, ages 20 to 40 years. Most cases have a history of rheumatic fever as a child. Thickening of the valves renders them less efficient in regulating the flow of blood through the heart thus allowing leakage by improper closure. Increased effort is required from the heart muscle to pump blood through the narrowed valves giving rise to fatigue and possible heart failure.

Prolapsus of the mitral valve is now recognised as predisposing to bacterial endocarditis. It is concluded that herbal antibiotic prophylaxis is justified in heart patients undergoing dental extraction, or other surgery where there is exposure to infection.

Symptoms: Breathlessness on exertion. Swelling of legs and ankles, palpitations, fainting, blue tinge to the skin and a permanent pink flush over the cheek bones. Clubbing of fingers. Enlarged spleen. Stethoscope reveals valvular regurgitation. The most common organism remains streptococcus viridans, by mouth. It may reach the heart by teeth extraction, scaling and intensive cleaning which may draw blood, posing a risk by bacteria.

Treatment. Acute conditions should be under the authority of a heart specialist in an Intensive Care Unit.

Absolute bedrest to relieve stress on the heart’s valves. For acute infection: Penicillin (or other essential antibiotics). Alternatives, of limited efficacy: Echinacea, Myrrh, Wild Indigo, Nasturtium, Holy Thistle. Avoid: excitement, chills, colds, fatigue and anything requiring extra cardiac effort. Convalescence will be long (weeks to months) during which resumption to normal activity should be gradual.

Aconite. With full bounding pulse and restless fever. Five drops Tincture Aconite to half a glass (100ml) water. 2 teaspoons hourly until temperature falls.

To sustain heart. Tincture Convallaria (Lily of the Valley), 5-15 drops, thrice daily.

To stimulate secretion of urine. Tincture Bearberry, 1-2 teaspoons, thrice daily.

Rheumatic conditions. Tincture Colchicum, 10-15 drops, thrice daily.

Various conventional treatments of the past can still be used with good effect: Tincture Strophanthus, 5 to 15 drops. Liquid Extract Black Cohosh, 15 to 30 drops. Spirits of Camphor, 5 to 10 drops. Bugleweed (American), 10 to 30 drops. To increase body strength: Echinacea. To sustain heart muscle: Hawthorn. Endocarditis with severe headache: Black Cohosh.

Teas: single or in combination (equal parts) – Nettles, Motherwort, Red Clover flowers, Lime flowers. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.

Decoction: equal parts: Hawthorn berries, Echinacea root, Lily of the Valley leaves. Mix. 2 teaspoons to each 2 cups water in a non-aluminium vessel, gently simmer 10 minutes. Dose: 1 cup 2-3 times daily. Formula. Echinacea 20; Cactus 10; Hawthorn 10; Goldenseal 2. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily.

Diet. See entry: DIET – HEART AND CIRCULATION. Pineapple juice. Treatment by or in liaison with general medical practitioner or cardiologist. ... endocarditis

The sounds made by the heart during each heartbeat. In each heart cycle, there are 2 main heart sounds that can clearly be heard through a stethoscope. The first is like a “lubb”. It results from closure of the tricuspid and mitral valves at the exits of the atria, which occurs when the ventricles begin contracting to pump blood out of the heart. The second sound is a higher-pitched “dupp” caused by closure of the pulmonary and aortic valves at the exits of the ventricles when the ventricles finish contracting.

Abnormal heart sounds may be a sign of various disorders.

For example, highpitched sounds or “clicks” are due to the abrupt halting of valve opening, which can occur in people with certain heart valve defects.

Heart murmurs are abnormal sounds caused by turbulent blood flow.

These may be due to heart valve defects or congenital heart disease.... heart sounds

Failure of the tricuspid valve to close fully, allowing blood to leak back into the right atrium when the right ventricle contracts. The condition, which is also known as tricuspid insufficiency, reduces the pumping efficiency of the heart.

The usual cause is pulmonary hypertension, but more rarely, it follows rheumatic fever, or, in intravenous drug users, a bacterial infection of the heart.

Tricuspid incompetence results in symptoms of rightsided heart failure, notably oedema of the ankles and abdomen. The liver is swollen and tender, and veins in the neck are distended.

A diagnosis is made from the symptoms, from hearing a heart murmur through a stethoscope, and by tests that may include an ECG, chest X-rays, echocardiography, and cardiac catheterization.

Treatment with diuretic drugs and ACE inhibitors often relieves the symptoms.... tricuspid incompetence

n. acute or chronic inflammation of the membranous sac (pericardium) surrounding the heart. Pericarditis may be seen alone or as part of pancarditis (see endomyocarditis). It has numerous causes, including virus infections, uraemia, and cancer. Acute pericarditis is characterized by fever, chest pain, and a pericardial friction rub (a harsh scratching noise audible over the anterior chest wall with the aid of a stethoscope). Fluid may accumulate within the pericardial sac (pericardial effusion). Rarely, chronic thickening of the pericardium (chronic constrictive pericarditis) develops. This interferes with activity of the heart and has many features in common with *heart failure, including oedema, pleural effusions, ascites, and engorgement of the veins. Constrictive pericarditis most often results from tubercular infection.

The treatment of pericarditis is directed to the cause. Pericardial effusions may be aspirated by a needle inserted through the chest wall. Chronic constrictive pericarditis is treated by surgical removal of the pericardium (pericardiectomy).... pericarditis