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The Connected Hearts! The Left Fist Of Certain Death

Your heart is a strong muscle that pumps blood to your body. A normal, healthy adult heart is about the size of your clenched fist. Just like an engine makes a car go, the heart keeps your body running. The heart has two sides, each with a top chamber (atrium) and a bottom chamber (ventricle). The right side pumps blood to the lungs to pick up oxygen. The left side receives blood rich with oxygen from the lungs and pumps it through arteries throughout the body. An electrical system in the heart controls the heart rate (heartbeat or pulse) and coordinates the contraction of the heart's top and bottom chambers.

The Connected Hearts! The Left Fist of Certain Death

Your kidneys are two bean-shaped organs and are usually about the size of your fist. They are located a little below your rib cage and to the left and right of your spine. Your kidneys are powerful chemical factories and have the following jobs:

In a complete transposition of the great arteries (also called dextro-transposition of the great arteries), the pulmonary artery and the aorta have switched positions. The pulmonary artery connects to the left ventricle, and the aorta is connected to the right ventricle.

Most sudden cardiac deaths are caused by abnormal heart rhythms called arrhythmias. The most common life-threatening arrhythmia is ventricular fibrillation, which is an erratic, disorganized firing of impulses from the ventricles (the heart's lower chambers). When this occurs, the heart is unable to pump blood and death will occur within minutes, if left untreated.

Intensive endurance training is able to cause a distinct pattern of functional and structural changes of the cardiovascular system. In an unknown proportion of athletes a so called "athlete's heart" develops. There is an overlap between this type of physiologic cardiac hypertrophy and mild forms of hypertrophic cardiomyopathy (HCM), the most common genetic disorder of the cardiovascular system with a prevalence of 0.2%. HCM is caused by mutations in 14 genes coding for sarcomere proteins. In the literature up to 50% of cases of sudden cardiac death (SCD) in younger sportsmen were connected to hypertrophic cardiomyopathy. It is therefore the most common cause of SCD in highly trained young athletes. Because of this data a great interest in distinguishing these two diagnoses exists. Apart from clinical examination and some non-specific ECG-changes, Echocardiography is the method of choice. The athlete's heart shows an eccentric biventricular hypertrophy with wall thicknesses under 15 mm and a moderately dilated left ventricle (LVEDD up to 58 mm). HCM is commonly characterized by asymmetric left ventricular hypertrophy with a reduced LV-diameter. In up to 70% of cases left ventricular outflow tract obstruction is evident during stress echocardiography. Systolic function is normal in highly trained athletes and the majority of HCM patients as well. There are important differences regarding diastolic filling patterns. Physiological hypertrophy is consistent with a normal diastolic function with even increased early diastolic filling. In case of HCM diastolic dysfunction (mostly relaxation disturbances) occurs in the majority of patients and is therefore inconsistent with an athlete's heart. If the diagnosis could not be stated using echocardiography, methods like cardiac-MRI, metabolic exercise testing, histological studies of endomyocardial biopsies and genetic testing can provide further information. A correct diagnosis may on the one hand prevent some athletes from sudden cardiac death. On the other hand sportsmen with an athlete's heart are reassured and able to continue as competitors. New insights into electrophysiological changes during physiological hypertrophy could probably change this view.

Although most of us place our right hand on our left chest when we pledge allegiance to the flag, we really should be placing it over the center of our chest, because that's where our hearts sit. Your heart is in middle of your chest, in between your right and left lung. It is, however, tilted slightly to the left.

Emotions and stress can cause your body to release certain hormones that, under certain circumstances, can paralyze large portions of your heart. This is called "takotsubo's cardiomyopathy" or "broken heart syndrome," and primarily affects post-menopausal women. The stress that triggers this phenomenon can be the death of a loved one, the loss of money, a surprise party or even the fear of performing in public. Fortunately this syndrome is only temporary, and after supportive measures, heart function usually returns to normal.

In this painting, the two Fridas are holding hands. Theyboth have visible hearts and the heart of the traditional Frida iscut and torn open. The main artery, which comes from the tornheart down to the right hand of the traditional Frida, is cut offby the surgical pincers held in the lap of the traditional Frida.The blood keeps dripping on her white dress and she is in dangerof bleeding to death. The stormy sky filled with agitated cloudsmay reflect Frida's inner turmoil.

*108 Dr. Cooper, in explaining why he was of the opinion that the unusual physical effort and mental stress and strain exerted and experienced by decedent immediately prior to his attack accelerated his death 100 per cent, said: "I don't see how you can apportion it. To my mind, I don't care how really severe the anatomical changes are, up to a certain degree. In this particular instance, he had a significant coronary artery disease, as I gather of all coronary vessels, and he had evidence of scarring, he even had evidence of diminishing of the wall due to lack of muscle tissue, but there is no way to predict whether he will, arbitrarily, survive for 30 or 40 years, or whether he will not, based on this disease. We have people who have evidence of involvement of all their arteries at various times who are still having excess pain under certain circumstances, and they will still work and nothing of a major consequence, and certainly not death, has occurred." In response to the question, "* * * is there any way that you can apportion " Dr. Cooper said: "I can't see how in this case. It looks like he is all or none. He was fully performing his duties up to the morning of the death and as far as I understand your question, there weren't any symptoms. And here at 12:00, he's dead. And I don't see how you can apportion it is either 100 per cent or nothing here. If I get your question correctly, I don't see how you can apportion that."

We are cognizant of the fact that in Victor Wine and Liquor, Inc. v. Beasley, Fla., 141 So. 2d 581, after quoting Section 440.02 (19), Fla. Stat.F.S.A., we stated: "In heart attack cases where the claimant is entitled to compensation, this statute excludes any recovery for disability attributable in fact to the pre-existing condition and limits recovery solely to injury from the aggravation. * * *". In that case, the claimant "sought workmen's compensation for a disability diagnosed as a coronary occlusion." We were not faced at that time with the question which is presented here: What should a Deputy Commissioner do when there is competent, substantial evidence presented to him to the effect that the deceased employee died as the result of "ventricular fibrillation" or "arrhythmia" super induced by unusual physical and mental stress and strain not common to his routine duties, rather than a myocardial infarction and that it is impossible to apportion the award by attributing a certain percentage to the pre-existing disease and another percentage to the acceleration of death "reasonably attributable to the accident" ?

In the cause under consideration the deputy, on conflicting medical evidence, found that the employee's death was causally related to his activity during the fire drill; that all four doctors agreed the employee had severe pre-existing coronary arteriosclerosis, had suffered previous coronary infarctions and probably died of ventricular fibrillation; that prior to claimant's fatal attack his right coronary artery was 100% occluded and the left coronary artery 95% occluded. Two doctors were of the opinion death could have been accelerated 5%, a third doctor testified 10% at most, by exertion during the fire drill.

At the close of the evidence introduced for the plaintiff, the defendant, by counsel, moved the court to instruct the jury that upon the pleadings and evidence, the plaintiff could not recover. That motion was denied, and the action of the court -- to which the defendant at the time excepted -- is assigned for error. This instruction, it is claimed, should have been given upon the ground that the evidence disclosed no symptom whatever of insanity upon the part of the insured. But that position cannot be sustained upon any proper view of the testimony. There certainly was evidence tending to show a material, if not radical, change for the worse in the mental condition of the insured immediately preceding his death. In the judgment of several who knew him intimately and had personal knowledge of such change, he was not himself at the time of the act of self-destruction. Whether this strange demeanor immediately before his death was the result of deliberate, conscious purpose

Exception was also taken to the action of the court in permitting the witness Aldrich to answer a certain question. He saw the deceased a few moments before his death, and observed that he "looked strange;" had "a very peculiar look," one that he had never seen before. It was "a wild look." Being asked what impression Pitkin made upon him by his manner and

One other assignment of error remains to be considered. It relates to the admissions of the statements made by two witnesses of what passed between each other on the occasion of their seeing and conversing with the deceased within an hour or two before he shot himself. They detailed what passed between them and the deceased, describing the latter's appearance and condition as indicating, in their judgment, that he was not in his right mind. As he left the presence of these witnesses, one of them remarked to the other that "Pitkin is not himself; George looks kind of crazy." The other, in response, expressed substantially, though in different language, his concurrence in that opinion. To the admission of this brief conversation between the witnesses on the occasion referred to the defendant objected, but the objection was overruled and an exception taken. We do not think there was in this any error to the prejudice of the substantial rights of the company. The witnesses, when under oath, expressed the same opinion as to the condition of the deceased. What passed between them at the time to which their testimony referred was a part of what occurred on the occasion when they saw the deceased, and may well have been repeated to the jury as showing that their opinion as to the mental condition of the deceased was not then presently formed, but was one formed at the very moment they saw him within a very few hours before his death. 350c69d7ab


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