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Who is at risk for Primary Ciliary Dyskinesia? ?
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Primary ciliary dyskinesia (PCD) is a rare disease that affects both males and females. The disease also affects people from all racial and ethnic groups.
Some people who have PCD have breathing problems from the moment of birth. However, other people can go through all or most of their lives without knowing that they have the disease.
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Primary Ciliary Dyskinesia
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What are the symptoms of Primary Ciliary Dyskinesia ?
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Primary ciliary dyskinesia (PCD) mainly affects the sinuses, ears, and lungs. One sign that you might have PCD is if you have chronic (ongoing) infections in one or more of these areas. Common signs, symptoms, and complications linked to PCD include the following:
Sinuses: - Chronic nasal congestion - Runny nose with mucus and pus discharge - Chronic sinus infections
Chronic nasal congestion
Runny nose with mucus and pus discharge
Chronic sinus infections
Ears: - Chronic middle ear infections - Hearing loss
Chronic middle ear infections
Hearing loss
Lungs: - Respiratory distress (breathing problems) in newborns - Chronic cough - Recurrent pneumonia - Collapse of part or all of a lung
Respiratory distress (breathing problems) in newborns
Chronic cough
Recurrent pneumonia
Collapse of part or all of a lung
PCD also can cause fertility problems in men and women. "Fertility" refers to the ability to have children. In men, PCD can affect cilia-like structures that help sperm cells move. Because the sperm cells don't move well, men who have the disease usually are unable to father children.
Fertility problems also occur in some women who have PCD. These problems likely are due to faulty cilia in the fallopian tubes. (The fallopian tubes carry eggs from the ovaries to the uterus.)
About half of all people who have PCD have Kartagener's syndrome. This syndrome involves three disorders: chronic sinusitis (si-nu-SI-tis), bronchiectasis (brong-ke-EK-tah-sis), and situs inversus.
Chronic sinusitis is a condition in which the sinuses are infected or inflamed. The sinuses are hollow air spaces around the nasal passages.
Bronchiectasis is a condition in which damage to the airways causes them to widen and become flabby and scarred.
Situs inversus is a condition in which the internal organs (for example, the heart, stomach, spleen, liver, and gallbladder) are in opposite positions from where they normally are.
Situs inversus can occur without PCD. In fact, only 25 percent of people who have the condition also have PCD. By itself, situs inversus may not affect your health. However, in PCD, it's a sign of Kartagener's syndrome.
Some people who have PCD have abnormally placed organs and congenital heart defects.
When Do Symptoms Occur?
The symptoms and severity of PCD vary from person to person. If you or your child has the disease, you may have serious sinus, ear, and/or lung infections. If the disease is mild, it may not show up until the teen or adult years.
The symptoms and severity of PCD also vary over time. Sometimes, you may have few symptoms. Other times, your symptoms may become more severe.
Some people who have PCD have breathing problems when they're born and need extra oxygen for several days. Afterward, airway infections are common.
Diagnosing PCD in children can be hard. This is because some PCD symptomssuch as ear infections, chronic cough, and runny noseare common in children, even if they don't have PCD. Also, the disease may be confused with another condition, such as cystic fibrosis.
A correct and early diagnosis of PCD is very important. It will allow you or your child to get the proper treatment to keep your airways and lungs as healthy as possible. An early diagnosis and proper treatment also can prevent or delay ongoing and long-term lung damage.
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Primary Ciliary Dyskinesia
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How to diagnose Primary Ciliary Dyskinesia ?
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Your doctor or your child's doctor will diagnose primary ciliary dyskinesia (PCD) based on signs and symptoms and test results.
If your primary care doctor thinks that you may have PCD or another lung disorder, he or she may refer you to a pulmonologist. This is a doctor who specializes in diagnosing and treating lung diseases and conditions.
Signs and Symptoms
Your doctor will look for signs and symptoms that point to PCD, such as:
Respiratory distress (breathing problems) at birth
Chronic sinus, middle ear, and/or lung infections
Situs inversus (internal organs in positions opposite of what is normal)
For more information, go to "What Are the Signs and Symptoms of Primary Ciliary Dyskinesia?"
Your doctor also may ask whether you have a family history of PCD. PCD is an inherited disease. "Inherited" means the disease is passed from parents to children through genes. A family history of PCD suggests an increased risk for the disease.
Diagnostic Tests
If the doctor thinks that you or your child might have PCD, he or she may recommend tests to confirm the diagnosis.
Genetic Testing
Researchers have found many gene defects associated with PCD. Genetic testing can show whether you have faulty genes linked to the disease.
Genetic testing is done using a blood sample. The sample is taken from a vein in your body using a needle. The blood sample is checked at a special genetic testing laboratory (lab).
Electron Microscopy
Doctors can use a special microscope, called an electron microscope, to look at samples of your airway cilia. This test can show whether your cilia are faulty.
An ear, nose, and throat (ENT) specialist or a pulmonologist (lung specialist) will take samples of your cilia. He or she will brush the inside of your nose or remove some cells from your airways.
The doctor will send the samples to a lab. There, a pathologist will look at them under an electron microscope. (A pathologist is a doctor who specializes in identifying diseases by studying cells and tissues under a microscope.)
Other Tests
Sometimes doctors use one or more of the following tests to help diagnose PCD. These tests are less complex than genetic testing and electron microscopy, and they can be done in a doctor's office.
However, these tests don't give a final diagnosis. Based on the test results, doctors may recommend the more complex tests.
Video microscopy. For this test, a pulmonologist brushes the inside of your nose to get a sample of cilia. Then, he or she looks at the cilia under a microscope to see how they move. Abnormal movement of the cilia may be a sign of PCD.
Radiolabeled particles. For this test, you breathe in tiny particles that have a small amount of radiation attached to them. When you breathe out, your doctor will test how well your cilia can move the particles.
If you breathe out a smaller than normal number of particles, your cilia may not be working well. This could be a sign of PCD.
Nasal nitric oxide. This test measures the level of nitric oxide (a gas) when you breathe out. In people who have PCD, the level of nitric oxide is very low compared with normal levels. Doctors don't know why people who have PCD breathe out such low levels of nitric oxide.
Semen analysis. This test is used for adult men. In men, PCD can affect cilia-like structures that help sperm cells move. As a result, men who have PCD may have fertility problems. ("Fertility" refers to the ability to have children.)
For this test, a sample of semen is checked under a microscope. Abnormal sperm may be a sign of PCD.
Tests for other conditions. Your doctor also might want to do tests to rule out diseases and disorders that have symptoms similar to those of PCD. For example, you may have tests to rule out cystic fibrosis or immune disorders.
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Primary Ciliary Dyskinesia
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What are the treatments for Primary Ciliary Dyskinesia ?
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Unfortunately, no treatment is available yet to fix faulty airway cilia. (Cilia are tiny, hair-like structures that line the airways.) Thus, treatment for primary ciliary dyskinesia (PCD) focuses on which symptoms and complications you have.
The main goals of treating PCD are to:
Control and treat lung, sinus, and ear infections
Remove trapped mucus from the lungs and airways
Specialists Involved
Many doctors may help care for someone who has PCD. For example, a neonatologist may suspect PCD or another lung disorder if a newborn has breathing problems at birth. A neonatologist is a doctor who specializes in treating newborns.
A pediatrician may suspect PCD if a child has chronic (ongoing) sinus, ear, and/or lung infections. A pediatrician is a doctor who specializes in treating children. This type of doctor provides children with ongoing care from an early age and treats conditions such as ear infections and breathing problems.
An otolaryngologist also may help diagnose and treat PCD. This type of doctor treats ear, nose, and throat disorders and also is called an ear, nose, and throat (ENT) specialist. If a child has chronic sinus or ear infections, an ENT specialist may be involved in the child's care.
A pulmonologist may help diagnose or treat lung problems related to PCD. This type of doctor specializes in diagnosing and treating lung diseases and conditions. Most people who have PCD have lung problems at some point in their lives.
A pathologist is a doctor who specializes in identifying diseases by studying cells and tissues under a microscope. This type of doctor may help diagnose PCD by looking at cilia under a microscope.
A pathologist also may look at mucus samples to see what types of bacteria are causing infections. This information can help your doctor decide which treatments to prescribe.
Treatments for Breathing and Lung Problems
Standard treatments for breathing and lung problems in people who have PCD are chest physical therapy (CPT), exercise, and medicines.
One of the main goals of these treatments is to get you to cough. Coughing clears mucus from the airways, which is important for people who have PCD. For this reason, your doctor also may advise you to avoid medicines that suppress coughing.
Chest Physical Therapy
CPT also is called chest clapping or percussion. It involves pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so that you can cough it up.
You might sit down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.
Some people find CPT hard or uncomfortable to do. Several devices have been made to help with CPT, such as:
An electric chest clapper, known as a mechanical percussor.
An inflatable therapy vest that uses high-frequency airwaves. The airwaves force the mucus that's deep in your lungs toward your upper airways so you can cough it up.
A small hand-held device that you breathe out through. The device causes vibrations that dislodge the mucus.
A mask that creates vibrations to help break the mucus loose from your airway walls.
Breathing techniques also may help dislodge mucus so you can cough it up. These techniques include forcing out a couple of short breaths or deeper breaths and then doing relaxed breathing. This may help loosen the mucus in your lungs and open your airways.
Exercise
Aerobic exercise that makes you breathe harder helps loosen the mucus in your airways so you can cough it up. Exercise also helps improve your overall physical condition.
Talk with your doctor about what types and amounts of exercise are safe for you or your child.
Medicines
If you have PCD, your doctor may prescribe antibiotics, bronchodilators, or anti-inflammatory medicines. These medicines help treat lung infections, open up the airways, and reduce swelling.
Antibiotics are the main treatment to prevent or treat lung infections. Your doctor may prescribe oral or intravenous (IV) antibiotics.
Oral antibiotics often are used to treat mild lung infections. For severe or hard-to-treat infections, you may be given IV antibiotics through a tube inserted into a vein.
To help decide which antibiotics you need, your doctor may send mucus samples to a pathologist. The pathologist will try to find out which bacteria are causing the infection.
Bronchodilators help open the airways by relaxing the muscles around them. You inhale these medicines. Often, they're taken just before CPT to help clear mucus from your lungs. You also may take bronchodilators before inhaling other medicines into your lungs.
Anti-inflammatory medicines can help reduce swelling in your airways that's caused by ongoing infections. These medicines may be inhaled or oral.
Treatments for Sinus and Ear Infections
To treat infections, your doctor may recommend saline nasal washes and anti-inflammatory nasal spray. If these treatments aren't enough, you may need medicines, such as antibiotics. If antibiotics don't work, surgery may be an option.
Tympanostomy (tim-pan-OS-toe-me) is a procedure in which small tubes are inserted into the eardrums to help drain mucus from the ears. This procedure may help children who have hearing problems caused by PCD.
Nasal or sinus surgery may help drain the sinuses and provide short-term relief of symptoms. However, the long-term benefits of this treatment are unclear.
Treatments for Advanced Lung Disease
People who have PCD may develop a serious lung condition called bronchiectasis. This condition often is treated with medicines, hydration (drinking plenty of fluids), and CPT.
If bronchiectasis severely affects part of your lung, surgery may be used to remove that area of lung.
In very rare cases, if other treatments haven't worked, lung transplant may be an option for severe lung disease. A lung transplant is surgery to remove a person's diseased lung and replace it with a healthy lung from a deceased donor.
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Primary Ciliary Dyskinesia
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What is (are) Pulmonary Embolism ?
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Pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE, is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg.
A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus (EM-bo-lus).
PE is a serious condition that can:
Damage part of your lung because of a lack of blood flow to your lung tissue. This damage may lead to pulmonary hypertension (increased pressure in the pulmonary arteries).
Cause low oxygen levels in your blood.
Damage other organs in your body because of a lack of oxygen.
If a blood clot is large, or if there are many clots, PE can cause death.
Overview
PE most often is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the bodymost often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery.
Deep vein clots are not like clots in veins close to the skin's surface. Those clots remain in place and do not cause PE.
Outlook
The exact number of people affected by DVT and PE isn't known. Estimates suggest these conditions affect 300,000 to 600,000 people in the United States each year.
If left untreated, about 30 percent of patients who have PE will die. Most of those who die do so within the first few hours of the event.
The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE.
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Pulmonary Embolism
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What causes Pulmonary Embolism ?
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Major Causes
Pulmonary embolism (PE) usually begins as a blood clot in a deep vein of the leg. This condition is called deep vein thrombosis. The clot can break free, travel through the bloodstream to the lungs, and block an artery.
The animation below shows how a blood clot from a deep vein in the leg can travel to the lungs, causing pulmonary embolism. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
Blood clots can form in the deep veins of the legs if blood flow is restricted and slows down. This can happen if you don't move around for long periods, such as:
After some types of surgery
During a long trip in a car or airplane
If you must stay in bed for an extended time
Blood clots are more likely to develop in veins damaged from surgery or injured in other ways.
Other Causes
Rarely, an air bubble, part of a tumor, or other tissue travels to the lungs and causes PE. Also, if a large bone in the body (such as the thigh bone) breaks, fat from the bone marrow can travel through the blood. If the fat reaches the lungs, it can cause PE
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Pulmonary Embolism
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Who is at risk for Pulmonary Embolism? ?
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Pulmonary embolism (PE) occurs equally in men and women. The risk increases with age. For every 10 years after age 60, the risk of having PE doubles.
Certain inherited conditions, such as factor V Leiden, increase the risk of blood clotting and PE.
Major Risk Factors
Your risk for PE is high if you have deep vein thrombosis (DVT) or a history of DVT. In DVT, blood clots form in the deep veins of the bodymost often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery.
Your risk for PE also is high if you've had the condition before.
Other Risk Factors
Other factors also can increase the risk for PE, such as:
Being bedridden or unable to move around much
Having surgery or breaking a bone (the risk goes up in the weeks following the surgery or injury)
Having certain diseases or conditions, such as a stroke, paralysis (an inability to move), chronic heart disease, or high blood pressure
Smoking
People who have recently been treated for cancer or who have a central venous catheter are more likely to develop DVT, which increases their risk for PE. A central venous catheter is a tube placed in a vein to allow easy access to the bloodstream for medical treatment.
Other risk factors for DVT include sitting for long periods (such as during long car or airplane rides), pregnancy and the 6-week period after pregnancy, and being overweight or obese. Women who take hormone therapy pills or birth control pills also are at increased risk for DVT.
The risk of developing blood clots increases as your number of risk factors increases.
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Pulmonary Embolism
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What are the symptoms of Pulmonary Embolism ?
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Major Signs and Symptoms
Signs and symptoms of pulmonary embolism (PE) include unexplained shortness of breath, problems breathing, chest pain, coughing, or coughing up blood. An arrhythmia (irregular heartbeat) also may suggest that you have PE.
Sometimes the only signs and symptoms are related to deep vein thrombosis (DVT). These include swelling of the leg or along a vein in the leg, pain or tenderness in the leg, a feeling of increased warmth in the area of the leg that's swollen or tender, and red or discolored skin on the affected leg.
See your doctor right away if you have any signs or symptoms of PE or DVT. It's also possible to have PE and not have any signs or symptoms.
Other Signs and Symptoms
Some people who have PE have feelings of anxiety or dread, light-headedness or fainting, rapid breathing, sweating, or an increased heart rate.
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Pulmonary Embolism
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How to diagnose Pulmonary Embolism ?
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Pulmonary embolism (PE) is diagnosed based on your medical history, a physical exam, and test results.
Doctors who treat patients in the emergency room often are the ones to diagnose PE with the help of a radiologist. A radiologist is a doctor who deals with x rays and other similar tests.
Medical History and Physical Exam
To diagnose PE, the doctor will ask about your medical history. He or she will want to:
Find out your deep vein thrombosis (DVT) and PE risk factors
See how likely it is that you could have PE
Rule out other possible causes for your symptoms
Your doctor also will do a physical exam. During the exam, he or she will check your legs for signs of DVT. He or she also will check your blood pressure and your heart and lungs.
Diagnostic Tests
Many tests can help diagnose PE. Which tests you have will depend on how you feel when you get to the hospital, your risk factors, available testing options, and other conditions you could possibly have. You may have one or more of the following tests.
Ultrasound
Doctors can use ultrasound to look for blood clots in your legs. Ultrasound uses sound waves to check blood flow in your veins.
For this test, gel is put on the skin of your legs. A hand-held device called a transducer is moved back and forth over the affected areas. The transducer gives off ultrasound waves and detects their echoes as they bounce off the vein walls and blood cells.
A computer turns the echoes into a picture on a computer screen, allowing the doctor to see blood flow in your legs. If the doctor finds blood clots in the deep veins of your legs, he or she will recommend treatment.
DVT and PE both are treated with the same medicines.
Computed Tomography Scans
Doctors can use computed tomography (to-MOG-rah-fee) scans, or CT scans, to look for blood clots in the lungs and legs.
For this test, dye is injected into a vein in your arm. The dye makes the blood vessels in your lungs and legs show up on x-ray images. You'll lie on a table, and an x-ray tube will rotate around you. The tube will take pictures from many angles.
This test allows doctors to detect most cases of PE. The test only takes a few minutes. Results are available shortly after the scan is done.
Lung Ventilation/Perfusion Scan
A lung ventilation/perfusion scan, or VQ scan, uses a radioactive substance to show how well oxygen and blood are flowing to all areas of your lungs. This test can help detect PE.
Pulmonary Angiography
Pulmonary angiography (an-jee-OG-rah-fee) is another test used to diagnose PE. This test isn't available at all hospitals, and a trained specialist must do the test.
For this test, a flexible tube called a catheter is threaded through the groin (upper thigh) or arm to the blood vessels in the lungs. Dye is injected into the blood vessels through the catheter.
X-ray pictures are taken to show blood flowing through the blood vessels in the lungs. If a blood clot is found, your doctor may use the catheter to remove it or deliver medicine to dissolve it.
Blood Tests
Certain blood tests may help your doctor find out whether you're likely to have PE.
A D-dimer test measures a substance in the blood that's released when a blood clot breaks down. High levels of the substance may mean a clot is present. If your test is normal and you have few risk factors, PE isn't likely.
Other blood tests check for inherited disorders that cause blood clots. Blood tests also can measure the amount of oxygen and carbon dioxide in your blood. A clot in a blood vessel in your lungs may lower the level of oxygen in your blood.
Other Tests
To rule out other possible causes of your symptoms, your doctor may use one or more of the following tests.
Echocardiography (echo). This test uses sound waves to create a moving picture of your heart. Doctors use echo to check heart function and detect blood clots inside the heart.
EKG (electrocardiogram). An EKG is a simple, painless test that detects and records the heart's electrical activity.
Chest x ray. This test creates pictures of your lungs, heart, large arteries, ribs, and diaphragm (the muscle below your lungs).
Chest MRI (magnetic resonance imaging). This test uses radio waves and magnetic fields to create pictures of organs and structures inside the body. MRI often can provide more information than an x ray.
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Pulmonary Embolism
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What are the treatments for Pulmonary Embolism ?
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Pulmonary embolism (PE) is treated with medicines, procedures, and other therapies. The main goals of treating PE are to stop the blood clot from getting bigger and keep new clots from forming.
Treatment may include medicines to thin the blood and slow its ability to clot. If your symptoms are life threatening, your doctor may give you medicine to quickly dissolve the clot. Rarely, your doctor may use surgery or another procedure to remove the clot.
Medicines
Anticoagulants (AN-te-ko-AG-u-lants), or blood thinners, decrease your blood's ability to clot. They're used to stop blood clots from getting larger and prevent clots from forming. Blood thinners don't break up blood clots that have already formed. (The body dissolves most clots with time.)
You can take blood thinners as either a pill, an injection, or through a needle or tube inserted into a vein (called intravenous, or IV, injection). Warfarin is given as a pill. (Coumadin is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube.
Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once warfarin starts to work, heparin usually is stopped.
Pregnant women usually are treated with heparin only, because warfarin is dangerous for the pregnancy.
If you have deep vein thrombosis, treatment with blood thinners usually lasts for 3 to 6months. If you've had blood clots before, you may need a longer period of treatment. If you're being treated for another illness, such as cancer, you may need to take blood thinners as long as PE risk factors are present.
The most common side effect of blood thinners is bleeding. This can happen if the medicine thins your blood too much. This side effect can be life threatening.
Sometimes the bleeding is internal, which is why people treated with blood thinners usually have routine blood tests. These tests, called PT and PTT tests, measure the blood's ability to clot. These tests also help your doctor make sure you're taking the right amount of medicine. Call your doctor right away if you're bruising or bleeding easily.
Thrombin inhibitors are a newer type of blood-thinning medicine. They're used to treat some types of blood clots in people who can't take heparin.
Emergency Treatment
When PE is life threatening, a doctor may use treatments that remove or break up the blood clot. These treatments are given in an emergency room or hospital.
Thrombolytics (THROM-bo-LIT-iks) are medicines that can quickly dissolve a blood clot. They're used to treat large clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.
Sometimes a doctor may use a catheter (a flexible tube) to reach the blood clot. The catheter is inserted into a vein in the groin (upper thigh) or arm and threaded to the clot in the lung. The doctor may use the catheter to remove the clot or deliver medicine to dissolve it.
Rarely, surgery may be needed to remove the blood clot.
Other Types of Treatment
If you can't take medicines to thin your blood, or if the medicines don't work, your doctor may suggest a vena cava filter. This device keeps blood clots from traveling to your lungs.
The filter is inserted inside a large vein called the inferior vena cava. (This vein carries blood from the body back to the heart). The filter catches clots before they travel to the lungs. This type of treatment can prevent PE, but it won't stop other blood clots from forming.
Graduated compression stockings can reduce the chronic (ongoing) swelling that a blood clot in the leg may cause.
Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the ankle and become looser as they go up the leg. This causes gentle compression (pressure) up the leg. The pressure keeps blood from pooling and clotting.
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Pulmonary Embolism
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How to prevent Pulmonary Embolism ?
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Preventing pulmonary embolism (PE) begins with preventing deep vein thrombosis (DVT). Knowing whether you're at risk for DVT and taking steps to lower your risk are important.
Exercise your lower leg muscles if you're sitting for a long time while traveling.
Get out of bed and move around as soon as you're able after having surgery or being ill. The sooner you move around, the better your chance is of avoiding a blood clot.
Take medicines to prevent clots after some types of surgery (as your doctor prescribes).
Follow up with your doctor.
If you've already had DVT or PE, you can take more steps to prevent new blood clots from forming. Visit your doctor for regular checkups. Also, use compression stockings to prevent chronic (ongoing) swelling in your legs from DVT (as your doctor advises).
Contact your doctor right away if you have any signs or symptoms of DVT or PE.
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Pulmonary Embolism
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What is (are) Sleep Apnea ?
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Espaol
Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They may occur 30times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, youll often move out of deep sleep and into light sleep.
As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.
Overview
Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, no blood test can help diagnose the condition.
Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea.
The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses.
When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea.
The animation below shows how obstructive sleep apnea occurs. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
The animation shows how the airway can collapse and block air flow to the lungs, causing sleep apnea.
Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of your brain that controls your breathing doesn't send the correct signals to your breathing muscles. As a result, you'll make no effort to breathe for brief periods.
Central sleep apnea can affect anyone. However, it's more common in people who have certain medical conditions or use certain medicines.
Central sleep apnea can occur with obstructive sleep apnea or alone. Snoring typically doesn't happen with central sleep apnea.
This article mainly focuses on obstructive sleep apnea.
Outlook
Untreated sleep apnea can:
Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes
Increase the risk of, or worsen, heart failure
Make arrhythmias (ah-RITH-me-ahs), or irregular heartbeats, more likely
Increase the chance of having work-related or driving accidents
Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, surgery, and breathing devices can successfully treat sleep apnea in many people.
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Sleep Apnea
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What causes Sleep Apnea ?
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When you're awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles relax, which narrows your throat.
Normally, this narrowing doesnt prevent air from flowing into and out of your lungs. But if you have sleep apnea, your airway can become partially or fully blocked because:
Your throat muscles and tongue relax more than normal.
Your tongue and tonsils (tissue masses in the back of your mouth) are large compared with the opening into your windpipe.
You're overweight. The extra soft fat tissue can thicken the wall of the windpipe. This narrows the inside of the windpipe, which makes it harder to keep open.
The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
The aging process limits your brain signals' ability to keep your throat muscles stiff during sleep. Thus, your airway is more likely to narrow or collapse.
Not enough air flows into your lungs if your airway is partially or fully blocked during sleep. As a result, loud snoring and a drop in your blood oxygen level can occur.
If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breathing then starts again, often with a loud snort or choking sound.
Frequent drops in your blood oxygen level and reduced sleep quality can trigger the release of stress hormones. These hormones raise your heart rate and increase your risk for high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats). The hormones also can raise your risk for, or worsen, heart failure.
Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obesity and diabetes.
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Sleep Apnea
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Who is at risk for Sleep Apnea? ?
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Obstructive sleep apnea is a common condition. About half of the people who have this condition are overweight.
Men are more likely than women to have sleep apnea. Although the condition can occur at any age, the risk increases as you get older. A family history of sleep apnea also increases your risk for the condition.
People who have small airways in their noses, throats, or mouths are more likely to have sleep apnea. Small airways might be due to the shape of these structures or allergies or other conditions that cause congestion.
Small children might have enlarged tonsil tissues in their throats. Enlarged tonsil tissues raise a childs risk for sleep apnea. Overweight children also might be at increased risk for sleep apnea.
About half of the people who have sleep apnea also have high blood pressure. Sleep apnea also is linked to smoking, metabolic syndrome, diabetes, and risk factors for stroke and heart failure.
Race and ethnicity might play a role in the risk of developing sleep apnea. However, more research is needed.
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Sleep Apnea
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What are the symptoms of Sleep Apnea ?
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Major Signs and Symptoms
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder.
You're asleep when the snoring or gasping happens. You likely won't know that you're having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will notice these problems before you do.
Not everyone who snores has sleep apnea.
Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active. Even if you don't have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.
Other Signs and Symptoms
Others signs and symptoms of sleep apnea include:
Morning headaches
Memory or learning problems and not being able to concentrate
Feeling irritable, depressed, or having mood swings or personality changes
Waking up frequently to urinate
Dry mouth or sore throat when you wake up
In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day.
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Sleep Apnea
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How to diagnose Sleep Apnea ?
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Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Your primary care doctor may evaluate your symptoms first. He or she will then decide whether you need to see a sleep specialist.
Sleep specialists are doctors who diagnose and treat people who have sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.
Medical and Family Histories
If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment.
Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder.
You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's "Your Guide to Healthy Sleep."
At your appointment, your doctor will ask you questions about how you sleep and how you function during the day.
Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them.
Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.
Many people aren't aware of their symptoms and aren't diagnosed.
If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.
Physical Exam
Your doctor will check your mouth, nose, and throat for extra or large tissues. Children who have sleep apnea might have enlarged tonsils. Doctors may need only a physical exam and medical history to diagnose sleep apnea in children.
Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.
Sleep Studies
Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea.
There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (poly-SOM-no-gram; also called a PSG) or a home-based portable monitor.
Polysomnogram
A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure.
A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe.
PSGs often are done at sleep centers or sleep labs. The test is painless. You'll go to sleep as usual, except you'll have sensors attached to your scalp, face, chest, limbs, and a finger. The staff at the sleep center will use the sensors to check on you throughout the night.
A sleep specialist will review the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment.
Your doctor also may use a PSG to find the best setting for you on a CPAP (continuous positive airway pressure) machine. CPAP is the most common treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your airway open while you sleep.
If your doctor thinks that you have sleep apnea, he or she may schedule a split-night sleep study. During the first half of the night, your sleep will be checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is.
If the PSG shows that you have sleep apnea, youll use a CPAP machine during the second half of the split-night study. The staff at the sleep center will adjust the flow of air from the CPAP machine to find the setting that works best for you.
Home-Based Portable Monitor
Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG. For example, it may record:
The amount of oxygen in your blood
Air movement through your nose while you breathe
Your heart rate
Chest movements that show whether you're making an effort to breathe
A sleep specialist may use the results from a home-based sleep test to help diagnose sleep apnea. He or she also may use the results to decide whether you need a full PSG study in a sleep center.
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Sleep Apnea
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What are the treatments for Sleep Apnea ?
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Sleep apnea is treated with lifestyle changes, mouthpieces, breathing devices, and surgery. Medicines typically aren't used to treat the condition.
The goals of treating sleep apnea are to:
Restore regular breathing during sleep
Relieve symptoms such as loud snoring and daytime sleepiness
Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease,stroke, and diabetes.
If you have sleep apnea, talk with your doctor or sleep specialist about the treatment options that will work best for you.
Lifestyle changes and/or mouthpieces may relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.
If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you're getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and teens need more. For more information, go to the Health Topics Sleep Deprivation and Deficiency article.)
If treatment and enough sleep don't relieve your daytime sleepiness, your doctor will consider other treatment options.
Lifestyle Changes
If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.
Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
Mouthpieces
A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.
A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.
If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.
Breathing Devices
CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose.
The machine gently blows air into your throat. The pressure from the air helps keep your airway open while you sleep.
Treating sleep apnea may help you stop snoring. But not snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Your sleep apnea will return if you stop using your CPAP machine or dont use it correctly.
Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's prescription. After the initial setup, you may need to have the CPAP adjusted from time to time for the best results.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn't adjusted properly, you may get stomach bloating and discomfort while wearing the mask.
If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce the side effects.
For example, the CPAP settings or size/fit of the mask might need to be adjusted. Adding moisture to the air as it flows through the mask or using nasal spray can help relieve a dry, stuffy, or runny nose.
There are many types of CPAP machines and masks. Tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different type that might work better for you.
People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
Surgery
Some people who have sleep apnea might benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.
Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
Surgery to shrink or stiffen excess tissue is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. You may need a series of treatments to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a piece of stiff plastic.
Surgery to remove excess tissue is done in a hospital. You're given medicine to help you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.
Surgery to remove the tonsils, if they're blocking the airway, might be helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.
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Sleep Apnea
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What is (are) Respiratory Failure ?
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Respiratory (RES-pih-rah-tor-e) failure is a condition in which not enough oxygen passes from your lungs into your blood. Your body's organs, such as your heart and brain, need oxygen-rich blood to work well.
Respiratory failure also can occur if your lungs can't properly remove carbon dioxide (a waste gas) from your blood. Too much carbon dioxide in your blood can harm your body's organs.
Both of these problemsa low oxygen level and a high carbon dioxide level in the bloodcan occur at the same time.
Diseases and conditions that affect your breathing can cause respiratory failure. Examples include COPD (chronic obstructive pulmonary disease) and spinal cord injuries. COPD prevents enough air from flowing in and out of the airways. Spinal cord injuries can damage the nerves that control breathing.
Overview
To understand respiratory failure, it helps to understand how the lungs work. When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries run through the walls of the air sacs. When air reaches the air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the air sacs. This process is called gas exchange.
In respiratory failure, gas exchange is impaired.
Respiratory failure can be acute (short term) or chronic (ongoing). Acute respiratory failure can develop quickly and may require emergency treatment. Chronic respiratory failure develops more slowly and lasts longer.
Signs and symptoms of respiratory failure may include shortness of breath, rapid breathing, and air hunger (feeling like you can't breathe in enough air). In severe cases, signs and symptoms may include a bluish color on your skin, lips, and fingernails; confusion; and sleepiness.
One of the main goals of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition.
Acute respiratory failure usually is treated in an intensive care unit. Chronic respiratory failure can be treated at home or at a long-term care center.
Outlook
The outlook for respiratory failure depends on the severity of its underlying cause, how quickly treatment begins, and your overall health.
People who have severe lung diseases may need long-term or ongoing breathing support, such as oxygen therapy or the help of a ventilator (VEN-til-a-tor). A ventilator is a machine that supports breathing. It blows airor air with increased amounts of oxygeninto your airways and then your lungs.
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Respiratory Failure
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What causes Respiratory Failure ?
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Diseases and conditions that impair breathing can cause respiratory failure. These disorders may affect the muscles, nerves, bones, or tissues that support breathing, or they may affect the lungs directly.
When breathing is impaired, your lungs can't easily move oxygen into your blood and remove carbon dioxide from your blood (gas exchange). This can cause a low oxygen level or high carbon dioxide level, or both, in your blood.
Respiratory failure can occur as a result of:
Conditions that affect the nerves and muscles that control breathing. Examples include muscular dystrophy, amyotrophic lateral sclerosis (ALS), spinal cord injuries, and stroke.
Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
Problems with the spine, such as scoliosis (a curve in the spine). This condition can affect the bones and muscles used for breathing.
Drug or alcohol overdose. An overdose affects the area of the brain that controls breathing. During an overdose, breathing becomes slow and shallow.
Lung diseases and conditions, such as COPD (chronic obstructive pulmonary disease), pneumonia, ARDS (acute respiratory distress syndrome), pulmonary embolism, and cystic fibrosis. These diseases and conditions can affect the flow of air and blood into and out of your lungs. ARDS and pneumonia affect gas exchange in the air sacs.
Acute lung injuries. For example, inhaling harmful fumes or smoke can injure your lungs.
Normal Lungs and Conditions Causing Respiratory Failure
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Respiratory Failure
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Who is at risk for Respiratory Failure? ?
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People who have diseases or conditions that affect the muscles, nerves, bones, or tissues that support breathing are at risk for respiratory failure. People who have lung diseases or conditions also are at risk for respiratory failure. For more information, go to "What Causes Respiratory Failure?"
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Respiratory Failure
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What are the symptoms of Respiratory Failure ?
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The signs and symptoms of respiratory failure depend on its underlying cause and the levels of oxygen and carbon dioxide in the blood.
A low oxygen level in the blood can cause shortness of breath and air hunger (feeling like you can't breathe in enough air). If the level of oxygen is very low, it also can cause a bluish color on the skin, lips, and fingernails. A high carbon dioxide level can cause rapid breathing and confusion.
Some people who have respiratory failure may become very sleepy or lose consciousness. They also may develop arrhythmias (ah-RITH-me-ahs), or irregular heartbeats. These symptoms can occur if the brain and heart are not getting enough oxygen.
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Respiratory Failure
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How to diagnose Respiratory Failure ?
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Your doctor will diagnose respiratory failure based on your medical history, a physical exam, and test results. Once respiratory failure is diagnosed, your doctor will look for its underlying cause.
Medical History
Your doctor will ask whether you might have or have recently had diseases or conditions that could lead to respiratory failure.
Examples include disorders that affect the muscles, nerves, bones, or tissues that support breathing. Lung diseases and conditions also can cause respiratory failure.
For more information, go to "What Causes Respiratory Failure?"
Physical Exam
During the physical exam, your doctor will look for signs of respiratory failure and its underlying cause.
Respiratory failure can cause shortness of breath, rapid breathing, and air hunger (feeling like you can't breathe in enough air). Using a stethoscope, your doctor can listen to your lungs for abnormal sounds, such as crackling.
Your doctor also may listen to your heart for signs of an arrhythmia (irregular heartbeat). An arrhythmia can occur if your heart doesn't get enough oxygen.
Your doctor might look for a bluish color on your skin, lips, and fingernails. A bluish color means your blood has a low oxygen level.
Respiratory failure also can cause extreme sleepiness and confusion, so your doctor might check how alert you are.
Diagnostic Tests
To check the oxygen and carbon dioxide levels in your blood, you may have:
Pulse oximetry. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood.
Arterial blood gas test. This test measures the oxygen and carbon dioxide levels in your blood. A blood sample is taken from an artery, usually in your wrist. The sample is then sent to a laboratory, where its oxygen and carbon dioxide levels are measured.
A low level of oxygen or a high level of carbon dioxide in the blood (or both) is a possible sign of respiratory failure.
Your doctor may recommend other tests, such as a chest x ray, to help find the underlying cause of respiratory failure. A chest x ray is a painless test that takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.
If your doctor thinks that you have an arrhythmia as a result of respiratory failure, he or she may recommend an EKG (electrocardiogram). An EKG is a simple, painless test that detects and records the heart's electrical activity.
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Respiratory Failure
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What are the treatments for Respiratory Failure ?
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Treatment for respiratory failure depends on whether the condition is acute (short-term) or chronic (ongoing) and its severity. Treatment also depends on the condition's underlying cause.
Acute respiratory failure can be a medical emergency. It often is treated in an intensive care unit at a hospital. Chronic respiratory failure often can be treated at home. If chronic respiratory failure is severe, your doctor may recommend treatment in a long-term care center.
One of the main goals of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition.
Oxygen Therapy and Ventilator Support
If you have respiratory failure, you may receive oxygen therapy. Extra oxygen is given through a nasal cannula (two small plastic tubes, or prongs, that are placed in both nostrils) or through a mask that fits over your nose and mouth.
Oxygen Therapy
Oxygen also can be given through a tracheostomy (TRA-ke-OS-to-me). This is a surgically made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy or trach tube, is placed in the hole to help you breathe.
Tracheostomy
If the oxygen level in your blood doesn't increase, or if you're still having trouble breathing, your doctor may recommend a ventilator. A ventilator is a machine that supports breathing. It blows airor air with increased amounts of oxygeninto your airways and then your lungs.
Ventilator
Your doctor will adjust the ventilator as needed. This will help your lungs get the right amount of oxygen. It also can prevent the machine's pressure from injuring your lungs. You'll use the ventilator until you can breathe on your own.
Other Treatments To Help You Breathe
Noninvasive positive pressure ventilation (NPPV) and a rocking bed are two methods that can help you breathe better while you sleep. These methods are very useful for people who have chronic respiratory failure.
NPPV is a treatment that uses mild air pressure to keep your airways open while you sleep. You wear a mask or other device that fits over your nose or your nose and mouth. A tube connects the mask to a machine, which blows air into the tube.
CPAP (continuous positive airway pressure) is one type of NPPV. For more information, go to the Health Topics CPAP article. Although the article focuses on CPAP treatment for sleep apnea, it explains how CPAP works.
A rocking bed consists of a mattress on a motorized platform. The mattress gently rocks back and forth. When your head rocks down, the organs in your abdomen and your diaphragm (the main muscle used for breathing) slide up, helping you exhale. When your head rocks up, the organs in your abdomen and your diaphragm slide down, helping you inhale.
Fluids
You may be given fluids to improve blood flow throughout your body and to provide nutrition. Your doctor will make sure you get the right amount of fluids.
Too much fluid can fill the lungs and make it hard for you to get the oxygen you need. Not enough fluid can limit the flow of oxygen-rich blood to the body's organs.
Fluids usually are given through an intravenous (IV) line inserted in one of your blood vessels.
Medicines
Your doctor may prescribe medicines to relieve discomfort.
Treatments for the Underlying Cause of Respiratory Failure
Once your doctor figures out what's causing your respiratory failure, he or she will plan how to treat that disease or condition. Treatments may include medicines, procedures, and other therapies.
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Respiratory Failure
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What is (are) Endocarditis ?
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Endocarditis (EN-do-kar-DI-tis) is an infection of the inner lining of the heart chambers and valves. This lining is called the endocardium (en-do-KAR-de-um). The condition also is called infective endocarditis (IE).
The term "endocarditis" also is used to describe an inflammation of the endocardium due to other conditions. This article only discusses endocarditis related to infection.
IE occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. The infection can damage your heart and cause serious and sometimes fatal complications.
IE can develop quickly or slowly; it depends on what type of germ is causing it and whether you have an underlying heart problem. When IE develops quickly, it's called acute infective endocarditis. When it develops slowly, it's called subacute infective endocarditis.
Overview
IE mainly affects people who have:
Damaged or artificial (man-made) heart valves
Congenital heart defects (defects present at birth)
Implanted medical devices in the heart or blood vessels
People who have normal heart valves also can have IE. However, the condition is much more common in people who have abnormal hearts.
Certain factors make it easier for bacteria to enter your bloodstream. These factors put you at higher risk for IE. For example, poor dental hygiene and unhealthy teeth and gums increase your risk for the infection.
Other risk factors include using intravenous (IV) drugs, having a catheter (tube) or another medical device in your body for long periods, and having a history of IE.
Common symptoms of IE are fever and other flu-like symptoms. Because the infection can affect people in different ways, the signs and symptoms vary. IE also can cause problems in many other parts of the body besides the heart.
If you're at high risk for IE, seek medical care if you have signs or symptoms of the infection, especially a fever that persists or unexplained fatigue (tiredness).
Outlook
IE is treated with antibiotics for several weeks. You also may need heart surgery to repair or replace heart valves or remove infected heart tissue.
Most people who are treated with the proper antibiotics recover. But if the infection isn't treated, or if it persists despite treatment (for example, if the bacteria are resistant to antibiotics), it's usually fatal.
If you have signs or symptoms of IE, see your doctor as soon as you can, especially if you have abnormal heart valves.
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Endocarditis
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What causes Endocarditis ?
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Infective endocarditis (IE) occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. Certain factors increase the risk of this happening.
A common underlying factor in IE is a structural heart defect, especially faulty heart valves. Usually your immune system will kill germs in your bloodstream. However, if your heart has a rough lining or abnormal valves, the invading germs can attach and multiply in the heart.
Other factors also can play a role in causing IE. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition.
Having a catheter (tube) or another medical device inserted through your skin, especially for long periods, also can allow bacteria to enter your bloodstream. People who use intravenous (IV) drugs also are at risk for IE because of the germs on needles and syringes.
Bacteria also may spread to the blood and heart from infections in other parts of the body, such as the gut, skin, or genitals.
Endocarditis Complications
As the bacteria or other germs multiply in your heart, they form clumps with other cells and matter found in the blood. These clumps are called vegetations (vej-eh-TA-shuns).
As IE worsens, pieces of the vegetations can break off and travel to almost any other organ or tissue in the body. There, the pieces can block blood flow or cause a new infection. As a result, IE can cause a range of complications.
Heart Complications
Heart problems are the most common complication of IE. They occur in one-third to one-half of all people who have the infection. These problems may include a new heart murmur, heart failure, heart valve damage, heart block, or, rarely, a heart attack.
Central Nervous System Complications
These complications occur in as many as 20 to 40 percent of people who have IE. Central nervous system complications most often occur when bits of the vegetation, called emboli (EM-bo-li), break away and lodge in the brain.
The emboli can cause local infections called brain abscesses. Or, they can cause a more widespread brain infection called meningitis (men-in-JI-tis).
Emboli also can cause strokes or seizures. This happens if they block blood vessels or affect the brain's electrical signals. These complications can cause long-term damage to the brain and may even be fatal.
Complications in Other Organs
IE also can affect other organs in the body, such as the lungs, kidneys, and spleen.
Lungs. The lungs are especially at risk when IE affects the right side of the heart. This is called right-sided infective endocarditis.
A vegetation or blood clot going to the lungs can cause a pulmonary embolism (PE) and lung damage. A PE is a sudden blockage in a lung artery.
Other lung complications include pneumonia and a buildup of fluid or pus around the lungs.
Kidneys. IE can cause kidney abscesses and kidney damage. The infection also can inflame the internal filtering structures of the kidneys.
Signs and symptoms of kidney complications include back or side pain, blood in the urine, or a change in the color or amount of urine. In some cases, IE can cause kidney failure.
Spleen. The spleen is an organ located in the left upper part of the abdomen near the stomach. In some people who have IE, the spleen enlarges (especially in people who have long-term IE). Sometimes emboli also can damage the spleen.
Signs and symptoms of spleen problems include pain or discomfort in the upper left abdomen and/or left shoulder, a feeling of fullness or the inability to eat large meals, and hiccups.
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Endocarditis
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Who is at risk for Endocarditis? ?
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Infective endocarditis (IE) is an uncommon condition that can affect both children and adults. It's more common in men than women.
IE typically affects people who have abnormal hearts or other conditions that put them at risk for the infection. Sometimes IE does affect people who were healthy before the infection.
Major Risk Factors
The germs that cause IE tend to attach and multiply on damaged, malformed, or artificial (man-made) heart valves and implanted medical devices. Certain conditions put you at higher risk for IE. These include:
Congenital heart defects (defects that are present at birth). Examples include a malformed heart or abnormal heart valves.
Artificial heart valves, an implanted medical device in the heart (such as a pacemaker wire), or an intravenous (IV) catheter (tube) in a blood vessel for a long time.
Heart valves damaged by rheumatic fever or calcium deposits that cause age-related valve thickening. Scars in the heart from a previous case of IE also can damage heart valves.
IV drug use, especially if needles are shared or reused, contaminated substances are injected, or the skin isn't properly cleaned before injection.
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Endocarditis
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What are the symptoms of Endocarditis ?
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Infective endocarditis (IE) can cause a range of signs and symptoms that can vary from person to person. Signs and symptoms also can vary over time in the same person.
Signs and symptoms differ depending on whether you have an underlying heart problem, the type of germ causing the infection, and whether you have acute or subacute IE.
Signs and symptoms of IE may include:
Flu-like symptoms, such as fever, chills, fatigue (tiredness), aching muscles and joints, night sweats, and headaches.
Shortness of breath or a cough that won't go away.
A new heart murmur or a change in an existing heart murmur.
Skin changes such as: - Overall paleness. - Small, painful, red or purplish bumps under the skin on the fingers or toes. - Small, dark, painless flat spots on the palms of the hands or the soles of the feet. - Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels.
Overall paleness.
Small, painful, red or purplish bumps under the skin on the fingers or toes.
Small, dark, painless flat spots on the palms of the hands or the soles of the feet.
Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels.
Nausea (feeling sick to your stomach), vomiting, a decrease in appetite, a sense of fullness with discomfort on the upper left side of the abdomen, or weight loss with or without a change in appetite.
Blood in the urine.
Swelling in the feet, legs, or abdomen.
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Endocarditis
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How to diagnose Endocarditis ?
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Your doctor will diagnose infective endocarditis (IE) based on your risk factors, your medical history and signs and symptoms, and test results.
Diagnosis of IE often is based on many factors, rather than a single positive test result, sign, or symptom.
Diagnostic Tests
Blood Tests
Blood cultures are the most important blood tests used to diagnose IE. Blood is drawn several times over a 24-hour period. It's put in special culture bottles that allow bacteria to grow.
Doctors then identify and test the bacteria to see which antibiotics will kill them. Sometimes the blood cultures don't grow any bacteria, even if a person has IE. This is called culture-negative endocarditis, and it requires antibiotic treatment.
Other blood tests also are used to diagnose IE. For example, a complete blood count may be used to check the number of red and white blood cells in your blood. Blood tests also may be used to check your immune system and to check for inflammation.
Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create pictures of your heart. Two types of echo are useful in diagnosing IE.
Transthoracic (tranz-thor-AS-ik) echo. For this painless test, gel is applied to the skin on your chest. A device called a transducer is moved around on the outside of your chest.
This device sends sound waves called ultrasound through your chest. As the ultrasound waves bounce off your heart, a computer converts them into pictures on a screen.
Your doctor uses the pictures to look for vegetations, areas of infected tissue (such as an abscess), and signs of heart damage.
Because the sound waves have to pass through skin, muscle, tissue, bone, and lungs, the pictures may not have enough detail. Thus, your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE).
Transesophageal echo. For TEE, a much smaller transducer is attached to the end of a long, narrow, flexible tube. The tube is passed down your throat. Before the procedure, you're given medicine to help you relax, and your throat is sprayed with numbing medicine.
The doctor then passes the transducer down your esophagus (the passage from your mouth to your stomach). Because this passage is right behind the heart, the transducer can get detailed pictures of the heart's structures.
EKG
An EKG is a simple, painless test that detects your heart's electrical activity. The test shows how fast your heart is beating, whether your heart rhythm is steady or irregular, and the strength and timing of electrical signals as they pass through your heart.
An EKG typically isn't used to diagnose IE. However, it may be done to see whether IE is affecting your heart's electrical activity.
For this test, soft, sticky patches called electrodes are attached to your chest, arms, and legs. You lie still while the electrodes detect your heart's electrical signals. A machine records these signals on graph paper or shows them on a computer screen. The entire test usually takes about 10 minutes.
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Endocarditis
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What are the treatments for Endocarditis ?
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Infective endocarditis (IE) is treated with antibiotics and sometimes with heart surgery.
Antibiotics
Antibiotics usually are given for 2 to 6 weeks through an intravenous (IV) line inserted into a vein. You're often in a hospital for at least the first week or more of treatment. This allows your doctor to make sure the medicine is helping.
If you're allowed to go home before the treatment is done, the antibiotics are almost always continued by vein at home. You'll need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment.
You also will need close medical followup, usually by a team of doctors. This team often includes a doctor who specializes in infectious diseases, a cardiologist (heart specialist), and a heart surgeon.
Surgery
Sometimes surgery is needed to repair or replace a damaged heart valve or to help clear up IE. For example, IE caused by fungi often requires surgery. This is because this type of IE is harder to treat than IE caused by bacteria.
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Endocarditis
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How to prevent Endocarditis ?
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If you're at risk for infective endocarditis (IE), you can take steps to prevent the infection and its complications.
Be alert to the signs and symptoms of IE. Contact your doctor right away if you have any of these signs or symptoms, especially a persistent fever or unexplained fatigue (tiredness).
Brush and floss your teeth regularly, and have regular dental checkups. Germs from a gum infection can enter your bloodstream.
Avoid body piercing, tattoos, and other procedures that may allow germs to enter your bloodstream.
Research shows that not everyone at risk for IE needs to take antibiotics before routine dental exams and certain other dental and medical procedures.
Let your health care providers, including your dentist, know if you're at risk for IE. They can tell you whether you need antibiotics before exams and procedures.
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Endocarditis
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What is (are) Restless Legs Syndrome ?
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Restless legs syndrome (RLS) is a disorder that causes a strong urge to move your legs. This urge to move often occurs with strange and unpleasant feelings in your legs. Moving your legs relieves the urge and the unpleasant feelings.
People who have RLS describe the unpleasant feelings as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, these feelings also occur in the arms.
The urge to move and unpleasant feelings happen when you're resting and inactive. Thus, they tend to be worse in the evening and at night.
Overview
RLS can make it hard to fall asleep and stay asleep. It may make you feel tired and sleepy during the day. This can make it hard to learn, work, and do other daily activities. Not getting enough sleep also can cause depression, mood swings, or other health problems.
RLS can range from mild to severe based on:
The strength of your symptoms and how often they occur
How easily moving around relieves your symptoms
How much your symptoms disturb your sleep
One type of RLS usually starts early in life (before 45 years of age) and tends to run in families. It may even start in childhood. Once this type of RLS starts, it usually lasts for the rest of your life. Over time, symptoms slowly get worse and occur more often. If you have a mild case, you may have long periods with no symptoms.
Another type of RLS usually starts later in life (after 45 years of age). It generally doesn't run in families. This type of RLS tends to have a more abrupt onset. The symptoms usually don't get worse over time.
Some diseases, conditions, and medicines may trigger RLS. For example, the disorder has been linked to kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a disease, condition, or medicine causes RLS, the symptoms usually start suddenly.
Medical conditions or medicines often cause or worsen the type of RLS that starts later in life.
Outlook
RLS symptoms often get worse over time. However, some people's symptoms go away for weeks to months.
If a medical condition or medicine triggers RLS, the disorder may go away if the trigger is relieved or stopped. For example, RLS that occurs due to pregnancy tends to go away after giving birth. Kidney transplants (but not dialysis) relieve RLS linked to kidney failure.
Treatments for RLS include lifestyle changes and medicines. Some simple lifestyle changes often help relieve mild cases of RLS. Medicines often can relieve or prevent the symptoms of more severe RLS.
Research is ongoing to better understand the causes of RLS and to find better treatments.
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Restless Legs Syndrome
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What causes Restless Legs Syndrome ?
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Faulty Use of Iron or Lack of Iron
Research suggests that the main cause of restless legs syndrome (RLS) is a faulty use of iron or a lack of iron in the brain. The brain uses iron to make the chemical dopamine (DO-pah-meen) and to control other brain activities. Dopamine works in the parts of the brain that control movement.
Many conditions can affect how much iron is in the brain or how it's used. These conditions include kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. All of these conditions increase your risk of RLS.
People whose family members have RLS also are more likely to develop the disorder. This suggests that genetics may contribute to the faulty use of iron or lack of iron in the brain that triggers RLS.
Nerve Damage
Nerve damage in the legs or feet and sometimes in the arms or hands may cause or worsen RLS. Several conditions can cause this type of nerve damage, including diabetes.
Medicines and Substances
Certain medicines may trigger RLS. These include some:
Antinausea medicines (used to treat upset stomach)
Antidepressants (used to treat depression)
Antipsychotics (used to treat certain mental health disorders)
Cold and allergy medicines that contain antihistamines
Calcium channel blockers (used to treat heart problems and high blood pressure)
RLS symptoms usually get better or may even go away if the medicine is stopped.
Certain substances, such as alcohol and tobacco, also can trigger or worsen RLS symptoms. Symptoms may get better or go away if the substances are stopped.
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Restless Legs Syndrome
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Who is at risk for Restless Legs Syndrome? ?
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Restless legs syndrome (RLS) affects about 515 percent of Americans. Many people who have RLS have family members with the disorder.
RLS can affect people of any racial or ethnic group, but the disorder is more common in people of Northern European descent. RLS affects both genders, but women are more likely to have it than men.
The number of cases of RLS rises with age. Many people who have RLS are diagnosed in middle age. People who develop RLS early in life tend to have a family history of the disorder.
People who have certain diseases or conditions or who take certain medicines are more likely to develop RLS. (For more information, go to "What Causes Restless Legs Syndrome?")
For example, pregnancy is a risk factor for RLS. It usually occurs during the last 3 months of pregnancy. The disorder usually improves or goes away after giving birth. Some women may continue to have symptoms after giving birth. Other women may develop RLS again later in life.
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Restless Legs Syndrome
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What are the symptoms of Restless Legs Syndrome ?
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The four key signs of restless legs syndrome (RLS) are:
A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
Symptoms that start or get worse in the evening or at night.
You must have all four of these signs to be diagnosed with RLS.
The Urge To Move
RLS gets its name from the urge to move the legs when sitting or lying down. This movement relieves the unpleasant feelings that RLS sometimes causes. Typical movements are:
Pacing and walking
Jiggling the legs
Stretching and flexing
Tossing and turning
Rubbing the legs
Unpleasant Feelings
People who have RLS describe the unpleasant feelings in their limbs as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Severe RLS may cause painful feelings. However, the pain usually is more of an ache than a sharp, stabbing pain.
Children may describe RLS symptoms differently than adults. In children, the condition may occur with hyperactivity. However, it's not fully known how the disorders are related.
The unpleasant feelings from RLS often occur in the lower legs (calves). But the feelings can occur at any place in the legs or feet. They also can occur in the arms.
The feelings seem to come from deep within the limbs, rather than from the surface. You usually will have the feelings in both legs. However, the feelings can occur in one leg, move from one leg to the other, or affect one leg more than the other.
People who have mild symptoms may notice them only when they're still or awake for a long time, such as on a long airplane trip or while watching TV. If they fall asleep quickly, they may not have symptoms when lying down at night.
The unpleasant feelings from RLS aren't the same as the leg cramps many people get at night. Leg cramps often are limited to certain muscle groups in the leg, which you can feel tightening. Leg cramps cause more severe pain and require stretching the affected muscle for relief.
Sometimes arthritis or peripheral artery disease (P.A.D.) can cause pain or discomfort in the legs. Moving the limbs usually worsens the discomfort instead of relieving it.
Periodic Limb Movement in Sleep
Many people who have RLS also have a condition called periodic limb movement in sleep (PLMS). PLMS causes your legs or arms to twitch or jerk about every 10 to 60 seconds during sleep. These movements cause you to wake up often and get less sleep.
PLMS usually affects the legs, but it also can affect the arms. Not everyone who has PLMS also has RLS.
Related Sleep Problems
RLS can make it hard to fall or stay asleep. If RLS disturbs your sleep, you may feel very tired during the day.
Lack of sleep may make it hard for you to concentrate at school or work. Not enough sleep also can cause depression, mood swings, and other health problems such as diabetes or high blood pressure.
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Restless Legs Syndrome
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How to diagnose Restless Legs Syndrome ?
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Your doctor will diagnose restless legs syndrome (RLS) based on your signs and symptoms, your medical and family histories, a physical exam, and test results.
Your doctor will use this information to rule out other conditions that have symptoms similar to those of RLS.
Specialists Involved
Your primary care doctor usually can diagnose and treat RLS. However, he or she also may suggest that you see a sleep specialist or neurologist.
Signs and Symptoms
You must have the four key signs of RLS to be diagnosed with the disorder.
Your doctor will want to know how your symptoms are affecting your sleep and how alert you are during the day.
To help your doctor, you may want to keep a sleep diary. Use the diary to keep a daily record of how easy it is to fall and stay asleep, how much sleep you get at night, and how alert you feel during the day.
For a sample sleep diary, go to the National Heart, Lung, and Blood Institute's "Your Guide to Healthy Sleep."
Medical and Family Histories
Your doctor may ask whether you have any of the diseases or conditions that can trigger RLS. These include kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency.
Your doctor also may want to know what medicines you take. Some medicines can trigger or worsen RLS.
The most common type of RLS tends to run in families. Thus, your doctor may ask whether any of your relatives have RLS.
Physical Exam
Your doctor will do a physical exam to check for underlying conditions that may trigger RLS. He or she also will check for other conditions that have symptoms similar to those of RLS.
Diagnostic Tests
Currently, no test can diagnose RLS. Still, your doctor may recommend blood tests to measure your iron levels. He or she also may suggest muscle or nerve tests. These tests can show whether you have a condition that can worsen RLS or that has symptoms similar to those of RLS.
Rarely, sleep studies are used to help diagnose RLS. A sleep study measures how much and how well you sleep. Although RLS can cause a lack of sleep, this sign isn't specific enough to diagnose the condition.
Researchers continue to study new ways to diagnose RLS.
Drug Therapy Trial
If your doctor thinks you have RLS, he or she may prescribe certain medicines to relieve your symptoms. These medicines, which are used to treat people who have Parkinson's disease, also can relieve RLS symptoms. If the medicines relieve your symptoms, your doctor can confirm that you have RLS.
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Restless Legs Syndrome
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What are the treatments for Restless Legs Syndrome ?
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Restless legs syndrome (RLS) has no cure. If a condition or medicine triggers RLS, it may go away or get better if the trigger is relieved or stopped.
RLS can be treated. The goals of treatment are to:
Prevent or relieve symptoms
Increase the amount of sleep you're getting and improve the quality of your sleep
Treat or correct any underlying condition that may trigger or worsen RLS
Mild cases of RLS often are treated with lifestyle changes and sometimes with periodic use of medicines. More severe RLS usually is treated with daily medicines.
Lifestyle Changes
Lifestyle changes can prevent or relieve the symptoms of RLS. For mild RLS, lifestyle changes may be the only treatment needed.
Preventing Symptoms
Many common substances, such as alcohol and tobacco, can trigger RLS symptoms. Avoiding these substances can limit or prevent symptoms.
Some prescription and over-the-counter medicines can cause or worsen RLS symptoms. Tell your doctor about all of the medicines you're taking. He or she can tell you whether you should stop or change certain medicines.
Adopting good sleep habits can help you fall asleep and stay asleepa problem for many people who have RLS. Good sleep habits include:
Keeping the area where you sleep cool, quiet, comfortable, and as dark as possible.
Making your bedroom sleep-friendly. Remove things that can interfere with sleep, such as a TV, computer, or phone.
Going to bed and waking up at the same time every day. Some people who have RLS find it helpful to go to bed later in the evening and get up later in the morning.
Avoiding staying in bed awake for long periods in the evening or during the night.
Doing a challenging activity before bedtime, such as solving a crossword puzzle, may ease your RLS symptoms. This distraction may make it easier for you to fall asleep. Focusing on your breathing and using other relaxation techniques also may help you fall asleep.
Regular, moderate physical activity also can help limit or prevent RLS symptoms. Often, people who have RLS find that if they increase their activity during the day, they have fewer symptoms.
Relieving Symptoms
Certain activities can relieve RLS symptoms. These include:
Walking or stretching
Taking a hot or cold bath
Massaging the affected limb(s)
Using heat or ice packs on the affected limb(s)
Doing mentally challenging tasks
Choose an aisle seat at the movies or on airplanes and trains so you can move around, if necessary.
Medicines
You may need medicines to treat RLS if lifestyle changes can't control symptoms. Many medicines can relieve or prevent RLS symptoms.
No single medicine works for all people who have RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.
Some of the medicines used to treat RLS also are used to treat Parkinson's disease. These medicines make dopamine or mimic it in the parts of the brain that control movement. (Dopamine is a chemical that helps you move properly.)
If medicines for Parkinson's disease don't prevent or relieve your symptoms, your doctor may prescribe other medicines. You may have to take more than one medicine to treat your RLS.
Always talk with your doctor before taking any medicines. He or she can tell you the side effects of each RLS medicine. Side effects may include nausea (feeling sick to your stomach), headache, and daytime sleepiness.
In some cases, RLS medicines may worsen problems with excessive gambling, shopping, or sexual activity. Sometimes, continued use of RLS medicines may make your RLS symptoms worse.
Contact your doctor if you have any of these problems. He or she can adjust your medicines to prevent these side effects.
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Restless Legs Syndrome
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What is (are) Arrhythmia ?
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Espaol
An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
A heartbeat that is too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that is too slow is called bradycardia (bray-de-KAR-de-ah).
Most arrhythmias are harmless, but some can be serious or even life threatening. During an arrhythmia, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
Understanding the Heart's Electrical System
To understand arrhythmias, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat.
With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.
Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the heart's upper right chamber, the right atrium (AY-tree-um). In a healthy adult heart at rest, the SA node fires off an electrical signal to begin a new heartbeat 60 to 100 times a minute.
From the SA node, the electrical signal travels through special pathways in the right and left atria. This causes the atria to contract and pump blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls).
The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down just a little, allowing the ventricles time to finish filling with blood.
The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. This pathway divides into a right bundle branch and a left bundle branch. The signal goes down these branches to the ventricles, causing them to contract and pump blood to the lungs and the rest of the body.
The ventricles then relax, and the heartbeat process starts all over again in the SA node. (For more information about the heart's electrical system, including detailed animations, go to the Health Topics How the Heart Works article.)
A problem with any part of this process can cause an arrhythmia. For example, in atrial fibrillation (A-tre-al fi-bri-LA-shun), a common type of arrhythmia, electrical signals travel through the atria in a fast and disorganized way. This causes the atria to quiver instead of contract.
Outlook
There are many types of arrhythmia. Most arrhythmias are harmless, but some are not. The outlook for a person who has an arrhythmia depends on the type and severity of the arrhythmia.
Even serious arrhythmias often can be successfully treated. Most people who have arrhythmias are able to live normal, healthy lives.
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Arrhythmia
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What causes Arrhythmia ?
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An arrhythmia can occur if the electrical signals that control the heartbeat are delayed or blocked. This can happen if the special nerve cells that produce electrical signals don't work properly. It also can happen if the electrical signals don't travel normally through the heart.
An arrhythmia also can occur if another part of the heart starts to produce electrical signals. This adds to the signals from the special nerve cells and disrupts the normal heartbeat.
Smoking, heavy alcohol use, use of some drugs (such as cocaine or amphetamines), use of some prescription or over-the-counter medicines, or too much caffeine or nicotine can lead to arrhythmias in some people.
Strong emotional stress or anger can make the heart work harder, raise blood pressure, and release stress hormones. Sometimes these reactions can lead to arrhythmias.
A heart attack or other condition that damages the heart's electrical system also can cause arrhythmias. Examples of such conditions include high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland (too much or too little thyroid hormone produced), and rheumatic heart disease.
Congenital (kon-JEN-ih-tal) heart defects can cause some arrhythmias, such as Wolff-Parkinson-White syndrome. The term "congenital means the defect is present at birth.
Sometimes the cause of arrhythmias is unknown.
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Arrhythmia
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Who is at risk for Arrhythmia? ?
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Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, and the number is rising.
Most serious arrhythmias affect people older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias.
Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can even cause arrhythmias as a side effect.
Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardia (PSVT), including Wolff-Parkinson-White syndrome, is more common in young people. PSVT is a fast heart rate that begins and ends suddenly.
Major Risk Factors
Arrhythmias are more common in people who have diseases or conditions that weaken the heart, such as:
Heart attack
Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals move through the heart
Heart tissue that's too thick or stiff or that hasn't formed normally
Leaking or narrowed heart valves, which make the heart work too hard and can lead to heart failure
Congenital heart defects (defects present at birth) that affect the heart's structure or function
Other conditions also can raise the risk for arrhythmias, such as:
High blood pressure
Infections that damage the heart muscle or the sac around the heart
Diabetes, which increases the risk of high blood pressure and coronary heart disease
Sleep apnea, which can stress the heart because the heart doesn't get enough oxygen
An overactive or underactive thyroid gland (too much or too little thyroid hormone in the body)
Several other risk factors also can raise your risk for arrhythmias. Examples include heart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream.
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Arrhythmia
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What are the symptoms of Arrhythmia ?
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Many arrhythmias cause no signs or symptoms. When signs or symptoms are present, the most common ones are:
Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or fast)
A slow heartbeat
An irregular heartbeat
Feeling pauses between heartbeats
More serious signs and symptoms include:
Anxiety
Weakness, dizziness, and light-headedness
Fainting or nearly fainting
Sweating
Shortness of breath
Chest pain
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Arrhythmia
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How to diagnose Arrhythmia ?
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Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical exam, and the results from tests and procedures.
Specialists Involved
Doctors who specialize in the diagnosis and treatment of heart diseases include:
Cardiologists. These doctors diagnose and treat adults who have heart problems.
Pediatric cardiologists. These doctors diagnose and treat babies, children, and youth who have heart problems.
Electrophysiologists. These doctors are cardiologists or pediatric cardiologists who specialize in arrhythmias.
Medical and Family Histories
To diagnose an arrhythmia, your doctor may ask you to describe your symptoms. He or she may ask whether you feel fluttering in your chest and whether you feel dizzy or light-headed.
Your doctor also may ask whether you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including whether anyone in your family:
Has a history of arrhythmias
Has ever had heart disease or high blood pressure
Has died suddenly
Has other illnesses or health problems
Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and supplements.
Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you've had emotional stress or anger.
Physical Exam
During a physical exam, your doctor may:
Listen to the rate and rhythm of your heartbeat
Listen to your heart for a heart murmur (an extra or unusual sound heard during your heartbeat)
Check your pulse to find out how fast your heart is beating
Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure
Look for signs of other diseases, such as thyroid disease, that could be causing the problem
Diagnostic Tests and Procedures
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. It's the most common test used to diagnose arrhythmias.
An EKG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart.
A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test.
To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.
Holter and Event Monitors
A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
Some event monitors are able to send data about your heart's electrical activity to a central monitoring station. Technicians at the station review the information and send it to your doctor. You also can use the device to report any symptoms you're having.
You can wear an event monitor for weeks or until symptoms occur.
Other Tests
Other tests also are used to help diagnose arrhythmias.
Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia.
Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged.
Echocardiography. This test uses sound waves to create a moving picture of your heart. Echocardiography (echo) provides information about the size and shape of your heart and how well your heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several types of echo, including stress echo. This test is done both before and after a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (CHD).
A transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach.
Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast.
The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.
Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals.
Your doctor can use the wire to electrically stimulate your heart and trigger an arrhythmia. This allows your doctor to see whether an antiarrhythmia medicine can stop the problem.
Catheter ablation, a procedure used to treat some arrhythmias, may be done during an EPS.
Tilt table testing. This test sometimes is used to help find the cause of fainting spells. You lie on a table that moves from a lying down to an upright position. The change in position may cause you to faint.
Your doctor watches your symptoms, heart rate, EKG reading, and blood pressure throughout the test. He or she may give you medicine and then check your response to the medicine.
Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack.
Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area.
An implantable loop recorder helps doctors figure out why a person may be having palpitations or fainting spells, especially if these symptoms don't happen very often. The device can be used for as long as 12 to 24 months.
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Arrhythmia
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What are the treatments for Arrhythmia ?
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Common arrhythmia treatments include medicines, medical procedures, and surgery. Your doctor may recommend treatment if your arrhythmia causes serious symptoms, such as dizziness, chest pain, or fainting.
Your doctor also may recommend treatment if the arrhythmia increases your risk for problems such as heart failure, stroke, or sudden cardiac arrest.
Medicines
Medicines can slow down a heart that's beating too fast. They also can change an abnormal heart rhythm to a normal, steady rhythm. Medicines that do this are called antiarrhythmics.
Some of the medicines used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medicines often are used to treat atrial fibrillation (AF).
Some of the medicines used to restore a normal heart rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some side effects can make an arrhythmia worse or even cause a different kind of arrhythmia.
Currently, no medicine can reliably speed up a slow heart rate. Abnormally slow heart rates are treated with pacemakers.
People who have AF and some other arrhythmias may be treated with blood-thinning medicines. These medicines reduce the risk of blood clots forming. Warfarin (Coumadin), dabigatran, heparin, and aspirin are examples of blood-thinning medicines.
Medicines also can control an underlying medical condition that might be causing an arrhythmia, such as heart disease or a thyroid condition.
Medical Procedures
Some arrhythmias are treated with pacemakers. A pacemaker is a small device that's placed under the skin of your chest or abdomen to help control abnormal heart rhythms.
Pacemakers have sensors that detect the heart's electrical activity. When the device senses an abnormal heart rhythm, it sends electrical pulses to prompt the heart to beat at a normal rate.
Some arrhythmias are treated with a jolt of electricity to the heart. This type of treatment is called cardioversion or defibrillation, depending on which type of arrhythmia is being treated.
Some people who are at risk for ventricular fibrillation are treated with a device called an implantable cardioverter defibrillator (ICD). Like a pacemaker, an ICD is a small device that's placed under the skin in the chest. This device uses electrical pulses or shocks to help control life-threatening arrhythmias.
An ICD continuously monitors the heartbeat. If it senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal heartbeat.
A procedure called catheter ablation is used to treat some arrhythmias if medicines don't work. During this procedure, a thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. Then, the tube is guided to your heart.
A special machine sends energy through the tube to your heart. The energy finds and destroys small areas of heart tissue where abnormal heart rhythms may start. Catheter ablation usually is done in a hospital as part of an electrophysiology study.
Your doctor may recommend transesophageal echocardiography before catheter ablation to make sure no blood clots are present in the atria (the heart's upper chambers).
Surgery
Doctors treat some arrhythmias with surgery. This may occur if surgery is already being done for another reason, such as repair of a heart valve.
One type of surgery for AF is called maze surgery. During this surgery, a surgeon makes small cuts or burns in the atria. These cuts or burns prevent the spread of disorganized electrical signals.
If coronary heart disease is the cause of your arrhythmia, your doctor may recommend coronary artery bypass grafting. This surgery improves blood flow to the heart muscle.
Other Treatments
Vagal maneuvers are another type of treatment for arrhythmia. These simple exercises sometimes can stop or slow down certain types of supraventricular arrhythmias. They do this by affecting the vagus nerve, which helps control the heart rate.
Some vagal maneuvers include:
Gagging
Holding your breath and bearing down (Valsalva maneuver)
Immersing your face in ice-cold water
Coughing
Putting your fingers on your eyelids and pressing down gently
Vagal maneuvers aren't an appropriate treatment for everyone. Discuss with your doctor whether vagal maneuvers are an option for you.
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Arrhythmia
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What is (are) Kawasaki Disease ?
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Kawasaki (KAH-wah-SAH-ke) disease is a rare childhood disease. It's a form of a condition calledvasculitis(vas-kyu-LI-tis). This condition involves inflammation of the blood vessels.
In Kawasaki disease, the walls of the blood vessels throughout the body become inflamed. The disease can affect any type of blood vessel in the body, including the arteries, veins, and capillaries.
Sometimes Kawasaki disease affects the coronary arteries, which carry oxygen-rich blood to the heart. As a result, some children who have Kawasaki disease may develop serious heart problems.
Overview
The cause of Kawasaki disease isn't known. The body's response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn't known.
The disease can't be passed from one child to another. Your child won't get it from close contact with a child who has the disease. Also, if your child has the disease, he or she can't pass it to another child.
Kawasaki disease affects children of all races and ages and both genders. It occurs most often in children of Asian and Pacific Island descent. The disease is more likely to affect boys than girls. Most cases occur in children younger than 5years old.
One of the main symptoms of Kawasaki disease is a fever that lasts longer than5days. The fever remains high even after treatment with standard childhood fever medicines.
Children who have the disease also may have red eyes, red lips, and redness on the palms of their hands and soles of their feet. These are all signs of inflamed blood vessels.
Early treatment helps reduce the risk of Kawasaki disease affecting the coronary arteries and causing serious problems.
Outlook
Kawasaki disease can't be prevented. However, most children who have the disease usually recover within weeks of getting symptoms. Further problems are rare.
The disease affects some children's coronary arteries, which can cause serious problems. These children need long-term care and treatment.
Researchers continue to look for the cause of Kawasaki disease and better ways to diagnose and treat it. They also hope to learn more about long-term health risks, if any, for people who have had the disease.
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Kawasaki Disease
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What causes Kawasaki Disease ?
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The cause of Kawasaki disease isn't known. The body's response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn't known.
Kawasaki disease can't be passed from one child to another. Your child won't get it from close contact with a child who has the disease. Also, if your child has the disease, he or she can't pass it to another child.
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Kawasaki Disease
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Who is at risk for Kawasaki Disease? ?
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Kawasaki disease affects children of all races and ages and both genders. It occurs most often in children of Asian and Pacific Island descent.
The disease is more likely to affect boys than girls. Most cases occur in children younger than 5 years old. Kawasaki disease is rare in children older than 8.
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Kawasaki Disease
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What are the symptoms of Kawasaki Disease ?
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Major Signs and Symptoms
One of the main symptoms during the early part of Kawasaki disease, called the acute phase, is fever. The fever lasts longer than 5 days. It remains high even after treatment with standard childhood fever medicines.
Other classic signs of the disease are:
Swollen lymph nodes in the neck
A rash on the mid-section of the body and in the genital area
Red, dry, cracked lips and a red, swollen tongue
Red, swollen palms of the hands and soles of the feet
Redness of the eyes
Other Signs and Symptoms
During the acute phase, your child also may be irritable and have a sore throat, joint pain, diarrhea, vomiting, and stomach pain.
Within 2 to 3 weeks of the start of symptoms, the skin on your child's fingers and toes may peel, sometimes in large sheets.
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Kawasaki Disease
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How to diagnose Kawasaki Disease ?
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Kawasaki disease is diagnosed based on your child's signs and symptoms and the results from tests and procedures.
Specialists Involved
Pediatricians often are the first to suspect a child has Kawasaki disease. Pediatricians are doctors who specialize in treating children.
If the disease has affected your child's coronary (heart) arteries, a pediatric cardiologist will confirm the diagnosis and give ongoing treatment. Pediatric cardiologists treat children who have heart problems.
Other specialists also may be involved in treating children who have Kawasaki disease.
Signs and Symptoms
The doctor will check your child for the classic signs and symptoms of Kawasaki disease.
The doctor will rule out other diseases that cause similar symptoms. These diseases include Rocky Mountain spotted fever, scarlet fever, and juvenile rheumatoid arthritis.
Generally, your child will be diagnosed with Kawasaki disease if he or she has a fever that lasts longer than 5 days plus four other classic signs or symptoms of the disease.
However, not all children have classic signs and symptoms of Kawasaki disease. Tests and procedures can help confirm whether a child has the disease.
Tests and Procedures
Echocardiography
If the doctor thinks that your child has Kawasaki disease, he or she will likely recommendechocardiography(EK-o-kar-de-OG-ra-fee), or echo. This painless test uses sound waves to create pictures of the heart and coronary arteries.
Echo also can help show the disease's effects over time, if any, on your child's coronary arteries. Often, the disease's effects on the coronary arteries don't show up until the second or third week after the first symptoms appear. Thus, this test is done regularly after the diagnosis.
Some children who have Kawasaki disease don't have the classic signs and symptoms of the acute phase. Doctors may not diagnose these children until 2 to 3 weeks after the onset of the disease. This is when another common sign of Kawasaki disease occurspeeling of the skin on the fingers and toes.
If your child is diagnosed at this point, he or she will likely need echo right away to see whether the disease has affected the coronary arteries.
Other Diagnostic Tests
Doctors also use other tests to help diagnose Kawasaki disease, such as:
Blood tests. The results from blood tests can show whether the body's blood vessels are inflamed.
Chest x ray. This painless test creates pictures of structures inside the chest, such as the heart and lungs. A chest x ray can show whether Kawasaki disease has affected the heart.
EKG (electrocardiogram). This simple test detects and records the heart's electrical activity. An EKG can show whether Kawasaki disease has affected the heart.
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Kawasaki Disease
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What are the treatments for Kawasaki Disease ?
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Medicines are the main treatment for Kawasaki disease. Rarely, children whose coronary (heart) arteries are affected may need medical procedures or surgery.
The goals of treatment include:
Reducing fever and inflammation to improve symptoms
Preventing the disease from affecting the coronary arteries
Initial Treatment
Kawasaki disease can cause serious health problems. Thus, your child will likely be treated in a hospital, at least for the early part of treatment.
The standard treatment during the disease's acute phase is high-dose aspirin and immune globulin. Immune globulin is a medicine that's injected into a vein.
Most children who receive these treatments improve greatly within 24 hours. For a small number of children, fever remains. These children may need a second round of immune globulin.
At the start of treatment, your child will receive high doses of aspirin. As soon as his or her fever goes away, a low dose of aspirin is given. The low dose helps prevent blood clots, which can form in the inflamed small arteries.
Most children treated for Kawasaki disease fully recover from the acute phase and don't need any further treatment. They should, however, follow a healthy diet and adopt healthy lifestyle habits. Taking these steps can help lower the risk of future heart disease. (Following a healthy lifestyle is advised for all children, not just those who have Kawasaki disease.)
Children who have had immune globulin should wait 11 months before having the measles and chicken pox vaccines. Immune globulin can prevent those vaccines from working well.
Long-Term Care and Treatment
If Kawasaki disease has affected your child's coronary arteries, he or she will need ongoing care and treatment.
It's best if a pediatric cardiologist provides this care to reduce the risk of severe heart problems. A pediatric cardiologist is a doctor who specializes in treating children who have heart problems.
Medicines and Tests
When Kawasaki disease affects the coronary arteries, they may expand and twist. If this happens, your child's doctor may prescribe blood-thinning medicines (for example, warfarin). These medicines help prevent blood clots from forming in the affected coronary arteries.
Blood-thinning medicines usually are stopped after the coronary arteries heal. Healing may occur about 18 months after the acute phase of the disease.
In a small number of children, the coronary arteries don't heal. These children likely will need routine tests, such as:
Echocardiography. This test uses sound waves to create images of the heart.
EKG (electrocardiogram). This test detects and records the heart's electrical activity.
Stress test. This test provides information about how the heart works during physical activity or stress.
Medical Procedures and Surgery
Rarely, a child who has Kawasaki disease may needcardiac catheterization(KATH-eh-ter-ih-ZA-shun). Doctors use this procedure to diagnose and treat some heart conditions.
A flexible tube called a catheter is put into a blood vessel in the arm, groin (upper thigh), or neck and threaded to the heart. Through the catheter, doctors can perform tests and treatments on the heart.
Very rarely, a child may need to have other procedures or surgery if inflammation narrows his or her coronary arteries and blocks blood flow to the heart.
Percutaneous coronary intervention (PCI), stent placement, or coronary artery bypass grafting(CABG) may be used.
Coronary angioplasty restores blood flow through narrowed or blocked coronary arteries. A thin tube with a balloon on the end is inserted into a blood vessel in the arm or groin. The tube is threaded to the narrowed or blocked coronary artery. Then, the balloon is inflated to widen the artery and restore blood flow.
A stent (small mesh tube) may be placed in the coronary artery during angioplasty. This device helps support the narrowed or weakened artery. A stent can improve blood flow and prevent the artery from bursting.
Rarely, a child may need to have CABG. This surgery is used to treat blocked coronary arteries. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery.
The grafted artery or vein bypasses (that is, goes around) the blocked part of the coronary artery. This improves blood flow to the heart.
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Kawasaki Disease
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How to prevent Kawasaki Disease ?
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Kawasaki disease can't be prevented. However, most children who have the disease recoverusually within weeks of getting signs and symptoms. Further problems are rare.
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Kawasaki Disease
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What is (are) Metabolic Syndrome ?
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Metabolicsyndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
The term "metabolic" refers to the biochemical processes involved in the body's normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.
In this article, "heart disease" refers to coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque builds up inside the coronary (heart) arteries.
Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead to chest pain, a heart attack, heart damage, or even death.
Metabolic Risk Factors
The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.
A large waistline. This also is called abdominal obesity or "having an apple shape." Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
A high triglyceride level (or you're on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.
High blood pressure (or you're on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
High fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.
Overview
Your risk for heart disease, diabetes, and stroke increases with the number of metabolic risk factors you have. The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical activity.
Insulin resistance also may increase your risk for metabolic syndrome. Insulin resistance is a condition in which the body cant use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where its used for energy. Insulin resistance can lead to high blood sugar levels, and its closely linked to overweight and obesity.Genetics (ethnicity and family history) and older age are other factors that may play a role in causing metabolic syndrome.
Outlook
Metabolic syndrome is becoming more common due to a rise in obesity rates among adults. In the future, metabolic syndrome may overtake smoking as the leading risk factor for heart disease.
It is possible to prevent or delay metabolic syndrome, mainly with lifestyle changes. A healthy lifestyle is a lifelong commitment. Successfully controlling metabolic syndrome requires long-term effort and teamwork with your health care providers.
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Metabolic Syndrome
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What causes Metabolic Syndrome ?
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Metabolic syndrome has several causes that act together. You can control some of the causes, such as overweight and obesity, an inactive lifestyle, and insulin resistance.
You can't control other factors that may play a role in causing metabolic syndrome, such as growing older. Your risk for metabolic syndrome increases with age.
You also can't control genetics (ethnicity and family history), which may play a role in causing the condition. For example, genetics can increase your risk for insulin resistance, which can lead to metabolic syndrome.
People who have metabolic syndrome often have two other conditions: excessive blood clotting and constant, low-grade inflammation throughout the body. Researchers don't know whether these conditions cause metabolic syndrome or worsen it.
Researchers continue to study conditions that may play a role in metabolic syndrome, such as:
A fatty liver (excess triglycerides and other fats in the liver)
Polycystic ovarian syndrome (a tendency to develop cysts on the ovaries)
Gallstones
Breathing problems during sleep (such as sleep apnea)
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Metabolic Syndrome
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Who is at risk for Metabolic Syndrome? ?
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People at greatest risk for metabolic syndrome have these underlying causes:
Abdominal obesity (a large waistline)
An inactive lifestyle
Insulin resistance
Some people are at risk for metabolic syndrome because they take medicines that cause weight gain or changes in blood pressure, blood cholesterol, and blood sugar levels. These medicines most often are used to treat inflammation, allergies, HIV, and depression and other types of mental illness.
Populations Affected
Some racial and ethnic groups in the United States are at higher risk for metabolic syndrome than others. Mexican Americans have the highest rate of metabolic syndrome, followed by whites and blacks.
Other groups at increased risk for metabolic syndrome include:
People who have a personal history of diabetes
People who have a sibling or parent who hasdiabetes
Women when compared with men
Women who have a personal history of polycystic ovarian syndrome (a tendency to develop cysts on the ovaries)
Heart Disease Risk
Metabolic syndrome increases your risk for coronary heart disease. Other risk factors, besides metabolic syndrome, also increase your risk for heart disease. For example, a high LDL (bad) cholesterol level and smoking are major risk factors for heart disease. For details about all of the risk factors for heart disease, go to the Coronary Heart Disease Risk Factors HealthTopic.
Even if you dont have metabolic syndrome, you should find out your short-term risk for heart disease. The National Cholesterol Education Program (NCEP) divides short-term heart disease risk into four categories. Your risk category depends on which risk factors you have and how many you have.
Your risk factors are used to calculate your 10-year risk of developing heart disease. The NCEP has an online calculator that you can use to estimate your 10-year risk of having a heart attack.
High risk: Youre in this category if you already have heart disease or diabetes, or if your 10-year risk score is more than 20 percent.
Moderately high risk: Youre in this category if you have two or more risk factors and your 10-year risk score is 10 percent to 20 percent.
Moderate risk: Youre in this category if you have two or more risk factors and your 10-year risk score is less than 10 percent.
Lower risk: Youre in this category if you have zero or one risk factor.
Even if your 10-year risk score isnt high, metabolic syndrome will increase your risk for coronary heart disease over time.
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Metabolic Syndrome
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What are the symptoms of Metabolic Syndrome ?
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Metabolic syndrome is a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. These risk factors can increase your risk for health problems even if they're only moderately raised (borderline-high risk factors).
Most of the metabolic risk factors have no signs or symptoms, although a large waistline is a visible sign.
Some people may have symptoms of high blood sugar if diabetesespecially type 2 diabetesis present. Symptoms of high blood sugar often include increased thirst; increased urination, especially at night; fatigue (tiredness); and blurred vision.
High blood pressure usually has no signs or symptoms. However, some people in the early stages of high blood pressure may have dull headaches, dizzy spells, or more nosebleeds than usual.
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Metabolic Syndrome
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How to diagnose Metabolic Syndrome ?
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Your doctor will diagnose metabolic syndrome based on the results of a physical exam and blood tests. You must have at least three of the five metabolic risk factors to be diagnosed with metabolic syndrome.
Metabolic Risk Factors
A Large Waistline
Having a large waistline means that you carry excess weight around your waist (abdominal obesity). This is also called having an "apple-shaped" figure. Your doctor will measure your waist to find out whether you have a large waistline.
A waist measurement of 35 inches or more for women or 40 inches or more for men is a metabolic risk factor. A large waistline means you're at increased risk for heart disease and other health problems.
A High Triglyceride Level
Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or higher (or being on medicine to treat high triglycerides) is a metabolic risk factor. (The mg/dL is milligrams per deciliterthe units used to measure triglycerides, cholesterol, and blood sugar.)
A Low HDL Cholesterol Level
HDL cholesterol sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries.
An HDL cholesterol level of less than 50 mg/dL for women and less than 40 mg/dL for men (or being on medicine to treat low HDL cholesterol) is a metabolic risk factor.
High Blood Pressure
A blood pressure of 130/85 mmHg or higher (or being on medicine to treat high blood pressure) is a metabolic risk factor. (The mmHg is millimeters of mercurythe units used to measure blood pressure.)
If only one of your two blood pressure numbers is high, you're still at risk for metabolic syndrome.
High Fasting Blood Sugar
A normal fasting blood sugar level is less than 100 mg/dL. A fasting blood sugar level between 100125 mg/dL is considered prediabetes. A fasting blood sugar level of 126 mg/dL or higher is considered diabetes.
A fasting blood sugar level of 100 mg/dL or higher (or being on medicine to treat high blood sugar) is a metabolic risk factor.
About 85 percent of people who have type 2 diabetesthe most common type of diabetesalso have metabolic syndrome. These people have a much higher risk for heart disease than the 15 percent of people who have type 2 diabetes without metabolic syndrome.
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Metabolic Syndrome
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What are the treatments for Metabolic Syndrome ?
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Heart-healthy lifestyle changes are the first line of treatment for metabolic syndrome. Lifestyle changes include heart-healthy eating, losing and maintaining a healthy weight, managing stress, physical activity, and quittingsmoking.
If lifestyle changes arent enough, your doctor may prescribe medicines. Medicines are used to treat and control risk factors, such as high blood pressure, high triglycerides, low HDL (good) cholesterol, and high blood sugar.
Goals of Treatment
The major goal of treating metabolic syndrome is to reduce the risk of coronary heart disease. Treatment is directed first at lowering LDL cholesterol and high blood pressure and managing diabetes (if these conditions are present).
The second goal of treatment is to prevent the onset of type2 diabetes, if it hasnt already developed. Long-term complications of diabetes often include heart and kidney disease, vision loss, and foot or leg amputation. If diabetes is present, the goal of treatment is to reduce your risk for heart disease by controlling all of your risk factors.
Heart-Healthy Lifestyle Changes
Heart-Healthy Eating
Heart-healthy eating is an important part of a heart-healthy lifestyle. Your doctor may recommend heart-healthy eating, which should include:
Fat-free or low-fat dairy products, such as skim milk
Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
Fruits, such as apples, bananas, oranges, pears, and prunes
Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
Vegetables, such as broccoli, cabbage, and carrots
Whole grains, such as oatmeal, brown rice, and corn tortillas
When following a heart-healthy diet, you should avoid eating:
A lot of red meat
Palm and coconut oils
Sugary foods and beverages
Two nutrients in your diet make blood cholesterol levels rise:
Saturated fatfound mostly in foods that come from animals
Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.
Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples:
If you eat:
Try to eat no more than:
1,200 calories a day
8 grams of saturated fat a day
1,500 calories a day
10 grams of saturated fat a day
1,800 calories a day
12 grams of saturated fat a day
2,000 calories a day
13 grams of saturated fat a day
2,500 calories a day
17 grams of saturated fat a day
Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are:
Avocados
Corn, sunflower, and soybean oils
Nuts and seeds, such as walnuts
Olive, canola, peanut, safflower, and sesame oils
Peanut butter
Salmon and trout
Tofu
Sodium
You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.
Dietary Approaches to Stop Hypertension
Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH.
Limiting Alcohol
Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weightgain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:
12 ounces of beer
5 ounces of wine
1 ounces of liquor
Maintaining a Healthy Weight
If you have metabolic syndrome and are overweight or obese, your doctor will recommend weight loss. He or she can help you create a weight-loss plan and goals. Maintaining a healthy weight can lower your risk for metabolic syndrome, coronary heart disease, and other health problems. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active.
Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI:
Below 18.5 is a sign that you are underweight.
Between 18.5 and 24.9 is in the normal range.
Between 25.0 and 29.9 is considered overweight.
Of 30.0 or higher is considered obese.
A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal.
Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be higher with a waist size that is greater than 35 inches for women or greater than 40 inches for men.
If youre overweight or obese, try to lose weight. A loss of just 3percent to 5percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL (bad) cholesterol, and increase HDL cholesterol.
Managing Stress
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as:
A stress management program
Meditation
Physical activity
Relaxation therapy
Talking things out with friends or family
Physical Activity
Regular physical activity can lower your risk for metabolic syndrome, coronary heart disease, and other health problems. Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week.
Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.
Read more about physical activity at:
Physical Activity and Your Heart
U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans
Quitting Smoking
If you smoke, quit. Smoking can raise your risk for heart disease and heart attack and worsen other heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. For more information about how to quit smoking, go to the Smoking and Your Heart Health Topic.
Medicines
Sometimes lifestyle changes arent enough to control your risk factors for metabolic syndrome. For example, you may need statin medications to control or lower your cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have:
Diabetes
Heart disease or had a prior stroke
High LDL cholesterol levels
Doctors may discuss beginning statin treatment with those who have an elevated risk for developing heart disease or having a stroke.
Your doctor also may prescribe other medications to:
Decrease your chance of having a heart attack or dying suddenly.
Lower your blood pressure.
Prevent blood clots, which can lead to heart attack or stroke.
Reduce your hearts workload and relieve symptoms of coronary heart disease.
Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart-healthy lifestyle, even if you take medicines to treat your risk factors for metabolic syndrome.
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Metabolic Syndrome
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How to prevent Metabolic Syndrome ?
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Making heart-healthy lifestyle choices is the best way to prevent metabolic syndrome by:
Being physically active
Following a heart-healthy eating plan
Knowing your weight, waist measurement, and body mass index
Maintaining a healthy weight
Make sure to schedule routine doctor visits to keep track of your cholesterol, blood pressure, and blood sugar levels. Speak with your doctor about a blood test called a lipoprotein panel, which shows your levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
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Metabolic Syndrome
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What is (are) Asthma ?
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Espaol
Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7million of these people are children.
Overview
To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. The inflammation makes the airways swollen and very sensitive. The airways tend to react strongly to certain inhaled substances.
When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.
This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.
Asthma
Sometimes asthma symptoms are mild and go away on their own or after minimal treatment with asthma medicine. Other times, symptoms continue to get worse.
When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. Asthma attacks also are called flareups or exacerbations (eg-zas-er-BA-shuns).
Treating symptoms when you first notice them is important. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.
Outlook
Asthma has no cure. Even when you feel fine, you still have the disease and it can flare up at any time.
However, with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.
If you have asthma, you can take an active role in managing the disease. For successful, thorough, and ongoing treatment, build strong partnerships with your doctor and other health care providers.
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Asthma
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What causes Asthma ?
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The exact cause of asthma isn't known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:
An inherited tendency to develop allergies, called atopy (AT-o-pe)
Parents who have asthma
Certain respiratory infections during childhood
Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing
If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air.
Some factors may be more likely to cause asthma in some people than in others. Researchers continue to explore what causes asthma.
The "Hygiene Hypothesis"
One theory researchers have for what causes asthma is the "hygiene hypothesis." They believe that our Western lifestylewith its emphasis on hygiene and sanitationhas resulted in changes in our living conditions and an overall decline in infections in early childhood.
Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children's immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.
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Asthma
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Who is at risk for Asthma? ?
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Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.
Young children who often wheeze and have respiratory infectionsas well as certain other risk factorsare at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.
Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It's not clear whether or how sex and sex hormones play a role in causing asthma.
Most, but not all, people who have asthma have allergies.
Some people develop asthma because of contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma.
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Asthma
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What are the symptoms of Asthma ?
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Common signs and symptoms of asthma include:
Coughing. Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
Chest tightness. This may feel like something is squeezing or sitting on your chest.
Shortness of breath. Some people who have asthma say they can't catch their breath or they feel out of breath. You may feel like you can't get air out of your lungs.
Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn't always mean that you have asthma. The best way to diagnose asthma for certain is to use a lung function test, a medical history (including type and frequency of symptoms), and a physical exam.
The types of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine.
Severe symptoms can be fatal. It's important to treat symptoms when you first notice them so they don't become severe.
With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.
What Causes Asthma Symptoms To Occur?
Many things can trigger or worsen asthma symptoms. Your doctor will help you find out which things (sometimes called triggers) may cause your asthma to flare up if you come in contact with them. Triggers may include:
Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers
Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home dcor products, and sprays (such as hairspray)
Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers
Sulfites in foods and drinks
Viral upper respiratory infections, such as colds
Physical activity, including exercise
Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions need treatment as part of an overall asthma care plan.
Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you may not be on the list. Talk with your doctor about the things that seem to make your asthma worse.
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Asthma
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How to diagnose Asthma ?
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Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.
Your doctor also will figure out the severity of your asthmathat is, whether it's intermittent, mild, moderate, or severe. The level of severity will determine what treatment you'll start on.
You may need to see an asthma specialist if:
You need special tests to help diagnose asthma
You've had a life-threatening asthma attack
You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall problems getting your asthma well controlled
You're thinking about getting allergy treatments
Medical and Family Histories
Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur.
Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.
Your doctor also may want to know what factors seem to trigger your symptoms or worsen them. For more information about possible asthma triggers, go to "What Are the Signs and Symptoms of Asthma?"
Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.
Physical Exam
Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema).
Keep in mind that you can still have asthma even if you don't have these signs on the day that your doctor examines you.
Diagnostic Tests
Lung Function Test
Your doctor will use a test called spirometry (spi-ROM-eh-tre) to check how your lungs are working. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out.
Your doctor also may give you medicine and then test you again to see whether the results have improved.
If the starting results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your diagnosis will likely be asthma.
Other Tests
Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:
Allergy testing to find out which allergens affect you, if any.
A test to measure how sensitive your airways are. This is called a bronchoprovocation (brong-KO-prav-eh-KA-shun) test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.
A test to show whether you have another condition with the same symptoms as asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.
A chest x ray or an EKG (electrocardiogram). These tests will help find out whether a foreign object or other disease may be causing your symptoms.
Diagnosing Asthma in Young Children
Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (aged 0 to 5 years) can be hard to diagnose.
Sometimes it's hard to tell whether a child has asthma or another childhood condition. This is because the symptoms of asthma also occur with other conditions.
Also, many young children who wheeze when they get colds or respiratory infections don't go on to have asthma after they're 6 years old.
A child may wheeze because he or she has small airways that become even narrower during colds or respiratory infections. The airways grow as the child grows older, so wheezing no longer occurs when the child gets colds.
A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:
One or both parents have asthma
The child has signs of allergies, including the allergic skin condition eczema
The child has allergic reactions to pollens or other airborne allergens
The child wheezes even when he or she doesn't have a cold or other infection
The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it's hard to do lung function tests in children younger than 5 years. Thus, doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis.
Doctors also may use a 46 week trial of asthma medicines to see how well a child responds.
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Asthma
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What are the treatments for Asthma ?
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Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:
Prevent chronic and troublesome symptoms, such as coughing and shortness of breath
Reduce your need for quick-relief medicines (see below)
Help you maintain good lung function
Let you maintain your normal activity level and sleep through the night
Prevent asthma attacks that could result in an emergency room visit or hospital stay
To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or olderand younger children who are ableshould take an active role in their asthma care.
Taking an active role to control your asthma involves:
Working with your doctor to treat other conditions that can interfere with asthma management.
Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
Working with your doctor and other health care providers to create and follow an asthma action plan.
An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed.
Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up.
Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.
Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma.
Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.
Asthma treatment for certain groups of peoplesuch as children, pregnant women, or those for whom exercise brings on asthma symptomswill be adjusted to meet their special needs.
Follow an Asthma Action Plan
You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room.
If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.
Go to the National Heart, Lung, and Blood Institute's (NHLBI's) "Asthma Action Plan" for a sample plan.
Avoid Things That Can Worsen Your Asthma
Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them. (For more information about asthma triggers, go to "What Are the Signs and Symptoms of Asthma?")
For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.
One possible asthma trigger you shouldnt avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
The NHLBI offers many useful tips for controlling asthma triggers. For more information, go to page 2 of NHLBI's "Asthma Action Plan."
If your asthma symptoms are clearly related to allergens, and you can't avoid exposure to those allergens, your doctor may advise you to get allergy shots.
You may need to see a specialist if you're thinking about getting allergy shots. These shots can lessen or prevent your asthma symptoms, but they can't cure your asthma.
Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Your doctor will treat these conditions as well.
Medicines
Your doctor will consider many things when deciding which asthma medicines are best for you. He or she will check to see how well a medicine works for you. Then, he or she will adjust the dose or medicine as needed.
Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs.
Not all inhalers are used the same way. Ask your doctor or another health care provider to show you the right way to use your inhaler. Review the way you use your inhaler at every medical visit.
Long-Term Control Medicines
Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines don't give you quick relief from symptoms.
Inhaled corticosteroids. Inhaled corticosteroids are the preferred medicine for long-term control of asthma. They're the most effective option for long-term relief of the inflammation and swelling that makes your airways sensitive to certain inhaled substances.
Reducing inflammation helps prevent the chain reaction that causes asthma symptoms. Most people who take these medicines daily find they greatly reduce the severity of symptoms and how often they occur.
Inhaled corticosteroids generally are safe when taken as prescribed. These medicines are different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren't habit-forming, even if you take them every day for many years.
Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects.
One common side effect from inhaled corticosteroids is a mouth infection called thrush. You might be able to use a spacer or holding chamber on your inhaler to avoid thrush. These devices attach to your inhaler. They help prevent the medicine from landing in your mouth or on the back of your throat.
Check with your doctor to see whether a spacer or holding chamber should be used with the inhaler you have. Also, work with your health care team if you have any questions about how to use a spacer or holding chamber. Rinsing your mouth out with water after taking inhaled corticosteroids also can lower your risk for thrush.
If you have severe asthma, you may have to take corticosteroid pills or liquid for short periods to get your asthma under control.
If taken for long periods, these medicines raise your risk for cataracts and osteoporosis (OS-te-o-po-RO-sis). A cataract is the clouding of the lens in your eye. Osteoporosis is a disorder that makes your bones weak and more likely to break.
Your doctor may have you add another long-term asthma control medicine so he or she can lower your dose of corticosteroids. Or, your doctor may suggest you take calcium and vitamin D pills to protect your bones.
Other long-term control medicines. Other long-term control medicines include:
Cromolyn. This medicine is taken using a device called a nebulizer. As you breathe in, the nebulizer sends a fine mist of medicine to your lungs. Cromolyn helps prevent airway inflammation.
Omalizumab (anti-IgE). This medicine is given as a shot (injection) one or two times a month. It helps prevent your body from reacting to asthma triggers, such as pollen and dust mites. Anti-IgE might be used if other asthma medicines have not worked well.
A rare, but possibly life-threatening allergic reaction called anaphylaxis might occur when the Omalizumab injection is given. If you take this medication, work with your doctor to make sure you understand the signs and symptoms of anaphylaxis and what actions you should take.
Inhaled long-acting beta2-agonists. These medicines open the airways. They might be added to inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control. They must used with inhaled corticosteroids.
Leukotriene modifiers. These medicines are taken by mouth. They help block the chain reaction that increases inflammation in your airways.
Theophylline. This medicine is taken by mouth. Theophylline helps open the airways.
If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine.
Long-term control medicines can have side effects. Talk with your doctor about these side effects and ways to reduce or avoid them.
With some medicines, like theophylline, your doctor will check the level of medicine in your blood. This helps ensure that youre getting enough medicine to relieve your asthma symptoms, but not so much that it causes dangerous side effects.
Quick-Relief Medicines
All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonists are the first choice for quick relief.
These medicines act quickly to relax tight muscles around your airways when you're having a flareup. This allows the airways to open up so air can flow through them.
You should take your quick-relief medicine when you first notice asthma symptoms. If you use this medicine more than 2 days a week, talk with your doctor about your asthma control. You may need to make changes to your asthma action plan.
Carry your quick-relief inhaler with you at all times in case you need it. If your child has asthma, make sure that anyone caring for him or her has the child's quick-relief medicines, including staff at the child's school. They should understand when and how to use these medicines and when to seek medical care for your child.
You shouldn't use quick-relief medicines in place of prescribed long-term control medicines. Quick-relief medicines don't reduce inflammation.
Track Your Asthma
To track your asthma, keep records of your symptoms, check your peak flow number using a peak flow meter, and get regular asthma checkups.
Record Your Symptoms
You can record your asthma symptoms in a diary to see how well your treatments are controlling your asthma.
Asthma is well controlled if:
You have symptoms no more than 2 days a week, and these symptoms don't wake you from sleep more than 1 or 2 nights a month.
You can do all your normal activities.
You take quick-relief medicines no more than 2 days a week.
You have no more than one asthma attack a year that requires you to take corticosteroids by mouth.
Your peak flow doesn't drop below 80 percent of your personal best number.
If your asthma isn't well controlled, contact your doctor. He or she may need to change your asthma action plan.
Use a Peak Flow Meter
This small, hand-held device shows how well air moves out of your lungs. You blow into the device and it gives you a score, or peak flow number. Your score shows how well your lungs are working at the time of the test.
Your doctor will tell you how and when to use your peak flow meter. He or she also will teach you how to take your medicines based on your score.
Your doctor and other health care providers may ask you to use your peak flow meter each morning and keep a record of your results. You may find it very useful to record peak flow scores for a couple of weeks before each medical visit and take the results with you.
When you're first diagnosed with asthma, it's important to find your "personal best" peak flow number. To do this, you record your score each day for a 2- to 3-week period when your asthma is well-controlled. The highest number you get during that time is your personal best. You can compare this number to future numbers to make sure your asthma is controlled.
Your peak flow meter can help warn you of an asthma attack, even before you notice symptoms. If your score shows that your breathing is getting worse, you should take your quick-relief medicines the way your asthma action plan directs. Then you can use the peak flow meter to check how well the medicine worked.
Get Asthma Checkups
When you first begin treatment, you'll see your doctor about every 2 to 6 weeks. Once your asthma is controlled, your doctor may want to see you from once a month to twice a year.
During these checkups, your doctor may ask whether you've had an asthma attack since the last visit or any changes in symptoms or peak flow measurements. He or she also may ask about your daily activities. This information will help your doctor assess your level of asthma control.
Your doctor also may ask whether you have any problems or concerns with taking your medicines or following your asthma action plan. Based on your answers to these questions, your doctor may change the dose of your medicine or give you a new medicine.
If your control is very good, you might be able to take less medicine. The goal is to use the least amount of medicine needed to control your asthma.
Emergency Care
Most people who have asthma, including many children, can safely manage their symptoms by following their asthma action plans. However, you might need medical attention at times.
Call your doctor for advice if:
Your medicines don't relieve an asthma attack.
Your peak flow is less than half of your personal best peak flow number.
Call 911 for emergency care if:
You have trouble walking and talking because you're out of breath.
You have blue lips or fingernails.
At the hospital, you'll be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.
Asthma Treatment for Special Groups
The treatments described above generally apply to all people who have asthma. However, some aspects of treatment differ for people in certain age groups and those who have special needs.
Children
It's hard to diagnose asthma in children younger than 5 years. Thus, it's hard to know whether young children who wheeze or have other asthma symptoms will benefit from long-term control medicines. (Quick-relief medicines tend to relieve wheezing in young children whether they have asthma or not.)
Doctors will treat infants and young children who have asthma symptoms with long-term control medicines if, after assessing a child, they feel that the symptoms are persistent and likely to continue after 6 years of age. (For more information, go to "How Is Asthma Diagnosed?")
Inhaled corticosteroids are the preferred treatment for young children. Montelukast and cromolyn are other options. Treatment might be given for a trial period of 1month to 6 weeks. Treatment usually is stopped if benefits aren't seen during that time and the doctor and parents are confident the medicine was used properly.
Inhaled corticosteroids can possibly slow the growth of children of all ages. Slowed growth usually is apparent in the first several months of treatment, is generally small, and doesn't get worse over time. Poorly controlled asthma also may reduce a child's growth rate.
Many experts think the benefits of inhaled corticosteroids for children who need them to control their asthma far outweigh the risk of slowed growth.
Older Adults
Doctors may need to adjust asthma treatment for older adults who take certain other medicines, such as beta blockers, aspirin and other pain relievers, and anti-inflammatory medicines. These medicines can prevent asthma medicines from working well and may worsen asthma symptoms.
Be sure to tell your doctor about all of the medicines you take, including over-the-counter medicines.
Older adults may develop weak bones from using inhaled corticosteroids, especially at high doses. Talk with your doctor about taking calcium and vitamin D pills, as well as other ways to help keep your bones strong.
Pregnant Women
Pregnant women who have asthma need to control the disease to ensure a good supply of oxygen to their babies. Poor asthma control increases the risk of preeclampsia, a condition in which a pregnant woman develops high blood pressure and protein in the urine. Poor asthma control also increases the risk that a baby will be born early and have a low birth weight.
Studies show that it's safer to take asthma medicines while pregnant than to risk having an asthma attack.
Talk with your doctor if you have asthma and are pregnant or planning a pregnancy. Your level of asthma control may get better or it may get worse while you're pregnant. Your health care team will check your asthma control often and adjust your treatment as needed.
People Whose Asthma Symptoms Occur With Physical Activity
Physical activity is an important part of a healthy lifestyle. Adults need physical activity to maintain good health. Children need it for growth and development.
In some people, however, physical activity can trigger asthma symptoms. If this happens to you or your child, talk with your doctor about the best ways to control asthma so you can stay active.
The following medicines may help prevent asthma symptoms caused by physical activity:
Short-acting beta2-agonists (quick-relief medicine) taken shortly before physical activity can last 2 to 3 hours and prevent exercise-related symptoms in most people who take them.
Long-acting beta2-agonists can be protective for up to 12 hours. However, with daily use, they'll no longer give up to 12 hours of protection. Also, frequent use of these medicines for physical activity might be a sign that asthma is poorly controlled.
Leukotriene modifiers. These pills are taken several hours before physical activity. They can help relieve asthma symptoms brought on by physical activity.
Long-term control medicines. Frequent or severe symptoms due to physical activity may suggest poorly controlled asthma and the need to either start or increase long-term control medicines that reduce inflammation. This will help prevent exercise-related symptoms.
Easing into physical activity with a warmup period may be helpful. You also may want to wear a mask or scarf over your mouth when exercising in cold weather.
If you use your asthma medicines as your doctor directs, you should be able to take part in any physical activity or sport you choose.
People Having Surgery
Asthma may add to the risk of having problems during and after surgery. For instance, having a tube put into your throat may cause an asthma attack.
Tell your surgeon about your asthma when you first talk with him or her. The surgeon can take steps to lower your risk, such as giving you asthma medicines before or during surgery.
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Asthma
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How to prevent Asthma ?
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You cant prevent asthma. However, you can take steps to control the disease and prevent its symptoms. For example:
Learn about your asthma and ways to control it.
Follow your written asthma action plan. (For a sample plan, go to the National Heart, Lung, and Blood Institute's "Asthma Action Plan.")
Use medicines as your doctor prescribes.
Identify and try to avoid things that make your asthma worse (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
Keep track of your asthma symptoms and level of control.
Get regular checkups for your asthma.
For more details about how to prevent asthma symptoms and attacks, go to "How Is Asthma Treated and Controlled?"
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Asthma
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What is (are) Stroke ?
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A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells.
If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing.
A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death.
If you think you or someone else is having a stroke, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Overview
The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke.
An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.)
Another condition thats similar to a stroke is a transient ischemic attack, also called a TIA or mini-stroke. A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isnt permanent (lasting).
Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, its important for your doctor to find the cause so you can take steps to prevent a stroke.
Both strokes and TIAs require emergency care.
Outlook
Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke.
If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke.
Researchers continue to study the causes and risk factors for stroke. Theyre also finding new and better treatments and new ways to help the brain repair itself after a stroke.
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Stroke
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What causes Stroke ?
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Ischemic Stroke and Transient Ischemic Attack
An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA.
For example, atherosclerosis (ath-er-o-skler-O-sis) is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque hardens and narrows the arteries, which limits the flow of blood to tissues and organs (such as the heart and brain).
Plaque in an artery can crack or rupture (break open). Blood platelets (PLATE-lets), which are disc-shaped cell fragments, stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery.
Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck. The two main arteries on each side of the neck are called the carotid (ka-ROT-id) arteries. These arteries supply oxygen-rich blood to the brain, face, scalp, and neck.
When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States.
An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brains arteries. This stops blood flow through the artery and damages brain cells.
Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is a common cause of embolic stroke.
In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers.
An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain.
Hemorrhagic Stroke
Sudden bleeding in the brain can cause a hemorrhagic stroke. The bleeding causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage brain cells and tissues.
Examples of conditions that can cause a hemorrhagic stroke include high blood pressure, aneurysms, and arteriovenous (ar-TEER-e-o-VE-nus) malformations (AVMs).
"Blood pressure" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If blood pressure rises and stays high over time, it can damage the body in many ways.
Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. High blood pressure can increase the risk of hemorrhagic stroke in people who have aneurysms or AVMs.
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Stroke
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Who is at risk for Stroke? ?
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Certain traits, conditions, and habits can raise your risk of having a stroke or transient ischemic attack (TIA). These traits, conditions, and habits are known as risk factors.
The more risk factors you have, the more likely you are to have a stroke. You can treat or control some risk factors, such as high blood pressure and smoking. Other risk factors, such as age and gender, you cant control.
The major risk factors for stroke include:
High blood pressure. High blood pressure is the main risk factor for stroke. Blood pressure is considered high if it stays at or above 140/90 millimeters of mercury (mmHg) over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.
Diabetes. Diabetes is a disease in which the blood sugar level is high because the body doesnt make enough insulin or doesnt use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where its used for energy.
Heart diseases.Coronary heart disease,cardiomyopathy,heart failure, andatrial fibrillationcan cause blood clots that can lead to a stroke.
Smoking. Smoking can damage blood vessels and raise blood pressure. Smoking also may reduce the amount of oxygen that reaches your bodys tissues. Exposure to secondhand smoke also can damage the blood vessels.
Age and gender. Your risk of stroke increases as you get older. At younger ages, men are more likely than women to have strokes. However, women are more likely to die from strokes. Women who take birth control pills also are at slightly higher risk of stroke.
Race and ethnicity. Strokes occur more often in African American, Alaska Native, and American Indian adults than in white, Hispanic, or Asian American adults.
Personal or family history of stroke or TIA. If youve had a stroke, youre at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke, as does having a family history of stroke.
Brainaneurysmsor arteriovenous malformations (AVMs). Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture (break open) within the brain. AVMs may be present at birth, but often arent diagnosed until they rupture.
Other risk factors for stroke, many of which of you can control, include:
Alcohol and illegal drug use, including cocaine, amphetamines, and other drugs
Certain medical conditions, such as sickle cell disease, vasculitis (inflammation of the blood vessels), and bleeding disorders
Lack of physical activity
Overweight and Obesity
Stress and depression
Unhealthy cholesterol levels
Unhealthy diet
Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack or cardiac bypass surgery. The risk may increase the longer NSAIDs are used. Common NSAIDs include ibuprofen and naproxen.
Following a healthy lifestyle can lower the risk of stroke. Some people also may need to take medicines to lower their risk. Sometimes strokes can occur in people who dont have any known risk factors.
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Stroke
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What are the symptoms of Stroke ?
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The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days.
The type of symptoms depends on the type of stroke and the area of the brain thats affected. How long symptoms last and how severe they are vary among different people.
Signs and symptoms of a stroke may include:
Sudden weakness
Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body
Confusion
Trouble speaking or understanding speech
Trouble seeing in one or both eyes
Problems breathing
Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
Loss of consciousness
Sudden and severe headache
A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 12 hours (although they may last up to 24 hours). A TIA may occur only once in a persons lifetime or more often.
At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care.
If you think you or someone else is having a TIA or stroke, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Stroke Complications
After youve had a stroke, you may develop other complications, such as:
Blood clots and muscle weakness. Being immobile (unable to move around) for a long time can raise your risk of developing blood clots in the deep veins of the legs. Being immobile also can lead to muscle weakness and decreased muscle flexibility.
Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You also may be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia.
Loss of bladder control. Some strokes affect the muscles used to urinate. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. Loss of bowel control or constipation also may occur after a stroke.
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Stroke
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How to diagnose Stroke ?
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Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results.
Your doctor will want to find out the type of stroke youve had, its cause, the part of the brain that's affected, and whether you have bleeding in the brain.
If your doctor thinks youve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke.
Medical History and Physical Exam
Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began.
During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly.
Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit (broo-E) may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries.
Diagnostic Tests and Procedures
Your doctor may recommend one or more of the following tests to diagnose a stroke or TIA.
Brain Computed Tomography
A brain computed tomography (to-MOG-rah-fee) scan, or brain CT scan, is a painless test that uses x rays to take clear, detailed pictures of your brain. This test often is done right after a stroke is suspected.
A brain CT scan can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing your symptoms.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test can detect changes in brain tissue and damage to brain cells from a stroke.
An MRI may be used instead of, or in addition to, a CT scan to diagnose a stroke.
Computed Tomography Arteriogram and Magnetic Resonance Arteriogram
A CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) can show the large blood vessels in the brain. These tests may give your doctor more information about the site of a blood clot and the flow of blood through your brain.
Carotid Ultrasound
Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries. These arteries supply oxygen-rich blood to your brain.
Carotid ultrasound shows whether plaque has narrowed or blocked your carotid arteries.
Your carotid ultrasound test may include a Doppler ultrasound. Doppler ultrasound is a special test that shows the speed and direction of blood moving through your blood vessels.
Carotid Angiography
Carotid angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your carotid arteries.
For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved up into one of your carotid arteries.
Your doctor will inject a substance (called contrast dye) into the carotid artery. The dye helps make the artery visible on x-ray pictures.
Heart Tests
EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
An EKG can help detect heart problems that may have led to a stroke. For example, the test can help diagnose atrial fibrillation or a previous heart attack.
Echocardiography
Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart.
The test gives information about the size and shape of your heart and how well your heart's chambers and valves are working.
Echo can detect possible blood clots inside the heart and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to all parts of your body.
Blood Tests
Your doctor also may use blood tests to help diagnose a stroke.
A blood glucose test measures the amount of glucose (sugar) in your blood. Low blood glucose levels may cause symptoms similar to those of a stroke.
A platelet count measures the number of platelets in your blood. Blood platelets are cell fragments that help your blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting).
Your doctor also may recommend blood tests to measure how long it takes for your blood to clot. Two tests that may be used are called PT and PTT tests. These tests show whether your blood is clotting normally.
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Stroke
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What are the treatments for Stroke ?
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Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions.
Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.
Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes.
Treating an Ischemic Stroke or Transient Ischemic Attack
An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures.
Medicines
If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, its important to know the signs and symptoms of a stroke and to call 911 right away for emergency care.
If you cant have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel.
Medical Procedures
If you have carotid artery disease, your doctor may recommend a carotid endarterectomy or carotid arteryangioplasty. Both procedures open blocked carotid arteries.
Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia (MERCI).
In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain.
MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter.
Treating a Hemorrhagic Stroke
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes arent treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse.
If youre taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, youll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding.
Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair.
Aneurysm Clipping and Coil Embolization
If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization.
Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. Youll be given medicine to make you sleep during the surgery. After the surgery, youll need to stay in the hospitals intensive care unit for a few days.
Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from burstingagain.Coil embolization is done in a hospital. Youll be given medicine to make you sleep during thesurgery.
Arteriovenous Malformation Repair
If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain.
Doctors use several methods to repair AVMs. These methods include:
Injecting a substance into the blood vessels of the AVM to block blood flow
Surgery to remove the AVM
Using radiation to shrink the blood vessels of the AVM
Treating Stroke Risk Factors
After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend heart-healthy lifestyle changes to help control your risk factors.
Heart-healthy lifestyle changes may include:
heart-healthy eating
maintaining a healthy weight
managing stress
physical activity
quitting smoking
If lifestyle changes arent enough, you may need medicine to control your risk factors.
Heart-Healthy Eating
Your doctor may recommend heart-healthy eating, which should include:
Fat-free or low-fat dairy products, such as skim milk
Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
Fruits, such as apples, bananas, oranges, pears, and prunes
Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
Vegetables, such as broccoli, cabbage, and carrots
Whole grains, such as oatmeal, brown rice, and corn tortillas
When following a heart-healthy diet, you should avoid eating:
A lot of red meat
Palm and coconut oils
Sugary foods and beverages
Two nutrients in your diet make blood cholesterol levels rise:
Saturated fatfound mostly in foods that come from animals
Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.
Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples:
1,200 calories a day
8 grams of saturated fat a day
1,500 calories a day
10 grams of saturated fat a day
1,800 calories a day
12 grams of saturated fat a day
2,000 calories a day
13 grams of saturated fat a day
2,500 calories a day
17 grams of saturated fat a day
Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are:
Avocados
Corn, sunflower, and soybean oils
Nuts and seeds, such as walnuts
Olive, canola, peanut, safflower, and sesame oils
Peanut butter
Salmon and trout
Tofu
Sodium
Try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.
Dietary Approaches to Stop Hypertension
Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH.
Alcohol
Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:
12 ounces of beer
5 ounces of wine
1 ounces of liquor
Maintaining a Healthy Weight
Maintaining a healthy weight is important for overall health and can lower your risk for stroke. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active.
Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI:
Below 18.5 is a sign that you are underweight.
Between 18.5 and 24.9 is in the normal range.
Between 25.0 and 29.9 is considered overweight.
Of 30.0 or higher is considered obese.
A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal.
Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk.
If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol.
Managing Stress
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as:
A stress management program
Meditation
Physical activity
Relaxation therapy
Talking things out with friends or family
Physical Activity
Regular physical activity can lower many risk factors for stroke.
Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week.
Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.
Read more about physical activity at:
Physical Activity and Your Heart
U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans
Quitting Smoking
If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for stroke. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, visit Smoking and Your Heart.
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Stroke
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How to prevent Stroke ?
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Taking action to control your risk factors can help prevent or delay a stroke. If youve already had a stroke, these actions can help prevent another one.
Be physically active. Physical activity can improve your fitness level and health. Talk with your doctor about what types and amounts of activity are safe for you.
Dont smoke, or if you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk of stroke. Talk with your doctor about programs and products that can help you quit. Also, secondhand smoke can damage the bloodvessels.
Maintain a healthy weight. If youre overweight or obese, work with your doctor to create a reasonable weight loss plan. Controlling your weight helps you control risk factors for stroke.
Make heart-healthy eating choices. Heart-healthy eating can help lower your risk or prevent a stroke.
Manage stress. Use techniques to lower your stress levels.
If you or someone in your family has had a stroke, be sure to tell your doctor. By knowing your family history of stroke, you may be able to lower your risk factors and prevent or delay a stroke. If youve had a transient ischemic attack (TIA), dont ignore it. TIAs are warnings, and its important for your doctor to find the cause of the TIA so you can take steps to prevent a stroke.
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Stroke
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What is (are) Diabetic Heart Disease ?
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The term "diabetic heart disease" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes:
Are at higher risk for heart disease
Have additional causes of heart disease
May develop heart disease at a younger age
May have more severe heart disease
What Is Diabetes?
Diabetes is a disease in which the body's blood glucose (sugar) level is too high. Normally, the body breaks down food into glucose and carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.
The two main types of diabetes are type 1 and type 2. In type 1 diabetes, the body doesn't make enough insulin. This causes the body's blood sugar level to rise.
In type 2 diabetes, the body's cells don't use insulin properly (a condition called insulin resistance). At first, the body reacts by making more insulin. Over time, though, the body can't make enough insulin to control its blood sugar level.
For more information about diabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' Introduction to Diabetes Web page.
What Heart Diseases Are Involved in Diabetic Heart Disease?
DHD may include coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy (KAR-de-o-mi-OP-ah-thee).
Coronary Heart Disease
In CHD, a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.
CHD can lead to chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh), irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart attack, or even death.
Heart Failure
Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. The term heart failure doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
If you have heart failure, you may tire easily and have to limit your activities. CHD can lead to heart failure by weakening the heart muscle over time.
Diabetic Cardiomyopathy
Diabetic cardiomyopathy is a disease that damages the structure and function of the heart. This disease can lead to heart failure and arrhythmias, even in people who have diabetes but don't have CHD.
Overview
People who have type 1 or type 2 diabetes can develop DHD. The higher a person's blood sugar level is, the higher his or her risk of DHD.
Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease, just like smoking, high blood pressure, and high blood cholesterol. In fact, people who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks.
Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Although research is ongoing, it's clear that diabetes and other conditionssuch as overweight and obesity and metabolic syndromeinteract to cause harmful physical changes to the heart.
Third, diabetes raises the risk of earlier and more severe heart problems. Also, people who have DHD tend to have less success with some heart disease treatments, such as coronary artery bypass grafting and percutaneous coronary intervention,also known as coronary angioplasty.
Outlook
If you have diabetes, you can lower your risk of DHD. Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors.
Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity can lower your blood pressure, help control your blood sugar level and your weight, and reduce stress.
It's also very important to follow your treatment plan for diabetes and see your doctor for ongoing care.
If you already have DHD, follow your treatment plan as your doctors advises. This may help you avoid or delay serious problems, such as a heart attack or heart failure.
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Diabetic Heart Disease
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What causes Diabetic Heart Disease ?
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At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes.
Researchers continue to study these processes because all of the details aren't yet known.
Coronary Atherosclerosis
Atherosclerosis is a disease in which plaque builds up inside the arteries. The exact cause of atherosclerosis isn't known. However, studies show that it is a slow, complex disease that may start in childhood. The disease develops faster as you age.
Coronary atherosclerosis may start when certain factors damage the inner layers of the coronary (heart) arteries. These factors include:
Smoking
High amounts of certain fats and cholesterol in the blood
High blood pressure
High amounts of sugar in the blood due to insulin resistance or diabetes
Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. This reduces the flow of oxygen-rich blood to your heart muscle.
Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.
Blood clots narrow the coronary arteries even more. This limits the flow of oxygen-rich blood to your heart and may worsen angina (chest pain) or cause a heart attack.
Metabolic Syndrome
Metabolic syndrome is the name for a group of risk factors that raises your risk of both CHD and type 2 diabetes.
If you have three or more of the five metabolic risk factors, you have metabolic syndrome. The risk factors are:
A large waistline (a waist measurement of 35 inches or more for women and 40 inches or more for men).
A high triglyceride (tri-GLIH-seh-ride) level (or youre on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries.
High blood pressure (or youre on medicine to treat high blood pressure).
A high fasting blood sugar level (or you're on medicine to treat high blood sugar).
It's unclear whether these risk factors have a common cause or are mainly related by their combined effects on the heart.
Obesity seems to set the stage for metabolic syndrome. Obesity can cause harmful changes in body fats and how the body uses insulin.
Chronic (ongoing) inflammation also may occur in people who have metabolic syndrome. Inflammation is the body's response to illness or injury. It may raise your risk of CHD and heart attack. Inflammation also may contribute to or worsen metabolic syndrome.
Research is ongoing to learn more about metabolic syndrome and how metabolic risk factors interact.
Insulin Resistance in People Who Have Type 2 Diabetes
Type 2 diabetes usually begins with insulin resistance. Insulin resistance means that the body can't properly use the insulin it makes.
People who have type 2 diabetes and insulin resistance have higher levels of substances in the blood that cause blood clots. Blood clots can block the coronary arteries and cause a heart attack or even death.
The Interaction of Coronary Heart Disease, High Blood Pressure, and Diabetes
Each of these risk factors alone can damage the heart. CHD reduces the flow of oxygen-rich blood to your heart muscle. High blood pressure and diabetes may cause harmful changes in the structure and function of the heart.
Having CHD, high blood pressure, and diabetes is even more harmful to the heart. Together, these conditions can severely damage the heart muscle. As a result, the heart has to work harder than normal. Over time, the heart weakens and isnt able to pump enough blood to meet the bodys needs. This condition is called heart failure.
As the heart weakens, the body may release proteins and other substances into the blood. These proteins and substances also can harm the heart and worsen heart failure.
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Diabetic Heart Disease
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Who is at risk for Diabetic Heart Disease? ?
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People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don't have diabetes, people who have the disease are more likely to:
Have heart attacks and other heart and blood vessel diseases. In men, the risk is double; in women, the risk is triple.
Have more complications after a heart attack, such as angina (chest pain or discomfort) and heart failure.
Die from heart disease.
The higher your blood sugar level is, the higher your risk of DHD. (A higher than normal blood sugar level is a risk factor for heart disease even in people who don't have diabetes.)
Type 2 diabetes raises your risk of having silent heart diseasethat is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Other Risk Factors
Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don't. You can control most of these risk factors, but some you can't.
For a more detailed discussion of these risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article.
Risk Factors You Can Control
Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called "bad" cholesterol) and low HDL cholesterol (sometimes called "good" cholesterol).
High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercurythe units used to measure blood pressure.)
Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues.
Prediabetes. This is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years.
Overweight or obesity. Being overweight or obese raises your risk of heart disease and heart attack. Overweight and obesity also are linked to other heart disease risk factors, such as high blood cholesterol, high blood pressure, and diabetes. Most people who have type 2 diabetes are overweight.
Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk of heart disease and type 2 diabetes. Metabolic syndrome also raises your risk of other health problems, such as stroke.
Lack of physical activity. Lack of physical activity can worsen other risk factors for heart disease, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
Unhealthy diet. An unhealthy diet can raise your risk of heart disease. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other heart disease risk factors.
Stress. Stress and anxiety can trigger your arteries to tighten. This can raise your blood pressure and your risk of having a heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke or overeat foods high in fat and sugar.
Risk Factors You Can't Control
Age. As you get older, your risk of heart disease and heart attack rises. In men, the risk of heart disease increases after age 45. In women, the risk increases after age 55. In people who have diabetes, the risk of heart disease increases after age 40.
Gender. Before age 55, women seem to have a lower risk of heart disease than men. After age 55, however, the risk of heart disease increases similarly in both women and men.
Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of CHD, heart attack, heart failure, and high blood pressure.
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Diabetic Heart Disease
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What are the symptoms of Diabetic Heart Disease ?
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Some people who have diabetic heart disease (DHD) may have no signs or symptoms of heart disease. This is called silent heart disease. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Thus, people who have diabetes should have regular medical checkups. Tests may reveal a problem before they're aware of it. Early treatment can reduce or delay related problems.
Some people who have DHD will have some or all of the typical symptoms of heart disease. Be aware of the symptoms described below and seek medical care if you have them.
If you think you're having a heart attack, call 911 right away for emergency care. Treatment for a heart attack works best when it's given right after symptoms occur.
Coronary Heart Disease
A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
See your doctor if you think you have angina. He or she may recommend tests to check your coronary arteries and to see whether you have CHD risk factors.
Other CHD signs and symptoms include nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness.
Some people don't realize they have CHD until they have a heart attack. A heart attack occurs if a blood clot forms in a coronary artery and blocks blood flow to part of the heart muscle.
The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.
The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. Shortness of breath may occur with or before chest discomfort.
Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms include nausea, vomiting, light-headedness or sudden dizziness, breaking out in a cold sweat, sleep problems, fatigue, and lack of energy.
Some heart attack symptoms are similar to angina symptoms. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.
If you don't know whether your chest pain is angina or a heart attack, call 911 right away for emergency care.
Not everyone who has a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. Also, diabetes-related nerve damage can interfere with pain signals in the body. As a result, some people who have diabetes may have heart attacks without symptoms.
Heart Failure
The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins in your neck. As the heart weakens, heart failure symptoms worsen.
People who have heart failure can live longer and more active lives if the condition is diagnosed early and they follow their treatment plans. If you have any form of DHD, talk with your doctor about your risk of heart failure.
Diabetic Cardiomyopathy
Diabetic cardiomyopathy may not cause symptoms in its early stages. Later, you may have weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet.
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Diabetic Heart Disease
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How to diagnose Diabetic Heart Disease ?
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Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures.
Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms.
Initial Tests
No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests.
Blood Pressure Measurement
To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.
Most often, you'll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you're at risk for DHD.
A blood test also can check the level of a hormone called BNP (brain natriuretic peptide) in your blood. The heart makes BNP, and the level of BNP rises during heart failure.
Chest X Ray
A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records your heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress.
During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you cant exercise, you may be given medicine to raise your heart rate.
Urinalysis
For this test, you'll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD.
Other Tests and Procedures
Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD.
For more information about other tests and procedures, go to the diagnosis sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.
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Diabetic Heart Disease
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What are the treatments for Diabetic Heart Disease ?
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Diabetic heart disease (DHD) is treated with lifestyle changes, medicines, and medical procedures. The goals of treating DHD include:
Controlling diabetes and any other heart disease risk factors you have, such as unhealthy blood cholesterol levels and high blood pressure
Reducing or relieving heart disease symptoms, such as angina (chest pain or discomfort)
Preventing or delaying heart disease complications, such as a heart attack
Repairing heart and coronary artery damage
Following the treatment plan your doctor recommends is very important. Compared with people who don't have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease.
Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors.
Lifestyle Changes
Following a healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone.
Following a Healthy Diet
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institutes (NHLBIs) Your Guide to Lowering Your Blood Pressure With DASH and the U.S. Department of Agricultures ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Maintaining a Healthy Weight
Controlling your weight helps you control heart disease risk factors. If youre overweight or obese, work with your doctor to create a reasonable weight-loss plan.
For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article.
Being Physically Active
Regular physical activity can lower many heart disease risk factors, and it helps control your blood sugar level. Physical activity also can improve how insulin works. (Insulin is a hormone that helps turn glucose into energy.)
Generally, adults should do at least 150 minutes (2hours and 30 minutes) of moderate-intensity physical activity each week. You dont have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each.
Talk with your doctor about what types and amounts and physical activity are safe for you. People who have diabetes must be careful to watch their blood sugar levels and avoid injury to their feet during physical activity.
For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."
Quitting Smoking
Smoking can damage your blood vessels and raise your risk of heart disease. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."
Managing Stress
Research shows that strong emotions, such as anger, can trigger a heart attack. Learning how to managestress, relax, and cope with problems can improve your emotional and physical health.
Medicines
Medicines are an important part of treatment for people who have diabetes and for people who have DHD.
Medicines can help control blood sugar levels, lower blood pressure, reduce the risk of blood clots, improve blood cholesterol levels, reduce the heart's workload, and treat angina symptoms.
Your doctor will prescribe medicines based on your specific needs.
Medical Procedures
If you have DHD, your doctor may recommend a medical procedure. The type of procedure will depend on the type of heart disease you have.
For example, both percutaneous coronary intervention (PCI),also known as coronaryangioplasty, and coronary artery bypass grafting (CABG) are used to treat coronary heart disease (CHD). Both of these procedures improve blood flow to your heart. PCI also can relieve chest pain. CABG can relieve chest pain and may help prevent a heart attack.
If you have heart damage and severe heart failure symptoms, your doctor may recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).
A CRT device is a type of pacemaker. A pacemaker is a small device that helps control abnormal heart rhythms. Its placed under the skin of the chest or abdomen. A CRT device helps the heart's lower chambers contract at the same time, which may decrease heart failure symptoms.
An ICD is similar to a pacemaker. An ICD is a small device thats placed under the skin of the chest or abdomen. The device uses electrical pulses or shocks to help control dangerous heart rhythms.
Your doctor also may recommend a pacemaker or ICD to treat diabetic cardiomyopathy. Other types of surgery also are used to treat this type of heart disease.
For more information about medical procedures used to treat diabetes-related heart diseases, go to the treatment sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.
Diabetes-Specific Treatment Issues
The treatments described above are used for people who have DHD and for people who have heart disease without diabetes. However, some aspects of heart disease treatment differ for people who have diabetes.
Treatment for High Blood Pressure and High Blood Cholesterol
Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don't. People who have diabetes also may have more aggressive treatment goals.
For example, your doctor may prescribe medicines called statins even if your blood cholesterol levels are in the normal range. Your doctor also may prescribe statins if you're older than 40 and have other heart disease risk factors.
Target goals for LDL cholesterol (sometimes called "bad" cholesterol) and high blood pressure also are lower for people who have diabetes than for those who don't. Studies suggest that most people who have diabetes will need more than one blood pressure medicine to reach their goals.
Research also has shown that some people who have diabetes may benefit more from certain blood pressure and cholesterol medicines than from others.
One example is a group of cholesterol medicines called bile acid sequestrants (such as cholestyramine). This type of medicine may offer advantages for people who have type 2 diabetes. It appears to improve blood sugar control and lower LDL cholesterol.
Treatment for Heart Failure
Some studies suggest that certain medicines may have advantages for treating heart failure in people who have diabetes. These medicines include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and beta blockers.
Research shows that two blood sugar medicines (insulin and sulfanylureas) don't seem to reduce the risk of heart failure in people who have type 2 diabetes. A third medicine (metformin) shows promise, but research is still ongoing.
Heart Attack Prevention
Doctors may recommend aspirin for people with diabetes who are at increased risk for heart disease and heart attack. Taken each day, low-dose aspirin may prevent blood clots that can lead to a heart attack.
People with diabetes who are at increased risk include most men older than 50 and most women older than 60 who have one or more of the following risk factors:
Smoking
High blood pressure
High blood cholesterol
A family history of early heart disease
A higher than normal level of protein in their urine
Blood Sugar Control
Controlling blood sugar levels is good for heart health. For example, controlling blood sugar improves everyday heart function for people who have diabetes and heart failure.
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Diabetic Heart Disease
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How to prevent Diabetic Heart Disease ?
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Taking action to control risk factors can help prevent or delay heart disease in people who have diabetes and in those who don't. Your risk of heart disease increases with the number of risk factors you have.
One step you can take is to adopt a healthy lifestyle. A healthy lifestyle should be part of a lifelong approach to healthy living. A healthy lifestyle includes:
Following a healthy diet
Maintaining a healthy weight
Being physically active
Quitting smoking
Managing stress
You also should know your family history of diabetes and heart disease. If you or someone in your family has diabetes, heart disease, or both, let your doctor know.
Your doctor may prescribe medicines to control certain risk factors, such as high blood pressure and high blood cholesterol. Take all of your medicines exactly as your doctor advises.
People who have diabetes also need good blood sugar control. Controlling your blood sugar level is good for heart health. Ask your doctor about the best ways to control your blood sugar level.
For more information about lifestyle changes and medicines, go to "How Is Diabetic Heart Disease Treated?"
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Diabetic Heart Disease
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What is (are) Bronchopulmonary Dysplasia ?
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Bronchopulmonary (BRONG-ko-PUL-mo-NAR-e) dysplasia (dis-PLA-ze-ah), or BPD, is a serious lung condition that affects infants. BPD mostly affects premature infants who need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube).
Most infants who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000 grams) at birth, and have breathing problems. Infections that occur before or shortly after birth also can contribute to BPD.
Some infants who have BPD may need long-term breathing support from nasal continuous positive airway pressure (NCPAP) machines or ventilators.
Overview
Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). RDS is a breathing disorder that mostly affects premature newborns. These infants' lungs aren't fully formed or aren't able to make enough surfactant (sur-FAK-tant).
Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so an infant can breathe in air once he or she is born.
Without surfactant, the lungs collapse, and the infant has to work hard to breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. Without proper treatment, the lack of oxygen may damage the infant's brain and other organs.
Babies who have RDS are treated with surfactant replacement therapy. They also may need oxygen therapy. Shortly after birth, some babies who have RDS also are treated with NCPAP or ventilators (machines that support breathing).
Often, the symptoms of RDS start to improve slowly after about a week. However, some babies get worse and need more oxygen or breathing support from NCPAP or a ventilator.
If premature infants still require oxygen therapy by the time they reach their original due dates, they're diagnosed with BPD.
Outlook
Advances in care now make it possible for more premature infants to survive. However, these infants are at high risk for BPD.
Most babies who have BPD get better in time, but they may need treatment for months or even years. They may continue to have lung problems throughout childhood and even into adulthood. There's some concern about whether people who had BPD as babies can ever have normal lung function.
As children who have BPD grow, their parents can help reduce the risk of BPD complications. Parents can encourage healthy eating habits and good nutrition. They also can avoid cigarette smoke and other lung irritants.
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Bronchopulmonary Dysplasia
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What causes Bronchopulmonary Dysplasia ?
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Bronchopulmonary dysplasia (BPD) develops as a result of an infant's lungs becoming irritated or inflamed.
The lungs of premature infants are fragile and often aren't fully developed. They can easily be irritated or injured within hours or days of birth. Many factors can damage premature infants' lungs.
Ventilation
Newborns who have breathing problems or can't breathe on their own may need ventilator support. Ventilators are machines that use pressure to blow air into the airways and lungs.
Although ventilator support can help premature infants survive, the machine's pressure might irritate and harm the babies' lungs. For this reason, doctors only recommend ventilator support when necessary.
High Levels of Oxygen
Newborns who have breathing problems might need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube). This treatment helps the infants' organs get enough oxygen to work well.
However, high levels of oxygen can inflame the lining of the lungs and injure the airways. Also, high levels of oxygen can slow lung development in premature infants.
Infections
Infections can inflame the lungs. As a result, the airways narrow, which makes it harder for premature infants to breathe. Lung infections also increase the babies' need for extra oxygen and breathing support.
Heredity
Studies show that heredity may play a role in causing BPD. More studies are needed to confirm this finding.
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Bronchopulmonary Dysplasia
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Who is at risk for Bronchopulmonary Dysplasia? ?
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The more premature an infant is and the lower his or her birth weight, the greater the risk of bronchopulmonary dysplasia (BPD).
Most infants who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000 grams) at birth, and have breathing problems. Infections that occur before or shortly after birth also can contribute to BPD.
The number of babies who have BPD is higher now than in the past. This is because of advances in care that help more premature infants survive.
Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). However, some babies who have mild RDS or don't have RDS also develop BPD. These babies often have very low birth weights and one or more other conditions, such as patent ductus arteriosus (PDA) and sepsis.
PDA is a heart problem that occurs soon after birth in some babies. Sepsis is a serious bacterial infection in the bloodstream.
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Bronchopulmonary Dysplasia
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What are the symptoms of Bronchopulmonary Dysplasia ?
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Many babies who develop bronchopulmonary dysplasia (BPD) are born with serious respiratory distress syndrome (RDS). The signs and symptoms of RDS at birth are:
Rapid, shallow breathing
Sharp pulling in of the chest below and between the ribs with each breath
Grunting sounds
Flaring of the nostrils
Babies who have RDS are treated with surfactant replacement therapy. They also may need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube).
Shortly after birth, some babies who have RDS also are treated with nasal continuous positive airway pressure (NCPAP) or ventilators (machines that support breathing).
Often, the symptoms of RDS start to improve slowly after about a week. However, some babies get worse and need more oxygen or breathing support from NCPAP or a ventilator.
A first sign of BPD is when premature infantsusually those born more than 10 weeks earlystill need oxygen therapy by the time they reach their original due dates. These babies are diagnosed with BPD.
Infants who have severe BPD may have trouble feeding, which can lead to delayed growth. These babies also may develop:
Pulmonary hypertension (PH). PH is increased pressure in the pulmonary arteries. These arteries carry blood from the heart to the lungs to pick up oxygen.
Cor pulmonale. Cor pulmonale is failure of the right side of the heart. Ongoing high blood pressure in the pulmonary arteries and the lower right chamber of the heart causes this condition.
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Bronchopulmonary Dysplasia
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How to diagnose Bronchopulmonary Dysplasia ?
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Infants who are born earlyusually more than 10 weeks before their due datesand still need oxygen therapy by the time they reach their original due dates are diagnosed with bronchopulmonary dysplasia (BPD).
BPD can be mild, moderate, or severe. The diagnosis depends on how much extra oxygen a baby needs at the time of his or her original due date. It also depends on how long the baby needs oxygen therapy.
To help confirm a diagnosis of BPD, doctors may recommend tests, such as:
Chest x ray. A chest x ray takes pictures of the structures inside the chest, such as the heart and lungs. In severe cases of BPD, this test may show large areas of air and signs of inflammation or infection in the lungs. A chest x ray also can detect problems (such as a collapsed lung) and show whether the lungs aren't developing normally.
Blood tests. Blood tests are used to see whether an infant has enough oxygen in his or her blood. Blood tests also can help determine whether an infection is causing an infant's breathing problems.
Echocardiography. This test uses sound waves to create a moving picture of the heart. Echocardiography is used to rule out heart defects or pulmonary hypertension as the cause of an infant's breathing problems
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Bronchopulmonary Dysplasia
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What are the treatments for Bronchopulmonary Dysplasia ?
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Preventive Measures
If your doctor thinks you're going to give birth too early, he or she may give you injections of a corticosteroid medicine.
The medicine can speed up surfactant production in your baby. Surfactant is a liquid that coats the inside of the lungs. It helps keep the lungs open so your infant can breathe in air once he or she is born.
Corticosteroids also can help your baby's lungs, brain, and kidneys develop more quickly while he or she is in the womb.
Premature babies who have very low birth weights also might be given corticosteroids within the first few days of birth. Doctors sometimes prescribe inhaled nitric oxide shortly after birth for babies who have very low birth weights. This treatment can help improve the babies' lung function.
These preventive measures may help reduce infants' risk of respiratory distress syndrome (RDS), which can lead to BPD.
Treatment for Respiratory Distress Syndrome
The goals of treating infants who have RDS include:
Reducing further injury to the lungs
Providing nutrition and other support to help the lungs grow and recover
Preventing lung infections by giving antibiotics
Treatment of RDS usually begins as soon as an infant is born, sometimes in the delivery room. Most infants who have signs of RDS are quickly moved to a neonatal intensive care unit (NICU). They receive around-the-clock treatment from health care professionals who specialize in treating premature infants.
Treatments for RDS include surfactant replacement therapy, breathing support with nasal continuous positive airway pressure (NCPAP) or a ventilator, oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube), and medicines to treat fluid buildup in the lungs.
For more information about RDS treatments, go to the Health Topics Respiratory Distress Syndrome article.
Treatment for Bronchopulmonary Dysplasia
Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU.
Such treatment usually includes:
Using radiant warmers or incubators to keep infants warm and reduce the risk of infection.
Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies' bodies.
Using sensors on fingers or toes to check the amount of oxygen in the infants' blood.
Giving fluids and nutrients through needles or tubes inserted into the infants' veins. This helps prevent malnutrition and promotes growth. Nutrition is vital to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats.
Checking fluid intake to make sure that fluid doesn't build up in the babies' lungs.
As BPD improves, babies are slowly weaned off NCPAP or ventilators until they can breathe on their own. These infants will likely need oxygen therapy for some time.
If your infant has moderate or severe BPD, echocardiography might be done every few weeks to months to check his or her pulmonary artery pressure.
If your child needs long-term ventilator support, he or she will likely get a tracheostomy (TRA-ke-OS-toe-me). A tracheostomy is a surgically made hole. It goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your child's doctor will put the breathing tube from the ventilator through the hole.
Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has some advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.)
Long-term use of an endotracheal tube can damage the trachea. This damage may need to be corrected with surgery later. A tracheostomy can allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.
While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your child's muscles and clear mucus out of his or her lungs.
Infants who have BPD may spend several weeks or months in the hospital. This allows them to get the care they need.
Before your baby goes home, learn as much as you can about your child's condition and how it's treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital.
Your child will likely continue on all or some of the treatments that were started at the hospital, including:
Medicines, such as bronchodilators, steroids, and diuretics.
Oxygen therapy or breathing support from NCPAP or a ventilator.
Extra nutrition and calories, which may be given through a feeding tube.
Preventive treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infantsespecially those in high-risk groupsRSV can lead to severe breathing problems.
Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist might be involved in his or her care.
Seek out support from family, friends, and hospital staff. Ask the case manager or social worker at the hospital about what you'll need after your baby leaves the hospital.
The doctors and nurses can assist with questions about your infant's care. Also, you may want to ask whether your community has a support group for parents of premature infants.
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Bronchopulmonary Dysplasia
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How to prevent Bronchopulmonary Dysplasia ?
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Taking steps to ensure a healthy pregnancy might prevent your infant from being born before his or her lungs have fully developed. These steps include:
Seeing your doctor regularly during your pregnancy
Following a healthy diet
Not smoking and avoiding tobacco smoke, alcohol, and illegal drugs
Controlling any ongoing medical conditions you have
Preventing infection
If your doctor thinks that you're going to give birth too early, he or she may give you injections of a corticosteroid medicine.
The medicine can speed up surfactant production in your baby. Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so your infant can breathe in air once he or she is born.
Usually, within about 24 hours of your taking this medicine, the baby's lungs start making enough surfactant. This will reduce the infant's risk of respiratory distress syndrome (RDS), which can lead to bronchopulmonary dysplasia (BPD).
Corticosteroids also can help your baby's lungs, brain, and kidneys develop more quickly while he or she is in the womb.
If your baby does develop RDS, it will probably be fairly mild. If the RDS isn't mild, BPD will likely develop.
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Bronchopulmonary Dysplasia
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What is (are) Hemophilia ?
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Espaol
Hemophilia (heem-o-FILL-ee-ah) is a rare bleeding disorder in which the blood doesn't clot normally.
If you have hemophilia, you may bleed for a longer time than others after an injury. You also may bleed inside your body (internally), especially in your knees, ankles, and elbows. This bleeding can damage your organs and tissues and may be life threatening.
Overview
Hemophilia usually is inherited. "Inherited means that the disorder is passed from parents to children through genes.
People born with hemophilia have little or no clotting factor. Clotting factor is a protein needed for normal blood clotting. There are several types of clotting factors. These proteins work with platelets (PLATE-lets) to help the blood clot.
Platelets are small blood cell fragments that form in the bone marrowa sponge-like tissue in the bones. Platelets play a major role in blood clotting. When blood vessels are injured, clotting factors help platelets stick together to plug cuts and breaks on the vessels and stop bleeding.
The two main types of hemophilia are A and B. If you have hemophilia A, you're missing or have low levels of clotting factor VIII (8). About 8 out of 10 people who have hemophilia have type A. If you have hemophilia B, you're missing or have low levels of clotting factor IX (9).
Rarely, hemophilia can be acquired. "Acquired means you aren't born with the disorder, but you develop it during your lifetime. This can happen if your body forms antibodies (proteins) that attack the clotting factors in your bloodstream. The antibodies can prevent the clotting factors from working.
This article focuses on inherited hemophilia.
Outlook
Hemophilia can be mild, moderate, or severe, depending on how much clotting factor is in your blood. About 7 out of 10 people who have hemophilia A have the severe form of the disorder.
People who don't have hemophilia have a factor VIII activity of 100 percent. People who have severe hemophilia A have a factor VIII activity of less than 1 percent.
Hemophilia usually occurs in males (with rare exceptions). About 1 in 5,000 males are born with hemophilia each year.
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Hemophilia
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What causes Hemophilia ?
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A defect in one of the genes that determines how the body makes blood clotting factor VIII or IX causes hemophilia. These genes are located on the X chromosomes (KRO-muh-somz).
Chromosomes come in pairs. Females have two X chromosomes, while males have one X and one Y chromosome. Only the X chromosome carries the genes related to clotting factors.
A male who has a hemophilia gene on his X chromosome will have hemophilia. When a female has a hemophilia gene on only one of her X chromosomes, she is a "hemophilia carrier and can pass the gene to her children. Sometimes carriers have low levels of clotting factor and have symptoms of hemophilia, including bleeding. Clotting factors are proteins in the blood that work together with platelets to stop or control bleeding.
Very rarely, a girl may be born with a very low clotting factor level and have a greater risk for bleeding, similar to boys who have hemophilia and very low levels of clotting factor. There are several hereditary and genetic causes of this much rarer form of hemophilia in females.
Some males who have the disorder are born to mothers who aren't carriers. In these cases, a mutation (random change) occurs in the gene as it is passed to the child.
Below are two examples of how the hemophilia gene is inherited.
Inheritance Pattern for HemophiliaExample 1
Each daughter has a 50 percent chance of inheriting the hemophilia gene from her mother and being a carrier. Each son has a 50 percent chance of inheriting the hemophilia gene from his mother and having hemophilia.
Inheritance Pattern for HemophiliaExample 2
Each daughter will inherit the hemophilia gene from her father and be a carrier. None of the sons will inherit the hemophilia gene from their father; thus, none will have hemophilia.
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Hemophilia
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What are the symptoms of Hemophilia ?
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The major signs and symptoms of hemophilia are excessive bleeding and easy bruising.
Excessive Bleeding
The extent of bleeding depends on how severe the hemophilia is.
Children who have mild hemophilia may not have signs unless they have excessive bleeding from a dental procedure, an accident, or surgery. Males who have severe hemophilia may bleed heavily after circumcision.
Bleeding can occur on the body's surface (external bleeding) or inside the body (internal bleeding).
Signs of external bleeding may include:
Bleeding in the mouth from a cut or bite or from cutting or losing a tooth
Nosebleeds for no obvious reason
Heavy bleeding from a minor cut
Bleeding from a cut that resumes after stopping for a short time
Signs of internal bleeding may include:
Blood in the urine (from bleeding in the kidneys or bladder)
Blood in the stool (from bleeding in the intestines or stomach)
Large bruises (from bleeding into the large muscles of the body)
Bleeding in the Joints
Bleeding in the knees, elbows, or other joints is another common form of internal bleeding in people who have hemophilia. This bleeding can occur without obvious injury.
At first, the bleeding causes tightness in the joint with no real pain or any visible signs of bleeding. The joint then becomes swollen, hot to touch, and painful to bend.
Swelling continues as bleeding continues. Eventually, movement in the joint is temporarily lost. Pain can be severe. Joint bleeding that isn't treated quickly can damage the joint.
Bleeding in the Brain
Internal bleeding in the brain is a very serious complication of hemophilia. It can happen after a simple bump on the head or a more serious injury. The signs and symptoms of bleeding in the brain include:
Long-lasting, painful headaches or neck pain or stiffness
Repeated vomiting
Sleepiness or changes in behavior
Sudden weakness or clumsiness of the arms or legs or problems walking
Double vision
Convulsions or seizures
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Hemophilia
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How to diagnose Hemophilia ?
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If you or your child appears to have a bleeding problem, your doctor will ask about your personal and family medical histories. This will reveal whether you or your family members, including women and girls, have bleeding problems. However, some people who have hemophilia have no recent family history of the disease.
You or your child also will likely have a physical exam and blood tests to diagnose hemophilia. Blood tests are used to find out:
How long it takes for your blood to clot
Whether your blood has low levels of any clotting factors
Whether any clotting factors are completely missing from your blood
The test results will show whether you have hemophilia, what type of hemophilia you have, and how severe it is.
Hemophilia A and B are classified as mild, moderate, or severe, depending on the amount of clotting factor VIII or IX in the blood.
The severity of symptoms can overlap between the categories. For example, some people who have mild hemophilia may have bleeding problems almost as often or as severe as some people who have moderate hemophilia.
Severe hemophilia can cause serious bleeding problems in babies. Thus, children who have severe hemophilia usually are diagnosed during the first year of life. People who have milder forms of hemophilia may not be diagnosed until they're adults.
The bleeding problems of hemophilia A and hemophilia B are the same. Only special blood tests can tell which type of the disorder you or your child has. Knowing which type is important because the treatments are different.
Pregnant women who are known hemophilia carriers can have the disorder diagnosed in their unborn babies as early as 12 weeks into their pregnancies.
Women who are hemophilia carriers also can have "preimplantation diagnosis" to have children who don't have hemophilia.
For this process, women have their eggs removed and fertilized by sperm in a laboratory. The embryos are then tested for hemophilia. Only embryos without the disorder are implanted in the womb.
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Hemophilia
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What are the treatments for Hemophilia ?
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Treatment With Replacement Therapy
The main treatment for hemophilia is called replacement therapy. Concentrates of clotting factor VIII (for hemophilia A) or clotting factor IX (for hemophilia B) are slowly dripped or injected into a vein. These infusions help replace the clotting factor that's missing or low.
Clotting factor concentrates can be made from human blood. The blood is treated to prevent the spread of diseases, such as hepatitis. With the current methods of screening and treating donated blood, the risk of getting an infectious disease from human clotting factors is very small.
To further reduce the risk, you or your child can take clotting factor concentrates that aren't made from human blood. These are called recombinant clotting factors. Clotting factors are easy to store, mix, and use at homeit only takes about 15 minutes to receive the factor.
You may have replacement therapy on a regular basis to prevent bleeding. This is called preventive or prophylactic (PRO-fih-lac-tik) therapy. Or, you may only need replacement therapy to stop bleeding when it occurs. This use of the treatment, on an as-needed basis, is called demand therapy.
Demand therapy is less intensive and expensive than preventive therapy. However, there's a risk that bleeding will cause damage before you receive the demand therapy.
Complications of Replacement Therapy
Complications of replacement therapy include:
Developing antibodies (proteins) that attack the clotting factor
Developing viral infections from human clotting factors
Damage to joints, muscles, or other parts of the body resulting from delays in treatment
Antibodies to the clotting factor. Antibodies can destroy the clotting factor before it has a chance to work. This is a very serious problem. It prevents the main treatment for hemophilia (replacement therapy) from working.
These antibodies, also called inhibitors, develop in about 2030 percent of people who have severe hemophilia A. Inhibitors develop in 25 percent of people who have hemophilia B.
When antibodies develop, doctors may use larger doses of clotting factor or try different clotting factor sources. Sometimes the antibodies go away.
Researchers are studying new ways to deal with antibodies to clotting factors.
Viruses from human clotting factors. Clotting factors made from human blood can carry the viruses that cause HIV/AIDS and hepatitis. However, the risk of getting an infectious disease from human clotting factors is very small due to:
Careful screening of blood donors
Testing of donated blood products
Treating donated blood products with a detergent and heat to destroy viruses
Vaccinating people who have hemophilia for hepatitis A and B
Damage to joints, muscles, and other parts of the body. Delays in treatment can cause damage such as:
Bleeding into a joint. If this happens many times, it can lead to changes in the shape of the joint and impair the joint's function.
Swelling of the membrane around a joint.
Pain, swelling, and redness of a joint.
Pressure on a joint from swelling, which can destroy the joint.
Home Treatment With Replacement Therapy
You can do both preventive (ongoing) and demand (as-needed) replacement therapy at home. Many people learn to do the infusions at home for their child or for themselves. Home treatment has several advantages:
You or your child can get quicker treatment when bleeding happens. Early treatment lowers the risk of complications.
Fewer visits to the doctor or emergency room are needed.
Home treatment costs less than treatment in a medical care setting.
Home treatment helps children accept treatment and take responsibility for their own health.
Discuss options for home treatment with your doctor or your child's doctor. A doctor or other health care provider can teach you the steps and safety procedures for home treatment. Hemophilia treatment centers are another good resource for learning about home treatment (discussed in "Living With Hemophilia).
Doctors can surgically implant vein access devices to make it easier for you to access a vein for treatment with replacement therapy. These devices can be helpful if treatment occurs often. However, infections can be a problem with these devices. Your doctor can help you decide whether this type of device is right for you or your child.
Other Types of Treatment
Desmopressin
Desmopressin (DDAVP) is a man-made hormone used to treat people who have mild hemophilia A. DDAVP isn't used to treat hemophilia B or severe hemophilia A.
DDAVP stimulates the release of stored factor VIII and von Willebrand factor; it also increases the level of these proteins in your blood. Von Willebrand factor carries and binds factor VIII, which can then stay in the bloodstream longer.
DDAVP usually is given by injection or as nasal spray. Because the effect of this medicine wears off if it's used often, the medicine is given only in certain situations. For example, you may take this medicine prior to dental work or before playing certain sports to prevent or reduce bleeding.
Antifibrinolytic Medicines
Antifibrinolytic medicines (including tranexamic acid and epsilon aminocaproic acid) may be used with replacement therapy. They're usually given as a pill, and they help keep blood clots from breaking down.
These medicines most often are used before dental work or to treat bleeding from the mouth or nose or mild intestinal bleeding.
Gene Therapy
Researchers are trying to find ways to correct the faulty genes that cause hemophilia. Gene therapy hasn't yet developed to the point that it's an accepted treatment for hemophilia. However, researchers continue to test gene therapy in clinical trials.
For more information, go to the "Clinical Trials" section of this article.
Treatment of a Specific Bleeding Site
Pain medicines, steroids, and physical therapy may be used to reduce pain and swelling in an affected joint. Talk with your doctor or pharmacist about which medicines are safe for you to take.
Which Treatment Is Best for You?
The type of treatment you or your child receives depends on several things, including how severe the hemophilia is, the activities you'll be doing, and the dental or medical procedures you'll be having.
Mild hemophiliaReplacement therapy usually isn't needed for mild hemophilia. Sometimes, though, DDAVP is given to raise the body's level of factor VIII.
Moderate hemophiliaYou may need replacement therapy only when bleeding occurs or to prevent bleeding that could occur when doing certain activities. Your doctor also may recommend DDAVP prior to having a procedure or doing an activity that increases the risk of bleeding.
Severe hemophiliaYou usually need replacement therapy to prevent bleeding that could damage your joints, muscles, or other parts of your body. Typically, replacement therapy is given at home two or three times a week. This preventive therapy usually is started in patients at a young age and may need to continue for life.
For both types of hemophilia, getting quick treatment for bleeding is important. Quick treatment can limit damage to your body. If you or your child has hemophilia, learn to recognize signs of bleeding.
Other family members also should learn to watch for signs of bleeding in a child who has hemophilia. Children sometimes ignore signs of bleeding because they want to avoid the discomfort of treatment.
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Hemophilia
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What is (are) Coronary Heart Disease ?
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Espaol
Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
Atherosclerosis
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.
Overview
If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur.
Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isnt restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death.
Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can't pump enough blood to meet your bodys needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.
Outlook
Lifestyle changes, medicines, and medical procedures can help prevent or treat coronary heart disease. These treatments may reduce the risk of related health problems.
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Coronary Heart Disease
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What causes Coronary Heart Disease ?
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Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:
Smoking
High levels of certain fats and cholesterol in the blood
High blood pressure
High levels of sugar in the blood due to insulin resistance or diabetes
Blood vessel inflammation
Plaque might begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause angina (chest pain or discomfort).
If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.
Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.
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Coronary Heart Disease
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Who is at risk for Coronary Heart Disease? ?
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In the United States, coronary heart disease (CHD) is a leading cause of death for both men and women. Each year, about 370,000 Americans die from coronary heart disease.
Certain traits, conditions, or habits may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.
You can control many risk factors, which may help prevent or delay CHD.
Major Risk Factors
Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called bad cholesterol) and low HDL cholesterol (sometimes called good cholesterol).
High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercurythe units used to measure blood pressure.)
Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues.
Insulin resistance. This condition occurs if the body can't use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used for energy. Insulin resistance may lead to diabetes.
Diabetes. With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly.
Overweight or obesity. The terms overweight and obesity refer to body weight thats greater than what is considered healthy for a certain height.
Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke.
Lack of physical activity. Being physically inactive can worsen other risk factors for CHD, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
Unhealthy diet. An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and trans fats, cholesterol, sodium, and sugar can worsen other risk factors for CHD.
Older age. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease increases starting at age 45. In women, the risk for coronary heart disease increases starting at age 55.
A family history of early coronary heart disease is a risk factor for developing coronary heart disease, specifically if a father or brother is diagnosed before age 55, or a mother or sister is diagnosed before age 65.
Although older age and a family history of early heart disease are risk factors, it doesn't mean that youll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults.
Emerging Risk Factors
Researchers continue to study other possible risk factors for CHD.
High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk of CHD and heart attack. High levels of CRP are a sign of inflammation in the body.
Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls may trigger inflammation and help plaque grow.
Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of CHD and heart attack.
High levels of triglycerides in the blood also may raise the risk of CHD, especially in women. Triglycerides are a type of fat.
Other Risks Related to Coronary Heart Disease
Other conditions and factors also may contribute to CHD, including:
Sleep apnea. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can increase your risk for high blood pressure, diabetes, and even a heart attack or stroke.
Stress. Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event, especially one involving anger.
Alcohol. Heavy drinking can damage the heart muscle and worsen other CHD risk factors. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.
Preeclampsia. This condition can occur during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.
For more detailed information, go to the Health Topics Coronary Heart Disease Risk Factors article.
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Coronary Heart Disease
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What are the symptoms of Coronary Heart Disease ?
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A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure. When you have heart failure, your heart can't pump enough blood to meet your bodys needs. Fluid builds up in your lungs, making it hard to breathe.
The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.
Signs and Symptoms of Heart Problems Related to Coronary Heart Disease
Some people who have CHD have no signs or symptomsa condition called silent CHD. The disease might not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).
Heart Attack
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. This can happen if an area of plaque in a coronary artery ruptures (breaks open).
Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. If a clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isnt treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Heart With Muscle Damage and a Blocked Artery
The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.
The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.
The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.
Chest pain or discomfort that doesnt go away or changes from its usual pattern (for example, occurs more often or while youre resting) might be a sign of a heart attack. If you dont know whether your chest pain is angina or a heart attack, call 911.
All chest pain should be checked by a doctor.
Other common signs and symptoms of a heart attack include:
Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach
Shortness of breath, which may occur with or before chest discomfort
Nausea (feeling sick to your stomach), vomiting, light-headedness or fainting, or breaking out in a cold sweat
Sleep problems, fatigue (tiredness), or lack of energy
For more information, go to the Health Topics Heart Attack article.
Heart Failure
Heart failure is a condition in which your heart can't pump enough blood to meet your bodys needs. Heart failure doesn't mean that your heart has stopped or is about to stop working.
The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, and veins in the neck.
All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
For more information, go to the Health Topics Heart Failure article.
Arrhythmia
An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast.
Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations (pal-pih-TA-shuns).
Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA usually causes death if it's not treated within minutes.
For more information, go to the Health Topics Arrhythmia article.
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Coronary Heart Disease
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How to diagnose Coronary Heart Disease ?
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Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures.
No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Stress Testing
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to raise your heart rate.
When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:
Abnormal changes in your heart rate or blood pressure
Shortness of breath or chest pain
Abnormal changes in your heart rhythm or your heart's electrical activity
If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).
As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.
Echocardiography
Echocardiography(echo) uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
Chest X Ray
A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels.
A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels might be a sign that you're at risk for CHD.
Coronary Angiography and Cardiac Catheterization
Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors show that you're likely to have CHD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.
Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter.
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Coronary Heart Disease
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What are the treatments for Coronary Heart Disease ?
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Treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, medical procedures and surgery, and cardiac rehabilitation. Treatment goals may include:
Lowering the risk of blood clots forming (blood clots can cause a heart attack)
Preventing complications of coronary heart disease
Reducing risk factors in an effort to slow, stop, or reverse the buildup of plaque
Relieving symptoms
Widening or bypassing clogged arteries
Heart-Healthy Lifestyle Changes
Your doctor may recommend heart-healthy lifestyle changes if you have coronary heart disease. Heart-healthy lifestyle changes include:
Heart-healthy eating
Maintaining a healthy weight
Managing stress
Physical activity
Quitting smoking
Heart-Healthy Eating
Your doctor may recommend heart-healthy eating, which should include:
Fat-free or low-fat dairy products, such as fat-free milk
Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
Fruits, such as apples, bananas, oranges, pears, and prunes
Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
Vegetables, such as broccoli, cabbage, and carrots
Whole grains, such as oatmeal, brown rice, and corn tortillas
When following a heart-healthy diet, you should avoid eating:
A lot of red meat
Palm and coconut oils
Sugary foods and beverages
Two nutrients in your diet make blood cholesterol levels rise:
Saturated fatfound mostly in foods that come from animals
Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats andmeats.
Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples:
1,200 calories a day
8 grams of saturated fat a day
1,500 calories a day
10 grams of saturated fat a day
1,800 calories a day
12 grams of saturated fat a day
2,000 calories a day
13 grams of saturated fat a day
2,500 calories a day
17 grams of saturated fat a day
Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels.
Some sources of monounsaturated and polyunsaturated fats are:
Avocados
Corn, sunflower, and soybean oils
Nuts and seeds, such as walnuts
Olive, canola, peanut, safflower, and sesame oils
Peanut butter
Salmon and trout
Tofu
Sodium
You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.
Dietary Approaches to Stop Hypertension
Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH.
Alcohol
Try to limit alcohol intake. Too much alcohol canraise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:
12 ounces of beer
5 ounces of wine
1 ounces of liquor
Maintaining a Healthy Weight
Maintaining a healthy weight is important for overall health and can lower your risk for coronary heart disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active.
Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI:
Below 18.5 is a sign that you are underweight.
Between 18.5 and 24.9 is in the normal range.
Between 25 and 29.9 is considered overweight.
Of 30 or more is considered obese.
A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal.
Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk.
If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol.
Managing Stress
Research shows that the most commonly reported trigger for a heart attack is an emotionally upsetting eventparticularly one involving anger. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingarent healthy.
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as:
A stress management program
Meditation
Physical activity
Relaxation therapy
Talking things out with friends or family
Physical Activity
Routine physical activity can lower many coronary heart disease risk factors, including LDL (bad) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the good cholesterol that helps prevent coronary heart disease.
Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week, or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time spread throughout the week.
Read more about physical activity at:
Physical Activity and Your Heart
U.S. Department of Health and Human Services 2008 Physical Activity Guidelines forAmericans
Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.
Quitting Smoking
If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen other coronary heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Read more about quitting smoking at Smoking and Your Heart.
Medicines
Sometimes lifestyle changes arent enough to control your blood cholesterol levels. For example, you may need statin medications to control or lower your cholesterol. By lowering your cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have:
Coronary heart disease, peripheral artery disease, or had a stroke
Diabetes
High LDL cholesterol levels
Doctors may discuss beginning statin treatment with those who have an elevated risk for developing heart disease or having a stroke.
Your doctor also may prescribe other medications to:
Decrease your chance of having a heart attack or dying suddenly.
Lower your blood pressure.
Prevent blood clots, which can lead to heart attack or stroke.
Prevent or delay the need for a stent or percutaneous coronary intervention (PCI) or surgery, such as coronary artery bypass grafting (CABG).
Reduce your hearts workload and relieve coronary heart disease symptoms.
Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart healthy lifestyle, even if you take medicines to treat your coronary heart disease.
Medical Procedures and Surgery
You may need a procedure or surgery to treat coronary heart disease. Both PCIand CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you.
Percutaneous Coronary Intervention
Percutaneous coronary intervention, commonly known as angioplasty, is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.
During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after angioplasty. Read more about this procedure at PCI.
Coronary Artery Bypass Grafting
CABG is a type of surgery in which arteries or veins from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
Read more about this surgery at CABG.
Cardiac Rehabilitation
Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Nearly everyone who has coronary heart disease can benefit from cardiac rehab. Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.
The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.
Rehab has two parts:
Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and how to deal with your fears about the future.
Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
Read more about this therapy at Cardiac Rehabilitation.
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Coronary Heart Disease
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How to prevent Coronary Heart Disease ?
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You can prevent and control coronary heart disease (CHD)by taking action to control your risk factors with heart-healthy lifestyle changes and medicines. Examples of risk factors you can control include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factorssuch as age, gender, and family historycant be controlled.
Your risk for CHD increases with the number of risk factors you have. To reduce your risk of CHD and heart attack, try to control each risk factor you have by adopting the following heart-healthy lifestyles:
Heart-healthy eating
Maintaining a healthy weight
Managing stress
Physical activity
Quitting smoking
Know your family history of health problems related to CHD. If you or someone in your family has CHD, be sure to tell your doctor. If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors.
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Coronary Heart Disease
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What is (are) Vasculitis ?
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Vasculitis (vas-kyu-LI-tis) is a condition that involves inflammation in the blood vessels. The condition occurs if your immune system attacks your blood vessels by mistake. This may happen as the result of an infection, a medicine, or another disease or condition.
Inflammation refers to the bodys response to injury, including injury to the blood vessels. Inflammation may involve pain, redness, warmth, swelling, and loss of function in the affected tissues.
In vasculitis, inflammation can lead to serious problems. Complications depend on which blood vessels, organs, or other body systems are affected.
Overview
Vasculitis can affect any of the body's blood vessels. These include arteries, veins, and capillaries. Arteries carry blood from your heart to your body's organs. Veins carry blood from your organs and limbs back to your heart. Capillaries connect the small arteries and veins.
If a blood vessel is inflamed, it can narrow or close off. This limits or prevents blood flow through the vessel. Rarely, the blood vessel will stretch and weaken, causing it to bulge. This bulge is known as an aneurysm (AN-u-rism).
Vasculitis
The disruption in blood flow caused by inflammation can damage the body's organs. Signs and symptoms depend on which organs have been damaged and the extent of the damage.
Typical symptoms of inflammation, such as fever and general aches and pains, are common among people who have vasculitis.
Outlook
There are many types of vasculitis, but overall the condition is rare. If you have vasculitis, the outlook depends on:
The type of vasculitis you have
Which organs are affected
How quickly the condition worsens
The severity of the condition
Treatment often works well if its started early. In some cases, vasculitis may go into remission. "Remission" means the condition isn't active, but it can come back, or "flare," at any time.
Sometimes vasculitis is chronic (ongoing) and never goes into remission. Long-term treatment with medicines often can control the signs and symptoms of chronic vasculitis.
Rarely, vasculitis doesn't respond well to treatment. This can lead to disability and even death.
Much is still unknown about vasculitis. However, researchers continue to learn more about the condition and its various types, causes, and treatments.
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Vasculitis
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What causes Vasculitis ?
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Vasculitis occurs if your immune system attacks your blood vessels by mistake. What causes this to happen isn't fully known.
A recent or chronic (ongoing) infection may prompt the attack. Your body also may attack its own blood vessels in reaction to a medicine.
Sometimes an autoimmune disorder triggers vasculitis. Autoimmune disorders occur if the immune system makes antibodies (proteins) that attack and damage the body's own tissues or cells. Examples of these disorders include lupus, rheumatoid arthritis, and scleroderma. You can have these disorders for years before developing vasculitis.
Vasculitis also may be linked to certain blood cancers, such as leukemia and lymphoma.
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Vasculitis
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Who is at risk for Vasculitis? ?
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Vasculitis can affect people of all ages and races and both sexes. Some types of vasculitis seem to occur more often in people who:
Have certain medical conditions, such as chronic hepatitis B or C infection
Have certain autoimmune diseases, such a lupus, rheumatoid arthritis, and scleroderma
Smoke
For more information, go to "Types of Vasculitis."
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Vasculitis
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What are the symptoms of Vasculitis ?
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The signs and symptoms of vasculitis vary. They depend on the type of vasculitis you have, the organs involved, and the severity of the condition. Some people may have few signs and symptoms. Other people may become very sick.
Sometimes the signs and symptoms develop slowly, over months. Other times, the signs and symptoms develop quickly, over days or weeks.
Systemic Signs and Symptoms
Systemic signs and symptoms are those that affect you in a general or overall way. Common systemic signs and symptoms of vasculitis are:
Fever
Loss of appetite
Weight loss
Fatigue (tiredness)
General aches and pains
Organ- or Body System-Specific Signs and Symptoms
Vasculitis can affect specific organs and body systems, causing a range of signs and symptoms.
Skin
If vasculitis affects your skin, you may notice skin changes. For example, you may have purple or red spots or bumps, clusters of small dots, splotches, bruises, or hives. Your skin also may itch.
Joints
If vasculitis affects your joints, you may ache or develop arthritis in one or more joints.
Lungs
If vasculitis affects your lungs, you may feel short of breath. You may even cough up blood. The results from a chest x ray may show signs that suggest pneumonia, even though that may not be what you have.
Gastrointestinal Tract
If vasculitis affects your gastrointestinal tract, you may get ulcers (sores) in your mouth or have stomach pain.
In severe cases, blood flow to the intestines can be blocked. This can cause the wall of the intestines to weaken and possibly rupture (burst). A rupture can lead to serious problems or even death.
Sinuses, Nose, Throat, and Ears
If vasculitis affects your sinuses, nose, throat, and ears, you may have sinus or chronic (ongoing) middle ear infections. Other symptoms include ulcers in the nose and, in some cases, hearing loss.
Eyes
If vasculitis affects your eyes, you may develop red, itchy, burning eyes. Your eyes also may become sensitive to light, and your vision may blur. Rarely, certain types of vasculitis may cause blindness.
Brain
If vasculitis affects your brain, symptoms may include headaches, problems thinking clearly, changes in mental function, or stroke-like symptoms, such as muscle weakness and paralysis (an inability to move).
Nerves
If vasculitis affects your nerves, you may have numbness, tingling, and weakness in various parts of your body. You also may have a loss of feeling or strength in your hands and feet and shooting pains in your arms and legs.
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Vasculitis
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