30‏/5‏/2011

صغيرتي

صغيرتي ويا املي
في حياتي دخلتي وفي ايامي
ربطتي أوقاتي بأوقاتك وافكاري بافكارك وكلماتي بكلماتك
وجدت كل ما حولي يكتب اسمك يربطني بفكرك ويربطني بك
حتي عواطفي لم تعد في صفي .....بل انحازت لك
تسمع منك ....تفكر فيك ..وتطلب منك كل لحظة الامل والمستقبل
وتطلبك انتي نفسك لذلك المستقبل .
مستقبل بجناحين ..نحن جناحاه
وانتي جناحي
سنحلق معا كالفراشات
سنشتم عبير الياسمين بين ازهار الباساتين
سنتقابل مع العاشقين ..سنعتكف في كهف المحبين
سنكتب بعبير الحب قصتنا سنعبر جسر الامل الي فكرتنا
وستعلمين يا صغيرتي غدا انني ......صادق عندما ترين واقع ما اقول
وليس لدي سوي حبك ليضمن لكي صدقي وصدق محبك الصغير
اما الان ساقولها لك ولك القرار


احبك يا صغيرتي

احبك يا صغيرتي

امك ثم امك ثم امك






ولكنها رفضـت لعلمهـا سوف يصرفـها فقط على ألعاب الفيديو وشراء الحلويات التي يحبها ...


استبد الغضب بالابن لما رأى من ظلم أصابه, وفي المساء عندما كانت الأم في المطبخ تعد العشاء ,

وقف الابن أمامها وسلمها ورقـة أعدها مسبقـاً بعد آن جففت الأم يدها وأمسكت بالورقة

وقرأت المكتوب :

1- سعر تنظيـف غرفتـي لهـذا الأسبوع
= 70 ريال

2- سعر ذهابي للسوق مكانك =20 ريال

3- سعر اللعب مع أخـي الصغير = 20 ريال

4- سعر مساعدتي لكِ في تنظيـف
البيت = 20 ريال

5- سعر حصُولـي على علامـات ممتازة
في المدرسة = 70 ريال

والمجموع = 200 ريال









"" وفوا ألأجير حقـه قبـل أن يجف عرٍقـه""



نظـرت الأم إلى ابنها الواقف بجـانبها , ابتسمت بحنـان والتقطت
قلمـاً و قلبت الورقة وكتـبت :


1- سعر تسعة أشهر حملتك بها في
أحشائي = بلا مقابل

2- سعر الحليب الكامل الذي أرضعتك
إياه عشرون شهـراً = بلا مقابل

3- سعر تغيير الحفاضات وتنظيفك
لست سنـوات = بلا مقابل

4- سعر كل الليالي التي سهرتها
بجانبك في مرضك ومن آجل تطبيبك
=بلا مقابل

5- سعر كل التعب والدموع التي
سببتها لي طوال السنين = بلا مقابل

6 - سعر كل الليالي التي شعـرت بها
بالفزع لأجلك وللقلق الذي انتابني= بلا مقابل

7 - سعر كـل الألعاب والطعـام
والملابس إلى اليوم = بلا مقابل

يا ابني :
حيـن تجمع كـل هذا فإن سعر حبـي
لـك بلا مقابل ..


حيين انتهى الابن ما كتبته أمـه أغرقت
عينـاه بالدموع
ونظـر لأمـه و قال :

" أمـي سامحيني أحبك كثيرا
ثـم أخـذ القلم وكتب بخط كبيـر ..

" دين لا يمكن ردهـ"

كـن معطاء ولا تكن متطـلبا ..
خصوصا مع أبويك فهناك الكثير لتعطيه لهما غيـر المال ...



النصيحة:

إذا كانت أمك على قيـد الحياة وقـريبة منـك ..
فقبـل رأسها وأطلب منها أن تسامحك..
وإذا كانت بعيدة عنـك أتصل بها ..
وإذا متوفية فأدعو لها الله بالرحمة...

27‏/5‏/2011

قصيدة بلقيس







شُكراً لكم ..
شُكراً لكم . .
فحبيبتي قُتِلَت .. وصار بوُسْعِكُم
أن تشربوا كأساً على قبر الشهيدهْ
وقصيدتي اغْتِيلتْ ..
وهل من أُمَّـةٍ في الأرضِ ..
- إلا نحنُ - تغتالُ القصيدة ؟

بلقيسُ ...
كانتْ أجملَ المَلِكَاتِ في تاريخ بابِِلْ
بلقيسُ ..
كانت أطولَ النَخْلاتِ في أرض العراقْ
كانتْ إذا تمشي ..
ترافقُها طواويسٌ ..
وتتبعُها أيائِلْ ..
بلقيسُ .. يا وَجَعِي ..
ويا وَجَعَ القصيدةِ حين تلمَسُهَا الأناملْ
هل يا تُرى ..
من بعد شَعْرِكِ سوفَ ترتفعُ السنابلْ ؟
يا نَيْنَوَى الخضراءَ ..
يا غجريَّتي الشقراءَ ..
يا أمواجَ دجلةَ . .
تلبسُ في الربيعِ بساقِهِا
أحلى الخلاخِلْ ..
قتلوكِ يا بلقيسُ ..
أيَّةُ أُمَّةٍ عربيةٍ ..
تلكَ التي
تغتالُ أصواتَ البلابِلْ ؟
أين السَّمَوْأَلُ ؟
والمُهَلْهَلُ ؟
والغطاريفُ الأوائِلْ ؟
فقبائلٌ أَكَلَتْ قبائلْ ..
وثعالبٌ قَتَـلَتْ ثعالبْ ..
وعناكبٌ قتلتْ عناكبْ ..
قَسَمَاً بعينيكِ اللتينِ إليهما ..
تأوي ملايينُ الكواكبْ ..
سأقُولُ ، يا قَمَرِي ، عن العَرَبِ العجائبْ
فهل البطولةُ كِذْبَةٌ عربيةٌ ؟
أم مثلنا التاريخُ كاذبْ ؟.

بلقيسُ
لا تتغيَّبِي عنّي
فإنَّ الشمسَ بعدكِ
لا تُضيءُ على السواحِلْ . .
سأقول في التحقيق :
إنَّ اللصَّ أصبحَ يرتدي ثوبَ المُقاتِلْ
وأقول في التحقيق :
إنَّ القائدَ الموهوبَ أصبحَ كالمُقَاوِلْ ..
وأقولُ :
إن حكايةَ الإشعاع ، أسخفُ نُكْتَةٍ قِيلَتْ ..
فنحنُ قبيلةٌ بين القبائِلْ
هذا هو التاريخُ . . يا بلقيسُ ..
كيف يُفَرِّقُ الإنسانُ ..
ما بين الحدائقِ والمزابلْ
بلقيسُ ..
أيَّتها الشهيدةُ .. والقصيدةُ ..
والمُطَهَّرَةُ النقيَّةْ ..
سَبَـأٌ تفتِّشُ عن مَلِيكَتِهَا
فرُدِّي للجماهيرِ التحيَّةْ ..
يا أعظمَ المَلِكَاتِ ..
يا امرأةً تُجَسِّدُ كلَّ أمجادِ العصورِ السُومَرِيَّةْ
بلقيسُ ..
يا عصفورتي الأحلى ..
ويا أَيْقُونتي الأَغْلَى
ويا دَمْعَاً تناثرَ فوق خَدِّ المجدليَّةْ
أَتُرى ظَلَمْتُكِ إذْ نَقَلْتُكِ
ذاتَ يومٍ .. من ضفاف الأعظميَّةْ
بيروتُ .. تقتُلُ كلَّ يومٍ واحداً مِنَّا ..
وتبحثُ كلَّ يومٍ عن ضحيَّةْ
والموتُ .. في فِنْجَانِ قَهْوَتِنَا ..
وفي مفتاح شِقَّتِنَا ..
وفي أزهارِ شُرْفَتِنَا ..
وفي وَرَقِ الجرائدِ ..
والحروفِ الأبجديَّةْ ...
ها نحنُ .. يا بلقيسُ ..
ندخُلُ مرةً أُخرى لعصرِ الجاهليَّةْ ..
ها نحنُ ندخُلُ في التَوَحُّشِ ..
والتخلّفِ .. والبشاعةِ .. والوَضَاعةِ ..
ندخُلُ مرةً أُخرى .. عُصُورَ البربريَّةْ ..
حيثُ الكتابةُ رِحْلَةٌ
بينِ الشَّظيّةِ .. والشَّظيَّةْ
حيثُ اغتيالُ فراشةٍ في حقلِهَا ..
صارَ القضيَّةْ ..
هل تعرفونَ حبيبتي بلقيسَ ؟
فهي أهمُّ ما كَتَبُوهُ في كُتُبِ الغرامْ
كانتْ مزيجاً رائِعَاً
بين القَطِيفَةِ والرخامْ ..
كان البَنَفْسَجُ بينَ عَيْنَيْهَا
ينامُ ولا ينامْ ..



نزار قبانى فى وفاة زوجته....رجلاً طالما قدس المراءة واحترها بغيداً عن تطاولاته الربانيه

26‏/5‏/2011

فتحت جرنال " التيت "





فتحت جرنال " التيت "

لقيتهم كاتبين شخابيط

أول خبر

نجحت الثورة

نجاح كبير

بفضل ميدان التحرير

بس خلاص ياجماعه نهدى

لاحسن الحمل بقى كبير

صبرنا عليهم وقولنا

عايزين ياحكومة حلول

قالوا مافيش فلوس

قولنا .. ح نقضيها طول الشهر فول

إحنا بنحب بلادنا وحنفضل بايدينا نبنيها

حتى لو ح نصوم شهر

هنصبر لأجل ما نعليها

سألنا ياترى اللي جي ح يكون إيه ..؟!

قالوا متسألوش لسه بنصفي القديم

اللي تعرفوا خلاص على الشاشة اتذاع

واللي محدش يعرفوا .. ده بقى لسه فيه كتير

النظام كان كله " شبربرم "

وكل أوراقهم .... غم

إختلاس

سرقه

نهب

أهو مال مالوش صاحب والكل فيه بيلم

أنا قلت أروح واسأل عن اشاعات النظام القديم

أخبار ايه الطيور وإنفلونزا الخنازير ..؟

قالولي اللحمه كانت صالحه وخنزيرنا عال العال

كانوا بيأكلوا الزباله والعدات كان شغال

قلت وانفلونزا الطيور بردو زي الخنازير ..؟

قالولي أما الطيور

دي كانت كدبة إبريل

والنظام خم المصريين .


جميع الحقوق محفوظه للكاتبه/ هايدى دياب

رسالة من تحت الماء







.. إن كنت صديقي
ساعدني كي أرحل عنك
.. أو كنت حبيبي
.. ساعدني كي أشفى منك
.. لو أني أعرف
.. أن الحب خطير جدا .. ما أحببت
.. لو أني أعرف
.. أن البحر عميق جدا .. ما أبحرت
.. لو أني أعرف خاتمتي
.. ما كنت بدأت

.. اشتقت إليك
.. فعلمني .. أن لا أشتاق
.. علمني
كيف أقص جذور هواك من الأعماق
.. علمني
.. كيف تموت الدمعة في الأحداق
.. علمني
.. كيف أثور عليك
وأنجو من سيف الأشواق
.. فأنا من بعدك باقية
.. ككتاب مقطوع الأوراق
.. يا كل الماضي والحاضر
.. يا عمر العمر
.. حبي لك حب شعري
.. فلماذا تقتل في الشعر ؟
حبي لك حب مائي
.. فلماذا تدفعني للصخر ؟
.. يا من أهديتك ضوء الشمس
لماذا تهديني الظلماء ؟
يا من قدمت لك الغابات
لماذا تعطيني الصحراء؟
.. يا من تتنزه فوق البر
.. وجسمي تمضغه الأنواء
.. أني في الماء
.. وصوتك يأتيني من تحت الماء
.. وملامح وجهك
.. تخرج لي كالمارد من أعماق الماء
.. وخطوط يديك تطاردني
.. حتى في الماء
. آه .. لو تغرق ذاكرتي
، لو يغرق وجهك ، والتاريخ
.. وتغرق آلاف الأشياء
.. آه .. كم أشعر بالإعياء

.. إن كنت نبيا
.. خلصني من هذا السحر
.. من هذا الكفر
، حبك كالكفر
.. فطهرني من هذا الكفر
.. إن كنت قويا
أخرجني من هذا اليم
.. فأنا لا اعرف فن العوم
.. الموج الأزرق .. في عينيك
.. يجرجرني نحو الأعمق
.. أزرق .. أزرق
لا شيء سوى اللون الأزرق
وأنا ما عندي تجربة
في الحب ، ولا عندي زورق
.. أن كنت أعز عليك
.. فخذ بيدي
.. فأنا عاشقة .. من رأسي
.. حتى قدمي
.. أني أتنفس تحت الماء
.. إني اغرق
.. أغرق .. أغرق
.. أغرق



نزار قبانى

24‏/5‏/2011

المدينة الفاضله





ظننتها المدينة الفاضلة

وظننتهم شرفاء

فاكتشفت باننى الغافلة

فطوال الوقت كنا نساق

وطوال الوقت كان يحكمنا الاباطرة

قضوا على كل الشرفاء

استوطن بلدى الغرباء

وعاملونى كزائرة

والعجيب باننى

استمريت اظنها المدينة الفاضلة

نعم!!!قد كنت غافلة

كيف لم نرى تلك الابتسامات الخبيثة

والانياب الكاسرة ؟؟

كيف لم ندقق فى وجوه الظلم يوما

ونقول كفى للجبابرة؟؟

يبدو واننى لم وحدى الغافلة

يوميا اسمع مئات القرارات الصادرة

ما هذا الفساد كله ؟

ءاصبح الشرف الان عملة نادرة؟

فقد كذبوا الصادق

وخونوا الامين

واصبح امير الخائنين على خزائنها

مسيطــــرا

ولطالما ظننتها المدينة الفاضلة

نعم قد كنت غافلة




by/ra7ma

جحود وحنين






قابلها صدفه بعد أن تركها طويلا

قال لها :

اعذرينى لقد أصبح لى حبيبة أخرى ♥
......
...وقلباً أخر ♥ ومستقبلاً أخر ♥ فماذا عن حياتك أنتى؟


:
فأغمضت ♥ عيناها حتى تخفى دموعها ومر شريط ذكرياتهم سوياً

أمام عينها كسرعه البرق تذكرت فيها كيف كانت بجانبه لحظه بلحظه

بأوقات حزنه قبل فرحه ♥

بلحظات يأسه قبل نجاحه ♥

كيف رفضت كل رجال العالم من أجل أن تظل معه ♥

فإستجمعت قواها و قررت الحفاظ على بقايا كبريائها و نظرت إليه بكل إبتسامة ..

وقالت له:

.. أعذرنى سيدى ..





هل أعـــرفـــك؟؟!!

فقال له عذرا كنت اشبه عليكى فمشى الاثنين ولم تمر ثوانى الا وادارا وجههما واخذا يجريان الى بعض وتكلمت الاحضان وهى تبكى فأبكو الجميع الا انا فانا من خيال نفسى وعبقرية مشاعرى رأيتهما كاذبان

23‏/5‏/2011

حبيبى وتقاليدى







أستميحك عذرا سيدى ان تتقبل قبلاتى

اتسمح ان تفتح قلبك وتُحسن استقبالى

اتوسلك ان ترحمنى من نيران عذاباتى

ارجوك الا تتركنى لغمرات اهوائى

ضائعه من دونك تائهه لا اعرف عنوانى

الصقنى الى راسك واستمع بنغم لدقاتى

سأصرخ وأعلنها للعالم بانك محبوبى

سئمت ومللت من صمتى وانتظاراتى

فسحقاً لعاداتى وتقاليدى وسحقاً لهذيانى

سارتمى فى احضانك واعترف بانك مجنونى

ساأسخر قلمى وكلماتى ليحكوا عن غمراتى

ونهاية سأستفيق من وهمى على يد ترهاتى

فلا سحقاًً للعاداتِ ولا تحطيماً لتقاليدى

لا استسماحاً ولا لك منى فى حباً توسلاتى

ولكن تبقى انت حبيبى واشهد ان لا غيرك محبوبى



كلماتى

22‏/5‏/2011

Congestive Heart Failure

Congestive Heart Failure
Overview
Congestive heart failure is a condition in which your heart can't pump enough oxygen-rich blood to meet your body's needs. When your heart doesn't pump efficiently, blood may back up into your lungs and other tissues.
The severity of congestive heart failure depends on how much pumping capacity your heart has lost. As they age, most people lose some pumping capacity. However, in congestive heart failure, your heart has very little pumping capacity. Congestive heart failure often results from damage caused by a heart attack, high blood pressure, diabetes or other conditions.
Why choose Mayo Clinic
The doctors and researchers at Mayo Clinic actively develop new ways to diagnose and treat people who have heart failure. Each year, Mayo Clinic doctors trained in heart care (cardiologists) evaluate and treat thousands of people who have congestive heart failure.
Cardiologists and other specialists staff heart failure clinics at each Mayo Clinic location. The staff works together as a team to diagnose and treat all forms of congestive heart failure. The Advanced Heart Failure Clinic at Mayo Clinic in Minnesota is a facility devoted specifically to surgical advanced heart failure treatment.
Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for Heart & Heart Surgery by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for Heart & Heart Surgery.

Research
As a major heart failure research center, Mayo Clinic focuses on the detection and diagnosis of heart failure in its earliest stages. Mayo Clinic researchers study investigational and new treatments for people who have congestive heart failure. Mayo Clinic is part of the National Institutes of Health Heart Failure Clinical Research Network.
You may have the opportunity to participate in clinical trials of experimental therapies not available at all medical centers. Learn more about cardiovascular research at the research website.
Mayo Clinic publications
See a list of publications by Mayo Clinic doctors on congestive heart failure on PubMed, a service of the National Library of Medicine.
Investigational treatment studies
Mayo Clinic investigators are studying several potential therapies for congestive heart failure, including:
• Percutaneous heart valve repair. Leaky heart valves can cause or worsen heart failure by overworking your heart. Mayo Clinic researchers are studying devices implanted under the skin without surgery to reduce or prevent heart valve leakage.
• New surgical approaches. Mayo Clinic surgeons are studying new left ventricular assist devices, surgical and nonsurgical valve repair and replacement and heart muscle surgeries.
• Artificial heart. An all-mechanical artificial heart exists for special situations and is available as an investigational procedure. More commonly, surgeons use a device that replaces the function of one side of your heart (left ventricular assist device) or both sides (biventricular assist devices).
• New drugs. Mayo Clinic researchers are testing new drugs that may help people who have heart failure. Researchers developed these drugs by modifying the heart's defense system, the natriuretic peptide system, to create drugs that may enhance heart and kidney function
Diagnosis
Mayo Clinic heart disease doctors with special training in heart failure (heart failure cardiologists) work with other specialists to evaluate and treat people who have heart failure. The team has training in many areas, including noninvasive studies which use radioactive dyes to show heart structure and function (nuclear cardiology), heart rhythm disorders (electrophysiology), echocardiography, radiologic heart imaging and cardiac catheterization.
To diagnose heart failure, your heart failure cardiologist discusses your medical history and risk factors, performs a thorough physical examination and may also recommend other tests, including:
• Blood tests. Blood tests may indicate other diseases that affect your heart. A blood test for congestive heart failure checks for levels of a hormone called B-type natriuretic peptide (BNP). Your heart secretes BNP in high levels when overworked. A large amount of BNP in the blood may suggest congestive heart failure.
• Chest X-ray. An X-ray image shows the size and shape of your lungs and heart. In congestive heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. An X-ray can also be used to diagnose other conditions.
• Coronary catheterization (angiogram). In this test the doctor inserts a thin, flexible tube (catheter) into a blood vessel in your groin or elbow and guides the catheter to your heart. The doctor injects a dye into the arteries in your heart, making the arteries visible under X-ray. This test identifies narrowed arteries to your heart (coronary artery disease), which can cause congestive heart failure. The test also helps to show the strength of your heart's main pumping chamber (left ventricle) and the health of your heart valves.
• Echocardiogram. An echocardiogram uses sound waves to produce a detailed video image of your heart's size, structure and function. These images can help doctors determine your heart's pumping capacity and distinguish between forms of heart failure. This test also measures the percentage of blood pumping out of the heart's main pumping chamber (ejection fraction).
• Electrocardiogram (ECG). In this test, your doctor places sensor patches with wires attached (electrodes) on your skin to measure the electrical impulses given off by your heart. This test can reveal heart rhythm disorders and damage to your heart from a heart attack.
• Magnetic resonance imaging (MRI). An MRI uses magnetic fields and radio waves to create detailed images of your heart.
• Myocardial biopsy. In this test, your doctor inserts a small flexible biopsy cord into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test is performed to diagnose certain types of heart muscle diseases that cause heart failure.
• Right heart catheterization. In this test, your doctor inserts a thin, flexible tube (catheter) into a blood vessel (vein) in your neck or groin and guides the catheter to the heart to measure pressures within the heart chambers. This helps guide treatment in heart failure.
• Stress tests. In a stress test or exercise test, you exercise on a treadmill or stationary bicycle, or take a drug to simulate heart activity during exercise, while an electrocardiogram (ECG) monitors your heart. The exercise test helps your doctor judge your therapy's effectiveness and plan the timing of more advanced treatments. Different types of stress tests measure the heart's response to exercise in different ways and are used in different situations. Mayo Clinic is one of the few centers in the world that measures the relaxation response of the heart to exercise, a test used to diagnose diastolic heart failure.
• Radionuclide ventriculography or Multiple-gated Acquisition Scanning (MUGA). In this nuclear medicine test, the doctor injects a small amount of radioactive dye into your vein and special cameras show how much blood your heart can pump with each beat.
Results of these tests help doctors determine the cause of your symptoms and develop a treatment plan. Doctors classify heart failure based on a scale of I to IV. In Class I heart failure, the mildest form, you can perform everyday activities and not feel winded or fatigued. In Class IV, the most severe, you have shortness of breath even when you are at rest.
Treatment
At Mayo Clinic, doctors trained in heart care (cardiologists) and cardiologists with advanced training in heart failure (heart failure cardiologists) treat people who have congestive heart failure. Mayo Clinic cardiac surgeons have extensive experience in all types of surgery to treat heart failure and other heart diseases. Surgeons perform minimally-invasive heart surgery, implant ventricular assist devices (VADs) and perform heart transplants.
Congestive heart failure treatment can significantly improve your symptoms and help your weakened heart work as efficiently as possible. Doctors treat some people by correcting the underlying cause of the condition, such as controlling a fast heart rhythm, opening blocked arteries or repairing or replacing diseased valves. Heart failure specialists also treat conditions that may aggravate your underlying heart problems, such as sleep apnea, thyroid problems, anemia and other blood abnormalities.
Congestive heart failure treatment at Mayo Clinic may include surgery, medical devices, medications and lifestyle changes.
• Surgery
o Heart valve repair or replacement. Cardiologists may recommend heart valve repair or replacement surgery to treat an underlying condition that led to congestive heart failure. Heart valve surgery may relieve your symptoms and improve your quality of life.
o Coronary bypass surgery. Cardiologists may recommend coronary bypass surgery to treat your congestive heart failure if your disease results from severely narrowed coronary arteries.
o Heart transplant. Some people who have severe congestive heart failure may need a heart transplant.
o Myectomy. In a myectomy, the surgeon removes part of the overgrown septal muscle in your heart to decrease the blockage that occurs in hypertrophic cardiomyopathy. Surgeons may perform myectomy when medication no longer relieves your symptoms.
• Medical devices

Ventricular assist device
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o Ventricular assist device (VAD). When your weakened heart needs help pumping blood, surgeons may implant a VAD into your abdomen and attach it to your heart. These mechanical heart pumps can be used either as a "bridge" to heart transplant or as permanent therapy for people who aren't candidates for a transplant. Mayo Clinic offers VADs to many people who may have no other options.

Cardiac resynchronization therapy device
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o Cardiac resynchronization therapy (CRT) device (biventricular cardiac pacemaker). A cardiac resynchronization therapy device (biventricular cardiac heart pacemaker) sends specifically timed electrical impulses to your heart's lower chambers. CRTs are suitable for people who have moderate to severe congestive heart failure and abnormal electrical conduction in the heart.
o Internal cardiac defibrillator (ICD). Doctors implant ICDs under the skin to monitor and treat fast or abnormal heart rhythms (arrhythmias), which occur in some people who have heart failure. The ICD sends electrical signals to your heart if it detects a high or abnormal rhythm to shock your heart into beating more slowly and pumping more effectively.
• Medications. Doctors usually treat people who have congestive heart failure with medications proven to relieve symptoms and increase survival in people who have heart failure. Your doctor may also prescribe medications to lower blood pressure, improve circulation and prevent blocked arteries or blood thinners to prevent blood clots.
Several types of drugs may help treat your heart failure if you have reduced blood flow pumping out of your heart's main pumping chamber (left ventricle).
• Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors lower blood pressure, improve blood flow and decrease your heart's workload.
• Angiotensin II (A-II) receptor blockers. These drugs provide several benefits of ACE inhibitors without the potential side effect of a persistent cough.
• Beta blockers. Beta blockers slow the heart rate, lower blood pressure and lessen the risk of some abnormal heart rhythms.
• Digoxin. Also known as digitalis, digoxin increases the strength of heart contractions and tends to slow your heartbeat.
• Diuretics. Diuretics prevent fluid from collecting in your body and decrease fluid in your lungs, making breathing easier.
• Nesiritide. Nesiritide, which is given through a vein (intravenously), is a synthetic version of B-type natriuretic peptide (BNP), a hormone that occurs naturally in your body.
• Aldosterone antagonists. These medications may help your heart work better, reverse scarring of the heart and help prolong your life if you have severe congestive heart failure.
• Inotropes. These are intravenous medications used in severe heart failure patients to improve heart pumping function and maintain blood pressure.
Sometimes congestive heart failure becomes severe enough to require hospitalization and monitoring for a few days. While you're in the hospital, you may take medications that quickly help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen. People who have severe congestive heart failure that doesn't improve with treatment may need supplemental oxygen on a long-term basis.
• Lifestyle changes. Lifestyle changes often can relieve symptoms of congestive heart failure and prevent your disease from worsening. Some changes you can make include:
o Avoiding or limiting alcohol to one drink two or three times a week
o Avoiding or limiting caffeine
o Eating a low-fat, low-sodium diet
o Exercising by yourself or in a structured cardiac rehabilitation program
o Maintaining a healthy weight or losing weight if you're overweight
Appointments
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Clinical Trials
Below is a list of Congestive Heart Failure clinical trials from the clinical trials database at Mayo Clinic.
Mayo's clinical trials include experimental treatments, often unavailable elsewhere, which frequently lead to improved patient care for people worldwide. Patients should ask their doctor at Mayo about clinical trials appropriate for their situation.
Genetic Basis of Left Ventricular Recovery in Congestive Heart Failure
Research suggests that many cases of cardiomyopathy are caused initially by a virus, which then causes the body's immune system to attack the heart. This is an inflammatory
reaction which leads to heart damage. In some patients with this disorder, the heart will recover significantly over the first year, while others will be left with a chronically weak heart. The purpose of this research study is to determine if persons who present with the recent onset of primary cardiomyopathy have a better chance of recovery if they have certain genes and for a stronger inflammatory reaction.
Read more
Heart Failure and Control Trial Investigating Outcomes of Exercise Training
Mayo Clinic's Cardiovascular Research Program is conducting a research study involving patients who have congestive heart failure. This study is being done to determine if a long-term exercise program affects illness and survival.

Read more
Renal Optimization Strategies Evaluation in Acute Heart Failure
Acute heart failure (AHF) is the most common cause of hospital admission in patients over age 65, accounting for 1,000,000 admissions, over 6 million hospital days, and $12 billion in costs annually. The prognosis of patients admitted with AHF is dismal, with a 20-30% readmission rate and a 20-30% mortality rate within six months after admission. Recent studies have established the prognostic importance of renal function in patients with heart failure. In patients who are hospitalized with decompensated congestive heart failure, worsening renal function is also associated with worse outcome, Various studies have estimated that 25-30% of patients hospitalized for decompensated CHF have worsening of renal function leading to prolonged hospitalization, increased morbidity and mortality. Although there are no FDA approved renal adjuvant therapies for AHF, several novel adjuvant therapies for use in AHF are being investigated in randomized clinical trials. Additionally, there are currently available strategies, with the potential for improving renal function in AHF such as low dose dopamine and low dose nesiritide. However, these strategies have not been investigated. Participation in this study will last 6 months. All potential participants will undergo initial screening, which wil include a medical history, physical exam, blood draws, measurements of fluid intake and output, and questionnaires. The same evaluations and procedures will be repeated at various points during the study. Eligible participants will be randomly assigned to receive low dose nesiritide or placebo with optimal diuretic dosing or low dose dopamine or placebo with optimal diuretic dosing. Follow-up assessments will occur at Baseline, 24 hours, 48 hours, 72 hours, day 7 or discharge, day 60 and 6 months. Follow-up assessments will include medical history, physical exam, blood draws, measurements of fluid intake and output, questionnaires and questions about medications and changes in health.
Read more
TOPCAT
Subjects with heart failure are asked to volunteer in this study. The purpose for this study is to see if adding a drug called spironolactone to the current treatment for heart failure is able to safely improve heart failure. The study aims to examine the safely and effectiveness of spironolactone compared with placebo, which is an inactive drug that serves as pretend treatment (with no active drug in it), in the treatment of adults with heart failure and a certain level of heart contraction. Spironolactone is approved by the Food and Drug Administration (FDA) for the treatment of congestive heart failure. However, this study uses a lower starting dosage of spironolactone that is not approved by the FDA and compares it to placebo to test if the drug has a real effect.
Read more
We are testing the safety and effectiveness of sildenafil (Viagra) to placebo (a pill containing no medication) in patients with diastolic heart failure.
The purpose of this study is to compare the safety and effectiveness of sildenafil (Viagra) to a placebo (a pill containing no medication) in patients with diastolic heart failure to see if it will improve your ability to exercise and your quality of life. You will be asked to take this study medication for 6 months

What is high blood pressure?


What is high blood pressure?

High blood pressure (HBP) or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high.
The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed.
An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.
It was previously thought that rises in diastolic blood pressure were a more important risk factor than systolic elevations, but it is now known that in people 50 years or older systolic hypertension represents a greater risk.
The American Heart Association estimates high blood pressure affects approximately one in three adults in the United States - 73 million people. High blood pressure is also estimated to affect about two million American teens and children, and the Journal of the American Medical Association reports that many are under-diagnosed. Hypertension is clearly a major public health problem.
Picture of high blood pressure

How is the blood pressure measured?

The blood pressure usually is measured with a small, portable instrument called a blood pressure cuff (sphygmomanometer). (Sphygmo is Greek for pulse, and a manometer measures pressure.) The blood pressure cuff consists of an air pump, a pressure gauge, and a rubber cuff. The instrument measures the blood pressure in units called millimeters of mercury (mm Hg).
The cuff is placed around the upper arm and inflated with an air pump to a pressure that blocks the flow of blood in the main artery (brachial artery) that travels through the arm. The arm is then extended at the side of the body at the level of the heart, and the pressure of the cuff on the arm and artery is gradually released. As the pressure in the cuff decreases, a health practitioner listens with a stethoscope over the artery at the front of the elbow. The pressure at which the practitioner first hears a pulsation from the artery is the systolic pressure (the top number). As the cuff pressure decreases further, the pressure at which the pulsation finally stops is the diastolic pressure (the bottom number).
Picture of the systolic and diastolic pressure systems of measuring
 blood pressure

How is high blood pressure defined?

Blood pressure can be affected by several factors, so it is important to standardize the environment when blood pressure is measured. For at least one hour before blood pressure is taken, avoid eating, strenuous exercise (which can lower blood pressure), smoking, and caffeine intake. Other stresses may alter the blood pressure and need to be considered when blood pressure is measured.
Even though most insurance companies consider high blood pressure to be 140/90 and higher for the general population, these levels may not be appropriate cut-offs for all individuals. Many experts in the field of hypertension view blood pressure levels as a range, from lower levels to higher levels. Such a range implies there are no clear or precise cut-off values to separate normal blood pressure from high blood pressure. Individuals with so-called pre-hypertension (defined as a blood pressure between 120/80 and 139/89) may benefit from lowering of blood pressure by life style modification and possibly medication especially if there are other risk factors for end-organ damage such as diabetes or kidney disease (life style changes are discussed below).
For some people, blood pressure readings lower than 140/90 may be a more appropriate normal cut-off level. For example, in certain situations, such as in patients with long duration (chronic) kidney diseases that spill (lose) protein into the urine (proteinuria), the blood pressure is ideally kept at 130/80, or even lower. The purpose of reducing the blood pressure to this level in these patients is to slow the progression of kidney damage. Patients with diabetes (diabetes mellitus) may also benefit from blood pressure that is maintained at a level lower than 130/80. In addition, African Americans, who have an increased risk for developing the complications of hypertension, may decrease this risk by reducing their systolic blood pressure to less than 135 and the diastolic blood pressure to 80 mm Hg or less.
In line with the thinking that the risk of end-organ damage from high blood pressure represents a continuum, statistical analysis reveals that beginning at a blood pressure of 115/75 the risk of cardiovascular disease doubles with each increase in blood pressure of 20/10. This type of analysis has led to an ongoing "rethinking" in regard to who should be treated for hypertension, and what the goals of treatment should be.

Isolated systolic high blood pressure

Remember that the systolic blood pressure is the top number in the blood pressure reading and represents the pressure in the arteries as the heart contracts and pumps blood into the arteries. A systolic blood pressure that is persistently higher than 140 mm Hg is usually considered elevated, especially when associated with an elevated diastolic pressure (over 90).
Isolated systolic hypertension, however, is defined as a systolic pressure that is above 140 mm Hg with a diastolic pressure that still is below 90. This disorder primarily affects older people and is characterized by an increased (wide) pulse pressure. The pulse pressure is the difference between the systolic and diastolic blood pressures. An elevation of the systolic pressure without an elevation of the diastolic pressure, as in isolated systolic hypertension, therefore, increases the pulse pressure. Stiffening of the arteries contributes to this widening of the pulse pressure.
Once considered to be harmless, a high pulse pressure is now considered an important precursor or indicator of health problems and potential end-organ damage. Isolated systolic hypertension is associated with a two to four times increased future risk of an enlarged heart, a heart attack (myocardial infarction), a stroke (brain damage), and death from heart disease or a stroke. Clinical studies in patients with isolated systolic hypertension have indicated that a reduction in systolic blood pressure by at least 20 mm to a level below 160 mm Hg reduces these increased risks.

White coat high blood pressure

A single elevated blood pressure reading in the doctor's office can be misleading because the elevation may be only temporary. It may be caused by a patient's anxiety related to the stress of the examination and fear that something will be wrong with his or her health. The initial visit to the physician's office is often the cause of an artificially high blood pressure that may disappear with repeated testing after rest and with follow-up visits and blood pressure checks. One out of four people that are thought to have mild hypertension actually may have normal blood pressure when they are outside the physician's office. An increase in blood pressure noted only in the doctor's office is called 'white coat hypertension.' The name suggests that the physician's white coat induces the patient's anxiety and a brief increase in blood pressure. A diagnosis of white coat hypertension might imply that it is not a clinically important or dangerous finding.
However, caution is warranted in assessing white coat hypertension. An elevated blood pressure brought on by the stress and anxiety of a visit to the doctor may not necessarily always be a harmless finding since other stresses in a patient's life may also cause elevations in the blood pressure that are not ordinarily being measured. Monitoring blood pressure at home by blood pressure cuff or continuous monitoring equipment or at a pharmacy can help estimate the frequency and consistency of higher blood pressure readings. Additionally, conducting appropriate tests to search for any complications of hypertension can help evaluate the significance of variable blood pressure readings.

orderline high blood pressure

Borderline hypertension is defined as mildly elevated blood pressure higher than 140/90 mm Hg at some times, and lower than that at other times. As in the case of white coat hypertension, patients with borderline hypertension need to have their blood pressure taken on several occasions and their end-organ damage assessed in order to establish whether their hypertension is significant.
People with borderline hypertension may have a tendency as they get older to develop more sustained or higher elevations of blood pressure. They have a modestly increased risk of developing heart-related (cardiovascular) disease. Therefore, even if the hypertension does not appear to be significant initially, people with borderline hypertension should have continuing follow-up of their blood pressure and monitoring for the complications of hypertension.
If, during the follow-up of a patient with borderline hypertension, the blood pressure becomes persistently higher than 140/ 90 mm Hg, an anti-hypertensive medication is usually started. Even if the diastolic pressure remains at a borderline level (usually under 90 mm Hg, yet persistently above 85) treatment may be started in certain circumstances.

What causes high blood pressure?

Two forms of high blood pressure have been described: essential (or primary) hypertension and secondary hypertension. Essential hypertension is a far more common condition and accounts for 95% of hypertension. The cause of essential hypertension is multifactorial, that is, there are several factors whose combined effects produce hypertension. In secondary hypertension, which accounts for 5% of hypertension, the high blood pressure is secondary to (caused by) a specific abnormality in one of the organs or systems of the body. (Secondary hypertension is discussed further in a separate section later.)
Essential hypertension affects approximately 72 million Americans, yet its basic causes or underlying defects are not always known. Nevertheless, certain associations have been recognized in people with essential hypertension. For example, essential hypertension develops only in groups or societies that have a fairly high intake of salt, exceeding 5.8 grams daily. Salt intake may be a particularly important factor in relation to essential hypertension in several situations, and excess salt may be involved in the hypertension that is associated with advancing age, African American background, obesity, hereditary (genetic) susceptibility, and kidney failure (renal insufficiency). The Institute of Medicine of the National Academies recommends healthy 19 to 50-year-old adults consume only 3.8 grams of salt to replace the average amount lost daily through perspiration and to achieve a diet that provides sufficient amounts of other essential nutrients.
Genetic factors are thought to play a prominent role in the development of essential hypertension. However, the genes for hypertension have not yet been identified. (Genes are tiny portions of chromosomes that produce the proteins that determine the characteristics of individuals.) The current research in this area is focused on the genetic factors that affect the renin-angiotensin-aldosterone system. This system helps to regulate blood pressure by controlling salt balance and the tone (state of elasticity) of the arteries.
Approximately 30% of cases of essential hypertension are attributable to genetic factors. For example, in the United States, the incidence of high blood pressure is greater among African Americans than among Caucasians or Asians. Also, in individuals who have one or two parents with hypertension, high blood pressure is twice as common as in the general population. Rarely, certain unusual genetic disorders affecting the hormones of the adrenal glands may lead to hypertension. (These identified genetic disorders are considered secondary hypertension.)
The vast majority of patients with essential hypertension have in common a particular abnormality of the arteries: an increased resistance (stiffness or lack of elasticity) in the tiny arteries that are most distant from the heart (peripheral arteries or arterioles). The arterioles supply oxygen-containing blood and nutrients to all of the tissues of the body. The arterioles are connected by capillaries in the tissues to the veins (the venous system), which returns the blood to the heart and lungs. Just what makes the peripheral arteries become stiff is not known. Yet, this increased peripheral arteriolar stiffness is present in those individuals whose essential hypertension is associated with genetic factors, obesity, lack of exercise, overuse of salt, and aging. Inflammation also may play a role in hypertension since a predictor of the development of hypertension is the presence of an elevated C reactive protein level (a blood test marker of inflammation) in some individuals.

What are the causes of secondary high blood pressure?

As mentioned previously, 5% of people with hypertension have what is called secondary hypertension. This means that the hypertension in these individuals is secondary to (caused by) a specific disorder of a particular organ or blood vessel, such as the kidney, adrenal gland, or aortic artery.

Renal (kidney) hypertension

Diseases of the kidneys can cause secondary hypertension. This type of secondary hypertension is called renal hypertension because it is caused by a problem in the kidneys. One important cause of renal hypertension is narrowing (stenosis) of the artery that supplies blood to the kidneys (renal artery). In younger individuals, usually women, the narrowing is caused by a thickening of the muscular wall of the arteries going to the kidney (fibromuscular hyperplasia). In older individuals, the narrowing generally is due to hard, fat-containing (atherosclerotic) plaques that are blocking the renal artery.
How does narrowing of the renal artery cause hypertension? First, the narrowed renal artery impairs the circulation of blood to the affected kidney. This deprivation of blood then stimulates the kidney to produce the hormones, renin and angiotensin. These hormones, along with aldosterone from the adrenal gland, cause a constriction and increased stiffness (resistance) in the peripheral arteries throughout the body, which results in high blood pressure.
Renal hypertension is usually first suspected when high blood pressure is found in a young individual or a new onset of high blood pressure is discovered in an older person. Screening for renal artery narrowing then may include renal isotope (radioactive) imaging, ultrasonographic (sound wave) imaging, or magnetic resonance imaging (MRI) of the renal arteries. The purpose of these tests is to determine whether there is a restricted blood flow to the kidney and whether angioplasty (removal of the restriction in the renal arteries) is likely to be beneficial. However, if the ultrasonic assessment indicates a high resistive index within the kidney (high resistance to blood flow), angioplasty may not improve the blood pressure because chronic damage in the kidney from long-standing hypertension already exists. If any of these tests are abnormal or the doctor's suspicion of renal artery narrowing is high enough, renal angiography (an X-ray study in which dye is injected into the renal artery) is done. Angiography is the ultimate test to actually visualize the narrowed renal artery.
A narrowing of the renal artery may be treated by balloon angioplasty. In this procedure, the physician threads a long narrow tube (catheter) into the renal artery. Once the catheter is there, the renal artery is widened by inflating a balloon at the end of the catheter and placing a permanent stent (a device that stretches the narrowing) in the artery at the site of the narrowing. This procedure usually results in an improved blood flow to the kidneys and lower blood pressure. Moreover, the procedure also preserves the function of the kidney that was partially deprived of its normal blood supply. Only rarely is surgery needed these days to open up the narrowing of the renal artery.
Any of the other types of chronic kidney disease that reduces the function of the kidneys can also cause hypertension due to hormonal disturbances and/or retention of salt.
It is important to remember that not only can kidney disease cause hypertension, but hypertension can also cause kidney disease. Therefore, all patients with high blood pressure should be evaluated for the presence of kidney disease so they can be treated appropriately.

Adrenal gland tumors

Two rare types of tumors of the adrenal glands are less common, secondary causes of hypertension. The adrenal glands sit right on top of the kidneys. Both of these tumors produce excessive amounts of adrenal hormones that cause high blood pressure. These tumors can be diagnosed from blood tests, urine tests, and imaging studies of the adrenal glands. Surgery is often required to remove these tumors or the adrenal gland (adrenalectomy), which usually relieves the hypertension.
One of the types of adrenal tumors causes a condition that is called primary hyperaldosteronism because the tumor produces excessive amounts of the hormone aldosterone. In addition to the hypertension, this condition causes the loss of excessive amounts of potassium from the body into the urine, which results in a low level of potassium in the blood. Hyperaldosteronism is generally first suspected in a person with hypertension when low potassium is also found in the blood. (Also, certain rare genetic disorders affecting the hormones of the adrenal gland can cause secondary hypertension.)
The other type of adrenal tumor that can cause secondary hypertension is called a pheochromocytoma. This tumor produces excessive catecholamines, which include several adrenaline-related hormones. The diagnosis of a pheochromocytoma is suspected in individuals who have sudden and recurrent episodes of hypertension that are associated with flushing of the skin, rapid heart beating (palpitations), and sweating, in addition to the symptoms associated with high blood pressure.

Coarctation of the aorta

Coarctation of the aorta is a rare hereditary disorder that is one of the most common causes of hypertension in children. This condition is characterized by a narrowing of a segment of the aorta, the main large artery coming from the heart. The aorta delivers blood to the arteries that supply all of the body's organs, including the kidneys.
The narrowed segment (coarctation) of the aorta generally occurs above the renal arteries, which causes a reduced blood flow to the kidneys. This lack of blood to the kidneys prompts the renin-angiotensin-aldosterone hormonal system to elevate the blood pressure. Treatment of the coarctation is usually the surgical correction of the narrowed segment of the aorta. Sometimes, balloon angioplasty (as described above for renal artery stenosis) can be used to widen (dilate) the coarctation of the aorta.

The metabolic syndrome and obesity

Genetic factors play a role in the constellation of findings that make up the "metabolic syndrome." Individuals with the metabolic syndrome have insulin resistance and a tendency to have type 2 diabetes mellitus (non-insulin-dependent diabetes).
Obesity, especially associated with a marked increase in abdominal girth, leads to high blood sugar (hyperglycemia), elevated blood lipids (fats), vascular inflammation, endothelial dysfunction (abnormal reactivity of the blood vessels), and hypertension all leading to premature atherosclerotic vascular disease. The American Obesity Association states the risk of developing hypertension is five to six times greater in obese Americans, age 20 to 45, compared to non-obese individuals of the same age. The American Journal of Clinical Nutrition reported in 2005 that waist size was a better predictor of a person's blood pressure than body mass index (BMI). Men should strive for a waist size of 35 inches or under and women 33 inches or under. The epidemic of obesity in the United States contributes to hypertension in children, adolescents, and adults.

What are the symptoms of high blood pressure?

Uncomplicated high blood pressure usually occurs without any symptoms (silently) and so hypertension has been labeled "the silent killer." It is called this because the disease can progress to finally develop any one or more of the several potentially fatal complications of hypertension such as heart attacks or strokes. Uncomplicated hypertension may be present and remain unnoticed for many years, or even decades. This happens when there are no symptoms, and those affected fail to undergo periodic blood pressure screening.
Some people with uncomplicated hypertension, however, may experience symptoms such as headache, dizziness, shortness of breath, and blurred vision. The presence of symptoms can be a good thing in that they can prompt people to consult a doctor for treatment and make them more compliant in taking their medications. Often, however, a person's first contact with a physician may be after significant damage to the end-organs has occurred. In many cases, a person visits or is brought to the doctor or an emergency room with a heart attack, stroke, kidney failure, or impaired vision (due to damage to the back part of the retina). Greater public awareness and frequent blood pressure screening may help to identify patients with undiagnosed high blood pressure before significant complications have developed.
About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor. In these patients, the diastolic blood pressure (the minimum pressure) exceeds 140 mm Hg! Affected persons often experience severe headache, nausea, visual symptoms, dizziness, and sometimes kidney failure. Malignant hypertension is a medical emergency and requires urgent treatment to prevent a stroke (brain damage).

How is end-organ damage assessed in the patient with high blood pressure?

Damage of organs fed by the circulatory system due to uncontrolled hypertension is called end-organ damage. As already mentioned, chronic high blood pressure can lead to an enlarged heart, kidney failure, brain or neurological damage, and changes in the retina at the back of the eyes. Examination of the eyes in patients with severe hypertension may reveal damage; narrowing of the small arteries, small hemorrhages (leaking of blood) in the retina, and swelling of the eye nerve. From the amount of damage, the doctor can gauge the severity of the hypertension.
People with high blood pressure have an increased stiffness, or resistance, in the peripheral arteries throughout the tissues of the body. This increased resistance causes the heart muscle to work harder to pump the blood through these blood vessels. The increased workload can put a strain on the heart, which can lead to heart abnormalities that are usually first seen as enlarged heart muscle. Enlargement of the heart can be evaluated by chest X-ray, electrocardiogram, and most accurately by echocardiography (an ultrasound examination of the heart). Echocardiography is especially useful in determining the thickness (enlargement) of the left side (the main pumping side) of the heart. Heart enlargement may be a forerunner of heart failure, coronary (heart) artery disease, and abnormal heart rate or rhythms (cardiac arrhythmias). Proper treatment of the high blood pressure and its complications can reverse some of these heart abnormalities.
Blood and urine tests may be helpful in detecting kidney abnormalities in people with high blood pressure. (Remember that kidney damage can be the cause or the result of hypertension.) Measuring the serum creatinine in a blood test can assess how well the kidneys are functioning. An elevated level of serum creatinine indicates damage to the kidney. In addition, the presence of protein in the urine (proteinuria) may reflect chronic kidney damage from hypertension, even if the kidney function (as represented by the blood creatinine level) is normal. Protein in the urine alone signals the risk of deterioration in kidney function if the blood pressure is not controlled. Even small amounts of protein (microalbuminuria) may be a signal of impending kidney failure and other vascular complications from uncontrolled hypertension. African American patients with poorly controlled hypertension are at a higher risk than Caucasians for most end-organ damage and particularly kidney damage.
Uncontrolled hypertension can cause strokes, which can lead to brain or neurological damage. The strokes are usually due to a hemorrhage (leaking blood) or a blood clot (thrombosis) of the blood vessels that supply blood to the brain. The patient's symptoms and signs (findings on physical examination) are evaluated to assess the neurological damage. A stroke can cause weakness, tingling, or paralysis of the arms or legs and difficulties with speech or vision. Multiple small strokes can lead to dementia (impaired intellectual capacity). The best prevention for this complication of hypertension or, for that matter, for any of the complications, is control of the blood pressure. Recent studies have also suggested the angiotensin receptor blocking drugs may offer an additional protective effect against strokes above and beyond control of blood pressure.
High Blood Pressure (Hypertension) At A Glance
  • High blood pressure (hypertension) is designated as either essential (primary) hypertension or secondary hypertension and is defined as a consistently elevated blood pressure exceeding 140/90 mm Hg.
  • In essential hypertension (95% of people with hypertension), no specific cause is found, while secondary hypertension (5% of people with hypertension) is caused by an abnormality somewhere in the body, such as in the kidney, adrenal gland, or aortic artery.
  • Essential hypertension may run in some families and occurs more often in the African American population, although the genes for essential hypertension have not yet been identified.
  • High salt intake, obesity, lack of regular exercise, excessive alcohol or coffee intake, and smoking may all adversely affect the outlook for the health of an individual with hypertension.
  • High blood pressure is called "the silent killer" because it often causes no symptoms for many years, even decades, until it finally damages certain critical organs.
  • Poorly controlled hypertension ultimately can cause damage to blood vessels in the eye, thickening of the heart muscle and heart attacks, hardening of the arteries (arteriosclerosis), kidney failure, and strokes.
  • Heightened public awareness and screening of the population are necessary to detect hypertension early enough so it can be treated before critical organs are damaged.
  • Lifestyle adjustments in diet and exercise and compliance with medication regimes are important factors in determining the outcome for people with hypertension.
  • Several classes of anti-hypertensive medications are available, including ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators.
  • Most antihypertensive medications can be used alone or in combination: some are used only in combination; some are preferred over others in certain specific medical situations; and some are not to be used (contraindicated) in other situations.
  • The goal of therapy for hypertension is to bring the blood pressure down to 140/85 in the general population and to even lower levels in diabetics, African Americans, and people with certain chronic kidney diseases.
  • Screening, diagnosing, treating, and controlling hypertension early in its course can significantly reduce the risk of developing strokes, heart attacks, or kidney failure.

بقـــــــايــــا امنيـــــــات





أغوص في تفكيري
وأبحر في أعماق ذاتي
أخوض إحساساً من نوع آخر
يستفز مشاعري
ويلهب أحاسيسي

أين سأصل بعد كل ذلك
وأي طريقٍ سأسلك
وانا مازلت ألمح نوراً للأمل

أحاول أن أستمع
لخفقات قلبي
ولهدير أنفاسي
وأترك لروحي العنان
لأحلق بعيداً جداً
ولأتخطى كل الحدود


أتبع ذاك البريق والنور
الذي مازال يشع هناك
ويخترق المسافات
ويبث خيوطه في أعماقي
لينير ظلام ليلي
ويزيل عتمة وحدتي
ويزرع الأمل بقلبي

أبحث عن بقايا أمنيات
عن حلمٍ جديد
عن أمل يحيي قلباً قد مات
وإحساسا ينسيني تلك اللحظات
يحتضن أنيني
ينسيني ويشعرني بقوتي التي فقدتها
ويعيد لي أعذب الأمنيات
لكي أرتاح من هجير أيامي
لتعود لي أحلامي من جديد
على ضفاف مراكب العمر
كي أرحل من زوايا صمتي الإنهزامي
وأهرب من أيامى المنكسرة
إلى حياتي الجميلة
أشعر بها دون أن تشعر بوجودي
كي أعيد ما سلبته الأقدار مني
وأعيش بقربها ... وبحبها
وأعيش حلماً من نوع آخر
أجد فيه ضالتي
يحميني من رهبة الأيام
ويرسمني بين أطياف الخيال
ويخرجني من دنيا أحلامي
ويمزق من قلبي ظلام الأيام
وذاك الحـــزن الساكن في أعماقي
والذي يكاد أن يلتهم آمالي

بتلك اللحظة
أحاول أن أوقف تصانيف القدر
وأتمنى أن يتوقف العالم والزمن
عند تلك اللحظات الأبدية

خدعوها بقولهم حسناء

خدعُوهـــا بقـــولهم: حســناء .... والغـــواني يَغُـــرُّهن الثَّنـــاءُ
أَتُراهـــا تناســت اســمِيَ لمّــا ..... كــثُرت فــي غرامِهـا الأَسـماءُ?
إِن رأَتنــي تميـل عنـي, كـأَن .... تـــكُ بينــي وبينهــا أَشــياءُ!
يـومَ كُنـا - ولا تسـلْ: كيف كُنّا? .... نتهــادَى مــن الهـوى مـا نشـاءُ
وعلينــا مــن العَفــافِ رقيــبٌ .... تَعِبَــتْ فــي مِراســه الأَهــواءُ
جــاذبتني ثـوبي العصِـيَّ وقـالت :::: أَنتـــمُ النــاسُ أَيُّهــا الشــعراءُ
فــاتقوا اللـهَ فـي قلـوبِ العـذارَى ... فـــالعذارى قلـــوبُهنّ هـــواءُ
نظـــرةٌ, فابتســـامةٌ, فســـلامٌ ... فكــــلامٌ, فموعـــدٌ, فلقـــاءُ
ففـــراقٌ يكـــون فيـــه دواءٌ...... أَو فــراقٌ يكــون منــه الــدَّاءُ
لا السُّــهْدُ يَطويــه ولا الإِغضـاءُ..... لَيْـــلٌ عِــدادُ نُجُومِــه رُقَبــاءُ
داجِـي عُبـابِ الجُـنْحِ, فَـوْضَى فُلْكُه.... مــا للهمــوم ولا لهــا إِرْســاءُ
أَغزالـة الإِشـراقِ, أَنـتِ مـن الدُّجى .... ومــن السُّــهادِ إِذا طلعْـتِ شِـفاءُ
رفقًـــا بجــفْنٍ كلَّمــا أَبْكَيْتِــهِ ..... ســال العَقيـقُ بـه, وقـام المـاءُ



للرائع احمد شوقى

19‏/5‏/2011

من حكم أمير المؤمنين الامام علي ابن ابي طالب علية السلام


كن سمحاً ولا تكن مبذراً وكن مقدراً ولا تكن مقتراً .
لا تستحي من إعطاء القليل ، فإن الحرمان أقل منه .
عجبت للبخيل الذي يستعجل الفقر الذي هرب منه .
الصبر صبران : صبر على ما يكره ، وصبر على ما يحب ، والصبر من الإيمان كالرأس من الجسد ، ولا خير في جسد لا رأس معه ، ولا في إيمان لا صبر معه .
ما جفت الدموع إلا لقسوة القلوب ، وما قست القلوب إلا لكثرة الذنوب .
من لم يملك لسانه يندم ، ومن لا يتعلم يجهل ، ومن لا يتحلم لا يحلم ، ومن لا يرتدع لا يعقل ، ومن لا يعقل يهن ، ومن يهن لا يوقر .
التدبير قبل العمل يؤمنك الندم .
في سعة الأخلاق كنوز الأرزاق .
احسبوا كلامكم من أعمالكم يقل كلامكم إلا في الخير.
لا يكونن المحسن والمسيء عندك بمنزلة سواء، فإن ذلك تزهيد لأهل الإحسان في الإحسان، وتدريب لأهل الإساءة على الإساءة، فالزم كلاً منهم ما ألزم نفسه أدباً منك
يا بني، اجعل نفسك ميزاناً بينك وبين غيرك. فأحبب لغيرك ما تحب لنفسك. واكره له ما تكره لها، ولا تظلم كما لا تحب أن تُظلم، وأحسن كما تحب أن يُحسن إليك. واستقبح من نفسك ما تستقبحه من غيرك، وارض من الناس بما ترضاه لهم من نفسك. ولا تقل ما لا تعلم وإن قلَّ ما تعلم، ولا تقل ما لا تحب أن يقال لك. واعلم أن الإعجاب ضد الصواب، وآفة الألباب. فاسع في كدحك، ولا تكن خازناً لغيرك. وإذا أنت هديت لقصدك فكن أخشع ما تكون لربك"
لسان العاقل في قلبه, وقلب الأحمق في فيه
نحن قوم لا نأكل حتى نجوع, واذا اكلنا لا نشبع

18‏/5‏/2011

قصيدة الميدان للشاعر عبد الرحمن الابنودي

ايادي مصرية سمرا ليها في التمييز
ممددة وسط الزئير بتكسر البراويز

سطوع لصوت الجموع شوف مصر تحت الشمس

آن الآوان ترحلي يا دولة العواجيز

عواجيز شداد مسعورين اكلوا بلدنا اكل

ويشبهوا بعضهم نهم وخسة وشكل

طلع الشباب البديع قلبوا خريفها ربيع

وحققوا المعجزة صحوا القتيل من القتل

اقتلني قتلي ما هيعيد دولتك تاني

بكتب بدمي حياة تانية لأوطاني

دمي دة ولا الربيع الاتنين بلون اخضر

وببتسم من سعادتي ولا احزاني

تحاولوا ما تحاولوا ما تشوفوا وطن غيره

سلبتوا دم الوطن وبشيمته من خيره

احلامنا بكرانا اصغر ضحكة علي شفة

شفتوتش الصياد يا خلق بيقتلوا طيروا

السوس بينخر وسارح تحت اشرافك

فرحان بيهم كنت وشايلهم علي كتافك

واما اهالينا من زرعوا وبنوا وصنعوا

كانوا مداس ليك ولولادك واحلافك

ويا مصر يا مصر آن العليل رجعتله انفاسه

وباس جبين للوطن ما للوطن داسه

من قبل موته بيوم صحوه اولاده

ان كان سبب علته محبته لناسه

الثورة فيضان قديم

محبوس مشافوش زول

الثورة لو جد متبانش في كلام او قول

تحلب وتعجن في سرية تفور في القلب وتنغزل فتلة فتلة في ضمير النول

متخافش علي مصر يابا مصر محروسة حتي من التهمة دي اللي فينا مدسوسة

ولو انت ابوها بصحيح وخايف عليها اوي تركتها ليه بدن بتنخره السوسة

وبيسرقوكي يا الوطن قدامنا عيني عينك

ينده بقوة الوطن ويقلي قوم

فينك ضحكت علينا الكتب بعدت بينا عنك

لولا ولادنا اللي قاموا يسددوا دينك

لكن خلاص يا وطن

صحيت جموع الخلق قبضوا علي الشمس بايديهم

وقالوا لا من المستحيل يفرطوا عقد الوطن تاني

و الكدب تاني محال يلبس قناع الحق

بكل حب الحياة خوط في دم اخوك

قول انت مين للي باعوا حلمنا وباعوك واهانوك

وذلوك ولعبوا قمار باحلامك

نيران هتافك تحرر صحبك الممسوك

يرجعلها صوتها مصر تعود ملامحها تاخد مكانها القديم

والكون يصالحها عشرات السنين تسكونوا بالكدب في عروقنا

والدنيا متقدمة ومصر مطرحها

كتبتوا اول سطور في صفحة ثورة

وهما علما و خبرة مداورة ومناورة

وقعتوا فرعون هرب من قلب تمثاله

لكن جيوشه مازالوا بيحلموا ببكرة

صباح حقيقي ودرس جديد اوي في الرفض

اتاري للشمس صوت واتاري للارض نبض

تاني معاكم رجعنا نحب كلمة مصر

تاني معاكم رجعنا نحب ضحكة بعض

مين كان يقول ابننا يطلع من النفق

دي صرخة ولا غني ودة دم ولا شفق

اتاريها حاجة بسيطة الثورة يا اخوانا

مين اللي شافها كدة مين اول اللي بدأ

مش دول شاببنا اللي قالوا كرهوا اوطانهم

ولبسنا توب الحداد وبعدنا اوي عنهم

هما اللي قاموا النهاردة يشعلوا الثورة

ويصنفوا الخلق مين عنهم ومين خانهم

يادي الميدان اللي حضن الذكري وسهرها

يادي الميدان اللي فتن الخلق وسحرها

يادي الميدان اللي غاب اسمه كتير عنه وصبرها

ما بين عباد عاشقة و عباد كارهة

شباب كان الميدان اهله وعنوانه

ولا في الميدان نسكافيه ولا كابتشينو

خدوده عرفوا جمال النوم علي الأسفلت

والموت عارفهم اوي وهما عارفينه

لا الظلم هين يا ناس ولا الشباب قاصر

مهما حاصرتوا الميدان عمروا ما يتحاصر

فكرتني يا الميدان بزمان وسحر زمان

فكرتني بأغلي ايام في زمن ناصر

شايل حياتك علي كفك صغير السن

ليل بعد يوم المعاناة وانت مش بتأن

جمل المحامل وانت غاضض

بتعجب امتي عرفت النضال

اسمحلي حاجة تجن

اتاريك جميل يا وطن مازلت و هتبقي

زال الضباب وانفجرت باعلي صوت

لا حركتنا نبتسم ودفعت انت الحساب

وبنبتسم بس بسمة طالعة بمشقة

فينك يا صبح الكرامة لما البشر هانوا

وأهل مصر الأصيلة اتخانوا واتهانوا

بنشتري العزة تاني والتمن غالي

فتح الوطن للجميع قلبوا و احضانوا

الثورة غيض الامل وغنوة الثوار

الليل اذا خانه لونه يتقلب لنهار

ضج الضجيج بالندا اصحي يا فجر الناس

فينك يا صوت الغلابة وضحكة الانفار

وأحنا وراهم أساتذة خايبة

تتعلم ازاي نحب الوطن وامتي نتكلم

لما طال الصدي قلبنا ويأسنا من فتحه

قلب الوطن قبلكم كان خاوي ومضلم

أولنا في الجوله لسة جوله ورا جولة

دة سوس بينخر يا ابويا في جسد دولة

ايوة الملك صار كتابة انما ابدا

لو غفلت عينا لحظة يقلبوا العملة

لكن خوفي مازال جوة الفؤاد يكبش

الخوف اللي ساكن شقوق القلب ومعشش

واللي مش راح يسيبه ولسة هيبقوا

وهيلاقولهم سكك وببان ما تتردش

وحاسبوا اوي من الديابة اللي في وسطيكم

وحاسبوا اوي من الديابة اللي في وسطيكم

والا تبقي الخيانة منك وفيكم

الضحك علي البق بس الرك علي النيات

فيهم عدوين اشد من اللي حواليكم







قصة الحكيم الصيني

ذهب شاب إلى أحد حكماء الصين ليتعلم منه سر النجاح، وسأله(هل تستطيع أن تذكر لي ما هو سر النجاح؟))
فرد عليه الحكيم الصيني بهدوء و قال : (( سر النجاح هو الدوافع )).
فسأله الشاب : (( ومن أين تأتي هذه الدوافع ؟!)).
فرد عليه الحكيم الصيني: ((من رغباتك المشتعلة )).
وباستغراب سأله الشاب : ((وكيف يكون عندنا رغبات مشتعلة)).
وهنا استأذن الحكيم الصيني لعدة دقائق وعاد ومعه وعاء كبير ملئ بالماء ، وسأل الشاب : (( هل أنت متأكد أنك تريد معرفة مصدر الرغبات المشتعلة ؟ )).
فأجابه الشاب بلهفة: (( طبعاً )).
فطلب منه الحكيم أن يقترب من وعاء الماء وينظر فيه، ونظر الشاب إلى الماء عن قرب وفجأة ضغط الحكيم بكلتي يديه على رأس الشاب ووضعه داخل وعاء الماء !! ومرت عدة ثوان ولم يتحرك الشاب، ثم بدأ ببطء يخرج رأسه من الماء، ولما بدأ يشعر بالاختناق بدأ يقاوم بشدة حتى نجح في تخليص نفسه وأخرج رأسه من الماء ثم نظر إلى الحكيم الصيني وسأله بغضب: (( ما الذي فعلته؟ )).

فرد عليه و هو ما زال محتفظاً بهدوئه و ابتسامته: (( ما الذي تعلمته من هذه التجربة؟ )) .
فقال : (( لم أتعلم شيئاً ))...
فنظر إليه الحكيم الصيني قائلاً:
(( لا يا بني لقد تعلمت الكثير، ففي خلال الثواني الأولى أردت أن تخلص نفسك من الماء و لكن دوافعك لم تكن كافية لعمل ذلك، و بعد ذلك كنت دائماً راغباً في تخليص نفسك فبدأت في التحرك والمقاومة ولكن ببطء حيث إن دوافعك لم تكن قد وصلت بعد لأعلى درجاتها، وأخيراً أصبح عندك الرغبة المشتعلة لتخليص نفسك، و عندئذ فقط أنت نجحت لأنه لم يكن هناك أي قوة في استطاعها أن توقفك
ثم أضاف الحكيم الصيني الذي لم تفارقه ابتسامته الهادئة:
عندما يكون لديك الرغبة المشتعلة للنجاح فلن يستطيع أحد إيقافك

سيدى القاضى...


سيدى القاضى انى استغيثك الحكم

بشخص هو رضى انا يكون للموت صديقا

طلب الموت على الطريقه السريعه بطعم الرصاص المميت

فقد الامل ...اعلن البكاء....واستمر فى النحيب....وجعل هدفه التشاؤم

سيدى القاضى فلتحكم له بالعدل....وعدلك ليس الاعدام اعرفه

الموت فى نظره راحه....ولكن عند قربه عذاب

فلا تحكم له بالعذاب...فالموت امنية البائسين...وانا اعرفه ليس بائسا

لربما هو متشائماً لكن سيدى القاضى...لا تحكم ع المجنى عليه

ففى قضيتك طرفان كلاً منهما جانى ومجنى عليه

هو جنى واُجنى عليه....وهى جنت واُجنى عليها

فرفقا بحكمك .....سيدى القاضى بلا تعجل ....أتحكم لهم بحياة ابديه تعيسه؟؟؟

استغيثك الحكم سيدى القاضى,,,هذا كلامى وهذه مرافعتى فلك القول...!!

ويقول سيدى القاضى....

مرافعتك جميله ولكنى لست انا من يحكم بالاعدام ع من تمنى الموت هروباً

فهذا نوعا من الهروب......رغبةً ان يبقى جانى ومجنى عليه هائماً بالاراضى

لعله يجد من يُذهب بأسه......اطمئن ايها الحبيب المكسور سوف تجد من امثالك كثيرين

فليس هذه اول قضيه احكم فيها بالحياة للحبيب مكسور...اذهب انطلق فلك الحياة والحريه

واقول......سيدى القاضى رفقاً به...فليس هذا حكم العدل

فالحريه قاتلة له...هو يحتاج الحكم والنصيحه

قائلاً لي اتركيه...فلا نصيحة تُجدى مع من لا هدف له

واصرخ قائله بل له فهوى اخاً لم تلده امى وانا اعلم.....فقط هو مجروح هو مكسور

ليس هذا الحكم الذى منك انتظرته .....فيا لقسوتك يا سيدى القاضى

اتعرف من هو كان القاضى؟؟ .........نفسك يا أخى

فيالها من نفس قاسيه .....تصالح مع نفسك وتقارب من ضميرك

لعل نفسك تُغير حكمها فيك

وانتبه فنفسك لم تسمع دفاع الطرف الاخر....اعطت الحكم دون دفاع ....لربما لديه اعذار ليس عذر

فاسمح لنفسك بسماع دفاع الجانيه والمجنى عليها...

وانتظر ولا تتعجل....فانت

فحكمت عليها من اول جلسه دون سماع شهود او اعادة المرافعه.

النهاية


اهداء...

17‏/5‏/2011

الرحيل السهل

انسي انسي انك كنت تعرفين رجلا طيبا هادئ الطباع
ولا كنت يوما اطلب الهاتف المحمول وترفضين سماعي
هكذا انتي اليوم فجربي اليوم الما كان بالامس بلا داعي 
تألمت تمزقت وحطمني امل ..االيوم عنه اقلاعي 
ذبت وذبني الحنين واستيقظت من حلمي علي اوجاعي 
فوهم لو تظنين اني اليك عائد بل عنك تبت وعن اندعافي
نام القلب وخاط الكري واندمل الجرح وللدرس اني واع
صلب انا كالحجر تقولين كلا نافخ في البارد بعد تسرع والتساع
خطواتي مضبوطة النقل افكاري محكمة كم ذقت من الاسراعي
لا تقولين احلام فكم من حلم احياه اصرار فيا للاطلاع
ذابل حلمك..نعم ..فلا عودة ولا جزع عرفت بعدك اين امتاعي
انت وهم كبير ادركته والحمد لله فمحيطك لم يبغ الا ضياعي
وسبحت في عالم لن تصليه ابدا فحبذا خضوعك للوداع
اذهبي ..اذهبي ولا تعودي ..ولا تفكري وافتحي مذياعي
تلك هدية بها شريط كلما جن يأس نسياني حبذا استماعي 
وداعا ..وداعا سيدة لا ترحمين لعوب انت بلا طباع

16‏/5‏/2011

رأيتهُمْ يَعصونْ

رأيتهُمْ يَعصونْ

واللهِ رأيتهم يعصون
والى طريقِ الموتِ يسيرون
وبنارِ الذُلِ يهتدون

والله رأيتهم يعصون

لوجودى لم يبالوا
لصوتِ العقلِ لم يسمعوا
وللأذانِ لم يلبوا
هيهاتَ لكم أيها المُتجبِرُون

والله رأيتهم يعصون

خضعتم للبطشِ قانعون
والآن عن الحق تخْرسُون
لماذا الآن حائرون ؟!
وبالخفايا تهمِسُون ؟!
خِفْتُمْ أم لجديدٍ تَرسمون

والله رأيتهم يعصون

تذكروا.....

أنتم من الجنةِ مَحرومون

وللعاب النار تسيلون
أفٍ منكم أيها المجرمون

والله رأيتهم يعصون

قلتم نحن أسفون
وللخطأِ تكررون
كيف الجَفْنِ تُغْمِضُون ؟!
وبالنومِ تهنئون؟!

والله رأيتهم يعصون

تُوبوا سريعاً الى الله
لعلكم تُرحمون

و...
رأيتهم يعصون


"ـــ مســ ك ــ الحيــاة ـــ"