How Does Nitrogen Oxide Pollution Affect the Environment

NOx pollution occurs when nitrogen oxides are released as a gas into the atmosphere during the high-temperature combustion of fossil fuels. These nitrogen oxides consist mainly of two molecules, nitric oxide (NO) and nitrogen dioxide (NO2); there are other nitrogen-based molecules considered to be NOx, but they occur in much lower concentrations. A closely related molecule, nitrous oxide (N2O), is a significant greenhouse gas that plays a role in global climate change. Where Does NOx Pollution Come From? Nitrogen oxides form when oxygen and nitrogen from the air interact during a high-temperature combustion event. These conditions occur in car engines and fossil fuel-powered electricity plants. Diesel engines, in particular, produce large amounts of nitrogen oxides. This is due to the combustion features characteristic of this type of engine, including their high operating pressures and temperatures, especially when compared to gasoline engines. In addition, diesel engines allow excess oxygen to exit the cylinders, diminishing the effectiveness of catalytic converters which prevent the release of most NOx gases in gasoline engines. What Are the Environmental Concerns Associated With NOx? NOx gases play an important role in the formation of smog, producing the brown haze often observed over cities, particularly during the summer. When exposed to the UV rays in sunlight, NOx molecules break apart and form ozone (O3). The problem is made worse by the presence of volatile organic compounds (VOC) in the atmosphere, which also interact with NOx to form dangerous molecules. Ozone at the ground level is a serious pollutant, unlike the protective ozone layer much higher up in the stratosphere. In the presence of rain, nitrogen oxides form nitric acid, contributing to the problem of acid rain. Additionally, NOx deposition in the oceans provides phytoplankton with nutrients, worsening the issue of red tides and other harmful algae blooms. What Are the Health Concerns Associated With NOx? Nitrogen oxides, nitric acid, and ozone can all readily enter the lungs, where they create serious damage to delicate lung tissue. Even short-term exposure can irritate the lungs of healthy people. For those with medical conditions like asthma, just a short time spent breathing these pollutants has been shown to increase the risks of an emergency room visit or hospital stay. Approximately 16% of houses and apartments in the United States are within 300 feet of a major road, increasing exposure to hazardous NOx and their derivatives. For these residents—especially the very young and elderly—this air pollution can lead to respiratory diseases such as emphysema and bronchitis. NOx pollution can also worsen asthma and heart disease and is tied to elevated risks of premature death. What Role Does NOx Pollution Play in the Volkswagen Diesel Scandal? For a long time, Volkswagen has marketed diesel engines for most vehicles in their fleet. These small diesel engines provide ample power and impressive fuel economy. There were concerns over the cars nitrogen oxide emissions, but those were appeased as the little Volkswagen diesel engines met the stringent requirements policed by the U.S. Environmental Protection Agency and the California Air Resources Board. Somehow, few other car companies seemed to be able to design and produce their own powerful but thrifty and clean diesel engines. It became clear why in September 2015, when the EPA revealed that VW had been cheating the emissions tests. The automaker had programmed its engines to recognize testing conditions and react by automatically operating under parameters that produce very low amounts of nitrogen oxides. When normally driven, however, these cars produce 10 to 40 times the maximum allowable limit. Sources EPA. Nitrogen Dioxide – HealthEPA. Nitrogen Dioxide (NOx) – Why and How They Are Controlled This article was written with assistance from Geoffrey Bowers, Professor of Chemistry at Alfred University, and author of the book Understanding Chemistry Through Cars (CRC Press).

Marketing Mix Example - 1838 Words

1. Read following paragraph and explain the process this firm might go through to reach this specific marketing strategy - how and why this company reach to use this decision. Also explain results this firm may get from using this specific marketing strategy. In addition, recommend any modification of strategy based on SWOT analysis. Bakery chain Tous Les Jours introduces two varieties of Kim Yu-na bread,à ¢Ã‚€Â  named after the popular Korean figure skater. The flavors, chosen by Kim herself, are the sweet potato and cream bread, and the kaya bun. The company said that the proceeds will go to various charities selected by Kim. The bread will be sold nationwide. à ¢Ã‚â€" how this company reach to use this decision they must go through this†¦show more content†¦tous les jours also can increase in sales and proceeds. moreover another sort of breads that they carry make sales more as a synergy effect because the customers who visited dont purchase just one bread.  à ¢Ã‚â€" recommend any modification of strategy based on SWOT analysis. in this case, the objective of marketing strategy is to build good image by SO strategy. I think it is good. but I want to recommend one thing with threat component of SWOT. nowadays most of food industry is forced to open food additives in order to reveal whether some food is good to eat or not. but bread is not mandatory to open their information. I think thats big problem in relation to trend. to remove risk about food problem, to notify this companys food is good and nice hygienically and also to prevent some problems, tous les jours had better choose things which deprive of threat, food-polluted problem. 2. Today we live in an environment of global warming and high oil prices, which demands energy efficiency. Choose any firm which is currently operating in a market, and develop marketing strategy which is applicable to that specific firm in relation with above statement. a. first step : market situation evaluation the customers need is changing into environment-friendly product. that means the customer forces the producer produce cost(energy)-efficient items because the globe grow warmer and warmer and the people are threatened by green houseShow MoreRelatedExamples Of Decisions ( Marketing Mix )870 Words   |  4 PagesExamples of Decisions (Marketing Mix) The main component of the marketing mix is the product. 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The contribution of the Upper tribunal to the first-tier tribunal’s work Free Essays

string(127) " feature of the new system and, as demonstrated above, shares features with the judicial review available in the courts\[24\]\." Introduction The reform of the haphazard system of tribunals in the UK has often provided a neat symmetry with the chaos the system has been vehemently criticised for. It has taken half a century for the Tribunals, Courts and Enforcement Act 2007 to be given royal assent, which Bradley Ewing rightly suggest to be the fulfilment of the conclusions of the influential Franks Committee of 1957, constituted to provide a once-in-a-generation review of tribunals and inquiries in the UK[1]. The Franks Committee concluded that tribunals are â€Å"machinery provided by Parliament for adjudication,† the operation of which should be fair, open and impartial[2]. We will write a custom essay sample on The contribution of the Upper tribunal to the first-tier tribunal’s work or any similar topic only for you Order Now Thus at one legislative stroke the proliferation of tribunals in the last century, which moved the then Lord Justice Woolf to author a paper entitled â€Å"a hotchpotch of appeals – the need for a blender†[3], has now been significantly curtailed by the 2007 Act which established two tiers of tribunals to simplify what was becoming unaccountable, undemocratic and in violation of ECHR treaty convention rights[4]. A review in 2001, formed under the auspices of the then Labour Government and the main catalyst for the 2007 Act, found that there were 70 different tribunals across England and Wales and that a number of them were obsolete[5]. The Government’s response in the White Paper Transforming Public Services: Complaints, Redress and Tribunals[6] laid the foundations for the unified system which now prevails. The problems of the past which plagued tribunals are of â€Å"historical interest† in the words of Bradley Ewing[7]. In the context of mental health the relevant first-tier tribunal chamber is the Health, Education and Social Care Chamber and in the Upper tribunal the relevant chamber is the Administrative Appeals Chamber which can hear appeals, with leave from the first-tier tribunal, on points of law only and exercises a judicial review function[8]. The two tiers of tribunals opened for business in November of 2008[9] and the first case in the context of mental health heard by the Administrative Appeals Chamber was heard in 2009[10]. Thus there have been almost three years of cases to evaluate the effectiveness of the Upper Tribunal’s contribution towards enhancing the safeguarding role of the first-tier tribunal in mental health cases[11]. In total there have been 28 cases hearing appeals from the Health, Education and Social Care Chamber within this time[12]. It is very early in the life of the unified system to conclusively say whether it is enhancing the system[13] but Bradley Ewing m ake some general observations on the advantages the two-tier system is bringing which are relevant to the mental health sphere: â€Å"One valuable result of the two-tier structure is to rationalise the diverging procedures that separate tribunals had used. This task has been carried out by the Tribunal Procedure Committee, Chaired by a Court of Appeal judge. The aims of the procedure rules include that of ensuring that in tribunal proceedings ‘justice is done’; that the tribunal system is ‘accessible and fair’; that proceedings are handled ‘quickly and efficiently’; and that the rules are ‘both simple and clearly expressed’†[14] The administrative advantages of a unified system[15] are perhaps obvious but the case law has revealed some potential weaknesses with the Supreme Court recently holding that the Upper Tribunal is amenable to judicial review itself[16]. This essay will critically analyse the contribution of the Upper tribunal to the first-tier tribunal’s work over the past three years by analysing the statutory basis of the tribunal in part 1 as well as the decided case law in the context of mental health. The essay will then, in part 2, discuss the strengths and weaknesses of the current system and conclude that the new Upper Tribunal is indeed enhancing the work of the first-tier tribunal as demonstrated by the high number of successful appeals, the innovative judicial review function and ECHR compliance under article 6. Part 1: The Upper Tribunal in mental health 1.1 The Administrative Appeals Chamber and the 2007 Act S.3(5) of the 2007 Act confers on the Upper Tribunal the status of a â€Å"superior court of record†[17]. As noted above in the introduction the Upper Tribunal is split into three Chambers with the Administrative Appeals Chamber dealing with, inter alia mental health cases, with its functions split neatly into three categories: appellate, judicial review and referral[18]. The ordinary appellate procedure on a point of law derives from article 7(a) of the First tier Tribunal and Upper Tribunal (Chambers) Order 2008 and, in the context of mental health, is able to hear an appeal â€Å"against a decision made by the first-tier tribunal†[19] but only in respect of a point of law which is not an â€Å"excluded decision† under s.11(5)(a) – (f). With respect to the novel judicial review function, what Lady Hale of Richmond called â€Å"a major innovation in the 2007 Act†[20], under article 7(b) of the 2008 Order this function has been transplanted from the High Court with the Administrative Appeals Chamber able to grant the following kinds of relief: a mandatory order, a prohibiting order, a quashing order, a declaration and an injunction[21]. This function has been qualified by the Lord Chief Justice in England and Wales who issued a practice direction to the effect that the relief of judicial review will be available where there is no power of appeal to the Upper Tribunal and where the decision is not an excluded one[22]. Finally the Administrative Appeals Chamber also has a referral function where cases may be transferred from the First-Tier Tribunal to the Upper Tribunal under s.9(5) of the 2007 Act where the First-Tier Tribunal has set aside a decision. Lady Hale noted in the Supreme Court that the appellate procedure is the most important function of the Administrative Appeal Chamber[23] although her Ladyship pointed out that this right can only be exercised with the permission of either the First-tier or Upper tribunal under ss11(3) and 11(4). The judicial review function of the Upper tribunal is indeed a novel feature of the new system and, as demonstrated above, shares features with the judicial review available in the courts[24]. You read "The contribution of the Upper tribunal to the first-tier tribunal’s work" in category "Essay examples" A curiosity of the system arose in 2011 in the Supreme Court where it was decided that decisions of the Upper Tribunal are amenable to judicial review in the High Court, a decision which Phillip Murray suggests undermines the advances the unified system represents[25] and which will be discussed in part 2 of this essay[26]. 1.2 Case law in mental health As noted in the introduction there have been 28 cases in the three years of the 2007 Act’s life which relate specifically to mental health law[27]. In order to determine whether or not the Upper Tribunal is enhancing the safeguarding role of the First-Tier Tribunal, the Health, Education and Social Care chamber, it is important to analyse the case law both qualitatively and quantitatively. In quantitative terms the appellate procedure is being used in the Upper Tribunal in the majority of cases with judicial review used very sparingly. In all cases heard in 2011, 13 in total, four were successful appeals with the decision of the First-Tier tribunal set aside[28] while in just one case the decision was taken not to set aside the decision despite the successful appeal[29]. In two cases no error on a point of law was discovered by the Upper Tribunal[30] and in only one case was the appeal dismissed entirely[31]. In another case permission to appeal was refused[32] and, to emphasi se the young nature of the tribunal two cases were dedicated to in-depth discussions of tribunal procedure about the open justice principle[33] and the revocation of Community Treatment Orders (CTO’s)[34]. The final decision[35] deserves closer attention in light of the fact that it is the only judicial review decision of 2011[36] and but the second judicial review in all three years[37]. The facts in this case were that while P was serving a five months’ sentence for various criminal offences he was sentenced to a further nine months’ in relation to an assault. On 21st October 2008 the Secretary of State used his powers under s.47 of the Mental Health Act 1983 to have P transferred to a psychiatric hospital. P then appealed against this decision to detain him to the First Tier tribunal on 19th February 2010 which ordered his discharge. A further appeal was made within the power of the First-Tier tribunal to review and set aside its own decisions and thus Judge Foster agreed to set aside the decision under Rule 45 of the Tribunal owing to a discussed Community Treatment Order which Judge Foster felt invalidated the original decision. A further appeal was then heard by Jud ge Foster against her own decision which led to the present judicial review proceedings. In essence, Judge David Pearl reinstated the original First-tier tribunal decision of 19th February 2010 and observed: â€Å"In this case, given the findings made by the First-tier Tribunal in its decision dated 19th February 2010, the tribunal was under a positive duty to direct a discharge, albeit deferred for a period of six weeks to enable after-care arrangements to be put in place. It follows therefore that Judge Foster’s two decisions must be quashed. Both of those decisions are unlawful, in that they are predicated on a reading of the First-tier Tribunal’s decision which can in no way be justified.†[38] Part 2:Discussion of the Administrative Appeals Chamber 2.1 Enhancing the first tier tribunal? (a) Weaknesses Despite the fact that the Administrative Appeals Chamber has only been in operation for a short time there are some evident weaknesses in the way case law has developed which arguably undermine rather than enhance the First-Tier tribunal’s role[39]. The most obvious weakness is the fact that the decisions of the Upper Tribunal are amenable to judicial review[40]. Perhaps it was wishful thinking that unappealable decisions of the Upper Tribunal would not be subject to judicial review and that the two-tier system would continue to be â€Å"authoritative, efficient and self-contained† as Phillip Murray points out[41]. There was a clear intention by Parliament in the drafting of the 2007 Act that the Upper Tribunal would have the final say as to whether any appeal from the First Tier Tribunal on a point of law should be allowed and, since there is little difference between an appeal on a point of law and a judicial review[42], a judicial leak has appeared in what was, until the Supreme Court’s decision[43], a very tight and secure system. The implications of allowing review of the Upper Tribunal’s decisions are, in Murray’s opinion, grave: â€Å"Judicial review is not, like appeal, concerned with settling important points of principle or practice. Rather, its concern is with vires – that is, ensuring that decision-makers act within the four corners of their power – as well as questions of procedural fairness. This is the primary focus of the Sivasubramaniam model, and it would have been preferable as a result. Such an approach would have maintained the orthodox constitutional basis for review, avoided flouting Parliament’s express will, and ensured proportionate protection of the rule of law.†[44] (b) Strengths The strengths of the administrative appeals chamber certainly outweigh the main weakness identified above in enhancing the First-Tier Tribunal. The high number of successful appeals which have, in the context of mental health and explored earlier, set aside decisions of the first-tier tribunal are obvious indicators of the Upper Tribunal enhancing the First-Tier Tribunal’s safeguarding role by ensuring justice is done[45]. Thus in the 28 cases it is apparent that erroneous decisions are being caught and corrected with appropriate procedures whether that is having the decision set aside or remitted back to a reconstituted First-Tier Tribunal. The use of the judicial review function is both innovative and flexible and has, in two key decisions, proved to be invaluable in reversing procedural decisions taken at first instance[46]. In the Mersey case the internal review procedure of the First Tier Tribunal was simply ineffective and it took the Upper Tribunal to step in and rectify matters under judicial review in an impartial and independent manner. The Administrative Appeals Chamber enables the First-Tier Tribunal to be compatible with article 6 of the European Convention on Human Rights both in terms of independence and also in terms of procedural fairness. Conclusion In conclusion the Administrative Appeals Chamber has, in its short lifespan, enhanced the safeguarding role of the First-Tier tribunal within the new unitary system ushered in by the Leggatt Review of 2001[47]. In the context of mental health cases there have been 28 in total in the 3 years of the 2007 Act’s operation which serve to validate the work of the Upper Tribunal. As can be expected the number of appeals is relatively modest but clearly the Upper Tribunal is performing a vital function in holding the First-Tier tribunal to account and, where appropriate, setting aside its decisions. In terms of the novel judicial review function this has been used only twice in the context of mental health but has demonstrated a willingness by the tribunal system to deploy it when natural justice demands it. The fact that the First-Tier Tribunal can review its own decisions is not in itself an adequate safeguard and the case of MP v Mersey Care NHS Trust[48] is a useful reminder that the first instance tribunals, just like courts, need to be supervised independently. The Upper Tribunal also ensures vital article 6 compliance. This aspect enhances the whole system which can now survive scrutiny from Strasbourg. The one main weakness, that the Upper Tribunal is susceptible to judicial review itself, is in reality a technical one and something that is unlikely to become a crippling problem. Overwhelmingly the Upper Tribunal has enhanced the First-Tier Tribunal in its short life. Bibliography 1.0 Books Bradley, AW Ewing, KD (2011) Constitutional Administrative Law Pearson: Worldwide Creyke, Robin (2008) Tribunals in the Common Law World Federation Press: Sydney Jacobs, Edward (2010) Tribunal Practice and Procedure: Tribunals under the Tribunals, Courts and Enforcement Act 2007 Legal Action Group: UK Thompson, Brian (2010) ‘Current Developments in the UK: System Building – From Tribunals to Administrative Justice’ in Adler, Michael (ed) Administrative Justice in Context Hart Publishing: Oregon and Portland at p.484 2.0Journals Case Comment (2011) ‘Tribunal Merger may â€Å"dilute rather than enhance† expertise, Lady Hale warns’ Solicitors Journal 155(25), 3 Gledhill, Kris (2009) ‘The First Flight of the Fledgling: The Upper Tribunal’s Substantive Debut’ Journal of Mental Health Law Spring 81-93 Mitchell, Gareth (2010) ‘Judicial Review, but not as we know it: Judicial Review in the Upper Tribunal’ Judicial Review 15(2), pp112-117 Murray, Phillip (2011) ‘Judicial Review of the Upper Tribunal: Appeal, Review, and the Will of Parliament’ in Cambridge Law Journal 70(3), pp487-489 Rutledge, Desmond (2011) ‘Practice and Procedure: Jurisdiction – Scope for Judicial Review of Upper Tribunal Decisions by High Court’ Journal of Social Security Law 18(4) pp135-137 3.0 Reports Leggatt, Andrew (2001) Tribunals for Users, One System, One Service accessed on 20/12/2011 and available from: http://webarchive.nationalarchives.gov.uk/+/http://www.tribunals-review.org.uk/leggatthtm/leg-00.htm Report of the Franks Committee, Cmnd 218, 1957, parts II and III Transforming Public Services: Complaints, Redress and Tribunals CM 6243, 2004 4.0 Statutes Tribunals, Courts and Enforcement Act 2007 European Convention on Human Rights article 6 First tier Tribunal and Upper Tribunal (Chambers) Order 2008 5.0 Cases AH v West London Mental Health Trust and another [2011] AACR 15 CM v DHNHSFT and Secretary of State (Justice) [2011] UKUT 129 (AAC) Dorset Healthcare NHS Foundation Trust v MH [2009] UKUT 4 (AAC) (UT) DN v Northumberland Tyne Wear NHS Foundation Trust [2011] UKUT 327 (AAC) JLG v Managers of Llanarth Court SOS for Justice [2011] UKUT 62 (AAC); DP v Hywel DDA Health Board [2011] UKUT 381 (AAC) KL v Somerset Partnership NHS Foundation Trust [2011] UKUT 233 (AAC) MB v BEH MH NHST SoSJ [2011] UKUT 328 (AAC) PS v Camden and Islington NHS Foundation Trust [2011] AACR 42 (on the application of Cart) v Upper Tribunal [2011] UKSC 28 (SC) R (On the application of Cart) (Appellant) v The Upper Tribunal [2011] UKSC 28 RN v Curo Care/ OE [2011] UKUT 263 (AAC) RB v Nottinghamshire Healthcare NHS Trust [2011] UKUT 73 (AAC) TR v Ludlow Street Healthcare Ltd and TR [2011] UKUT 152 (AAC) Appendix A: Decided cases of the Administrative Appeals Chamber in Mental Health From research conducted for this essay from the Government’s tribunal judiciary homepage accessed on 19/12/2011 and available from: http://www.administrativeappeals.tribunals.gov.uk/Decisions/decisions.htm Top of Form Decision DateFile No.NCNCategorySubcategoryDecision Added 28/05/2010JR 3066 20092010 UKUT 160 AACTribunal procedure and practice (including UT)other29/06/2010 23/04/2010M 837 20102010 UKUT 119 AACMental healthAll05/05/2010 08/04/2010M 1653 20092010 UKUT 102 AACMental healthAll05/05/2010 25/02/2010M 2704 20092010 UKUT 59 AACMental healthAll15/03/2010 01/10/2009M 827 20092009 UKUT 195 AACTribunal procedure and practice (including UT)tribunal jurisdiction13/10/2009 07/08/2009M 708 20092009 UKUT 157 AACMental healthAll02/09/2009 08/01/2009M 3592 20082009 4Mental healthAll14/01/2009 Top of Form Decision DateFile No.NCNCategorySubcategoryDecision Added 15/03/2011JR 2381 20102011 UKUT 107 AACMental healthAll30/03/2011 17/02/2011HM 84 20102011 UKUT 74 AACMental healthAll07/03/2011 11/02/2011HM 840 20102011 UKUT 73 AACMental healthAll07/03/2011 09/02/2011HMW 2881 20102011 UKUT 62 AACMental healthAll07/03/2011 20/12/2010HM 1533 20102010 UKUT 454 AACMental healthAll12/01/2011 17/12/2010HM 525 20102010 UKUT 455 AACMental healthAll12/01/2011 12/11/2010M 695 20092010 UKUT 32 AACTribunal procedure and practice (including UT)statements of reasons17/02/2010 03/09/2010HMW 134 20102010 UKUT 319 AACMental healthAll06/10/2010 29/07/2010M 84 20102010 UKUT 264 AACMental healthAll17/08/2010 02/06/2010M 1089 20092010 UKUT 185 AACMental healthAll17/06/2010 Bottom of Form Top of Form Decision DateFile No.NCNCategorySubcategoryDecision Added 21/09/2011HMW 1339 20112011 UKUT 381 AACMental healthAll06/12/2011 16/08/2011HM 226 20112011 UKUT 327 AACMental healthAll13/09/2011 12/08/2011HM 803 20112011 UKUT 328 AACMental healthAll13/09/2011 10/06/2011HM 2479 20102011 UKUT 233 AACMental healthAll29/06/2011 11/04/2011HM 2201 20102011 UKUT 263 AACMental healthAll04/07/2011 07/04/2011HMW 509 20112011 UKUT 152 AACMental healthAll27/04/2011 30/03/2011HM 487 20112011 UKUT 143 AACMental healthAll19/04/2011 29/03/2011HM 840 20102011 UKUT 135 AACMental healthAll19/04/2011 23/03/2011HM 2915 20102011 UKUT 129 AACMental healthAll19/04/2011 15/03/2011JR 2381 20102011 UKUT 107 AACMental healthAll30/03/2011 How to cite The contribution of the Upper tribunal to the first-tier tribunal’s work, Essay examples

Cardiomyopathy A Disease Of The Heat Muscle Essay Example For Students

Cardiomyopathy : A Disease Of The Heat Muscle Essay Cardiomyopathy is a disease of the heat muscle and has many different types. Dilated, Hypertrophic, and Restrictive are the three main types of cardiomyopathy. Each of these types have different causes, signs and symptoms, and treatments. In cardiomyopathy, the heart muscle can become enlarge, thick, or rigid, and in some rare incidents the muscle tissue can become replaced with scar tissue. As the condition worsens, the heart becomes weaker and less able to pump blood throughout the body. The heart will also become unable to maintain a normal electrical rhythm. Results from cardiomyopathy can lead to heart failure or irregular heartbeats called arrthymias (American Heart Association, 2016). Dilated cardiomyopathy is the most common type of cardiomyopathy, occurring in adults between the ages of 20-60. It affects more of the male population then the female population. Dilated cardiomyopathy affects the heart’s lower (ventricles) and upper (atria) chambers of the heart. The disease starts in the left ventricle (heart’s main pumping chamber). As the chamber dilates, the heart muscle doesn’t contract normally and can’t pump blood very well. The inside of the chamber enlarges and the problem often spreads to the right ventricle and then to the atria (Elliot. 2000). Signs and symptoms of dilated cardiomyopathy †¢ Systemic embolism ( blood clot in arterial circulation) †¢ Pulmonary congestion (excess fluid in the lungs) †¢ Low cardiac output †¢ Fatigue for many months or years †¢ Intercurrent illness †¢ Development of arrhythmias †¢ Genetics †¢ Sudden death (Elliot, 2000) Myocarditis an inflammation of the heart muscle is known to be a cause of dilated cardiomyopathy. A carnitine and calcium deficiency can also lead to dilated cardiomyopathy. Excessive alcohol and drug use such as Anthracyclines have been linked to the cause of dilated cardiomyopathy. Anomalous coronary arteries, a malformation of coronary vessels and arteriovenous malformations, a congenial disorder of blood vessels in the brain are some other known causes. X linked diseases such as Becker’s and Duchene’s muscular dystrophies are linked to dilated cardiomyopathy as well as mitochondrial mutations. Becker’s muscular dystrophy is an x linked recessive inherited disorder in which the leg and pelvis muscle slowly weakens. Duchene’s muscular dystrophy is a severe form that is caused by an x linked genetic defect that prevents the production of dystrophin, a normal protein found in muscles. Most cases of dilated cardiomyopathy are idiopathic (Elliot, 2000). Diagnosis for dilated cardiomyopathy starts with an assessment of the patient’s family history, specially paying attention to a history of muscular dystrophy, mitochondrial diseases (epilepsy), and signs/symptoms of other inherited diseases. A complete drug history is also essential, both in the administration of drugs that are toxic to the heart and the use of illegal drugs such as cocaine. An ECG in patients with dilated cardiomyopathy could be remarkably normal, but abnormalities in an isolated T wave to septal changes to Q wave can show up with patients who have extensive left ventricular fibrosis, prolonged AV conductions, and bundle branch block may be seen. 20%-30% of patients have non-sustained ventricular tachycardia and a small percent present with sustained ventricular tachycardia. Metabolic exercise testing may be able to provide diagnostic information in patients with ventricular impairment by detecting a severe state of low blood pH (Elliot, 2000). There is no specific treatment for dilated cardiomyopathy. The primary aim of treatment is to control the symptoms, prevent disease progression, and prevent complications of progressive heart failure, sudden death, and obstruction of blood vessels by a blood clot. Warfin is used to treat patients with moderate ventricular dilation. Partial left ventriculectomy is performed to reduce the left ventricular size by removing a portion of its circumference to reduce stress on the wall and to improve ventricular blood flow (Elliot, 2000). .uc96d7413db3006f94bae5df3248cf11b , .uc96d7413db3006f94bae5df3248cf11b .postImageUrl , .uc96d7413db3006f94bae5df3248cf11b .centered-text-area { min-height: 80px; position: relative; } .uc96d7413db3006f94bae5df3248cf11b , .uc96d7413db3006f94bae5df3248cf11b:hover , .uc96d7413db3006f94bae5df3248cf11b:visited , .uc96d7413db3006f94bae5df3248cf11b:active { border:0!important; } .uc96d7413db3006f94bae5df3248cf11b .clearfix:after { content: ""; display: table; clear: both; } .uc96d7413db3006f94bae5df3248cf11b { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uc96d7413db3006f94bae5df3248cf11b:active , .uc96d7413db3006f94bae5df3248cf11b:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uc96d7413db3006f94bae5df3248cf11b .centered-text-area { width: 100%; position: relative ; } .uc96d7413db3006f94bae5df3248cf11b .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uc96d7413db3006f94bae5df3248cf11b .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uc96d7413db3006f94bae5df3248cf11b .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uc96d7413db3006f94bae5df3248cf11b:hover .ctaButton { background-color: #34495E!important; } .uc96d7413db3006f94bae5df3248cf11b .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uc96d7413db3006f94bae5df3248cf11b .uc96d7413db3006f94bae5df3248cf11b-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uc96d7413db3006f94bae5df3248cf11b:after { content: ""; display: block; clear: both; } READ: General Studies and research of Cardiology EssayHypertrophic cardiomyopathy (HCM) is a primary disease of the muscle of the heart in which a portion of the heart muscle is thickened without any obvious cause. The thickening of the heart muscle creates functional impairment and can make it harder for the heart to pump blood. This type of cardiomyopathy is the leading cause of sudden death in young athletes. HCM can often go undiagnosed because most people have few, if any symptoms and can lead normal lives with no significant problems. However, a small number of people with a thickened heat muscle may experience shortness of breath, chest discomfort, fainting, dizziness, pa lpitations, and extreme fatigue. HCM is caused by a gene mutation and appears in 50% of people of any generation. The mutated gene influences certain proteins that are part of the heart muscle (Maron, 2002). Hypertrophic cardiomyopathy is usually identified by an echocardiogram that produces ultrasound images of the thickened wall of the heart muscle. HCM is most prominent in the wall separating the left and right ventricle (ventricular septum). Echocardiograms may also show partial obstruction of blood flow from the left ventricle into the aorta, caused by forward motion of the mitral valve and whether there is abnormal leakage through the mitral valve. Atrial fibrillation occurs frequently in HCM and accounts for the high numbers of unexpected hospitalizations. A-fib in older patients can cause heart failure and stroke, so anticoagulants may be recommended (Maron, 2002). Implantable cardioverter-defibrillator (ICD) is the most reliable and effective treatment for hypertrophic cardiomyopathy patients at high-risk. ICD has the potential to alter the course of the disease by automatically sensing and terminating lethal disturbances of heart rhythm, often in young people with little to no symptoms. If blood flow obstruction is detected, then a septal myectomy operation is recommended. A surgeon removes a small amount of muscle from the upper part of the septum. Treatment options are more limited to patients who have severe symptoms and these patients may become candidates for a heart transplant. Sudden death occurs in young patients who are athletes due to vigorous exertion (Maron, 2002). Restrictive cardiomyopathy (RCM) is a rare form of heart muscle disease that is characterized by restrictive filling of the hearts ventricles. The squeezing (contractile) function of the heart and wall thickness are usually normal, but the relaxation or filling phase of the heart is very abnormal. The lower walls of the heart become abnormally rigid and lack the flexibility to expand and to fill with blood. RCM is found mostly in children ages 5-6 years old and mostly in girls. There is no known cause (Goldstein, 2014). Signs and Symptoms of RCM †¢ Repeated lung infections †¢ Appearance of an enlarged heart †¢ Fluid in abdomen †¢ Enlarged liver †¢ Edema †¢ Abnormal heart sound †¢ Signs of heart failure †¢ Fainting †¢ Sudden death (Goldstein, 2014). Diagnosis for restrictive cardiomyopathy is very difficult to establish and is only made after certain symptoms become present such as decreased exercise tolerance, a gallop heart sound, syncope (fainting), or chest pain during exercise. Once suspected, certain test are performed to help confirm a diagnosis. An ECG can be most helpful by showing abnormalities of the atria. Cardiac catheterization is used to confirm a diagnosis of RCM, a catheter is slowly advanced through an artery or vein into the heart, while the doctor is watching it on a TV monitor, so the pressure in the hearts chambers can be measured. These measurements show significant elevated pressure during the relaxation period of the heart. In rare cases a cardiac biopsy may be performed to look for potential causes of RCM (Goldstein, 2014). Currently there is no â€Å"cure† for restrictive cardiomyopathy. Treatment is used to improve the symptoms of RCM. Diuretics, sometimes called water pills, can be taken to reduce excess fluid in the lungs and other organs by increasing urine production. Beta-blockers can be also given to slow the heartbeat and increase relaxation time of the heart. This can allow the heart to fill better with blood before each heart beat and decrease some of the symptoms created by stiff pumping chambers. Heart transplantation is the only effective surgery offered for patients with RCM, particularly those who already have symptoms at the time of diagnosis or have reactive pulmonary hypertension (Goldstein, 2014). .uc5e0655dea8a2376166e872a8102dca2 , .uc5e0655dea8a2376166e872a8102dca2 .postImageUrl , .uc5e0655dea8a2376166e872a8102dca2 .centered-text-area { min-height: 80px; position: relative; } .uc5e0655dea8a2376166e872a8102dca2 , .uc5e0655dea8a2376166e872a8102dca2:hover , .uc5e0655dea8a2376166e872a8102dca2:visited , .uc5e0655dea8a2376166e872a8102dca2:active { border:0!important; } .uc5e0655dea8a2376166e872a8102dca2 .clearfix:after { content: ""; display: table; clear: both; } .uc5e0655dea8a2376166e872a8102dca2 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uc5e0655dea8a2376166e872a8102dca2:active , .uc5e0655dea8a2376166e872a8102dca2:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uc5e0655dea8a2376166e872a8102dca2 .centered-text-area { width: 100%; position: relative ; } .uc5e0655dea8a2376166e872a8102dca2 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uc5e0655dea8a2376166e872a8102dca2 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uc5e0655dea8a2376166e872a8102dca2 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uc5e0655dea8a2376166e872a8102dca2:hover .ctaButton { background-color: #34495E!important; } .uc5e0655dea8a2376166e872a8102dca2 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uc5e0655dea8a2376166e872a8102dca2 .uc5e0655dea8a2376166e872a8102dca2-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uc5e0655dea8a2376166e872a8102dca2:after { content: ""; display: block; clear: both; } READ: Essay on Transcatheter Aortic Valve ReplacementPrognosis for cardiomyopathy is based on the different types. For dilated cardiomyopathy the prognosis is poor. 50% of patients die within 2 years of diagnosis and 25% survive longer than five years with treatment. The common cause of death for dilated cardiomyopathy is progressive heart failure and arrthymia. The overall annual mortality rate for hypertrophic cardiomyopathy is 3-5% in adult and at least 6% in children. Severity of disease and prognosis varies according to the genetic features associated with HCM. Restrictive cardiomyopathy has a very poor prognosis with patients dying within a year of the diagnosis even with treatment (Oakley, 1997).