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Sunday, June 7, 2009
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Aortic Insufficiency




ALSO KNOWN AS

Aortic regurgitation

DESCRIPTION

* The heart pumps blood from the left ventricle (left lower chamber) of the heart to the rest of the body by way of a large blood vessel known as the aorta. The aortic valve, located between the left ventricle and the aorta, opens when the ventricle pumps blood to the aorta, and closes (passively) when at rest (i.e., between heartbeats). If the valve leaflets are damaged or fail to close properly, blood leaks back from the aorta into the left ventricle between heartbeats. This is known as aortic regurgitation.



SYMPTOMS

* Usually none until age 40-50
* Fatigue
* Shortness of breath on exertion
* Shortness of breath while resting prone
* Chest pain
* Lightheadedness



CAUSE

* Congenital bicuspid aortic valve (person is born with only two aortic valve leaflets, instead of the normal three)
* Rheumatic heart disease (caused by untreated "strep throat" in childhood)
* Hypertension
* Infective endocarditis
* Marfan's Syndrome
* Ankylosing Spondylitis
* Reiter's Syndrome
* Aortic Dissection
* Syphilis

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HOW THE DIAGNOSIS IS MADE

* Chronic (slow onset) aortic regurgitation, e.g., rheumatic heart disease --

1. Decreased diastolic blood pressure
2. Wide pulse pressure (large difference between systolic and diastolic)
3. Pulse has a rapid rise and fall (known as a Corrigan's pulse)
4. Diastolic murmur over a partially compressed femoral artery
5. Nail bed capillaries show pulsations
6. Apical heart impulse is prominent
7. Heart reveals a high-pitched decrescendo (decreasing in loudness) diastolic murmur in the aortic area. An Austin Flint murmur may be present (low-pitched, mid or late diastolic murmur).
8. Electrocardiogram shows left ventricular hypertrophy
9. Chest X-Rays shows an enlarged heart (cardiomegaly)

* Acute aortic regurgitation, e.g., infective endocarditis --

1. Sudden onset of aortic regurgitation murmur
2. Lungs may reveal crackles of Pulmonary Edema

* Echocardiogram -- reveals the valve abnormality, and Doppler studies show the degree of regurgitation.
* Scintigraphic studies can asses left ventricular function
* Cardiac catheterization is often helpful

TREATMENT

* Chronic --

1. Vasodilator medications such as ACE inhibitors, hydralazine, and nifedipine can decrease the severity of the regurgitation.
2. Beta-blocker medications may slow progression in those with Marfan's Syndrome.
3. Surgical valve replacement in those with symptoms or significant left ventricular dysfunction

* Acute --

- Usually caused by infective endocarditis -- surgical replacement of the valve is usually needed. Vasodilators may temporarily stabilize the condition.

IF YOU SUSPECT THIS CONDITION

* Acute aortic regurgitation -- this is a life-threatening medical condition. Seek immediate emergency medical treatment.
* Chronic aortic regurgitation -- this condition needs to be followed carefully by your physician. A cardiologist is often consulted.

MISCELLANEOUS

* Special Consideration

- Persons with aortic regurgitation should have antibiotic prophylaxis to prevent infective endocarditis. This includes dental, respiratory, esophageal, gastrointestinal, and genitourinary procedures.


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Aortic Dissection


Abnormal
Normal

DESCRIPTION

* The aorta is the large artery that carries blood from the heart to the rest of the body. Anatomically, it arches over the heart, down the back of the chest cavity, into the abdomen. Though the wall of the aorta is thick, a tear may occur in the wall. Tears generally start from the inside and burrow downward. A tear in the aorta is called an aortic dissection. Aortic dissections are classified into two types, based on the location of the tear: If the tear is high in the aorta (ascending aorta and the arch) it is called Type A; lower (descending aorta), it is called Type B.




SYMPTOMS

* Sudden onset of severe chest pain
* Pain radiates down arms or into neck
* Sweating
* Loss of consciousness
* Shortness of breath
* Weakness
* Ripping/tearing pain in the back or chest


CAUSE

* A tear in the internal layer of the aorta that extends down the wall, creating a false lumen.
* Possibly, injuries during catheterization

HOW THE DIAGNOSIS IS MADE

* Examination:

1. Diminished pulses in wrists and/or legs/feet
2. Wide pulse pressure
3. Low or High Blood Pressure
4. Heart murmur
5. Lung crackles

* Electrocardiogram may show left ventricular hypertrophy. It may show myocardial ischemia (decreased blood to heart) if dissection extends into coronary blood vessels.
* Imaging:

1. Chest X-Rays show abnormal aortic contour or widened mediastinum (center cavity of chest) -- a widened area where the aorta is normally narrower
2. CT scan
3. MRI
4. Angiography (dye is injected into the aorta and X-Rays taken)
5. Transesophageal Echocardiography (ultrasound of heart done by passing a scope into the esophagus)



RISK FACTORS

* Long-standing High Blood Pressure
* Age
* Bicuspid aortic valve
* Aortic coarctation
* Pregnancy
* Marfan's Syndrome (a genetic disorder that results in a defect in components that make up wall structure of the aorta)
* Ehlers-Danlos syndrome
* Cardiac surgery
* Trauma to the chest
* Cocaine abuse

TREATMENT

* Medications:

1. Intravenous beta blockers decrease shear force and blood pressure
2. Intravenous nitroprusside to lower blood pressure

* Surgery:

Replacement of torn aorta with an artificial graft

* Note: Type A dissections nearly always need surgery, whereas Type B is generally managed with medications.

IF YOU SUSPECT THIS CONDITION

* You need emergency medical treatment. The death rate for untreated aortic dissection is 20% in the first day, and 90% over 3 months.

PREVENTION

* One of the major causes of aortic dissection is untreated High Blood Pressure. Proper monitoring and use of blood pressure medications will prevent aortic dissection in most cases.

SIMILAR CONDITIONS

* Myocardial Infarction
* Angina pectoris
* Aortic aneurysm
* Pulmonary Embolism
* Marfan's Syndrome


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Anxiety

DESCRIPTION

* Generalized anxiety is very common. Most people experience periods of anxiety in their lives. Others have general anxiety most of the time. The latter condition generally begins between 20-35 years of age, and is somewhat more common in women.



SYMPTOMS

* Apprehension
* Worry
* Dizziness
* Sweating
* Trembling
* Tense feeling
* Vigilance
* Irritability
* Other body systems may be involved, with the resulting possible symptoms:



1. Headaches, including migraines
2. Heart racing
3. Tightness or pressure in the chest
4. Increased blood pressure
5. Stomach pain and acid feeling
6. Indigestion
7. Hyperventilation or rapid, shallow breathing
8. Choking sensation
9. Tingling sensation

CAUSE

* Genetic predisposition, psychological stressors (e.g., social, cultural, and major significant events), neurochemical abnormalities, e.g., serotonin, GABA (gamma aminobutyric acid), and other brain chemicals may all play a role.

HOW THW DIAGNOSIS IS MADE

* Rule out other causes, such as thyroid problems, e.g., Pheochromocytoma

TREATMENT

* Biofeedback
* Regular exercise/ meditation and stress reduction techniques (e.g., deep breathing).
* Psychotherapy counseling
* Medications:

1. Buspar
2. Paxil and other calming anti-depressants
3. Benzodiazepines such as Xanax, used cautiously due to addicting potential

SIMILAR CONDITIONS

* Post traumatic stress disorder
* Social phobia
* Use of or withdrawal from drugs such as caffeine, amphetamines, cocaine, and alcohol
* Asthma and other lung problems
* Metabolic and hormonal problems such as Hyperthyroidism, Cushing's disease, Pheochromocytoma, and hypoglycemia.
* Neurological problems, such as essential tremors
* Panic Disorder
* Depression
* Obsessive-compulsive disorder
* Hyperthyroidism





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Anosmia

ALSO KNOWN AS

Smelling difficulties

DESCRIPTION

* Smelling problems occur either because of obstruction or injury of nasal passages, or due to problems with neurological processing. There are multiple causes, as listed below.



CAUSE

* Aging
* Nasal Obstruction
* Allergies
* Sinusitis
* Viral Rhinitis (Cold)
* nasal polyps
* Nasal tumors
* Brain/Head tumors
* Head trauma
* Diabetes Mellitus
* Hypothyroidism
* Cushing's Syndrome
* Nutritional problems
* Anxiety disorders
* Lead Poisoning
* Prolonged use of nasal decongestants
* Medications e.g. estrogen, phenothiazines
* Drugs such as amphetamines (speed)
* Cocaine abuse (nasally inhaled)
* Parkinson's Disease
* Alzheimer's disease
* Korsakoff's Psychosis
* Vitamin B12 Deficiency
* Zinc deficiency
* Kallmann's syndrome



TREATMENT

* Treat the underlying cause
* For sudden neurosensory loss (neurosensory system is not working properly for unknown reason) -- Zinc and Vitamin A replacement may be tried




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