Calcium channel blockers – By Dr.Harold Gunatillake

 

Calcium channel blockers - By Dr.Harold Gunatillake

 

by Harold Gunatillake

 

Calcium channel blockers
By Dr.Harold Gunatillake FRCS, FIACS, FICS, AM (Sing), MBBS. – Health writer

 

Do you know what calcium channel blockers are?
Most of you may be on a calcium channel blocker, prescribed by your
family physician, without your knowledge, for High Blood Pressure (essential
hypertension).

They are also called calcium antagonists, given for the treatment of a variety of conditions, such as high blood pressure, migraine and Raynaud’s disease (peripheral arterial spasm).

Calcium is required by the heart muscles and other blood vessels for efficient contraction movement. So blocking such a mechanism or inhibiting transport of calcium into cells will lower the blood pressure and widen blood vessels by affecting the muscle cells in the arterial walls, especially those of the coronary arteries. These calcium antagonists also tend to slow the heart rate which is also beneficial in situations where not only the blood pressure but also the heart rate needs to be slowed down for efficient muscle contractions and prevent premature aging of the muscle cells of the heart. By such action, the blood pressure is lowered chest pain (angina) is relieved and also corrects irregular heartbeat.




Some calcium channel blockers are available in short-acting forms and other long-acting forms. The quick-acting ones act quickly and the effects last only a few hours, while the long-acting medications are slowly released to provide a longer-lasting effect.

Examples of calcium channel blocking medication available include:
• Amlodipine (Norvasc)
• Diltiazem (Cardizem)
• Felodipine (Plendil)
• Isradipine (DynaCirc SR)
• Nifedipine (Adalat CC)
• Nisoldipine (Sular)
• Verapamil ( Calan Verelan

These drugs are normally prescribed in combination with other antihypertensive drugs. These calcium channel blockers are beneficial to prevent or improve symptoms in a variety of conditions, including
• High blood pressure
• Chest pain due to angina
• Migraine headaches
• Brain aneurysm complications
• Irregular heart beats
• Circulatory conditions like Raynaud’s disease

Effect on kidneys
Studies suggest that calcium channel blockers do not worsen the progression of renal disease but may rather provide benefit when systemic blood pressure has been tightly normalized.

Side effects of these medications are:
• Constipation-(beware of verapamil). Increase your fiber content and
drink plenty of water)
• Headache-(due to widening of arteries)
• Rapid heart rate
• Rash
• Drowsiness
• Flushing- (due to widening and relaxing of arteries)
• Nausea
• Swelling of legs and feet (pitting edema due to water retention).




Serious side effects are rare, and it is not wise to stop calcium-channel blockers without speaking to your doctor.

Most people who take these medications have no side –effects, or only
minor ones.

These channel blockers should not be taken with grapefruit as they can reduce your liver’s ability to eliminate calcium channel blockers from your body, allowing the medications to build up in your body.

Rebound effect
Some people who suddenly stop taking a calcium-channel blocker have a ‘rebound’ flare up of angina. Therefore, it is best not to stop taking these drugs without first consulting a doctor.

Check your blood pressure weekly until it is stable. Early high blood pressure has no early signs or symptoms as the body gets accustomed to the slow rising of the blood pressure. Most heart attacks and stroke are preventable if your blood pressure is taken care of.

Hope this article will be useful.
Stay safe


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Origin of Tamils & Sinhalese- video presentation- 2nd series – Dr. Harold Gunatillake

by Harold Gunatillake

 

Overview

This is the 2nd presentation on the Origins of Dravidian Tamils and Indo-Aryan Sinhalese. A very controversial topic, but the presenter has made it light and balanced, more for enjoyment.

www.Doctorharold.com




 

 

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Tummy bloating is discussed-By Dr Harold Gunatillake

Dr Harold

Written by Dr. Harold Gunatillake
FRCS, FIACS, FICS, AM (Sing), MB, BS, -Health writer Tummy bloating or distension is a quite common condition due to gas production in your gut, that needs no attention, unless it becomes more severe and permanent.

In such a situation, think of eating high fibre foods. Oats is ideal for breakfast. It’s eaten in the form of rolled oats, oatmeal, oat milk, and oat bran and oat flour. They have several essential nutrients, including high dietary fibre. 100 gram serving provides 389 cals Avoid foods baked or cooked with processed rice and wheat flour for breakfast
You need to get 35 grams of fibre per day, so choose plant foods like grapes, bell peppers, beans, whole grains and nuts. High fibre foods keep you out of constipation and heart healthy, too
You may have extra gas in your tummy and cause heartburn- annoying symptom before you start the day. Eat enough to plan a diet to keep your weight within the normal range to help to minimise these symptoms.
Home remedy for heartburn is to drink some cold milk straight from the fridge and munching some cucumber slices kept in the fridge may suffice.
Eat small meals and more often to avoid indigestion. Eat sufficient not to feel full, and enjoy the day comfortably and you’ll relate to people better.
Hydrate yourself by drinking water, juices, tea and other beverages with little added sugar. Sometimes you feel down when you are dehydrated and you may not suspect the cause. Hydrating yourself you revive like watering a dehydrated plant.
Walking may help to relieve indigestion and gaseous feelings. Think of doing a walk if you feel uncomfortable in your belly.




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Dilani wife of HE. Nimal Bandara -Consul General of Sri Lanka in Sydney – birthday celebrations

Dilani wife of HE. Nimal Bandara -Consul General of Sri Lanka in Sydney, had her birthday celebrations, at their residence in Strathfield, Sydney, on 3rd January 2020. With the staff of the Consulate Office.

Invited guests: Jaya Jayawardena, his wife and Dr. Harold Gunatillake and his wife Irangani.

It was a private and homely event with traditional foods and lavish home-made dinner.

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

birthday celebrations

 

 




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Video talk on high blood pressure – BY Dr Harold Gunatillake

Dr Harold

Script
Let us discuss today, the importance of checking your blood pressure regularly.When you are 40 and over, it is advised that you check your BP annually.Owning your own BP apparatus would be an impetus for such recordings, regularly When you are a kid, your heart works beautifully with absolute, no strain. This is attributed to the fact that all your arteries -major, minor and minute tributaries to the fingers and toes are expandable, elastic and mobile, and not stiff, causing no resistance to the pumping action of your heart.

With age, the blood vessels seem to harden, become less expandable, becomes stiff and increases the resistance on pumping the blood from your heart.With increased resistance from the thickened blood vessels the heart needs to pump more forcefully.

That creates the higher pressure on the arteries, and that would be the onset of high blood pressure.

This pressure is measured by the sphygmomanometer by your doctor in his office. The upper reading is referred to as the systolic pressure, because that is a measure of how much the left ventricle of your heart is straining to pump the blood to the periphery.

When the left ventricle of your heart which pumps the blood to the periphery now needs to relax to fill with blood from the left upper chamber -called the left atrium.The lower pressure created in the blood vessels is related to the phase when the heart muscle relaxes between beats allowing the chambers to fill with blood. This is referred to as the diastolic pressure

So systolic pressure is when the heart contracts, and diastolic pressure is when the heart relaxes to fill with blood for the next beat, or you could say between beats. Adults should keep their systolic pressure at 120mm. of mercury and the diastolic could vary between 60 to 80 mm. of mercury.

When the diastolic pressure is more than 90 or higher means you have high blood pressure.

There was a time when your doctor would say when the BP is higher, it is okay for your age.

Now, it is believed that all adults at any age should keep the BP consistently at 120/60-70

Both systolic and diastolic blood pressures are important, but for those forty and older systolic is more important than the diastolic. It is the systolic pressure what increases our risk of having a heart attack, stroke or artery disease in the legs. So, remember, that systolic BP is more important and needs to be kept at 120mm of mercury.
No bargaining at all.

When the BP increases with a systolic pressure of 180 mm of mercury or higher or a bottom number of 120mm Hg can damage blood vessels and is referred to as a hypertensive crisis.

In the early stages of rising blood pressure, it happens so slowly over months or years, the body seems to accommodate the increase until such time the vessels cannot tolerate anymore, and the warning signs are imminent.

This is the main reason why you should check your BP at home or with your doctor frequently with every visit to your doctor, to prevent such episodes that can cause instant death.

How can you prevent high blood pressure?
The answer applies to all chronic diseases whether it’s high blood pressure, heart disease, cancer, diabetes among others.

Eat the right foods meaning unprocessed low fat, and low carb in small quantities at a meal.

Avoid animal foods with high saturated fats.
Avoid those foods in the refrigerated section of your supermarket where all frozen foods are saturated with transfat- a killer that is used to maintain the shelf life of foods.

Exercise daily, at least a brisk walk of 10,000 steps.
Control your diabetes with medication and low GI foods.
Eat more oily fish than meat. Oily fish contains omega 3 fatty acids that keep your blood vessels soft and elastic.
Now let’s talk about the pulse rate or heart rate
When you get your BP checked you don’t seem to record the pulse rate which is as important, for deciding on medication for high BP.

If your BP is high and pulse rate is also rapid- more than 80 per minute at rest, your doctor will prescribe certain drugs like betablockers and calcium blocker drugs in addition to slow the heart rate to about 70 at rest.

When you exercise your target heart rate tells you if you’re exercising too hard or not hard enough. Everyone’s target is different, but in general, during moderate or vigorous exercise, you want it to be between 50% and 85% of your maximum heart rate, which is the hardest your heart can work safely. Your maximum heart rate when you exercise should be 220 minus your age.

Using a heart rate monitor can help you get fit.
Wearable electronic heart monitors, and exercise machines with built-in heart sensors, can give you up-to-the-minute information on how hard your heart is working. That can tell you how hard you’re exercising. It can help you pace yourself, too. It may even help keep you motivated.
Summering
Hypertension is the most common condition seen in old people and lead to heart attack, stroke, kidney disease, if not detected early and taken steps to treat adequately.
Blood pressure increase is inevitable as you age, due to the thickening of arteries- a natural event called arteriosclerosis.
The heart becomes strained to push the blood from its left ventricle into the circulatory system.
High blood pressure is avoidable if you take steps to check your BP regularly.
Hope this video has been useful.
Thank you for watching

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Seniors event- Annual Seniors’ Day for expat Sri Lankans in NSW, Australia – Video thanks to Dr Harold Gunatillake

Annual Seniors Day incorporated with The Sri Lankan Community Young Achiever Awards 2019 was held at Community Hall, Thornleigh NSW, Australia. Filming was done by Dr Harold Gunatillake

 




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Keeping your Circulatory system, healthy

There are two circulatory systems: blood circulatory system and lymphatic system in our body, and efficient working of those systems keep us healthy and shapely, too. 

We are only discussing about the blood circulatory system, also called cardio-vascular system, in this article. The central pump (heart) including the receiving pump in thissystem are the central figures most important to deliver nutrients and oxygen to the cells of the body and return the de-oxygenated blood (bad blood) back to the right chambers of the heart be sent to the left chambers of the heart after purification( oxygenation) in the lungs.Just like the circulatory system the pump (heart) needs to be maintained in prime condition to remain healthy.

 The complex system of circulation that supplies nutrients and oxygen can get disturbed and result in diseases detrimental to our health.

 The pipes (arteries) in this system can get damaged. In healthy situations, they are flexible, elastic and expandable, as seen mostly in young kids. In a condition called Atherosclerosis these pipes can get hardened in patches with fatty deposits from your food and other inflammatory processes, may cause partial obstruction to the flow of oxygenated blood and micronutrients, resulting in irreparable harm to your body.

Such pathological changes do occur with age, and lifestyle changes. High blood pressure is one of the commonest outcomes of thickened arteries. High blood pressure may affect your heart, kidneys, eyes, cognitive decline and may lead to stroke through neglect.

There is a difference between ‘Arteriosclerosis’ and ‘Atherosclerosis’. One could say that the latter is a specific type of arteriosclerosis. The former occurs through aging and is a natural phenomenon in all human beings. Over time the walls in your arteries can harden for no definite reasons, other than just aging and genetics may play a part in it.

When you are over forty, you need to check your blood pressure yearly, failing will result being a victim to this silent killer.

According to the American Heart Association under the new guidelines the BP should be below 130/80 from 140/90 millimeters of mercury. Above these figures you enter the criteria for stage 1 hypertension.

Lifestyle changes without pills can lower blood pressure, during this early stage of hypertension. Lose weight, read labels, avoid foods containing very high amounts of sodium (salt) such as breads and rolls, cold cuts and cured meats, pizzas, and Chinese food. Did you know that Chinese and Japanese food includes lot of salt? It is paradoxical why those nations do not show a higher incidence of hypertension and other circulatory problems.

Heart disease: Not only blood vessels supplying the periphery of the body gets affected in hypertension, the coronary blood vessels of your heart can get constricted with hypertension. These vessels get blocked by blood clots and lead to anginal episodes and heart attacks. So, always keep your BP in the normal approved range.

With chronic neglected hypertension your heart valves can prolapse and lead to incomplete closure, leading to leak and back flow of blood (regurgitation). Narrowing of the valves in hypertension can cause stenosis (narrowing) and preventing the free flow of blood from the heart.

Arrhythmias: With uncontrolled blood pressure, the heart muscles get strained and stressed and contractions could become erratic, can cause abnormal heart rates and rhythms. You could always self-diagnose this condition from feeling an irregular pulse rate at your wrist, or a dropped beat.

High cholesterol: You may have read that cholesterol has made a U turn, giving you the idea not to worry about eating foods with high cholesterol. It is partially true that cholesterol in your food such as in eggs may not influence the cholesterol numbers in your blood, but remember most foods have high saturated fats along with natural cholesterol that harms. So, avoid unhealthy diets, and lead an active life with regular exercise to lower your cholesterol in your blood. The bad cholesterol (LDL) do collects in plaques and damage the blood vessels (arteries). If you have high cholesterol due to genetic factors, you need to take statins to control the cholesterol numbers in your blood.

Heart failure: With high blood pressure the peripheral blood vessels tend to get stiff and non-elastic. This leads to back pressure on your pump (heart) and cause additional strain on your left ventricle that pumps your blood to the rest of your body.

Neglecting your hypertension ultimately leads to heart failure. Initially the heart muscles get hypertrophied (expanded). At this stage x rays reveal an enlarged heart. If no remedial action is taken the muscles can get weak and go into failure. At this terminal stage, there is water-logging in your body, lead to fatigue, shortness of breath, coughing, and lead to a miserable life causing much misery to yourself and loved ones.

Stroke: Due to high blood pressure the vessels supplying the brain can rupture, or lead to blockage with blood clots and prevent oxygen from getting to the brain.

Most strokes are preventable. You only need to keep your BP under control with healthy lifestyle changes.

Peripheral artery disease (PAD): With chronic hypertension your peripheral blood vessels could narrow just like the central ones. Uncontrolled diabetes is one of the main culprits that can cause this condition, and ultimately leads to gangrene of limbs needing amputation. Such incidents are rare today, as most people have access to good health care.

Carotid artery stenosis: In addition to narrowing of the limb vessels, it is quite common to see the carotid arteries supplying blood to the brain getting restricted with plaque formation in these main vessels in the neck. The plaques can get dislodged, ulcerate and bleed, causing a condition called Transient ischemic attacks (TIA). This leads to a transient stroke, a warning sign for action to prevent a full- blown stroke.

Aortic aneurysms: Uncontrolled hypertension can lead to ‘ballooning out” at weak points I your blood vessels, as at bifurcations of vessels. These bulges or aneurysms could burst and become medical emergencies.

Other factors: To keep your circulatory system healthy you need to be aware of the consequences of neglect. Smoking can damage your blood vessels. Fortunately, the incidence of smoking among the adults are reducing, whilst it catches on among the young and in third world countries where the cigarette companies still promote through advertising.

Being overweight could be a strain on your heart and circulatory system. However, awareness, keeping your weight under controlled with healthy low-calorie diets and exercise the risk could be reduced.

Inflammation from diseases: There are certain diseases where thickening and narrowing of blood vessels are inevitable, includes arthritis, lupus an autoimmune disease, and inflammation due to unknown causes.

Conclusions: Be aware of circulatory diseases and take lifestyle measures to prevent them. Do not weight to see the doctor until you get a life-threatening circulatory problem, as they are all preventable unless there is a congenital or familial factor.

Eating a healthful diet, checking your BP regularly, exercising, not smoking can avoid these preventable issues in your circulatory system. If you are a diabetic, you need to tightly control blood sugar levels with proper diet and medication.

Hope this article will help you to stay fit and lively.

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey). Government scholar to the UK for higher studies.

 

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