Coordinates	45°30′″N73°40′″N
name	Flanders
native name	Vlaanderen Flandre
native name lang
settlement type	Region of Belgium
flag size	150px
flag alt	Flag of Flanders
map alt	Flanders shown within Belgium and the EU
map caption	Present-day Belgian Flanders (red) shown within Belgium and the EU. Brussels is in some contexts considered part of Flanders and in other contexts separate.
area land km2	13522
population total	6161600
population as of	1 January 2008
population density km2	456
timezone1	CET
utc offset1	+1
timezone1 dst	CEST
utc offset1 dst	+2 }}

name	French Flanders
native name	Flandre française Frans-Vlaanderen
native name lang
settlement type	Province of France
flag size	150px
flag alt	Flag of French Flanders
map alt	French Flanders shown within the Nord-Pas de Calais region
map caption	French Flanders, with its two historical subprovinces, shown within the Nord-Pas de Calais region
area land km2	2621
population total	1733184
population as of	1 January 2008
population density km2	661
timezone1	CET
utc offset1	+1
timezone1 dst	CEST
utc offset1 dst	+2 }}

Flanders (Dutch: , , sometimes ''(les) Flandres'') is the (political) community of the Flemings but also one of the institutions in Belgium, and a geographical region located in parts of present-day Belgium, France and the Netherlands. "Flanders" can also refer to the northern part of Belgium that contains Brussels, Bruges, Ghent and Antwerp. Over the course of history, the geographical territory that was called "Flanders" has varied. From the during the earlier industrialization leading southern region of Belgium, French-speaking Wallonia, a gradual "shift of political and economic power to the Flemish" since shortly after the mid-twentieth century, is noticed.

To the English speaking peoples, Flanders meant historically (from ''circa'' 1000 AD) the land situated along the North Sea from the Strait of Dover to the Scheldt estuary. The southern borders were generally ill-defined. Over the last millennium, it was mostly the southern and western borders that receded to give the present day borders within northern Belgium.

Flanders has figured prominently in European history. Between the early 17th century and 1945, the political outcomes of modern Spain, France, Britain, the Netherlands, Germany and Austria were often decided by battles on the plains of Flanders. Even earlier in British and Irish history, the Flemings or Flemish were important allies of the Normans in their conquest of England (1066) and invasion of Ireland (1169–71).

In contemporary Belgium, there is pressure to consider Flanders as the 'country of the Flemings' rather than just a ''region of Belgium''. As it stands by statute today, however, Flanders consists of the north of Belgium (the Flemish Region) and the Brussels Capital Region, which is part of the Flemish Community. Brussels is also part of the French Community of Belgium. The use of the name Belgium in the legal name of only one Community has led to enormous political discourse throughout Belgium.

For the last few decades, with the legal establishment of the Flemish Community (), the Flemings have their own political institutions. The parliament and government are the governing institutions of Flanders. There is also a geographical, political and administrative entity called the ''Flemish Region'' () but it has ceded all its competencies to the Flemish Community. Thus, the institutions of the Community govern both the Community and the Region. The capital city of Flanders is Brussels.

In feudal times, Flanders formed a county, the County of Flanders, which extended over the present day:

Belgian provinces of West Flanders and East Flanders

French regions French Flanders in the ''départment'' Nord-Pas de Calais and extending into neighboring ''départments'',

Dutch region Zeelandic Flanders (''Zeeuws-Vlaanderen'') in the province of Zeeland

Related to these geographical or political uses of the noun 'Flanders', and the adjective 'Flemish', they may also be used to describe several other distinct (but inter-connected) cultural, geographical, historical, linguistic or political items or entities.

Uses of the term

Northern part of Belgium

The term "Flanders" has several main meanings:

the social, cultural and linguistic, scientific and educational, economical and political community of the Flemings; generally called the "Flemish community" ''(small "c")'' (others refer to this as the "Flemish nation"). It has over 6 million inhabitants, or about 60% of the population of Belgium.

the constituent governing institution of the federal Belgian state through the institutions named the Flemish Community ''(capital "C")'', exercising the powers in most of those domains for the aforementioned community, and the officially Dutch-speaking Flemish Region which has powers mainly on economical matters. The Community absorbed the Region, leading to a single operative body: the Flemish Government and a single legislative organ: the Flemish Parliament;

the geographical region in the north of Belgium coinciding with the federal Belgian state's Flemish Region but excluding the bilingual Capital Region;

the geographical area comprising the two westernmost provinces of the Flemish Region, West Flanders and East Flanders, parts of a former county named Flanders.

Historical parts of the County of Flanders

When ''Flandria'' appeared in the 8th century, it was a Frankish fief centred on Bruges. The region's name is thought to derive from the Old Low German word ''flauma'', which means ''flooded land''. Originally this referred to the polders surrounding Bruges and dates from a period before the counts of Flanders expanded their territory. In the 14th century, the county of Flanders reached its maximum size, and became the wealthiest part of the Seventeen Provinces. It extended over the modern-day Belgian provinces of East Flanders, West Flanders, and Hainaut.

In the 14th century, the French kings conquered Picardy, where French is now spoken, earning the area the name, ''la Flandre romane'' (Romance Flanders) or ''la Flandre gallicante'' (Gallic Flanders), or incorrectly ''Flandre-wallonne'' (Walloon Flanders) though its language was not Walloon, but Picard. In the 16th century, Artois was also conquered by the French. In 17th and 18th century, king Louis XIV of France captured more French-speaking areas in southern Flanders still referred to as French Flanders or ''la Flandre Lilloise''. French Flanders contains the departements Nord and Pas de Calais), comprising the arrondissements of Lille and Douai. Originally, Dutch was spoken there, and, to this day, a Flemish dialect persists in some rural areas near Dunkirk. The city of Lille identifies itself as a part of historic Flanders, and thus as "Flemish" in the geographical and historical sense, and this is reflected, for instance, in the name of its local railway station TGV ''Lille-Flandres''.

During this period of French encroachment on the region, the United Provinces also took some areas of northern Flanders. These areas now form Zeelandic Flanders (''Zeeuws-Vlaanderen''), a part of the Netherlands province of Zeeland.

Dutch-speaking part of Belgium

The significance of the County and its counts eroded through time, but the designation remained in a very broad sense. In the Early Modern, the term Flanders was associated with the southern part of the Low Countries, the Southern Netherlands. During the 19th and 20th centuries, it became increasingly commonplace to refer to the Dutch-speaking part of Belgium as "Flanders". The linguistic limit between French and Dutch was recorded in the early '60's, from Kortrijk to Maastricht. Now, Flanders extends over the northern part of Belgium, including the Belgian parts of the Duchy of Brabant and Limburg.

The ambiguity between this eastwardly much wider area and that of the Countship (or the Belgian parts thereof), still remains. In most present-day contexts however, the term Flanders is generally taken to refer to either the political, social, cultural and linguistic community (and the corresponding official institution, the Flemish Community), or the geographical area, one of the three institutional regions in Belgium, namely the Flemish Region.

In history of art and other fields, the adjectives Flemish and Netherlandish are commonly used to designate all the artistic production in this area before about 1580, after which it refers specifically to the southern Netherlands. For example the term ''Flemish Primitives'', now outdated in English but used in French, Flemish and other languages, is a synonym for ''Early Netherlandish painting'', and it is not uncommon to see Mosan art categorized as Flemish art. In music the ''Franco-Flemish School'' is also known as the ''Dutch School''.

Describing Flanders as the Dutch-speaking part of Belgium is commonplace, although Jewish groups have been speaking Yiddish in Antwerp for centuries, and Flanders' minority residents include 170 nationalities — their larger groups speaking French, Berber, Turkish, Arabic, Spanish, Italian and Polish. Typically, in each group, some people switch to using Dutch in their daily life, while others maintain their language of origin.

History

Early history

The area, roughly encompassing the later geographical meanings of Flanders, had been inhabited by Celts until Germanic people began immigrating by crossing the Rhine, either gradually driving them south- or westwards, or rather merging with them. By the first century BC Germanic languages had become prevalent, and the inhabitants were called Belgæ while the area was the coastal district of Gallia Belgica, the most northeastern province of the Roman Empire at its height. The boundaries were the Marne and Seine in the West, with Armorica (Brittany), and the Rhine in the East, with Frisia. This changed upon the Count of Rouen's settlement with the King of France, which made a cession of western Flanders and eastern Armorica to the Normans.

Historical Flanders: County of Flanders

Created in the year 862 as a feudal fief in West Francia, the County of Flanders was divided when its western districts fell under French rule in the late 12th century. The remaining parts of Flanders came under the rule of the counts of neighbouring Hainaut in 1191. The entire area passed in 1384 to the dukes of Burgundy, in 1477 to the Habsburg dynasty, and in 1556 to the kings of Spain. The western districts of Flanders came finally under French rule under successive treaties of 1659 (Artois), 1668, and 1678.

During the late Middle Ages Flanders' trading towns (notably Ghent, Bruges and Ypres) made it one of the richest and most urbanized parts of Europe, weaving the wool of neighbouring lands into cloth for both domestic use and export. As a consequence, a very sophisticated culture developed, with impressive achievements in the arts and architecture, rivaling those of Northern Italy. Ghent, Bruges, Ypres and the Franc of Bruges formed the Four Members, a form of parliament which exercised considerable power in Flanders.

Increasingly powerful from the 12th century, the territory's autonomous urban communes were instrumental in defeating a French attempt at annexation (1300–1302), finally defeating the French in the Battle of the Golden Spurs (July 11, 1302), near Kortrijk. Two years later, the uprising was defeated and Flanders remained part of the French Crown. Flemish prosperity waned in the following century, however, owing to widespread European population decline following the Black Death of 1348, the disruption of trade during the Anglo-French Hundred Years' War (1337–1453), and increased English cloth production. Flemish weavers had gone over to Worstead and North Walsham in Norfolk in the 12th century and established the woolen industry.

Flanders in the Low Countries

; Beeldenstorm In 1500, Charles V was born in Ghent. He inherited the Seventeen Provinces (1506), Spain (1516) with its colonies and in 1519 was elected Holy Roman Emperor. The Pragmatic Sanction of 1549, issued by Charles V, established the Low Countries as the Seventeen Provinces (or Spanish Netherlands in its broad sense) as an entity separate from the Holy Roman Empire and from France. In 1556 Charles V abdicated due to ill health (he suffered from crippling gout). Spain and the Seventeen Provinces went to his son, king Philip II of Spain.

Meanwhile, Protestantism had reached the Low Countries. Among the wealthy traders of Antwerp, the Lutheran beliefs of the German Hanseatic traders found appeal, perhaps partly for economic reasons. The spread of Protestantism in this city was aided by the presence of an Augustinian cloister (founded 1514) in the St. Andries quarter. Luther, an Augustinian himself, had taught some of the monks, and his works were in print by 1518. The first Lutheran martyrs came from Antwerp. The Reformation resulted in consecutive but overlapping waves of reform: a Lutheran, followed by a militant Anabaptist, then a Mennonite, and finally a Calvinistic movement. These movements existed independently of each other.

Philip II, a devout Catholic and self-proclaimed protector of the Counter-Reformation, suppressed Calvinism in Flanders, Brabant and Holland (what is now approximately Belgian Limburg was part of the Bishopric of Liège and was Catholic ''de facto''). In 1566, the iconoclasm (''Beeldenstorm'') began as protest against Philip II and promoted the disfigurement of statues and paintings depicting saints. This was associated with the ensuing religious war between Catholics and Protestants, especially the Anabaptists. The ''Beeldenstorm'' started in what is now French Flanders, with open-air sermons () that spread through the Low Countries, first to Antwerp and Ghent, and from there further east and north. In total it lasted not even a month. The iconoclasm resulted not only in the destruction of Catholic art, but also cost the lives of many priests.

; The Eighty Years' War and its consequences Subsequently, Philip II sent the Duke of Alba to the Provinces to repress the revolt. Alba recaptured the southern part of the Provinces, who signed the Union of Atrecht, which meant that they would accept the Spanish government on condition of more freedom. But the northern part of the provinces signed the Union of Utrecht and settled in 1581 the Republic of the Seven United Netherlands. Spanish troops quickly started fighting the rebels, but before the revolt could be completely defeated, a war between England and Spain had broken out, forcing Philip's Spanish troops to halt their advance. Meanwhile, the Spanish armies had already conquered the important trading cities of Bruges and Ghent. Antwerp, which was then arguably the most important port in the world, also had to be conquered. On August 17, 1585, Antwerp fell. This ended the Eighty Years' War for the (from now on) Southern Netherlands. The United Provinces (the Northern Netherlands) fought on until 1648 – the Peace of Westphalia.

While Spain was at war with England, the rebels from the north, strengthened by refugees from the south, started a campaign to reclaim areas lost to Philips II's Spanish troops. They managed to conquer a considerable part of Brabant (the later Noord-Brabant of the Netherlands), and the south bank of the Scheldt estuary (Zeeuws-Vlaanderen), before being stopped by Spanish troops. The front line at the end of this war stabilized and became the current border between present-day Belgium and the Netherlands. The Dutch (as they later became known) had managed to reclaim enough of Spanish-controlled Flanders to close off the river Scheldt, effectively cutting Antwerp off from its trade routes.

First the fall of Antwerp to the Spanish and later also the closing of the Scheldt were causes of a considerable emigration of Antverpians. Many of the Calvinist merchants of Antwerp and also of other Flemish cities left Flanders and emigrated to the north. A large number of them settled in Amsterdam, which was at the time a smaller port, only of significance in the Baltic trade. In the following years Amsterdam was rapidly transformed into one of the world's most important ports. Because of the contribution of the Flemish exiles to this transformation, the exodus is sometimes described as "''creating a new Antwerp''".

Flanders and Brabant, due to these events, went into a period of relative decline from the time of the Thirty Years War. In the Northern Netherlands however, the mass emigration from Flanders and Brabant became an important driving force behind the Dutch Golden Age.

; Southern Netherlands (1581–1795)

Although arts remained at a relatively impressive level for another century with Peter Paul Rubens (1577–1640) and Anthony van Dyck, Flanders experienced a loss of its former economic and intellectual power under Spanish, Austrian, and French rule, with heavy taxation and rigid imperial political control compounding the effects of industrial stagnation and Spanish-Dutch and Franco-Austrian conflict. The Southern Netherlands suffered severely under the Spanish Succession war, but under the reign of empress Maria-Theresia these lands economically flourished again. Influenced by the Enlightenment, the Austrian emperor Joseph II was the first sovereign who has been in the Southern Netherlands since king Philip II of Spain left them in 1559.

; French Revolution and Napoleonic France (1795–1815) In 1794 the French Republican Army started using Antwerp as the northernmost naval port of France, which country officially annexed Flanders the following year as the ''départements'' of Lys, Escaut, Deux-Nèthes, Meuse-Inférieure and Dyle. Obligatory (French) army service for all men aged 16–25 was one of the main reasons for the people's uprising against the French in 1798, known as the ''Boerenkrijg'' (''Peasants' War''), with the heaviest fighting in the Campine area.

; United Kingdom of the Netherlands (1815–1830) After the defeat of Napoleon Bonaparte at the 1815 Battle of Waterloo in Waterloo, Brabant, sovereignty over the Austrian Netherlands – Belgium minus the East Cantons and Luxembourg – was given by the Congress of Vienna (1815) to the United Netherlands (Dutch: ''Verenigde Nederlanden''), the state that briefly existed under Sovereign Prince William I of Orange Nassau, the latter King William I of the United Kingdom of the Netherlands, after the French Empire was driven out of the Dutch territories. The United Kingdom of the Netherlands was born. The Protestant King of the Netherlands, William I rapidly started the industrialisation of the southern parts of the Kingdom. The political system that was set up however, slowly but surely failed to forge a true union between the northern and the southern parts of the Kingdom. The southern bourgeoisie mainly was Roman Catholic, in contrast to the mainly Protestant north; large parts of the southern bourgeoisie also primarily spoke French rather than Dutch.

In 1815 the Dutch Senate was reinstated (Dutch: ''Eerste Kamer der Staaten Generaal''). The nobility, mainly coming from the south, became more and more estranged from their northern colleagues. Resentment grew both among the Roman Catholics from the south and the Protestants from the north and among the powerful liberal bourgeoisie from the south and their more moderate colleagues from the north. On August 25, 1830 (after the showing of the opera 'La Muette de Portici' of Daniel Auber in Brussels) the Belgian Revolution sparked off and became a fact. On October 4, 1830, the Provisional Government (Dutch: ''Voorlopig Bewind'') proclaimed the independence which was later confirmed by the National Congress that issued a new Liberal Constitution and declared the new state a Constitutional Monarchy, under the House of Saxe-Coburg. Flanders now became part of the Kingdom of Belgium, which was recognized by the major European Powers on January 20, 1831. The de facto dissidence was only finally recognized by the United Kingdom of the Netherlands on April 19, 1839.

Kingdom of Belgium

In 1830, the Belgian Revolution led to the splitting up of the two countries. Belgium was confirmed as an independent state by the Treaty of London of 1839, but deprived of the eastern half of Limburg (now Dutch Limburg), and the Eastern half of Luxembourg (now the Grand-Duchy of Luxembourg). Sovereignty over Zeeuws Vlaanderen, south of the Westerscheldt river delta, was left with the Kingdom of the Netherlands, which was allowed to levy a toll on all traffic to Antwerp harbour until 1863.

; Rise of the Flemish Movement

The Belgian Revolution was not well supported in Flanders and even on the 4th of October 1830, when the Belgian independence was eventually declared, Flemish authorities refused to take orders from the new Belgian government in Brussels. Only after Flanders was subdued with the aid of a large French military force one month later, under the leadership of the Count de Pontécoulant, did Flanders become a true part of Belgium.

The French-speaking bourgeoisie showed very little respect for the Flemish part of the population. French became the only official language in Belgium and all secondary and higher education in the Flemish language was abolished. Belgium's co-founder, Charles Rogier, wrote in 1832 to the minister of justice Jean-Joseph Raikem, that "the first principles of a good administration are based upon the exclusive use of one language, and it is evident that the only language of the Belgians should be French. In order to achieve this result, it is necessary that all civil and military functions are entrusted to Walloons and Luxemburgers; this way, the Flemish, temporarily deprived of the advantages of these offices, will be constrained to learn French, and we will hence destroy bit by bit the Germanic element in Belgium."

In 1838, another co-founder, senator Alexandre Gendebien, even declared that the Flemish were "one of the more inferior races on the Earth, just like the negroes".

In 1834, all people even remotely suspected of being "Flemish minded" or calling for the reunification of the Netherlands were prosecuted and their houses looted and burnt. Flanders, until then a very prosperous European region, was not considered worthwhile for investment and scholarship. A study in 1918 demonstrated that in the first 88 years of its existence, 80% of the Belgian GNP was invested in Wallonia. This led to a widespread poverty in Flanders, forcing roughly 300.000 Flemish to emigrate to Wallonia to start working there in the heavy industry.

All of these events led to a silent uprising in Flanders against the French-speaking domination. But it was not until 1878 that Dutch was allowed to be used for official purposes in Flanders, although French remained the only official language in Belgium.

In 1873, Dutch was again allowed in secondary schools; the first of which reopened in 1889. The Flemings had to wait until 1919—after many Flemish soldiers died in the trenches of World War I—to have their language officially recognised and until 1930 before the first Flemish university was reopened.

The first translation of the Belgian constitution in Dutch was not published until 1967.

; World War I and its consequences Flanders (and Belgium as a whole) saw some of the greatest loss of life on the Western Front of the First World War, in particular from the three battles of Ypres. Due to the hundreds of thousands of casualties at Ypres, the poppies that sprang up from the battlefield afterwards, later immortalised in the Canadian poem "In Flanders Fields", written by John McCrae, have become a symbol for lives lost in war.

Flemish feeling of identity and consciousness grew through the events and experiences of war. The occupying German authorities took several Flemish-friendly measures. More importantly, the experiences of many Dutch-speaking soldiers on the front led by French-speaking officers catalysed Flemish emancipation. The French-speaking officers often gave orders in French only, followed by "et pour les Flamands, la même chose!" which meant "and for the Flemish, the same thing!" (which obviously did not help the Flemish conscripts, who were mostly uneducated farmers and workers who could not have understood what had been said in French). The resulting suffering is still remembered by Flemish organizations during the yearly Yser pilgrimage in Diksmuide at the monument of the Yser Tower.

; Right-Wing Nationalism in the interbellum and World War II

During the interbellum and World War II, several right-wing fascist and/or national-socialistic parties emerged in Belgium, the Flemish ones being energized by the anti-Flemish discrimination of the Wallonians. Since these parties were promised more rights for the Flemings by the German government during World War II, many of them collaborated with the Nazi regime. After the war, collaborators (or people who were "Zwart", "Black" during the war) were prosecuted and punished, among them many Flemish Nationalists whose main goal had been for more rights for Flanders. As a result, up until this day Flemish Nationalism is often associated with right-wing and fascist ideologies.

; Flemish autonomy

After World War II, the differences between Dutch-speaking and French-speaking Belgians became clear in a number of conflicts, such as the question whether King Leopold III should return (which most Flemings supported but not the Walloons) and the use of Dutch in the Catholic University of Leuven. As a result, several state reforms took place in the second half of the 20th century, which transformed the unitary Belgium into a federal state with communities, regions and language areas. This resulted also in the establishment of a Flemish Parliament and Government.

Several Flemish parties still advocate for more Flemish autonomy, some even for Flemish independence (see Partition of Belgium), whereas the French-speakers would like to keep the current state as it is. Recent governments (such as Verhofstadt I Government) have transferred certain federal competences to the regional governments.

On 13 December 2006, a spoof news broadcast by the Belgian Francophone public broadcasting station RTBF declared that Flanders had decided to declare independence from Belgium.

The 2007 federal elections showed more support for Flemish autonomy. All the political parties that advocated a significant increase of Flemish autonomy gained votes as well as seats in the Belgian parliament. This was especially the case for CD&V; and N-VA (who had participated on a shared electoral list). The 2009 regional elections have strengthened the parties in favor a significant increase of Flemish autonomy: CD&V; and N-VA were the clear winners. N-VA became even the largest party in Flanders and Belgium during the 2010 federal elections.

These victories for the advocates of much more Flemish autonomy are very much in parallel with opinion polls that show a structural increase in popular support for their agenda. Since 2006, certain polls have started showing a majority in favor of Flemish independence. Those polls are not yet representative, but they point to a significant long-term trend.

Several negotiators having come and gone since the federal elections of 10 June 2007 without diminishing the disagreements between Flemish and Walloon politicians regarding a further State reform, causing difficulties for the formation of the federal government and ultimately leading to the fall of the government and new elections on June 13, 2010. These were won by the pro-independence party of the N-VA in Flanders. The long-lasting government formation of 2010 broke the previous record of 2007.

Government and politics

Both the Flemish Community and the Flemish Region are constitutional institutions of the Kingdom of Belgium with precise geographical boundaries. In practice, the Flemish Community and Region together form a single body, with its own parliament and government, as the Community legally absorbed the competences of the Region.

The area of the Flemish Community is represented on the maps above, including the area of the Brussels-Capital Region (hatched on the relevant map). Roughly, the Flemish Community exercises competences originally oriented towards the individuals of the Community's language: culture (including audiovisual media), education, and the use of the language. Extensions to personal matters less directly associated with language comprise sports, health policy (curative and preventive medicine), and assistance to individuals (protection of youth, social welfare, aid to families, immigrant assistance services, etc.).

The area of the Flemish Region is represented on the maps above. It has a population of around 6 million (excluding the Dutch-speaking community in the Brussels Region, grey on the map for it is not a part of the Flemish Region). Roughly, the Flemish Region is responsible for territorial issues in a broad sense, including economy, employment, agriculture, water policy, housing, public works, energy, transport, the environment, town and country planning, nature conservation, credit, and foreign trade. It supervises the provinces, municipalities, and intercommunal utility companies.

The number of Dutch-speaking Flemish people in the Capital Region is estimated to be between 11% and 15% (official figures do not exist as there is no language census and no official subnationality). According to a survey conducted by the Université Catholique de Louvain in Louvain-La-Neuve and published in June 2006, 51% of respondents from Brussels claimed to be bilingual, even if they do not have Dutch as their first language. They are governed by the Brussels Region for economics affairs and by the Flemish Community for educational and cultural issues.

As of 2005, Flemish institutions such as Flanders' government, parliament, etc. represent the Flemish Community and the Flemish region. The region and the community thus ''de facto'' share the same parliament and the same government. All these institutions are based in Brussels. Nevertheless, both bodies (the Community and the Region) still exist and the distinction between both is important for the people living in Brussels. Members of the Flemish parliament who were elected in the Brussels Region cannot vote on affairs belonging to the competences of the Flemish Region.

The official language for all Flemish institutions is Dutch. French enjoys a limited official recognition in a dozen municipalities along the borders with French-speaking Wallonia, and a large recognition in the bilingual Brussels Region. French is widely known in Flanders, with 59% claiming to know French according to a survey conducted by the Université catholique de Louvain in Louvain-La-Neuve and published in June 2006.

Politics

Many new political parties during the last half century were founded in Flanders: the nationalist Volksunie of which the right nationalist Vlaams Blok (Vlaams Belang) split off, and which later dissolved into the former SPIRIT (now SLP), moderate nationalism rather left of the spectrum, and the NVA, more conservative moderate nationalism; the leftist alternative/ecological Groen!; the short-lived anarchistic libertarian spark ROSSEM and more recently the conservative-right liberal Lijst Dedecker, founded by Jean-Marie Dedecker.

Flemish nation

For many Flemings, Flanders is more than just a geographical area or the federal institutions (Flemish Community and Region). Some even call it a nation: a people of over 6 million living in the Flemish Region and in the Brussels-Capital Region. Flemings share many political, cultural, scientific, social and educational views. Although most Flemings identify themselves more with Flanders than with Belgium, the largest group defines itself as both Flemish and Belgian. The idea of an independent Flanders finds its root in the romantic nationalism of the 19th century.

Administrative divisions

The Flemish Region covers and contains over 300 municipalities. It is divided into 5 provinces: # Antwerp (''Antwerpen'') # Limburg (''Limburg'') # East Flanders (''Oost-Vlaanderen'') # Flemish Brabant (''Vlaams-Brabant'') # West Flanders (''West-Vlaanderen'')

Independently from the provinces, Flanders has its own local institutions in the Brussels-Capital Region, being the ''Vlaamse GemeenschapsCommissie'' (VGC), and its municipal antennae (''Gemeenschapscentra'', community centers for the Flemish community in Brussels). These institutions are independent from the educational, cultural and social institutions which depend directly on the Flemish Government. They exert, among others, all those cultural competences that outside Brussels fall under the provinces.

Geography and climate

Antwerp, Ghent, Bruges and Leuven are the largest cities of the Flemish Region. Antwerp has a population of more than 480,000 citizens and is the largest city, Ghent has a population of 240,000 citizens, followed by Bruges with 120,000 citizens and Leuven counts almost 100,000 citizens. Brussels is a part of Flanders as far as community matters are concerned, but does not belong to the Flemish Region.

Flanders has two main geographical regions: the coastal Yser basin plain in the north-west and a central plain. The first consists mainly of sand dunes and clayey alluvial soils in the polders. Polders are areas of land, close to or below sea level that have been reclaimed from the sea, from which they are protected by dikes or, a little further inland, by fields that have been drained with canals. With similar soils along the lowermost Scheldt basin starts the central plain, a smooth, slowly rising fertile area irrigated by many waterways that reaches an average height of about five metres (16.4 ft) above sea level with wide valleys of its rivers upstream as well as the Campine region to the east having sandy soils at altitudes around thirty metres Near its southern edges close to Wallonia one can find slightly rougher land richer of calcium with low hills reaching up to 150 m (492 ft) and small valleys, and at the eastern border with the Netherlands, in the Meuse basin, there are marl caves (''mergelgrotten''). Its exclave around Voeren between the Dutch border and the Walloon province of Liège attains a maximum altitude of 288 m (945 ft) above sea level.

The climate is maritime temperate, with significant precipitation in all seasons (Köppen climate classification: ''Cfb''; the average temperature is 3 °C (37 °F) in January, and 21 °C (69.8 °F) in July; the average precipitation is 65 millimetres (2.6 in) in January, and 78 millimetres (3.1 in) in July).

Economy

Total GDP of the Flemish Region in 2004 was € 165,847 million (Eurostat figures). Per capita GDP at purchasing power parity was 23% above the EU average.

Flanders was one of the first continental European areas to undergo the Industrial Revolution, in the 19th century. Initially, the modernization relied heavily on food processing and textile. However, by the 1840s the textile industry of Flanders was in severe crisis and there was famine in Flanders (1846–50). After World War II, Antwerp and Ghent experienced a fast expansion of the chemical and petroleum industries. Flanders also attracted a large majority of foreign investments in Belgium, among others thanks to its well-educated and industrious labour force. The 1973 and 1979 oil crises sent the economy into a recession. The steel industry remained in relatively good shape. In the 1980s and 90s, the economic centre of Belgium continued to shift further to Flanders. Nowadays, the Flemish economy is mainly service-oriented, although its diverse industry remains a crucial force. Flemish productivity per capita is between 20 and 25% higher than that in Wallonia.

Flanders has developed an excellent transportation infrastructure of ports, canals, railways and highways. The Port of Antwerp is the second-largest in Europe, after Rotterdam.

In 1999, the euro, the single European currency, was introduced in Flanders. It replaced the Belgian franc in 2002. The Flemish economy is strongly export oriented, in particular of high value-added goods. The main imports are food products, machinery, rough diamonds, petroleum and petroleum products, chemicals, clothing and accessories, and textiles. The main exports are automobiles, food and food products, iron and steel, finished diamonds, textiles, plastics, petroleum products, and nonferrous metals. Since 1922, Belgium and Luxembourg have been a single trade market within a customs and currency union—the Belgium-Luxembourg Economic Union. Its main trading partners are Germany, the Netherlands, France, the United Kingdom, Italy, the United States, and Spain.

Demographics

The highest population density is found in the area circumscribed by the Brussels-Antwerp-Ghent-Leuven agglomerations that surround Mechelen and is known as the Flemish Diamond, in other important urban centres as Bruges and Kortrijk to the west, and notable centres Turnhout and Hasselt to the east. In April 2005 the Flemish Region had a population of 6,058,368, and about 15% of the 1,018,029 people in the Brussels Region are also considered Flemish.

The (Belgian) ''laicist'' constitution provides for freedom of religion, and the various government generally respects this right in practice. Since independence, Catholicism, counterbalanced by strong freethought movements, has had an important role in Belgium's politics, since the 20th century in Flanders mainly via the Christian trade union (ACV) and the Christian Democrat party (CD&V;). According to the ''2001 Survey and Study of Religion'', about 47 percent of the Belgian population identify themselves as belonging to the Catholic Church, while Islam is the second-largest religion at 3.5 percent. A 2006 inquiry in Flanders, considered more religious than Wallonia, showed that 55% considered themselves religious, and 36% believed that God created the world. (See also Religion in Belgium).

Education is compulsory from the ages of six to 18, but most Flemings continue to study until around 23. Among the OECD countries in 1999, Flanders had the third-highest proportion of 18–21-year-olds enrolled in postsecondary education. Flanders also scores very high in international comparative studies on education. Its secondary school students consistently rank among the top three for mathematics and science. However, the success is not evenly spread: ethnic minority youth score consistently lower, and the difference is larger than in most comparable countries.

Mirroring the historical political conflicts between the freethought and Catholic segments of the population, the Flemish educational system is split into a ''laïque'' branch controlled by the communities, the provinces, or the municipalities, and a subsidised religious—mostly Catholic—branch controlled by both the communities and the religious authorities—usually the dioceses. It should however be noted that—at least for the Catholic schools—the religious authorities have very limited power over these schools. Smaller school systems follow 'methodical pedagogies' (Steiner, Montessori, Freinet, ...) or serve the Jewish and Protestant minorities. During the school year 2003-2004, 68.30% of the total population of children between the ages of six and 18 went to subsidized private schools (both religious schools or 'methodical pedagogies' schools).

Language and culture

At first sight, ''Flemish culture'' is defined by its language and its gourmandic mentality, as compared to the more Calvinistic Dutch culture. Dutch and Flemish paintings enjoyed more equal international admiration.

The standard language in Flanders is Dutch; spelling and grammar are regulated by a single authority, the Nederlandse Taalunie ('Union of Dutch Language'), comprising a committee of ministers of the Flemish and Dutch governments, their advisory council of appointed experts, a controlling commission of 22 parliamentarians, and a secretariate. The term Flemish can be applied to the Dutch spoken in Flanders; it shows many regional and local variations.

Literature in non-standardized dialects of the current area of Flanders originated with Hendrik van Veldeke's ''Eneas Romance'', the first courtly romance in a Germanic language (12th Century). With a writer of Hendrik Conscience's statue, Flemish Literature rose ahead of French literature in Belgium's early history. Guido Gezelle not only explicitly referred to his writings as Flemish, but actually used it in many of his poems, and strongly defended it: Original from ''kleengedichtjes'' (1860?) ''Gij zegt dat ‘t vlaamsch te niet zal gaan:'' ''‘t en zal!'' ''dat ‘t waalsch gezwets zal boven slaan:'' ''‘t en zal!'' ''Dat hopen, dat begeren wij:'' ''dat zeggen en dat zweren wij:'' ''zoo lange als wij ons weren, wij:'' ''‘t en zal, ‘t en zal,'' ''‘t en zal!'' Translation 2011-02-17 — 2011-02-19. For explanations, continue along each 'next' edit comment ''You say Flemish will fade away:'' ''It shan't!'' ''that Walloon twaddle will have its way:'' ''It shan't!'' ''This we hope, for this we hanker:'' ''this we say and this we vow:'' ''as long as we fight back, we:'' ''It shan't, It shan't,'' ''It shan't!''

The distinction between Dutch and Flemish literature, often perceived politically, is also made on intrinsic grounds by some experts such as Kris Humbeeck, professor of Literature at the University of Antwerp. Nevertheless, nearly all Dutch-language literature read (and appreciated to varying degrees) in Flanders is the same as that in the Netherlands.

Influential Flemish writers include Ernest Claes, Stijn Streuvels and Felix Timmermans. Their novels mostly describe rural life in Flanders in the 19th century and at beginning of the 20th. Widely read by the older generations, they are considered somewhat old-fashioned by present-day critics. Some famous Flemish writers of the early 20th century wrote in French, including Nobel Prize winners (1911) Maurice Maeterlinck and Emile Verhaeren. They were followed by a younger generation, including Paul van Ostaijen and Gaston Burssens, who ''activated'' the Flemish Movement. Still widely read and translated into other languages (including English) are the novels of authors such as Willem Elsschot, Louis Paul Boon and Hugo Claus. The recent crop of writers includes the novelists Tom Lanoye and Herman Brusselmans, and poets such as the married couple Herman de Coninck and Kristien Hemmerechts.

See also

Burgundian Netherlands

Count of Flanders

Flemish Movement

Flemish Parliament

Flemish Primitives

Seventeen Provinces

Wallonia

References

External links

Flemish authorities (Dutch: ''Vlaamse overheid'') Flemish authorities (Dutch: ''Vlaamse overheid'')

Flemish Government (Dutch: ''Vlaamse regering'')

Flemish Community Council in Brussels (Dutch: ''Vlaamse Gemeenschapscommissie (VGC)'')

Visit Flanders Flanders Today (Weekly independent magazine on Flanders)

Toerisme Vlaanderen

Dag Vlaanderen

French Flanders Flanders reaches 6 million inhabitants

Belgium Rift: Flanders vs. Wallonia - slideshow by ''Life magazine''

Category:Divided regions

af:Vlaandere an:Flandres be:Фландрыя, гістарычная вобласць br:Flandrez ca:Flandes cv:Фландри cs:Vlámsko cy:Fflandrys da:Flandern de:Flandern el:Φλάνδρα es:Región Flamenca eo:Flandrio eu:Flandria fa:فلاندرز fr:Flandre (Belgique) fy:Flaanderen ga:Flóndras gv:Yn Flandyryn gl:Flandres - Vlaanderen ko:플랑드르 hr:Flandrija is:Flæmingjaland it:Fiandre he:פלנדריה sw:Flandria la:Flandria li:Vlaandere (gewes) hu:Flandria mk:Фландрија mr:फ्लांडर्स arz:فلاندر ms:Flanders nl:Vlaanderen nds-nl:Vlaanderen ja:フランドル no:Flandern oc:Flandra pap:Vlaanderen pl:Flandria (region) pt:Flandres ro:Flandra ru:Фландрия (историческая область) scn:Fiandri simple:Flemish Region sr:Фландрија fi:Flanderi sv:Flandern tl:Flandes th:ฟลานเดอร์ tr:Flandre uk:Фландрія vi:Flanders vls:Vloandern zh:弗兰德

Coordinates	45°30′″N73°40′″N
name	Justin Bieber
background	solo_singer
birth name	Justin Drew Bieber
birth date	March 01, 1994
birth place	London, Ontario, Canada
origin	Stratford, Ontario, Canada
instrument	Vocals, guitar, piano, percussion, trumpet
genre	Pop, R&B;, teen pop
occupation	Singer, musician, actor
years active	2009–present
label	Island, RBMG
associated acts	Usher
website	justinbiebermusic.com }}

Justin Drew Bieber ( , born March 1, 1994) is a Canadian pop/R&B; singer, songwriter and actor. Bieber was discovered in 2008 by Scooter Braun, who came across Bieber's videos on YouTube and later became his manager. Braun arranged for him to meet with Usher in Atlanta, Georgia, and Bieber was soon signed to Raymond Braun Media Group (RBMG), a joint venture between Braun and Usher, and then to a recording contract with Island Records offered by L.A. Reid. Bieber's debut single, "One Time", was released in 2009 and peaked in the top ten in Canada and charted in the top thirty in several international markets. His debut album, the seven-track EP ''My World'', followed in November 2009, and was soon certified platinum in the United States. He became the first artist to have seven songs from a debut album chart on the ''Billboard'' Hot 100.

Bieber's first full-length studio album, ''My World 2.0'', was released in March 2010. It debuted at number one or within the top ten in several countries and was certified platinum in the United States. It was preceded by the worldwide top-ten single, "Baby". The music video of "Baby" is currently ranked as the most viewed and most discussed YouTube video. Bieber followed-up the release of his debut album with his first headlining tour, the My World Tour, the remix albums ''My Worlds Acoustic'' and ''Never Say Never – The Remixes'', and the 3D biopic-concert film ''Justin Bieber: Never Say Never'' – which had an opening weekend gross that nearly matched the record for the biggest opening weekend for a concert-film. Bieber released his second studio album, ''Under the Mistletoe'' in November 2011, which debuted at number one on the ''Billboard'' 200. Bieber has received numerous awards, including Artist of the Year at the 2010 American Music Awards — and has been nominated for numerous awards, including Best New Artist and Best Pop Vocal Album at the 53rd Grammy Awards.

Life and career

1994–2007: Childhood and youth

Bieber was born on March 1, 1994, in London, Ontario, and was raised in Stratford, Ontario. Bieber's mother, Patricia Lynn "Pattie" Mallette, was 18 years old when she became pregnant with her son. Mallette, originally from Stratford, raised her son with the help of her parents, Bruce and Diane. Mallette worked a series of low-paying office jobs, raising Bieber as a single mother in low-income housing. Bieber has maintained contact with his father, Jeremy Jack Bieber, who married another woman and had two children. Bieber's paternal great-grandfather was a German immigrant to Canada. His mother's ancestry is French Canadian. Bieber attended French immersion school at Stratford school Jean Sauve.

During his childhood, Bieber was interested in hockey, soccer, and chess; he often kept his musical aspirations to himself. As he grew up, Bieber taught himself to play the piano, drums, guitar, and trumpet. In early 2007, when he was twelve, Bieber sang Ne-Yo's "So Sick" for a local singing competition in Stratford and placed second. Mallette posted a video of the performance on YouTube for their family and friends to see. She continued to upload videos of Bieber singing covers of various R&B; songs, and Bieber's popularity on the site grew. Chris Hicks, Bieber's A&R; at Island/Def Jam, explained the young artist's huge online following to HitQuarters by saying:

"He was doing something different. He was an attractive white kid singing very soulful R&B; hits. That set him apart immediately from anyone in his range because no one was covering or singing these kind of records. But equally important was that you believed in these songs – it was real. And you wanted to hear more."

2008–09: Discovery and ''My World''

While searching for videos of a different singer, Scooter Braun, a former marketing executive of So So Def, clicked on one of Bieber's 2007 videos by accident. Impressed, Braun tracked down the theater Bieber was performing in, located Bieber's school, and finally contacted Mallette. Mallette was reluctant because of Braun's Jewish religion; she remembered praying, "God, I gave him to you. You could send me a Christian man, a Christian label! ... you don’t want this Jewish kid to be Justin’s man, do you?" However, after praying with her church elders and receiving their encouragement, she permitted Braun to fly Bieber, then 13, to Atlanta, Georgia, to record demo tapes. A week after arriving, Bieber sang for R&B; singer/songwriter Usher. Bieber was soon signed to Raymond Braun Media Group (RBMG), a joint venture between Braun and Usher. Justin Timberlake was also reportedly in the running to sign Bieber, but lost the bidding war to Usher. Usher then sought assistance in finding a label home for the artist from then manager Chris Hicks, who helped engineer an audition with his contact Antonio L.A. Reid of Island Def Jam Music Group. Reid signed Bieber to Island Records in October 2008 (resulting in a joint venture between RBMG and Island Records) and appointed Hicks as executive Vice-President of Def Jam where he would be able manage Bieber's career at the label. At that point, Bieber and his mother moved to Atlanta temporarily, also the home of Usher and Braun, to record and get counseling from Braun. Braun became Bieber's manager.

Bieber's first single, "One Time", was released to radio while Bieber was still recording his debut album. The song reached number 12 on the Canadian Hot 100 during its first week of release in July 2009, and later peaked at number 17 on the Billboard Hot 100. During fall 2009 it had success in international markets. The song was certified Platinum in Canada and the US and Gold in Australia and New Zealand. Bieber's first release, an extended play entitled ''My World'', was released on November 17, 2009. The album's second single, "One Less Lonely Girl", and two promo singles, "Love Me", and "Favorite Girl", were released exclusively on the iTunes store and charted within the top forty of the Billboard Hot 100. "One Less Lonely Girl" was later also released to radio and peaked within the top fifteen in Canada and the US, being certified Gold in the latter. ''My World'' was eventually certified Platinum in the US and Double Platinum in both Canada and the UK. To promote the album, Bieber performed on several live shows such as mtvU's VMA 09 Tour, European program ''The Dome'', YTV's ''The Next Star'', ''The Today Show'', ''The Wendy Williams Show'', ''Lopez Tonight'', ''The Ellen DeGeneres Show'', ''It's On with Alexa Chung'', ''Good Morning America'', ''Chelsea Lately'', and BET's ''106 & Park'' with Rihanna. Bieber also guest starred in an episode of ''True Jackson, VP'' in late 2009.

Bieber performed Stevie Wonder's "Someday at Christmas" for U.S. President Barack Obama and first lady Michelle Obama at the White House for ''Christmas in Washington'', which was broadcast on December 20, 2009, on U.S. television broadcaster TNT. Bieber was also one of the performers at Dick Clark's New Year's Rockin' Eve with Ryan Seacrest on December 31, 2009. Bieber was a presenter at the 52nd Grammy Awards on January 31, 2010. He was invited to be a vocalist for the remake of We Are The World (a song written by Michael Jackson and Lionel Richie) for its 25th anniversary to benefit Haiti after the earthquake. Bieber sings the opening line, which was sung by Lionel Richie in the original version. On March 12, 2010, a version of K'naan's "Wavin' Flag" recorded by a collective of Canadian musicians known as Young Artists for Haiti was released. Bieber is featured in the song, performing the closing lines.

2010: ''My World 2.0'' and continued success

"Baby", the lead single from his debut album, ''My World 2.0'', which features Ludacris, was released in January 2010 and became his biggest hit thus far, charting at number five in the U.S. and reaching the top ten in seven other countries. Two promo singles "Never Let You Go", and "U Smile" were top thirty hits on the U.S. Hot 100, and top twenty hits in Canada. According to review aggregator Metacritic, the album has received "generally favorable reviews". It debuted at number one on the U.S. ''Billboard'' 200, making Bieber the youngest solo male act to top the chart since Stevie Wonder in 1963. ''My World 2.0'' also debuted at number one on the Canadian Albums Chart, Irish Albums Chart, and Australian Albums Chart, and the New Zealand Albums Chart and reached the top ten of fifteen other countries. To promote the album, Bieber appeared on several live programs including ''The View'', the 2010 Kids Choice Awards, ''Nightline'', ''The Late Show with David Letterman'', ''The Dome'' and ''106 and Park''. Bieber collaborated with Sean Kingston on his single "Eenie Meenie" which also appeared on Bieber's debut album. The song reached the top ten in the United Kingdom and Australia, and the top-twenty of most other markets. thumb|left|Bieber performing at the Conseco Fieldhouse, in August 2010 On April 10, 2010, Bieber was the musical guest on ''Saturday Night Live''. On July 4, 2010, Bieber performed at the Macy's Fourth of July Fireworks Spectacular in New York City. The second single from ''My World 2.0'', "Somebody to Love", was released in April 2010, and a remix was released featuring Bieber's mentor Usher. The single reached number ten in Canada, number fifteen in the United States, and the top twenty in multiple international countries.

On June 23, 2010, Bieber went on his first official headlining tour, the My World Tour, starting in Hartford, Connecticut, to promote ''My World'' and ''My World 2.0''. In July 2010, it was reported that Bieber was the most searched for celebrity on the Internet. That same month his music video, "Baby", surpassed Lady Gaga's "Bad Romance" to become the most viewed, and most disliked YouTube video ever. In September 2010, it was reported that Bieber accounted for three percent of all traffic on Twitter, according to an employee of the social-networking site.

Bieber began recording his second album in July 2010 in New York City. At this point, because of puberty, his voice was deeper than it was when he recorded his first album. In April 2010, the singer discussing his vocals remarked, "It cracks. Like every teenage boy, I'm dealing with it and I have the best vocal coach in the world. [...] Some of the notes I hit on "Baby" I can't hit anymore. We have to lower the key when I sing live." British singer/songwriter Taio Cruz confirmed in July 2010 that he is writing songs for Bieber's next album. Hip hop producer Dr. Dre produced two songs with Bieber in July 2010 but it is unknown if they were made for the album, which is currently due for a 2011 release. Bieber guest-starred in the season premiere of the CBS crime drama ''CSI: Crime Scene Investigation'', aired on September 23, 2010. He played a "troubled teen who is faced with a difficult decision regarding his only brother", who is also a serial bomber. Bieber was also in a subsequent episode which aired on February 17, 2011, in which his character is killed. Bieber performed a medley of "U Smile", "Baby", and "Somebody to Love" and briefly played the drums at the 2010 MTV Video Music Awards on September 12, 2010. Bieber announced in October 2010 that he would release an acoustic album, called ''My Worlds Acoustic''. It was released on Black Friday in the United States and featured acoustic versions of songs from his previous albums, and accompanied the release of a completely new song titled "Pray".

2011–present: ''Never Say Never'' film, ''Under the Mistletoe'' and ''Believe''

A 3-D part-biopic, part-concert film starring Bieber entitled ''Justin Bieber: Never Say Never'', was released on February 11, 2011, directed by ''Step Up 3D'' director Jon Chu. It topped the box office with an estimated grossing of $12.4 million on its opening day from 3,105 theaters. It grossed $30.3 million for the weekend and was narrowly beaten by the romantic comedy ''Just Go With It'', which grossed $31 million. ''Never Say Never'' is said to have exceeded industry expectations, nearly matching the $31.1 million grossed by Miley Cyrus's 2008 3-D concert film, Hannah Montana & Miley Cyrus: Best of Both Worlds Concert, which holds the record for the top debut for a music-documentary. The film is accompanied by his second remix album, ''Never Say Never – The Remixes'', released February 14, 2011, and features remixes of songs from his debut album, with guest appearances from Miley Cyrus, Chris Brown, and Kanye West, among others.

On February 27, 2011, Bieber attended the 2011 Vanity Fair Oscar Party with American actress and singer Selena Gomez, confirming several months of media speculation about a romantic relationship between the pair.

In June 2011, Bieber was ranked number 2 on the Forbes list of Best-Paid Celebrities under 30. He is the youngest star and 1 of 7 musicians on the list raking in with $53 million earned in a 12 month period. On November 1, 2011, Bieber released ''Under the Mistletoe'', his second studio album. It debuted at number one on the ''Billboard'' 200, selling 210,000 copies in its first week of release. Bieber is currently recording his third studio album entitled ''Believe''. Kanye West and Drake are confirmed to be featured on the album.

Image

''The Observer'' newspaper in the UK published a report indicating that Justin Bieber is more influential in the social networking sphere than Barack Obama or The Dalai Lama. According to Jan Hoffman of ''The New York Times'', part of Bieber's appeal stems from his YouTube channel. Long before he released his EP, ''My World'', in mid-November, the YouTube videos attracted millions of views. Braun recognized the appeal. Prior to flying him to Atlanta, Braun wanted to "build him up more on YouTube first" and had Bieber record more home videos for the channel. "I said: 'Justin, sing like there’s no one in the room. But let's not use expensive cameras.' We'll give it to kids, let them do the work, so that they feel like it's theirs", recalled Braun. Bieber continues to upload videos to the same channel and has opened a Twitter account, from which he interacts with fans regularly; his account was reported in November 2010 to have over 6 million followers. Since then he has been consistently gaining followers at an average of 24,000 per day. The accounts also serve marketing purposes; for example, Bieber's music video for "One Time" only began selling quickly after it was uploaded to YouTube. Usher comments that while he and Bieber were both signed at the same age, "I had the chance to ramp up my success, where this has happened to Bieber abruptly." As a result, Usher, Braun, Bieber's bodyguard Kenny, and other adults surrounding Bieber constantly coach him on handling fame and his public image. After signing Bieber, Usher appointed one of his former assistants, Ryan Good, to be Bieber's road manager and stylist. Good, once nicknamed Bieber's "swagger coach", created a "streetwise look" for the singer which consisted of baseball caps, hoodies, dog chains and flashy sneakers. Amy Kaufman of ''The Los Angeles Times'' comments, "Though a product of a middle-class suburban upbringing in Stratford, Ontario, Bieber's manner of dress and speech ("Wassup man, how you doin'?" or "It's like, you know, whateva' ") suggest he's mimicking his favorite rappers."

Bieber is often featured in teen magazines such as ''Tiger Beat'', and has been labeled as a "teen hearthrob". Bieber has released a collection of nail varnishes to raise awareness for charity. Wax statues of Bieber are on display at Madame Tussauds wax museums in New York, Amsterdam and London. His change of hairstyle in 2010, and the consequent alterations to Bieber products, led to it being called 'the most expensive musical haircut of all time; one company spent $100,000 to fix its dolls for the 2011 Christmas season.

Bieber has been criticized for looking and sounding younger than his age, his teen-pop music, image, and frequent media attention. He has been a frequent target of Internet bloggers and message board posters, notably by users of Internet message board 4chan and users of YouTube. Nick Collins of ''The Daily Telegraph'' speculated that "Bieber's character also appears to strike a particularly sour note with his Internet critics, with many remarks commenting on his youthful appearance, his teen-pop songs, his image as a heart-throb to young teenage girls and his manner of speech".

Personal views

Bieber is a Christian, and said he has a relationship with Jesus, talks to him and that "he's the reason I'm here".

Bieber's comments in a February 2011 profile in ''Rolling Stone'' sparked controversy. Asked whether a person should wait until marriage to have sex, Bieber responded, "I don't think you should have sex with anyone unless you love them." Asked about his opinion on abortion, Bieber said he does not "believe in abortion" and that it is "like killing a baby". When asked about abortion in cases of rape, he said, "Well, I think that's really sad, but everything happens for a reason. I don't know how that would be a reason. I guess I haven't been in that position, so I wouldn't be able to judge that." In the same interview, Bieber talked about homosexuality, stating that "It's everyone's own decision to do that. It doesn’t affect me and shouldn't affect anyone else", and ''Rolling Stone'' commented, "It is not clear whether he intended to label homosexuality as a lifestyle choice." However, Bieber has also contributed to the It Gets Better Project, a project started in response to the suicide of Billy Lucas, a teenager who was the target of anti-gay bullying.

Bieber has said he is not interested in obtaining United States citizenship, praising Canada as being "the best country in the world", citing its health care system as an example.

Discography

''My World 2.0'' (2010)

''Under the Mistletoe'' (2011)

''Believe'' (2012)

Tours

2009: Urban Behavior Tour

2010–2011: My World Tour

Filmography

rowspan="4" ''Extreme Makeover: Home Edition'' Himself

Year !! Title !! Role !! Notes
rowspan="2"	2009	''True Jackson, VP''	>rowspan="3"| Guest star
''My Date With...''
	Silent Library (MTV series)>Silent Library''
''School Gyrls (film)	School Gyrls''	Cameo
''Saturday Night Live''
''CSI: Crime Scene Investigation''	Jason McCann
''Hubworld''	Guest star
''The X Factor (UK)''	Performer
rowspan="9"	2011	|	Guest star
''CSI: Crime Scene Investigation''	Jason McCann
''Khloé & Lamar''	|Episode:The Father In Law (uncredited) Himself playing the NBA Celebrity All Star Game
''Saturday Night Live''
''Justin Bieber: Never Say Never''	Himself
''Dancing With The Stars''	Guest star
''So Random!''	Himself
''Disney Parks Christmas Day Parade''	Guest star
''The X Factor (UK)''	Performer

Awards and nominations

References

Further reading

External links

Category:1994 births Category:Canadian child singers Category:Canadian Christians Category:Canadian dance musicians Category:Canadian expatriate musicians in the United States Category:Canadian Internet personalities Category:Canadian male singers Category:Canadian people of French descent Category:Canadian people of German descent Category:Canadian pop singers Category:Canadian rhythm and blues singers Category:Child pop musicians Category:Hip hop singers Category:Island Records artists Category:Musicians from Ontario Category:People from Stratford, Ontario Category:Living people

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Coordinates	45°30′″N73°40′″N
Landscape	yes
Background	solo_singer
Birth name	Tramar Dillard
Born	September 17, 1979 Carol City, Florida, U.S.
Occupation	Rapper, Songwriter, Actor
Genre	Southern hip hop, Pop rap, R&B;, Dance
Years active	2006–present
Label	Atlantic, Poe Boy
Associated acts	Brisco, Timbaland, David Guetta, Ke$ha, T-Pain, Akon
Website	}}

Tramar Dillard (born September 17, 1979), better known by his stage name Flo Rida ("flow rider"), is an American rapper and singer-songwriter. He released his debut album, ''Mail on Sunday'', in March 2008. His debut single "Low", featuring T-Pain, was a #1 hit for ten weeks in United States in early 2008. Two other singles resulted from ''Mail on Sunday'': "Elevator" and "In the Ayer". In 2009, his second album ''R.O.O.T.S.'' was released; its most successful single "Right Round" was at the top of the Hot 100 for six weeks. Since then, he has released his third studio album titled ''Only One Flo (Part 1)'', which will see a sequel titled ''Only One Rida (Part 2)''.

Early life

Tramar Dillard was born in the 187th Street projects of Carol City, Florida. His single mother raised him and his seven sisters, some of whom sang in a local gospel group. Dillard's brother-in-law was a hypeman for local rap group 2 Live Crew, and, while in Ninth Grade, Dillard formed his own amateur group with some friends called the Groundhoggz. His work with 2 Live Crew member Fresh Kid Ice attracted attention of DeVante Swing, a member of the band Jodeci. However, he was rejected by several of the major labels, so he sought many other jobs outside of music. After graduating from high school in 1998, he studied international business management at the University of Nevada, Las Vegas for two years and attended Barry University for two months. He returned to Florida to continue pursuing his music career after receiving a phone call from a representative of the independent label Poe Boy Entertainment. Dillard signed with Poe Boy in 2006, and as Flo Rida he began affiliating with other artists, such as Rick Ross, Trina, T-Pain, and Trick Daddy. A promotional street single entitled "Birthday", featuring Rick Ross, was his first significant release. He made his debut guest appearance with the song "Bitch I'm from Dade County" on DJ Khaled's album ''We the Best'', which featured Trick Daddy, Trina, Rick Ross, Brisco, C-Ride, and Dre.

Music career

''Mail on Sunday'' (2007–08)

Flo Rida's first single was "Low", featuring T-Pain. It was his first official single from his debut album ''Mail On Sunday'' and the soundtrack to the movie ''Step Up 2: The Streets''. "Low" reached #1 on the ''Billboard'' Hot 100 chart. "Elevator", featuring Timbaland, "In the Ayer" featuring will.i.am, and "Roll" featuring Sean Kingston followed and all charted on the Hot 100 and other charts.

After the success of ''Mail on Sunday'', Flo Rida made guest performances on other R&B;, rap, and pop singles, including "Move Shake Drop" by DJ Laz, "We Break the Dawn" by Michelle Williams, the remix of "4 Minutes" by Madonna, "Running Back" by Australian R&B; singer Jessica Mauboy, "Feel It" by DJ Felli Fel, and the remix of "Speedin'" by Rick Ross. During the summer of 2008, he did live performances on the Fox dance competition program ''So You Think You Can Dance'' in the US and 2008 MuchMusic Video Awards in Canada. He appeared on the albums ''We Global'' by DJ Khaled, ''Gutta'' by Ace Hood, and ''The Fame'' by Lady Gaga, among others.

''R.O.O.T.S.'' (2009)

According to ''Billboard'' magazine, Flo Rida began recording his sophomore nine months after ''Mail On Sunday''. The album is titled ''R.O.O.T.S.'' and was released on March 31, 2009. The first single "Right Round" featured Ke$ha and was released for airplay in January 2009. "Right Round" jumped from number 58 to the top spot in one week in late February. The song broke a record for the most digital one week sales in the U.S., with 636,000, beating the previous record he had set himself with "Low". "Right Round" sampled "You Spin Me Round (Like a Record)", a 1985 hit by Dead or Alive. The second official single was "Sugar", which featured R&B; singer Wynter Gordon. The song reached #5 on the Billboard Hot 100. Other singles were "Jump" featuring Nelly Furtado, which reached #54 on the Hot 100 and was the promotional single for the animated film ''G-Force'', and "Be On You" featuring Ne-Yo, which reached #19 on the Hot 100. In addition to singles from his own album, Flo Rida made guest performances on "Feel It" by DJ Felli Fel, "Starstruck" by Lady Gaga, and "Feel It" by Three 6 Mafia. "Bad Boys", the first single by winner of British reality show ''The X Factor'' Alexandra Burke that featured Flo Rida, debuted at #1 on the UK Singles Chart in October.

''Only One Flo (Part 1)'' (2010)

Flo Rida's third album ''Only One Flo (Part 1)'' was released on November 24, 2010. In March 2010, Flo Rida announced on Twitter that the album would be titled ''The Only One''. ''Billboard'' reported that ''The Only One'' was to be a double album. "Club Can't Handle Me", produced by David Guetta, was the first official single and reached #9 on the ''Billboard'' Hot 100 in the United States. Flo Rida also made guest appearances on "iYiYi", a song by Australian teen singer Cody Simpson, and on the song "Out My Video" by Bulgarian singer LiLana. Flo Rida collaborated with UK girl group The Saturdays, recording a new version of the girl's single, "Higher".

In December 2010, the Associated Press reported that Flo Rida had created his own label, International Music Group, inspired by Nicki Minaj's signing with Lil Wayne's. He has signed an 18 year-old rapper, Brianna and Git Fresh to International. Currently Flo Rida teamed up with Malaysian singer, Mizz Nina in Take Over. They shoot Take Over in Miami, Florida.

''Only One Rida (Part 2)'' (2011)

On August 29th, 2011 Flo Rida released his new single off the album Only One Rida (Part 2), called Good Feeling, which is now out now on the US iTunes store. The Album is due out later in 2011. A track called Hangover is rumored to be the second Track, Taio Cruz is featured on it. Inna, Starboy Nathan will be featured on the record, too.

Legal issues

On June 9, 2011, Flo Rida was arrested in Miami Beach, Florida for DUI and driving with a suspended license. Flo Rida was released from jail after he posted $2,000 bail and obtained a signed court order allowing him to travel to Asia for a series of previously scheduled concerts in Bangkok over the weekend.

Discography

''Mail on Sunday'' (2008)

''R.O.O.T.S.'' (2009)

''Only One Flo (Part 1)'' (2010)

''Only One Rida (Part 2)'' (2011)

Awards and nominations

! Year	! Type	! Award	! Result
		Breakthrough Performer
Favourite Male Hip-Hop Artist
	Best New Artist
Rookie of the Year
	Breathrough Artist
	Choice Breakout Artist
Choice Rap Artist
APRA Awards
MOBO Awards
MTV Video Music Awards	Best Hip-Hop Video ("Right Round" with Kesha)
NT Indigenous Music Awards
People's Choice Awards
Teen Choice Awards	Best Hip-Hop Rap Track ("Right Round" with Kesha)
	APRA Awards
Grammy Awards	Best Rap Album (''R.O.O.T.S.'')
People's Choice Awards	Hip-Hop Artist of the Year

See also

List of Miami rappers

References

External links

Category:1979 births Category:Living people Category:African American rappers Category:American dance musicians Category:Atlantic Records artists Category:Barry University alumni Category:Electro-hop musicians Category:Hip hop singers Category:Rappers from Miami, Florida Category:University of Nevada, Las Vegas alumni

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Coordinates	45°30′″N73°40′″N
name	David Guetta
landscape	yes
background	non_vocal_instrumentalist
born	November 07, 1967Paris, France
genre	House, electro house, hip house
occupation	DJ, record producer, songwriter
years active	1984-present
label	EMI Music France/Virgin, Positiva, Astralwerks
website	}}

David Guetta (, born Pierre David Guetta on 7 November 1967) is a French house music producer and DJ. Originally a DJ at nightclubs during the 1980s and 1990s, he co-founded Gum Productions and released his first album, ''Just a Little More Love'', in 2002. Later, he released ''Guetta Blaster'' (2004) and ''Pop Life'' (2007). His 2009 album ''One Love'' included the hit singles "When Love Takes Over" (featuring Kelly Rowland), "Gettin' Over You" (featuring Chris Willis, Fergie & LMFAO) and "Sexy Bitch" (featuring Akon), the last becoming a top five hit in the US and all three reaching #1 in the UK, as well as another internationally known single called "Memories" featuring Kid Cudi which became a top five hit in many countries.

Guetta has sold over three million albums and 15 million singles worldwide. He is currently one of the most sought-after music producers.

Biography

1984–2000: Early life and career

At age 17, Guetta began DJing at the Broad Club in Paris. He first played popular songs, and he discovered house music when he heard a Farley master Funk track on French radio in 1987. The next year, he began hosting his own club nights. In 1990, he released "Nation Rap", a hip-hop collaboration with French rapper Sidney Duteil.

In the mid 1990's Guetta played in clubs including Le Centrale, the Rex, Le Boy, and Folies Pigalle. Released in 1994 Guetta's second single, a collaboration with American house vocalist Robert Owens titled "Up & Away", was a minor club hit. In 1994, David Guetta became the manager of ''Le Palace'' nightclub and he continued to organise parties there and in other clubs, such as the "Scream" parties in ''Les Bains Douches''.

2001–2006: ''Just a Little More Love'' and ''Guetta Blaster''

In 2001, David Guetta along with Joachim Garraud founded Gum Productions, and in the same year Guetta's first hit single, "Just a Little More Love", featuring American singer Chris Willis was released. Willis was vacationing in France when he met Guetta. Guetta's debut album ''Just a Little More Love'' was released in 2002 on Virgin Records and sold over 300,000 copies. The follow-up singles, ("Love Don't Let Me Go", "People Come People Go" and "Give Me Something"), were released in 2002. Guetta released a compilation, ''Fuck Me I'm Famous'', in 2003, named after his party in Ibiza. It included "Just for One Day (Heroes)", a remix of David Bowie's song "Heroes". Later in his career, Guetta continued recording compilations under that title.

Guetta's second album, ''Guetta Blaster'', was released in 2004. It were released four singles: "Money" and "Stay" featuring Chris Willis and "The World Is Mine" and "In Love With Myself" featuring JD Davis. In 2006 "Love Don't Let Me Go" was released as a mash-up with the Tocadisco remix of "Walking Away" by The Egg. The mash-up single charted higher than the original release of the song.

2007–2008: ''Pop Life''

In 2007, Guetta's third album ''Pop Life'' was released. The album was successful in the UK and Ireland as well as in mainland Europe. According to EMI in 2010, the album has sold a total of 530,000 copies worldwide. The lead single "Love Is Gone" reached Number 1 on the American Dance Chart and charted on the ''Billboard'' Hot 100.

He played in many countries around the world to promote the album. He played in Mauritius in January 2008, accompanied by French rapper JoeyStarr. In the same year, he and his wife Cathy also planned a new event which took place in the Stade de France on 5 July 2008. The event was called "UNIGHTED", he performed with Tiësto, Carl Cox, Joachim Garraud and Martin Solveig in front of a crowd of 40,000.

In 2009, he was placed third in the "Top 100 DJs" poll by ''DJ Magazine'', and was elected "Best House DJ" by DJ Awards in 2008. Since April 2009, Guetta had his own radio show on the internet radio station RauteMusik on Saturday evening. The show was afterwards moved into Radio 538, being aired every Friday evening after ''Tiësto's Club Life''. Its name is ''DJ Mix''. Guetta performs a one-hour set of house music, presenting mainly new talents inside.

2009–2010: ''One Love'' and international breakthrough

David Guetta's fourth studio album, ''One Love'', was released in August 2009. Its first single "When Love Takes Over", which featured Kelly Rowland, peaked at #1 on the UK Singles Chart and topped many other countries worldwide. His second single from the album, "Sexy Bitch" featuring Akon, became his second #1 in the UK. "One Love" featuring Estelle, "Memories" featuring Kid Cudi and "Gettin' Over" featuring Chris Willis, Fergie and LMFAO followed. As of May 2011 the album had sold three million copies worldwide. Guetta's fourth studio album ''One Love'' was nominated as "Best Electronic/Dance Album" at the 52nd Grammy Awards. His song "When Love Takes Over" featuring American R&B; singer Kelly Rowland received two nominations; Best Dance Recording and Best Remixed Recording, Non-Classical, and won the latter. After conflicts over whether or not an album re-issue should go ahead, ''One More Love'' was released on 29 November 2010. First single, titled "Who's That Chick?" featuring Rihanna was released a few weeks prior.

On 16 June 2009, The Black Eyed Peas released the David Guetta-produced "I Gotta Feeling" as their second single from their fifth studio album, ''The E.N.D.''. It became a worldwide hit topping the charts in seventeen countries. It became the most downloaded song of all-time in the United States with almost 7.5 million downloads and in the United Kingdom selling more than 1 million copies. He was nominated twice for his work with The Black Eyed Peas at the 52nd Grammy Awards; in the category Record of the Year for "I Gotta Feeling" and Album of the Year for their album ''The E.N.D.''. In 2010, David Guetta co-wrote and produced Kelly Rowland's "Commander" from her third album ''Here I Am''. It peaked at number one on ''Billboard'''s Hot Dance Club Songs chart in the United States, and reached top ten positions in Belgium and the United Kingdom. Guetta has also co-produced "Forever and a Day", which was Kelly's next UK single from that album. Guetta also produced the singles "Acapella" and "Scream" for American singer-songwriter Kelis's fifth studio album, ''Flesh Tone'', released on 14 May 2010. "Acapella" was released as the lead single on 23 February 2010 and topped the dance charts in the United Kingdom and United States. On 28 June 2010 American rapper Flo Rida released the single "Club Can't Handle Me" featuring David Guetta. The song is included on the soundtrack album to the American 3D dance film ''Step Up 3D''.

2011–present: ''Nothing But the Beat''

Guetta's fifth studio album, ''Nothing But the Beat'' will be released on August 30, 2011. It will be released as a double-disc album; one disc being electronic and the other being vocal. The French DJ was inspired by rock bands such as Kings of Leon and Coldplay to add rock influences to his dance productions. "Where Them Girls At" featuring Nicki Minaj and Flo Rida, the first single off the album, was released worldwide on 2 May 2011. "Little Bad Girl", featuring Ludacris and Taio Cruz, was released as the second single on 28 June 2011.. Guetta later released "Titanium" featuring Sia. Soon after that, he released "Night Of Your Life" featuring Jennifer Hudson.

Personal life

His father was a restaurateur of Moroccan Jewish descent. He is married to Cathy Guetta and has two children, Tim Elvis Eric (born 2004) and Angie (born 2007).

Discography

''Just a Little More Love'' (2002)

''Guetta Blaster'' (2004)

''Pop Life'' (2007)

''One Love'' (2009)

''Nothing but the Beat'' (2011)

Awards and nominations

{| class=wikitable |- !Year !Award !Category !Nominated work !Result |- ||2006 |rowspan="3"|DJ Awards |Best House DJ | | |- |rowspan="4"|2007 |Best International DJ | | |- |Best Ibiza Night | | |- |World Music Awards |World's Best Selling DJ | | |- |TMF Awards |Best Dance Act | | |- |rowspan="2"|2008 |DJ Awards |Best House DJ | | |- |MTV Europe Music Awards |Best French Act | | |- |rowspan="2"|2009 |DJ Awards |Best House DJ | | |- |DJ Magazine |Top 100 DJs | |Third Place |- |rowspan="9"|2010 |rowspan="4"|Grammy Awards |Record of the Year |"I Gotta Feeling"(with The Black Eyed Peas) | |- |Best Dance Recording |rowspan="2"|"When Love Takes Over"(with Kelly Rowland) | |- |Best Remixed Recording, Non-Classical | |- |Best Electronic/Dance Album |''One Love'' | |- |rowspan="3"|World Music Awards |Best DJ | | |- |Best Producer | | |- |Best Selling French artist | | |- ||NRJ Music Awards | International Album of the Year |''One Love'' | |- |DJ Magazine |Top 100 DJs | |Second Place |- ||2011 ||Grammy Awards |Best Remixed Recording, Non-Classical |"|"Revolver"(with Madonna) | |}

References

External links

David Guetta official store

David Guetta information at Ultra Records

Review of 'Memories' on the Daily Music Guide

|title=David Guetta biography|publisher=Allmusic|author=David Jeffries|accessdate=2008-09-22}}

David Guetta in PACHA NEWS

David Guetta at Billboard.com

Review of 'Gettin Over you' on the Daily Music Guide

Category:1967 births Category:Astralwerks artists Category:Club DJs Category:Living people Category:French people of Moroccan descent Category:French dance musicians Category:French DJs Category:Musicians from Paris Category:World Music Awards winners Category:Grammy Award winners

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Coordinates	45°30′″N73°40′″N
name	Myocardial infarction
disasesdb	8664
icd10	-
icd9
medlineplus	000195
emedicinesubj	med
emedicinetopic	1567
emedicine mult
meshid	D009203 }}

Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (''infarction'') of heart muscle tissue (''myocardium'').

Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom). Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue. Approximately one quarter of all myocardial infarctions are "silent", without chest pain or other symptoms.

Among the diagnostic tests available to detect heart muscle damage are an electrocardiogram (ECG), echocardiography, and various blood tests. The most often used markers are the creatine kinase-MB (CK-MB) fraction and the troponin levels. Immediate treatment for suspected acute myocardial infarction includes oxygen, aspirin, and sublingual nitroglycerin.

Most cases of STEMI (ST elevation MI) are treated with thrombolysis or percutaneous coronary intervention (PCI). NSTEMI (non-ST elevation MI) should be managed with medication, although PCI is often performed during hospital admission. In people who have multiple blockages and who are relatively stable, or in a few emergency cases, bypass surgery may be an option.

Heart attacks are the leading cause of death for both men and women worldwide. Important risk factors are previous cardiovascular disease, older age, tobacco smoking, high blood levels of certain lipids (triglycerides, low-density lipoprotein) and low levels of high density lipoprotein (HDL), diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, excessive alcohol consumption, the abuse of certain drugs (such as cocaine and methamphetamine), and chronic high stress levels.

Classification

There are two basic types of acute myocardial infarction: Transmural: associated with atherosclerosis involving major coronary artery. It can be subclassified into anterior, posterior, or inferior. Transmural infarcts extend through the whole thickness of the heart muscle and are usually a result of complete occlusion of the area's blood supply. Subendocardial: involving a small area in the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles. Subendocardial infarcts are thought to be a result of locally decreased blood supply, possibly from a narrowing of the coronary arteries. The subendocardial area is farthest from the heart's blood supply and is more susceptible to this type of pathology.

Clinically, a myocardial infarction can be further subclassified into a ST elevation MI (STEMI) versus a non-ST elevation MI (non-STEMI) based on ECG changes.

The phrase "heart attack" is sometimes used incorrectly to describe sudden cardiac death, which may or may not be the result of acute myocardial infarction. A heart attack is different from, but can be the cause of cardiac arrest, which is the stopping of the heartbeat, and cardiac arrhythmia, an abnormal heartbeat. It is also distinct from heart failure, in which the pumping action of the heart is impaired; severe myocardial infarction may lead to heart failure, but not necessarily.

A 2007 consensus document classifies myocardial infarction into five main types:

Type 1 – Spontaneous myocardial infarction related to ischaemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection

Type 2 – Myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anaemia, arrhythmias, hypertension, or hypotension

Type 3 – Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischaemia, accompanied by presumably new ST elevation, or new LBBB, or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood

Type 4 – Associated with coronary angioplasty or stents:

* Type 4a – Myocardial infarction associated with PCI

* Type 4b – Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy

Type 5 – Myocardial infarction associated with CABG

Signs and symptoms

The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous. Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and epigastrium, where it may mimic heartburn. Levine's sign, in which the patient localizes the chest pain by clenching their fist over the sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed that it had a poor positive predictive value.

Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system which occurs in response to pain and the hemodynamic abnormalities that result from cardiac dysfunction. Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock) and sudden death (frequently due to the development of ventricular fibrillation) can occur in myocardial infarctions.

Women and older patients report atypical symptoms more frequently than their male and younger counterparts. Women also report more numerous symptoms compared with men (2.6 on average vs 1.8 symptoms in men). The most common symptoms of MI in women include dyspnea (shortness of breath), weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring symptoms which may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest pain may be less predictive of coronary ischemia than in men.

Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms. These cases can be discovered later on electrocardiograms, using blood enzyme tests or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus and after heart transplantation, probably because the donor heart is not fully innervated by the nervous system of the recipient. In diabetics, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms.

Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are called an acute coronary syndrome.

The differential diagnosis includes other catastrophic causes of chest pain, such as pulmonary embolism, aortic dissection, pericardial effusion causing cardiac tamponade, tension pneumothorax, and esophageal rupture. Other non-catastrophic differentials include gastroesophageal reflux and Tietze's syndrome.

Causes

Heart attack rates are higher in association with intense exertion, be it psychological stress or physical exertion, especially if the exertion is more intense than the individual usually performs. Quantitatively, the period of intense exercise and subsequent recovery is associated with about a 6-fold higher myocardial infarction rate (compared with other more relaxed time frames) for people who are physically very fit. For those in poor physical condition, the rate differential is over 35-fold higher. One observed mechanism for this phenomenon is the increased arterial pulse pressure stretching and relaxation of arteries with each heart beat which, as has been observed with intravascular ultrasound, increases mechanical "shear stress" on atheromas and the likelihood of plaque rupture.

Acute severe infection, such as pneumonia, can trigger myocardial infarction. A more controversial link is that between ''Chlamydophila pneumoniae'' infection and atherosclerosis. While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.

There is an association of an increased incidence of a heart attack in the morning hours, more specifically around 9 a.m. Some investigators have noticed that the ability of platelets to aggregate varies according to a circadian rhythm, although they have not proven causation.

Risk factors

Risk factors for atherosclerosis are generally risk factors for myocardial infarction:

Diabetes (with or without insulin resistance) – the single most important risk factor for ischaemic heart disease (IHD)

Tobacco smoking

Hypercholesterolemia (more accurately hyperlipoproteinemia, especially high low density lipoprotein and low high density lipoprotein)

Low HDL

High Triglycerides

High blood pressure

Family history of ischaemic heart disease (IHD)

Obesity (defined by a body mass index of more than 30 kg/m², or alternatively by waist circumference or waist-hip ratio).

Age — Men acquire an independent risk factor at age 45, Women acquire an independent risk factor at age 55; in addition individuals acquire another independent risk factor if they have a first-degree male relative (brother, father) who suffered a coronary vascular event at or before age 55. Another independent risk factor is acquired if one has a first-degree female relative (mother, sister) who suffered a coronary vascular event at age 65 or younger.

Hyperhomocysteinemia (high homocysteine, a toxic blood amino acid that is elevated when intakes of vitamins B₂, B₆, B₁₂ and folic acid are insufficient)

Stress — Occupations with high stress index are known to have susceptibility for atherosclerosis

Alcohol — Studies show that prolonged exposure to high quantities of alcohol can increase the risk of heart attack

Males are more at risk than females.

Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile. Non-modifiable risk factors include age, sex, and family history of an early heart attack (before the age of 60), which is thought of as reflecting a genetic predisposition.

Socioeconomic factors such as a shorter education and lower income (particularly in women), and unmarried cohabitation may also contribute to the risk of MI. To understand epidemiological study results, it's important to note that many factors associated with MI mediate their risk via other factors. For example, the effect of education is partially based on its effect on income and marital status.

Women who use combined oral contraceptive pills have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors, such as smoking.

Inflammation is known to be an important step in the process of atherosclerotic plaque formation. C-reactive protein (CRP) is a sensitive but non-specific marker for inflammation. Elevated CRP blood levels, especially measured with high sensitivity assays, can predict the risk of MI, as well as stroke and development of diabetes. Moreover, some drugs for MI might also reduce CRP levels. The use of high sensitivity CRP assays as a means of screening the general population is advised against, but it may be used optionally at the physician's discretion, in patients who already present with other risk factors or known coronary artery disease. Whether CRP plays a direct role in atherosclerosis remains uncertain.

Inflammation in periodontal disease may be linked to coronary heart disease, and since periodontitis is very common, this could have great consequences for public health. Serological studies measuring antibody levels against typical periodontitis-causing bacteria found that such antibodies were more present in subjects with coronary heart disease. Periodontitis tends to increase blood levels of CRP, fibrinogen and cytokines; thus, periodontitis may mediate its effect on MI risk via other risk factors. Preclinical research suggests that periodontal bacteria can promote aggregation of platelets and promote the formation of foam cells. A role for specific periodontal bacteria has been suggested but remains to be established. There is some evidence that influenza may trigger an acute myocardial infarction.

Baldness, hair greying, a diagonal earlobe crease (Frank's sign) and possibly other skin features have been suggested as independent risk factors for MI. Their role remains controversial; a common denominator of these signs and the risk of MI is supposed, possibly genetic.

Calcium deposition is another part of atherosclerotic plaque formation. Calcium deposits in the coronary arteries can be detected with CT scans. Several studies have shown that coronary calcium can provide predictive information beyond that of classical risk factors.

The European Society of Cardiology and the European Association for Cardiovascular Prevention and Rehabilitation have developed an interactive tool for prediction and managing the risk of heart attack and stroke in Europe. HeartScore is aimed at supporting clinicians in optimising individual cardiovascular risk reduction. The Heartscore Programme is available in 12 languages and offers web based or PC version.

Pathophysiology

Acute myocardial infarction refers to two subtypes of acute coronary syndrome, namely non-ST-elevated myocardial infarction and ST-elevated myocardial infarction, which are most frequently (but not always) a manifestation of coronary artery disease. The most common triggering event is the disruption of an atherosclerotic plaque in an epicardial coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery. Atherosclerosis is the gradual buildup of cholesterol and fibrous tissue in plaques in the wall of arteries (in this case, the coronary arteries), typically over decades. Blood stream column irregularities visible on angiography reflect artery lumen narrowing as a result of decades of advancing atherosclerosis. Plaques can become unstable, rupture, and additionally promote a thrombus (blood clot) that occludes the artery; this can occur in minutes. When a severe enough plaque rupture occurs in the coronary vasculature, it leads to myocardial infarction (necrosis of downstream myocardium).

If impaired blood flow to the heart lasts long enough, it triggers a process called the ischemic cascade; the heart cells in the territory of the occluded coronary artery die (chiefly through necrosis) and do not grow back. A collagen scar forms in its place. Recent studies indicate that another form of cell death called apoptosis also plays a role in the process of tissue damage subsequent to myocardial infarction. As a result, the patient's heart will be permanently damaged. This myocardial scarring also puts the patient at risk for potentially life threatening arrhythmias, and may result in the formation of a ventricular aneurysm that can rupture with catastrophic consequences.

Injured heart tissue conducts electrical impulses more slowly than normal heart tissue. The difference in conduction velocity between injured and uninjured tissue can trigger re-entry or a feedback loop that is believed to be the cause of many lethal arrhythmias. The most serious of these arrhythmias is ventricular fibrillation (''V-Fib''/VF), an extremely fast and chaotic heart rhythm that is the leading cause of sudden cardiac death. Another life threatening arrhythmia is ventricular tachycardia (''V-Tach''/VT), which may or may not cause sudden cardiac death. However, ventricular tachycardia usually results in rapid heart rates that prevent the heart from pumping blood effectively. Cardiac output and blood pressure may fall to dangerous levels, which can lead to further coronary ischemia and extension of the infarct.

The cardiac defibrillator is a device that was specifically designed to terminate these potentially fatal arrhythmias. The device works by delivering an electrical shock to the patient in order to depolarize a critical mass of the heart muscle, in effect "rebooting" the heart. This therapy is time dependent, and the odds of successful defibrillation decline rapidly after the onset of cardiopulmonary arrest.

Diagnosis

The diagnosis of myocardial infarction can be made after assessing patient's complaints and physical status. ECG changes, coronary angiogram and levels of cardiac markers help to confirm the diagnosis. ECG gives valuable clues to identify the site of myocardial damage while coronary angiogram allows visualization of narrowing or obstructions in the heart vessels. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings.

A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed upon arrival to an emergency department. New regional wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction. Echo may be performed in equivocal cases by the on-call cardiologist. In stable patients whose symptoms have resolved by the time of evaluation, Technetium (99mTc) sestamibi (i.e. a "MIBI scan") or thallium-201 chloride can be used in nuclear medicine to visualize areas of reduced blood flow in conjunction with physiologic or pharmocologic stress. Thallium may also be used to determine viability of tissue, distinguishing whether non-functional myocardium is actually dead or merely in a state of hibernation or of being stunned.

WHO criteria formulated in 1979 have classically been used to diagnose MI; a patient is diagnosed with myocardial infarction if two (probable) or three (definite) of the following criteria are satisfied: # Clinical history of ischaemic type chest pain lasting for more than 20 minutes # Changes in serial ECG tracings # Rise and fall of serum cardiac biomarkers such as creatine kinase-MB fraction and troponin

The WHO criteria were refined in 2000 to give more prominence to cardiac biomarkers. According to the new guidelines, a cardiac troponin rise accompanied by either typical symptoms, pathological Q waves, ST elevation or depression or coronary intervention are diagnostic of MI.

Prevention

The risk of a recurrent myocardial infarction decreases with strict blood pressure management and lifestyle changes, chiefly smoking cessation, regular exercise, a sensible diet for those with heart disease, and limitation of alcohol intake. People are usually commenced on several long-term medications post-MI, with the aim of preventing secondary cardiovascular events such as further myocardial infarctions, congestive heart failure or cerebrovascular accident (CVA). Unless contraindicated, such medications may include:

Antiplatelet drug therapy such as aspirin and/or clopidogrel should be continued to reduce the risk of plaque rupture and recurrent myocardial infarction. Aspirin is first-line, owing to its low cost and comparable efficacy, with clopidogrel reserved for patients intolerant of aspirin. The combination of clopidogrel and aspirin may further reduce risk of cardiovascular events, however the risk of hemorrhage is increased. Beta blocker therapy such as metoprolol or carvedilol should be commenced. These have been particularly beneficial in high-risk patients such as those with left ventricular dysfunction and/or continuing cardiac ischaemia. β-Blockers decrease mortality and morbidity. They also improve symptoms of cardiac ischemia in NSTEMI. ACE inhibitor therapy should be commenced 24–48 hours post-MI in hemodynamically-stable patients, particularly in patients with a history of MI, diabetes mellitus, hypertension, anterior location of infarct (as assessed by ECG), and/or evidence of left ventricular dysfunction. ACE inhibitors reduce mortality, the development of heart failure, and decrease ventricular remodelling post-MI. Statin therapy has been shown to reduce mortality and morbidity post-MI. The effects of statins may be more than their LDL lowering effects. The general consensus is that statins have plaque stabilization and multiple other ("pleiotropic") effects that may prevent myocardial infarction in addition to their effects on blood lipids. The aldosterone antagonist agent eplerenone has been shown to further reduce risk of cardiovascular death post-MI in patients with heart failure and left ventricular dysfunction, when used in conjunction with standard therapies above. Spironolactone is another option that is sometimes preferable to eplerenone due to cost. Evidence supports the consumption of polyunsaturated fats instead of saturated fats as a measure of decreasing coronary heart disease. Omega-3 fatty acids, commonly found in fish, have been shown to reduce mortality post-MI. While the mechanism by which these fatty acids decrease mortality is unknown, it has been postulated that the survival benefit is due to electrical stabilization and the prevention of ventricular fibrillation. However, further studies in a high-risk subset have not shown a clear-cut decrease in potentially fatal arrhythmias due to omega-3 fatty acids.

Blood donation may reduce the risk of heart disease for men, but the link has not been firmly established.

A Cochrane review found that giving heparin to people who have heart conditions like unstable angina and some forms of heart attacks reduces the risk of having another heart attack. However, heparin also increases the chance of suffering from minor bleeding.

Management

An MI is a medical emergency which requires immediate medical attention. Treatment attempts to salvage as much myocardium as possible and to prevent further complications, thus the phrase "time is muscle". Oxygen, aspirin, and nitroglycerin may be administered. Morphine was classically used if nitroglycerin was not effective; however, it may increase mortality in the setting of NSTEMI. A 2009 and 2010 review of high flow oxygen in myocardial infarction found increased mortality and infarct size, calling into question the recommendation about its routine use. Other analgesics such as nitrous oxide are of unknown benefit. Percutaneous coronary intervention (PCI) or fibrinolysis are recommended in those with an STEMI.

Prognosis

The prognosis post myocardial infarction varies greatly, depending on a person's health, the extent of the heart damage and the treatment given. For the period 2005–2008 in the United States the median mortality at 30 days was 16.6% with a range from 10.9% to 24.9% depending on the hospital. Using variables available in the emergency room, people with a higher risk of adverse outcome can be identified. One study found that 0.4% of patients with a low risk profile died after 90 days, whereas in high risk people it was 21.1%.

Some of the more reproduced risk stratifying factors include: age, hemodynamic parameters (such as heart failure, cardiac arrest on admission, systolic blood pressure, or Killip class of two or greater), ST-segment deviation, diabetes, serum creatinine, peripheral vascular disease and elevation of cardiac markers. Assessment of left ventricular ejection fraction may increase the predictive power. The prognostic importance of Q-waves is debated. Prognosis is significantly worsened if a mechanical complication such as papillary muscle or myocardial free wall rupture occur. Morbidity and mortality from myocardial infarction has improved over the years due to better treatment.

Complications

Complications may occur immediately following the heart attack (in the acute phase), or may need time to develop (a chronicproblem). Acute complications may include heart failure if the damaged heart is no longer able to adequately pump blood around the body; aneurysm or rupture of the myocardium; mitral regurgitation, particularly if the infarction causes dysfunction of the papillary muscle; and arrhythmias, such as ventricular fibrillation, ventricular tachycardia, atrial fibrillation and heart block. Longer-term complications include heart failure, atrial fibrillation, and the increased risk of a second myocardial infarction.

Epidemiology

Myocardial infarction is a common presentation of ischemic heart disease. The WHO estimated in 2002, that 12.6 percent of worldwide deaths were from ischemic heart disease with it the leading cause of death in developed countries, and third to AIDS and lower respiratory infections in developing countries. Worldwide more than 3 million people have STEMIs and 4 million have NSTEMIs a year.

Coronary heart disease is responsible for 1 in 5 deaths in the United States. It is becoming more common in the developing world such that in India, cardiovascular disease (CVD) is the leading cause of death. The deaths due to CVD in India were 32% of all deaths in 2007 and are expected to rise from 1.17 million in 1990 and 1.59 million in 2000 to 2.03 million in 2010. Although a relatively new epidemic in India, it has quickly become a major health issue with deaths due to CVD expected to double during 1985–2015. Mortality estimates due to CVD vary widely by state, ranging from 10% in Meghalaya to 49% in Punjab (percentage of all deaths). Punjab (49%), Goa (42%), Tamil Nadu (36%) and Andhra Pradesh (31%) have the highest CVD related mortality estimates. State-wise differences are correlated with prevalence of specific dietary risk factors in the states. Moderate physical exercise is associated with reduced incidence of CVD in India (those who exercise have less than half the risk of those who don't).

Legal implications

At common law, a myocardial infarction is generally a disease, but may sometimes be an injury. This has implications for no-fault insurance schemes such as workers' compensation. A heart attack is generally not covered; however, it may be a work-related injury if it results, for example, from unusual emotional stress or unusual exertion. Additionally, in some jurisdictions, heart attacks suffered by persons in particular occupations such as police officers may be classified as line-of-duty injuries by statute or policy. In some countries or states, a person who has suffered from a myocardial infarction may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.

Research

Patients who receive stem cell treatment by coronary artery injections of stem cells derived from their own bone marrow after a myocardial infarction (MI) show improvements in left ventricular ejection fraction and end-diastolic volume not seen with placebo. The larger the initial infarct size, the greater the effect of the infusion. Clinical trials of progenitor cell infusion as a treatment approach to ST elevation MI are proceeding.

There are currently 3 biomaterial and tissue engineering approaches for the treatment of MI, but these are in an even earlier stage of medical research, so many questions and issues need to be addressed before they can be applied to patients. The first involves polymeric left ventricular restraints in the prevention of heart failure. The second utilizes ''in vitro'' engineered cardiac tissue, which is subsequently implanted ''in vivo''. The final approach entails injecting cells and/or a scaffold into the myocardium to create ''in situ'' engineered cardiac tissue.

References

External links

American Heart Association's Heart Attack web site – Information and resources for preventing, recognizing and treating heart attack.

Heart Attack – overview of resources from MedlinePlus

Category:Aging-associated diseases Category:Causes of death Category:Ischemic heart diseases Category:Medical emergencies

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