Written by Shanaiah Regine M. Tonelete

Reviewed by Dr. Reuben J C. Los Baños, Ph.D.

Cardiac rhythm is the heart’s rhythm or the electrical activity of the heart. People assume that this only pertains to the heart’s contraction and relaxation. Yet, every heartbeat you have is far more complex than that.

If you can recall, the heart has four chambers. The upper chambers are the atria (sing. atrium), while the lower ones are the ventricles. These chambers, together with specific bundles of cells, generate your cardiac rhythm.

Whenever your heart beats, a bundle of specialized cells works to regulate it. The sinoatrial (SA) node (sinus node) sends electrical impulses to begin your heartbeat. The SA node is your heart’s natural pacemaker; thus, it sets your heart’s rate and rhythm.

The sinus node, found at the right atrium’s epicardium, sends impulses to your atria. These impulses spread to the walls of each atrium which prompts their contraction. When the atria contract, it allows blood to flow towards your ventricles.

Before reaching the ventricles, the blood needs to pass a specific cluster of cells. The atrioventricular (AV) node acts as a gateway for your blood. It slows down the signal sent by the SA node to allow your atria to contract before the ventricles.

Meanwhile, the His-Purkinje Network spreads the impulse to the lower chambers’ walls. It causes your ventricles to contract and pump blood to the lungs and body.

These nodes and fibers allow your heart to have a controlled beating. When the ventricles release blood, the SA node sends another electrical impulse. It will trigger another heartbeat, and the cycle continues.

What is an abnormal cardiac rhythm called?

When your heart rhythm is too slow or fast, it can suggest many things. This abnormality in your cardiac rhythm refers to arrhythmia (dysrhythmia). Arrhythmia originated from the Greek words a– and rhythmos which means loss of rhythm.

To know whether you have an irregular heartbeat, you need to measure your pulse. The regular heart rate ranges from 50 to 100 beats per minute (bpm). You can count it by touching your wrist and neck or using an electrocardiogram (EKG).

The usual classifications for abnormal cardiac rhythms are bradycardia and tachycardia. A rate lower than 60 bpm is bradycardia. A rate greater than 100 bpm is tachycardia.

Another way to know if you have arrhythmia is when you experience palpitations. You can also suffer from shortness of breath and fatigue. Although these symptoms are subjective and some people may not have them.

There are also various reasons why you can have this condition. It can be due to hypertension, valve disorders, and other medical conditions. Your excessive consumption of alcohol/coffee and exercising can also cause it.

Cardiologists often use some tests to diagnose arrhythmia. The tests to confirm the presence of abnormal heartbeats include:

• Cardiac Catheterization
• Echocardiogram
• Electrocardiogram
• Electrophysiology Study (EPS)
• Stress Test
• Tilt Table Test

What are the 5 lethal cardiac rhythms?

The word lethal is often associated with death. It means that something is destructive or harmful for you. Thus, lethal cardiac rhythms can infer that these rhythms might cause your death. Here are five arrhythmias considered lethal.

Premature Ventricular Contraction (PVC)

PVC is an ectopic (abnormal) beat in your ventricles but is not an actual rhythm. It causes the ventricles to depolarize before the next sinus beat. Thus, it earned the label of premature.

Since PVCs arise in ventricles, there are changes in the ventricular depolarization sequence. The extra beats due to PVCs disrupt your heart’s rhythm. Although PVCs are often benign, some are life- threatening due to other heart problems.

Ventricular Tachycardia (VT)

Three or more consecutive PVCs or heartbeats can suggest ventricular tachycardia. VT is an abnormal heart rate that starts in the lower chambers of your heart. Its usual rate is 100-250 bpm.

Some of the possible causes of VT include cardiomyopathy and coronary artery disease. VT can be life-threatening if it continues for more than a few seconds.

Ventricular Fibrillation (VF)

When there is disorganization in the ventricles’ electrical activity, they will quiver. This condition is what you call ventricular fibrillation. Scientists describe the ventricular myocardium as a “can of worms” during VF.

VF is dangerous since there is no cardiac output when your ventricles quiver. Thus, there is no palpable pulse, no blood pressure, and you will become cyanotic. Within 3-5 minutes, this rhythm can become lethal.

Some of the possible causes of VF are cardiomyopathy and untreated ventricular tachycardia. Acid- base imbalance and electrolyte imbalances can also result in VF.

Asystole

Asystole is the absence of movement or electrical activity in your heart. You can see it as a flat line on the EKG screen. When you have asystole, it means that you have no heart rate and rhythm.

Although VF and asystole seem similar, you can differentiate them through telemetry reading. Asystole becomes lethal when it persists for more than fifteen minutes. It can cause death since there is not enough oxygen to supply your body, especially the brain.

Other Arrhythmias

Pulseless Electrical Activity (PEA)

When your heart has an electrical activity but no pulse, you have a condition called PEA. Since you have no cardiac output, you will be pulseless and unconscious. Often, hypovolemia causes PEA.

Various rhythms belong to this category. It includes electromechanical dissociation (EMD), bradyasystole rhythm, and pseudo-EMD.

Agonal Rhythm

It is a condition characterized by having an irregular rhythm with a rate of ≤20 bpm. It is the rhythm seen during the last stages of unsuccessful resuscitation. The agonal rhythm later ends at asystole.

How long can you live with irregular heart beat?

Having arrhythmia is a challenge. Being able to live a comfortable life despite having it depends on the type of arrhythmia you have. Your life expectancy also depends on it.

If you have a harmless or benign arrhythmia, you can live a healthy and longer life. There is no definite life span for those with benign arrhythmias. Research only reveals that people with harmless arrhythmias do not need treatment. But treatment is not necessary only if there are no other complications involved.

Meanwhile, those considered life-threatening can give you a few minutes if not treated. Lethal arrhythmias such as ventricular fibrillation and asystole can grant you 3-15 minutes. If not immediately treated within that time, it can cause your death.

What is the best medication for irregular heartbeat?

Antiarrhythmic drugs are the medications used by people with irregular heartbeats. These drugs treat the abnormality in your heart rhythm or slow its rate.

It is necessary to consult your doctor first before taking any medications. You can choose between two approaches to taking the drugs. These are the “pill in the pocket” method and regular intake.

The “pill in the pocket” method is helpful when your episodes appear less frequent. You can put the pill in your wallet and take it when you experience an arrhythmia episode. Meanwhile, the second method is taking the drugs every day.

Some medications prescribed by doctors are beta-blockers and calcium channel blockers.

Beta-Blockers

These drugs decrease your cardiac output. They help slow down your heart’s rhythm, but they may also stop your arrhythmia. They work by blocking the effects of adrenaline which lowers your blood pressure.

Some of the examples of beta-blockers are sotalol and nadolol. Bisoprolol and metoprolol (beta- blockers) can also treat atrial fibrillation (AF).

Calcium Channel Blockers

These refer to the drugs that interrupt calcium movement in the heart. Thus, they are calcium antagonists. If there is less calcium, then there is a reduction in the heart’s electrical activity.

Verapamil and diltiazem are examples of calcium antagonists. Those who have AF can also take digoxin.

Can irregular heartbeat go back to normal?

Irregular heartbeat is often reversible. It goes back to normal on its own, but there are also things you can do to regulate your heart rate.

When you exercise, it is normal to have an increased rate after. Overexercising can result in the irregular beating of your heart muscle. Too much caffeine, alcohol, or nicotine can also trigger it.

To avoid this, you can do the following:

• Avoid too much consumption of caffeine
• Avoid alcohol
• Avoid stimulant drugs
• Do not smoke
• Get enough sleep
• Relax and manage your stress

Meanwhile, some arrhythmias are possible to regulate but hard to restore. Taking medications can repair them for a while, but without them, they will return. These are the arrhythmias associated with other heart problems. Scientists claim that irregular heartbeats are incurable. Unless treatment for other complications is available, then they will remain.

Some of the causes of this type of arrhythmia are high blood pressure and damaged heart tissue and. Congenital heart problems and inflammatory disorders can also cause it.

Can stress cause an irregular heart beat?

The heart and brain have a complex interaction with each other. When you experience physical or emotional stress, your brain sends a signal to the rest of your body. The heart receives this signal, then increases its heartbeat and elevates blood pressure.

Thus, stress-induced cardiac arrhythmias are possible. Negative emotions prompt the release of catecholamines or stress hormones. These hormones are responsible for your fight-or-flight response.

The heart’s cardiac output increases when the adrenal glands release catecholamines. This hormone increases the contractility and excitability of the cardiac muscle. It also increases the AV nodal conduction velocity and the SA nodal discharge rate of the heart. Thus, increasing the cardiac output.

To avoid having stress-induced arrhythmias, you can try doing:

• Eating nutritious food

• Have a positive attitude

• Meditation

• Regular exercise

If irregular heartbeats continue to persist, you can try contacting your doctor. There might be other reasons why you have the condition. It is necessary to seek professional advice before taking any medications.

REFERENCES

American Heart Association. (2016, September 30). Medications for Arrhythmia. American Heart Association. Retrieved October 27, 2021, from https://www.heart.org/en/health- topics/arrhythmia/prevention–treatment-of-arrhythmia/medications-for-arrhythmia

Arrhythmia. (2018, June 12). Cleveland Clinic. Retrieved October 27, 2021, from https://my.clevelandclinic.org/health/diseases/16749-arrhythmia

Beckerman, J. (2020, August 24). What to Do If Your Heart Races, Slows Down, or Skips a Beat.

WebMD. https://www.webmd.com/heart-disease/atrial-fibrillation/what-to-do-heart-races

British Heart Foundation. (n.d.). Drug cabinet: Anti-arrhythmics. British Heart Foundation. Retrieved October 27, 2021, from https://www.bhf.org.uk/informationsupport/heart-matters- magazine/medical/drug-cabinet/anti-arrhythmics

Heart Beat. (2019, May 1). Cleveland Clinic. Retrieved October 27, 2021, from https://my.clevelandclinic.org/health/articles/17064-heart-beat

Living With an Arrhythmia. (n.d.). Aging Care. Retrieved October 27, 2021, from https://www.agingcare.com/articles/how-to-manage-arrhythmia-114028.htm

Mayo Clinic. (2021, March 18). Atrial fibrillation and managing stress. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/in-depth/atrial- fibrillation-managing-stress/art-20118647

RN.com. (2003). Lethal Arrhythmias: Advanced Rhythm Interpretation. AMN Healthcare, Inc. https://lms.rn.com/getpdf.php/633.pdf

Secretion and physiological effects of catecholamines. (2016, September 28). WikiLectures. Retrieved October 27, 2021, from https://www.wikilectures.eu/w/Secretion_and_physiological_effects_of_catecholamines

University of Birmingham. (2018, May 10). Patients who have had an irregular heart beat can’t ever be considered ‘cured’. Science Daily. https://www.sciencedaily.com/releases/2018/05/180510145948.htm

Written by Biana Isabel Agner

Reviewed by Dr. Reuben J C. Los Baños, Ph.D.

The central framework of your body is the skeletal system. The musculoskeletal system is another name for it. Bones and connective tissue make up the structure.

The skeletal system serves a variety of purposes. It not only gives us our human shape and features but it allows us the following:

• Movement – The skeleton helps you stand and move by supporting body weight. The collaboration of joints, connective tissues, and muscles make your body parts mobile.

• Produces blood cells – The bone marrow is a type of marrow that produces blood cells. The bone marrow makes red and white blood cells.

• Protects and supports organs – The skull protects the brain; the ribs protect your heart and lungs. The backbone protects the spine.

• Mineral storage – Bones store minerals such as calcium and vitamin D for your body.

Some of the skeletal system’s functions are more visible than others. You can feel how your bones can support you, help movement, and protect your organs when you move.

The bones and cartilages of the skeletal system serve as a frame for support. Bones help you move by acting as attachment points for your muscles. It also covers or surround internal organs to protect.

Bone tissue also serves many important metabolic functions. It serves as a reservoir for a variety of minerals important to body function. Examples of these minerals are calcium and phosphorus. Releasing these minerals back into the bloodstream maintain the right level to support.

What type of skeleton do humans have?

In an adult, the human skeleton is an endoskeleton made up of 206 bones. The endoskeleton serves five primary purposes. It supports the body, stores minerals and lipids, and produce blood cells. It also protects internal organs and allow movement.

Endoskeletons come in variety of shapes and sizes. It also comes in complexity, shape, and function depending on the animal’s needs. The endoskeleton of most vertebrates has mineralized tissue. These tissues are in the form of bone and cartilage.

The axial skeleton includes the skull, vertebral column, and rib cage. The appendicular skeleton consists of the shoulders, limb bones, pectoral, and pelvic girdle. The axial and appendicular are the major divisions of the skeleton.

The skull, vertebral column, and thoracic cage make up the axial skeleton. The axial skeleton is the central axis of the human body. It supports and protects the brain, spinal cord, and organs in the ventral body cavity.

It serves as a surface for the attachment of muscles that move the head, neck, and trunk. It also moves those that perform respiratory movements. Adults have 80 bones in their axial skeleton.

The skull’s bones support and protect the face’s structures as well as the brain. The skull consists of 22 bones with two groups: cranial and facial bones. The cranial bones are eight bones that make up the cranial activity. It houses the brain and serves as a resting place for the head and neck muscles.

There are eight cranial bones. These are the frontal bone, two parietal bones, two temporal bones, and occipital bone. The sphenoid bone and ethmoid bone are also cranial bones.

The face has fourteen facial bones. It provides cavities for the sense organs – eyes, mouth, and nose. It also protects the digestive and respiratory tract entrances. The facial bones serve as attachments points for muscles. The 14 facial bones contain the following:

• nasal bones,
• maxillary bones
• zygomatic bones
• palatine, vomer
• lacrimal bones
• inferior nasal conchae
• mandible

What’s the weakest bone in your body?

The clavicle or collarbone is the softest and weakest bone in the body. It is a thin bone that runs in a horizontal manner between your breastbone and shoulder blade. Because of its location, it is easy for the clavicle to break.

This bone is an important part of the skeletal system. It is important because it connects the axial skeleton to the pectoral girdle. It allows everyday functional movement.

 The clavicle can function as a shoulder brace. It allows weight to transfer from the upper extremities to the axial skeleton. Injuries in the clavicle make it difficult to carry out daily tasks.

Between the ribcage and the shoulder blade is the clavicle. It is the bone that joins the arm to the rest of the body. The clavicle is above several vital nerves and blood vessels. It is a long bone that palpates along its entire length. It is visible beneath the skin in thin people.

The clavicle serves three purposes:

• Connects the upper limb to the trunk as a part of the shoulder girdle.
  
  
• Protects underlying neurovascular structures that supplies the upper limb.
  
  
• It conveys force from the upper limb to the axial skeleton.

Do females have more ribs than males?

Females do not have more ribs than males. Regardless of gender, most people have the same number of ribs. The belief that men have fewer ribs than women is common, but it is incorrect. This belief may stem from the biblical story of Adam and Eve.

The ribs protect organs and assists in breathing. The bony framework of the thoracic cavity contains the ribs. The ribs are the main structural component of the thoracic cage. It protects the thoracic organs.

The majority of people are born with 24 ribs, 12 on each side of their bodies. The costovertebral joint connects each rib to two thoracic vertebrae in the back. The first rib articulates with the first thoracic vertebra.

The three classified groups of the ribs are:

• True ribs – The true ribs are ribs 1-7. This have coastal cartilages that are direct and articulate with the sternum. The sternocostal joints connect them to the sternum.

 The first rib is an exception to this rule because it is a synarthrosis. The costoclavicular joint allows the rib to articulate with the clavicle in a unique way.

• False ribs – The false ribs (8,9,10) articulate with the sternum through the costochondral joint. It connects their costal cartilages to the seventh costal cartilage.
• Floating ribs – The sternum does not articulate with the floating ribs (11,12).

The anatomical components of the ribs are as follows:

• Two articular facets on the head
• Tubercle
• Neck
• Shaft
• Costal groove

Most of the ribs are standard ribs. Standard ribs have all these characteristics. While atypical ribs are those that lack these characteristics:

• The first rib is wide and short. It has two costal grooves and one articular facet.

• The second rib is thin and long. It has a tuberosity on its superior surface to attach the serratus anterior muscle.

• The tenth rib only has one articular facet.
  
  
• The eleventh and twelfth rib has only one articular facet with no neck.

What bone takes the longest to heal?

It takes a long time for the femur to heal after it breaks. The femur, also known as the thigh bone, is the largest and most powerful bone in your body. Because the femur is one of the main bones used to walk, breaking it can make everyday tasks much more difficult.

The femur is a large, strong, and difficult bone to break. A severe accident is the most common cause of a broken femur. Vehicle accidents are the most common reason for a broken femur.

The adult’s bones are weaker, and a fall can result in a femur fraction. It depends on how close the break is to the hip. The break is a hip fracture rather than a femur fracture.

The femur is the body’s longest bone and the only bone in the thigh. It has three parts: proximal, shaft, and distal. It serves as the origin and attachment point of muscles and ligaments.

• Proximal – The hip joint contains the proximal aspect of the femur with the acetabulum of the pelvis. The greater and lesser trochanters are two bony processes that make up the head and neck.
• Shaft – The femur shaft descends in a medical direction. This increases stability by bringing knees closer to the body’s center of gravity. The shaft’s cross section is circular in the middle but flattened at the proximal and distal ends.
• Distal – The medial and lateral condyles, articulate with the tibia and patella to form the knee joint. It is at the distal end of the femur.
  
  

A femur fracture is an injury to the thigh bone that causes it to crack, break, or crush. Smaller, less complicated femur fractures usually do not need surgery. Others need immediate surgery if the bone is completely broken, crushed, or displaced.

It takes a lot of force to break the femur because it is so strong.

A high-energy collision, such as a car or motorcycle accident, is usually the source of the problem. In people who have weak bones, even a low-force event like a fall can result in a broken femur.

It can take anywhere from 12 weeks to 12 months to recover. But, with the help of a physical therapist, many patients can begin walking much earlier. Recovery times for surgery can differ depending on a variety of factors.

Are women’s bones weaker than men?

The size and sturdiness of skeleton bones differs between men and women. Differences in bone structures are present as early as childhood. Puberty is the period of physical maturation. It is the transformation of a child’s body into an adult body that is capable of reproduction.

Bones of males are larger and stronger, both in size and density. Male bone mass peaks at around 50% higher than female bone mass, and women lose bone faster as they age. Black people’s bones are stronger than white people. In fact, black women’s peak bone mass is comparable to white men.

A factor to consider when it comes to bone growth in boys is testosterone. Testosterone is the have sex hormone that aids on bone growth. While estrogen is the main sex hormone in females that inhibits bone growth as well.           

The fact that boys develop larger bones than girls is because of the differences of the hormones. And because of this difference, adult women have higher risk of fractures due to the hormones. This makes the women’s bones weaker than men.

When women reach menopause, their level of estrogen drops, which can lead to bone loss. When women approach menopause, their risk of developing osteoporosis rises. For women of various ages and backgrounds, osteoporosis and bone health issues differ.

In comparison to men, women have wider pelvises and torsos.Researchers can even tell if a skeleton is male or female by measuring the hip bones. Women have stronger pelvises because of their unique ability to carry a child and give birth.

The shape and size of the pelvis is a factor in childbirth for support. It is wider and longer and is together with ligaments that loosen during pregnancy. Women’s torsos are also wider than men’s for the body to accommodate organs in pregnancy.

How many floating ribs do humans have?

People have two floating ribs (ribs 11 and 12) at the bottom of the ribcage. People often have extra or missing ribs and vertebrae, which is surprising. The sternum is not attached to the last two pairs of ribs at the bottom of the rib cage.

These are “floating ribs” because their only attachment is at the back of the rib cage. These ribs anchor to the spine’s vertebrae, which makes them prone to injury due to lack of attachment. This injury is a painful condition known as “slipping rib syndrome”.

In the chest, the rib cage is a bony structure (thoracic cavity). There are 12 pairs of ribs in total. The sternum, a bony process at the front of the rib cage that serves as an anchor point, is where each pair has a number. The cartilage at the end of each rib (costal cartilage) attaches to the sternum.

The purpose of the human rib cage (thoracic cage) is to protect the heart and lungs. The ribs, which are flat bones, are part of the axial skeleton. The primary function of flat bones is to protect the structures beneath them. The pelvis and skull are two other flat bones in the human body.

References

Anatomy and Physiology. (n.d.). https://open.oregonstate.education/aandp/chapter/6-1-the-

functions-of-the-skeletal-system/

Biga, L. M., Dawson, S., Harwell, A., Hopkins, R., Kaufmann, J., LeMaster, M., Matern, P.,

Morrison-Graham, K., Quick, D., & Runyeon, J. (n.d.). Anatomy & Physiology.

Endoskeleton. (2017, April 28). biology dictionary. Retrieved October 27, 2021, from

How many ribs does the human body have? Differences between men and women. (n.d.).

Medical News Today. Retrieved October 29, 2021, from https://www.medicalnewstoday.com/articles/enthesitis#causes

Morrison, W. (2018, July 31). Broken Femur: healthline. Retrieved October 30, 2021, from

https://www.healthline.com/health/broken-femur#diagnosis

Ribs. (n.d.). Physiopedia. Retrieved October 30, 2021, from https://www.physio-pedia.com/Ribs 

Skeletal system. (2019, November 11). Cleveland Clinic. Retrieved October 25, 2021, from

https://my.clevelandclinic.org/health/body/21048-skeletal-system

What is the strongest and weakest bone in the human body? (n.d.). Vedantu online learning.

Retrieved October 27, 2021, from https://www.vedantu.com/question-answer/which-is-the-strongest-and-weakest-bone-in-the-class-11-biology-cbse-60d4937b80258b738178e5b0 

Written by Ysandra Prille A. Tabilon

Reviewed by Dr. Reuben J C. Los Baños, Ph.D.

Congestive Heart Failure (CHF) is also identified as heart failure (HF) or congestive cardiac failure (CCF). It is the primary cause of death throughout the globe. It is also a life-threatening disorder in which it impairs the heart’s ability to pump blood. There is fluid accumulation around the cardiac muscle, placing strain on the heart. Thus, it impairs blood circulation.

The term “heart failure” might be misleading to some people. When you have the condition, it doesn’t imply that you have a failing or are about to quit working cardiac organ. Instead, your pumping organ has a mechanical problem that can’t keep up with your body’s demands.

Your cardiac muscle loses its ability to contract over time, limiting the amount of blood it can hold. That is why it enlarges and beats faster to make room for the blood. But, this extra effort can cause palpitations. Additionally, shortness of breath is another consequence of fluid build-up in the lungs.

Your other body organs, such as your kidneys, also attempt to compensate in various ways. Yet, these extra efforts have drawbacks and consequences, such as organ failures. Regardless of how well your body compensates and the number of treatments you receive, HF is often progressive. In a nutshell, it deteriorates over time.

Common Types of CHF

The condition has two types which are the left-sided CHF and right-sided CHF. A person can develop both types together, but usually, the left side problem occurs first. If left untreated, it will then progress to the right side.

The most common one is the left-sided CHF. It occurs when your left ventricle does not pump blood well as it used to. This can be detrimental to your lungs since it results in fluid build-up. Additionally, it comes in two types: Diastolic HF and Systolic HF.

The second type of CHF is right-sided CHF. It occurs when the right ventricle is incapable of supplying blood to the lungs. As a result, blood becomes congested in the blood vessels. Fluid accumulation will occur in your lower extremities, abdomen, and vital organs.

Diagnosis

There is no single examination for diagnosing CHF. Your doctor will most likely take into account your medical and family history. This will also include your physical examination and other tests for your heart. The test may involve the following:

• Electrocardiogram (EKG)
• Chest X-ray
• Echocardiogram
• Holter monitor
• Exercise stress test
• Cardiac Catheterization
• Ejection Fraction (EF)
• Electrocardiogram (EKG or ECG)
• Others

Symptoms

CHF can manifest itself as an acute or chronic condition. While some people may not exhibit symptoms, this does not mean they are clear of the disease. Symptoms range in severity from moderate to severe. The common signs and symptoms of CHF are the following:

• Shortness of breath
• Fatigue and weakness
• Swelling in the legs, ankles, feet, and abdomen
• Rapid or irregular heartbeat (palpitations)
• Very rapid weight gain from fluid build-up
• Coughing or wheezing that persists with white or pink blood-tinged mucous
• Nausea and lack of appetite
• Dizziness, confusion, difficulty concentrating, fainting.
• Difficulty concentrating or decreased alertness
• Chest pain if HF is due to Myocardial infarction
• Others

It is necessary to see a doctor if you exhibit some of the symptoms. These include chest pain, fainting, rapid heartbeat, shortness of breath, and constant coughing. Although, it is crucial to avoid self- diagnosing with such symptoms as HF. It could be the cause of other health problems.

What are the main causes of congestive heart failure?

The condition occurs due to added stress in your heart that makes it work too hard, in the long run, damaging it. Certain lifestyle factors can also increase your chance of myocardial infarction and stroke. These include smoking, obesity, consuming fatty foods, and physical inactivity. These factors can also contribute to cardiac failure.

As you age, your heart loses some of its ability to pump blood, but it doesn’t mean all people will get the condition. Other individuals are more susceptible than others. These individuals are those that have underlying conditions. Some common conditions that contribute to HF include the following:

Coronary artery disease. This condition occurs when there is a build-up of fatty deposits in the walls of your arteries. As a result, less blood will reach the heart due to fatty substances blocking your blood supply. It can contribute to hypertension, which might result in HF over time.

Myocardial infarction. It may result in CHF because the damaged heart tissues after a heart attack are unable to contract well. It will impair your pumping organ. Sometimes, it can strike at any time following a myocardial infarction.

Hypertension (High blood pressure). Uncontrolled hypertension raises your risk of developing HF and sudden cardiac death. It pushes your heart to pump harder to keep blood flowing throughout your body. This stresses your pumping organ, causing it to grow larger and weaker over time.

Abnormal heart valves. This problem results from endocarditis or congenital abnormality. The valves do not open or close with each heartbeat like they used to be. As a result, cardiac muscles must pump more blood to keep circulation going. When the strain becomes severe, cardiac arrest can occur.

Other risk factors for HF include obesity and diabetes. Also, people with lung diseases are at risk because of the connection between the lungs and the heart. Sometimes, a sleeping disorder such as sleep apnea can also be fatal. This is because it may also result in complications such as CHF.

What are the 4 stages of congestive heart failure?

CHF is a long-term chronic condition that worsens over time. According to the American College of Cardiology and American Heart Association, the condition has four stages (A, B, C, and D). It ranges from an increased risk of acquiring the disease to advanced HF.

Moreover, there are treatments on each stage that prevent you from moving to the next stage. But, when your condition worsens, you will have to advance to the next stage. Once you’ve entered that stage, there is no more going back. As a result, you will have lower chances of surviving.

Stage A. It is a stage that refers to pre-cardiac failure. It suggests that you are more likely to develop the condition because it runs in your family. It could also be due to underlying diseases like hypertension, diabetes, coronary artery disease, and others. History of alcohol abuse, drug use may also be factors.

The treatment plans for this stage include having a healthy lifestyle and medications.

Stage B. It is a stage considered to be a silent cardiac failure because it is asymptomatic. You have a systolic left ventricular dysfunction but without any symptoms of HF. In an echocardiogram, your ejection fraction will show a reading of 40 percent or less. The treatments are the same as those in stage A, but with more drugs and possible surgery.

Stage C. In this stage, you will show signs and symptoms of HF. It includes difficulty breathing, fatigue, oedema, and others. You will also encounter problems with your pumping chambers. Treatments for this stage are those in stages A and B, but with more medications and therapies.

Stage D. This is the final stage of cardiac failure. In this stage, you will show severe symptoms even at minimal exertion or at rest. You will have to undergo advanced specialized treatments. It will include mechanical circulatory support, cardiac transplant, and others.

The New York Heart Association (NYHA) developed another type of class for CHF. It has four stages (Class I, II, III, and IV) depending on your pumping organ’s functional capabilities.

Class I. You won’t have any adverse symptoms (asymptomatic). You are still able to do physical activities without experiencing fatigue and dyspnea.

Class II. Slight limitation of physical activities because of experiencing fatigue, palpitation and dyspnea

(mild). But you are comfortable when resting.

Class III. Marked limitation of physical activities. Minimal activities will result in weakness, increased pulse rate, dyspnea, and others (moderate). But, when you’re resting, you’re comfortable and experiencing no problems.

Class IV. You aren’t able to join in physical activities without experiencing discomfort (severe). HF symptoms are evident at all times, even when you are at rest.

What is the life expectancy of someone with congestive heart failure?

A person’s CHF life expectancy varies from a person and will depend on various factors. It depends on what stage you are in, how severe it is, and whether you have any other underlying conditions.

According to statistics, about half of those diagnosed with CHF can live for five years. Yet, only around thirty percent will live for ten years. Moreover, around 21 percent of individuals who had cardiac transplants are still alive after 20 years.

You may have a higher chance of living a longer life if the condition gets discovered and managed early. If the illness is severe, it is most likely difficult to expect a longer life expectancy.

Younger people diagnosed with CHF have a longer life expectancy than older individuals. This could also be because invasive procedures for severe stages are no longer effective at a certain age. In most situations, survival beyond one year after diagnosis is uncommon.

Is congestive heart failure curable?

CHF has no cure as of the moment. Although, there are many treatments available to slow further damage. Treatments are also useful in preventing the condition from worsening. The sort of treatment used depends on the severity of the individual’s disease. Among the features of a treatment plan include the following:

Medications. Patients will need a variety of drugs, each of which will address a particular symptom of the illness. To get the benefits of your medications, you must take them exactly as prescribed by your physician. Some medications usually prescribed to treat the condition includes:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers
• Angiotensin-receptor neprilysin inhibitors (ARNIs)
• Beta-blockers
• Aldosterone antagonists
• Diuretics
• Others

Surgical Procedures. Surgery is not recommended for the treatment of HF. But, doctors will recommend it once they detect a correctable cause of the condition. The common reason for a surgery is due to heart valve malfunction or a blocked coronary artery. Some possible surgical procedures and implantable diseases may include:

• Biventricular pacing therapy
• Implantable cardioverter defibrillator (ICD)
• Ventricular assist devices (VAD therapy)
• Cardiac resynchronization therapy (CRT)
• Left ventricular assist device (LVAD)
• Cardiac transplantation
• Percutaneous coronary intervention
• Others

Lifestyle modifications. A healthy lifestyle can enhance the quality of life for patients with CHF. It may serve to lessen HF symptoms and slow the progression of your illness. Several of the healthy lifestyle choices you must make include the following:

• Quit smoking
• Engage in moderate exercise
• Eat healthy foods
• Limit fluid intake
• Lose weight
• Restrict salt intake
• Manage stress
• Avoid alcohol and caffeine drinks.
• Others

Can the heart repair itself after congestive heart failure?

It was once believed that your pumping organ was incapable of regeneration following a heart attack, let alone a cardiac failure. After depletion of oxygen, the cardiac muscle dies and does not generate new muscle cells. The heart then replaces the dead tissues with fibroblasts scar tissues. The problem is that fibroblasts lack the ability to pump, which weakens the cardiac organ.

Yet, new studies discovered that the heart is able to renew the cardiac muscle cells as well as scarring. It is also capable of self-repair, but the rate of regeneration is very slow. It shows that the damaged organ had recovered to the level of a healthy heart’s pumping ability. Further research is being conducted at the moment.

How do they remove fluid from congestive heart failure?

Fluid accumulation is a common clinical symptom of CHF. To help your overworked organ with pumping blood, your kidneys produce more renin. This results in more aldosterone production, followed by sodium and water retention.

Excessive fluid build-up can be fatal. This could be a signal that your condition is worsening. Thus, it is critical to maintaining a healthy fluid balance. A well-known method of reducing excess fluid is by taking Diuretics. It is a non-prescription medication referred to as “water pills.”

It aids in removing salt and water from your body and avoids fluid build-up by making you urinate more often. It reduces the amount of fluid moving through your blood vessels. Diuretics have three classifications: thiazide, loop, and potassium-sparing diuretics. It is critical that you must consult your physician to determine what matches you.

Another way would be the fluid removal therapy that uses ultrafiltration. It is capable of removing up to four liters of excess fluid in eight hours. Right after the procedure, you will experience instant relief from the symptom. Thus it helps in improving one’s quality of life.

References:

Ali, Y. (2020, August 3) Heart Failure: Simple Ways to Manage Fluid Buildup. HealthCentral.

https://www.healthcentral.com/slideshow/how-to-fight-fluid-buildup-heart-failure

American Heart Association (2017, May 31) Causes of Heart Failure. Heart Organization. https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of- heart-failure

Blumental, R. & Jones, S. (n.d.) Congestive Heart Failure: Prevention, Treatment and Research. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/congestive- heart-failure-prevention-treatment-and-research

Conha, J. (2020, October 5) How Long Can You Live with Congestive Heart Failure? emedicinehealth.

https://www.emedicinehealth.com/congestive_heart_failure_survival_rate/article_em.htm

Kohli, P. (2021, May 28) Congestive heart failure: Life expectancy and stages. Medical News Today.

https://www.medicalnewstoday.com/articles/321538

Levin, H. (2003) New Developments in Congestive Heart Failure: The Use of Ultrafiltration. Cath LabDigest. https://www.hmpgloballearningnetwork.com/site/cathlab/articles/New-Developments- Congestive-Heart-Failure-The-Use-Ultrafiltration

Mayo Clinic. (2021, July 21) Heart Failure. Mayo Clinic. https://www.mayoclinic.org/diseases- conditions/heart-failure/symptoms-causes/syc-20373142

Paddock, C. (2017, October 5) Severe heart failure may be reversible. Medical News Today.

https://www.medicalnewstoday.com/articles/319649

Tang, K. (2020, February 12) Understanding the four stages of heart failure. Top Doctors.

https://www.topdoctors.co.uk/medical-articles/understanding-4-stages-heart-failure#

Young, B. (2021, May 11) What’s the Outlook for Congestive Heart Failure? Healthline.

https://www.healthline.com/health/chf-life-expectancy

Written by Acel Joy Cimafranca

Reviewed by Dr. Reuben J C. Los Baños, Ph.D.

Living in this world, we have touched and felt many wonders. Most organisms have skins, thick fur, or any covering that helps them thrive and survive. To live without even the skin is unimaginable. It would surprise you that the hair and nails you have are part of the same system. Together, they make up the integumentary system.

This particular system is the body’s biggest organ. It forms a physical barrier between the external and the internal environment. The skin helps protect and maintain our body’s internal structures. It may be from physical, chemical, biological, radiological, and thermal damage. Besides its barrier function, it performs many intricate processes. For example, body temperature regulation, Vitamin D synthesis, and stimuli detection.

The components of the system work together to carry out the following functions:

• Physical protection– its’ most clear function is protection as it covers the body. Each of the layers contributes to the strength of this network of cells knitted tight. Created by layers of dead keratin, the epidermis makes up the outermost layer. This part withstands the wear and tear of the outer environment. The dermis provides the epidermis with an adequate blood supply. It has nerves that announce danger amongst other functions. The hypodermis allows physical cushioning to any mechanical trauma.
• Immunity- the skin is a physical barrier preventing entry of pathogens. Antimicrobial peptides and lipids on the skin act as a biomolecular barrier. They disrupt the bacterial membranes. Resident immune cells are available in the skin. In contrast, dermal dendritic cells travel and activate the more excellent immune system.
• Wound healing- this occurs when our body undergoes trauma with injury. The integumentary system orchestrates wound healing. It does this through hemostasis, inflammation, proliferation, and remodeling.
• Thermoregulation– the skin is very vascularized. It allows it to conserve and release heat through vasoconstriction and vasodilation. The system helps regulate body temperature by association with the sympathetic nervous system. It monitors body temperature and also initiates appropriate motor responses. Sweat glands secrete water, salt, and other substances to cool the body when it becomes warm.

When body temperatures drop, the arterioles will constrict to lessen heat loss. This reduced circulation results in the skin getting pale. Although the skin temperature drops, it prevents passive heat loss. Hence, internal organs and structures remain warm.

• Vitamin D synthesis– the primary sources of vitamin D are sun exposure and oral intake. The epidermal layer synthesizes vitamin D when exposed to UV radiation. With enough sunlight, the body forms vitamin D3 called cholecalciferol. The liver converts cholecalciferol to calcidiol. Vitamin D is critical for the normal absorption of calcium and phosphorous. Healthy bones need this vitamin. Also, it is vital for general immunity against bacterial, viral, and fungal infections. Recent studies are also finding links between insufficient vitamin D and cancer.
• Sensation– the sensory nerve endings cause skin innervation. It allows you to distinguish against pain, temperature, touch, and vibration. Each type of receptor and nerve fiber is unique in its adaptive and conductive speeds. These lead to a wide range of signals used to understand the external environment. It helps the body react the right way.

Why is it called the integumentary system?

The explanation behind this is quite simple. Integumentary is an adjective used when referring to a covering or coating. It derives from integumentum, a Latin word for “a covering.” In a figurative sense, it means a cloak or a disguise. In English, “integument” is a modern word. Its origin traced back to the early seventeenth century. It can mean material or layer that encloses, clothes, or covers in the sense of cladding or coating.

In biology, the integument is the natural covering of an organism or an organ, such as its skin, husk, cover, or peel. An integument is any coating or covering. But, the term refers to the outer layer of natural things like animals and plants most of the time. With that in context, the system’s name comes from its largest organ, the skin. Since it makes up most of the surface area, it is sensible to refer to the system with the word integument.

What organs are in the integumentary system?

The integumentary system consists of the skin, hypodermis, hair, nails, and exocrine glands. These organs have their function in maintaining and protecting the body. Since they are external, you may think of them as accessories. But, they serve essential physiological roles. For further details, read the following:

• Skin- it is the body’s largest organ. The standard square inch of skin has 20 blood vessels, 650 sweat glands. Also, it has more than a thousand nerve endings. It has 60,000 incredible cells producing pigment. All these structures manifest as a stack of cells that is 2 mm thick.

The skin makes up of two prominent layers. These are the superficial epidermis and the deeper dermis.

1. Epidermis– the tough outer layer. It is the first line of defense against the external environment. It comprises squamous epithelial cells that further break down into layers. In the palms and soles is an extra layer between the stratum corneum and stratum lucidum. It makes the skin there thicker.

2. Dermis– the underlying connective tissue framework provides supports to the epidermis. It subdivides into two layers. The dermis is under the epidermis. It contains connective tissues, nervous tissues, blood, and blood vessels. The dermis is way thicker than the epidermis. It also gives the skin strength and elasticity. There are two separate regions: the papillary layer and the reticular layer.

• Hypodermis- rests between the dermis and underlying organs. It is also described as subcutaneous tissue.

This layer encompasses loose areolar tissue and adipose tissue. It provides more cushion and insulation through its fat storage function. Also, it connects the skin to underlying structures such as muscle.

The hypodermis serves as the adaptable connection between the skin, muscles, and bones. The areolar connective tissue in the hypodermis contains elastin and collagen fibers. It allows the skin to stretch and move free of its underlying structures. Fatty adipose tissue in the hypodermis supplies energy.

• Hair- originate from the epidermis. But, it grows its roots deep into the dermis. Its structure splits into the visible hair shaft and the hair follicle within the skin. The hair is an accessory organ of the skin. It is dead keratinocytes found in most body regions.

The hairless parts of the body include the palms, feet, lips, labia minora, and glans penis. The hair protects us from UV radiation by blocking sunlight from striking the skin.

• Nails- form as layers of keratin at the dorsal tips of the fingers and toes. The nail growth set out at the nail matrix generates new cells and drives worn-out cells.

The discernible part of the nail is the nail plate covering the nail bed, where it clings to the finger. Nails operate to protect the fingers and toes. It does so while increasing the accuracy of movements and enhancing sensation. They are keratinocytes congealed and found on the ends of the fingers and toes. Fingernails and toenails strengthen and protect the end of the digits. These also scrape and manipulate small objects.

• Associated Glands– there are four exocrine glands within human skin. These are sudoriferous, sebaceous, ceruminous, and mammary glands.         
• Sudoriferous glands are one of the exocrine glands found in the skin’s dermis. They are also called sweat glands. There are two major types of sudoriferous glands. These are eccrine sweat glands and apocrine sweat glands.
• Sebaceous glands are part of the pilosebaceous group. It includes the hair, hair follicle, and arrector pili muscle. These secrete an oily substance called sebum.
•  Ceruminous glands are special glands located only in the dermis of the ear canals. These produce a waxy secretion known as cerumen to protect the ear canals.

What are the three layers of the skin?

Like our planet Earth, the skin has three prominent layers. These are the epidermis, dermis, hypodermis (subcutaneous tissue)

• Epidermis– the outermost layer of skin. The epidermis provides a waterproof barrier and creates our skin tone.

The epidermis is a water-resistant outer layer of the skin. This layer has 4-5 sublayers of packed cells. The epidermis processes the cell renewal cycle. The dead skin cells shed off the stratum corneum. Then, new, healthy cells generate. The epidermis also consists of your pores that allow oil and dirt to escape your body.

The epidermis contains specialized cells, including:

1. Keratinocyte cells – produce and store keratin (the protein that strengthens skin)

2. Langerhans cells – help prevent infection and defend the immune system

3. Melanocyte cells – produce melanin (the pigment that determines skin color)

4. Squamous cells and basal cells – cause basal cell and squamous cell carcinoma

The epidermis is super thin on selected parts of your body and thicker on others. This layer handles:

a. Making new skin cells

b. Giving skin color

c. Protecting your body

• Dermis – found beneath the epidermis. It contains tough connective tissue, hair follicles, and sweat glands.

The dermis also contains nerve endings that send messages to the brain when you feel. Blood vessels located in this layer help supply your skin with fresh blood. They carry the oxygen as well as the nutrients it needs to be strong.

Within its connective tissues, the dermis makes two essential proteins: Collagen and elastin. The two are responsible for the shape, structure, firmness, and elasticity of your skin. The roles of the dermis include:

a. Making sweat.

b. Helping you feel things.

c. Growing hair.

d. Making oil.

e. Providing blood to your skin.

• Hypodermis (subcutaneous tissue)- composed of fat and connective tissue.

The hypodermis comprises subcutaneous fats, connective tissues, blood vessels, and nerve cells. The blood vessels in this layer are larger. Stored fat helps track body tissue. Also, it cushions your body’s internal organs against negative impact.

The tissue in the hypodermis produces one crucial cell called Adipocytes. These cells store fat used for energy, cushioning, and insulation. The bottom layer of the skin is the subcutaneous fat layer. This layer plays an essential part in your body by:

a. Attaching the dermis to your muscles and bones.

b. Helping the blood vessels and nerve cells.

c. Controlling your body temperature.

d. Storing your fat.

What are the two primary components of the integumentary system?

In this part, we will tackle the two primary components of the integumentary system. These are the cutaneous membrane and the accessory structures.

• Cutaneous membrane- the operational term for our skin. It is a multi-layered membrane composed of epithelial and connective tissues. The apical surface of this membrane subjects itself to the external environment. It is dead, keratinized cells that help protect the body from pathogens. As mentioned, our skin comprises three layers. They are the epidermis, dermis, and subcutaneous tissue.
• Accessory structures- include the hair, nails, sweat glands, and sebaceous glands. These structures originate from the epidermis. Often termed “appendages”, they can extend down through the dermis into the hypodermis.

Accessory structures of the skin consist of not only the hair and nails. This group also includes sweat glands and sebaceous glands. Although these structures appear to be part of the dermis, they come from the epidermis. Dead, keratinized cells make up the hair shaft and get their color from melanin pigments. Nails are also keratinized. They protect the extremities of our fingers and toes from damage. Sweat glands and sebaceous glands create sweat and sebum.

What material makes the epidermis tough?

Look at your toes, your face, and your hands. What you’re watching are your keratinocytes. They put together over 90% of the epidermis cells, the outermost layer of the skin. The keratinocytes make the epidermis strong. The skin on every part of your body is not the same. This difference is due to toughness. The number of keratin proteins produced in certain parts causes this distinction. Keratin is an intermediate filament protein made by keratinocytes.

The main aim of these keratin-producing cells is to preserve. It may be against microbial, viral, fungal, and parasitic invasion. They also protect us against UV radiation. Apart from that, they cut the heat, solute, and water loss.

Keratinocytes are very well specialized. They play an indispensable role in protection because they form a tight barrier. It prevents foreign substances from entering the body. Also, they shorten the loss of moisture, heat, and other constituents. In maintaining them in their locations, they form tight bonds with the other cells. Also, keratinocytes function as immunomodulators following skin injuries.

Which layer of the skin does hair grow from?

Your hair is a keratinous filament growing out of your epidermis. Dead and keratinized cells predominate this layer. Strands of hair originate in an epidermal permeation called the hair follicle.

The hair shaft is part of the hair. It is not anchored to the follicle, and much of this is visible at the skin’s surface. The rest of the hair lies below the surface of the skin. This is the hair root. The hair root stops deep in the dermis at the hair bulb. It also includes a layer of active basal cells called the hair matrix. The hair bulb surrounds the papilla hair. It contains blood capillaries and nerve endings from the dermis.

The basal layer of the epidermis creates the layers of epidermis that get shoved to the surface. This happens as the dead skin sheds. The same cells of the hair bulb divide and push cells out in the hair root and shaft. It occurs as the hair grows. The medulla structures the core of the hair. The cortex surrounds it. The cuticle covers this layer of compressed keratinized cells.

Hair grows, then sheds, and the new hair replaces it. There are three stages to this. The first is the anagen phase, when cells at the hair’s root divide, pushing the hair shaft up and out. We use years to measure this phase, and it usually lasts between 2 and 7 years.

Also, the catagen phase lasts only 2 to 3 weeks. It announces the end of the growth phase of the hair follicle. Finally, the hair follicle is dormant throughout the telogen period. By this time, no new growth occurs. A new anagen phase begins after this phase, which lasts roughly 2 to 4 months. As the growth cycle repeats, the basal cells in the hair matrix generate a new hair follicle. It pulls the old hair out. During the anagen phase, hair develops at a rate of 0.3 mm every day. Every day, about 50 inches fall out. Hair loss happens when the amount of hair shed exceeds the amount of hair restored. It can occur due to hormonal or nutritional changes.

REFERENCES:

American Academy of Dermatology Association. (2021). What kids should know about the layers of the skin. https://www.aad.org/public/parents-kids/healthy-habits/parents/kids/skin-layers

American Hair Loss Association. (2010, March 1). Hair Loss: The Science of Hair. WebMD. https://www.webmd.com/skin-problems-and-treatments/hair-loss/science-hair

Betts, J. G., Young, K. A., & Wise, J. A. (2013). Anatomy and Physiology. OpenStax.

Biga, L. (2021). Anatomy and Physiology (1st ed.). Pressbooks. https://open.oregonstate.education/aandp/chapter/4-1-types-of-tissues/

Hoffman, M. (2021, August 1). The Skin (Human Anatomy). WebMD. https://www.webmd.com/skin-problems-and-treatments/picture-of-the-skin

Kim, J., & Dao, H. (2021, May 9). Physiology Integument. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK554386/

Lumen Candela. (2020, August). The Skin. Lumen Learning. https://courses.lumenlearning.com/boundless-ap/chapter/the-skin/

Martini, N., & Ober, K. (2018). Visual Anatomy and Physiology (3rd ed.). Pearson. https://www.palmbeachstate.edu/slc/Documents/AandPch05LecturePearson.pdf

Mohs Skin Cancer Surgery. (2020, January 30). The Layers of Skin. Florida Dermatology and Skin Cancer Center. https://fldscc.com/2020/01/30/three-layers-skin/

Pane, C. (2020, September 27). Keratinocytes. PromoCell. https://promocell.com/cell-culture-basics/keratinocytes/#

Physiopedia. (2020, October 23). The Integumentary System. https://www.physio-pedia.com/Integumentary_System

Reina, O. (2016, September 13). Keratinocytes: Their Purpose, Their Subtypes and Their Lifecycle. Tempo Bioscience. https://www.tempobioscience.com/blog/keratinocytes-their-purpose-their-subtypes-and-their-lifecycle/

Taylor, T. (2021, May 17). Integumentary System. Innerbody Research. https://www.innerbody.com/anatomy/integumentary#continued

Xandrea, P. (2019, December 9). Skin 2: accessory structures of the skin and their functions. Nursing Times. https://www.nursingtimes.net/clinical-archive/tissue-viability/skin-2-accessory-structures-of-the-skin-and-their-functions-09-12-2019/

Written by Risa Mae Q. Paladar

Reviewed by Dr. Reuben J C. Los Baños, Ph.D.

The condition that you will read more about in this article is one of the leading causes of death. Hypertension is a disorder in which your blood level increases than conventional values.

Another term for it is high blood pressure or HTN. It is a prevalent ailment in which the blood’s long-term force against the artery walls is high enough. It contributes to heart diseases.

Before going into much detail, you will learn first about what blood pressure is.

It is the exerted force by flowing blood on the walls of one of your body’s primary blood vessels. These are the arteries. BP is its acronym. Readings of BP that are higher than average for consecutive days are the basis for the diagnosis.

How do you measure BP?

There are two crucial components considered. One is the blood quantity that your heart pumps. The other one is defiance to blood flow in your arteries.

When diagnosed with HTN, it indicates that your heart has been working too much harder. It is also a sign that it is pumping more blood than usual, with your arteries becoming narrower than ever. mmHg or millimeters of mercury is the unit of measurement. Two digits represent it.

The top number reflects your systolic pressure. It denotes the tension in your arteries whenever your heart contracts or beats. The bottom number reflects your diastolic pressure. This digit represents the stress in your arteries when your heart relaxes.

BP should be less than 120/80 for it to be normal. You may be at risk when your systolic and diastolic is equal to or greater than 140mmHg and 90mmHg.

Types of Hypertensions

Primary hypertension is when there is no known cause for your condition. It is also known as essential hypertension. Identification happens after a doctor detects that your BP is high. This should be for consecutive visits. Diagnosis occurs when the physician has ruled out all other reasons.

If diagnosed with primary hypertension, you may not experience any symptoms at all. But, there is still a probability that you will experience fatigue and headache at times. It stated that the cause is not definite. Yet, researchers still identified related factors. These include genetics, alcohol intake, smoking, diet, and obesity.

The second significant type is secondary hypertension. Unlike essential hypertension, this type has a known cause. According to researchers, the most common reason for this type is an anomaly in the arteries.

There is a disruption of blood distribution to the kidneys. An underlying severe condition or disease may give rise to this. Examples of these are tumors and cancer.

Symptoms

“Silent killer” is another term for hypertension. It may be present without you experiencing any symptoms. It may be hard to persuade you to take medications, knowing that you may be asymptomatic.

Yet, it is crucial to remember that there can be an early detection for hypertension. This highlights the importance of having regular check-ups. Whenever diagnosed, your doctor will give you medications to control the disease.

While most people may be asymptomatic, you may encounter headaches and dyspnea. These symptoms do not appear until your BP has reached a dangerous level.

What is the main cause of hypertension?

According to research, there are a couple of risk factors that can cause HTN. For primary hypertension, there is no known cause. Your lifestyle, such as gaining weight and consuming much sodium and alcohol, genetics, and certain diseases are the leading causes of secondary hypertension.

Primary Hypertension

As mentioned earlier, there is no known or definite cause for primary HTN. It usually develops over time.

Secondary Hypertension

Causes of secondary hypertension range from a variety of illnesses to drugs, including:

• Obstructive sleep apnea
• Kidney disease
• Adrenal gland tumors
• Thyroid problems
• Certain defects you’re born with (congenital) in blood vessels.
• Certain medications: birth control pills, cold remedies, decongestants, and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

Risk Factors

There is no certainty that these are causes for hypertension development. But, they can still be threats and could escalate your risk of developing them in your later years.

These are the following:

• Male gender: Men appear to have a more significant chance of acquiring the disease than women.
• Old age: Higher rates of hypertension are prevalent in older people. Along with the risk factors are the primary and usual reasons for HTN diagnosis.

1. Genetics

Some DNA can cause the disease. Although you cannot solve this problem, you must tell your physician if it runs in your family.

2.  Obesity

Several studies have found that those who are obese have higher BP than those who are fit. Greater weight accounts for almost forty percent of all hypertension diagnoses.

3. Too much sodium intake

Excess salt consumption correlates with an increased HTN risk. If you overeat sodium, your body will not excrete fluid, which will raise your BP.

4. Little potassium intake

Potassium plays a significant role in your body. It helps stabilizes the sodium amount in your cells. Thus, the right amount of potassium intake equates to the excellent health of your heart. If not, sodium may build up in your blood.

5. Inactive physical activity/sedentary lifestyle

Having such a lifestyle increases your heart rate. It implies that every time your heart contracts, it has to work harder. Additionally, the force applied to the arteries is also more potent and more complex. It could also lead to obesity or being overweight.

6. Excessive alcohol consumption

In the long run, heavy drinking causes detrimental effects on your heart. There are recommendations on the number of drinks both for men and women to protect your health. Furthermore, excessive alcohol intake may also cause an elevation in your cholesterol levels.

7. Kidney problems

Kidneys also play a crucial role in eliminating harmful toxins and wastes as you urinate. When the kidneys get damaged, they cannot do their job with efficiency. There is a retention of the fluid inside your body. This situation leads to high BP and HTN.

What can happen if you have hypertension?

Because of its ability to keep patients unaware of their state, HTN is often known as the “silent killer.” You may experience symptoms like headache, irregular heart rhythms, fatigue, and others. It may also lead to heart diseases, stroke, kidney disorders, and blindness.

Symptoms

• Nosebleeds
  • Irregular heart rhythm
  • Vision changes
  • Headaches
  • Buzzing in the ears

If the extent of hypertension that you have is more severe, you may also experience the following:

• Nausea
  • Fatigue
  • Anxiety
  • Vomiting
  • Muscle tremors
  • Chest pain

Aside from the various manifestations, it can also cause catastrophic damage to your other organs such as the heart, eyes, kidneys, and brain.

1. Heart Attack and Heart Disease

HTN makes your arteries less flexible which may cause a decrease in the blood and oxygen flow to your heart. This situation leads to heart diseases. Additionally, decreased blood flow may also contribute to the following:

• Heart attack– The blockage of blood supply causes excellent damage to your heart. It is because the oxygen does not also reach the organ. Without adequate oxygen, the cardiac muscle begins to perish. The longer the time there is a restriction of your blood flow, the more damage the heart suffers.
  • Heart failure– It is a disorder in which your heart becomes unable to pump adequate blood and oxygen to your other organs.

2. Chest pain (angina)

• Stroke and brain problems

A stroke occurs when the arteries delivering oxygen and blood to the brain become blocked or rupture. During this, your brain cells may die because they become deprived of oxygen. You may also find yourself having disabilities in your speech and movement.

Another is a brain aneurysm. Your vessels become weak and bulge, forming an aneurysm. If this ruptures, it could be life-threatening.

4.  Kidney disorders

The blood vessels in your kidneys become weak and narrow, preventing the organ from functioning with efficiency.

5.  Loss of vision/blindness

The blood vessels in your eyes become thick, narrow, and torn.

6.  Death

Can hypertension be cured?

It is relevant to understand the difference between cure and treatment. The term “cure” usually refers to a complete recovery of one’s health. Treatment may not mean the absolute eradication of the disease. It only leads to your health’s improvement. HTN has no cure, but there is prevention and treatment.

A chronic illness such as hypertension is an example. Medication and maintaining or switching to a healthy lifestyle can help moderate it. But there is no cure.

Written below is a list of things that you can do and apply in your lives to ward off and mitigate HTN.

• Cutting back on salt or sodium

As adults, you should consume no more than 2 grams of sodium per day. You should check the salt amount of packed goods found on the nutrition labels.

• Eating a balanced diet.

Eat fruits, vegetables, fish, lean meat, and low-fat dairy products in reasonable amounts. You should avoid foods heavy in salt, sugar, or oil on a regular basis.

• Exercising

Do not sit all day. Engage yourselves in physical activities that will allow you to sweat.

• Limiting alcohol consumption

If you must consume alcohol, keep your consumption to the least amount.

• Managing stress

Allow yourself to feel all emotions. Have a sound support system whom you can vent out your sentiments. Meditate and allow yourself to rest every once in a while.

• Avoiding smoking

What food causes hypertension?

You may be conscious of your diet once you identified the effects of hypertension. Table salt, a few condiments and sauces, foods with saturated and trans-fat, fried food, fast food, canned, frozen, and processed foods all cause HTN.

·         Table salt

You may always end up looking for more salt, out of habit, in preparing your snacks and meals. It is important to remember that high salt intake is one of the causes of hypertension. Usage of it should be with much precaution. You may also opt to avoid using it and look for alternatives such as herbs and new spices.

·         Some condiments and sauces

Once you have decided to replace your salt, there is a list of condiments that you should not use as substitutes. These include soy sauce, ketchup, steak sauce, and salad dressing. Because of their high sodium content, it is the case.

·         Foods with saturated and trans fat

Even if you have HTN, you can eat healthy fats, but saturated and trans fats are not among them. Foods with saturated and trans-fat include donuts, ice cream, cakes, and margarine. BP and cholesterol are both affected by foods fried in many oils or meats with a lot of fat. You must consume low-fat dairy foods.

Reduce or cut your red meat in your diet. If you cannot resist eating one, check the labels and select the leanest cuts possible.

·         Fried food

Fried meals are high in saturated fat and sodium. Examples include chickens, French fries, crispy pata, and many more.

·         Fast food

Frozen foods cooked in high-fat oils are common in fast-food restaurants. They’re also salted often. All these increase your risk of having HTN. These include your favorite hamburger, chicken, and fries from Jollibee or McDonalds.

·         Canned, frozen, and processed foods

Most of these contain much salt to preserve the flavor through all the processes. Canned soups are significant examples. Frozen pizzas are on the list too. Sodium levels are high in frozen pizzas with thick crusts and a lot of toppings.

What is the best drink for hypertension?

You have read the foods mentioned above that pose a greater risk for HTN. It is time to turn your eyes to the different drinks that could help ease your HTN. Tomato juice, beet juice, prune juice, skim milk, and tea are the best drinks for HTN.

In this part of the article, you will be learning about the different drinks best for HTN.

·         Tomato Juice

Japanese researchers surveyed in 2019. Findings say that tomato juice helps both your diastolic and systolic pressure. Participants in the study were people with heart disease risk factors.

In the later studies, an average of one cup a day also improves the BP of pregnant women. The same goes for people suffering from stage 1 hypertension.

·         Beet Juice

The juice of both raw and cooked beets can lower BP. This finding was according to a randomized pilot research published in 2016Trusted Source. Raw beet juice had a more significant effect on BP.

·         Prune Juice

A 2010 studyTrusted Source says that prune juice is effective in lowering BP. People who ate one dosage of three prunes each day had lower BP, according to the study. There was a more significant reduction in the systolic blood pressure in people who ate six prunes per day.

·         Skim Milk

Low-fat dairy products can prevent and treat your HTN. Skim milk, belonging to the group, would be another drink best for your condition. A 2011 review concluded that your consumption of low-fat milk yielded a lower risk.

·         Tea

The effect of tea on your condition varies depending on the type. According to a 2014 study, green tea yields a more significant decrease in blood pressure. But, long-term consumption of both green and black tea also had a positive impact.

Does coffee lower blood pressure?

Caffeine is a chemical found in your coffee. There are contradicting studies about the topic. Coffee causes a brief but significant spike in your blood pressure. To some, yes, it lowers BP and poses less risk for hypertension occurrence.

According to some researchers, caffeine can block a hormone. This blocked hormone keeps your arteries open or widened. Others believe that caffeine stimulates your adrenal glands to generate extra adrenaline. A temporary increase in BP is the result. Moreover, caffeine is an example of a vasoconstrictor. It produces the same effect.

Previous studies have produced contradicting results when it comes to this topic.

In a medical review, there is a statement that blood vessels get stiffer as you age. This situation could trigger an elevation in blood pressure. According to the latest research, moderate coffee consumption may help to offset this.

In the same study, older people who consume a moderate amount of coffee have more elastic vessels. This finding is despite having HTN.

According to a 2012 study, caffeine intake has a variable influence on blood pressure. Caffeinated coffee causes a significant increase in BP. This is when compared to decaffeinated coffee.

Increased coffee intake causes a slight reduction in the incidence of hypertension in prospective cohort studies, according to 2017 prospective cohort studies.

Despite all this, there is more research conducted in the present to gain a better and single perspective about the relationship between coffee and your blood pressure.

References:

Coffee consumption and blood pressure. (n.d.) Coffee & Health. https://www.coffeeandhealth.org/topic- overview/coffee-consumption-and-blood-pressure/

11 Foods that increase blood pressure. (n.d.) Durham Nephrology. https://www.durhamnephrology.com/foods-that- increase-blood-pressure/

High blood pressure. (2021, May 18). Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/about.htm

High blood pressure. (2021). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood- pressure/symptoms-causes/syc-20373410

Hypertension – the preventable and treatable silent killer. (2013, March 1). Centre for Health Protection. https://www.chp.gov.hk/en/features/28272.html#:~:text=Hypertension%20is%20a%20chronic%20disease,fol low%20up%2C%20usually%20for%20life.

Hypertension. (2021, August 25). World Health Organization. https://www.who.int/news–room/fact- sheets/detail/hypertension

Iliades, C. (2009, November 18). Different types of hypertension. Everyday Health. https://www.everydayhealth.com/hypertension/understanding/types-of-hypertension.aspx

Laino, C. (2010, September 1). Coffee may combat high blood pressure. WebMD. https://www.webmd.com/hypertension-high-blood-pressure/news/20100901/coffee-may-combat-high-blood- pressure

Lopez-Jimenez,     F.                   (2021,   June 8).     Caffeine: How   does                    it         affect             blood   pressure?      Mayo      Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/blood-pressure/faq- 20058543#:~:text=How%20does%20caffeine%20affect%20blood,t%20have%20high%20blood%20pressure

Treatment vs. Cure. (n.d.) Merriam Webster. https://www.merriam-webster.com/words-at-play/treatment-vs-cure- difference#:~:text=Cure%20usually%20refers%20to%20a,the%20complete%20elimination%20of%20diseas e.

Vandergriendt,       C.         (2020,         September          17).  7             Drinks for             lowering            blood           pressure.   Healthline. https://www.healthline.com/health/drinks-to-lower-blood-pressure

Written by Alexis Marian Balisbis

Reviewed by Dr. Reuben J C. Los Baños, Ph.D.

There are 100 trillion cells or more in the human body. These make up tissues, tissues make up organs, and organs make up the organ system. The various functions performed by cells lead to their different shapes and sizes. The female ovum or egg cell is the largest cell in the human body.

Its size is about 120 micrometers (0.0047 in) in diameter and 20 times the size of male sperm, making it visible to the naked eye without the aid of a magnification device. The female ovum is the reproductive cell in the female body. It needs to gather enough nutrients to support a growing embryo after fertilization.

There are approximately 1 million eggs at birth. Moreover, by the time of puberty or menstruation, only 300,000 eggs remain. Usually, females ovulate one egg per month.

What is the smallest cell in the human body?

A cell is the smallest, basic unit of life that controls all the processes of life. Most scientists suggest that the smallest cell in the human body for volume is the male sperm. The reproductive cell of males is the sperm.

A bit smaller than your red blood cell, the sperm head is about 4 micrometers in length and a tail 50 micrometers long. A fertile man may produce between 40 million and 1800 million sperms in total. It will only survive in warm environments; thus, it dies outside the body or when ejaculated.

Which blood cell is smallest in size?

A blood cell is also known as a hematopoietic cell, hemocyte, or hematocyte. The three main types of hemocytes include red blood cell or erythrocyte, white blood cell or leukocyte, and platelet or thrombocyte. The smallest hemocyte in size is the platelets or thrombocytes.

Platelets are minute discs 1 to 4 micrometers in diameter, only about 20% of the diameter of erythrocytes. 150,000 – 350,000 per microliter of blood is the average platelet count. But, they are miniature, so they make up a tiny fraction of the volume. They play a significant role in the repair and regeneration of connective tissue.

• Production:

The production or formation of platelets occurs in the bone marrow from megakaryocytes or the “giant” cell, which are giant hematopoietic cells in the marrow. The thrombopoietin or TPO, a dominant hormone controlling megakaryocyte development, regulates the production.

Megakaryocyte develops into a giant cell that releases over 1,000 platelets per megakaryocyte due to fragmentation. They break up into the minute platelets either in the bone marrow or soon after entering the blood, especially as they squeeze through capillaries.

• Structure:

Platelets are the smallest of the circulating fragments of cells, so they are not actual cells. Their average lifespan is about 5 to 9 days only. The shape of platelets, usually plate-like, may change when a break in the blood vessel stimulates them.

When there is a break in the vessel, they become round and extend long filaments. They look like octopuses with long tentacles reaching out to contact the broken vessel wall or other platelets. Then, platelets form a plug to seal the damaged vessel with the long filaments.

Platelets also contain many structures that are necessary to stop bleeding, such as proteins and granules. Proteins on the surface allow them to stick to breaks in the vessel wall and each other. Like muscle protein, they also allow them to change shape when sticky. Granules secrete other proteins that create a firm plug to seal vessel breaks.

• Function:

Platelets are being pushed out from the center of flowing red fluid to the vessel wall because they are the lightest. They pass along the surface of the vessel lined by cells called the endothelium. Endothelium prevents anything from sticking to it.

The platelets react first to injury. When there is a wound or bruise and a broken endothelial layer, this causes exposure of the tough fibers surrounding a vessel to the liquid flowing blood. The tough fibers attract platelets like a magnet, which stimulates the shape change. They clump onto the fibers, forming blood clots or the initial seal to prevent bleeding.

• Disorders: (You can explore more conditions but the ones mentioned are some of them)

Thrombocytopenia, a term derived from an old name for platelets, “thrombocytes,” is a disorder with low platelet counts. The cause can be due to the failure of the bone marrow to produce the standard number of platelets. Increased platelet destruction may also happen once production finishes and when releasing it into the circulation.

Thrombocythemia is a disorder in which your bone marrow makes too many platelets. Some symptoms may include bleeding, headache, bruises, and bloody stools.

Which blood cell is known as a scavenger?

White blood cells or leukocytes are the fewest of the hemocytes. There are only 5,000 to 10,000 leukocytes per microliter or about 1% of your blood. The several types of leukocytes all connect to immunity and fighting infection. The hemocyte called macrophages, also known as natural scavengers, is a type of leukocyte.

Macrophages, also called granulocytes, are cells in the immune system that belong to the so-called scavenger cells or the phagocyte family. They live in almost all body tissues, such as the liver, brain, small intestine, and skin. They destroy bacteria, stimulate other immune system cells’ action, and remove dead cells.

They are also made in the bone marrow and protect the body against infection. Granulocytes have granules in their cytoplasm. The three classes or subdivisions of Macrophages are:

• Neutrophil

Neutrophils are the most common type and the most many, making up about 50% to 70% of all leukocytes and have a lifespan of 7 hours. The granules are very tiny and light, so they are challenging to see. They are the first line of protection when infection strikes to kill and digest bacteria and fungi.

• Eosinophil

These are less common, making up less than 5% of leukocytes and a lifespan of 8 to 12 days. They damage the cells that make up the cuticle or body wall of larger parasites and cancer cells. The large granules contain digestive enzymes that are effective against parasitic worms in their larval form.

• Basophil

Basophils are the least many and rarely seen, making up less than 1% of all leukocytes and a lifespan of a few hours to a few days. They release heparin which is a substance that inhibits blood clotting, histamine, and other substances that have essential roles in some allergic reactions to help control the immune response or the inflammatory response.

What is the largest blood cell?

The other type of white blood cell is the Agranulocytes that have no distinct granules in their cytoplasm. Examples are lymphocytes and monocytes. The largest blood cell is the monocyte, a leukocyte averaging 15 to 18 micrometers in diameter and making up about 7% of the leukocytes.

In the cytoplasm, large numbers of granules often appear to be more in number near the plasma membrane. The nucleus is big, kidney bean-shaped, and tends to have indenting or folding. Monocytes enter areas of inflamed tissue later than the granulocytes or macrophages.

 Monocytes are capable of motion and are phagocytic (engulfing) cells. They can ingest infectious agents and other large particles. They may help break down bacteria, but they cannot replace the function of neutrophils in the removal and destruction of bacteria.

Production in the bone marrow takes place, then they leave and circulate in the blood. After a few hours, the monocytes enter the tissues, where they develop or mature into macrophages. They have a life span of 3 days which is longer than the life span of many white blood cells.

The other type of agranular leukocyte is the lymphocytes, a part of the immune response to foreign substances in the body. They make up about 28% – 42% of the white cells of the blood. These are much smaller than the three granulocytes. The nucleus is enormous for the size of the cell.

Many lymphocytes are in the spleen, lymph nodes, tonsils, thymus, and lymphoid tissue of the gastrointestinal tract. The T-lymphocytes act against tumor cells and virus-infected cells, while the B-lymphocytes produce antibodies against possible harmful invaders. Both of these are memory cells that may live for many years.

What blood cells carry oxygen?

Blood is the life-sustaining fluid that circulates through the entire body. It also carries nutrients to the body tissues. The life-sustaining cells that transport oxygen all over the body are the red blood cells or erythrocytes. These are the most many, about 5,000,000 per microliter, making about 40% of your total blood volume.

• Production:

The hormone erythropoietin or EPO manages the production of erythrocytes, which occurs in the bone marrow. With small amounts made by the liver, the kidneys are the leading site for EPO production in response to decreased oxygen delivery, such as anemia and hypoxia or increased levels of androgen hormones.

• Structure:

Disks that are a bit flattened with an indented center or round, biconcave discs are usually the shape of erythrocytes. The microscopic view looks like an orange or red tire with a thin, almost transparent center. They live for about 120 days or four months. Your body makes new erythrocytes to replace the dead or lost ones.

• Function:

The hemoglobin in erythrocytes is a protein that carries oxygen. When hemoglobin picks up oxygen in your lungs, the life-sustaining fluid gets its bright red color. The hemoglobin releases oxygen to the different parts of the body as it travels. Erythrocytes also bring carbon dioxide to the lungs for you to exhale, removing it from your body.

• Illness: (Mentioned below is only one condition, but you can search other types of anemia)

Some causes of these illnesses are diseases, a lack of iron or vitamins in your diet, or inherited from family.

Anemia is a disease in which too few erythrocytes carry enough oxygen all over the body. Pale skin, feeling cold, tiredness, and fast heart rate are some symptoms of anemia. In severe cases, it may cause heart failure. Children with anemia develop slower than other children.

There are many types of anemia, including the most common, iron deficiency anemia. Your body would not make enough hemocytes if you did not have enough iron in your body. Causes may include sudden blood loss, inability to absorb enough iron from food, a low-iron diet, and ongoing chronic fluid loss such as from heavy menstrual periods.

What vitamin helps the body make red blood cells?

The body needs enough erythrocytes to provide oxygen to body tissues. Foods rich in iron and vitamins can aid in maintaining healthy erythrocytes. The vitamin that helps the body erythrocytes is Vitamin B12.

You can get vitamin B12 from eating meat, cheese, eggs, milk, and cereal – usually absorbed by your digestive systems, such as the stomach and intestines.  Supplements containing B12 along with other B vitamins or folate are also available.

Some factors that make it difficult for your soma to absorb enough vitamin B12 include:

• Poor nutrition during pregnancy
• Poor diet in infants
• Eating a strict vegetarian diet
• Alcohol use
• Surgery that removes particular parts of the stomach or small intestine, such as some weight-loss surgeries
• Pernicious anemia happens when the body destroys cells that make intrinsic factor, a protein produced by specialized cells that line the stomach wall.

References:

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Massachusetts Institute of Technology. (2021, March 6). Study reveals how egg cells get so big.Retrieved from https://www.sciencedaily.com/releases/2021/03/210306113142.htm

Byju’s. (n.d.). Name the smallest and largest cell in the body?

Vedantu. (n.d.). Questions & answers. Retrieved from

https://www.vedantu.com/question-answer/smallest-blood-cells-are-arbc-bwbc-cplatelets-class-11-biology-cbse-5f7c1286de7d79546eff0c98

George, J. (2015). Platelets on the web. Retrieved from

https://www.ouhsc.edu/platelets/platelets/platelets%20intro.html

Humphrey, J. & Perdue, S. (2020). Immune system: Macrophages. Retrieved from

https://www.britannica.com/science/immune-system/Interferons

University of Rochester Medical Center. (n.d.). What are white blood cells? Retrieved from

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentID=35&ContentTypeID=160

Conley, L. & Schwartz, R. (2020). Blood: Monocytes. Retrieved from

https://www.britannica.com/science/blood-biochemistry/White-blood-cells-leukocytes#ref62367

Wick, S. (n.d.). Immunology. Retrieved from

https://www2.nau.edu/~fpm/immunology/blood.html

University of Rochester Medical Center. (n.d.). What are red blood cells? Retrieved from

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentID=34&ContentTypeID=160

The American National Red Cross. (n.d.). Red blood cells and why they are important. Retrieved

from https://www.redcrossblood.org/donate-blood/dlp/red-blood-cells.html#:~:text=Red%20blood%20cells%20carry%20oxygen,our%20lungs%20to%20be%20exhaled.

KidsHealth. (2019). What’s blood? Retrieved from https://kidshealth.org/en/kids/blood.html

MedlinePlus. (2021). Vitamin B12 deficiency anemia. Retrieved from

https://medlineplus.gov/ency/article/000574.htm

Healthwise. (2020, September 23). Vitamin B12 deficiency anemia. Retrieved from

https://www.uofmhealth.org/health-library/hw65706