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MoonDragon's Health & Wellness
Disorders

COMMON HEART PROBLEMS
& Cardiac-Related Procedures


For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.





  • Understanding Heart Disease & Procedures
  • Aneurysm
  • Angina Pectoris
  • Angiogram
  • Angioplasty
  • Aorta (Anatomical Overview)
  • Aortic Atherosclerosis
  • Aortic Stenosis (AS)
  • Arrhythmia
  • Cardiac Arrest
  • Cardiomegaly
  • Cardiomyopathy
  • Cardioversion
  • Carditis
  • Carotid Artery Disease
  • Catherization)
  • Claudication
  • Congenital Heart Defect
  • Congestive Heart Failure
  • Coronary Arteries
  • Coronary Artery Disease
  • Echocardiogram
  • Electrocardiogram
  • Embolism

  • Endarteritis Obliterans
  • Endocarditis
  • Fibrillation
  • Gated Blood Pool Scan
  • Heart Attack
  • Heart Failure
  • Heart Murmur
  • Hematoma
  • Holter Monitor
  • Hypertension
  • Hypotension
  • Ischemic Heart Disease
  • Magnetic Resonance Spectroscopy (MRS)
  • Mitrial Valve Prolapse (MVP)
  • Pericarditis
  • Phlebitis (or Thrombophlebitis)
  • Positron Emission Tomography (PET) Scan
  • Pulmonary Stenosis (PS)
  • Rheumatic Heart Disease
  • Stress Test (Exercise Electrocardiogram)
  • Stroke
  • Thrombosis
  • Troponin T Test (Procedure)
  • Healthy Cholesterol & Blood Pressure Levels




  • COMMON CARDIAC PROBLEMS DESCRIPTIONS

    UNDERSTANDING HEART DISEASE & PROCEDURES

    If either you or a loved one has heart trouble, you can better understand and participate in treatment if you familiarize yourself with the following medical terms that may be used by your health care provider.





    CARDIOVASCULAR RISK FACTORS & WARNING SIGNS


    Following is a brief summary of known risk factors and warning signs of present or possible future cardiovascular problems, including stroke.

    RISK FACTORS

  • High blood pressure.
  • Heart disease, especially a type of arrhythmia (irregular heartbeat) called atrial fibrillation (AF).
  • Smoking.
  • Diabetes.
  • High blood cholesterol.
  • Obesity or eating disorder (anorexia, bulimia).
  • Poor diet.

  • WARNING SIGNS

  • Numbness or weakness in face, arm, or leg.
  • Difficulty speaking.
  • Severe dizziness, loss of balance or coordination.
  • Sudden dimness, loss of vision.
  • Sudden intense headache.
  • Brief loss of consciousness.

  • If any of the known risk factors apply to you, consult with your health care provider about ways to lower your risk. If you experience any of the warning signs listed above, seek medical attention at once.





    ANEURYSM

    An aneurysm is a localized spot in a blood vessel where the wall becomes thin and bulges (balloon-like) outward as blood presses against it. If it ruptures, circulation is disrupted. Depending on the location of the aneurysm, the consequences of this can be dangerous or even fatal. If detected in time, aneurysms can be repaired surgically in many cases.



    Aneurysms can occur in any blood vessel, with examples including aneurysms of the circle of Willis in the brain, aortic aneurysms affecting the thoracic aorta, and abdominal aortic aneurysms. Aneurysms can also occur within the heart itself. As the aneurysm increases in size, the risk of rupture increases. A ruptured aneurysm can lead to bleeding and subsequent hypovolemic shock, leading to death. Aneurysms are a result of a weakened blood vessel wall, and can be a result of a hereditary condition or an acquired disease. Aneurysms can also be a point of origin for clot formation (thrombosis) and embolization.

    TRUE & FALSE ANEURYSMS

    A True Aneurysm is one that involves all three layers of the wall of an artery (intima, media and advetitia). True aneurysms include atherosclerotic, syphilitic, and congenital aneurysms, as well as ventricular aneurysms that follow transmural myocardia infarctions (aneurysms that involve all layers of the attenuated wall of the heart are also considered tru aneurysms).

    A False Aneurysm, or Pseudoaneurysm, is a collection of blood leading completely out of an artery of vein, but confined next to a the vessel by the surrounding tissue. This blood-filled cavity will eventually either thrombose (clot) enough to seal the leak, or rupture out of the surrounding tissue. Pseucoaneurysms can be caused by trauma that punctures the artery, such as a knife and bullet wounds, as a result of percutaneous surgical procedures such as coronary angiography or arterial grafting, or use of an artery for injection.

    SHAPE CLASSIFICATION

    Aneurysms come in two shapes.

    The first is called a Saccular Aneurysm and is a spherical shaped formation, a sac or pouch on one side of the blood vessel wall. They involve only a portion of the vessel wall and they vary in size from 5 cm (2 inches) to 20 cm (8 inches) in diameter, and are often filled, either partially or fully, by a thrombus (blood clot).

    The second type is called a Fusiform Aneurysm and is an outward bulging of the blood vessel wall in all directions. A ruptured aneurysm is one that has burst and caused bleeding into the surrounding tissues. These are spindle-shaped aneurysms, variable in both their diameter and length. Their diameters can extend up to 20 cm (8 inches). The often involve large portions of the ascending and transverse aortic arch, the abdominal aorta, or less frequently the iliac arteries.

    LOCATION CLASSIFICATION

    Aneurysms can also be classified by their location.
    • Arterial and venous, with arterial being more common.
    • The heart, including coronary artery aneurysms, ventricular aneurysms, aneurysm of sinus of Valsalva, and aneurysms following cardiac surgery.
    • The aorta, namely aortic aneurysms including thoracic aortic aneurysms and abdominal aortic aneurysms.
    • The brain, including cerebral aneurysms, berry aneurysms, and CharcotĖBouchard aneurysms.
    • The legs, including the popliteal arteries.
    • The kidney, including renal artery aneurysm and intraparechymal aneurysms.
    • Capillaries, specifically capillary aneurysms.

    Cerebral aneurysms, also known as intracranial or brain aneurysms, occur most commonly in the anterior cerebral artery, which is part of the circle of Willis. This can cause severe strokes leading to death. The next most common sites of cerebral aneurysm occurrence are in the internal carotid artery.

    Incidence rates of cranial aneurysms are estimated at between 0.4 and 3.6 percent. Those without risk factors have expected prevalence of 2 to 3 percent. In adults, females are more likely to have aneurysms. They are most prevalent in people ages 35 to 60, but can occur in children as well. Aneurysms are rare in children with a reported prevalence of 0.5 to 4.6 percent. The most common incidence are among 50-year-olds, and there are typically no warning signs. Most aneurysms develop after the age of 40. Pediatric aneurysms have different incidences and features than adult aneurysms. Intracranial aneurysms are rare in childhood, with over 95 percent of all aneurysms occurring in adults.

    SYMPTOMS

    Aneurysm presentation may range from life-threatening complications of hypovolemic shock to being found incidentally on X-ray.[9] Symptoms will differ by the site of the aneurysm and can include:

  • Cerebral Aneurysm: Symptoms can occur when the aneurysm pushes on a structure in the brain. Symptoms will differ if an aneurysm has ruptured or not. There may be no symptoms present at all until the aneurysm ruptures. For an aneurysm that has not ruptured the following symptoms can occur:
    • Fatigue.
    • Loss of perception.
    • Loss of balance.
    • Speech problems.
    • Double vision.

    For a ruptured aneurysm, symptoms of a subarachnoid hemorrhage may present:
    • Severe headaches.
    • Loss of vision.
    • Double vision.
    • Neck pain and/or stiffness.
    • Pain above and/or behind the eyes.

  • Abdominal aneurysm: Abdominal aneurysms can cause central back pain, edema and deep vein thrombosis, vomiting, and lower limb ischemia.

  • Renal (kidney) aneurysm:
    • Flank pain and tenderness.
    • Hypertension.
    • Hematuria.
    • Signs of hypovolemic shock.

    RISK FACTORS

    Risk factors for an aneurysm include diabetes, obesity, hypertension, tobacco use, alcoholism, high cholesterol, copper deficiency, increasing age, and tertiary syphilis infection. Specific infective causes associated with aneurysm include:
    • Advanced syphilis infection resulting in syphilitic aortitis and an aortic aneurysm.
    • Tuberculosis, causing Rasmussen's aneurysms.
    • Brain infections, causing infectious intracranial aneurysms.

    A minority of aneurysms are associated with genetic factors. Examples include:
    • Berry aneurysms of the anterior communicating artery of the circle of Willis, associated with autosomal dominant polycystic kidney disease.
    • Familial thoracic aortic aneurysms.
    • Cirsoid aneurysms, secondary to congenital arteriovenous malformations.

    Incidence rates are two to three times higher in males, while there are more large and giant aneurysms and fewer multiple aneurysms. Intracranial hemorrhages are 1.6 times more likely to be due to aneurysms than cerebral arteriovenous malformations in whites, but four times less in certain Asian populations. Most patients, particularly infants, present with subarachnoid hemorrhage and corresponding headaches or neurological deficits. The mortality rate for pediatric aneurysms is lower than in adults.

    CAUSES

    Aneurysms form for a variety of interacting reasons. Multiple factors, including factors affecting a blood vessel wall and the blood through the vessel, contribute.
  • Atherosclerosis. A variety of different factors, including atherosclerosis, may contribute to weakening of a blood vessel wall. The repeated trauma of blood flowing through the vessel may contribute to degeneration of the vessel wall. Hypertensive injury may compound this degeneration and accelerate the expansion of the aneurysm. As the aneurysm expands, the wall tension increases. The pressure of blood within the expanding aneurysm may also injure the blood vessels supplying the artery itself, further weakening the vessel wall. Without treatment, these aneurysms will ultimately progress and rupture.

  • Infection. A mycotic aneurysm is an aneurysm that results from an infectious process that involves the arterial wall. A person with a mycotic aneurysm has a bacterial infection in the wall of an artery, resulting in the formation of an aneurysm. The most common locations include arteries in the abdomen, thigh, neck, and arm. A mycotic aneurysm can result in sepsis, or life-threatening bleeding if the aneurysm ruptures. Less than 3 percent of abdominal aortic aneurysms are mycotic aneurysms.

  • Syphilis. The third stage of syphilis also manifests as aneurysm of the aorta, which is due to loss of the vasa vasorum in the tunica adventitia.

  • Copper Deficiency. A minority of aneurysms are caused by copper deficiency, which results in a decreased activity of the lysyl oxidase enzyme, affecting elastin, a key component in vessel walls. Copper deficiency results in vessel wall thinning, and thus has been noted as a cause of death in copper-deficient humans, chickens and turkeys.

  • DIAGNOSIS

    Diagnosis of a ruptured cerebral aneurysm is commonly made by finding signs of subarachnoid hemorrhage on a computed tomography (CT) scan. If the CT scan is negative but a ruptured aneurysm is still suspected based on clinical findings, a lumbar puncture can be performed to detect blood in the cerebrospinal fluid. Computed tomography angiography (CTA) is an alternative to traditional angiography and can be performed without the need for arterial catheterization. This test combines a regular CT scan with a contrast dye injected into a vein. Once the dye is injected into a vein, it travels to the cerebral arteries, and images are created using a CT scan. These images show exactly how blood flows into the brain arteries.

    TREATMENT

    Historically, the treatment of arterial aneurysms has been limited to either surgical intervention, or watchful waiting in combination with control of blood pressure. In recent years, endovascular or minimally invasive techniques have been developed for many types of aneurysms.

  • Intracranial Aneurysms: There are currently two treatment options for brain aneurysms: surgical clipping or endovascular coiling. There is currently debate in the medical literature about which treatment is most appropriate given particular situations. Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It consists of a craniotomy to expose the aneurysm and closing the base or neck of the aneurysm with a clip. The surgical technique has been modified and improved over the years. Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991. It consists of passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries, and finally into the aneurysm itself. Platinum coils initiate a clotting reaction within the aneurysm that, if successful fill the aneurysm dome and prevent its rupture.

  • Aortic & Peripheral Aneurysms: For aneurysms in the aorta, arms, legs, or head, the weakened section of the vessel may be replaced by a bypass graft that is sutured at the vascular stumps. Instead of sewing, the graft tube ends, made rigid and expandable by nitinol wireframe, can be easily inserted in its reduced diameter into the vascular stumps and then expanded up to the most appropriate diameter and permanently fixed there by external ligature. New devices were recently developed to substitute the external ligature by expandable ring allowing use in acute ascending aorta dissection, providing airtight (i.e. not dependent on the coagulation integrity), easy and quick anastomosis extended to the arch concavity. Less invasive endovascular techniques allow covered metallic stent grafts to be inserted through the arteries of the leg and deployed across the aneurysm.

  • Renal Aneurysms: Renal aneurysms are very rare consisting of only 0.1 to 0.09 percent, while rupture is even more rare. Conservative treatment with control of concomittant hypertension being the primary option with aneurysms smaller than 3 cm. If symptoms occur, or enlargement of the aneurysm, then endovascular or open repair should be consider. Pregnant women due to high rupture risk of up to 80 percent should be treated surgically.


  • FOR DETAILED INFORMATION

    Wikipedia: Aneurysm
    Texas Heart Institute: Aneurysms & Dissections
    MGH / Harvard: Brain Aneurysm & Arteriovenous Malformation Center
    The Internet Encyclopedia of Science: Aneurysms





    ANGINA PECTORIS

    Angina, also called angina pectoris, refers to pain or heavy pressure in the chest that is caused by reduced blood flow to the heart muscle an insufficient supply of oxygen to the heart tissue. It is typically described as squeezing, pressure, heaviness, tightness or pain in the chest. This chest pain may be severe or mild and is usually associated with physical exertion and relieved by rest. Angina can be a recurring problem or a sudden, acute health concern. It can be a warning sign of impending heart attack.



    Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

    SYMPTOMS

    Symptoms associated with angina include:
    • Chest pain or discomfort.
    • Pain in your arms, neck, jaw, shoulder or back accompanying chest pain.
    • Nausea.
    • Fatigue.
    • Shortness of breath.
    • Sweating.
    • Dizziness.

    The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion. The severity, duration and type of angina can vary. It is important to recognize if you have new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. Stable angina is the most common form of angina, and it typically occurs with exertion and goes away with rest. If chest discomfort is a new symptom for you, it is important to see your health care provider to find out what is causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.

  • Characteristics of Stable Angina:
    • Develops when your heart works harder, such as when you exercise or climb stairs.
    • Can usually be predicted and the pain is usually similar to previous types of chest pain you have had.
    • Lasts a short time, perhaps five minutes or less.
    • Disappears sooner if you rest or use your angina medication.

  • Characteristics of Unstable Angina (A Medical Emergency).
    • Occurs even at rest.
    • Is a change in your usual pattern of angina.
    • Is unexpected.
    • Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes.
    • May not disappear with rest or use of angina medication.
    • Might signal a heart attack.

  • Angina in Women: A woman's angina symptoms can be different from the classic angina symptoms. For example, women often experience symptoms such as nausea, shortness of breath, abdominal pain or extreme fatigue, with or without chest pain. Or a woman may feel discomfort in her neck, jaw or back or stabbing pain instead of the more typical chest pressure. These differences may lead to delays in seeking treatment.

  • If your chest pain lasts longer than a few minutes and does not go away when you rest or take your angina medications, it may be a sign you are having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

    CAUSES

    Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle is not getting enough oxygen, it causes a condition called ischemia. The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by deposits called plaques. This is called atherosclerosis. This reduced blood flow is a supply problem in that your heart is not getting enough oxygen-rich blood. You may wonder why you do not always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand when you are resting, for example, your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

  • Stable Angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it is harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors, such as emotional stress, cold temperatures, heavy meals and smoking, also can narrow arteries and trigger angina.

  • Unstable Angina. If fat-containing deposits (plaques) in a blood vessel rupture and a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels. Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow does not improve, heart muscle deprived of oxygen dies, a heart attack. Unstable angina is dangerous and requires emergency treatment.

  • Variant Angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina can occur even when you are at rest, and is often severe. It can be relieved with medications.

  • RISK FACTORS

    The following risk factors increase your risk of coronary artery disease and angina:
    • Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries, including arteries to your heart, allowing deposits of cholesterol to collect and block blood flow.
    • Diabetes. Diabetes is the inability of your body to produce enough insulin or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis.
    • High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries.
    • High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
    • History of heart disease. If you have coronary artery disease or if you have had a heart attack, you are at a greater risk of developing angina.
    • Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults.
    • Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your health care provider before starting an exercise program.
    • Obesity. Obesity raises the risk of angina and heart disease because it is associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
    • Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

    The chest pain that can occur with angina can make some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack. Common signs and symptoms of a heart attack include:
    • Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes.
    • Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw.
    • Increasing episodes of chest pain.
    • Prolonged pain in the upper abdomen.
    • Shortness of breath.
    • Sweating.
    • Impending sense of doom.
    • Fainting.
    • Nausea and vomiting.

    If you are having sudden chest pain (unstable angina), call 911 or your local emergency number right away. If you think you may have recurring angina because your symptoms are brief and only occur during exercise, or you are worried about your angina risk because of a strong family history, make an appointment with your family practitioner. If angina is found early, your treatment may be easier and more effective.

    DIAGNOSIS

    To diagnose angina, your health care provider will start by doing a physical exam and asking about your symptoms. You will also be asked about any risk factors, including whether you have a family history of heart disease. There are several tests your doctor may order to help confirm whether you have angina:
    • Electrocardiogram (ECG or EKG). An electrocardiogram traces the electrical signals that cause your heart to beat as they travel through your heart. Your practitioner can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed, interrupted or if you are having a heart attack.
    • Stress Test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. While exercising, your blood pressure is monitored and your ECG readings are watched. If you are unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising.
    • Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. These images are used to identify whether there are areas of your heart muscle that have been damaged by poor blood flow, a cause of angina. An echocardiogram is sometimes given during a stress test.
    • Nuclear Stress Test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream. This substance mixes with your blood and travels to your heart. A special scanner, which detects the radioactive material in your heart, creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the images.
    • Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
    • Blood Tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.
    • Coronary Angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization. During coronary angiography, a type of dye that is visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at your blood vessels.
    • Cardiac Computerized Tomography (CT) Scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.

    TREATMENT & MEDICATIONS

    There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death. However, if you have unstable angina or angina pain that is different from what you usually have, such as occurring when you are at rest, you need immediate treatment in a hospital.

  • Medications: If lifestyle changes alone do not help your angina, you may need to take medications. These may include:
    • Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.
    • Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But do not start taking a daily aspirin without talking to your health care provider first.
    • Clot-Preventing Drugs. Certain medications, such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta), can help prevent blood clots from forming by making your blood platelets less likely to stick together.
    • Beta Blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
    • Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
    • Calcium Channel Blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
    • Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.

  • Medical Procedures & Surgery: Lifestyle changes and medications are frequently used to treat stable angina. But procedures, such as angioplasty, stenting and coronary artery bypass surgery, also are used to treat angina.
    • Angioplasty & Stenting. During an angioplasty, also called a percutaneous coronary intervention (PCI), a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications do not effectively treat your chronic, stable angina.
    • Coronary Artery Bypass Surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It is a treatment option for both unstable angina and stable angina that has not responded to other treatments.

  • Lifestyle Changes: If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Because heart disease is often the cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors. Preventing angina can be achieved by making these same lifestyle changes helping to improve your symptoms. Making lifestyle changes is the most important step you can take. These changes include the following:
    • If you smoke, stop smoking. Avoid exposure to secondhand smoke.
    • If you are overweight, talk to your practitioner about weight-loss options. Maintain a healthy weight.
    • If you have diabetes, make sure that it is well-controlled and that you are following an optimal diet and exercise plan.
    • Because angina is often brought on by exertion, it is helpful to pace yourself and take rest breaks.
    • Avoid large meals that may you feel overly full.
    • Avoiding stress is easier said than done, but try to find ways to relax. Use stress-reduction techniques.
    • Eat a healthy diet with lots of whole grains, many fruits and vegetables, and limited amounts of saturated fat.
    • Discuss with your health care provider about starting safe exercise plan. Increase your physical activity as recommended by your health care provider.
    • If you must take anti-angina medications as prescribed, follow directions carefully.
    • Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.

    FOR DETAILED INFORMATION

    eMedicine: Angina Pectoris
    Wikipedia: Angina Pectoris
    HeartOnline.org: Angina
    MerckManual: Angina Pectoris





    ANGIOGRAM

    An angiogram is a diagnostic picture produced by injecting into the heart and / or blood vessels a type of dye that is visible on x-ray. It may be done to diagnose valvular disease, blood vessel blockage, and other conditions.

    angiogram of a healthy heart


    A coronary angiogram is a procedure that uses X-ray imaging to see your heart's blood vessels. Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterization. Heart catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of heart catheterization procedure.

    During a coronary angiogram, a type of dye that is visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your health care provider can perform procedures such as an angioplasty during your coronary angiogram. Your practitioner may recommend that you have a coronary angiogram if you have:
    • Symptoms of coronary artery disease, such as chest pain (angina).
    • Pain in your chest, jaw, neck or arm that cannot be explained by other tests.
    • New or increasing chest pain (unstable angina).
    • A heart defect you were born with (congenital heart disease).
    • Heart failure.
    • Other blood vessel problems or a chest injury.
    • A heart valve problem that requires surgery.

    You may also need an angiogram if you are going to have surgery unrelated to your heart, but you are at high risk of having a heart problem during that surgery. Because there is a small risk of complications, angiograms are usually done after noninvasive heart tests have been performed, such as an electrocardiogram, an echocardiogram or a stress test. As with most procedures done on your heart and blood vessels, a coronary angiogram has some risks. Major complications are rare, though. Potential risks and complications include:
    • Heart attack.
    • Stroke.
    • Injury to the catheterized artery.
    • Irregular heart rhythms (arrhythmias).
    • Allergic reactions to the dye or medications used during the procedure.
    • A tear in your heart or artery.
    • Kidney damage.
    • Excessive bleeding.
    • Infection.
    • Radiation exposure from the X-rays.

    PREPARING FOR THE TEST

    In some cases, coronary angiograms are performed on an emergency basis. More commonly, though, they are scheduled in advance, giving you time to prepare. Angiograms are performed in the catheterization (cath) lab of a hospital. Usually you go to the hospital the morning of the procedure. Your health care team will give you specific instructions and talk to you about any medications you take. General guidelines include:
    • Do not eat or drink anything after midnight the day before your angiogram. Angiograms are often scheduled during the morning hours.
    • Take all your medications to the hospital with you in their original bottles. Ask your health care provider about whether or not to take your usual morning medications.
    • If you have diabetes, ask your practitioner if you should take insulin or other oral medications before your angiogram.

    Before your angiogram procedure starts, your health care team will review your medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs, such as blood pressure and pulse. You empty your bladder and change into a hospital gown. You may have to remove contact lenses, eyeglasses, jewelry and hairpins.

    DURING THE PROCEDURE

    For the procedure, you lie on your back on an X-ray table. Because the table may be tilted during the procedure, safety straps may be fastened across your chest and legs. X-ray cameras may move over and around your head and chest to take pictures from many angles. An intravenous (IV) line is inserted into a vein in your arm. You may be given a sedative through the IV to help you relax, as well as other medications and fluids. You will be awake during the procedure so that you can follow instructions. Throughout the procedure, you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions.

    Electrodes on your chest monitor your heart throughout the procedure. A blood pressure cuff tracks your blood pressure and another device, a pulse oximeter, measures the amount of oxygen in your blood. You may receive medication (anticoagulants) to help prevent your blood from clotting on the catheter and in your coronary arteries.

    A small amount of hair may be shaved from your groin or arm where the catheter is to be inserted. The area is washed and disinfected and then numbed with an injection of local anesthetic. A small incision is made at the entry site, and a short plastic tube (sheath) is inserted into your artery. The catheter is inserted through the sheath into your blood vessel and carefully threaded to your heart or coronary arteries. Threading the catheter should not cause pain, and you should not feel it moving through your body. Tell your health care team if you have any discomfort.

    Dye (contrast material) is injected through the catheter. When this happens, you may have a brief sensation of flushing or warmth. But again, tell your health care team if you feel pain or discomfort. The dye is easy to see on X-ray images, and as it moves through your blood vessels, your health care provider can observe its flow and identify any blockages or constricted areas. Depending on what your practitioner discovers during your angiogram, you may have additional catheter procedures at the same time, such as a balloon angioplasty or a stent placement to open up a narrowed artery.

    Having an angiogram takes about one hour, although it may be longer, especially if combined with other heart catheter procedures. Preparation and post-procedure care can add more time.

    AFTER THE PROCEDURE

    When the angiogram is over, the catheter is removed from your arm or groin and the incision is closed with manual pressure, a clamp or a small plug. You will be taken to a recovery area for observation and monitoring. When your condition is stable, you return to your own room, where you are monitored regularly. You will need to lie flat for several hours to avoid bleeding. During this time, pressure may be applied to the incision to prevent bleeding and promote healing.

    You may be able to go home the same day, or you may have to remain in the hospital for a day or longer. Drink plenty of fluids to help flush the dye from your body. If you are feeling up to it, have something to eat. Ask your health care team when you should resume taking your medications, bathe or shower, return to work, and resume other normal activities. Avoid strenuous activities and heavy lifting for several days. Your puncture site is likely to remain tender for a while. It may be slightly bruised and have a small bump.

    Call your health care provider's office if you notice bleeding, new bruising or swelling at the catheter site, you develop increasing pain or discomfort at the catheter site, you have signs of infection, such as redness, drainage or fever, or if there is a change in temperature or color of the leg or arm that was used for the procedure. If you feel faint or weak, develop chest pain or shortness of breath, or if the catheter site is actively bleeding or begins swelling, apply pressure to the site and contact emergency medical services.

    RESULTS

    An angiogram can show your practitioner what is wrong with your blood vessels. It can:
    • Show how many of your coronary arteries are blocked or narrowed by fatty plaques (atherosclerosis).
    • Pinpoint where blockages are located in your blood vessels.
    • Show how much blood flow is blocked through your blood vessels.
    • Check the results of previous coronary bypass surgery.
    • Check the blood flow through your heart and blood vessels.

    Knowing this information can help your practitioner determine what treatment is best for you and how much danger your heart condition poses to your health. Based on your results, your practitioner may decide, for instance, that you would benefit from having coronary angioplasty to help unblock clogged arteries. It is also possible that angioplasty or stenting could be done during your angiogram to avoid needing another procedure.

    FOR DETAILED INFORMATION

    VascularWeb: What is a Coronary Angiogram?
    Mayo Clinic: Coronary Angiography: A Look Inside Your Heart's Blood Vessels
    RadiologyInfo: Computed Tomography (CT) - Angiography
    Wikipedia: Angiography





    ANGIOPLASTY

    Angioplasty is a non-surgical procedure employed to treat heart disease. It is used to open up blocked coronary arteries. Angioplasty is performed in a cardiac catherization laboratory by a team of specialists composed of a head cardiologist, cardiovascular nurses and technicians.

    Angioplasty is a step by step process in which a small balloon is inserted into a blocked or partially blocked artery and then inflated. This compresses the plaque on the vessel wall, widening the artery and allowing more blood to flow through it.



    Angioplasty is a step by step process. First of all, the patient is given local anesthesia. Next, a thin plastic tube or sheath is inserted into the artery. Usually the plastic tube is inserted in the groin region through the femoral artery. Sometimes the artery in the arm is also used. The catheter is then passes through the sheath and guided through the blood vessel to the arteries of the heart. A contrast material or dye is passed through the catheter and its circulation in the chambers of the heart is monitored. By analyzing the digital pictures of the contrast material, the precise location of the block or malfunctioning of the valves can be found out.

    Once the block is detected one of the following interventional techniques are used to remove the block:
    • Balloon Angioplasty: In balloon angioplasty, a special catheter is used. The catheter has a balloon tip which is inflatable. The catheter is guided to the region of the block and once it is in place, the balloon in inflated. The inflating balloon compresses the fatty deposits into the wall of the artery and stretches the lumen of the blood vessels so that the flow of blood to the heart muscle becomes free.
    • Stent: A stent is a small cylindrical tube made of mesh which is used to provide support to the coronary artery. The stent is placed in the coronary artery which has become narrow due to cholesterol deposits, using a balloon catheter. Once in place the balloon tip is inflated which causes the stent to expand and fit into the coronary artery. The stent holds the coronary artery open. The balloon tip is then deflated and removed while the stent stays. Over the next few weeks, the artery wall heals around the stent. Stents are commonly used during interventional procedures such angioplasty as these procedures require that the coronary artery be open. Stents that contain medicine are also available. The medicine on the stent prevents re-stenosis.
    • Rotoblation: In rotoblation a special catheter is used which has a rotating diamond tip. The catheter is guided to the place of artery blockage and the diamond tip is then activated. The diamond tip cuts away the plaque into microscopic granules. These granules are carried by away the blood stream and removed by the liver and spleen. Rotoblation is repeated as and when needed to allow better flow of blood through the coronary artery. Rotoblation is not being used nowadays. Balloon angioplasty and stent give much better results that rotoblation. Also rotoblation is difficult to perform when compared with balloon angioplasty and stent.
    • Atherectomy: A special catheter is used in atherectomy. The tip is the catheter is made of a hollow cylinder and an inflatable on the other side. The cylinder has a window and cutting blades inside it. When the balloon is inflated, the cylinder is pushed into the fatty matter. The fatty deposits enter into the window and are shaved off by the blades inside the cylinder. The shaved off deposits are stored inside the cylinder and are removed. This procedure is performed as and when required until the lumen of the coronary artery opens wide open, allowing sufficient blood to flow to the heart muscle.
    • Cutting Balloon: The cutting balloon catheter has a inflatable balloon and small cutting blades at its tip. When the balloon is inflated, the blades are activated. The blades chop of the plaque and at the same time the scored off plaque is compressed into the wall of the artery.
    These interventional procedures can open a blocked artery but they cannot cure coronary artery disease. Coronary artery disease can only be treated through lifestyle changes. Smoking should be avoided at any cost. Consumption of high fat, fried, and junk foods should be avoided. Regular exercise and avoiding stress are advised.

    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
    National Institute of Health: What Is Percutaneous Coronary Intervention (PCI) (Coronary Angioplasty)?
    VascularWeb: Angioplasty & Stenting
    Wikipedia: Angioplasty





    AORTA ANATOMICAL OVERVIEW

    The aorta is the main channel for arterial circulation; the large artery into which oxygenated blood is pumped by the heart. The aorta is the largest artery in the body. It rises from the heart's major pumping chamber, the left ventricle and supplies oxygen-rich blood from the heart to the rest of the body. When the aorta is diseased or compromised it puts all other organ systems at risk.



    AORTA STRUCTURE

    Aortic Root - The aorta begins at the root. Starting from the aortic valve (annulus) and becoming slightly wider in diameter (sinuses of Valsalva), it gives rise to two coronary arteries and ends at the beginning of the ascending aorta (sinotubular junction). The two coronary arteries are responsible for carrying oxygen-rich blood to the heart muscle itself.

    Ascending Aorta - Extends upward from the aortic root to the point where the innominate artery branches off the aorta, and the aorta begins to form an arch. It is within the heart sack (pericardium) by itself and has no branching arteries. There is little support from surrounding tissue and must therefore handle the entire cardiac output volume (minus the coronary arteries). The ascending segment is the most vulnerable part of the aorta.

    Aortic Arch - Represents the curved portion at the top of the aorta. The innominate, left common carotid, and left subclavian arteries supply blood to the head and upper body, and branch from the arch. The aortic arch is outside the pericardial sack and has better support from surrounding structures.

    Descending Aorta - This section begins just beyond the arch as the aorta bends down into the body and ends at the diaphragm. It contains the arteries that feed the spinal cord.

    Thoracoabdominal Aorta - It begins at the diaphragm and ends at the celiac, superior mesenteric and renal arteries which are known as the visceral vessels.

    Abdominal Aorta - This segment begins below the renal arteries, which supply blood to the kidneys, and ends where it divides into the two iliac arteries. It contains a small artery named the inferior mesenteric artery.

    FOR DETAILED INFORMATION

    HHMI.org: Anatomy & Physiology of the Heart (Cool Animated Heart Graphics!)
    VirtualRheumatologyCentre: Anatomy & Physiology of the Heart (Great Tutorial Graphics!)





    AORTIC ATHEROSCLEROSIS

    Aortic Atherosclerosis is a systemic disease involving the heart, brain, aorta, and peripheral arteries. Blood tests have not traditionally been used to diagnose or to assess risk. Trans-esophageal echocardiography, a type of ultrasound test, and MRI (magnetic resonance imaging) have been used to identify plaque buildup. A resent blood test for the presence of C-reactive protein may be helpful. The C-reactive protein is a systemic biomarker for inflammation.

    gradual artery blockage


    Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff, sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis usually is preventable and is treatable.

    SYMPTOMS

    Atherosclerosis develops gradually. Mild atherosclerosis usually does not have any symptoms. You usually will not have atherosclerosis symptoms until an artery is so narrowed or clogged that it cannot supply adequate blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke. Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example:

  • If you have atherosclerosis in your heart arteries, you may have symptoms, such as chest pain or pressure (angina).
  • If you have atherosclerosis in the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke.
  • If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (intermittent claudication).
  • If you have atherosclerosis in the arteries leading to your kidneys, you develop high blood pressure or kidney failure.
  • If you have atherosclerosis in the arteries leading to your genitals, you may have difficulties having sex. Sometimes, atherosclerosis can cause erectile dysfunction in men. In women, high blood pressure can reduce blood flow to the vagina, making sex less pleasurable.


  • If you think you have atherosclerosis, talk to your health care provider. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another medical emergency.

    CAUSES

    Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by:
    • High blood pressure.
    • High cholesterol, often from getting too much cholesterol or saturated fats in your diet.
    • High triglycerides, a type of fat (lipid) in your blood.
    • Smoking and other sources of tobacco.
    • Diabetes.
    • Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause.

    Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. Over time, fatty deposits (plaques) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then do not receive enough blood to function properly. Eventually pieces of the fatty deposits may break off and enter your bloodstream. In addition, the smooth lining of a plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ.

    RISK FACTORS

    Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include:
    • High blood pressure.
    • High cholesterol.
    • Diabetes.
    • Obesity.
    • Smoking and other tobacco use.
    • A family history of early heart disease.
    • Lack of exercise.

    The complications of atherosclerosis depend on which arteries are blocked. For example:
    • Coronary Artery Disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure.
    • Carotid Artery Disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
    • Peripheral Artery Disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene).
    • Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point.

    DIAGNOSIS

    During a physical exam, your health care provider may find signs of narrowed, enlarged or hardened arteries, including:
    • A weak or absent pulse below the narrowed area of your artery.
    • Decreased blood pressure in an affected limb.
    • Whooshing sounds (bruits) over your arteries, heard using a stethoscope.
    • Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee.
    • Evidence of poor wound healing in the area where your blood flow is restricted.

    Depending on the results of the physical exam, your health care provider may suggest one or more diagnostic tests, including:
    • Blood Tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You will need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your health care provider should tell you ahead of time if this test will be performed during your visit.
    • Doppler Ultrasound. Your health care provider may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your health care provider gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
    • Ankle-Brachial Index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your health care provider may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
    • Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your health care provider may ask you to walk on a treadmill or ride a stationary bike during an ECG.
    • Stress Test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm and blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you are unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.
    • Cardiac Catheterization & Angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that is fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.

    Other imaging tests may include the use of ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.

    TREATMENT

    ifestyle changes, such as eating a healthy diet and exercising, are often the best treatment for atherosclerosis. Sometimes, medication or surgical procedures may be recommended as well. Various drugs can slow or even reverse the effects of atherosclerosis. Here are some common choices:
    • Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your health care provider can choose from a range of cholesterol medications, including drugs known as statins and fibrates. In addition to lowering cholesterol, statins have additional effects that help stabilize the lining of your heart arteries and prevent atherosclerosis.
    • Anti-platelet medications. Your health care provider may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
    • Beta blocker medications. These medications are commonly used for coronary artery disease. They lower your heart rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta blockers reduce the risk of heart attacks and some heart rhythm problems.
    • Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks.
    • Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina.
    • Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.

    Your health care provider may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed. Sometimes more aggressive treatment is needed. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures:
    • Angioplasty and stent placement. In this procedure, your health care provider inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
    • Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it is called a carotid endarterectomy.
    • Thrombolytic therapy. If you have an artery that is blocked by a blood clot, your health care provider may use a clot-dissolving drug to break it apart.
    • Bypass surgery. Your health care provider may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.

    Lifestyle changes can help you prevent or slow the progression of atherosclerosis (coronary artery disease).
    • Stop Smoking. Smoking is a major risk factor for coronary artery disease. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack.
    • Control Your Blood Pressure. Ask your health care provider for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. The ideal blood pressure is below 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg).
    • Check Your Cholesterol. Ask your health care provider for a baseline cholesterol test when you are in your 20s and at least every five years after. If your test results are not within desirable ranges, your practitioner may recommend more-frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L).
    • Keep Diabetes Under Control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
    • Get Moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. All risk factors for coronary artery disease. Ideally, you should exercise 30 to 60 minutes most days of the week. If you cannot fit it all into one session, try breaking it up into 10-minute intervals. You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television. Regular exercise can condition your muscles to use oxygen more efficiently. Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes.
    • Eat Healthy Foods. A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts, and is low in saturated fat, cholesterol and sodium. It can help you control your weight, blood pressure, cholesterol and blood sugar. Eating one or two servings of fish a week also is beneficial. Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat.
    • Maintain Healthy Weight. Being overweight increases your risk of coronary artery disease. Losing even just a few pounds can help lower your blood pressure and reduce your risk of coronary artery disease. Lose extra pounds and maintain a healthy weight. If you are overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes.
    • Manage Stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

    In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease, such as high cholesterol, high blood pressure and diabetes, have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health. Some individuals may consider asking their practitioner about a yearly flu vaccine. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.

  • Nutritional changes are important. In addition to a heart healthy diet, these nutrients are important for heart health and are available in our foods and as supplements.
    • Omega-3 Fatty Acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. Fish and Fish Oil are the most effective sources of omega-3 fatty acids. Fatty fish, such as salmon, herring and, to a lesser extent, tuna, contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish. Flaxseed & Flaxseed Oil also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol. Other dietary sources of omega-3 fatty acids include walnuts, canola oil, Soybeans & Soybean Oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health is not as strong.

    Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. Nuts and seeds are good dietary sources of essential nutrients used to control cholesterol and contribute to heart health. These nutrients include:
    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
    MicroscopyU: Human Pathology - Aortic Atherosclerosis
    WebMD: Atherosclerosis
    AHA Journals: Aortic Atherosclerosis Disease & Stroke - Circulation
    EMedicineHealth: Hardening of the Arteries: Facts on Atherosclerosis
    Wikipedia: Atherosclerosis





    AORTIC STENOSIS (AS)

    Aortic Stenosis (AS) is a condition in which there is a narrowing of the exit of the left ventricle of the heart. It may occur at the aortic valve as well as above or below this level. When this is narrowed, problems from the restriction of blood flow from the heart into the aorta. It can be a result from congenital malformations of the valve or from damage, such as from rheumatic fever. It typically gets worse over time. Symptoms, which may come on gradually with a decreased ability to exercise often occurring first. It may begin in early childhood, include fainting, chest pain, and shortness of breath, especially with exertion. If heart failure, loss of consciousness, or heart related chest pain occurs due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of heart failure include shortness of breath especially with lying down, at night, and with exercise as well as swelling of the legs. Thickening of the valve without narrowing is known as aortic sclerosis.

    aortic stenosis


    AORTIC VALVE STENOSIS SYMPTOMS

    Aortic valve stenosis, also known as aortic stenosis, occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body. When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump and may weaken your heart muscle. If you have severe aortic valve stenosis, you will usually need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.

    Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe and can include:
    • Chest pain (angina) or tightness.
    • Feeling faint or fainting with exertion.
    • Shortness of breath, especially with exertion.
    • Fatigue, especially during times of increased activity.
    • Heart palpitations, sensations of a rapid, fluttering heartbeat.
    • Heart murmur.

    The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet. Aortic valve stenosis often does not produce warning signs or symptoms right away, making it difficult to detect at first. You also may not recognize that you are experiencing symptoms. The condition is often discovered during a routine physical when your health care provider hears an abnormal heart sound (heart murmur). This murmur may occur long before other signs and symptoms develop. Depending on the amount of narrowing, an infant or child with aortic valve stenosis may have no symptoms, may tire easily or may have chest pain with vigorous physical activity.

    Aortic valve stenosis usually affects adults but can occur in children. Infants and children with the condition may experience symptoms similar to those of adults. If you or your child experiences such signs or symptoms, see a health practitioner, especially if you or your child has a known heart problem.

    CAUSES

    Aortic valve stenosis is narrowing of the aortic valve. Many things can narrow this passageway between your heart and aorta. Causes of aortic valve stenosis include:
    • Congenital Heart Defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called leaflets. Some children are born with an aortic valve that has only one (unicuspid), two (bicuspid) or four (quadricuspid) leaflets, not three. This deformity may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced. Having a congenitally abnormal aortic valve requires regular evaluation by a practitioner to watch for signs of valve problems. In most cases, practitioners do not know why a heart valve fails to develop properly, so it is not something you could have prevented.
    • Calcium Buildup on the Valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can accumulate on the valve's leaflets. These deposits may never cause any problems. These calcium deposits are not linked to taking calcium tablets or drinking calcium-fortified drinks. However, in some people, particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve, calcium deposits result in stiffening of the leaflets of the valve. This stiffening narrows the aortic valve and can occur at a younger age. However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in men older than 65 and women older than 75.
    • Rheumatic Fever. A complication of strep throat infection or scarlet fever, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. The mitral valve is another common valve damaged by rheumatic fever bacteria. A damaged heart valve may not open fully or close fully, or both. While rheumatic fever and scarlet is rare in the United States today, some older adults had rheumatic fever and scarlet fever as children.

    HEART FUNCTION: Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers (atria) receive blood. The two lower chambers (ventricles) pump blood. Blood returning to your heart enters the right upper chamber (right atrium). From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Blood from your lungs then returns to your heart but this time to the left side, to the left upper chamber (left atrium). Blood then flows into the left ventricle, your heart's main pump. With each heartbeat, the left ventricle forces blood through the aortic valve into the aorta, your body's largest artery. Blood flows through your heart's chambers, aided by four heart valves. These valves open and close to let blood flow in only one direction through your heart:
    • Tricuspid valve.
    • Pulmonary valve.
    • Mitral valve.
    • Aortic valve.

    The aortic valve, your heart's gateway to the aorta, consists of three tightly fitting, triangular-shaped flaps of tissue called leaflets. These leaflets connect to the aorta via a ring called the annulus. Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When all of the left ventricular blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.

    A defective heart valve is one that fails to either open or close fully. When a valve does not close tightly, blood can leak backward. This backward flow through a valve is called regurgitation. When a valve narrows, the condition is called stenosis.

    RISK FACTORS

    Aortic valve stenosis is not considered preventable, and presently it is not known why some people develop this condition. Some risk factors include:
    • A deformed aortic valve. Some people are born with an already narrowed aortic valve or develop aortic valve stenosis later in life because they were born with a bicuspid aortic valve, one with two flaps (leaflets) instead of three. People may also develop aortic valve stenosis if they were born with one leaflet (unicuspid aortic valve) or four leaflets (quadricuspid aortic valve), but these are much more rare conditions. A bicuspid aortic valve is a major risk factor for aortic valve stenosis. A bicuspid aortic valve can run in families, so knowing your family history is important. If you have a first-degree relative, such as a parent, sibling or child, with a bicuspid aortic valve, it is reasonable to check to see if you have this abnormality.
    • Age. Aortic valve stenosis may be related to increasing age and the buildup of calcium deposits on heart valves.
    • Previous rheumatic fever. Rheumatic fever can cause the flaps (leaflets) of your aortic valve to stiffen and fuse, eventually resulting in aortic valve stenosis.
    • Chronic kidney disease. Aortic valve stenosis is associated with chronic kidney disease.

    Risk factors for aortic valve stenosis and atherosclerotic heart disease are similar, such as high blood pressure, high cholesterol, type 2 diabetes and smoking, which may indicate a link between the two.

    Aortic valve stenosis, of any cause, can be a serious condition. If the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. In response, the left ventricle may thicken and enlarge. At first, these adaptations help the left ventricle pump blood with more force. But eventually it is harder for the heart to maintain the blood flow to the body through the narrowed valve. Then you will start to experience symptoms. Eventually, the extra work of the heart can weaken the left ventricle and your heart overall. Left unchecked, aortic valve stenosis can lead to life-threatening heart problems, including:
    • Chest pain (angina).
    • Fainting (syncope).
    • Heart failure.
    • Irregular heart rhythms (arrhythmias).
    • Cardiac arrest.

    PREVENTION

    Some possible ways to prevent aortic valve stenosis include:
    • Taking steps to prevent rheumatic fever. You can do this by making sure you see your health care provider when you have a sore throat. Untreated strep throat or scarlet fever can develop into rheumatic fever. Fortunately, strep throat and scarlet fever can usually be easily treated with antibiotics. Rheumatic fever is more common in children and young adults.
    • Addressing risk factors for coronary artery disease. These include high blood pressure, obesity and high cholesterol levels. These factors may be linked to aortic valve stenosis, so it is a good idea to keep your weight, blood pressure and cholesterol levels under control if you have aortic valve stenosis. Taking care of your teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and aggravate aortic valve stenosis. Once you know that you have aortic valve stenosis, your health care provider may recommend that you limit strenuous activity to avoid overworking your heart.
    • If you are a woman of childbearing age with aortic valve stenosis, discuss pregnancy and family planning with your health care provider before you become pregnant. Your heart works harder during pregnancy. How a heart with aortic valve stenosis tolerates this extra work depends on the degree of stenosis and how well your heart pumps. Should you become pregnant, you will need evaluation by your cardiologist and obstetrician throughout your pregnancy, labor and delivery, and after delivery.

    DIAGNOSIS

    To diagnose your condition, your health care provider will review your medical history and symptoms and conduct a physical examination. As part of a routine physical exam, a stethoscope is used to listen to your heart for, among other things, an abnormal heart sound (heart murmur). If your practitioner discovers a heart murmur, he or she will discuss it with you. Many heart conditions, including aortic valve stenosis, can produce a heart murmur. In the case of aortic valve stenosis, the heart murmur results from turbulent blood flow through the narrowed valve.

    If your health care provider suspects that you or your child may have a deformed or narrowed aortic valve, you may need to undergo several tests to confirm the diagnosis and gauge the severity of the problem. You may be referred to a practitioner trained in heart conditions (cardiologist) for tests such as:
    • Echocardiogram. This test uses sound waves to produce an image of your heart. This is the primary test that may used to diagnose your condition if a heart valve condition is suspected. In an echocardiogram, sound waves are directed at your heart from a wandlike device (transducer) held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram helps to closely examine the heart and heart valves to check for any problems or abnormalities. This test helps to diagnose aortic valve stenosis, evaluate the severity of your condition and determine the most appropriate treatment for your condition. An echocardiogram will also be used to monitor your condition over time. In some cases, a tube with a transducer attached to it may be inserted and guided down your throat into your esophagus (transesophageal echocardiogram) while you are sedated. This type of echocardiogram may offer more detailed images of your heart.
    • Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG can provide clues about whether the left ventricle is thickened or enlarged, a problem which can occur with aortic valve stenosis.
    • Chest X-ray. An X-ray image of your chest allows your health care provider to check the size and shape of your heart to determine whether the left ventricle is enlarged, a possible indicator of aortic valve stenosis. A chest X-ray can also reveal calcium deposits on the aortic valve. In addition, a chest X-ray helps check the condition of your lungs. Aortic valve stenosis may lead to blood and fluid backing up in your lungs, which causes congestion that may be visible on an X-ray.
    • Cardiac Catheterization. This procedure may be ordered if noninvasive tests have not provided enough information to firmly diagnose the type or severity of your heart condition. In this procedure, a thin tube (catheter) is threaded through an artery in your arm or groin and guided to an artery in your heart. A dye is injected through the catheter, which helps your arteries become visible on an X-ray (coronary angiogram). This test helps show any blockages in arteries to your heart that can coexist with aortic valve stenosis that may need surgical treatment along with aortic valve stenosis.
    • Exercise Tests. In exercise tests, you exercise to increase your heart rate and make your heart work harder. If you have severe aortic valve stenosis but are not experiencing symptoms, your practitioner may order exercise tests to evaluate how your heart responds to exertion (exercise) and to measure your tolerance for activity.
    • Computerized Tomography (CT) Scan. A CT scan uses a series of X-rays to create detailed images of your heart and heart valves. This test may used to measure the size of your aorta and look at your aortic valve more closely. Sometimes practitioners may inject a dye into your blood vessels to show the blood flow (CT angiography).
    • Magnetic Resonance Imaging (MRI). An MRI uses powerful magnets and radio waves to create detailed images of your heart and heart valves. Practitioners may inject a dye into your blood vessels to highlight the heart and blood vessels in images (magnetic resonance angiography). Doctors may use this test to measure the size of your aorta.

    These tests and others help your health care provider determine how narrow or tight your aortic valve may be and how well your heart is pumping. Once aortic valve stenosis is discovered, your health care provider will either recommend treatment or suggest careful monitoring.

    TREATMENT & MEDICATIONS

    No medications can reverse aortic valve stenosis. However, you may be prescribed certain medications to help your symptoms, such as ones to reduce fluid accumulation, to slow your heart rate or to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure may prevent or slow the development of aortic stenosis. Ask if you need to lower your blood pressure with medications.

    Medications sometimes can ease symptoms of aortic valve stenosis. However, the only way to eliminate aortic valve stenosis is surgery to repair or replace the valve and open up the passageway. Surgery is not always needed right away. If tests reveal that you have mild to moderate aortic valve stenosis and you have no symptoms, your practitioner will schedule checkups to carefully monitor the valve so that surgery can be done at the appropriate time. In follow-up appointments, your health care provider will review your medical history and conduct a physical examination. Your practitioner may also discuss symptoms and what to expect as your condition progresses. An echocardiogram may be ordered to view your aortic valve and monitor your condition every three to five years if you have mild aortic valve stenosis, and every year if you have moderate aortic valve stenosis.

    If you have severe aortic valve stenosis, you may be scheduled for checkups every three to six months. An echocardiogram may be ordered every six to 12 months to view your heart valve and monitor your condition. In some cases, additional tests may be ordered.

    In general, surgery is necessary when narrowing becomes severe and symptoms develop. In some cases, surgery may recommended if you have severe aortic valve stenosis even if you are not experiencing symptoms. If you have moderate or severe aortic valve stenosis and other conditions that require heart surgery, surgery may be recommended to treat your conditions.

    You may need valve repair or replacement to treat aortic valve stenosis. Although less invasive approaches are possible in some cases, surgery is the primary treatment for this condition. Therapies to repair or replace the aortic valve include:
    • Balloon Valvuloplasty. Occasionally, balloon valvuloplasty is an option. Balloon valvuloplasty uses a soft, thin tube (catheter) tipped with a balloon. A catheter is guided through a blood vessel in your groin to your heart and into your narrowed aortic valve. Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open the aortic valve and stretches the valve opening, improving blood flow. The balloon is then deflated, and the catheter with the balloon is guided back out of your body. Balloon valvuloplasty may relieve aortic valve stenosis and its symptoms, especially in infants and children. However, in adults, the valve tends to narrow again even after initial success. For these reasons, balloon valvuloplasty is rarely used today to treat aortic valve stenosis in adults, except in people who are too sick to undergo surgery or are waiting for a transcatheter aortic valve replacement.
    • Aortic Valve Replacement. This is the primary surgical treatment for severe aortic valve stenosis. Your surgeon removes the narrowed aortic valve and replaces it with a mechanical valve or a tissue valve. This procedure is generally performed during open-heart surgery. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical valve, you will need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves, which may come from a pig, cow or human deceased donor, often eventually narrow over the years and need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible but less likely in an older person. Your health care provider can discuss the risks and benefits of each type of heart valve with you. Aortic valve replacement can relieve aortic valve stenosis and its symptoms.
    • Transcatheter Aortic Valve Replacement (TAVR). Aortic valve replacement, the most common treatment for aortic valve stenosis, has traditionally been performed with open-heart surgery. This is a less invasive approach that involves replacing the aortic valve with a prosthetic valve via the femoral artery in your leg (transfemoral) or the left ventricular apex of your heart (transapical). In TAVR, a catheter is inserted with a balloon at the tip in an artery in your leg or in a small incision in your chest and guided to your heart and into your aortic valve. A balloon at the tip of the catheter, which has a folded valve around it, is then inflated. This pushes open the aortic valve and stretches the valve opening and expands the folded valve into the aortic valve. The balloon is then deflated and the catheter with the balloon is guided back out of your body. Alternatively, a self-expanding valve may be inserted into the aortic valve, and a balloon then is not used. In some cases, a valve can be inserted via a catheter into a tissue replacement valve that needs to be replaced (valve-in-valve procedure). TAVR is usually reserved for individuals with severe aortic valve stenosis who are at increased risk of complications from aortic valve surgery. This procedure can relieve severe aortic valve stenosis and its symptoms in those who are at increased risk of complications from aortic valve surgery. TAVR has a higher risk of stroke and vascular complications than aortic valve replacement surgery. The technique is relatively new and is evolving quickly, and there are newer valves and indications occurring frequently. TAVR is sometimes referred to as transcatheter aortic valve implantation (TAVI).
    • Surgical Valvuloplasty. In rare cases, surgical repair may be a more effective option than balloon valvuloplasty, such as in infants born with an aortic valve in which the leaflets of the valve are fused together. Using traditional surgical tools, a cardiac surgeon operates on the valve and separates these leaflets to reduce stenosis and improve blood flow. Aortic valve stenosis can be treated effectively with surgery. However, you will need regular follow-up appointments with your practitioner to check for any changes in your condition. You may still be at risk of irregular heart rhythms even after you have been treated for aortic valve stenosis. You may need to take medications to lower that risk. If your heart has become weakened from aortic valve stenosis, you may need medications to treat heart failure. If you have had aortic valve replacement surgery, you need to take antibiotics before certain dental or medical procedures due to the risk of infection in your heart tissue (endocarditis).

    FOR DETAILED INFORMATION

    Wikipedia: Aortic Stenosis
    NewHeartValve: What Is Aortic Stenosis?
    WebMD: Aortic Valve Stenosis
    ClevelandClinicMedEd: Aortic Valve Disease
    CincinnatiChildrens: Congenital Aortic Valve Stenosis
    Boston Children's Hospital: Aortic Valve Stenosis In Children





    ARRHYTHMIA

    Cardiac arrhythmias are disruptions in the natural rhythm of the heartbeat that are caused by improper functioning of electrical system cells in the heart. When the electrical impulses that coordinate your heartbeats do not work properly, this causes your heart to beat too fast, too slow or irregularly. Heart arrhythmias may feel like a fluttering or racing heart and may be harmless. However some heart arrhythmias may cause bothersome, sometimes even life-threatening signs and symptoms. There are different kinds of arrhythmias.
    • Palpitations is a term that refers to the feeling of a pounding heartbeat, whether regular or irregular.
    • Tachycardia is an abnormal increase in the resting heart rate.
    • Bradycardia is the opposite, and abnormally slow heart rate.
    • Ectopic beats are premature beats (often felt as "skipped" beats).
    • Flutter and fibrillation are situations in which the normal steady beating of the heart are converted by electrical error into a rapid twitching of the heart muscle. This ineffective functioning results in an insufficient supply of blood being carried to the body's tissues.
    cardia arrhythmia - the heart's electrical system


    Electrical conduction in the heart originates in the SA node and travels through the AV node to the ventricles, resulting in a heart beat.

    Heart arrhythmia treatment can often control or eliminate fast or irregular heartbeats. In addition, because troublesome heart arrhythmias are often made worse, or even caused, by a weak or damaged heart, you may be able to reduce your arrhythmia risk by adopting a heart-healthy lifestyle.

    SYMPTOMS

    Arrhythmias may not cause any signs or symptoms. In fact, your health care provider might find you have an arrhythmia before you do, during a routine examination. Noticeable signs and symptoms do not necessarily mean you have a serious problem, however. Noticeable arrhythmia symptoms may include:
    • A fluttering in your chest.
    • A racing heartbeat (tachycardia).
    • A slow heartbeat (bradycardia).
    • Chest pain.
    • Shortness of breath.
    • Lightheadedness.
    • Dizziness.
    • Fainting (syncope) or near fainting.

    Arrhythmias may cause you to feel premature or extra heartbeats, or you may feel that your heart is racing or beating too slowly. Other signs and symptoms may be related to your heart not pumping effectively due to the fast or slow heartbeat. These include shortness of breath or wheezing, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort. Seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you would not expect to feel them.

    Tachycardia is an abnormally fast heart rhythm. Common symptoms associated with tachycardia are palpitations, dizziness, chest pain, shortness of breath, and even fainting spells. Sometimes tachycardias are so mild that they are not even noticed; but some tachycardias may be life-threatening. Most cases of tachycardia are due to an abnormal electrical pathway known as a re-entry circuit. When an electrical impulse gets into the pathway, it may start traveling in a loop, causing the heart to contract with each impulse through the pathway. As a result, the heart beats very rapidly. Types of tachycardia that are most common among the general population include AV Nodal Re-entrant Tachycardia, accessory pathway tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia.

    Ventricular fibrillation is one type of arrhythmia that can be deadly. It occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly instead of pumping blood. Without an effective heartbeat, blood pressure plummets, cutting off blood supply to your vital organs. A person with ventricular fibrillation will collapse within seconds and soon will not be breathing or have a pulse. If this occurs, follow these steps:
      EMERGENCY STEPS: Call 911 or the emergency number in your area. If there is no one nearby trained in cardiopulmonary resuscitation (CPR), provide hands-only CPR. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive. To do chest compressions, push hard and fast in the center of the chest. You do not need to do rescue breathing. If you or someone nearby knows CPR, begin providing it if it is needed. CPR can help maintain blood flow to the organs until an electrical shock (defibrillation) can be given. Find out if an automated external defibrillator (AED) is available nearby. These portable defibrillators, which can deliver an electric shock that may restart heartbeats, are available in an increasing number of places, such as in airplanes, police cars and shopping malls. They can even be purchased for your home. No training is required. The AED will tell you what to do. They are programmed to allow a shock only when appropriate.

    CAUSES

    Many things can lead to, or cause, an arrhythmia, including:
    • A heart attack that is occurring right now.
    • Scarring of heart tissue from a prior heart attack.
    • Changes to your heart's structure, such as from cardiomyopathy.
    • Blocked arteries in your heart (coronary artery disease).
    • High blood pressure.
    • Diabetes.
    • Overactive thyroid gland (hyperthyroidism).
    • Underactive thyroid gland (hypothyroidism).
    • Smoking.
    • Drinking too much alcohol or caffeine.
    • Drug abuse>
    • Stress.
    • Certain prescription medications.
    • Certain dietary supplements and herbal treatments.
    • Electrical shock.
    • Air pollution.

    normal heart rhythm


    THE NORMAL HEART BEAT & RHYTHM

    The normal human heart is made up of four chambers - two upper chambers (atria) and two lower chambers (ventricles). The rhythm of the heart is normally controlled by a natural pacemaker (the sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat. From the sinus node, electrical impulses travel across the atria, causing the atria muscles to contract and pump blood into the ventricles. The electrical impulses then arrive at a cluster of cells called the atrioventricular node (AV node) - usually the only pathway for signals to travel from the atria to the ventricles. The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body. In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute in the average adult. Conditioned athletes at rest commonly have a heart rate less than 60 beats a minute because their hearts are so efficient.

    TYPES OF ARRHTHYMIAS

    Health care providers classify arrhythmias not only by where they originate (atria or ventricles) but also by the speed of heart rate they cause:
    • Tachycardia: This refers to a fast heartbeat, a resting heart rate greater than 100 beats a minute.
    • Bradycardia: This refers to a slow heartbeat, a resting heart rate less than 60 beats a minute.

    Not all tachycardias or bradycardias mean you have heart disease. For example, during exercise it is normal to develop a fast heartbeat as the heart speeds up to provide your tissues with more oxygen-rich blood. During sleep or times of deep relaxation, it is not unusual for the heart beat to be slower.

    Atrial Tachycardias: Tachycardias originating in the atria include:
    • Atrial Fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated, weak contractions of the atria. The chaotic electrical signals bombard the AV node, usually resulting in an irregular, rapid rhythm of the ventricles. Atrial fibrillation may be temporary, but some episodes will not end unless treated. Atrial fibrillation may lead to serious complications such as stroke.
    • Atrial Flutter. Atrial flutter is similar to atrial fibrillation. The heartbeats in atrial flutter are more-organized and more-rhythmic electrical impulses than in atrial fibrillation. Atrial flutter may also lead to serious complications such as stroke.
    • Supraventricular Tachycardia. Supraventricular tachycardia is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular) in the atria or AV node.
    • Wolff-Parkinson-White Syndrome. In Wolff-Parkinson-White syndrome, a type of supraventricular tachycardia, there is an extra electrical pathway between the atria and the ventricles, which is present at birth. However, you may not experience symptoms until you're an adult. This pathway may allow electrical signals to pass between the atria and the ventricles without passing through the AV node, leading to short circuits and rapid heartbeats.

    Ventricular Tachycardias: Tachycardias occurring in the ventricles include:
    • Ventricular Tachycardia. Ventricular tachycardia is a rapid, regular heart rate that originates with abnormal electrical signals in the ventricles. The rapid heart rate does not allow the ventricles to fill and contract efficiently to pump enough blood to the body. Ventricular tachycardia can often be a medical emergency. Without prompt medical treatment, ventricular tachycardia may worsen into ventricular fibrillation.
    • Ventricular Fibrillation. Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This serious problem is fatal if the heart is not restored to a normal rhythm within minutes. Most people who experience ventricular fibrillation have an underlying heart disease or have experienced serious trauma, such as being struck by lightning.
    • Long QT Syndrome. Long QT syndrome is a heart disorder that carries an increased risk of fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the electrical system of your heart, may lead to fainting, and can be life-threatening. In some cases, your heart's rhythm may be so erratic that it can cause sudden death. A person can be born with a genetic mutation that puts them at risk of long QT syndrome. In addition, several medications may cause long QT syndrome. Some medical conditions, such as congenital heart defects, may also cause long QT syndrome.

    Bradycardia: A Slow Heartbeat

    Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low resting heart rate does not always signal a problem. If you are physically fit, you may have an efficient heart capable of pumping an adequate supply of blood with fewer than 60 beats a minute at rest. In addition, certain medications used to treat other conditions, such as high blood pressure, may lower your heart rate. However, if you have a slow heart rate and your heart is not pumping enough blood, you may have one of several bradycardias, including:
    • Sick Sinus Syndrome. If the sinus node, which is responsible for setting the pace of the heart, is not sending impulses properly, the heart rate may be too slow (bradycardia), or it may speed up (tachycardia) and slow down intermittently. Sick sinus syndrome can also be caused by scarring near the sinus node that is slowing, disrupting or blocking the travel of impulses.
    • Conduction Block. A block of your heart's electrical pathways can occur in or near the AV node, which lies on the pathway between your atria and your ventricles. A block can also occur along other pathways to each ventricle. Depending on the location and type of block, the impulses between the upper and lower halves of the heart may be slowed or blocked. If the signal is completely blocked, certain cells in the AV node or ventricles can make a steady, although usually slower, heartbeat. Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia. Slower heart rates or a conduction block may cause symptoms of fatigue, dizziness or fainting.

    Premature Heartbeats: Although it often feels like a skipped heartbeat, a premature heartbeat is actually an extra beat. Even though you may feel an occasional premature beat, it seldom means you have a more serious problem. Still, a premature beat can trigger a longer lasting arrhythmia, especially in people with heart disease. Premature heartbeats are commonly caused by stimulants, such as caffeine from coffee, tea and soft drinks; over-the-counter cold remedies containing pseudoephedrine; and some asthma medications.

    RISK FACTORS

    Certain factors may increase your risk of developing an arrhythmia. These include:
    • Coronary Artery Disease, Other Heart Problems & Previous Heart Surgery. Narrowed heart arteries, a heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
    • High blood pressure. This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to become stiff and thick, which can change how electrical impulses travel through your heart.
    • Congenital Heart Disease. Being born with a heart abnormality may affect your heart's rhythm.
    • Thyroid Problems. Having an overactive or underactive thyroid gland can raise your risk for arrhythmias.
    • Drugs & Supplements. Certain over-the-counter cough and cold medicines and certain prescription drugs may contribute to arrhythmia development.
    • Diabetes. Your risk of developing coronary artery disease and high blood pressure greatly increases with uncontrolled diabetes.
    • Obstructive Sleep Apnea. This disorder, in which your breathing is interrupted during sleep, can increase your risk of bradycardia, atrial fibrillation and other arrhythmias.
    • Electrolyte Imbalance. Substances in your blood called electrolytes, such as Potassium, Sodium, Calcium and Magnesium, help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development.
    • Excessive Alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing atrial fibrillation.
    • Caffeine or Nicotine Use. Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.

    Certain arrhythmias may increase your risk of developing conditions such as:
    • Stroke. When your heart quivers, it is unable to pump blood effectively, which can cause blood to pool. This can cause blood clots to form. If a clot breaks loose, it can travel from your heart to your brain. There it might block blood flow, causing a stroke. Certain medications, such as blood thinners, can greatly lower your risk of stroke or damage to other organs caused by blood clots. Your health care provider will determine if a blood-thinning medication is appropriate for you, depending on your type of arrhythmia and your risk of blood clots.
    • Heart Failure. Heart failure can result if your heart is pumping ineffectively for a prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation. Sometimes controlling the rate of an arrhythmia that is causing heart failure can improve your heart's function.

    DIAGNOSIS & TESTS

    To diagnose a heart arrhythmia, your health care provider will review your symptoms and your medical history and conduct a physical examination. Your practitioner may ask about, or test for, conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Heart monitoring tests may be performed that are specific to arrhythmias. These may include:
    • Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
    • Holter Monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
    • Event Monitor. For sporadic arrhythmias, you keep this portable ECG device available, attaching it to your body and pressing a button when you have symptoms. This lets your health care provider check your heart rhythm at the time of your symptoms.
    • Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion.

    If your practitioner does not find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:
    • Stress Test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you will be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If health care providers are evaluating you to determine if coronary artery disease may be causing the arrhythmia, and you have difficulty exercising, then your practitioner may use a drug to stimulate your heart in a way that is similar to exercise.
    • Tilt Table Test. This test may be recommended if you have had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your practitioner observes how your heart and the nervous system that controls it respond to the change in angle.
    • Electrophysiological Testing & Mapping. In this test, practitioners thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart. In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger or halt an arrhythmia. This allows your health care provider to see the location of the arrhythmia and what may be causing it.

    TREATMENTS & MEDICATIONS

    If you have an arrhythmia, treatment may or may not be necessary. Usually it is required only if the arrhythmia is causing significant symptoms or if it is putting you at risk of a more serious arrhythmia or arrhythmia complication.

  • Treating Slow Heartbeats: If slow heartbeats (bradycardias) do not have a cause that can be corrected, practitioners often treat them with a pacemaker because there are not any medications that can reliably speed up your heart. A pacemaker is a small device that is usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady rate.

  • Treating Fast Heartbeats: For fast heartbeats (tachycardias), treatments may include one or more of the following:
    • Vagal Maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing. These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. However, vagal maneuvers do not work for all types of arrhythmias.
    • Medications. For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm. It is very important to take any anti-arrhythmic medication exactly as directed by your practitioner in order to minimize complications. If you have atrial fibrillation, you may be prescribed blood-thinning medications to help keep dangerous blood clots from forming.
    • Cardioversion. If you have a certain type of arrhythmia, such as atrial fibrillation, your practitioner may use cardioversion, which can be conducted as a procedure or using medications. In the procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.
    • Catheter Ablation. In this procedure, your practitioner threads one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips can use heat, extreme cold or radiofrequency energy to damage (ablate) a small spot of heart tissue and create an electrical block along the pathway that is causing your arrhythmia.

  • Implantable Devices: Treatment for heart arrhythmias also may involve use of an implantable device:
    • Pacemaker. A pacemaker is an implantable device that helps control abnormal heart rhythms. A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it is permanently anchored. If a pacemaker detects a heart rate that is abnormal, it emits electrical impulses that stimulate your heart to beat at a normal rate.
    • Implantable Cardioverter Defibrillator (ICD). This device may be recommended if you are at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your practitioner may also recommend an ICD. An ICD is a battery-powered unit that is implanted under the skin near the collarbone similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm. If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD does not prevent an abnormal heart rhythm from occurring, but it treats it if it occurs.

  • Surgical Treatments: In some cases, surgery may be the recommended treatment for heart arrhythmias:
    • Maze Procedure. In the maze procedure, a surgeon makes a series of surgical incisions in the heart tissue in the upper half of your heart (atria) to create a pattern or maze of scar tissue. Because scar tissue does not conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia. The procedure is effective, but because it requires surgery, it is usually reserved for people who do not respond to other treatments or for those who are having heart surgery for other reasons. The surgeon may use radiofrequency energy or extreme cold (cryotherapy) to create the scars.
    • Coronary Bypass Surgery. If you have severe coronary artery disease in addition to arrhythmias, your practitioner may perform coronary bypass surgery. This procedure may improve the blood flow to your heart.

    LIFESTYLE CHANGES

    Your health care provider may suggest that, in addition to other treatments, you make lifestyle changes that will keep your heart as healthy as possible. These same recommendations also are helpful in preventing arrhythmia and reduce your risk of heart disease.These healthy lifestyle changes may include:
    • Eat heart-healthy foods. Eat a healthy diet that is low in salt and solid fats and rich in fruits, vegetables and whole grains.
    • Exercise regularly. Exercise daily and increase your physical activity.
    • Quit and avoid smoking. If you smoke and cannot quit on your own, discuss strategies or programs to help you break a smoking habit.
    • Maintain a healthy weight. Being overweight increases your risk of developing heart disease.
    • Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure (hypertension) or high cholesterol.
    • Drink alcohol in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. Limiting or avoiding caffeine and alcohol is recommended.
    • Reducing stress, as intense stress and anger can cause4 heart rhythm problems.
    • Using over the counter medication with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.
    • Maintain follow-up care. Take your medications as prescribed and have regular follow-up appointments with your health care provider. Tell your practitioner if your symptoms worsen.

    Research is ongoing regarding the effectiveness of several forms of complementary and alternative medical therapies for arrhythmia. Some types of complementary and alternative therapies may be helpful to reduce stress, such as:
    FOR DETAILED INFORMATION

    Wikipedia: Cardiac Arrhythmia
    MedlinePlus: NIH - Arrhythmia
    NHLBI NIH: What Is an Arrhythmia?
    American Heart Association: Arrhythmia
    MedicineNet: Heart Arrhythmia (Irregular Heartbeat)





    CARDIAC ARREST

    Cardiac arrest occurs when the heart stops beating. When this happens, the blood supply to the brain is cut off and the person loses consciousness. A person in apparent good health who experiences cardiac arrest usually has unsuspected coronary artery disease.

    cardiac arrest and cpr


    SUDDEN CARDIAC ARREST

    Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to the rest of your body. Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest. Sudden cardiac arrest is a medical emergency. If not treated immediately, it causes sudden cardiac death. With fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation (CPR) or even just compressions to the chest can improve the chances of survival until emergency personnel arrive.

    SYMPTOMS

    Sudden cardiac arrest symptoms are immediate and drastic.
    • Sudden collapse.
    • No pulse.
    • No breathing.
    • Loss of consciousness.

    Sometimes other signs and symptoms precede sudden cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. But sudden cardiac arrest often occurs with no warning.

    If you have frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, or fainting or near fainting or you are feeling lightheaded or dizzy, see your health care provider promptly. If these symptoms are ongoing, you should call 911 or emergency medical help. When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. Death or permanent brain damage can occur within four to six minutes. Time is critical when you are helping an unconscious person who is not breathing. Take immediate action. Call 911, or the emergency number in your area, if you encounter someone who has collapsed or is found unresponsive. If the unconscious person is a child and you are alone, administer CPR, or chest compressions only, for two minutes before calling 911 or emergency medical help or before using a portable defibrillator. Perform CPR. Quickly check the unconscious person's breathing. If he or she is not breathing normally, begin CPR. Push hard and fast on the person's chest, about 100 compressions a minute. If you have been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions. If you have not been trained, just continue chest compressions. Allow the chest to rise completely between compressions. Keep doing this until a portable defibrillator is available or emergency personnel arrive.

    Use a portable defibrillator, if one is available. If you are not trained to use a portable defibrillator, a 911 or emergency medical help operator may be able to guide you in its use. Deliver one shock if advised by the device and then immediately begin CPR starting with chest compressions, or give chest compressions only, for about two minutes. Using the defibrillator, check the person's heart rhythm. If necessary, the defibrillator will administer a shock. Repeat this cycle until the person recovers consciousness or emergency personnel take over. Portable automated external defibrillators (AEDs) are available in an increasing number of places, including airports, casinos and shopping malls. You can also purchase them for your home. AEDs come with built-in instructions for their use. They are programmed to allow a shock only when appropriate.

    FOR DETAILED INFORMATION

    MoonDragon's Health Care Index: CPR & Cardiovascular Patient Care
    MoonDragon's EMS Information Index - Emergency Medical Service Protocols
    Wikipedia: Cardiac Arrest
    EMedicine: Sudden Cardiac Arrest/a>
    MayoClinic: Sudden Cardiac Arrest/a>





    CARDIOMEGALY

    Cardiomegaly is the medical term for enlargement of the heart. If the heart is unable to function effectively, as in heart failure, or if there is too much resistance to the normal pumping of blood through the blood vessels, as in high blood pressure, the body attempts to increase the strength of the heart by increasing its size. Cardiomegaly is characteristic of a number of different heart disorders. It is also known as cardiac hypertrophy.

    cardiomegaly - cardiac hypertrophy cardiomegaly - enlarged heart


    An enlarged heart (cardiomegaly) is not a disease, but rather a symptom of another condition. The term "cardiomegaly" most commonly refers to an enlarged heart seen on a chest X-ray. Other tests are then needed to diagnose the condition causing your enlarged heart. You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms. An enlarged heart may be treatable by correcting the cause. Treatment for an enlarged heart can include medications, medical procedures or surgery.

    SYMPTOMS

    In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms:
    • Shortness of breath.
    • Abnormal heart rhythm (arrhythmia).
    • Swelling (edema).

    An enlarged heart is easier to treat when it is detected early, so talk to your health care provideror if you have concerns about your heart. If you have new signs or symptoms that might be related to your heart, make an appointment to see your practitioner. Seek emergency medical care if you have any of these signs and symptoms, which may mean you are having a heart attack:
    • Chest pain.
    • Severe shortness of breath.
    • Fainting.

    CAUSES

    An enlarged heart can be caused by conditions that cause your heart to pump harder than usual or that damage your heart muscle. Sometimes the heart enlarges and becomes weak for unknown reasons (idiopathic). A heart condition you are born with (congenital), damage from a heart attack or an abnormal heartbeat (arrhythmia) can cause your heart to enlarge. Other conditions associated with an enlarged heart include:
    • High Blood Pressure. Your heart may have to pump harder to deliver blood to the rest of your body, enlarging and thickening the muscle. High blood pressure can cause the left ventricle to enlarge, causing the heart muscle eventually to weaken. High blood pressure may also enlarge the upper chambers of your heart (atria).
    • Heart Valve Disease. Four valves in your heart keep blood flowing in the right direction. If the valves are damaged by conditions such as rheumatic fever, a heart defect, infections (infectious endocarditis), connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge.
    • Cardiomyopathy. Disease of the heart muscle, as this thickening and stiffening of heart muscle progresses, your heart may enlarge to try to pump more blood to your body.
    • Pulmonary Hypertension. Pulmonary hypertension is high blood pressure in the artery connecting your heart and lungs. Your heart may need to pump harder to move blood between your lungs and your heart. As a result, the right side of your heart may enlarge. Fluid around your heart (pericardial effusion). Accumulation of fluid in the sac (pericardium) that contains your heart may cause your heart to appear enlarged on a chest X-ray.
    • Anemia From Low Red Blood Cell Count. Anemia is a condition in which there are not enough healthy red blood cells to carry adequate oxygen to your tissues. Untreated, chronic anemia can lead to a rapid or irregular heartbeat. Your heart must pump more blood to make up for the lack of oxygen in the blood.
    • Thyroid Disorders. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
    • Hemochromatosis. Excessive iron in the body is called hemochromatosis. Hemochromatosis is a disorder in which your body does not properly metabolize iron, causing it to build up in various organs, including your heart. This can cause an enlarged left ventricle due to weakening of the heart muscle.
    • Amyloidosis. Rare diseases that can affect your heart, such as amyloidosis. Amyloidosis is a condition in which abnormal proteins circulate in the blood and may be deposited in the heart, interfering with your heart's function and causing it to enlarge.

    RISK FACTORS

    You may have a greater risk of developing an enlarged heart if you have any of the following risk factors:
    • High Blood Pressure. Having a blood pressure measurement higher than 140/90 millimeters of mercury puts you at an increased risk of developing an enlarged heart.
    • A Family History. Having a family history of enlarged hearts or cardiomyopathy. If an immediate family member, such as a parent or sibling, has had an enlarged heart, you may be more susceptible to developing the condition.
    • Coronary Heart Disease. Blocked arteries in your heart is a condition in which fatty plaques in your heart arteries obstruct blood flow through your heart vessels, which can lead to a heart attack. When a section of heart muscle dies, your heart has to pump harder to get adequate blood to the rest of your body, causing it to enlarge.
    • Congenital Heart Disease. If you are born with a condition that affects the structure of your heart, you may be at risk of developing an enlarged heart.
    • Valvular Heart Disease. The heart has four valves called aortic, mitral, pulmonary and tricuspid, These valves open and close to direct blood flow through your heart. Conditions that damage the valves may cause the heart to enlarge.
    • Heart Attack. Having a heart attack increases your risk of developing an enlarged heart.

    COMPLICATIONS

    The risk of complications from an enlarged heart depends on the part of the heart that is enlarged and the cause. Complications of enlarged heart can include:
    • Heart Failure. One of the most serious types of enlarged heart, an enlarged left ventricle, increases the risk of heart failure. In heart failure, your heart muscle weakens, and the ventricles stretch (dilate) to the point that the heart cannot pump blood efficiently throughout your body.
    • Blood Clots. Having an enlarged heart may make you more susceptible to forming blood clots in the lining of your heart. If clots enter your bloodstream, they can block blood flow to vital organs, even causing a heart attack or stroke. Clots that develop on the right side of your heart may travel to your lungs, a dangerous condition called a pulmonary embolism.
    • Heart Murmur. For people who have an enlarged heart, two of the heart's four valves, the mitral and tricuspid valves, may not close properly because they become dilated, leading to a backflow of blood. This flow creates sounds called heart murmurs. Although not necessarily harmful, heart murmurs should be monitored by your health care provider.
    • Cardiac Arrest & Sudden Death. Some forms of enlarged heart can lead to disruptions in your heart's beating rhythm. Heart rhythms too slow to move blood or too fast to allow the heart to beat properly can result in fainting or, in some cases, cardiac arrest or sudden death.

    DIAGNOSIS & TESTS

    If you have symptoms of a heart problem, your health care provider will perform a physical exam and order tests to determine if your heart is enlarged and to find the cause of your condition. These tests may include:
    • Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. If your heart is enlarged on an X-ray, other tests will usually be needed to find the cause.
    • Electrocardiogram.This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps to diagnose heart rhythm problems and damage to your heart from a heart attack.
    • Echocardiogram.This test for diagnosing and monitoring an enlarged heart uses sound waves to produce a video image of your heart. With this test, the four chambers of the heart can be evaluated. The results can be used to see how efficiently your heart is pumping, determine which chambers of your heart are enlarged, look for evidence of previous heart attacks and determine if you have congenital heart disease.
    • Stress Test. A stress test, also called an exercise stress test, provides information about how well your heart works during physical activity. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.
    • Cardiac Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI). In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine called a gantry. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that uses a magnetic field and radio waves to produce signals that create images of your heart.
    • Blood Tests. Blood tests may be ordered to check the levels of certain substances in your blood that may point to a heart problem. Blood tests can also help rule out other conditions that may cause your symptoms.
    • Cardiac Catheterization & Biopsy. In this procedure, a thin tube (catheter) is inserted in your groin and threaded through your blood vessels to your heart, where a small sample (biopsy) of your heart, if indicated, can be extracted for laboratory analysis. Pressure within the chambers of your heart can be measured to see how forcefully blood pumps through your heart. Pictures of the arteries of the heart can be taken during the procedure (coronary angiogram) to ensure that you do not have a blockage.

    TREATMENTS & MEDICATIONS

    Treatments for an enlarged heart focus on correcting the cause. If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your health care provider may recommend medications. These may include:
    • Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart.
    • Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart's pumping capability.
    • Angiotensin receptor blockers (ARBs) to provide the benefits of ACE inhibitors for those who can't take ACE inhibitors.
    • Beta blockers to lower blood pressure and improve heart function.
    • Digoxin to help improve the pumping function of your heart and lessen the need for hospitalization for heart failure.
    • Anticoagulants to reduce the risk of blood clots that could cause a heart attack or stroke.
    • Anti-arrhythmics to keep your heart beating with a normal rhythm.
    If medications are not enough to treat your enlarged heart, medical procedures or surgery may be necessary. Medical devices to regulate your heartbeat may be considered. For a certain type of enlarged heart (dilated cardiomyopathy), a pacemaker that coordinates the contractions between the left and right ventricle may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option. ICDs are small devices, about the size of a pager, implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers. If the main cause of your enlarged heart is atrial fibrillation, then you may need procedures to return your heart to regular rhythm or to keep your heart from beating too quickly.

    If your enlarged heart is caused by a problem with one of your heart valves, you may have surgery to remove the valve and replace it with either an artificial valve or a tissue valve from a pig, cow or deceased human donor. If blood leaks backward through your valve (valve regurgitation), the leaky valve may be surgically repaired or replaced. If your enlarged heart is related to coronary artery disease, a coronary artery bypass surgery may be recommended.

    Left ventricular assist device (LVAD). If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump. You may have an LVAD implanted while you wait for a heart transplant or, if you are not a heart transplant candidate, as a long-term treatment for heart failure. Heart transplant. If medications cannot control your symptoms, a heart transplant may be a final option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.

    LIFESTYLE RECOMMENDATIONS

    There are ways to improve your condition, even though you cannot cure it. Your health care provider may recommend the following lifestyle changes:
    • Quit smoking.
    • Lose excess weight.
    • Limit salt in your diet.
    • Control diabetes.
    • Monitor your blood pressure.
    • Get modest exercise, after discussing with your practitioner the most appropriate program of physical activity.
    • Avoid or eliminate alcohol and caffeine.
    • Try to sleep eight hours nightly.

    Let your health care provider known if you have a family history of conditions that can cause an enlarged heart, such as cardiomyopathy. If cardiomyopathy or other heart conditions are diagnosed early, treatments may prevent the disease from worsening. Controlling risk factors for coronary artery disease, such as tobacco use, high blood pressure, high cholesterol and diabetes, helps to reduce your risk of an enlarged heart and heart failure by reducing your risk of heart attack. You can help reduce your chance of developing heart failure by eating a healthy diet and not abusing alcohol or cocaine. Controlling high blood pressure with diet, exercise and possibly medications also prevents many people who have an enlarged heart from developing heart failure.

    FOR DETAILED INFORMATION

    Wikipedia: Cardiomegaly (Enlarged Heart)
    WebMD: What Is An Enlarged Heart (Cardiomegaly)
    MedicineNet: Enlarged Heart (Cardiomegaly)





    CARDIOMYOPATHY

    Cardiomyopathy is any of a group of diseases of the heart muscle that result in impaired heart function and, ultimately heart failure. Cardiomyopathies are classified according to characteristic physical changes in the heart, such as enlargement of the heart, dilation of one or more of the heart's chambers, or rigidity of the heart muscle. These disorders may be related to inherited defects or may be caused by any of a number of different diseases. Often, the cause is unknown.

    cardiomyopathy types


    FOR DETAILED INFORMATION

    Cardiomyopathy Association
    Children's Cardiomyopathy Foundation
    MedlinePlus: Cardiomyopathy
    The Internet Encyclopedia of Science: Cardiomyopathy





    CARDIOVERSION

    Cardioversion is a procedure used to correct arrhythmia, in which electrical current is applied to the heart to restore rhythm. For many people, drugs alone will not convert an arrhythmia to a normal heart rhythm. For these people, a procedure called cardioversion or electrical cardioversion may be necessary.

    Cardioversion is a treatment for heart rhythms that are irregular (arrhythmia). During cardioversion, a special machine is used to send electrical energy to the heart muscle to restore normal rhythm. The procedure restores the normal heart rate and rhythm, allowing the heart to pump more effectively. Cardioversion can be used to treat many types of fast and/or irregular heart rhythms. Most often, it is used to treat atrial fibrillation or atrial flutter. But cardioversion may also be used to treat ventricular tachycardia, another arrhythmia that can lead to a dangerous condition called ventricular fibrillation (a cause of sudden cardiac death.)

    How Is Cardioversion Performed? While your heart and blood pressure are monitored, a short-acting sedative is administered. Then an electrical shock is delivered to your chest wall through paddles or patches that stops the abnormal heartbeat and allows your heart to resume a normal rhythm. Your health care provider may want to give you blood thinners prior to and for a period after the procedure. In some people, a moderately invasive imaging test called transesophageal echocardiogram (or TEE) may be performed prior to the cardioversion to make sure that the heart is free from blood clots. The TEE is performed by swallowing a narrow tube with a camera at its tip that can be placed against the back wall of the heart. Internal cardioversion may be used in people whose heartbeat did not return to normal after external cardioversion. Internal cardioversion works by delivering an electrical shock through soft wires (catheters) placed in the heart. Because the patient is sedated, the shock isn't felt. A successful cardioversion may take several electrical shocks.

    What's the Difference Between Cardioversion and Defibrillation? Cardioversion and defibrillation procedures both employ the use of a device to deliver an electrical shock to the heart. Electrical cardioversion, however, uses much lower electricity levels to administer the shock than defibrillation. Defibrillation is often used to treat much more difficult to convert arrhythmias.

    What Happens After the Procedure? Recovery from cardioversion only takes a few hours. After the procedure, you may also be required to take antiarrhythmia drugs to help your heart maintain its normal rhythm. Additional cardioversion may be needed as well.

    cardioversion - emergency CPR and defillibration to start heart


    FOR DETAILED INFORMATION

    MoonDragon's Health Care Index: Cardiopulmonary Resuscitation (CPR)
    MoonDragon's EMS Information Index - Emergency Medical Service Protocols
    Heart Rhythm Society: Cardioversion
    ClevelandClinic: Cardioversion Procedure





    CARDITIS

    Carditis is an inflammation of the heart muscle. This can result from infection or from an inflammatory response, as in rheumatic fever, and it can lead to permanent heart damage if not treated.

    FOR DETAILED INFORMATION

    Carditis Net Taskforce
    Wikipedia: Carditis





    CAROTID ARTERY DISEASE

    The carotid artery is the major artery to the brain. Carotid artery disease occurs when the major arteries in your neck become narrowed or blocked. These arteries, called the carotid arteries, supply your brain with blood. Your carotid arteries extend from your aorta in your chest to the brain inside your skull.

    carotid artery disease


    FOR DETAILED INFORMATION

    MedlinePlus: Carotid Artery Disease
    MayoClinic: Carotid Artery Disease
    WebMD: Heart Disease - Carotid Artery Disease





    CATHETERIZATION

    Cardiac catheterization is a procedure sometimes used to diagnose the condition of the heart and/or circulatory system and, in some cases, to treat cardiovascular disease. A hollow, flexible tube called a catheter is inserted by means of a very fine flexible wire into a blood vessel somewhere in the body (usually the arm, neck, or leg), and from there is threaded through the blood vessel to the heart or other location being investigated. Catheterization can be used to detect (and in some cases to treat) arterial blockage, to discover malformations of the heart, and to study electrical conduction in the heart, among other things.

    cardiac catheterization


    FOR DETAILED INFORMATION

    WebMD: Cardiac Catheterization
    MayoClinic: Cardiac Catheterization
    Wikipedia: Cardiac Catheterization





    CLAUDICATION

    Claudication is cramp-like pains in the leg as a result of poor circulation to the leg muscle. This usually occurs as a result of atherosclerosis. Claudication is largely a disorder of the elderly. It is estimated that at least 10 percent of persons over the age of 70 years have claudication; by comparison, it is seen in only 1 to 2 percent of those 37 to 69 years of age. Claudication is therefore growing as a clinical problem due to the increasingly aged population of the United States and other developed countries.

    claudication locations


    The location of claudication pain correlates to the site of occlusion. For instance, the blue shaded area in the picture above would most likely correspond to an occlusion in the femoral artery/common inguinal artery, the orange shaded area = popliteal/tibial arteries, the green shaded area = distal tibial (ie. PT or DP).

    FOR DETAILED INFORMATION

    AAFP: A Primary Care Approach - Claudication
    MedicineNet: Claudication Causes, Symptoms, Diagnosis, & Treatment
    MayoClinic: Claudication
    Wikipedia: Claudication





    CONGENITAL HEART DEFECT

    A congenital heart defect is a defect that is present at birth, though not necessarily inherited. The most common types of congenital heart defects are:
    • Ventricular septal defect (A)
    • Complete transposition of the great vessels (B)
    • Tetralogy of Fallot (C)
    • Coarctation of the aorta (D)
    • Hypoplastic left heart syndrome (E)
    congenital heart defects


    Many types of heart defects exist, most of which either obstruct blood flow in the heart or vessels near it, or cause blood to flow through the heart in an abnormal pattern. Other defects, such as long QT syndrome, affect the heart's rhythm. Heart defects are among the most common birth defects and are the leading cause of birth defect-related deaths. Approximately 9 people in 1000 are born with a congenital heart defect. Many defects do not need treatment, but some complex congenital heart defects require medication or surgery.

    FOR DETAILED INFORMATION

    Wikipedia: Congenital Heart Defects
    CongenitalHeartDefects.com: CHD-Related Resources
    MedlinePlus: Congenital Heart Defects
    KidsHealth: Congenital Heart Defects





    CONGESTIVE HEART FAILURE

    Congestive heart failure (CHF) is a condition of chronic heart failure that results in fluid accumulation in the lungs, labored breathing after even mild exertion, and edema (swelling) in the ankles and feet.

    congestive heart failure


    Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle does not pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. Lifestyle changes, such as exercising, reducing salt in your diet, managing stress and losing weight, can improve your quality of life. One way to prevent heart failure is to control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.

    SYMPTOMS

    Heart failure can be ongoing (chronic), or your condition may start suddenly (acute). Heart failure signs and symptoms may include:
    • Shortness of breath (dyspnea) when you exert yourself or when you lie down.
    • Fatigue and weakness.
    • Swelling (edema) in your legs, ankles and feet.
    • Rapid or irregular heartbeat.
    • Reduced ability to exercise.
    • Persistent cough or wheezing with white or pink blood-tinged phlegm.
    • Increased need to urinate at night.
    • Swelling of your abdomen (ascites).
    • Sudden weight gain from fluid retention.
    • Lack of appetite and nausea.
    • Difficulty concentrating or decreased alertness.
    • Sudden, severe shortness of breath and coughing up pink, foamy mucus.
    • Chest pain if your heart failure is caused by a heart attack.

    See your health care provider or your emergency room if you think you might be experiencing signs or symptoms of heart failure. Seek emergency treatment if you experience any of the following:
    • Chest pain.
    • Fainting or severe weakness.
    • Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting.
    • Sudden, severe shortness of breath and coughing up pink, foamy mucus.

    Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Do not try to diagnose yourself. Call 911 or your local emergency number for immediate help. Emergency room health care providers will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.

    If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your health care provider promptly.

    CAUSES

    Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart does not need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff. In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart cannot pump blood efficiently throughout your body. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.

    An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher - meaning that more than half of the blood that fills the ventricle is pumped out with each beat. But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.

    The term "congestive heart failure" comes from blood backing up into, or congesting, the liver, abdomen, lower extremities and lungs. However, not all heart failure is congestive. You might have shortness of breath or weakness due to heart failure and not have any fluid building up. Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle, your heart's main pumping chamber.


    TYPE OF HEART FAILURE

    DESCRIPTION

    Left-sided Heart Failure

    Fluid may back up in your lungs, causing shortness of breath.

    Right-sided Heart Failure

    Fluid may back up into your abdomen, legs and feet, causing swelling.

    Systolic Heart Failure

    The left ventricle cannot contract vigorously, indicating a pumping problem.

    Diastolic Heart Failure
    (Also called heart failure with preserved ejection fraction)

    The left ventricle cannot relax or fill fully, indicating a filling problem.


    Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:
  • Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. The buildup of plaques can cause reduced blood flow to your heart. A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to form, which may block blood flow to an area of the heart muscle, weakening the heart's pumping ability and often leaving permanent damage. If the damage is significant, it can lead to a weakened heart muscle.
  • High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
  • Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve, due to a heart defect, coronary artery disease or heart infection, forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed or replaced if found in time.
  • Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors play an important role in several types of cardiomyopathy, such as dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction and restrictive cardiomyopathy.
  • Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure. Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.
  • Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, which creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
  • Other diseases. Chronic diseases, such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis), also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

  • RISK FACTORS

    A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk. Risk factors include:
    • High blood pressure. Your heart works harder than it has to if your blood pressure is high.
    • Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
    • Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
    • Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
    • Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Do not stop taking these medications on your own, though. If you are taking them, discuss with your health care provider whether you need to make any changes.
    • Sleep apnea. The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
    • Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
    • Valvular heart disease. People with valvular heart disease have a higher risk of heart failure.
    • Viruses. A viral infection may have damaged your heart muscle.
    • Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.
    • Tobacco use. Using tobacco can increase your risk of heart failure.
    • Obesity. People who are obese have a higher risk of developing heart failure.
    • Irregular heartbeats. These abnormal rhythms, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.

    If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:
    • Kidney damage or failure. Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment.
    • Heart valve problems. The valves of your heart, which keep blood flowing in the proper direction through your heart, may not function properly if your heart is enlarged or if the pressure in your heart is very high due to heart failure.
    • Heart rhythm problems. Heart rhythm problems (arrhythmias) can be a potential complication of heart failure.
    • Liver damage. Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.

    Some people's symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may require heart transplantation or support with a ventricular assist device.

    DIAGNOSIS & TESTS

    To diagnose heart failure, your health care provider will take a careful medical history, review your symptoms and perform a physical examination. Your practitioner will also check for the presence of risk factors, such as high blood pressure, coronary artery disease or diabetes. Using a stethoscope, your practitioner can listen to your lungs for signs of congestion. The stethoscope also picks up abnormal heart sounds that may suggest heart failure. The practitioner may examine the veins in your neck and check for fluid buildup in your abdomen and legs. After the physical exam, your health care provider may also order some of these tests:
    • Blood Tests. A sample of your blood may be taken to check your kidney, liver and thyroid function and to look for indicators of other diseases that affect the heart. A blood test to check for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) may help in diagnosing heart failure if the diagnosis is not certain when used in addition to other tests.
    • Chest X-ray. X-ray images may be recommended see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. The X-ray can be used to diagnose conditions other than heart failure that may explain your signs and symptoms.
    • Electrocardiogram (ECG). This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps to diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
    • Echocardiogram. An important test for diagnosing heart failure is the echocardiogram. An echocardiogram helps distinguish systolic heart failure from diastolic heart failure in which the heart is stiff and cannot fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This test can be used to see the size and shape of your heart and how well your heart is pumping. The echocardiogram also can help to look for valve problems or evidence of previous heart attacks, other heart abnormalities, and some unusual causes of heart failure. Your ejection fraction is measured during an echocardiogram and can also be measured by nuclear medicine tests, cardiac catheterization and cardiac MRI. This is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment.
    • Stress Test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Sometimes the stress test can be done while wearing a mask that measures the ability of your heart and lungs to take in oxygen and breathe out carbon dioxide. Stress tests help to see if you have coronary artery disease. Stress tests also determine how well your body is responding to your heart's decreased pumping effectiveness and can help guide long-term treatment decisions. If your practitioner also wants to see images of your heart while you are exercising, a nuclear stress test or a stress echocardiogram may be ordered. It is similar to an exercise stress test, but it also uses imaging techniques to visualize your heart during the test.
    • Cardiac Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI). These tests can be used to diagnose heart problems, including causes of heart failure. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.
    • Coronary Angiogram. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray. This test helps identify narrowed arteries to your heart (coronary artery disease) that can be a cause of heart failure. The test may include a ventriculogram, a procedure to determine the strength of the heart's main pumping chamber (left ventricle) and the health of the heart valves.
    • Myocardial Biopsy. In this test, your health care provider inserts a small, flexible biopsy cord into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.

    Results of these tests help practitioners determine the cause of your signs and symptoms and develop a program to treat your heart. To determine the most appropriate treatment for your condition, the practitioner may classify heart failure using two systems:

  • New York Heart Association Classification. This symptom-based scale classifies heart failure in four categories.
    • In Class I heart failure, you do not have any symptoms.
    • In Class II heart failure, you can perform everyday activities without difficulty but become winded or fatigued when you exert yourself.
    • With Class III, you will have trouble completing everyday activities.
    • Class IV is the most severe, and you are short of breath even at rest.

  • American College of Cardiology/American Heart Association Guidelines. This stage-based classification system uses letters A to D. The system includes a category for people who are at risk of developing heart failure. For example:
    • A person who has several risk factors for heart failure but no signs or symptoms of heart failure is Stage A.
    • A person who has heart disease but no signs or symptoms of heart failure is Stage B.
    • Someone who has heart disease and is experiencing or has experienced signs or symptoms of heart failure is Stage C.
    • A person with advanced heart failure requiring specialized treatments is Stage D.

    Health care practitioners use this classification system to identify your risk factors and begin early, more aggressive treatment to help prevent or delay heart failure.

    These scoring systems are not independent of each other. Your practitioner often will use them together to help decide your most appropriate treatment options. Ask your practitioner about your score if you are interested in determining the severity of your heart failure. Your health care provider can help you interpret your score and plan your treatment based on your condition.

    TREATMENT & MEDICATIONS

    Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Treatment may help you live longer and reduce your chance of dying suddenly. Medical practitioners sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, the treatment of heart failure involves a balance of the right medications and, in some cases, use of devices that help the heart beat and contract properly.

  • Medications: Heart failure is usually treated with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
    • Angiotensin-converting enzyme (ACE) inhibitors. These drugs help people with systolic heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
    • Angiotensin II receptor blockers. These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. They may be an alternative for people who cannot tolerate ACE inhibitors.
    • Beta blockers. This class of drugs not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart if you have systolic heart failure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer.
    • Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily. Because diuretics make your body lose potassium and magnesium, you may be prescribed supplements of these minerals. If you are taking a diuretic, you will likely be monitored for levels of Potassium and Magnesium in your blood through regular blood tests.
    • Aldosterone antagonists. These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer. nlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your practitioner if increased potassium is a concern, and learn if you need to modify your intake of food that's high in potassium.
    • Inotropes. These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.
    • Digoxin (Lanoxin). This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation. You may need to take two or more medications to treat heart failure. Your health care provider may prescribe other heart medications as well, such as nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots, along with heart failure medications.

    You may be hospitalized if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen long term.

  • Surgery & Medical Devices: In some cases, health care providers recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include:
    • Coronary bypass surgery. If severely blocked arteries are contributing to your heart failure, your practitioner may recommend coronary artery bypass surgery. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
    • Heart valve repair or replacement. If a faulty heart valve causes your heart failure, your practitioner may recommend repairing or replacing the valve. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty). Valve replacement is done when valve repair is not possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve. Certain types of heart valve repair or replacement can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterization techniques.
    • Implantable cardioverter-defibrillators (ICDs). An ICD is a device similar to a pacemaker. It is implanted under the skin in your chest with wires leading through your veins and into your heart. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is going too slow.
    • Cardiac resynchronization therapy (CRT), or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner. Many people with heart failure have problems with their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
    • Heart pumps. These mechanical devices, such as ventricular assist devices (VADs), are implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body. VADs are most often used in the heart's left ventricle, but they can also be used in the right ventricle or in both ventricles. Practitioners first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. VADs are now sometimes used as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with severe heart failure who are not eligible for or able to undergo heart transplantation or are waiting for a new heart.
    • Heart transplant. Some people have such severe heart failure that surgery or medications do not help. They may need to have their diseased heart replaced with a healthy donor heart. Heart transplants can dramatically improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait a long time before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.

  • End-of-Life Care & Heart Failure: Even with the number of treatments available for heart failure, it is possible that your heart failure may worsen to the point where medications are no longer working and a heart transplant or device is not an option. If this occurs, you may need to enter hospice care. Hospice care provides a special course of treatment to terminally ill people. Hospice care allows family and friends, with the aid of nurses, social workers and trained volunteers, to care for and comfort a loved one at home or in hospice residences. Hospice care provides emotional, social, psychological, and spiritual support for people who are ill and those closest to them. Although most people under hospice care remain in their own homes, the program is available anywhere, including nursing homes and assisted living centers. For people who stay in a hospital, specialists in end-of-life care can provide comfort, compassionate care and dignity. It can be difficult to discuss end-of-life issues with your family and medical team. Part of this discussion will likely involve advance directives, a general term for oral and written instructions you give concerning your medical care should you become unable to speak for yourself. If you have an implantable cardioverter-defibrillator (ICD), one important consideration to discuss with your family and practitioners is turning off the defibrillator so that it cannot deliver shocks to make your heart continue beating.

  • LIFESTYLE CHANGES & PREVENTIONS

    Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make. Recommended lifestyle changes and preventions may include:
    • Do not smoke and stop smoking, if you do smoke. Smoking damages your blood vessels, raises blood pressure, reduces the amount of oxygen in your blood and makes your heart beat faster. If you smoke, ask your practitioner to recommend a program to help you quit. You cannot be considered for a heart transplant if you continue to smoke. Avoid secondhand smoke, too.
    • Consider getting certain vaccinations. If you have heart failure, you may want to get influenza and pneumonia vaccinations. Ask your practitioner about these vaccinations.
    • Eat a healthy diet with healthy foods. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins. Restrict salt in your diet. Too much sodium contributes to water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet. Check with your practitioner for the sodium restriction recommended for you. Keep in mind that salt is already added to prepared foods, and be careful when using salt substitutes.
    • Discuss weight monitoring and maintain a healthy weight. Discuss with your practitioner how often you should weigh yourself and how much weight gain you should notify him or her about. Weight gain may mean that you are retaining fluids and need a change in your treatment plan. Check your legs, ankles and feet for swelling daily. Check for any changes in swelling in your legs, ankles or feet daily. Check with your practitioner if the swelling worsens. Maintain a healthy weight. If you are overweight, your dietitian will help you work toward your ideal weight. Even losing a small amount of weight can help. Limit fats and cholesterol. In addition to avoiding high-sodium foods, limit the amount of saturated fat, trans fat and cholesterol in your diet. A diet high in fat and cholesterol is a risk factor for coronary artery disease, which often underlies or contributes to heart failure. Limit alcohol and fluids. Your practitioner likely will recommend that you do not drink alcohol if you have heart failure, since it can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms. If you have severe heart failure, you may also limit the amount of fluids you drink.
    • Be active. Moderate aerobic activity helps keep the rest of your body healthy and conditioned, reducing the demands on your heart muscle. Before you start exercising though, talk to your practitioner about an exercise program that is right for you. Your practitioner may suggest a walking program. Check with your local hospital to see if it offers a cardiac rehabilitation program; if it consider enrolling in the program.
    • Reduce stress. When you are anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, since your heart is already having trouble meeting the body's demands. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
    • Sleep easy. If you are having shortness of breath, especially at night, sleep with your head propped up using a pillow or a wedge. If you snore or have had other sleep problems, make sure you get tested for sleep apnea. To improve your sleep at night, prop up your head with pillows. Also, discuss with your practitioner changing the time for taking medications, especially diuretics. Taking diuretics earlier in the day may decrease the need to urinate as often during the night.

    As part of your lifestyle management and prevention, it is important to control certain health conditions, such as high blood pressure and diabetes. Treatment and lifestyle changes can sometimes improve symptoms and help you to live longer. Pay attention to your body and how you feel. Keep communications open with your health care provider and do not be afraid to ask questions about your care as they arise. Keep track of your diet, your medications, and dietary supplements. Discuss these during your medical visits. Monitor your blood pressure, your weight, and exercise, making necessary changes and adjustments as needed.

    FOR DETAILED INFORMATION

    Wikipedia: Congestive Heart Failure
    MedicineNet: Congestive Heart Failure
    Texas Heart Institute: Congestive Heart Failure





    CORONARY ARTERIES

    Like all organs, your heart is made of tissue and requires a supply of oxygen and nutrients. Although its chambers are full of blood, the heart receives no nourishment from this blood. The heart receives its own supply of blood from a network of arteries, called the coronary arteries. Two major coronary arteries branch off from the aorta near the point where the aorta and the left ventricle meet:

    ANATOMY & FUNCTION OF THE CORONARY ARTERIES

    Coronary arteries supply oxygen-rich blood to the heart muscle. Like all other tissues in the body, the heart muscle needs oxygen-rich blood to function, and oxygen-depleted blood must be carried away. The coronary arteries run along the outside of the heart and have small branches that dive into the heart muscle to bring it blood.

    coronary arteries


    The two main coronary arteries are the left main and right coronary arteries.
    • The right coronary artery (RCA) which supplies the right atrium and right ventricle and the SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm. The right coronary artery divides into smaller branches, including the right posterior descending artery which supplies the bottom portion of the left ventricle, back of the septum and the acute marginal artery.

    • The left main coronary artery (LMCA). The left main coronary artery supplies blood to the left side of the heart muscle (the left ventricle and left atrium). The left main coronary divides into branches:
      • The circumflex artery, which branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the outer side left atrium, side and back of the left ventricle.
      • The left anterior descending artery (LAD), which branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the e front and bottom of the left side of the heart, ventricle and the front of the septum.

    Additional smaller branches of the coronary arteries include obtuse marginal (OM), septal perforator (SP), and diagonals. These arteries and their branches supply all parts of the heart muscle with blood.

    The coronary arteries are important since they deliver blood to the heart muscle itself. Any coronary artery disease or disorder can have seriolus implications by reducing the flow of oxygen and nutrients to the heart muscle. This can lead to a heart attack and possibly death. Atherosclerosis (a buildup of plaque in the inner lining of an artery causing it to narrow or become blocked) is the most common cause of heart disease.

    FOR DETAILED INFORMAITON

    Wikipedia: Coronary Circulation
    ClevelandClinic: The Coronary Arteries





    CORONARY ARTERY DISEASE (CAD)

    Coronary artery disease (CAD) is a chronic disease in which blood flow is obstructed through the coronary arteries that supply the heart with oxygen-rich blood and nutrients, with the arteries becoming damaged and diseased. This obstruction is known as atherosclerosis. An estimated 13.2 million Americans suffer from CAD. It is also referred to as coronary heart disease, CAD is the most common form of cardiovascular disease in the United States today.

    coronary artery disease


    Cholesterol containing deposits, called plaque, in the arteries and inflammation are usually to blame for CAD. When plaques build up, they narrow your coronary arteries, decreasing blood flow to your heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack. Because coronary artery disease often develops over decades, it can go unnoticed until you have a heart attack. But there is plenty you can do to prevent and treat coronary artery disease. Start by committing to a healthy lifestyle.

    SYMPTOMS

    If your coronary arteries narrow, they cannot supply enough oxygen-rich blood to your heart, especially when it ss beating hard, such as during exercise. At first, the decreased blood flow may not cause any coronary artery disease symptoms. As the plaques continue to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including:
    • Chest Pain (Angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. The pain, referred to as angina, is usually triggered by physical or emotional stress. It typically goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the abdomen, back or arm.
    • Shortness of Breath. If your heart cannot pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion.
    • Heart Attack. A completely blocked coronary artery may cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. Women are somewhat more likely than men are to experience less typical signs and symptoms of a heart attack, such as nausea and back or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.

    If you suspect you are having a heart attack, immediately call 911 or your local emergency number. If you do not have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort. If you have risk factors for coronary artery disease, such as high blood pressure, high cholesterol, tobacco use, diabetes or obesity, talk to your health care provider. He or she may want to test you for the condition, especially if you have signs or symptoms of narrowed arteries. Even if you do not have evidence of coronary artery disease, your health care provider may recommend aggressive treatment of your risk factors. Early diagnosis and treatment may stop progression of coronary artery disease and help prevent a heart attack.

    CAUSES

    Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:
    • Smoking.
    • High blood pressure.
    • High cholesterol.
    • Diabetes or insulin resistance.
    • Radiation therapy to the chest, as used for certain types of cancer.
    • Sedentary lifestyle.

    Once the inner wall of an artery is damaged, fatty deposits (plaques) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of these plaques breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.

    RISK FACTORS

    Risk factors for coronary artery disease include:
    • Age. Simply getting older increases your risk of damaged and narrowed arteries.
    • Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
    • Family History. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or your mother or a sister developed it before age 65.
    • Smoking. Nicotine constricts your blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. The incidence of heart attack in women who smoke at least 20 cigarettes a day is six times that of women who have never smoked. For men who smoke, the incidence is triple that of nonsmokers.
    • High Blood Pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.
    • High Blood Cholesterol Levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL), known as the "bad" cholesterol. A low level of high-density lipoprotein (HDL), known as the "good" cholesterol, also can promote atherosclerosis.
    • Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Both conditions share similar risk factors, such as obesity and high blood pressure.
    • Obesity. Excess weight typically worsens other risk factors.
    • Physical Inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well.
    • High Stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease.

    Risk factors often occur in clusters and may build on one another, such as obesity leading to diabetes and high blood pressure. When grouped together, certain risk factors put you at an even greater risk of coronary artery disease. For example, metabolic syndrome (a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist) increases the risk of coronary artery disease. Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including:
    • Sleep Apnea. This disorder causes you to repeatedly stop and start breathing while you are sleeping. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system, possibly leading to coronary artery disease.
    • C-Reactive Protein. C-reactive protein (CRP) is a normal protein that appears in higher amounts when there is swelling somewhere in your body. High CRP levels may be a risk factor for heart disease. It is thought that as coronary arteries narrow, you will have more CRP in your blood.
    • High Triglycerides. This is a type of fat (lipid) in your blood. High levels may raise the risk of coronary artery disease, especially for women.
    • Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase your risk of coronary artery disease.
    • Lipoprotein (a). This substance forms when a low-density lipoprotein (LDL) particle attaches to a specific protein. Lipoprotein (a) may disrupt your body's ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.

    Coronary artery disease can lead to:
    • Chest Pain (Angina). When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest, particularly during physical activity. This can cause chest pain (angina) or shortness of breath.
    • Heart Attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage of your heart artery may trigger a heart attack. The lack of blood flow to your heart may damage your heart muscle. The amount of damage depends in part on how quickly you receive treatment.
    • Heart Failure. If some areas of your heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or if your heart has been damaged by a heart attack, your heart may become too weak to pump enough blood to meet your body's needs. This condition is known as heart failure.
    • Abnormal Heart Rhythm (Arrhythmia). Inadequate blood supply to the heart or damage to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart rhythms.

    DIAGNOSIS

    The health care practitioner will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:
    • Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that is in progress. In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 to 48 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.
    • Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your health care provider can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
    • Stress Test. If your signs and symptoms occur most often during exercise, your practitioner may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise. Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram. Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine exercise stress test but with images in addition to an ECG. Trace amounts of radioactive material such as thallium are injected into your bloodstream. Special cameras can detect areas in your heart that receive less blood flow.
    • Cardiac Catheterization or Angiogram. To view blood flow through your heart, your practitioner may inject a special dye into your arteries (intravenously). This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart. This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.
    • Heart Scan. Computerized tomography (CT) technologies can help your practitioner see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely. A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries.
    • Magnetic Resonance Angiography (MRA). This procedure uses MRI technology, often combined with an injected contrast dye, to check for areas of narrowing or blockages, although the details may not be as clear as those provided by coronary catheterization.

    TREATMENT

    Treatment for coronary artery disease usually involves drugs and certain medical procedures, if necessary, as well as lifestyle and dietary changes.

  • Medications - various drugs can be used to treat coronary artery disease, including:
    • Cholesterol-Modifying Medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your health care practitioner can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.
    • Aspirin. Your health care provider may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you have had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin is not appropriate, such as if you have a bleeding disorder or you are already taking another blood thinner, so ask your health care provider before starting to take aspirin.
    • Beta Blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you have had a heart attack, beta blockers reduce the risk of future attacks.
    • Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood.
    • Angiotensin-Converting Enzyme (ACE) Inhibitors & Angiotensin II Receptor Blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you have had a heart attack, ACE inhibitors reduce the risk of future attacks.

  • Procedures to restore and improve blood flow - sometimes more aggressive treatment is needed. Here are some options:
    • Angioplasty & Stent Placement (Percutaneous Coronary Revascularization). Your practitioner inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.
    • Coronary Artery Bypass Surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it is most often reserved for cases of multiple narrowed coronary arteries.

  • Lifestyle Changes - Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries and preventing heart disease. The same lifestyle habits that can help treat coronary artery disease can also help prevet it from developing in the first place.
    • Quit smoking.
    • Eat healthy foods. Eat a low fat, low salt diet rich in fruits, vegetables and whole grains.
    • Exercise regularly and stay physically active.
    • Lose excess weight and maintain a healthy weight.
    • Control conditions such as high blood pressure, high cholesterol and diabetes.
    • Reduce and manage stress.

    Lifestyle changes can help you prevent or slow the progression of coronary artery disease.
    • Stop Smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack.
    • Control Your Blood Pressure. Ask your health care provider for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. The ideal blood pressure is below 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg).
    • Check Your Cholesterol. Ask your health care provider for a baseline cholesterol test when you are in your 20s and at least every five years after. If your test results are not within desirable ranges, your practitioner may recommend more-frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L).
    • Keep Diabetes Under Control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
    • Get Moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. All risk factors for coronary artery disease. With your practitioner's approval, aim for 30 to 60 minutes of physical activity most or all days of the week.
    • Eat Healthy Foods. A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts, and is low in saturated fat, cholesterol and sodium. It can help you control your weight, blood pressure and cholesterol. Eating one or two servings of fish a week also is beneficial.
    • Maintain Healthy Weight. Being overweight increases your risk of coronary artery disease. Losing even just a few pounds can help lower your blood pressure and reduce your risk of coronary artery disease.
    • Manage Stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

    In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease, such as high cholesterol, high blood pressure and diabetes, have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health. Some individuals may consider asking their practitioner about a yearly flu vaccine. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.

  • Nutritional changes are important. In addition to a heart healthy diet, these nutrients are important for heart health and are available in our foods and as supplements.
    • Omega-3 Fatty Acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. Fish and Fish Oil are the most effective sources of omega-3 fatty acids. Fatty fish, such as salmon, herring and, to a lesser extent, tuna, contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish. Flaxseed & Flaxseed Oil also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol. Other dietary sources of omega-3 fatty acids include walnuts, canola oil, Soybeans & Soybean Oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health is not as strong.

    Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. Nuts and seeds are good dietary sources of essential nutrients used to control cholesterol and contribute to heart health. These nutrients include:
    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
    Wikipedia: Coronary Artery Disease
    MedlinePlus: Coronary Artery Disease
    YourTotalHealth: Coronary Artery Disease





    ECHOCARDIOGRAM

    An echocardiogram is a procedure in which ultrasound technology (sound waves) is used to form an image of the heart. It is used to detect structural and functional abnormalities in the heart muscle and valves, enlargement or inflammation of the heart, and other conditions. The test allows your practitioner to see how your heart is beating and pumping blood. Depending on what information your health care provider needs, you may have one of several types of echocardiograms. Each type of echocardiogram has few risks involved.

    echocardiogram


    An echocardiogram may be recommended if your practitioner suspects problems with the valves or chambers of your heart or your heart's ability to pump. An echocardiogram can also be used to detect congenital heart defects in unborn babies. Depending on what information your health care provider needs, you may have one of the following kinds of echocardiograms:
    • Transthoracic Echocardiogram. This is a standard, noninvasive echocardiogram. A technician (sonographer) spreads gel on your chest and then presses a device known as a transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart. The transducer records the sound wave echoes your heart produces. A computer converts the echoes into moving images on a monitor. If your lungs or ribs block the view, a small amount of intravenous dye may be used to improve the images.
    • Transesophageal Echocardiogram. If it is difficult to get a clear picture of your heart with a standard echocardiogram, your practioner may recommend a transesophageal echocardiogram. In this procedure, a flexible tube containing a transducer is guided down your throat and into your esophagus, which connects your mouth to your stomach. From there, the transducer can obtain more-detailed images of your heart. Your throat will be numbed, and you will have medications to help you relax during a transesophageal echocardiogram.
    • Doppler Echocardiogram. When sound waves bounce off blood cells moving through your heart and blood vessels, they change pitch. These changes (Doppler signals) can help your practitioner measure the speed and direction of the blood flow in your heart. Doppler techniques are used in most transthoracic and transesophageal echocardiograms, and they can check blood flow problems and blood pressures in the arteries of your heart that traditional ultrasound might not detect. Sometimes, the blood flow shown on the monitor is colorized to help your practitioner pinpoint any problems (color flow echocardiogram).
    • Stress Echocardiogram. Some heart problems, particularly those involving the coronary arteries that supply blood to your heart muscle, occur only during physical activity. For a stress echocardiogram, ultrasound images of your heart are taken before and immediately after walking on a treadmill or riding a stationary bike. If you are unable to exercise, you may get an injection of a medication to make your heart work as hard as if you were exercising.

    There are few risks involved in a standard transthoracic echocardiogram. You may feel some discomfort similar to pulling off an adhesive bandage when the technician removes the electrodes placed on your chest during the procedure. If you have a transesophageal echocardiogram, your throat may be sore for a few hours afterward. Rarely, the tube may scrape the inside of your throat. Your oxygen level will be monitored during the exam to check for any breathing problems caused by sedation medication. During a stress echocardiogram, exercise or medication, not the echocardiogram itself, may temporarily cause an irregular heartbeat. Serious complications, such as a heart attack, are rare.

    Your health care provider will look for healthy heart valves and chambers, as well as normal heartbeats. Information from the echocardiogram may show:
    • Heart Size. Weakened or damaged heart valves, high blood pressure or other diseases can cause the chambers of your heart to enlarge. Your doctor can use an echocardiogram to evaluate the need for treatment or monitor treatment effectiveness.
    • Pumping Strength. An echocardiogram can help your practitioner determine your heart's pumping strength. Specific measurements may include the percentage of blood that's pumped out of a filled ventricle with each heartbeat (ejection fraction) or the volume of blood pumped by the heart in one minute (cardiac output). If your heart is not pumping enough blood to meet your body's needs, heart failure may be a concern.
    • Heart Muscle Damage. During an echocardiogram, your practitioner can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
    • Valve Problems. An echocardiogram shows how your heart valves move as your heart beats. Your practitioner can determine if the valves open wide enough for adequate blood flow or close fully to prevent blood leakage. Abnormal blood flow patterns and certain conditions, such as aortic valve stenosis or mitral valve stenosis (when the heart's valve is narrowed) can be detected as well.
    • Heart Defects. Many heart defects can be detected with an echocardiogram, including problems with the heart chambers, abnormal connections between the heart and major blood vessels, and complex heart defects that are present at birth. Echocardiograms can even be used to monitor a baby's heart development before birth.

    FOR DETAILED INFORMATION

    Heartsite.com: Echocardiogram
    Medicinenet: Echocardiogram
    Wikipedia: Echocardiography
    Medline: Echocardiography





    ELECTROCARDIOGRAM (ECG or EKG)

    An electrocardiogram (EKG or ECG) is a diagnostic test that tracks electrical impulses in the heart and checks for problems with the electrical activity of your heart. An EKG translates the heart's electrical activity into line tracings on paper. The spikes and dips in the line tracings are called waves.

    electrocardiogram


    An electrocardiogram is a painless, noninvasive way to diagnose many common types of heart problems. Your health care provider may use an electrocardiogram to detect:
    • Irregularities in your heart rhythm (arrhythmias).
    • Heart defects.
    • Problems with your heart's valves.
    • Blocked or narrowed arteries in your heart (coronary artery disease).
    • A heart attack, in emergency situations.
    • A previous heart attack.

    An electrocardiogram is a safe procedure. There may be minor discomfort, similar to removing a bandage, when the electrodes taped to your chest to measure your heart's electrical signals are removed. Rarely, a reaction to the electrodes may cause redness or swelling of the skin. A stress test, in which an ECG is performed while you exercise or after you take medication that mimics effects of exercise, may cause irregular heartbeats or, rarely, a heart attack. These side effects are caused by the exercise or medication, not the ECG itself. There is not any risk of electrocution during an electrocardiogram. The electrodes placed on your body only record the electrical activity of your heart. They do not emit electricity.

    No special preparations are necessary. However, avoid drinking cold water or exercising immediately before an electrocardiogram. Cold water can produce potentially misleading changes in one of the electrical patterns recorded during the test. Physical activity, such as climbing stairs, may increase your heart rate.

    An electrocardiogram can be done in the practitioner's office or hospital, and is often performed by a technician. After changing into a hospital gown, you will lie on an examining table or bed. Electrodes, often 12 to 15, will be attached to your arms, legs and chest. The electrodes are sticky patches applied with a gel to help detect and conduct the electrical currents of your heart. If you have hair on the parts of your body where the electrodes will be placed, the technician may need to shave the hair so that the electrodes stick properly.

    You can breathe normally during the electrocardiogram. Make sure you are warm and ready to lie still, however. Moving, talking or shivering may distort the test results. A standard ECG takes just a few minutes. If you have a heartbeat irregularity that tends to come and go, it may not be captured during the few minutes a standard ECG is recording. To work around this problem, your health care provider may recommend another type of ECG:
    • Holter Monitoring. Also known as an ambulatory ECG monitor, a Holter monitor records your heart rhythms for an entire 24 to 48-hour period. Wires from electrodes on your chest go to a battery-operated recording device carried in your pocket or worn on a belt or shoulder strap. While you are wearing the monitor, you will keep a diary of your activities and symptoms. Your health care provider will compare the diary with the electrical recordings to try to figure out the cause of your symptoms.
    • Event Recorder. If your symptoms do not occur often, your health care provider may suggest wearing an event recorder. This device is similar to a Holter monitor, but it allows you to record your heart rhythm just when the symptoms are happening. You can send the ECG readings to your health care provider through your phone line.
    • Stress Test. If your heart problems occur most often during exercise, your health care provider may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is called a stress test. If you have a medical condition that makes it difficult for you to walk, medication may be injected to mimic the effect of exercise on the heart.

    After the procedure, usually, your health care provider will be able to tell you the results of your ECG the same day it is performed. If your electrocardiogram is normal, you may not need any other tests. If the results show there is a problem with your heart, you may need a repeat ECG or other diagnostic tests, such as an echocardiogram. Treatment depends on what is causing your signs and symptoms.

    To obtain the results, your health care provider will look for a consistent, even heart rhythm and a heart rate between 50 and 100 beats a minute. Having a faster, slower or irregular heartbeat provides clues about your heart health, including:
    • Heart Rate. Normally, heart rate can be measured by checking your pulse. But an ECG may be helpful if your pulse is difficult to feel or too fast or too irregular to count accurately.
    • Heart Rhythm. An ECG can help your practitioner identify an unusually fast heartbeat (tachycardia), unusually slow heartbeat (bradycardia) or other heart rhythm irregularities (arrhythmias). These conditions may occur when any part of the heart's electrical system malfunctions. In other cases, medications, such as beta blockers, psychotropic drugs or amphetamines, can trigger arrhythmias.
    • Heart Attack. An ECG can often show evidence of a previous heart attack or one that is in progress. The patterns on the ECG may indicate which part of your heart has been damaged, as well as the extent of the damage.
    • Inadequate Blood & Oxygen Supply to the Heart. An ECG done while you are having symptoms can help your practitioner determine whether chest pain is caused by reduced blood flow to the heart muscle, such as with the chest pain of unstable angina.
    • Structural Abnormalities. An ECG can provide clues about enlargement of the chambers or walls of the heart, heart defects and other heart problems.

    FOR DETAILED INFORMATION

    Wikipedia: Electrocardiography
    WebMD: Electrocardiogram
    MedicineNet: Electrocardiogram (ECG, EKG) Procedure & Results





    EMBOLISM

    An embolism is a circulatory condition in which a foreign object such as a blood clot, air bubble, tissue, gas, or a piece of tumor is transported around the body and becomes trapped in a blood vessel, obstructing the flow of blood. Embolisms are usually described by either the type of material that is involved, such as air or fat, or the vessel that is obstructed, such as the pulmonary artery. The most common type is a thromboembolism, which is caused by a piece of a blood clot. This could lead to heart attack or stroke.

    embolism


    To function properly, the body's tissues and organs need oxygen, which is transported around the body in the bloodstream. If the blood supply to a major organ, such as the brain, heart or lungs, is blocked, the organ will lose some or all of its function. Two of the most serious conditions caused by an embolism are:
    • Stroke: Occurs where the supply of blood to the brain is interrupted or cut off.
    • Pulmonary Embolisms: Occurs when a foreign body blocks the artery transporting blood to the lungs.

    CAUSES

    A foreign body is any object or substance which should not be in your blood. Foreign bodies that cause embolisms are known as emboli. A single emboli is called an embolus.
  • Blood Clots: Blood contains natural clotting agents which help prevent excessive bleeding when you cut yourself. Certain health conditions, such as obesity, heart disease, cancer or pregnancy, can cause blood clots to form even where there is no bleeding. A clot can travel in the bloodstream before being deposited in an organ or limb. Deep vein thrombosis (DVT), a blood clot in the deep veins of your leg, is one of the main causes of pulmonary embolisms.

  • Fat: A fracture to a long bone, such as a thigh bone, can lead to fat particles within the bone being released into the bloodstream. They can also sometimes develop following severe burns or as a complication of bone surgery.

  • Air: Embolisms can also occur if air bubbles or other gases enter the bloodstream. Air bubbles can be introduced into the bloodstream by an injection. Before injections, air bubbles should be removed from syringes and intravenous lines. Catheters or other tubes inserted into the body should be inserted and removed using a technique that minimizes the possility of air getting into the blood vessels. Patients should be closely monitored to help ensure air bubbles do not form in blood vessels during surgery. Air embolisms resulting from surgery, anethesthesia or other medical procedures can be difficult to treat. Air embolisms are a particular concern for scuba divers. If a diver swims to the surface too quickly, the change in pressure can cause nitrogen bubbles to develop in their bloodstream. This can cause decompression sickness, which is often referred to as "the bends".

  • Cholesterol: In people with severe atherosclerosis (narrowed arteries due to a build-up of cholesterol), small pieces of cholesterol can sometimes break away from the side of a blood vessel, resulting in an embolism.

  • Amniotic Fluid: In rare cases, amniotic fluid, the fluid which surrounds and protects a baby inside the womb, can leak into the mother's blood vessels during labor, causing a blockage. This could lead to breathing problems, a drop in blood pressure and loss of consciousness.

  • RISK FACTORS

    Embolism risk increases with:
    • Overweight or obesity, having a body mass index (BMI) of 30 or more.
    • Pregnancy.
    • Age, being 60 years old or over.
    • Smoking.
    • History of heart disease.
    • Immobility for long periods of time.

    TREATMENT

    Embolism treatment will depend on the cause of the blockage, the size of the blockage, and where in the body the blockage occurs. A surgical procedure called an embolectomy is sometimes carried out to remove an obstruction. During this operation, the surgeon will make a cut in the affected artery and the foreign body causing the blockage will be sucked out in a aspiration process.

    Medication may be used to dissolve embolisms (thrombolysis) caused by blood clots. Anticoagulant medication, such as warfarin, heparin and low-dose aspirin, can help make the blood less sticky and stop further clots forming.

    Embolisms caused by air bubbles are usually treated in a hyperbaric chamber. The air pressure inside the chamber is higher than the normal air pressure outside, which helps reduce the size of the air bubbles inside the diver's body.

    PREVENTION

    It is not possible to prevent all embolisms, but you can take steps to significantly reduce your risk. Eating a healthy diet low in fat, high in fiber and including whole grains, plenty of fresh fruit and vegetables (at least 5 portions a day) and limiting the amount of salt in your diet to no more than 1 teaspoon (1 grams or 0.2 ounces) a day. Losing weight if you are overweight or obese and using a combination of regular exercise, a minimum of 150 minutes weekly, and a calorie controlled diet is recommended. Stop smoking if you smoke.

    FOR DETAILED INFORMATION

    Wikipedia: Embolism
    Wikipedia: Pulmonary Embolism
    MedicineNet: Deep Vein Thrombosis (Blood Clot in the Legs)
    NHS Choices: Air Embolism
    MedlinePlus: Arterial Embolism





    ENDARTERITIS OBLITERANS

    Endarteritis obliterans, also called obliterating arteritis, is a severe inflammation of the innermost coat (intima) of the arterial wall, particularly of small arteries, accompanied by degeneration of the intima, leading to the narrowing of the passage and obstruction in the flow of blood.

    Obliterating endarteritis can occur due to a variety of medical conditions such as a complication of radiation poisoning, TB meningitis, or a syphilis infection.





    ENDOCARDITIS

    Endocarditis is an inflammation of the endocardium, the membrane surrounding the heart muscle, usually as a result of a bacterial infection. Bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves and lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in certain cases, surgery.

    Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have damaged heart valves, artificial heart valves or other heart defects. Endocarditis is not uncommon in persons with compromised immune systems, such as those with HIV and AIDS. It also can occur as a complication of surgery to replace defective heart valves. This disorder can result in permanent heart damage.

    bacterial endocarditis and valve damage


    SYMPTOMS

    Endocarditis may develop slowly or suddenly, depending on what is causing the infection and whether you have any underlying heart problems. Endocarditis signs and symptoms vary, but may include:
    • Fever and chills.
    • A new or changed heart murmur, heart sounds made by blood rushing through your heart.
    • Fatigue.
    • Aching joints and muscles.
    • Night sweats.
    • Shortness of breath.
    • Paleness.
    • Persistent cough.
    • Swelling in your feet, legs or abdomen.
    • Unexplained weight loss.
    • Blood in your urine (either visible or found microscopically).
    • Tenderness in your spleen, an infection-fighting abdominal organ on your left side, just below your rib cage.
    • Osler's nodes which are red, tender spots under the skin of your fingers.
    • Petechiae, which are tiny purple or red spots on the skin, whites of your eyes or inside your mouth

    If you develop signs or symptoms of endocarditis, see your health care provider right away. This is especially if you have risk factors for this serious infection, such as a heart defect or a previous case of endocarditis. Although less serious conditions can cause similar signs and symptoms, you will not know for sure until you are evaluated.

    CAUSES

    Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms also may be responsible. Sometimes the culprit is one of many common bacteria that live in your mouth, throat or other parts of your body. The offending organism may enter your bloodstream through:
    • Everyday oral activities. Activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream, especially if your teeth and gums are not healthy.
    • An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted infection or an intestinal disorder, such as inflammatory bowel disease, also may give bacteria the opportunity to enter your bloodstream.
    • Catheters or needles. Bacteria can enter your body through a catheter, a thin tube that doctors sometimes use to inject or remove fluid from the body. The bacteria that can cause endocarditis can also enter your bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a special concern for people who use intravenous (IV) drugs.
    • Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream.

    Usually, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.

    Most people who develop endocarditis have a diseased or damaged heart valve, an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply. Endocarditis does occasionally occur on previously normal heart valves.

    RISK FACTORS

    If your heart is healthy, you are unlikely to develop endocarditis. The germs that cause infection tend to stick to and multiply in damaged or surgically implanted heart valves. Those at highest risk of endocarditis are those who have:
    • Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve.
    • Congenital heart defects. If you were born with certain types of heart defects, your heart may be more susceptible to infection.
    • A history of endocarditis. An episode of endocarditis damages heart tissue and valves, increasing the risk of a future heart infection.
    • Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or scar one or more of your heart valves, making them more prone to endocarditis.
    • History of intravenous (IV) illegal drug use. People who use illegal drugs by injecting them are at a greater risk of endocarditis. The needles used to inject drugs can be contaminated with the bacteria that can cause endocarditis.

    If you have a known heart defect or heart valve problem, ask your health care provider about your risk of developing endocarditis. Even if your heart condition has been repaired or has not caused symptoms, you may be at risk.

    Endocarditis can cause several major complications:
    • Stroke and organ damage. In endocarditis, clumps of bacteria and cell fragments (vegetations) form in your heart at the site of the infection. These clumps can break loose and travel to your brain, lungs, abdominal organs, kidneys or extremities. This may cause various problems, including stroke or damage to other organs or tissues.
    • Infections in other parts of your body. Endocarditis can cause you to develop pockets of collected pus (abscesses) in other parts of your body, including the brain, kidneys, spleen or liver. An abscess may develop in the heart muscle itself as well, causing an abnormal heartbeat. Severe abscesses may require surgery to treat them.
    • Heart failure. Left untreated, endocarditis can damage your heart valves and permanently destroy your heart's inner lining. This can cause your heart to work harder to pump blood, eventually causing heart failure, a chronic condition in which your heart is unable to pump enough blood to meet your body's needs. If the infection progresses untreated, it is usually fatal.

    DIAGNOSIS

    Your health care provider may suspect endocarditis based on your medical history and physical signs and symptoms, such as fever. Using a stethoscope to listen to your heart, your practitioner may hear a new heart murmur or a change in a previous heart murmur, possible signs of endocarditis. The infection can mimic other illnesses in its early stages. Various tests may be necessary to help make the diagnosis:
    • Blood Tests. The most important test is a blood culture used to identify bacteria in the bloodstream. Blood tests can also help your health care provider to identify certain conditions, including anemia, a shortage of healthy red blood cells that can be a sign of endocarditis.
    • Transesophageal Echocardiogram. An echocardiogram uses sound waves to produce images of your heart at work. This type of echocardiogram allows your health care provider to get a closer look at your heart valves. It is often used to check for signs of infection. During this test, an ultrasound device is passed through your mouth and into your esophagus, the tube that connects your mouth and stomach.
    • Electrocardiogram (ECG). Your health care provider may order this noninvasive test if he or she thinks endocarditis may be causing an irregular heartbeat. During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
    • Chest X-ray. X-ray images help your health care provider see the condition of your lungs and heart. X-ray images can be used to see if endocarditis has caused your heart to enlarge or if infection has spread to your lungs.
    • Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI). You may need a CT or MRI scan of your brain, chest or other parts of your body if your health care provider that infection has spread to these areas.

    PREVENTION

    To help prevent endocarditis, make sure to practice good hygiene. Pay special attention to your dental health. Brush and floss your teeth and gums often, and have regular dental checkups. Avoid procedures that may lead to skin infections, such as body piercings or tattoos. Seek prompt medical attention if you develop any type of skin infection or open cuts or sores that do not heal properly.

    Preventive antibiotics may be considered. Certain dental and medical procedures may allow bacteria to enter your bloodstream. Antibiotics taken before these procedures can help destroy or control the harmful bacteria that may lead to endocarditis. Because people with the following heart conditions are at risk of more-serious outcomes from endocarditis, they may need to take preventive antibiotics beore certain medical or dental procedures to prevent endocarditis:
    • Artificial (prosthetic) heart valve.
    • Previous endocarditis infection.
    • Certain types of congenital heart defects.
    • Heart transplant complicated by heart valve problems.

    Antibiotics are recommended before only the following procedures:
    • Certain dental procedures (those that cut your gum tissue or part of the teeth).
    • Procedures involving the respiratory tract, infected skin or tissue that connects muscle to bone.

    Antibiotics are no longer recommended before all dental procedures or for procedures of the urinary tract or gastrointestinal system.

    If you have had to take preventive antibiotics in the past before your dental exams, you may be concerned about these changes. In the past, you were likely told to get antibiotics because of a concern that common dental procedures increased your risk of endocarditis. But as practitioners have learned more about endocarditis prevention, they have realized that endocarditis is much more likely to occur from exposure to random germs than from a standard dental exam or surgery. This does not mean it is not important to take good care of your teeth through brushing and flossing. There is some concern that infections in your mouth from poor oral hygiene might increase the risk of germs entering your bloodstream. In addition to brushing and flossing, regular dental exams are an important part of maintaining good oral health.

    TREATMENT

    The first line of treatment for endocarditis is antibiotics. Sometimes, if your heart valve is damaged by your infection, surgery is necessary.

  • Antibiotics: If you have endocarditis, you may need high doses of intravenous (IV) antibiotics in the hospital. Blood tests may help identify the type of microorganism that is infecting your heart. This information will help your health care provider choose the best antibiotic or combination of antibiotics to fight the infection. You will usually need to take antibiotics for two to six weeks or longer to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you may be able to leave the hospital and continue IV antibiotic therapy with visits to your health care provider's office or at home with home-based care. You will need to see your health care provider regularly to make sure your treatment is working. Report to your practitioner any signs or symptoms that your infection is getting worse, such as: Fever, Chills, Headaches, Joint pain or Shortness of breath. Diarrhea, a rash, itching or joint pain may indicate a reaction to an antibiotic, another reason to contact your health care provider. See your practitioner immediately if you experience shortness of breath or swelling in your legs, ankles or feet. These signs and symptoms may indicate heart failure.

  • Surgery: If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that is caused by a fungal infection. Depending on your condition, your health care provider may recommend either repairing your damaged valve or replacing it with an artificial valve made of animal tissue or man-made materials.


  • FOR DETAILED INFORMATION

    Wikipedia: Endocarditis
    MedicineNet: Information About Endocarditis
    eMedicine: Endocarditis
    Chaser News: Bacterial Endocarditis





    FIBRILLATION

    Fibrillation is an irregular heartbeat characterized by a rapid twitching or vibrating of heart muscle rather than slow, steady beats. Atrial fibrillation can be episodic or chronic, even constant. Symptoms may include dizziness, light-headedness, and general weakness. Ventricular fibrillation is a medical emergency that can lead rapidly to loss of consciousness and death. It most often is a complication of a heart attack.

    atrial fibrillation


    In atrial fibrillation, the electrical signals from the upper chambers of the heart (the atria) are fast and irregular, causing the atria to quiver instead of beating effectively. To fix it, surgeons seek to isolate the electrical signals causing the problem. This is typically done by creating a lesion or burn around the atrium through microwave energy. If successful, the resulting scar tissue will prevent the abnormal electrical impulses from affecting the rest of the heart.

    ventricular fibrillation


    Ventricular fibrillation is similar to ventricular tachycardia only the heart beats even faster and more erratically, over 300 beats each minute, and the electrical action is quite disorganized. Very little blood is pumped from the heart and around the body. A person with ventricular fibrillation becomes unconscious very quickly.

    FOR DETAILED INFORMATION

    Wikipedia: Atrial Fibrillation
    Wikipedia: Ventricular Fibrillation





    GATED BLOOD POOL SCAN

    Gated Blood Pool Scan, also known as Multi Gated Acquisition Scan (MUGA), Radionuclide Angiography, Radionuclide Ventriculography, Gated Blood Pool Imaging, Synchronized Multigated Acquisition Scan (SYMA). This is considered a non-invasive diagnostic test in which a small amount of radioactive tracer is injected to "tag" red blood cells, which are then tracked as they progress through the heart, creating a series of pictures that show the size and shape of the heart, the motion of the heart wall, and the heart's pumping efficiently. The test can be done while you are resting or during exercise.

    gated blood pool scan gated blood pool scan


    FOR DETAILED INFORMATION

    Wikipedia: MUGA Scan
    Wikipedia: Radionuclide Angiography
    MedlinePlus: Nuclear Ventriculography





    HEART ATTACK (MYOCARDIAL INFARCTION)

    The medical term for a heart attack is myocardial infarction (MI). This refers to the formation of infarcts (areas of local tissue death or decay) in the myocardium (heart muscle). Infarction occurs when the blood supply to an area of the heart is cut off, usually as a result of a blood clot that blocks a narrowed coronary artery. Depending on the size and location of the areas affected, a heart attack may be described as mild or severe, but it always involves some irreparable damage to the heart muscle.

    severe acute myocardial ischemia and infarction


    SYMPTOMS

    The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. About 30 percent of people have atypical symptoms, with women more likely than men to present atypically. Among those over 75 years old, about 5 percent have had an MI with little or not history of symptoms. An MI may cause heart failure, an irregular heartbeat, or cardiac arrest.

    CAUSES & RISK FACTORS

    Most MIs occur due to coronary artery disease. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol, among others. The mechanism of an MI often involves the rupture of an atherosclerotic plaque leading to complete blockage of a coronary artery. MIs are less commonly caused by coronary artery spasms which may be due to cocaine, significant emotional stress, and extreme cold, among others.

    DIAGNOSIS

    A number of tests are useful to help with diagnosis including electrocardiograms (ECGs), blood tests, and coronary angiography. An ECG may confirm an ST elevation MI if ST elevation is present. Commonly used blood tests include troponin and less often creatine kinase MB.

    TREATMENT

  • Aspirin is an appropriate immediate treatment for a suspected MI.
  • Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes.
  • Supplemental oxygen should be used in those with low oxygen levels or shortness of breath.
  • In ST elevation MIs treatments which attempt to restore blood flow to the heart are typically recommended and include angioplasty, where the arteries are pushed open, or thrombolysis, where the blockage is removed using medications.
  • People who have a non-ST elevation myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the additional use angioplasty in those at high risk.
  • In people with blockages of multiple coronary arteries and diabetes, bypass surgery (CABG) may be recommended rather than angioplasty.
  • After an MI lifestyle modifications along with long term treatment with aspirin, beta blockers, and statins is typically recommended.


  • FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
    Wikipedia: Myocardial Infarction
    WebMD: Heart Attach - Myocardial Infarction
    eMedicine: Myocardial Infarction





    HEART FAILURE

    Heart failure (HF) is often referred to as chronic heart failure (CHF) and the terms congestive heart failure (CHF) or congestive cardiac failure (CCF) are often used interchangeably with chronic heart failure. Heart failure is a disorder that occurs when a damaged heart becomes unable to pump effectively, unable to sufficiently maintain blood flow to meet the body's needs, depriving the body's tissues of adequate oxygen and nutrients to function properly. Heart failure can be either acute (short-term) or chronic, and has a variety of different causes.

    heart failure


    SYMPTOMS

    Symptoms commonly include shortness of breath, excessive tiredness, and leg swelling. The shortness of breath is usually worse with exercise, while lying down, and may wake the person at night. A limited ability to exercise is also a common feature.

    CAUSES

    Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause. These cause heart failure by changing either the structure or the functioning of the heart. There are two main types of heart failure: heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction depending on if the ability of the left ventricle to contract is affected, or the heart's ability to relax. The severity of disease is usually graded by the degree of problems with exercise. Heart failure is not the same as myocardial infarction (in which part of the heart muscle dies) or cardiac arrest (in which blood flow stops altogether). Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver problems, anemia and thyroid disease.

    DIAGNOSIS

    The condition is diagnosed based on the history of the symptoms and a physical examination with confirmation by echocardiography. Blood tests, electrocardiography, and chest radiography may be useful to determine the underlying cause.

    TREATMENT

    Treatment depends on the severity and cause of the disease. In people with chronic stable mild heart failure, treatment commonly consists of lifestyle modifications such as stopping smoking, physical exercise, and dietary changes, as well as medications. In those with heart failure due to left ventricular dysfunction, angiotensin converting enzyme inhibitors or angiotensin receptor blockers along with beta blockers are recommended. For those with severe disease, aldosterone antagonists, or hydralazine plus a nitrate may be used. Diuretics are useful for preventing fluid retention. Sometimes, depending on the cause, an implanted device such as a pacemaker or an implantable cardiac defibrillator may be recommended. In some moderate or severe cases cardiac resynchronization therapy (CRT) may be suggested or cardiac contractility modulation may be of benefit. A ventricular assist device or occasionally a heart transplant may be recommended in those with severe disease despite all other measures. Heart failure is a common, costly, and potentially fatal condition.

    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
    Wikipedia: Heart Failure
    Mayo Clinic: Heart Failure
    Medtronic.com: Treatment Options For Heart Failure
    Heart Failure Online





    HEART MURMUR

    A heart murmur is a sound made by the heart that may or may not point to the existence of a heart condition. A diastolic murmur occurs between beats. A systolic murmur occurs during heart contractions.

    Heart murmurs are very common, especially in children, and are usually harmless. These normal murmurs are called "innocent" heart murmurs. There is nothing wrong with your heart when you have an innocent murmur. Up to half of all children have innocent murmurs. They usually go away as children grow.

    Adults can have innocent murmurs too. They can happen when your blood flows harder and faster than usual-during pregnancy, for example, or a temporary illness, such as a fever. They usually go away on their own.

    Sometimes, though, a heart murmur is a sign of a serious heart problem. This is called an abnormal heart murmur. Abnormal murmurs are signs of a heart problem. In children, abnormal heart murmurs are usually caused by problems they are born with, such as a heart valve that does not work right or a hole in the wall between two heart chambers. In adults, abnormal murmurs are most often caused by damaged heart valves. Heart valves operate like one-way gates, helping blood flow in one direction between heart chambers as well as into and out of the heart. When disease or an infection damages a heart valve, it can cause scarring and affect how well the valve works. The valve may not be able to close properly, allowing blood to leak through. Or the valve may become too narrow or stiff to let enough blood through. When a damaged heart valve cannot close properly, the problem is called regurgitation. When the valve cannot let enough blood through, the problem is called stenosis.

    heart murmur - leaky valve


    Heart valves can be damaged by heart disease or by infections like rheumatic fever or endocarditis. The normal wear and tear that comes with aging can also cause some damage. Some heart murmurs are caused by an enlarged heart. When the heart muscle grows too large, it can get in the way of normal blood flow and cause a murmur.

    FOR DETAILED INFORMATION

    Wikipedia: Heart Murmur
    MayoClinic: Heart Murmurs
    Texas Heart Institute: Heart Murmurs





    HEMATOMA

    A hematoma is a localized collection of blood outside the blood vessels, usually in liquid form trapped within the tissues of the skin and/or muscles, or in an organ, after a trauma or surgery. It occurs because the wall of a blood vessel wall, artery, vein or capillary, has been damaged and blood has leaked into tissues where it does not belong. The hematoma may be tiny, with just a dot of blood or it can be large and cause significant swelling.

    Hematomas can occur within a muscle. Some form into hard masses under the surface of the skin. This is caused by the limitation of the blood to a subcutaneous or intramuscular tissue space isolated by fascial planes. This is a key anatomical feature that prevents such injuries from causing massive blood loss. In most cases the sac of blood or hematoma eventually dissolves; however, in some cases they may continue to grow or show no change. If the sac of blood does not disappear, then it may need to be surgically removed. Hematomas can occur when heparin is given via an intramuscular route; to avoid this, heparin must be given intravenously or subcutaneously.

    The slow process of reabsorption of hematomas can allow the broken down blood cells and hemoglobin pigment to move in the connective tissue. For example, a patient who injures the base of his thumb might cause a hematoma, which will slowly move all through the finger within a week. Gravity is the main determinant of this process. Hematomas on articulations can reduce mobility of a member and present roughly the same symptoms as a fracture. In most cases, movement and exercise of the affected muscle is the best way to introduce the collection back into the blood stream. A misdiagnosis of a hematoma in the vertebra can sometimes occur; this is correctly called a hemangioma (buildup of cells) or a benign tumor.

    epidural hemotoma


    TYPES OF HEMATOMAS

  • Subdermal hematoma (under the skin).
  • Skull/Brain: Although the brain is protected by tough bone (skull) and padding (membranes), it can still be injured. Head injuries that are severe enough to affect brain function are termed traumatic brain injuries (TBIs). Damage can range from mild to severe as the brain can affect everything you do. Traumatic brain injuries result from either a blow to the head that does not penetrate the skull (closed head injury) or from an object penetraing through the skull into brain tissues (open brain injury). There are term variations in medical literature regarding these descriptions.
    • Subgaleal hematoma (between the galea aponeurosis and periosteum).
    • Cephalohematoma (between the periosteum and skull). Commonly caused by vacuum delivery and vertex delivery.
    • Epidural hematoma (between the skull and dura mater).
    • Subdural hematoma (between the dura mater and arachnoid mater).
    • Subarachnoid hematoma (between the arachnoid mater and pia mater (the subarachnoid space).
    • Othematoma (between the skin and the layers of cartilage of the ear).

    A concussion is considered to be a milder form of traumatic closed brain injury by most clinicians. In most people, recovery from a mild concussion is quick. However, if the person suffers a severe concussion, the person may be unconscious for a long time period. Some people develop comas or even die from this type of closed head injury.

    Although the skull is like a helmet that protects the brain tissues, it can be cracked, dented, and penetrated with enough force. Sharp bone fragments of the skull can then press into the brain. This can result in brain tissue damage or brain tissue death and may also cause bleeding into the brain. If after a person sustains head trauma and has clear fluid or a bloody discharge from the ears or nose, a skull fracture should be suspected. Bleeding inside the brain is a medical emergency. The blood, under pressure, has no place to drain so it often pools and forms a hematoma. The hematoma can put pressure on the surrounding tissue and squeeze off the blood supply to parts of the brain. Signs of a hematoma include headaches, vomiting, and loss or decrease in normal balance.

  • Breast hematoma (breast)
  • Perichondral hematoma (ear)
  • Perianal hematoma (anus)
  • Subungual hematoma (nail)

  • DEGREES

  • Petechiae: A small pinpoint hematomas less than 3 mm in diameter.
  • Purpura (Purple): A bruise about 1 cm in diameter, generally round in shape.
  • Ecchymosis: Subcutaneous extravasation of blood in a thin layer under the skin, i.e. bruising or "black and blue," over 1 cm in diameter.


  • SYMPTOMS

    The blood vessels in the body are under constant repair. Minor injuries occur routinely and the body is usually able to repair the damaged vessel wall by activating the blood clotting cascade and forming fibrin patches. Sometimes the repair fails if the damage is extensive and the large defect allows for continued bleeding. As well, if there is great pressure within the blood vessel, for example a major artery, the blood will continue to leak through the damaged wall and the hematoma will expand.

    Blood that escapes from within a blood vessel is very irritating to the surrounding tissue and may cause symptoms of inflammation including pain, swelling, and redness. Symptoms of a hematoma depend upon their location, their size, and whether they cause associated swelling or edema in adjacent structures.

  • Bruises & Contusions: The medical term ecchymosis is what most people would recognize as a bruise, or blood that has leaked out of an injured blood vessel beneath the skin.. Another word for this injury is a contusion. An ecchymosis tends to be flat while a hematoma has more of a three dimensional character to it. As well, hematomas may occur in any organ and not just under the skin.

  • Hemorrhage: Hemorrhage is the term used to describe active bleeding. The term hematoma describes blood that has already clotted.

  • CAUSES

  • Trauma: An injury resulting in trauma to the tissue is the most common cause of a hematoma. When people think of trauma, they generally think of car accidents, falls, head injuries, broken bones, and gunshot wounds. Trauma to tissue may also be caused by an aggressive sneeze or an unexpected twist of a limb. When a blood vessel is damaged blood leaks into the surrounding tissue; this blood tends to coagulate or clot. The greater the amount of bleeding that occurs, the larger the amount of clot formation.

  • Weak Fragile Blood Vessels: Blood vessels that are fragile may contribute to hematoma formation. For example, an aneurysm or weakening in a blood vessel wall may spontaneously leak.

  • Anticoagulants: There are many people who take blood thinners (anticoagulation) medications. Examples include warfarin (Coumadin), aspirin, clopidogrel (Plavix), prasugrel (Effient), rivaroxaban (Xarelto), and apixaban (Eliquis). These medications increase the potential for spontaneous bleeding and for hematomas to expand because the body cannot efficiently repair blood vessels and this allows blood to continually leak through the damaged areas.

  • Coagulation-Related Diseases: Occasionally, diseases may occur that decrease the number of platelets in the bloodstream (thrombocytopenia) or their ability to function. The platelets are the cells in the bloodstream that help initiate blood clot and fibrin formation.

  • All of the above situations may exist independently to cause a hematoma or they may occur together

    TREATMENT

    Treatment of a hematoma depends upon which organ or body tossie os affected. Superficial hematomas of the skin and soft tissue, such as muscle, may be treated with rest, ice, compression, and elevation (RICE). Heat may be considered./

    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Bruising
    Health Scout: Hematoma - Symptoms, Treatment & Prevention





    HOLTER MONITOR

    A Holter Monitor is a small device worn on the body that monitors the heart on a 24 hour basis. A Holter monitor, also called ambulatory electrocardiography, ambulatory ECG or ambulatory EKG, is a battery-operated, portable device that measures and tape-records the heartís electrical activity continuously, usually for a period of 24 to 48 hours so that any irregular heart activity can be correlated with a personís activity. The device uses electrodes or small conducting patches placed on the chest and attached to a small recording monitor that is carried in a pocket or in a small pouch worn around the neck.

    wearing a holter monitor holter monitor


    FOR DETAILED INFORMATION

    Wikipedia: Holter Monitor
    MayoClinic: Holter Monitor





    HYPERTENSION (HIGH BLOOD PRESSURE)

    Hypertension is also known as high blood pressure. High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

    You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

    SYMPTOMS

    Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms usually do not occur until high blood pressure has reached a severe or life-threatening stage.

    You will likely have your blood pressure taken as part of a routine health care provider's appointment. Ask your health care providerr for a blood pressure reading at least every two years starting at age 18. Blood pressure should be checked in both arms to determine if there is a difference. Your health care provider will likely recommend more frequent readings if you have already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups. If you do not regularly see your health care provider, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free, but these machines can give you inaccurate results.

    CAUSES

    There are two types of high blood pressure.

  • Primary (Essential) Hypertension: For most adults, there are no identifiable causes of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

  • Secondary Hypertension: Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
    • Kidney problems.
    • Adrenal gland tumors.
    • Thyroid problems.
    • Certain defects in blood vessels you are born with (congenital).
    • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs.
    • Illegal drugs, such as cocaine and amphetamines.
    • Alcohol abuse or chronic alcohol use.
    • Obstructive sleep apnea.
    RISK FACTORS

    High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack, and kidney failure, also are more common in blacks.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you do not get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
  • Too little vitamin D in your diet. It is uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease and sleep apnea. Sometimes pregnancy contributes to high blood pressure, as well.

  • Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

    Hypertension can cause serious complications. The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.Uncontrolled high blood pressure can lead to:
    • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
    • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
    • Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
    • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
    • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
    • Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL); or "good," cholesterol; high blood pressure; and high insulin levels. If you have high blood pressure, you are more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
    • Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
    It is never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high blood pressure and its complications, including heart attack and stroke.

    DIAGNOSIS

    To measure your blood pressure, your health care provider will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure). Blood pressure measurements fall into four general categories:

  • Normal Blood Pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some health practitioners recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
  • Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time.
  • Stage 1 Hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
  • Stage 2 Hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

  • high blood pressure levels


    Both numbers in a blood pressure reading are important. But after age 60, the systolic reading is even more significant. Isolated systolic hypertension is when diastolic pressure is normal but systolic pressure is high, which is a common type of high blood pressure among people older than 60. Your health care provider will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and sometimes specifically during visits to the health care provider, a condition called white-coat hypertension. Your blood pressure should be measured in both arms to determine if there is a difference. Your health care provider may ask you to record your blood pressure at home and at work to provide additional information.

    If you have any type of high blood pressure, your health care provider will review your medical history and conduct a physical examination. Your health care provider may also recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram, a test that measures your heart's electrical activity. Your health care provider may also recommend additional tests, such as a cholesterol test, to check for more signs of heart disease.

    Taking your blood pressure at home: An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available and can be purchased at most pharmaceutical stores. You do not need a prescription to buy one.

    TREATMENT

    Changing your lifestyle can go a long way toward controlling high blood pressure. Eating a healthy diet with less salt, exercising regularly, quit smoking and maintain a healthy weight is a good start to a healthy lifestyle. But sometimes lifestyle changes are not enough. In addition to lifestyle changes, your health care provider may recommend medication to lower your blood pressure. Your blood pressure treatment goal depends on how healthy you are.

  • Blood Pressure Treatment Goals: Although 120/80 mm Hg or lower is the ideal blood pressure goal, health care providers are unsure if you need treatment (medications) to reach that level.



  • Less than150/90 mm Hg

    If you are a healthy adult age 60 or older.

    Less than140/90 mm Hg

    If you are a healthy adult younger than age 60.

    Less than140/90 mm Hg

    If you have chronic kidney disease, diabetes, or coronary artery disease or at high risk of coronary artery disease.

    If you are age 60 or older, and use of medications results in lower systolic blood pressure (such as less than 140 mm Hg), your medications will not need to be changed unless they cause negative effects to your health or quality of life. Also, people older than 60 commonly have isolated systolic hypertension, when diastolic pressure is normal but systolic pressure is high. The category of medication your health care provider prescribes depends on your blood pressure measurements and whether you also have other medical problems.


    Medications to treat high blood pressure include:
    • Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. If you are not taking a diuretic and your blood pressure remains high, talk to your health care provider about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for blacks than do angiotensin-converting enzyme (ACE) inhibitors alone.
    • Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers do not work as well, especially in older adults, but may be effective when combined with other blood pressure medications.
    • Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ACE inhibitors as one of their medications. Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ARBs as one of their medications.
    • Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and blacks than do ACE inhibitors alone. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your health care provider if you are concerned about interactions.
    • Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you should not take aliskiren with ACE inhibitors or ARBs.
    Additional medications to treat high blood pressure - If you are having trouble reaching your blood pressure goal with combinations of the above medications, your health care provider may prescribe:
    • Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
    • Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
    • Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
    • Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.
    Once your blood pressure is under control, your health care provider may have you take a daily aspirin to reduce your risk of cardiovascular disorders. To reduce the number of daily medication doses you need, your health care provider may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs may be more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.

    high blood pressure nutrition


    No matter what medications your health care provider prescribes to treat your high blood pressure, you will need to make lifestyle changes to lower your blood pressure. These may include eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet), exercising regularly, quitting smoking, and losing weight,

  • Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat. Although diet and exercise are the most appropriate tactics to lower your blood pressure, some supplements also may help lower it. These include:
  • While it is best to include these supplements in your diet as foods, you can also take supplement pills or capsules. Discuss with your health care provider before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects, such as an increased bleeding risk that could be fatal.

  • Decrease the salt in your diet. A lower sodium level to 1,500 milligrams (mg) a day. This is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that is in the processed foods you eat, such as canned soups or frozen dinners.
  • Maintain a healthy weight. If you are overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.

  • Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.

  • Limit alcohol. Even if you are healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

  • Do not smoke. Tobacco and nicotine injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your health care provider to help you quit.

  • Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices may temporarily reduce your blood pressure. Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that can help guide your breathing for relaxation.

  • Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your health care provider to potential complications. If your blood pressure is under control, you may be able to make fewer visits to your health care provider if you monitor your blood pressure at home.

  • RESISTANT HYPERTENSION

    When your high blood pressure is difficult to control and if your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that is resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. Having resistant hypertension does not mean your blood pressure will never get lower. In fact, if you and your health care provider can identify what is behind your persistently high blood pressure, there is a good chance you can meet your goal with the help of treatment that is more effective.

    Your health care provider can evaluate whether the medications and doses you are taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. In addition, you and your health care provider can review medications you are taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your health care provider about all the medications or supplements you take. If you do not take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you cannot afford the medication, because you have side effects or because you simply forget to take your medications, talk to your health care provider about solutions. Do not change your treatment without your health care provider's guidance.

    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
    Wikipedia: Hypertension (High Blood Pressure)
    MerckManual: High Blood Pressure Consumer Version
    WebMD: Hypertension (High Blood Pressure)
    American Society of Hypertension, Inc.





    HYPOTENSION (LOW BLOOD PRESSURE)

    Hypotension is also known as low blood pressure. In physiology and medicine, hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is not hypertension, which is high blood pressure. Hypotension may cause symptoms of dizziness and fainting. In severe cases, low blood pressure can be life-threatening.

    Blood pressure (BP) is a measurement of the pressure in your arteries during the active and resting phases of each heart beat. Here are what the numbers mean:
    • Systolic Pressure: The first (top number) in a BP reading is the amount of pressure your heart generates when pumping blood through your arteries to the rest of your body.
    • Diastolic Pressure: The second (bottom number) in a BP reading refers to the amount of pressure in your arteries when your heart is at rest between beats.

    taking blood pressure readings


    Current guidelines identify normal blood pressure as lower than 120/80 mm Hg. Although a normal low blood pressure varies from person to person (what may normal for one person may not be normal for another), most health care practitioners consider low blood pressure too low only if it causes noticeable symptoms. A blood pressure reading of 90 millimeters of mercury (mm Hg) or less systolic blood pressure (the top number in a blood pressure reading) or 60 mm Hg or less diastolic blood pressure (the bottom number) is generally considered low blood pressure. You only need to have one number in the low range for your blood pressure to be considered lower than normal. An example would be if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you are considered to have a lower than normal pressure.

    Although you can get an accurate blood pressure reading at any given time, blood pressure is not always the same. It can vary considerably in a short amount of time, sometimes from one heartbeat to the next, depending on body position, breathing rhythm, stress level, physical condition, medications you take, what you eat and drink, and even time of day. Blood pressure is usually lowest at night and rises sharply on waking. A sudden fall in blood pressure also be dangerous. A change of just 20 mm Hg (a drop from 110 systolic to 90 mm HG systolic, for example, can cause dizziness and fainting when the brain fails to receive an adequate supply of blood. Big plunges in BP, especially those caused by uncontrolled bleeding, severe infections or allergic reactions, can be life threatening.

    cardiac problems, low blood pressure range


    CAUSES

    The causes of low blood pressure can range from dehydration to serious medical or surgical disorders. In some rare instances, low blood pressure can be a sign of serious, even life-threatening disorders. Low blood pressure is treatable, but it is important to find out what is causing your condition so that it can be properly treated.

    Athletes and people who exercise regularly tend to have lower blood pressure and a slower heart rate than do people who are not as fit. So, in general, do nonsmokers and people who eat a healthy diet and maintain a normal weight.

  • Pregnancy. Because a woman's circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you have given birth.
  • Heart Problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.

  • These conditions may cause low blood pressure because they prevent your body from being able to circulate enough blood.

  • Endocrine Problems. Thyroid conditions, such as parathyroid disease, adrenal insufficiency (Addison's disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure.
  • Dehydration. When you become dehydrated, your body loses more water than it takes in. Even mild dehydration can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration. Far more serious is hypovolemic shock, a life-threatening complication of dehydration. It occurs when low blood volume causes a sudden drop in blood pressure and a reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours.
  • Blood Loss. Losing a lot of blood from a major injury or internal bleeding reduces the amount of blood in your body, leading to a severe drop in blood pressure.
  • Severe Infection (Septicemia). Septicemia can happen when an infection in the body enters the bloodstream. This condition can lead to a life-threatening drop in blood pressure called septic shock.
  • Severe Allergic Reaction (Anaphylaxis). Anaphylaxis is a severe and potentially life-threatening allergic reaction. Common triggers of anaphylaxis include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a drop in blood pressure.
  • Nutritional Deficiencies. A lack of important nutrients in your diet, such as a lack of the Vitamins B-12 and Folate (Folic Acid) can cause a condition in which your body does not produce enough red blood cells (anemia), causing low blood pressure.

  • Some medications you may take can also cause low blood pressure, including:

  • Diuretics (Water Pills), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, Oretic).
  • Alpha Blockers, such as prazosin (Minipress) and labetalol.
  • Beta Blockers, such as atenolol (Tenormin), propranolol (Inderal, Innopran XL, others) and timolol.
  • Parkinson's Disease Drugs, such as pramipexole (Mirapex) or those containing levodopa.
  • Antidepressants (Tricyclic), including doxepin (Silenor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil).
  • Sildenafil (Viagra) or Tadalafil (Cialis), particularly in combination with the heart medication nitroglycerin.

  • TYPES OF LOW BLOOD PRESSURE

    Health care practitioners often break down low blood pressure (hypotension) into different categories, depending on the causes and other factors. Some types of low blood pressure include:

  • Low blood pressure on standing up (orthostatic, or postural, hypotension). This is a sudden drop in blood pressure when you stand up from a sitting position or if you stand up after lying down. Ordinarily, gravity causes blood to pool in your legs whenever you stand. Your body compensates for this by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain. But in people with orthostatic hypotension, this compensating mechanism fails and blood pressure falls, leading to symptoms of dizziness, lightheadedness, blurred vision and even fainting. Orthostatic hypotension can occur for a variety of reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders. A number of medications also can cause orthostatic hypotension, particularly drugs used to treat high blood pressure, such as diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors, as well as antidepressants and drugs used to treat Parkinson's disease and erectile dysfunction. Orthostatic hypotension is especially common in older adults, with as many as 20 percent of those older than age 65 experiencing orthostatic hypotension. But orthostatic hypotension can also affect young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after working for a time in a squatting position.

  • Low blood pressure after eating (postprandial hypotension). Postprandial hypotension is a sudden drop in blood pressure after eating. It affects mostly older adults. Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tract after you eat. Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels to help maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness, faintness and falls. Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders such as Parkinson's disease. Lowering the dose of blood pressure drugs and eating small, low-carbohydrate meals may help reduce symptoms.

  • Low blood pressure from faulty brain signals (neurally mediated hypotension). This disorder causes blood pressure to drop after standing for long periods, leading to signs and symptoms such as dizziness, nausea and fainting. Neurally mediated hypotension mostly affects young people, and it seems to occur because of a miscommunication between the heart and the brain. When you stand for extended periods, your blood pressure falls as blood pools in your legs. Normally, your body then makes adjustments to normalize your blood pressure. But in people with neurally mediated hypotension, nerves in the heart's left ventricle actually signal the brain that blood pressure is too high, rather than too low. As a result, the brain lessens the heart rate, decreasing blood pressure even further. This causes more blood to pool in the legs and less blood to reach the brain, leading to lightheadedness and fainting.

  • Low blood pressure due to nervous system damage (multiple system atrophy with orthostatic hypotension). Also called Shy-Drager syndrome, this rare disorder causes progressive damage to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion. Although this condition can be associated with muscle tremors, slowed movement, problems with coordination and speech, and incontinence, its main characteristic is severe orthostatic hypotension in combination with very high blood pressure when lying down.

  • RISK FACTORS

    Low blood pressure (hypotension) can occur in anyone, though certain types of low blood pressure are more common depending on your age or other factors:

  • Age. Drops in blood pressure on standing or after eating occur primarily in adults older than 65. Orthostatic, or postural, hypotension happens after standing up, while postprandial hypotension happens after eating a meal. Neurally mediated hypotension happens as a result of a miscommunication between the brain and heart. It primarily affects children and younger adults.
  • Medications. People who take certain medications, such as high blood pressure medications like alpha blockers, have a greater risk of low blood pressure.
  • Certain Diseases. Parkinson's disease, diabetes and some heart conditions put you at a greater risk of developing low blood pressure.

  • SYMPTOMS

    For some people, low blood pressure can signal an underlying problem, especially when it drops suddenly or is accompanied by signs and symptoms such as:
    • Dizziness or lightheadedness.
    • Fainting (syncope).
    • Lack of concentration.
    • Blurred vision.
    • Nausea.
    • Cold, clammy, pale skin.
    • Rapid, shallow breathing.
    • Fatigue.
    • Depression.
    • Thirst.

    In many instances, low blood pressure is not serious. If you have consistently low readings but feel fine, your health care provider is likely to monitor you during routine exams. Even occasional dizziness or lightheadedness may be a relatively minor problem, the result of mild dehydration from too much time in the sun or a hot tub, for example. In these situations, it is not a matter so much of how far, but of how quickly, your blood pressure drops. Still, it is important to see your health care provider if you experience any signs or symptoms of hypotension because they sometimes can point to more-serious problems. It can be helpful to keep a record of your symptoms, when they occur and what you were doing at the time.

    Even moderate forms of low blood pressure can cause not only dizziness and weakness but also fainting and a risk of injury from falls. And severely low blood pressure from any cause can deprive your body of enough oxygen to carry out its normal functions, leading to damage to your heart and brain.

    DIAGNOSIS

    No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly. Make sure the person taking your blood pressure uses a proper sized coff. A cuff too loose or too tight can alter BP readings. Do not stop taking any prescription medications that you think may affect your blood pressure without your health care provider's advice. Because appointments can be brief, and because there is often a lot to discuss, it is a good idea to be prepared for your appointment. Follow preappointment restriction instructions, if any. Write down questions, symptoms, key personal information and history, medications and supplements you are taking. It is wise to take another person with your to help you remember information.

    The goal of testing for low BP is to find the underlying cause. Tests may include:
    • Blood Pressure Test using an inflatable arm cuff and a pressure measuring gauge with a stethoscope. The cuff is inflated until it cuts off circulation in your arm and slowly released while the stethoscope head is placed over your artery in the curve of your arm (in front of the elbow). As the air is released from the cuff, the practitioner listens for the first heart beat sound. This heart beat is noted on the gauge and is the systolic (top) number. The heart beat continues to be heard as the air is slowly released until it is no longer heard. This point is also noted on the gauge. This is the diastolic (bottom) number.

    • Blood Tests can provide information about your overall health as well as whether you have low blood sugar (hypoglycemia), high blood sugar (hyperglycemia) or diabetes), low number of red blood cells (anemia), endocrine and thyroid health, nutritional deficiencies, and others.

    • Electrocardiogram (ECG) is a painless, noninvasive test using soft sticky electrode patches attached to your skin on your chest, arms and legs. Used to detect heart's electrical signals while the machine records them on graph paper or displayse them on a screen. It can be used to detect irregularities in heart rhythms, structural abnormalities in the heart, blood supply problems, heart muscle oxygen, and if you have had or are having a heart attack. If rhythm abnormalies come and go, you may be asked to wear a 24 hour Holter monitor while you go about your daily routine.

    • Echocardiogram A noninvasive exam includes an ultrasound of the chest and shows images of your heart structure and function. A computer uses the information from the transducer to create moving images on a video monitor.

    • Stress Test is to assess the heart while it is working rather than at rest. This may be an exercise test using a bicycle or treadmill, or one induced using medicications to make your heart work harder. The working heart and BP will be monitored with electrocardiography or echocardiography.

    • Valsalva Maneuver is a noninvasive test checks the functioning of the autonomic nervous system by analyzing the heart rate and BP after several cycles of deep breathing. You take a deep breath and then force the air out through your lips, as if you were trying to blow up a stiff balloon.

    • Tilt Table Test is used to test your body's reaction to position changes. It is used if you have low BP on standing, or from faulty brain signals (neurally mediated hypotension) by movement of a table tilted to simulate the movement from horizontal to standing position.
    cardiac problems, low blood pressure


    TREATMENT

    Low blood pressure that either does not cause signs or symptoms or causes only mild symptoms, such as brief episodes of dizziness when standing, rarely requires treatment. If you have symptoms, the most appropriate treatment depends on the underlying cause, and health care providers usually try to address the primary health problem, such as dehydration, heart failure, diabetes or hypothyroidism, for example, rather than the low blood pressure itself. When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication or stopping it entirely. If it is not clear what is causing low blood pressure or no effective treatment exists, the goal is to raise your blood pressure and reduce signs and symptoms. Depending on your age, health status and the type of low blood pressure you have, you can do this in several ways:

  • Go slowly when changing body positions. You may be able to reduce the dizziness and lightheadedness that occur with low blood pressure on standing by taking it easy when you move from a prone to a standing position. Before getting out of bed in the morning, breathe deeply for a few minutes and then slowly sit up before standing. Sleeping with the head of your bed slightly elevated also can help fight the effects of gravity. If you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.

  • Wear compression stockings. The same elastic stockings commonly used to relieve the pain and swelling of varicose veins may help reduce the pooling of blood in your legs.

  • Medications. Several medications, either used alone or together, can be used to treat low blood pressure that occurs when you stand up (orthostatic hypotension). For example, the drug fludrocortisone is often used to treat this form of low blood pressure. This drug helps boost your blood volume, which raises blood pressure. Health care providers often use the drug midodrine (Orvaten) to raise standing blood pressure levels in people with chronic orthostatic hypotension. It works by restricting the ability of your blood vessels to expand, which raises blood pressure.

  • Use more salt. Experts usually recommend limiting the amount of salt in your diet because sodium can raise blood pressure, sometimes dramatically. For people with low blood pressure, that can be a good thing. But because excess sodium can lead to heart failure, especially in older adults, it is important to check with your health care provider before increasing the salt in your diet.

  • Drink more water. Although nearly everyone can benefit from drinking enough water, this is especially true if you have low blood pressure. Fluids increase blood volume and help prevent dehydration, both of which are important in treating hypotension. Drink less alcohol. Alcohol is dehydrating and can lower blood pressure, even if taken in moderation.

  • Follow a healthy diet. Get all the nutrients you need for good health by focusing on a variety of foods, including whole grains, fruits, vegetables, and lean chicken and fish. If your health care provider suggests using more salt but you do not like a lot of salt on your food, try using natural soy sauce or adding dry soup mixes to dips and dressings. Eat small, low-carb meals. To help prevent blood pressure from dropping sharply after meals, eat small portions several times a day and limit high-carbohydrate foods such as potatoes, rice, pasta and bread. Your health care provider also may recommend drinking caffeinated coffee or tea with meals to temporarily raise blood pressure. But because caffeine can cause other problems, check with your health care provider before drinking more caffeinated beverages.

  • FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Shock
    Wikipedia: Hypotension (Low Blood Pressure)
    MedicineNet: Hypotension (Low Blood Pressure), Causes, Symptoms, Diagnosis & Treatment





    ISCHEMIC HEART DISEASE

    Ischemic heart disease (IHD) is a condition in which the blood flow (and thus the oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is the name for decreased blood flow and oxygen to the heart muscle. It is caused by obstruction of the blood flow to the heart, usually (most often) as a result of atherosclerosis, usually present even when the artery lumens appear normal by angiography. Ischemia (lack of sufficient oxygen) can lead to angina, cardiac arrhythmias, congestive heart failure, or a heart attack.

    ISCHEMIC HEART DISEASE

    It is the term given to heart problems caused by partial or complete narrowing of heart arteries, also known as coronary arteries. The coronary arteries supply blood to the heart muscle and no alternative blood supply exists, so a blockage in the coronary arteries or when arteries are narrowed, less blood and oxygen reaches the heart muscle. This is also called myocardial ischemia, cardiac ischemia, coronary artery disease and coronary heart disease. This can ultimately lead to heart attack. Ischemia often causes chest pain or discomfort known as angina pectoris.

    Initially there is sudden severe narrowing or closure of either the large coronary arteries and/or of coronary artery end branches by debris showering downstream in the flowing blood. It is usually felt as angina, especially if a large area is affected.

    The narrowing or closure is predominantly caused by the covering of atheromatous plaques within the wall of the artery rupturing, in turn leading to a heart attack. A sudden, severe blockage of a coronary artery may lead to a heart attack. Heart attacks cause by just artery narrowing are rare. A heart attack causes damage to heart muscle by cutting off its blood supply.

    Cardiac ischemia can lead to a number of serious complications. It can damage your heart muscle, reducing it ability to pump blood efficiently. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to heart attack that destroys part of the heart muscle, causing serious and in some cases fatal heart damage. It may also cause serious abnormal, irregular heart rhythms (arrhythmia). Your heart muscle needs sufficient oxygen to beat properly. It it does not receive enough oxygen, the electrical impulses in your heart that coordinate your heartbeats may malfunction, causing your heart to beat too fast, too slow, or irregularly. In some cases, arrhythmias can be life threatening. Cardiac ischemia can damage the heart muscle itself, leading to a reduction in its ability to effectively pump blood to the rest of your body. Over time, this damay may lead to heart failure.

    SILENT ISCHEMIA

    Many Americans may have ischemic episodes without knowing it as they do not experience any signs or symptoms. These people have ischemia without pain, known as silent ischemia. They may have a heart attack with no prior warning. People with angina also may have undiagnosed episodes of silent ischemia. In addition, people who have had previous heart attacks or those with diabetes are especially at risk for developing silent ischemia.

    CAUSES

    Conditions that may cause myocardial ischemia include:
    • Coronary Artery Disease (Atherosclerosis). Atherosclerosis occurs when plaques made of cholesterol and waste products build up on your artery walls and restrict blood flow. Atherosclerosis of the heart arteries is called coronary artery disease and is the most common cause of myocardial ischemia.
    • Blood Clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot, which may lead to sudden, severe myocardial ischemia, resulting in a heart attack.
    • Coronary Artery Spasm. A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle.
    Things that may trigger chest pain associated with myocardial ischemia include:
    • Physical exertion.
    • Emotional stress.
    • Cold temperatures.
    • Lying down.
    • Cocaine use.

    SYMPTOMS

  • Chest pressure or pain, typically on the left side of the body (angina pectoris).
  • Neck or jaw pain.
  • Shoulder or arm pain.
  • A fast heartbeat.
  • Shortness of breath.
  • Nausea and vomiting.


  • If you have chest discomfort, especially if it i accompanied by one or more of the other signs and symptoms listed above, seek medical care immediately. Call 911 or your local emergency number. If you do not have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.

    Diagnosis may include an electrocardiogram (ECG) test. You may need to wear a Holter monitor (a battery-operated portable tape recording that measures and records your electrocardiogram (ECG) continuously, usually for 24 to 48 hours). A stress test involving a treaedmill or stationary bike while being monitored can reveal problems otherwise not noticeable. These are two tests often used to diagnose this problem. Other tests also may be used and may include an echocardiogram using sound waves to produce images of the heart. nuclear scan using radioactive material injected into your bloodstream and detected by special cameras to identify blood flow problems, coronary angiography using x-ray imaging with a special type of dye to examine the inside of the heart's blood vessels, and Cardiac CT scan for a detailed look at the inside of blood vessels to determine coronary artery calcification, a sign of coronary atherosclerosis, and .

    RISK FACTORS

    Factors that may increase your risk of developing myocardial ischemia include:
    • Tobacco. Both smoking and long-term exposure to secondhand smoke can damage the interior walls of arteries, including arteries in your heart, allowing deposits of cholesterol and other substances to collect and slow blood flow. Smoking also increases the risk of blood clots forming in the arteries that can cause myocardial ischemia.
    • Diabetes. Diabetes is the inability of your body to adequately produce or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Both type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.
    • High Blood Pressure (Hypertension). Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure is more common in those who are obese. Eating a diet high in salt also may increase your risk of high blood pressure.
    • High Blood Cholesterol or Triglyceride Levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of "bad" (low-density lipoprotein, or LDL) cholesterol in your blood is linked to an increased risk of atherosclerosis and myocardial ischemia. A high LDL level may be due to an inherited condition or a diet high in saturated fats and cholesterol. A high level of triglycerides, another type of blood fat, may also contribute to atherosclerosis. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), which helps the body clean up excess cholesterol, is desirable and lowers your risk of heart attack.
    • Lack of Physical Activity. An inactive lifestyle contributes to obesity and is associated with higher cholesterol and triglycerides and an increased risk of atherosclerosis. People who get regular aerobic exercise have better cardiovascular fitness, which is associated with a decreased risk of myocardial ischemia and heart attack. Exercise also lowers high blood pressure.
    • Obesity. Obese people have a high proportion of body fat, often with a body mass index of 30 or higher. Obesity raises the risk of myocardial ischemia because it is associated with high blood cholesterol levels, high blood pressure and diabetes.
    • Waist Circumference. A waist circumference of more than 35 inches (88 centimeters) for women and 40 inches (102 cm) or more in men increases the risk of heart disease.
    • Family History. If you have a family history of heart attack or coronary artery disease, you may be at increased risk of myocardial ischemia.

    TREATMENT

    Treatment is directed at improving blood flow to the heart muscle and may include medications, a procedure to open blocked arteries , or coronary artery bypass surgery. Making heart-healthy lifestyle choices and following a health diet is important in preventing and treating Cardiac Ischemia.

    FOR DETAILED INFORMATION

    MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
    MoonDragon's Health & Wellness: Heart Attack
    Mayo Clinic: Myocardial Ischemia
    Wikipedia: Coronary Artery Disease (CAD) & Ischemic Heart Disease (IHD)





    MAGNETIC RESONANCE SPECTROSCOPY (MRS)

    Magnetic Resonance Spectroscopy (MRS) is used in conjunction with magnetic resonance imaging (MRI), an imaging test that can show areas of damaged heart muscle. It does this by measuring levels of creatine kinase MB, an enzyme that is severely depleted after a heart attack.

    MR Angiogram in congential heart disease - partial anomalous pulmonary venous drainage by CMR


    CARDIAC MRI

    Cardiac MRI is complementary to other imaging techniques, such as echocardiography, cardiac CT and nuclear medicine. Its applications include assessment of mycardial ishemia and viability, myocarditis, cardiomyopathies, iron overlad, congenital heart disease and vascular diseases.

    CMR shows different orientations of a cardiac tumor - atrial myxoma


    FOR DETAILED INFORMATION

    Wikipedia: Magnetic Resonance Imaging
    Wikipedia: Cardiac Magnetic Resonance Imaging





    MITRIAL VALVE PROLAPSE (MVP)

    Mitrial valve prolapse (MVP) is a valvular heart disease condition characterized by the displacement of an abnormally thickened mitral valve leaflet, which controls blood flow from the left atrium and left ventricle, protrudes too far into the left atrium between beats (during systole). This means the valve does not close properly leading to blood leaking backward into the left atrium. In most people, mitral valve prolapse is not life-threatening and does not require treatment or changes in lifestyle. Some people with mitral valve prolapse, however, require treatment.

    MVP is the primary form of myxomatous degeneration of the valve. Myxomatous degeneration refers to a pathological weakening of connective tissue. There are various types of MVP, broadly classified as classic and nonclassic. In its nonclassic form, MVP carries a low risk of complications and often can be kept minimal by dietary attention. In severe cases of classic MVP, complications include mitral regurgitation, infective endocarditis, congestive heart failure, and, in rare circumstances, cardiac arrest.

    SYMPTOMS

    MVP may or may not cause symptoms, such as dizziness or palpitations. Although mitral valve prolapse is usually a lifelong disorder, many people with this condition never have symptoms. When diagnosed, people may be surprised to learn that they have a heart condition. When signs and symptoms do occur, it may be because blood is leaking backward through the valve (regurgitation). Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild and develop gradually. Symptoms may include:
    • A racing or irregular heartbeat (arrhythmia).
    • Dizziness or lightheadedness.
    • Difficulty breathing or shortness of breath, often when lying flat or during physical activity.
    • Fatigue.
    • Chest pain that is not caused by a heart attack or coronary artery disease.

    Mitral Valve Prolapse (MVP)


    Mitral valve prolapse is frequently associated with mild mitral regurgitation, a disorder of the heart in which the mitral valve does not close properly when the heart pumps out blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium. Mitral valve regurgitation is the most common complication. Being male or having high blood pressure increases the risk of mitral valve regurgitation. Other complications include heart rhythm problems (arrhythmias, irregular heart rhythms), heart valve infection (endocarditis, an infection of the thin membrane lining inside the heart) from bacteria, leading to further damage to the mitral valve.

    MVP can develop in any person of at any age. Serious symptoms of MVP tend to occur most often in men older than 50. It can also run in familes and be linked to several other conditions. MVP may occur with greater frequency in individuals with Ehlers-Danlos Syndrome, Ebstein's anomaly, Marfan Sydrome, Muscular dystrophy, Scoliosis, or polycystic kidney disease. Other risk factors include Graves disease and chest wall deformities such as pectus excavatum. Rheumatic fever is a common worldwide cause for many cases of damaged heart valves. In the older generation and in much of the less-developed world, valvular disease (including mitral valve prolapse and mitral valve stenosis, reinfection in the form of valvular endocarditis, and valve rupture) from undertreated rheumatic fever continues to be a problem.

    DIAGNOSIS

    Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. 2D and 3D echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative tot he mitral annulus. This allows measurement of the leaflet thickness and their displacement relative tot he annulus. Thickening of the mitral leaflets greater than 5mm and leaflet displacement greater than 2mm indicates classice mitral valve prolapse.

    TREATMENT

    Individuals with mitral valve prolapse, particularly those without symptoms, often require no treatment. Those with MVP and symtpoms of palpitations and chest pain may benefit from beta-blockers. Patients with prior stroke and/or atrial fibrillation may require blood thinners, such as aspirin or warfarin. In rare cases when MVP is associated with severe mitral regurgitation, mitral valve repair or surgical replacement may be necesseary. Repair if preferable to replacement.

    FOR DETAILED INFORMATION

    Wikipedia: Mitral Valve Prolapse
    MayoClinic: Mitral Valve Proplapse
    MedicineNet: Mitral Valve Prolapse (MVP) - Symptoms, Causes, Diagnosis & Treatment
    MerckManuals: Mitral Valve Prolapse





    PERICARDITIS

    Pericarditis is the inflammation of the fibrous sac (pericardium) that surrounds the heart. A characteristic chest pain is often present.

    Pericarditis


    The causes of pericarditis are varied, including infections of the pericardium by viruses or bacteria (Mycobacterium tuberculosis), idiopathic cause4s, uremic pericarditis, post-infarct pericarditis (within 24 hours of a heart attack), or Dressler's syndrome (weeks to months after a heart attack).

    Depending on the time of presentation and duration, pericarditis is divided into acute and chronic forms. Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or even as a result of a heart attack (myocardial infarction). Chronic pericarditis is less common, a form of which is constrictive pericarditis. Clinical classification is acute (less than 6 weeks), subacute (6 weeks to 6 months) and chronic (more than 6 months).

    ACUTE PERICARDITIS

    Acute Pericarditis can be classified according to the composition of the fluid that accumulates around the heart. Types include:
    • Serous Pericarditis: Fluid, pale yellow and transparent bodily fluid of a benign nature that fills the inside of body cavities with secretions enriched with proteins and water. Serous membrane fluid collects on microvilli on the outer layer and acts as a lubricant and reduces friction from muscle movement. Usually caused by noninfectious inflammation, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The fluid will demonstrate few PMNs, lymphocytes, or histiocytes. The usual volume is 50 to 200 mL and accumulates slowly. Fibrous adhesions rarely occur. Dialysis-associated pericarditis is cause by fluid overload, and the fluid is usually serous.

    • Purulent / Suppurative Pericarditis: Purulent fluid, is also known as pus. Infection is the most common cause. Organisms may arise from direct extension, hematogenous seeding, lymphatic extension, or by direct introduction during cardiotomy. Immunosuppression facilitates this condition. The fluid usually is 400 to 500 mL in volume and shows a thin to creamy pus. Clinical features include fever, chills, and spiking temperatures. Constrictive pericarditis is a serious potential complication. Bacteria that cause pus are called suppurative, pyogenic, or purulent. It is generally composed of water and the dissolve solutes of the main circulatory fluid such as blood. It may contain some or all plasma proteins, white blood cells, platelets, and in the case of local vascular damage, red blood cells. It typically is white-yellow, yellow, or yellowbrown, formed at the site of inflammation during infection. Before the antibiotic era, pneumonia was the prime cause of purulent pericarditis. Currently, causes include thoracic surgery, chemotherapy, immunosuppression, and hemodialysis. Presentation is usually acute with high fevers, chills, night sweats, and dyspnea, but the classic findings of chest pain or friction rub are rare. Cardiac tamponade occurs frequently (42 to 77 percent of patients in select series), and mortality is high. If purulent pericarditis is suspected, hospital admission with immediate pericardiocentesis and intravenous broad-spectrum antibiotics are mandatory, followed by early surgical drainage. Findings on pericardial fluid analysis include a high protein level (more than 6 g/dL), low glucose level (lower than 35 mg/dL), and very high leukocyte count (6,000 to 240,000/mm3)

    • Fibrinous & Serofibrinous Pericarditis: These two types represent the same basic process and are the most frequent type of pericarditis. Common causes are acute myocardial infarction (AMI), postinfarction (Dressler's syndrome), uremia, radiation, RA, SLE and trauma. Severe infections may also cause a fibrinous reaction, as does routine cardiac surgery. Fibrinous fluid consists of stringy pale fibrin strands and leukocytes (white blood cells), mainly neutrophils. A scratchy, grating, high-pitched friction rub (squeak of new saddle leather) is caused by fibrinous deposits in the pericardial space.

    • Caseous Pericarditis: Until proven otherwise, caseation within the pericardial sac is tuberculous in origin. Untreated, this is the most common antecedent to chronic constrictive, fibrocalcific pericarditis.

    • Hemorrhagic Pericarditis: Blood mixed with a fibrinous or suppurative effusion most commonly is caused by tuberculosis or direct neoplastic invasion. It also can occur in severe bacterial infections or in patients with a bleeding diathesis. It is common after cardiac surgery and may cause tamponade. The clinical significance is similar to suppurative pericarditis.
    The most common symptom of acute pericarditis is severe, sharp, retrosternal chest pain, often radiating to the neck, shoulders, or back. Positional changes are characteristic, with worsening of the pain in the supine position and with inspiration, and improvement with sitting upright and leaning forward. Other symptoms may occur, reflecting the underlying disease.

    CLINICAL PRESENTATION OF PERICARDITIS
    Characteristic / Parameter
    Pericarditis
    Myocardial Infarction
    Pain Description
    Sharp, pleuric, retro-sternal (under the sternum) or left precordial (left chest) pain.
    Crushing, pressure-like, heavy pain described as "elephant on the chest."
    Radiation
    Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation.
    Pain radiates to the jaw, or the left shoulder or arm, or does not radiate.
    Exertion
    Does not change the pain.
    Can increase the pain.
    Position
    Pain is worse in the supine position or upon inspiration (breathing in).
    Not positional.
    Onset / Duration
    Sudden pain, that lasts for hours or sometimes days before a patient comes into the ER.
    Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER.


    CHRONIC PERICARDITIS

  • Adhesive Mediastinopericarditis: This reaction usually follows suppurative or caseous pericarditis, cardiac surgery, or irradiation. It rarely is caused by a simple fibrinous exudate. The pericardial potential space is obliterated and the subsequently there is adhesion of the external surface of the parietal layer to the surrounding structures. Clinically, systolic contraction of the ribcage and diaphragm, and pulsus paradoxus may be observed. The increased workload may cause massive hypertrophy and dilatation, which can mimic an idiopathic cardiomyopathy.

  • Constrictive Pericarditis: This usually is caused by suppurative, caseous, or hemorrhagic pericarditis. The heart may become encased in a 0.5 to 1.0 cm thick layer of scar or calcification (concretio cordis), resembling a plaster mold. Contrary to clinical findings in adhesive mediastinopericarditis, the heart cannot hypertrophy or dilate because of insufficient space.


  • CARDIAC TAMPONADE

  • Penetrating Cardiac Injuries: Identification of any pericardial fluid in the setting of penetrating injury to the thorax or upper abdomen requires aggressive resuscitation.

  • Hemopericardium is the most common feature of penetrating cardiac injuries. In acute massive hemopericardium, there is insufficient time for defibrination to occur. The hemopericardium organizes and may partially clot resulting in a pericardial hematoma. The hematoma may appear echogenic instead of echo-free.

  • Iatrogenic Causes: Potential sources of perforation include central line placement (CVP), pacemaker insertion, cardiac catheterization, sternal bone marrow biopsies, and pericardiocentesis.

  • The right atrium is the most common site of perforation from catheter placement. Perforation as well as direct infusion of fluids through the catheter can cause tamponade.

  • Delayed tamponade has occurred secondary to catheter misplacement (hours to days).


  • CAUSES

    Pericarditis may be caused by viral, bacterial, or fungal infection. The most common viral pathogen has traditionally been considered to be coxsackievirus based on studies in children from the 1960s, but recent data suggest that adults are most commonly affected with cytomegalovirus, herpesvirus, and HIV. Pneumococcus or tuberculous pericarditis are the most common bacterial forms. Anaerobic bacteria can also be a rare cause. Fungal pericarditis is usually due to histoplasmosis, or in immunocompromised hosts Aspergillus, Candida, and coccidioides. The most common cause of pericarditis worldwide is infectious percarditis with Tuberculosis.

    Other causes include idiopathic (no identifiable etiology found after routine testing), immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever. Myocardial infarction (Dressler's syndrome), Trauma to the heart (e.g., puncture, resulting in infection or inflammation), Uremia (uremic pericarditis), or Malignancy (as a paraneoplastic phenomenon) may be causes of pericarditis. Side effects of some medications (e.g., isoniazid, cyclosporine, hydralazine, warfarin, and heparin) may be a cause. Other causes may include Radiation-induced, Aortic dissection, Tetracyclines, and Postpericardiotomy syndrom, usually after CABG surgery.

    TREATMENT

    The treatment in viral or idiopathic pericarditis is with aspirin, or NSAIDS, such as ibuprofen. Colchicine may be added to the above as it decreases the risk of further episodes of pericarditis. Severe cases may require one or more of the following:
    • Pericardiocentesis to treat percardial effusion/tamponade.
    • Antibiotics to treat tuberculosis or other bacterial causes.
    • Steroids are used in acute pericarditis but are not favored because they increase the chance of recurrent pericarditis.
    • In rare cases, surgery.
    • In cases of constrictive pericarditis, pericardiectomy.
    FOR DETAILED INFORMATION

    MayoClinic: Pericarditis
    American Heart Asso: Pericardium & Pericarditis
    HealthCommunities: Pericarditis Overview
    Wikipedia: Pericarditis
    EMJournal: PERICARDITIS & CARDIAC TAMPONADE





    PHLEBITIS (OR THROMBOPHLEBITIS)

    Phlebitis (or thrombophlebitis) is the inflammation of a vein, most often accompanied by a clot. This condition may be caused by trauma to the vessel wall, clots forming in the blood, infection, or long periods of immobility.

    thrombophlebitis


    The inflammation is often accompanied by formation of a thrombus (clot), which blocks the blood flow through the vein. This is known as thrombophlebitis or venous thrombosis.

    There are two general types of thrombophlebitis:
    • Superficial Phlebitis: A superficial condition that is painful but not life-threatening; and deep thrombophlebitis, a potentially serious condition involving an interior blood vessel. About 300,000 Americans are hospitalized each year because of deep thrombophlebitis, the major danger being that a portion of the clot will break away and travel through the venous system to the lungs, forming a pulmonary embolism. If one of the large pulmonary vessels is blocked, death may result. Superficial phlebitis is most likely to develop in people with varicose veins, patients who are bedridden, or in pregnant women. There may be obvious swelling and a red streak along the involved vein; there may also be heaviness and pain in the leg. Localized redness and swelling, pain or burning along the length of the vein, vein bein hard and cord-like are common symptoms. The discomfort is usually eased when the leg is elevated and worsened when it is lowered.

    • Deep Thrombophlebitis: Deep thrombophlebitis is more likely to cause pain, tenderness, and swelling of the entire limb. Unfortunately, deep thrombophlebitis may occur without producing symptoms until a pulmonary embolism signals its presence.
    CAUSES

    It occurs most commonly as a result of local trauma to the vessel wall of the vein, hypercoagulability of the blood, infection, prolonged sitting, standing, immobilization, or after a long period of intravenous catheterization. However, phlebitis can also occur due to a complication of connective tissue disorders such as lupus, or of pancreatic, breast, or ovarian cancers. Phlebitis can also result from certain medications and drugs that irritate the veins, such as desomorphine.

    Superficial phlebitis often presents as an early sign in thromboangiitis obliterans, also known as Buerger's Disease, a vasculitis that afftects small and medium sized arteries and veins in distal extremities often associated with cigarette smoking.

    TREATMENT

    Superficial thrombophlebitis is generally treated with periods of rest with the leg elevated, non-steroidal anti-flammatory drugs (NSAIDs), such as ibuprofen, and if needed, antibiotics to treat bacterial infection. Warm local compresses may ease the inflammation, and elastic stockings or bandages may be recommended to reduce the swelling.

    Deep thrombophlebitis is usually treated with anticoagulant drugs to reduce the formation of clots and to permit the clots that have already formed to dissolve. Bedrest with the leg elevated may be necessary.

    Anticoagulant drugs may be prescribed for up to several months to prevent recurrence. If these drugs are used for long-term treatment, patients are cautioned not to take any other medication, especially drugs like aspirin that may interact with them. Patients on anticoagulants should have periodic blood tests and also should be alert for any signs of abnormal bleeding, such as bloody or tarry stools, blood in the urine, or excessive bleeding of the gums or small cuts. Anticoagulant therapy and streptokinase may be administered, and moist heat is applied to the affected area; intense heat, which may burn edematous skin, is avoided. Every four hours the blood pressure, temperature, pulse, respiration, circulation of the affected extremity, skin condition, and pulses in all extremities are checked. The patient is kept warm and dry and is helped to turn, cough and deep breathe every two hours.

    Observations for signs of pulmonary embolism, myocardial infarction, cardiovascular accident, or decreased renal function is constant. As inflammation subsides, the use of support or anti-embolic stockings is demonstrated and an exercise program is begun. The patient is instructed to alternate exercise with bedrest, never to dangle the legs, walk 10 minutes every hour, avoid prolonged standing, avoid becoming overweight, and when sitting, elevate the legs and avoid constricting circulation in the groin or crossing the legs at the knees.

    PREVENTION

    Thrombophlebitis is often a complication of treatments and conditions in the hospitalized patient. Much routine nursing care is directed towards avoiding thrombophlebitis. Early postoperative and postpartum ambulation, range of motion exercises for the immobilized patient, good technique in intravenous catheterization, attention to fluid balance, and proper positioning of the patient are common nursing measures to promote good circulation and reduce venous stasis (stoppage or diminution of flow), and the development of thrombophlebitis.

    People susceptible to phlebitis (or any other circulatory or cardiovascular problem) should not smoke since this promotes clot formation. Moderate physical activity is recommended to maintain muscle tone and promote circulation.

    FOR MORE DETAILED INFORMATION

    MoonDragon's Health & Wellness: Thrombophlebitis
    MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
    E-MedicineHealth: Phlebitis
    DiagnoseMe.com: Phlebitis / Thrombophlebitis
    HealthScout: Phlebitis - Symptoms, Treatment & Prevention
    WebMD: Understanding Thrombophlebitis - The Basics





    POSITRON EMISSION TOMOGRAPHY (PET) SCAN

    A PET scan is an imaging test that helps health practitioners to see how your heart and its tissues are working at the cellular level. The test is most often used to diagnose heart conditions such as coronary artery disease (CAD). The results allow your practitioner to see if there is any significant blockage of the coronary artery by performing a stress (perfusion) test, and the degree of heart damage, if any, after a heart attack.

    PET scan


    The PET scanner is a large, tunnel-shaped machine. You will lie on a narrow examination table, which slides through the center of the PET scanner. Before the scan, leads that monitor your heart rhythm are attached to your chest and a very small amount of a radioactive material (called a radiotracer) is injected into a vein in your arm. The radiotracer collects in your organs and tissues as it moves through your body. The scanner detects the energy that the radiotracer gives off, and then a computer is used to create 3D images representing whether there is enough blood flow to different parts of your heart muscle and whether there is any scar due to prior heart attack.

    A PET scan is done on an outpatient basis, meaning you will not have to stay overnight in the hospital. Depending on the type of test your cardiologist requests, the test may take between 1 and 4 hours.

    Patients are usually told not to eat anything 4 to 6 hours before the test. You may drink water but it is important to avoid any caffeinated beverages (such as coffee, tea, soda, chocolate) for at least 12 hours before the test. If you have diabetes, you should talk to your health practitioner about your food and insulin intake, because not eating can affect your blood sugar levels (especially if the test is ordered to detect the presence or absence of any heart damage).

    Talk to your health care provider about any medicines (prescription, over-the-counter, or supplements) that you are taking, because he or she may want you to stop taking them before the test. It is important to avoid any theophylline-containing medications for at least 48 hours prior to the PET scan. Consult with your cardiologist about your specific medications. It is always helpful to make a list of your medicines and bring it with you to the procedure, so that health care practitioners know exactly what you are taking and how much.

    You will be asked to put on a hospital gown. Then, you will lie down on a table, which will be slowly moved through the center of the PET scanner. You will be asked to lie still, because too much movement will make the images blurry. The radiotracer usually takes about 45 minutes to 1 hour to travel throughout your body, and the PET scan itself may take up to 1 hour. If you are having the test because your health care provider suspects you have heart disease, you may also undergo a stress test, where you are given medicines that have the same effect on your body as exercise does. After the test, you may go about your normal activities.

    PET scanning is a very safe test. The amount of radiation you receive is within the acceptable limit that is commonly given to patients. Some people could have an allergic reaction to the radiotracer, but this is extremely rare. You can help flush the radiotracer out of your body by drinking lots of liquids after the test. After the test, the nuclear cardiologist that is specially trained in this area will review the data and a full report will be sent to your cardiologist. If you are pregnant, or think you might be pregnant, or if you are nursing, you must tell your doctor. The radiation exposure can be harmful to a fetus or a nursing infant.

    CARDIAC ASSESSMENT

    A positron emission tomography (PET) scan is a diagnostic test that can be used to assess blood flow through the arteries to the heart. It is a nuclear medicine, functional imaging technique that produces a 3-D (three dimensional) image of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. 3-D images of tracer concentration within the body are then constructed by computer analysis. In modern PET-CT scanners, 3D imaging is often accomplished with the aid of CT X-ray scan performed on the patient during the same session, in the same machine.

    Cardiac PET (Cardiac Positron Emission Tomography) is a form of diagnostic imaging in which the presence of heart disease is evaluated using a PET scanner. Intravenous injection of a radiotracer is performed as part of the scan. Commonly used radiotracers are Rubidium-82, Nitrogen-13 ammonia and Oxygen-15 water.

    The requirements to perform Cardiac PET imaging include:
    • Facility: Taking into consideration clinical workflow, as well as regulatory requirements such as requisite shielding from radiation exposure.
    • Capital Equipment: PET or PET/CT scanner.
    • Radiopharmaceutical: Rubidium-82 generator system or close access to cyclotron produced isotopes such as Nitrogen-13 ammonia.
    • Personnel: Including specially trained physician, radiographers, radiation safety supervisors and optional nursing support.
    • Operations: Stress test monitoring, as well as emergency response equipment, processing and review workstations, administrative and support personnel are additional considerations.
    This form of diagnostic imaging has traditionally been perceived as cost-prohibitive in comparison to general nuclear medicine cardiac stress testing using single photon emission computed tomography (SPECT). However, due to significant gains in access to scanners, related to the widely accepted role of PET/CT in clinical oncology, cardiac PET is likely to become more widely available, particularly given various clinical and technical advantages that might make this a potential test of choice in the diagnosis of coronary artery/heart disease.

    Cardiac PET imaging has now been expanded to mobile services to facilitate all healthcare providers by a company called Cardiac Imaging, Inc. located in Wheaton, Illinois. They now have the only Medicare approved mobile Cardiac PET scanner available for patient use.

    FOR MORE DETAILED INFORMATION

    Wikipedia: Positron Emission Tomography
    Wikipedia: Positron Emission Tomography
    PET Scan: PET Scan Info Reveals
    WebMD: Positron Emission Tomography
    MayoClinic.com: Diagnostic Tests - Positron Emission Tomography
    Intrinsic Imaging: Cardiovascular & Thoracic Radiology, Boston Massachusetts





    PULMONARY (VALVE) STENOSIS (PS)

    Pulmonary stenosis (PS) is a condition in which the pulmonic artery is narrowed or the pulmonary heart valve is narrowed, thickened or fused and does not fully open thus restricting the flow of blood, allowing less blood flow from the heart to the pulmonary artery. The pulmonary artery carries blood from the heart to the lungs. This is the valve separating the right ventricle (one of the heart chambers) and the pulmonary artery. The pulmonary artery carries oxygen-poor blood to the lungs to become oxygenated. Narrowing that occurs in the valve itself is called pulmonary valve stenosis. There may also be a narrowing just before or after the valve. Valvular pulmonic stenosis accounts for about 80 percent of right ventricular outflow tract obstruction.
    This is most often a congenital defect. It causes a distinctive murmur and may or may not cause symptoms. The defect may occur alone or with other heart defects that are present at birth. The condition can be mild to severe. Pulmonary valve stenosis is a rare disorder, but in some cases the problem runs in families. The cause is unknown, but genes may play a role. Pulmonary valve stenosis may also be due to rheumatic heart disease or a malignant carcinoid tumor. Both stenosis of the pulmonary artery and pulmonary valve stenosis are causes of pulmonic stenosis.

    When the valve narrowing (stenosis) is moderate to severe, the symptoms includ abdominal distention, bluish color to the skin (cyanosis), chest pain, fainting, fatigue, poor weight gain or failure to thrive in infants with a severe blockage, shortness of breath, sudden death. Symptoms may get worse with exercise of activity.

    pulmonary valve stenosis


    DIAGNOSIS

    Pulmonary stenosis is usually first diagnosed in childhood. A heart murmur may be heard when listening to the heart using a stethoscope. Murmurs are blowing, whoosing or rasping sounds heard during a heartbeat. Tests used ot diagnose pulmonary stenosis may include cardiac catheterization, ECG, Echocardiogram, Chest x-ray, or MRI of the heart. The severity of the valve stenosis will be graded to plan treatment.

    pulmonary stenosis


    TREATMENT

    If the condition is mild, treatment may not be needed. When there are also other heart defects, medications may be used to help blood flow through the heart (prostaglandins), help the heart beat stronger, prevent clotting (anticoagulants), remove excess fluid (diuretics), and to treat abnormal heartbeats and rhythms.

    Percutaneous balloon pulmonary dilation (valvuloplasty) may be performed when no other defects are present. This procedure is done through an artery in the groin. A flexible tube (catheter) is sent with a balloon attached to the heart. Diagnostic imaging is used to help guide the catheter. The balloon stretches the opening of the valve.

    Surgery may be indicated for some individuals to repair or replace the pulmonary valve. The new valve can be made from different materials. If the valve cannot be repaired or replaced, other procedures may be needed.

    People with mild disease rarely get worse. However, those with moderate to severe disease will get worse. The outcome is often very good when surgery or balloon dilation is successful. Other congenital heart defects may be a factor in the final outlook. Most ofetn the new valves can last for decades. However, some will wear out and need replacement. Complications include abnormal heartbeats (arrhythmias), heart failure and enlargement of the right side of the heart, lealking of blood back into the right ventricle (pulmonary regurgitation) after repair. and death. If you have been treated or have untreated pulmonary valve stenosis and have developed swelling of the ankles, legs, or abdomen, difficulty breathing, or other symptoms, contact your health care provider.

    FOR MORE DETAILED INFORMATION

    Wikipedia: Pulmonic Stenosis
    Wikipedia: Pulmonary Valve Stenosis
    MayoClinic: Pulmonary Valve Stenosis
    American Heart Asso: Pulmonary Valve Stenosis
    MedlinePlus: Pulmonary Valve Stenosis





    RHEUMATIC HEART DISEASE

    Rheumatic heart disease is damage to the heart caused by rheumatic fever, a complication of infection with group A streptococcus bacteria, the bacteria that causes strep throat and scarlet fever, both of which can progress into rheumatic fever. It causes scarring and contracture of heart valves (e.g., mitral valve stenosis), and can lead to arrhythmias and heart failure.

    rheumatic fever heart valve


    Rheumatic fever is an inflammatory disease that can involve heart, joints, skin, and brain. The disease typically develops 2 to 4 weeks after a throat infection. Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and a characteristic but uncommon non-itchy rash known as erythema marginatum. The heart is involved in about half of cases. Permanent damage to the hear valves, known as rheumatic heart disease (RHD), usually only occurs after multiple attacks but may occasionally occur after a single case of acute rheumatic fever. The damaged valves may result in heart failure. The abnormal valves also increase the risk of the person developing atrial fibrillation and infection of the valves. Acute rheumatic fever may occur following the infection of the throat by the bacteria Streptococcus pyogenes (group A streptococcus).

    rheumatic mitral valve stenosis


    Scarlet fever is an infectious disease which most commonly affects children. Signs and symptoms include sore throat,fever, and a characteristic red rash. Scarlet fever is usually spread by inhalation. There is no vaccine, but the disease is effectively treated with antibiotics. Most of the clinical features associated with scarlet fever are caused by erythrogenic toxin, a substance produced by the bacterium Streptococcus pyrogenes (group A streptococcus) when it is infected by a certain bacteriophage. Before the availability of antibiotics, scarlet fever was a major cause of death. It also sometimes caused late complications, such as kidney problems (glomerulonephritis) and endocarditis leading to heart valve disease, all of which were protracted and often fatal afflictions at the time. Strains of group A streptococcus that produce the erythrogenic toxin are not inherently more dangerous than other strains that do not, they are merely more easily diagnosed because of the characteristic rash.

    FOR MORE DETAILED INFORMATION

    MoonDragon's Health & Wellness: Rheumatic Fever
    Wikipedia: Rheumatic Fever & Rheumatic Heart Disease
    Texas Heart Institute: Rheumatic Fever
    Cardiac Matters: Rheumatic Heart Disease
    Wikipedia: Scarlet Fever
    MedicineNet: Scarlet Fever (Scarlatina)





    STRESS TEST (CARDIAC STRESS TEST)

    A stress test (also known as Exercise Electrocardiogram Test, Physiologic Stress Test, Graded Exercise Test, Exercise Cardiac Stress Test, Cardiac Stress Test, Exercise Treadmill Test, Treadmill Test, Exercise Electrocardiography, ETT), is a diagnostic test used to assess blood flow to the heart.

    The cardiac stress test or cardiac diagnostic test is a test used in medicine and cardiology to measure the heart's ability to respond to external stress in a controlled clinical environment. The stress response is done with heart stimulation, either induced by exercise on a treadmil, pedalling a stationary exercise bicycle ergometer, or with intravenous pharmacological drug stimulation, with the patient connected to an electrocardiogram (ECG). People who cannot use their legs may exercise with a bicycle-like crank that they can turn with their arms. The level of mechanical stress is progressively increased by adjusting the difficulty (steepness of the slope) and speed. The test administrator or attending health care provider examines the symptoms and blood pressure response. With use of ECG, the test is most commonly called a cardiac stress test, but is known by many other names.

    Cardiac stress tests compare the coronary circulation while the patient is at rest with the same patient's circulation observed during maximum physical exertion, showing any abnormal blood flow to the heart's muscle tissue (they myocardium). The results can be interpreted as a reflection on the general physical condition of the test patient. This test can be used to diagnose ischemic heart disease, and for patient prognosis after a heart attack (myocardial infarction).

    cardiac stress test


    TAKING THE TESTS

    A person taking the test is hooked up to equipment to monitor the heart. He walks slowly in place on a treadmill. Then the speed is increased for a faster pace and the treadmill is tilted to produce the effect of going up a small hill. He may be asked to breathe into a tube for a couple of minutes and he can stop the test at any time if needed. Afterwards he will sit or lie down to have their heart and blood pressure checked. Heart rate, breathing, blood pressure, electrocardiogram (ECG or EKG), and how tired the patient feels are monitored during the test.

    A nuclear stress test may be given. The first part of the test involves the injection of a radioactive imaging substance into the arm. About an hour later, the heart is photographed. In the second part of the test, an intravenous line is placed in the arm and EKG reading is taken as the patient walks on a treadmill. When the heart is working at its hardest, the first part of the test is repeated. Also known as a myocardial perfusion stress test.

    THALLIUM STRESS TEST

    This is a type of nuclear scanning test or myocardial perfusion imaging test. It shows how well blood flows to the heart muscle. It's usually done along with an exercise stress test on a treadmill or bicycle.The thallium stress test is useful to determine:
    • Extent of a coronary artery blockage.
    • Prognosis of patients who have suffered a heart attack.
    • Effectiveness of cardiac procedures done to improve circulation in coronary arteries.
    • Cause(s) of chest pain.
    • Level of exercise that a patient can safely perform.

    When the patient reaches his or her maximum level of exercise, a small amount of a radioactive substance called thallium is injected into the bloodstream. Then the patient lies down on a special table under a camera ("gamma camera") that can see the thallium and make pictures. The thallium mixes with the blood in the bloodstream and heart's arteries and enters heart muscle cells. If a part of the heart muscle does not receive a normal blood supply, less than a normal amount of thallium will be in those heart muscle cells. The first pictures are made shortly after the exercise test and show blood flow to the heart during exercise. The heart is "stressed" during the exercise test - thus the name "stress test." The patient then lies quietly for 2 to 3 hours and another series of pictures is made. These show blood flow to the heart muscle during rest.

    If the test is normal during both exercise and rest, then blood flow through the coronary arteries is normal. The coronary arteries supply blood to the heart muscle. If the test shows that perfusion (blood flow) is normal during rest but not during exercise (a perfusion defect), then the heart is not getting enough blood when it must work harder than normal. This may be due to a blockage in one or more coronary arteries. If the test is abnormal during both exercise and rest, there's limited blood flow to that part of the heart at all times. If no thallium is seen in some part of the heart muscle, the cells in this part of the heart are dead from a prior heart attack. (They have become scar tissue.)

    Sometimes you cannot do an exercise test because you are too sick or have physical problems. In this case, a drug such as dipyridamole or adenosine is given. This drug increases blood flow to the heart and thus "mimics" an exercise test. Then the thallium test is given.

    FOR MORE DETAILED INFORMATION

    WebMD: Exercise Electrocardiogram
    AmericanHeart.org: Exercise Stress Test
    WebMD: Heart Disease & Stress Test
    MayoClinic: Nuclear Stress Test
    Wikipedia: Cardiac Stress Test





    STROKE

    A stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult (CVI), or brain attack, is when poor blood flow or an interruption of blood flow to the brain results in cell death. There are two main types of stroke, ischemic and hemorrhagic. Both result in part of the brain not functioning properly.

    stoke types


    BASIC TYPES OF STROKE

  • A hemorrhagic stroke occurs when there is bleeding in the brain. An intra cranial hemorrhage is the accumulation of blood anywhere within the cranial vault. The main types of intracranial hemorrhage are epidural hematoma (bleeding between the dura mater and the skull), subdural hematoma (in the subdural space) and subarachnoid hemorrhage (between the arachnoid mater and the pia matter). A cerebral hemorrhage is bleeding within the brain tissue. A cerebral hemorrhage can be due to either intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system). Most of the hemorrhagic stroke syndromes have specific symptoms particularly headaches, or have evidence of a previous head injury. Loss of consciousness, headache, and vomiting usually occurs more often in hemorrhage stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing the brain.

  • An ischemic stroke, which is more common, is caused by a clot that forms in a blood vessel that supplies the brain, or a clot that moves from another part of the body to the brain. When the blood supply is decreased, it leads to dysfunction of the brain tissue in that area. There are four reasons why this might happen:
    • Thrombosis (obstruction of a blood vessel by a blood clot forming locally).
    • Embolism (obstruction due to an embolus from elsewhere in the body).
    • Systemic hypoperfusion (general decrease in blood supply, as in shock.
    • Venous thrombosis.
    Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin), this constitutes 30 to 40 percent of all ischemic strokes.

    SIGNS & SYMPTOMS

    Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of vision to one side, among others. Sudden-onset face weakness, arm drift (a person raising both arms involuntarily lets one arm drift downward) and abnormal speech are the most likely indications of a stroke. When all three of these are absent, the likelihood of stroke is significantly decreased. FAST (face, arms, speech, and time) is a proposed assessment guideline system. These indications are not perfect for diagnosing a stroke, however the fact that they can be evaluated relatively rapidly and easily make them a very valuable assessment in an acute setting.

    Signs and symptoms often appear soon after the stroke has occurred, typically starting suddenly, over seconds to minutes, and in most cases do not progress further. If symptoms last less than one or two hours, it is known as a transient ischemic attack (TIA). The more extensive the area of brain affected, the more functions that are likely to be lost. Some forms of strok can cause additional symptoms. For example, in intracranial hemorrhage, the affected area may compress other structures. Hemorrhagic strokes may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia or loss of bladder control. Most forms of stroke are not associated with headache, apart from subarachnoid hemorrhage and cerebral venous thrombosis and occasionally intracerebral hemorrhage.

    RISK FACTORS

    The main risk factor for stroke is high blood pressure. Other risk factors include tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, and atrial fibrillation among others. Useres of stimulant drugs such as cocaine and methamphetamine are at a high risk of ischemic strokes. An ischemic stroke is typically caused by blockage of a blood vessel. A hemorrhagic stroke is caused by bleeding either directly into the brain or into the space surround the brain. Bleeding may occur due to a brain aneurysm. Diagnosis is typically with medical imaging such as a CT scan or MRI scan along with a physical exam. Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and rule out other possible causes. Low blood sugar may cause similar symptoms. About half of people who have had a stroke live less than one year. Overall, two-thirds of strokes occurred in those over 65 years old.

    PREVENTION & TREATMENT

    Prevention includes decreasing risk factors as well as possibly aspirin, statins, surgery to open up the arteries to the brain in those with problematic narrowing, and warfarin in those with atrial fibrillation. A stroke often requires emergency care. An ischemic stroke, if detected within three to four and half hours, may be treatable with a medication that can break down the clot. Aspirin should be used. Some hemorrhagic strokes benefit from surgery. Treatment to try recover lost function is called stroke rehabilitation and ideally takes place in a stroke unit; however, these are not available in much of the world.

    FOR MORE DETAILED INFORMATION

    MoonDragon's Health & Wellness: Stroke
    Wikipedia: Stroke
    National Stroke Association: Information on Stroke Prevention, Recovery & Care
    MedlinePlus: Stroke
    American Stroke Association
    Stroke & Assisted Living: Caring For Those Of All Ages Who Have Suffered From A Stroke





    THROMBOSIS

    Thrombosis is the formation of a clot in a blood vessel. There are both superficial and deep veins in the limbs or extremities (hands, arms, legs, and feet). A blood clot in the deep veins is a concern because it can be dangerous. A tendency to form blood clots can occur when people are immobile, have a blood tendency toward clotting, or have injury to veins or their adjacent tissues.

    Deep vein thrombosis, or deep venous thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein, predominantly in the legs. DVT often develops in the calf veins and "grows" in the direction of venous flow, towards the heart. When DVT does not grow, it can be cleared naturally and dissolved into the blood (fibrinolysis). Veins in the calf or thigh are most commonly affected, including the femoral vein, the popliteal vein, and the iliofemoral vein (as with May-Thurner syndrome). Extensive lower-extremity DVT can reach into the iliac vein of the pelvis or the inferior vena cava. Occasionally the veins of the arm are affected (as after central venous catheter placement and with the rare Paget-Schrotter disease).

    SYMPTOMS

    Symptoms of deep vein thrombosis include pain, swelling, warmth, tenderness, and redness of the leg or arm. Leg swelling generally occurs because of the abnormal accumulation of fluid in the tissues of the lower extremity. Symptoms that can be associated with leg swelling include leg pain, numbness, redness, itching, rash, shortness of breath, and ulceration of the skin.

    CLOTTING MECHANISM

    The mechanism behind arterial thrombosis, such as with heart attacks, is more established than the steps that cause venous thrombosis. With arterial thrombosis, blood vessel wall damage is required, as it initiates coagulation, but clotting in the veins mostly occurs without any such damage. The beginning of venous thrombosis is thought to be caused by tissue factor, which leads to conversion of prothrombin to thrombin, followed by fibrin deposition. Red blood cells and fibrin are the main components of venous thrombi, and the fibrin appears to attach to the blood vessel wall lining (endothelium), a surface that normally acts to prevent clottin. Platelets and white blood cells are also components. Platelets are not as prominent in venous clots as they are in arterial ones, but they may play a role. Inflammation is associated with VTE, and white blood cells play a role in the formation and resolution of venous clots. Non-specific signs may include pain, swelling, redness, warmness, and engorged superficial veins.

    Often DVT begins in the valves of veins. The blood flow pattern in the valves can cause low oxygen concentrations in the blood (hypoxemia) of a valve sinus. Hypoxemia, which is worsened by venous stasis, activates pathways - ones that include hypoxia-inducible factor -1 and early-growth-response protein 1. Hypoxemia also results in the production of reactive oxygen species, which can activate these pathways, as well as nuclear factor-kB, which regulates hypoxia-inducable factor-1 transcription. Hypoxia-inducible factor-1 and early-growth-response protein 1 contribute to monocyte association with endothelial proteins, such as P-selectin, prompting monocyts to release tissue factor-filled microvesicles, which presumably begin clotting after binding to the endothelial surface.

    There are other types of thrombosis such as cerebral venous thrombosis (CVT), portal vein thrombosis, and cavernous sinus thrombosis.

    DIAGNOSIS

    The diagnosis of DVT can be suggested by blood tests and confirmed by ultrasound or other imaging tests.

    TREATMENT

    Treatment of DVT typically involves blood thinning medications (anticoagulants) unless they cannot be used in a patient (contraindicated). In that situation, and inferior vena cava filter is potentially considered.

    COMPLICATIONS

    A blood clot in the deep venous system of the leg becomes dangerous when a piece of the blood clot breaks off (embolus, plural- emboli), travels downstream through the heart into the pulmonary circulation system and becomes lodged in the lung. Pulmonary embolism (PE), a potentially life-threatening complication, is caused by the detachment (embolization) of a clot that travels to the lungs. Together, DVT and pulmonary embolism constitute a single disease process known as venous thromboembolism. Post-thrombic syndrome, another complication, significantly contributes to the health care cost of DVT.

    PREVENTION

    Prevention options for at-risk individuals include early and frequent walking, calf exercises, anticoagulants, aspirin, graduated compression stockings, and intermittent pneumatic compression.

    FOR MORE DETAILED INFORMATION

    MoonDragon's Health & Wellness: Thrombophlebitis
    MedicineNet: Deep Vein Thrombosis
    Wikipedia: Deep Vein Thrombosis
    MayoClinic: Deep Vein Thrombosis
    WebMD: Deep Vein Thrombosis (DVT)





    TROPONIN T TESTS

    TROPONIN TESTS

    Troponin Tests are also known as Cardiac-specific Troponin I and Troponin T, TnI, TnT, cTnI, and cTnT. Troponin T and Troponin I are proteins found in heart muscle and are released into the blood when there is damage to the heart. Troponin elevation following cardiac cell necrosis starts within 2 to 3 hours, peaks in approximately 24 hours, and persists for 1 to 2 weeks.

    Troponin tests are primarily ordered to help diagnose a heart attack and rule out other conditions with similar signs and symptoms. Either a troponin I or troponin T test can be performed; usually a laboratory will offer one test or the other. The concentrations are different, but they basically provide the same information. Troponin tests are also sometimes used to evaluate people for heart injury due to causes other than a heart attack or to distinguish signs and symptoms such as chest pain that may be due to other causes. Testing may also be done to evaluate people with angina if their signs and symptoms worsen.

    Troponin tests are sometimes ordered along with other cardiac biomarkers, such as CK-MB or myoglobin. However, troponin is the preferred test for a suspected heart attack because it is more specific for heart injury than other tests (which may be elevated in the blood with skeletal muscle injury) and remain elevated for a longer period of time.

    A troponin test will usually be ordered when a person with a suspected heart attack first comes into the emergency room, followed by a series of troponin tests performed over several hours. A heart attack may be suspected and testing done when a person has signs and symptoms such as those listed below. Note that not everyone will experience chest pain, and women are more likely than men to have sign and symptoms that are not typical.
    • Chest pain, discomfort and/or pressure (most common).
    • Rapid heart rate, skipping a beat.
    • Shortness of breath and/or difficulty breathing.
    • Fatigue; undue fatigue.
    • Nausea, vomiting.
    • Cold sweat.
    • Lightheaded.
    • Pain in other places: back, arm, jaw, neck, or stomach.
    In people with stable angina, a troponin test may be ordered when:
    • Symptoms worsen.
    • Symptoms occur when a person is at rest.
    • Symptoms are no longer eased with treatment.

    These are all signs that the angina is becoming unstable, which increases the risk of a heart attack or other serious heart problem in the near future.

    Troponin T Test


    TROPONIN T TEST

    Troponin T Test is a blood test that can detect damage to heart muscle from a heart attack. The Troponin T Test assesses levels of the protein troponin T, which is released into the bloodstream after a heart attack. This test can detect even the mildest "silent" heart attack.

    When myocardial infarction is suspected, every minute counts. The TROPT sensitive rapid assay allows rapid determination of the cardiac marker troponin T from a whole blood sample. A qualitative result is available within minutes - saving you precious time in emergency situations. Troponin T is highly cardiac specific.

    Chest pain or suspected "heart attack" is one of the more common medical emergencies and prompt diagnosis is essential. TROPT sensitive is most suitable for the rapid diagnosis of myocardial infarction. Patients with acute coronary syndromes can be diagnosed according to the release of a biochemical marker of myocardial necrosis. In the absence of characteristic ECG changes, a positive TROPT sensitive rapid assay clearly establishes the diagnosis of non-ST, non-Q wave myocardial infarction (NSTEMI) which can be treated immediately and effectively.

    TROPININ TEST RESULTS

    A high troponin and even slight elevations may indicate some degree of damage to the heart. When a person has significantly elevated troponin levels and, in particular, a rise in the results from a series of tests done over several hours, then it is likely that the person has had a heart attack or some other form of damage to the heart. Levels of troponin can become elevated in the blood within 3 or 4 hours after heart injury and may remain elevated for 10 to 14 days.

    In people with angina, an elevated troponin may indicate that their condition is worsening and they are at increased risk of a heart attack.

    Troponin levels may also be elevated with other heart conditions such as myocarditis (heart inflammation), weakening of the heart (cardiomyopathy), or congestive heart failure, and with conditions unrelated to the heart, such as severe infections and kidney disease.

    Normal troponin values in a series of measurements over several hours means that it is unlikely that a person's heart has been injured. Signs and symptoms may be due to a cause unrelated to the heart.

    Because troponin tests are measuring cardiac muscle-specific troponin, the test is not affected by damage to skeletal muscles, so injections, accidents, and drugs that can damage muscle do not affect cardiac troponin levels. Troponin may rise following strenuous exercise, although in the absence of signs and symptoms of heart disease, it is usually of no medical significance.

    Increased troponin levels should not be used by themselves to diagnose or rule out a heart attack. A physical exam, clinical history, and ECG are also important. Your healthcare provider may also need to see whether the troponin levels from a series of tests are stably elevated or show a rise over several hours. Very rarely, people who have a heart attack will have normal troponin concentrations, and some people with increased troponin concentrations have no apparent heart injury.

    A Note About Reference Ranges: Reference values are frequently dependent on many factors, including patient age, sex, sample population, and test method, and numeric test results can have different meanings in different labs. For these reasons, there is no reference range given here. The lab report containing your test results should include the specific reference range for your test(s). Consult with your health care provider or the laboratory that performed the test(s) to obtain the reference range if you do not have the lab report.

    FOR MORE DETAILED INFORMATION

    Wikipedia: Troponin
    AmericanHeartAsso: How To Interpret Elevated Cardiac Troponin Levels
    MayoMedicalLabs: Troponin T Test Clinical Information
    MedlinePlus: Troponin Test
    Lab Tests Online: Troponin: The Test




    HEALTHY CHOLESTEROL & BLOOD PRESSURE LEVELS

    CARDIOVASCULAR GUIDELINES

    Two important measurements used in assessing cardiovascular health are blood fat (including cholesterol and triglycerides) levels and blood pressure. The tables below are approximate guides to both cholesterol and blood pressure levels. Keep in mind that both levels vary from person to person, so it is always recommended to have your blood pressure and cholesterol level checked by your health care provider on a regular basis. Also not that the values here reflect recent revisions in desirable levels.



    CHOLESTEROL & TRIGLYCERIDE LEVELS
    For People Without Heart Disease (mg/dL)

    BLOOD LIPID
    GOOD
    BORDERLINE
    HIGH
    Total Cholesterol
    200 or Less
    200 to 239
    240 and Above
    LDL Cholesterol
    ("Bad Cholesterol")
    130 or Less
    130 to 159
    160 and Above
    Triglycerides
    150 or Less
    150 to 199
    200 and Above

  • The desirable level of HDL cholesterol ("good cholesterol") is 60 mg/dL or above.


  • BLOOD PRESSURE LEVELS
    For People Without Heart Disease (HT=Hypertension)

    BLOOD PRESSURE
    GOOD
    NORMAL
    BORDERLINE
    HIGH
    Systolic
    (When the heart contracts
    and pumps blood out.)
    120 or Less
    120 to130
    131 to 140
    141 and Above
    Diastolic
    (Between beats, as your heart
    fills with blood again.)
    80 or Less
    80 to 85
    86 to 90
    91 and Above
    BLOOD PRESSURE
    NORMAL
    PRE-HT
    STAGE 1 HT
    STAGE 2 HT
    Systolic
    (When the heart contracts
    and pumps blood out.)
    120 or Less
    120 to 139
    140 to 159
    160 and Higher
    Diastolic
    (Between beats, as your heart
    fills with blood again.)
    80 or Less
    80 to 89
    90 to 99
    100 and Higher






    CARDIOVASCULAR & RELATED LINKS

    MoonDragon's Health & Wellness Disorders: The Circulatory System
    MoonDragon's Health & Wellness Disorders: Cardiovascular Problems
    MoonDragon's Health & Wellness Disorders: Cardiac Nutrition
    MoonDragon's Health & Wellness Disorders: The Cardiovascular System
    MoonDragon's Health & Wellness Disorders: Atherosclerosis & Arteriosclerosis
    MoonDragon's Health & Wellness Disorders: Heart Attack
    MoonDragon's Health & Wellness Disorders: Heartburn
    MoonDragon's Health & Wellness Disorders: Hemophilia
    MoonDragon's Health & Wellness Disorders: High Cholesterol
    MoonDragon's Health & Wellness Disorders: Hypertension (High Blood Pressure)
    MoonDragon's Health & Wellness Disorders: Rheumatic Fever
    MoonDragon's Health & Wellness Disorders: Thrombophlebitis
    MoonDragon's Health & Wellness Disorders: Varicose Veins
    MoonDragon's Health & Wellness: Hypothyroidism
    MoonDragon's Health & Wellness: Raynaud's Phenomenon
    MoonDragon's Health Care: Cardiovascular Patient Care
    MoonDragon's Health care: CPR - Adult One Rescuer
    MoonDragon's Health Care: CPR - Adult Two Rescuers
    MoonDragon's Health Care: CPR (Cardiopulmonary Resuscitation) Complications
    MedLib.com: Heart Sounds
    MedStudents.com: Cardiology Heart Sounds Wave Files
    MoonDragon's Nutrition Information: Diet Index
    MoonDragon's Women's Health: Smoking
    MoonDragon's Health Therapy: Biofeedback






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    AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES


    Allspice Leaf Oil
    Angelica Oil
    Anise Oil
    Baobab Oil
    Basil Oil
    Bay Laurel Oil
    Bay Oil
    Benzoin Oil
    Bergamot Oil
    Black Pepper Oil
    Chamomile (German) Oil
    Cajuput Oil
    Calamus Oil
    Camphor (White) Oil
    Caraway Oil
    Cardamom Oil
    Carrot Seed Oil
    Catnip Oil
    Cedarwood Oil
    Chamomile Oil
    Cinnamon Oil
    Citronella Oil
    Clary-Sage Oil
    Clove Oil
    Coriander Oil
    Cypress Oil
    Dill Oil
    Eucalyptus Oil
    Fennel Oil
    Fir Needle Oil
    Frankincense Oil
    Geranium Oil
    German Chamomile Oil
    Ginger Oil
    Grapefruit Oil
    Helichrysum Oil
    Hyssop Oil
    Iris-Root Oil
    Jasmine Oil
    Juniper Oil
    Labdanum Oil
    Lavender Oil
    Lemon-Balm Oil
    Lemongrass Oil
    Lemon Oil
    Lime Oil
    Longleaf-Pine Oil
    Mandarin Oil
    Marjoram Oil
    Mimosa Oil
    Myrrh Oil
    Myrtle Oil
    Neroli Oil
    Niaouli Oil
    Nutmeg Oil
    Orange Oil
    Oregano Oil
    Palmarosa Oil
    Patchouli Oil
    Peppermint Oil
    Peru-Balsam Oil
    Petitgrain Oil
    Pine-Long Leaf Oil
    Pine-Needle Oil
    Pine-Swiss Oil
    Rosemary Oil
    Rose Oil
    Rosewood Oil
    Sage Oil
    Sandalwood Oil
    Savory Oil
    Spearmint Oil
    Spikenard Oil
    Swiss-Pine Oil
    Tangerine Oil
    Tea-Tree Oil
    Thyme Oil
    Vanilla Oil
    Verbena Oil
    Vetiver Oil
    Violet Oil
    White-Camphor Oil
    Yarrow Oil
    Ylang-Ylang Oil
    Aromatherapy
    Healing Baths For Colds
    Aromatherapy
    Herbal Cleansers
    Using Essential Oils


    AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES


    Almond, Sweet Oil
    Apricot Kernel Oil
    Argan Oil
    Arnica Oil
    Avocado Oil
    Baobab Oil
    Black Cumin Oil
    Black Currant Oil
    Black Seed Oil
    Borage Seed Oil
    Calendula Oil
    Camelina Oil
    Castor Oil
    Coconut Oil
    Comfrey Oil
    Evening Primrose Oil
    Flaxseed Oil
    Grapeseed Oil
    Hazelnut Oil
    Hemp Seed Oil
    Jojoba Oil
    Kukui Nut Oil
    Macadamia Nut Oil
    Meadowfoam Seed Oil
    Mullein Oil
    Neem Oil
    Olive Oil
    Palm Oil
    Plantain Oil
    Plum Kernel Oil
    Poke Root Oil
    Pomegranate Seed Oil
    Pumpkin Seed Oil
    Rosehip Seed Oil
    Safflower Oil
    Sea Buckthorn Oil
    Sesame Seed Oil
    Shea Nut Oil
    Soybean Oil
    St. Johns Wort Oil
    Sunflower Oil
    Tamanu Oil
    Vitamin E Oil
    Wheat Germ Oil





    HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS

  • MoonDragon's Nutrition Basics Index
  • MoonDragon's Nutrition Basics: Amino Acids Index
  • MoonDragon's Nutrition Basics: Antioxidants Index
  • MoonDragon's Nutrition Basics: Enzymes Information
  • MoonDragon's Nutrition Basics: Herbs Index
  • MoonDragon's Nutrition Basics: Homeopathics Index
  • MoonDragon's Nutrition Basics: Hydrosols Index
  • MoonDragon's Nutrition Basics: Minerals Index
  • MoonDragon's Nutrition Basics: Mineral Introduction
  • MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index
  • MoonDragon's Nutrition Basics: Dietary Supplements Introduction
  • MoonDragon's Nutrition Basics: Specialty Supplements
  • MoonDragon's Nutrition Basics: Vitamins Index
  • MoonDragon's Nutrition Basics: Vitamins Introduction


  • NUTRITION BASICS ARTICLES

  • MoonDragon's Nutrition Basics: 4 Basic Nutrients
  • MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients
  • MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute?
  • MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods
  • MoonDragon's Nutrition Basics: Foods That Destroy
  • MoonDragon's Nutrition Basics: Foods That Heal
  • MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals
  • MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods
  • MoonDragon's Nutrition Basics: Phytochemicals
  • MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce
  • MoonDragon's Nutrition Basics: Limit Your Use of Salt
  • MoonDragon's Nutrition Basics: Use Proper Cooking Utensils
  • MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water





  • RELATED MOONDRAGON HEALTH LINKS & INFORMATION

  • MoonDragon's Nutrition Information Index
  • MoonDragon's Nutritional Therapy Index
  • MoonDragon's Nutritional Analysis Index
  • MoonDragon's Nutritional Diet Index
  • MoonDragon's Nutritional Recipe Index
  • MoonDragon's Nutrition Therapy: Preparing Produce for Juicing
  • MoonDragon's Nutrition Information: Food Additives Index
  • MoonDragon's Nutrition Information: Food Safety Links
  • MoonDragon's Aromatherapy Index
  • MoonDragon's Aromatherapy Articles
  • MoonDragon's Aromatherapy For Back Pain
  • MoonDragon's Aromatherapy For Labor & Birth
  • MoonDragon's Aromatherapy Blending Chart
  • MoonDragon's Aromatherapy Essential Oil Details
  • MoonDragon's Aromatherapy Links
  • MoonDragon's Aromatherapy For Miscarriage
  • MoonDragon's Aromatherapy For Post Partum
  • MoonDragon's Aromatherapy For Childbearing
  • MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing
  • MoonDragon's Aromatherapy Chart of Essential Oils #1
  • MoonDragon's Aromatherapy Chart of Essential Oils #2
  • MoonDragon's Aromatherapy Tips
  • MoonDragon's Aromatherapy Uses
  • MoonDragon's Alternative Health Index
  • MoonDragon's Alternative Health Information Overview
  • MoonDragon's Alternative Health Therapy Index
  • MoonDragon's Alternative Health: Touch & Movement Therapies Index
  • MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy
  • MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy
  • MoonDragon's Alternative Health: Therapeutic Massage
  • MoonDragon's Holistic Health Links Page 1
  • MoonDragon's Holistic Health Links Page 2
  • MoonDragon's Health & Wellness: Nutrition Basics Index
  • MoonDragon's Health & Wellness: Therapy Index
  • MoonDragon's Health & Wellness: Massage Therapy
  • MoonDragon's Health & Wellness: Hydrotherapy
  • MoonDragon's Health & Wellness: Pain Control Therapy
  • MoonDragon's Health & Wellness: Relaxation Therapy
  • MoonDragon's Health & Wellness: Steam Inhalation Therapy
  • MoonDragon's Health & Wellness: Therapy - Herbal Oils Index







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    MOONDRAGON'S REALM - WEBSITE DIRECTORY


    A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.




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