February 8, 2017

Long QT syndrome (LQTS) is a disorder of the heart’s electrical activity. It can cause sudden, uncontrollable, dangerous arrhythmias (ah-RITH-me-ahs) in response to exercise or stress. Arrhythmias are problems with the rate or rhythm of the heartbeat.

People who have LQTS also can have arrhythmias for no known reason. However, not everyone who has LQTS has dangerous heart rhythms. When they do occur, though, they can be fatal.

The electrical activity of the heart is produced by the flow of ions (electrically charged particles of sodium, calcium, potassium, and chloride) in and out of the cells of the heart. Tiny ion channels control this flow. The Q-T interval is the section on the electrocardiogram (ECG) – that represents the time it takes for the electrical system to fire an impulse through the ventricles and then recharge. It is translated to the time it takes for the heart muscle to contract and then recover.

LQTS occurs as the result of a defect in the ion channels, causing a delay in the time it takes for the electrical system to recharge after each heartbeat. When the Q-T interval is longer than normal, it increases the risk for torsade de pointes, a life-threatening form of ventricular tachycardia. LQTS is rare. The prevalence is about 1 in 5,000 persons in the Untied States.

Long QT syndrome can cause temporary loss of consciousness and cardiac arrest, as well as sudden death — which, unfortunately, is sometimes the first symptom of untreated LQTS.

Causes

LQTS can be congenital (present at birth) or acquired (developed under certain conditions).

Congenital LQTS is related to an inherited genetic defect. Thirteen genes have been associated with the disorder, but mutations on three of them account for most cases. Because the gene abnormalities are present at birth, congenital LQTS often is diagnosed in childhood, sometimes as early as one or two years old. Risk of arrhythmia is related to a patient’s particular gene defect. For instance, people with a mild genetic abnormality might not experience symptoms unless exposed to a trigger, such as an LQTS-inducing drug.

Congenital LQTS manifests in different ways, depending on the particular gene affected. In patients with long QT syndrome type 1 (LQTS1), arrhythmia is commonly triggered by exercise, especially swimming. Patients with LQTS2 may experience arrhythmia after being startled, such as by a loud telephone ring. For those with LQTS3, arrhythmia is usually triggered at night during sleep.

Acquired LQTS usually is caused by certain commonly prescribed medications that can lengthen the QT interval, triggering dangerous arrhythmias in some patients. Among several classes of drugs that can induce this disorder, those at highest risk include medications for cardiac arrhythmias; drugs used to treat psychiatric illness; and antibiotics, particularly those in the quinolone and macrolide families. An extensively used pain reliever called methadone, and some cold medications also may cause a prolonged QT interval.

Acquired LQTS also can occur due to an electrolyte disturbance, such as low potassium caused by severe diarrhea or vomiting.

Risk Factors

People who may have a higher risk of inherited or acquired long QT syndrome may include –

  • Children, teenagers and young adults with unexplained fainting, unexplained near drownings or other accidents, unexplained seizures, or a history of cardiac arrest
  • Family members of children, teenagers and young adults with unexplained fainting, unexplained near drownings or other accidents, unexplained seizures, or a history of cardiac arrest
  • First-degree relatives of people with known long QT syndrome
  • People taking medications known to cause prolonged QT intervals
  • People with low potassium, magnesium or calcium blood levels — such as those with the eating disorder anorexia nervosa

Long QT syndrome often goes undiagnosed or is misdiagnosed as a seizure disorder, such as epilepsy. However, long QT syndrome might be responsible for some otherwise unexplained deaths in children and young adults. For example, an unexplained drowning of a young person might be the first clue to inherited long QT syndrome in a family.

Symptoms

Major Signs and Symptoms

If people have long QT syndrome (LQTS), they can have sudden and dangerous arrhythmias (abnormal heart rhythms). Signs and symptoms of LQTS-related arrhythmias often first occur during childhood and include –

  • Unexplained fainting. This happens because the heart isn’t pumping enough blood to the brain. Fainting may occur during physical or emotional stress. Fluttering feelings in the chest may occur before fainting.
  • Unexplained drowning or near drowning. This may be due to fainting while swimming.
  • Unexplained sudden cardiac arrest (SCA) or death. SCA is a condition in which the heart suddenly stops beating for no obvious reason. People who have SCA die within minutes unless they receive treatment. In about 1 out of 10 people who have LQTS, SCA or sudden death is the first sign of the disorder.

Other Signs and Symptoms – Often, people who have LQTS 3 develop an abnormal heart rhythm during sleep. This may cause noisy gasping while sleeping.

Silent Long QT Syndrome – Sometimes long QT syndrome doesn’t cause any signs or symptoms. This is called silent LQTS. For this reason, doctors often advise family members of people who have LQTS to be tested for the disorder, even if they have no symptoms.

Complications

Sometimes, prolonged QT intervals in people with long QT syndrome never cause problems. However, physical or emotional stress might “trip up” a heart susceptible to prolonged QT intervals. This can cause the heart’s rhythm to spin out of control, triggering life-threatening, irregular heart rhythms (arrhythmias) including –

  • Torsades de pointes — ‘twisting of the points‘ – This arrhythmia is characterized by the heart’s two lower chambers (ventricles) beating fast, making the waves on an ECG monitor look twisted.
  • Ventricular fibrillation – This condition causes the ventricles to beat so fast that the heart quivers and effectively ceases pumping blood.

Treatment

LQTS is a treatable condition and the doctor may prescribe medication, surgery or recommend lifestyle changes.

Medication – Beta-blockers are the most commonly prescribed medication and they work by slowing the heart rate by reducing the effect of adrenaline on the heart. It is important to discuss with the doctor the medications that work best for some and to follow instructions carefully.

Surgery – In certain circumstances, some may be required to have surgery on nerves that regulate the heartbeat or they may need an implantable cardioverter defibrillator (ICD) if LQTS causes abnormal heart rhythms.

Lifestyle – If properly treated and controlled, many people with LQTS require very few changes to their normal lifestyle. However, a diagnosis of LQTS may require the patient to make some adjustments to their lifestyle. For instance certain sports or activities increase the risk of fainting or more serious events in patients with LQTS. It is important for the patient to discuss this matter with their cardiologist to determine how best to live a healthy, active lifestyle while minimizing the risk of further complications.

Alternative Treatment

Potassium – Potassium is a mineral that is found in the body. It is derived from the diet and is important for cardiac health. Potassium supplements may improve the heart’s recharging system and may be helpful for people with certain forms of LQTS. If the potassium content in the blood rises, the action potential shortens. It is believed that increasing potassium concentration could minimize the occurrence of arrhythmias. Potassium supplements tend to work best in LQT2, because the HERG (human ether-a-go-go-related gene) potassium channel in the heart is especially sensitive to potassium concentration.

Magnesium – Intravenous magnesium has been reported to reduce the incidence of atrial fibrillation and cardiac arrhythmia.

Aconite – The toxic effects associated with aconitine (a poisonous alkaloid and the active principle of aconite) limit its ability to be used to treat arrhythmia.

Corydalis – Early evidence suggests certain compounds found in corydalis may be of benefit for arrhythmia.

L-carnitine – L-carnitine, or acetyl-L-carnitine, is an amino acid found in the body. L-carnitine has been reported to be beneficial in maintaining a healthy heart. Although preliminary results are promising, well-designed and reported clinical trials investigating the effect of L-carnitine on arrhythmia are lacking.

Omega-3 fatty acids – There is evidence from multiple clinical studies supporting the intake of omega-3 fatty acid (also known as fish oil) supplements for a healthy heart. Fish oil supplements have been reported to lower triglycerides and reduce the risk of death, heart attack, and stroke in people with known heart disease. Fish oil may also slow the buildup of atherosclerotic plaques (hardening of the arteries) and lower blood pressure slightly.

Traditional Chinese medicine – Traditional Chinese medicine (TCM) is a broad term encompassing many different methods and traditions of healing, such as acupuncture, herbal medicines, cupping, and moxibustion. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) and dating back over 5,000 years. TCM herb combinations have been used to stabilize arrhythmias after viral myocarditis (inflammation of the heart).

 

Reference –

http://lifeinthefastlane.com/ecg-library/basics/qt_interval/

https://www.nhlbi.nih.gov/health/health-topics/topics/qt

http://my.clevelandclinic.org/services/heart/disorders/arrhythmia/long-qt-syndrome

http://www.sads.org/What-is-SADS/Long-QT-Syndrome#.VsHzdPJ97IV

http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484075/k.F8EF/Heart_disease__What_is_Long_QT_Syndrome.htm

http://www.chop.edu/conditions-diseases/long-qt-syndrome#.VsHNmPJ97IU

http://www.irishheart.ie/iopen24/long-syndrome-support-group-t-11_35_221.html

http://www.huffingtonpost.com/entry/awareness-of-long-qt-synd_b_8330360.html?section=india

http://www.seattlechildrens.org/medical-conditions/heart-blood-conditions/long-qt-syndrome-symptoms/

http://www.nhs.uk/conditions/long-qt-syndrome/Pages/Introduction.aspx

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/long-qt-syndrome

https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/long-qt-syndrome.html

 

February 8, 2017

Kawasaki disease is the most common cause of acquired heart disease in children. It affects about 7,000 children in the United States every year. Although most with Kawasaki disease are younger than 5 years, it can occur in children of all ages and even in young adults.

Kawasaki disease is a rare syndrome of unknown origin that causes high fever, reddening of the eyes (conjunctivitis), lips and mucous membrane of the mouth, gingivitis (ulcerative gum disease), swollen neck glands and a bright red rash over the skin of the hands and feet, in young children.

Kawasaki disease causes inflammation in the walls of arteries throughout the body, including the coronary arteries, which supply blood to the heart muscle. As it affects the lymph nodes, skin, and mucous membranes inside the nose, mouth and throat it is also called mucocutaneous lymph node syndrome.

Kawasaki disease is more common in boys than girls. It was first diagnosed by Tomiraku Kawasaki, a Japanese doctor in 1967, hence the name. Kawasaki disease has nothing to do with motorbikes or motorbike accidents.

Causes

Although Kawasaki disease can occur in community outbreaks, particularly in the winter and early spring, no one knows the cause. The peak age of occurrence in the United States is between six months and five years.

Infection – The symptoms of Kawasaki disease are similar to those of an infection. This means that bacteria or a virus may be responsible. However, so far, a bacterial or viral cause hasn’t been identified. As Kawasaki disease isn’t contagious, it can’t be passed from one person to another. Therefore, it is unlikely to be caused by a virus alone.

Genetics – The children who develop Kawasaki disease may be genetically predisposed to it. This means that the genes they inherit from their parents may make them more likely to get the condition. One theory is that rather than there being a single gene responsible for Kawasaki disease, it may be the result of many genes that each slightly increase the chances of a child developing the condition.

Others – One theory is that Kawasaki disease may be an autoimmune condition (where the immune system attacks healthy tissues and organs). Other theories suggest Kawasaki disease may be a reaction to certain medications, or environmental pollutants such as chemicals or toxins (poisons).

Risk Factors

Three things are known to increase your child’s risk of developing Kawasaki disease, including: –

  • Age – Children under 5 years old are most at risk of Kawasaki disease.
  • Sex – Boys are slightly more likely than girls are to develop Kawasaki disease.
  • Ethnicity – Children of Asian descent, such as Japanese or Korean, have higher rates of Kawasaki disease.

Symptoms

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 symptoms that may develop include –

  • arthritis-like symptoms (joint pain and swelling of the joints)
  • extreme irritability
  • diarrhea
  • vomiting
  • abdominal pain
  • enlarged liver or gallbladder
  • cough and respiratory symptoms

Kawasaki and Autism – Studies reported that there is a statistically significant association between Kawasaki disease and the diagnosis of an autistic disorder. Population-based claims database, tested the hypothesis that Kawasaki disease may increase the risk of autism.

Complications

Even though complications are very rare, when they do occur they can be serious, and on some occasions fatal.

Aneurysm – the blood vessels leading to the heart can become inflamed, causing a section of the artery wall to weaken and bulge outwards. If the aneurysm does not heal itself a blood clot can form, which raises the risk of a heart attack or internal bleeding if the aneurysm bursts.

The following complications from Kawasaki disease are also possible:

  • Myocarditis – inflammation of the myocardium (heart muscle).
  • Pericarditis – inflammation of the pericardium (lining around the heart).
  • Arrhythmia – irregular heart beat.
  • Cardiomegaly – the heart becomes larger than normal as a result of heart disease.
  • Mitral regurgitation – blood flows back from the left ventricle to the left atrium of the heart due to a valve problem (blood flows back when it shouldn’t).

Treatment

Medications – Two main medicines for Kawasaki disease treatment:

  • Aspirin – children under 16 should not be given aspirin. However, it is prescribed if a child has Kawasaki disease. Children with Kawasaki disease have a very high blood platelet count, making them very susceptible to blood clots forming in their bloodstream. Aspirin helps prevent blood clots, as well as reducing the fever, rash and joint inflammation.
  • Gammaglobulin – these are cells in the blood which help fight infection (antibodies). Gammaglobulin is administered intravenously (through a vein in the child’s arm). Symptoms tend to improve rapidly; within 24 hours of administering gammaglobulin.

Coronary artery angioplasty – this procedure opens up an artery that has narrowed by inflating a small balloon inside the artery which squashes a clot against the wall of the blood vessel.

Stent – a stent may be placed in the clogged artery to help prop it open, reducing the risk of it becoming blocked again. A stent placement is often done along with an angioplasty.

Coronary artery bypass graft – blood flow is rerouted round a diseased coronary artery by grafting a section of blood vessel from the chest, arm or leg to use as the alternate route. The bypass effectively goes around the blocked area of the artery, allowing blood to pass through into the heart muscle.

Alternative Treatment

Copper Supplements – Copper is essential to all living organisms and is a universally important cofactor for many hundreds of metalloenzynes. Copper deficiency is widespread and appears in many forms . It leads to Kawasaki disease.

 

Reference –

http://www.aafp.org/afp/2006/1001/p1141.html

http://www.examiner.com/article/kawasaki-disease-syndrome

http://www.mayoclinic.org/diseases-conditions/kawasaki-disease/basics/risk-factors/con-20024663

https://www.nhlbi.nih.gov/health/health-topics/topics/kd/signs

http://www.kkh.com.sg/HealthPedia/Pages/ChildhoodIllnessesHeartKawasakiDisease.aspx

http://patient.info/health/kawasaki-disease-leaflet

http://arstechnica.com/science/2015/06/the-mystery-of-kawasaki-disease/

http://www.independent.co.uk/news/world/asia/kawasaki-disease-an-unknown-illness-with-no-definitive-medical-diagnosis-and-no-known-cause-but-it-10376403.html

 

 

February 8, 2017

Inflammation is the innate immune system response to an attack on the body. This can occur through a blunt-force or penetrating tissue injury or in response to an infection caused by a pathogen. Exposure to chemical irritants or toxins will cause inflammation, as will burns, frostbite, or other injuries.

The word inflammation comes from the Latin “inflammo”, meaning “I set alight, I ignite”. Inflammation is a process by which the body’s white blood cells and substances they produce protect the human body from infection with foreign organisms, such as bacteria and viruses. With inflammation, white blood cells are released to protect the body from injury. These white blood cells have chemicals within them that, when leaked, induce swelling. If the injury occurs near the surface of the skin, the damaged area will throb and become red and warm. Blood flow also increases during inflammation. Inflammation can also affect internal organs, displaying a variety of symptoms depending upon the organ involved. The most common symptom of inflammation is pain.

However, in some diseases like, asthma, diabetes, obesity, depression, heart disease, arthritis, Alzheimer’s disease, osteoporosis, and other aging diseases, researchers have proven significant link between inflammation and the host.

The inflammation process protects the body by isolating the damaged area, attracting immune cells and molecules to the site and, in later stages, promoting the healing of affected tissues. In fact, without inflammation, wounds or infections would never heal.

Types of Inflammation

Acute inflammation occurs within minutes of an injury such as a cut, splinter, or insect bite. Or, it can take several hours to become fully activated in cases of bacterial infection, for example. But, in either case, it is a comparatively sudden, rapid, and short-term response to infection, injury, or toxic exposure. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks. Examples include –

  • Acute bronchitis
  • Infected ingrown toenail
  • Sore throat from a cold or flu
  • A scratch/cut on the skin
  • Exercise (especially intense training)
  • Acute appendicitis
  • Acute dermatitis
  • Acute tonsillitis
  • Acute infective meningitis
  • Acute sinusitis
  • A blow

The acute inflammatory response requires constant stimulation to remain active. So, when the injury starts to heal or the source of infection has been neutralized, the symptoms of inflammation also go away.

Chronic Inflammation occurs when the immune system can launch an inflammatory response against what should be relatively harmless irritants like, for example, dust or pollen. The resulting asthma or allergy attacks can often be far worse than the effects of exposure to the allergen itself. In some cases, the body can sustain a long-term inflammatory state in response to a lingering, low-grade infection that is never fully knocked out by the rest of the immune response. Examples include –

  • Asthma
  • Chronic peptic ulcer
  • Tuberculosis
  • Rheumatoid arthritis
  • Chronic periodontitis
  • Ulcerative colitis and Crohn’s disease
  • Chronic sinusitis
  • Chronic active hepatitis

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

CAUSES

There are many causes of inflammation ranging from blunt trauma and injuries to long-term, chronic health conditions. Inflammation can also be provoked by sore joints, muscles, and broken bones that have either not healed at all, or have healed incorrectly. Inflammation is one of the man conditions that can result from a compromised immune system.

  • Microbial infections – One of the most common causes of inflammation is microbial infection. Microbes include viruses, bacteria, protozoa, fungi and various parasites. Viruses lead to death of individual cells by intracellular multiplication, and either cause the cell to stop functioning and die, or cause explosion of the cell (cytolytic), in which case it also dies. Bacteria release specific toxins – either exotoxins or endotoxins. What’s the difference? Exotoxins are produced specifically for export (like anthrax toxins or tetanus toxins) whereas endotoxins are just part of the cell walls of Gram negative bacteria and they do terrible things to the body too but they aren’t as specific in their actions as the exotoxins.
  • Hypersensitivity reactions – A hypersensitivity reaction occurs when an altered state of immunologic responsiveness causes an inappropriate or excessive immune reaction that damages the tissues.
  • Physical agents, irritant and corrosive chemicals Tissue damage leading to inflammation may occur through physical trauma, ultraviolet or other ionizing radiation, burns or excessive cooling (‘frostbite’). Corrosive chemicals (acids, alkalis, oxidizing agents) provoke inflammation through direct tissue damage. These chemical irritants cause tissue damage that leads directly to inflammation.
  • Tissue necrosis – Death of tissues from lack of oxygen or nutrients resulting from inadequate blood flow (infarction) is a potent inflammatory stimulus. The edge of a recent infarct often shows an acute inflammatory response.

Possibly, one of the greatest reasons for inflammation is an imbalance of essential fatty acids. It is very important to maintain a balance between omega-3 and omega-6 fatty acids in the diet. Omega-3 fatty acids help reduce inflammation and most omega-6 fatty acids tend to promote inflammation. An inappropriate balance of these essential fatty acids contributes to the development of disease while a proper balance helps maintain and even improve health.

A healthy diet should consist of roughly one to four times more omega-6 fatty acids than omega-3 fatty acids. The typical American diet tends to contain 11 to 30 times more omega-6 fatty acids than omega-3 fatty acids and many researchers believe this imbalance is a significant factor in the rising rate of inflammatory disorders in the United States.

The four Principle Effects of Inflammation

  • Redness (rubor) – An acutely inflamed tissue appears red, due to dilatation of small blood vessels within the damaged area (hyperemia).
  • Swelling (tumor) – Swelling results from edema, the accumulation of fluid in the extravascular space as part of the inflammatory fluid exudate, and to a much lesser extent, from the physical mass of the inflammatory cells migrating into the area.
  • Heat (calor) – Increase in temperature is readily detected in the skin. It is due to increased blood flow (hyperemia) through the region, resulting in vascular dilation and the delivery of warm blood to the area.
  • Pain (dolor) – Pain results partly from the stretching and distortion of tissues due to inflammatory edema and, in part from some of the chemical mediators of acute inflammation, especially bradykinin and some of the prostaglandins.
  • Loss of function (functio laesa) – Loss of function, a well-known consequence of inflammation. Movement of an inflamed area is inhibited by pain, either consciously or by reflexes, while severe swelling may physically immobilize the affected area.

Autoimmune Diseases and Inflammation

An autoimmune disease, also known as autoimmune disorder, is one where the body initiates an immune response to healthy tissues, mistaking them for harmful pathogens or irritants. The immune response triggers an inflammatory response. These include –

  • Rheumatoid arthritis – There is inflammation in the joints, tissues surrounding the joints, and sometimes some other organs in the body
  • Ankylosing spondylitis – There is inflammation of the vertebrae, muscles, ligaments, and also the sacroiliac joints (where the spine and hips meet)
  • Celiac disease – There is inflammation and destruction of the inner lining of the small intestine
  • Crohn’s disease – The gastrointestinal tract becomes inflamed. Inflammation is most common in the ileum (small intestine), but may occur anywhere in the GI tract, from the mouth to the anus
  • Fibromyalgia – Often a set of symptoms related to another autoimmune disorder, such as lupus or rheumatoid arthritis. There is pain in various parts of the body. Location and even the existence of inflammation is unclear
  • Graves’ disease – One of the signs is goiter; when the thyroid gland is inflamed. Exophthalmos, inflammation of the muscles behind the eyes. Grave’s dermopathy, inflammation of the skin, usually the shins and the top of feet (uncommon)
  • Idiopathic pulmonary fibrosis – The role of inflammation is unclear. Experts used to think that the disease was mainly caused by inflammation within the alveoli (tiny sacs within the lungs
  • Lupus – There can be inflammation in the joints, lungs, heart, kidney and skin
  • Psoriasis – There is inflammation of the skin. In some cases, as in psoriatic arthritis, the joints and tissue surrounding the joints may also become inflamed
  • Type 1 Diabetes – Inflammation in various parts of the body are likely if the diabetes is not well controlled
  • Addison’s disease – Inflammation of the adrenal glands. The stress to the body caused by this disease can also lead to inflammation elsewhere
  • Vaslculitis – Refers to a group of disorders in which inflammation eventually destroys blood vessels, both arteries and veins
  • Transplant rejection – There is already substantial inflammation caused by the transplant operation. If the organ recipient’s immune system rejects the new organ, there is typically inflammation in and around the donated organ
  • Various allergies – All allergies have inflammation. Asthma has inflammation of the airways, in hay fever the nose, ear and throat mucous membranes become inflamed, people who are allergic to bee stings may have serious life-threatening inflammation which affects the whole body (anaphylaxis)
  • Vitamin A deficiency – Inflammatory responses are much more likely if the person is deficient in vitamin A.

Inflammation and Gut

Inflammation leads to disturbed gut flora, malfunctioning toll-like receptors, and leaky gut, allowing proteins to enter the body and provoke an inflammatory response by the immune system. More inflammation, more bacterial overgrowth. A bout of antibiotics thrown in for good measure which wipes out the bacteria, leaving a clean slate and prompting another mad dash by microbes to fill the vacancies, and the result is – potentially – a permanently altered/disrupted distribution of gut flora both supporting and supported by chronic systemic inflammation. When damaging proteins (like lectins from grains and legumes, for example, or gluten)  slip into the blood stream, they are recognized and the immune system responds as it normally would to foreign, damaging intruders: with inflammation.

Treatment

Conventional Treatment

Analgesics – These reduce pain, but do not reduce inflammation. These include Acetaminophen like Tylenol. Side effects include depleted Glutathione, which plays a critical part in the detoxification and anti-oxidation processes of the enzyme system.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – These are the most widely used and prescribed medications, since they reduce pain as well as inflammation. These include Aspirin which reduces inflammation, suppresses fever, and acts as an anticoagulant. Side effects include reduction in the levels of Folic acid, iron, potassium, sodium, and vitamin C.

Corticosteroids – These are synthetic forms of naturally occurring hormones produced by the adrenal glands that provide powerful and immediate short-term relief of inflammation. These include Cortisone, Hydrocortone, and Prednisone.

Alternative Treatment

Essential Fatty Acids – GLA (GammaLinoleicAcid) & Omega-3 essential fatty acids (EPA/DHA from fish oils). The daily consumption of fish oil, omega-3 reduced both inflammation and anxiety in a group of young healthy people.

Antioxidants – Acai, blueberry, cranberry, grape seed, green tea, hesperidin, lycopene, mangosteen, pomegranate, quercetin have has anti-allergy, antibacterial, anti-inflammatory, antifungal and antihistamine properties.

Minerals – Calcium,magnesium, phosphorus, potassium, sodium are powerful anti-inflammatory nutrient.

Vitamin D – The increased levels of vitamin D was shown to improve muscular function, control blood pressure and improve levels of glucose in the body.

Vitamin C – A hardworking antioxidant, vitamin C offers two added bonuses: it helps the body deal with stress, and it boosts the activity of another outstanding anti-inflammatory, vitamin E.

Vitamin E – While vitamin E is commonly known as a fat-soluble antioxidant, it is also becoming a more popular choice to use as an anti-inflammatory.

Trace Minerals – Boron, chromium, copper, iodine, iron, manganese, molybdenum, selenium, silver, zinc help in inflammation.

Herbs

Harpagophytum procumbens – also known as devil’s claw, wood spider or grapple plant comes from South Africa and is related to sesame plants. European colonists brought devil’s claw back home to treat arthritis, fever and pain.

Ginger, also known as ginger root, is the mass of roots (rhizome) of the Zingiber officinale plant. It is used as a medicine or a spice. It has been used for hundreds of years to treat dyspepsia, constipation, colic, other gastrointestinal problems, as well as rheumatoid arthritis pain.

Curcumin a powerhouse anti-inflammatory, curcumin is the active ingredient in turmeric, the spice used in curries and other Indian foods.

Boswellia (frankincense). Similarly, the boswellia plant, from which the aromatic resin frankincense is derived, contains powerful anti-inflammatory compounds known as boswellic acids.

Spirulina. This increasingly popular blue-green microalgae variety is poised to become the next big thing as far as “superfoods” are concerned, and for good reason.

Cannabis contains a cannabinnoid called cannabichromene, which has been shown to have anti-inflammatory properties.

 

Reference

http://www.medicalnewstoday.com/articles/248423.php?page=2

http://articles.mercola.com/sites/articles/archive/2013/03/07/inflammation-triggers-disease-symptoms.aspx

http://lpi.oregonstate.edu/mic/micronutrients-health/inflammation

http://www.webmd.com/a-to-z-guides/prevention-15/vitamins/chronic-pain-relief

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011108/

http://www.nutrishield.com/the-science/anti-inflammatory/

http://www.aboutibs.org/site/what-is-ibs/gut-bacteria

http://www.marksdailyapple.com/gut-flora-inflammation/#axzz3r0tcTbCh

http://kellybroganmd.com/article/from-gut-to-brain-the-inflammation-connection/

http://articles.mercola.com/sites/articles/archive/2013/03/07/inflammation-triggers-disease-symptoms.aspx

 

February 8, 2017

Hypotension, also known as low blood pressure, is condition in which the blood pressure is abnormally low, either because of reduced blood volume or because of increased blood-vessel capacity. Though not in itself an indication of ill health, it often accompanies disease.

The heart pumps blood around the body through the blood vessels. Blood pressure is the amount of force exerted on the artery walls by the pumping blood. Blood pressure varies according to environmental demands. For example, it rises during physical exertion and drops in extreme heat. Low blood pressure is only a problem if it has a negative impact on the body. For example, vital organs (particularly the brain) may be starved of oxygen and nutrients if the blood pressure is too low for that particular person.

What is blood pressure?

Blood pressure is written as two numbers – for example, 120 over 80 millimeters of mercury. The first number is the systolic pressure. This is the pressure in the arteries when the heart beats and fills them with blood. The second number is the diastolic pressure. This is the pressure in the arteries when the heart rests between beats.

Anybody with a reading if 90/60 mmHg or lower is regarded as having hypotension (low blood pressure). People with low blood pressure have some protection from factors which raise blood pressure to undesirable levels. However, low blood pressure may be a sign of an underlying problem, and can cause unpleasant symptoms.

Types of Hypotension

  • Acute – Acute hypotension is a sudden drop in the BP that may be life-threatening.
  • Constitutional – Constitutional hypotension means that the BP is lower than it should be most or all of the time. This is a chronic condition that occurs with no known medical cause.
  • Orthostatic – Orthostatic hypotension normally occurs when a person stands up from a sitting or lying position. It is also called postural hypotension.
  • Postprandial – Postprandial hypotension means the BP becomes too low after a meal. The BP may drop within 2 hours after a person eats, and is more common when the meal is high in carbohydrates.

Causes

Low blood pressure has many different causes including:

  • Emotional stress, fear, insecurity or pain (the most common causes of fainting)
  • Dehydration, which reduces blood volume
  • The body’s reaction to heat, which is to shunt blood into the vessels of the skin, leading to dehydration
  • Blood donation
  • Internal bleeding, such as a perforated stomach ulcer
  • Blood loss from trauma, such as a road accident or deep cut
  • Pregnancy
  • Medications for high blood pressure
  • Diuretics, which produce fluid loss
  • Medications for depression
  • Medications for certain heart conditions
  • Allergic reaction to certain drugs or chemicals
  • Some forms of infection, such as toxic shock syndrome
  • Heart disease, which can hamper the pumping action of the heart muscle
  • Some nervous system disorders, such as Parkinson’s disease
  • Addison’s disease (where the adrenal glands fail to produce sufficient blood-pressure maintaining hormones)
  • Anemia or blood loss
  • Nervous system, heart, or adrenal disorders
  • Dehydration from not drinking enough liquids, frequent vomiting, diarrhea, or severe burns
  • Some medicines, such as those used to treat high blood pressure, heart conditions, pain, depression, or cancer
  • A blood infection (sepsis)

Who is at risk?

  • Hypotension can affect people of all ages. However, people in certain age groups are more likely to have certain types of hypotension.
  • Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have neurally mediated hypotension.
  • People who take certain medicines—such as diuretics (“water pills”) or other high blood pressure medicines—are at increased risk for hypotension. Certain conditions also increase the risk for hypotension. Examples include central nervous system disorders (such as Parkinson’s disease) and some heart conditions.
  • Other risk factors for hypotension include being immobile (not being able to move around very much) for long periods, being out in the heat for a long time, and pregnancy. Hypotension during pregnancy is normal and usually goes away after birth.

Symptoms

If blood pressure is so low that the supply of blood to the brain and other vital organs is insufficient the patient will need medical attention. Severe hypotension is caused by an underlying illness or condition.

  • Below are the most common symptoms of hypotension:
  • Blurred vision
  • Cold, clammy, pale skin
  • Depression
  • Dizziness
  • Fainting
  • Fatigue
  • General feeling of weakness
  • Nausea
  • Palpitations
  • Rapid, shallow breathing
  • Thirst

There is a particular type of low blood pressure called ‘postural hypotension’ or ‘orthostatic hypotension’. In this condition, a person’s blood pressure is normal when they are sitting or lying down, but it drops suddenly when they stand, making them feel dizzy or lightheaded.

Complications

Falls due to low blood pressure in older adults can lead to a broken hip or spine fracture. These injuries can reduce a person’s health and ability to move around

Sudden severe drops in the blood pressure starves the body of oxygen. This can lead to damage of the heart, brain, and other organs. This type of low blood pressure can be life threatening if not treated right away.

Treatment

Medications –

Alpha-adrenoreceptor agonists – These medicines may increase the BP and decrease the symptoms.

Steroids – This medicine helps prevent salt loss from the body. Steroids may also help increase the amount of fluid in the body and raise the BP.

Vasopressors – These medicines help constrict (make smaller) the blood vessels and increase the BP. Vasopressor medicines may increase the blood flow to the brain and help decrease the symptoms.

Antidiuretic hormone – This medicine helps control the BP and helps decrease the need to urinate during the night.

Antiparkinson medicine – This medicine may help increase tjhe standing BP and decrease the symptoms.

Compression stockings or abdominal binder -These may help blood return to the heart and decrease  hypotension.

IV fluids – These may be used to increase the BP if a person is dehydrated or have blood loss or sepsis.

Alternative Treatment

DHEA – DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in patients with septicemia (serious bacterial infections in the blood), which may lead to hypotension.

Iodine -Rinsing with povidone-iodine may help reduce the incidence and severity of septicemia (serious bacterial infections in the blood).

Ephedra – Chemicals in ephedra can stimulate the heart, increase heart rate, and raise blood pressure. Ephedrine, a component of ephedra, is sometimes used in hospitals to help control blood pressure.

Hawthorn – Hawthorn (Crataegus spp.), a flowering shrub of the rose family has an extensive history of use in cardiovascular disease dating back to the 1st Century. Preliminary study suggests that fresh hawthorn berries may improve orthostatic hypotension.

Selenium – Selenium is a mineral found in soil, water, and some foods. Study results of selenium supplementation in patients with sepsis (severe bacterial infection in the blood) are mixed.

Adrenal extract – Adrenal extracts come from the adrenal glands of cows, pigs, or sheep. It has been suggested that adrenal extract may help treat patients with hypotension.

Rhubarb – Limited available study indicates that rhubarb may be helpful in treating systemic inflammation reaction syndrome (SIRS).

Ginger – The underground stems (called rhizomes) and above ground stems of ginger have been used in Chinese, Japanese, and Indian medicine for hundreds of years. There have been anecdotal reports of reduced blood pressure in people who took ginger.

Hydrotherapy – Hydrotherapy is broadly defined as the external application of water in any form or temperature for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth.

Physical therapy – The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions.

 

Reference –

http://www.healthtranslations.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Hypotension/$File/Hypotension.pdf

http://www.britannica.com/science/hypotension

http://www.bloodpressureuk.org/BloodPressureandyou/Yourbody/Lowbloodpressure

https://www.medschool.lsuhsc.edu/emergency_medicine/docs/EMP%20Ultrasound%20&%20Hypotension.pdf

http://emedicine.medscape.com/article/1154266-overview

http://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/symptoms-of-heart-and-blood-vessel-disorders/postprandial-hypotension

http://www.aafp.org/afp/2011/0901/p527.html

http://www.pdf.org/en/orthostatic_hypotension_pd

 

 

 

February 8, 2017

Hypertension, also known as high blood pressure is the force of blood pushing against the walls of arteries as it flows through them. Arteries are the blood vessels that carry oxygenated blood from the heart to the body’s tissues.

As blood flows through arteries it pushes against the inside of the artery walls. The more pressure the blood exerts on the artery walls, the higher the blood pressure will be. The size of small arteries also affects the blood pressure. When the muscular walls of arteries are relaxed, or dilated, the pressure of the blood flowing through them is lower than when the artery walls narrow, or constrict.

Blood pressure is highest when the heart beats to push blood out into the arteries. When the heart relaxes to fill with blood again, the pressure is at its lowest point. Blood pressure when the heart beats is called systolic pressure. Blood pressure when the heart is at rest is called diastolic pressure. When blood pressure is measured, the systolic pressure is stated first and the diastolic pressure second. Blood pressure is measured in millimeters of mercury (mm Hg).

Hypertension is having a blood pressure higher than 140 over 90 mmHg, a definition shared by all the medical guidelines. This can damage the blood vessels and cause health problems.  Anyone can develop high blood pressure, but it becomes more common as you get older.

Hypertension is a major health problem, especially because it has no symptoms. Many people have hypertension without knowing it. In the United States, about 50 million people age six and older have high blood pressure. Hypertension is more common in men than women and in people over the age of 65 than in younger persons. More than half of all Americans over the age of 65 have hypertension. It also is more common in African-Americans than in white Americans.

Hypertension is serious because people with the condition have a higher risk for heart disease and other medical problems than people with normal blood pressure. Serious complications can be avoided by getting regular blood pressure checks and treating hypertension as soon as it is diagnosed. Hypertension makes the heart work harder to pump blood through the body. The extra workload can make the heart muscle thicken and stretch. When the heart becomes too enlarged it cannot pump enough blood. If the hypertension is not treated, the heart may fail.

Risk Factors

  • People with close blood relatives who have HBP
  • African Americans
  • Overweight or Age – Everyone is at greater risk of high blood pressure as they get older. Prevalence of hypertension is higher in people over 60 years of age
  • Race – African-American adults are at higher risk than white or Hispanic American adults
  • Size – Being overweight or obese is a key risk factor
  • Sex – Men and women have different risk profiles. While they have the same lifetime risks, men are more prone at younger ages while women are more prone at older ages
  • Lifestyle – As mentioned above, this is to blame for growing rates of hypertension, from greater uptakes of dietary salt, excessive alcohol, low dietary potassium, and physical inactivity.gout or kidney disease
  • Pregnant women
  • Women who take birth control pills, who are overweight, had HBP during pregnancy, have a family history of HBP or have mild kidney disease.

In general, the older you get, the greater your chance of developing HBP.

Causes

There are two types of Hypertension –

Essential Hypertension – In as many as 95% of reported high blood pressure cases in the U.S., the underlying cause cannot be determined. This type of high blood pressure is called essential hypertension. This is caused by –

  • Genetics and Family History – When members of a family pass traits from one generation to another through genes, that process is called heredity.
  • Genetic factors likely play some role in high blood pressure, heart disease, and other related conditions. However, it is also likely that people with a family history of high blood pressure share common environments and other potential factors that increase their risk.
  • The risk for high blood pressure can increase even more when heredity combines with unhealthy lifestyle choices, such as smoking cigarettes and eating an unhealthy diet.
  • Unhealthy Diet – A diet that is too high in sodium and too low in potassium puts you at risk for high blood pressure. Eating too much sodium—an element in table salt—increases blood pressure. Most of the sodium we eat comes from processed and restaurant foods. Learn more about sodium and high blood pressure.
  • Not eating enough potassium also can increase blood pressure. Potassium is found in bananas, potatoes, beans, and yogurt.
  • Physical Inactivity – Not getting enough physical activity can make you gain weight, which can lead to high blood pressure.
  • Obesity – Obesity is excess body fat. Obesity is linked to higher “bad” cholesterol and triglyceride levels and to lower “good” cholesterol levels. In addition to high blood pressure, obesity can also lead to heart disease and diabetes. Talk to your health care team about a plan to reduce your weight to a healthy level.
  • Too Much Alcohol – Drinking too much alcohol can raise your blood pressure.
  • Tobacco Use – Tobacco use increases your risk for high blood pressure. Cigarette smoking can damage the heart and blood vessels. Also, nicotine raises blood pressure, and carbon monoxide reduces the amount of oxygen that your blood can carry.

Secondary Hypertension – Secondary hypertension has specific causes – that is, it is secondary to another problem. One example, thought to be the most common, is primary aldosteronism, a hormone disorder causing an imbalance between potassium and sodium levels and so high blood pressure. Common reversible causes are excessive intake of alcohol and use of oral contraceptives, which can cause a slight rise in blood pressure; hormone therapy for menopause is also a culprit.7 Other secondary hypertensions are caused by –

  • Kidney disease
  • Pheochromocytoma (a cancer)
  • Cushing syndrome (which can be caused by use of corticosteroid drugs)
  • Congenital adrenal hyperplasia (disorder of the adrenal glands, which secrete the hormone cortisol)
  • Hyperthyroidism (overactive thyroid gland).

Symptoms

High blood pressure itself is usually experienced by patients without any symptoms at all (asymptomatic). It can do its damage silently.

Hypertension can lead to problems in the organs affected by high blood pressure. Long-term hypertension can lead to the following complications via arteriosclerosis, which causes narrowing of blood vessels by forming plaques –

  • An enlarged or weakened heart, to a point where it may fail to pump enough blood (heart failure)
  • Aneurysm – an abnormal bulge in the wall of an artery
  • Blood vessel narrowing – in the kidneys, leading to possible kidney failure; also in the heart, brain and legs, leading to potential heart attack, stroke or amputation, respectively
  • Blood vessels in the eyes my rupture or bleed, leading to vision problems or blindness (hypertensive retinopathies, which can be classified by worsening grades one through four).

Treatment

Medications – Drugs currently used to treat hypertensive emergencies include nicardipine, labetalol, and sodium nitroprusside.

Many antihypertensive drugs are available for the treatment of chronic hypertension. The choice of drug is usually based on the mode of action and the potential for adverse effects. From a pharmacologic point of view, antihypertensive drugs may be classified in the following categories –

  • Diuretics, which block sodium reabsorption at various levels of the renal tubules
  • Adrenergic blockers, which act by competitively inhibiting the catecholamines
  • Direct vasodilators, which act by means of various mechanisms
  • Angiotensin-converting enzyme (ACE) inhibitors, which block the conversion of angiotensin I to angiotensin II
  • Angiotensin II receptor blockers (ARBs), which interfere with the binding of angiotensin II to angiotensin I receptors
  • Calcium-channel blockers, which block the entry of calcium into the cells, producing vasodilation

Lifestyle changes that may reduce blood pressure by about 5 to 10 mm Hg include –

  • Reducing salt intake
  • Reducing fat intake
  • Losing weight
  • Getting regular exercise
  • Quitting smoking
  • Reducing alcohol consumption
  • Managing stress

Alternative Treatment

Fish Oils are useful for thinning the blood and improving circulation and it is now known that those whose diets are high in fish oils have a lower risk for hypertension. It helps to lower the risk for hypertension.

Potassium is helpful in hypertension. Those who have low potassium levels are more likely to have high blood pressure.

Magnesium levels have been found to be consistently low in individuals with hypertension. In one study, supplemental magnesium lowered blood pressure in 19 out of 20 hypertensives.

The non-essential amino acid L-Taurine may exhibit hypotensive properties. However, the doses utilized to reap hypotensive results vary widely in the studies.

CoQ10 – High CoQ10 dosages could lead to shallow sleep which is not helpful since deep sleep reduces hypertension risk. Among antioxidants, coenzyme Q10 (CoQ10) stands out for its ability to promote healthy blood pressure levels.

Vitamin D – Blood pressure reduction is one of the many extraordinary health benefits of vitamin D. People deficient in vitamin D are more likely to have high blood pressure.48,49 Vitamin D supplementation, alone or with calcium, can reduce blood pressure in people with hypertension.50,51 Vitamin D likely exerts this effect in part by suppressing the expression of the blood pressure hormone renin, similar to the effect of prescription angiotensin-converting enzyme (ACE) inhibitors.

Garlic – The compounds found in garlic help regulate the immune response involved in the inflammatory process and have been shown to lower lipid levels.

Folic acid – Folic acid is sometimes given as an alternative treatment for hypertension because of its effects on the arterial walls. There is some evidence that accumulation of the amino acid homocysteine in the blood can damage these walls. Folic acid, typically given in combination with vitamins B6 or B12, reduces homocysteine levels.

Alpha-Linolenic Acid (ALA) – ALA is a type of omega-3 fatty acid found in plants such as flax and walnuts.

Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA) – Similar to ALA, these essential fatty acids may decrease blood pressure slightly.

Fiber/Psyllium – The Journal of the American Dietetic Association reports that replacing refined carbohydrates with whole grains that contain high amount of fiber reduces blood pressure.

Calcium – Those with low calcium seem to be at higher risk for hypertension. The exact relationship between calcium and high blood pressure is unknown, but ensuring proper intake of calcium is helpful.

Flavonoids – Flavonoids are compounds found in high concentrations in tea, cocoa, wine, and grapes. They also appear to have beneficial effects when it comes to lowering blood pressure.

Folate – Women with an increased dietary or supplement-based intake of folate have been shown to have a lower incidence of hypertension.

 

 

February 8, 2017

Hyperlipidemia is a medical condition characterized by elevated levels of lipids and cholesterol in the blood, and is also identified as dyslipidemia, to describe the manifestations of different disorders of lipoprotein metabolism. Genetic predisposition, cigarette smoking, obesity, poor diet, and a sedentary lifestyle can all lead to hyperlipidemia.

Although hyperlipidemia does not cause symptoms, it can significantly increase your risk of developing cardiovascular disease, including disease of blood vessels supplying the heart (coronary artery disease), brain (cerebrovascular disease), and limbs (peripheral vascular disease). These conditions can in turn lead to chest pain, heart attacks, strokes, and other problems. Because of these risks, treatment is often recommended for people with hyperlipidemia.

It is commonly referred to as high cholesterol. One-third of American adults have it, only 1 in 3 have it under control, and having hyperlipidemia doubles the risk of developing heart disease.

What is Lipid? Lipid is the scientific term for fats in the blood. Cholesterol is essential for the formation of cell membranes and the manufacture of several hormones. At proper levels, lipids perform important functions in the body, but can cause health problems if they are present in excess. High lipid levels can speed up a process called atherosclerosis, or hardening of the arteries. The arteries are normally smooth and unobstructed on the inside, but as the age increases, a sticky substance called plaque forms in the walls of the arteries. Plaque is made of lipids and other materials circulating in your blood. As more plaque builds up, the arteries can narrow and stiffen. Eventually, enough plaque may build up to reduce blood flow through the arteries. Atherosclerosis increases the risk of heart disease, stroke, and other vascular diseases.

Even the brain depends on cholesterol for proper functioning. Cholesterol becomes a problem when too much of the bad kind is produced or ingested through regular eating of unhealthy foods. Cholesterol is carried through the blood to cells by lipoproteins that are either low density (LDL) or high density (HDL). Think of the lipoprotein as the vehicle and cholesterol as the passenger.

HDL is the good lipoprotein because it carries extra cholesterol back to the liver where it can be eliminated. LDL is bad, as it will build up excess cholesterol in the blood.

Types of Hyperlipidemia

This condition is divided into two subtypes which are: primary hyperlipidemia and secondary hyperlipidemia.

  • Primary Hyperlipidemia – This usually takes place as a result of genetic problems i.e., mutation within receptor protein.
  • Secondary Hyperlipidemia – This will arise as a result of other underlining diseases like diabetes. Alteration and/ or abnormality in the metabolism of lipid and lipoproteins is a very common condition that taken place within general population, and it consider as one of the main risk factor in the incidence of cardiovascular disease due to their influence on atherosclerosis.

Causes

The causes of hyperlipidemia are either genetic (familial or primary hyperlipidemia) or from a poor diet and other specific factors (secondary hyperlipidemia). When the body cannot utilize or remove the excess fat, it accumulates in the blood. Over time, the buildup damages the arteries and internal organs. This process contributes to the development of heart disease.

In familial hyperlipidemia, the high cholesterol has nothing to do with poor habits but is caused by a genetic disorder. There is a greater chance of developing hyperlipidemia if a man is older than age 45 or a woman is older than age 55. The causes also include –

  • Hereditary factors are the most common cause.
  • A diet high in saturated fat and cholesterol increases blood cholesterol and triglyceride levels.
  • Other disorders, such as diabetes mellitus, kidney disease, and hypothyroidism, may promote hypertriglyceridemia.
  • Certain drugs, such as estrogen, corticosteroids, retinoids, protease inhibitors, thiazide diuretics, and beta-blockers, may cause hypertriglyceridemia.
  • Obesity increases the risk of hyperlipidemia.
  • Chronic, excessive alcohol use increases the risk of hypertriglyceridemia.
  • Smoking and not exercising may lead to hyperlipidemia.
  • Steroid uses, alcoholism, hypothyroidism, oral contraceptives, chronic renal failure, hypopituitarism and nephritic syndrome are other contributors to hyperlipidemia.

Symptoms

In the early years there may be no symptoms. When symptoms appear, they may include –

  • Chest pain (angina) or other signs of coronary artery disease; may be present at a young age.
  • Cramping of one or both calves when walking.
  • Sores on the toes that do not heal.
  • Sudden stroke-like symptoms, such as trouble speaking, drooping on one side of the face, weakness of an arm or leg, and loss of balance.

People with this condition may develop high cholesterol or high triglyceride levels as teenagers, or the condition may be diagnosed when people are in their 20s and 30s. The levels remain high all during life. Those with familial combined hyperlipidemia have an increased risk of early coronary artery disease and heart attacks. They also have higher rates of obesity and are more likely to have glucose intolerance.

Excessive fat in the blood accumulates over time, forming plaques on the walls of the arteries and blood vessels. This will narrow the openings, producing turbulent blood flow through the vessels, and cause the heart to use more force to get the blood through the constricted areas.

Treatment

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if these important lifestyle changes are made and still the cholesterol levels remains high, the doctor may recommend medication.

The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, the current health and possible side effects. Common choices include –

  • Statins — Among the most commonly prescribed medications for lowering cholesterol — block a substance the liver needs to make cholesterol. This causes the liver to remove cholesterol from the blood. Statins may also help the body reabsorb cholesterol from built-up deposits on the artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
  • Bile-acid-binding resins – The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts the liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in the blood.
  • Cholesterol absorption inhibitors – The small intestine absorbs the cholesterol from the diet and releases it into the bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.
  • Combination cholesterol absorption inhibitor and statin – The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in the small intestine and production of cholesterol in the liver. It’s unknown whether Vytorin is more effective in reducing heart disease risk than taking simvastatin by itself.
  • Injectable medication – A new class of drugs can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in your blood. The Food and Drug Administration recently approved alirocumab (Praluent) and evolocumab (Repatha) for people who have a genetic condition that causes very high levels of LDL. These drugs also may be used for people who have had heart attacks or strokes and need additional lowering of their LDL levels. These injectable drugs are administered at home one or two times a month.

Alternative Treatment

Nutritional Supplements

  • Marine-derived omega-3 polyunsaturated fatty acids (fish oil) are often touted as being preventative of major cardiovascular adverse outcomes by the postulated mechanisms of lowering triglyceride levels.
  • Garlic is used most frequently as a dietary supplement for treatment of hyperlipidemia, heart disease, and hypertension. A well-conducted, randomized trial demonstrated that there was no significant difference in LDL-cholesterol, HDL-cholesterol, triglycerides, or total cholesterol-HDL. There is evidence that garlic is associated with blood pressure reductions in patients with elevated systolic blood pressures.
  • Ginseng has a plethora of cardiovascular benefits, including cardioprotection, antihypertensive effects, and attenuation of myocardial hypertrophy and heart failure.
  • Ginkgo biloba is purported to have cardioprotective effects by several studies through its antioxidant, antiplatelet, antithrombotic, vasodilatory, and antihypertensive properties.
  • Hawthorn leaf and flower extracts are advocated as an oral treatment option for patients with chronic heart failure; in fact, the German Commission E approved the use of hawthorn extracts in patients with heart failure graded stage 2.
  • Flaxseed supplementation was associated with a decrease in blood total and LDL-cholesterol concentrations but did not significantly affect HDL-cholesterol and triglycerides. Flaxseed contains a large amount of fiber, and dietary soluble fiber has been shown to have cholesterol-lowering effects.
  • Antioxidants, which include anthocyanins, beta-carotene, catechins, coenzyme Q10, flavonoids, lipoic acid, lutein, lycopene, selenium, and vitamins C and E, have shown promising results in laboratory and observational studies; however, systematic reviews of the literature and large, randomized, controlled trials have generally found no beneficial effects of antioxidant supplements for primary or secondary prevention. In fact, vitamin A, beta-carotene, and vitamin E may actually increase mortality.
  • Red yeast rice contains monacolin K, which has the same chemical structure as lovastatin, an inhibitor of HMG-CoA reductase. Monacolin K in substantial amounts lowers blood levels of total cholesterol and LDL-cholesterol.
  • Soy protein and isoflavones (phytoestrogens) have gained attention for their potential role in improving risk factors for CVD (Cardio Vascular Diseases).
  • L-carnitine is FDA approved for replacement therapy in primary (i.e., inborn errors of metabolism) and secondary (i.e., secondary to hemodialysis) L-carnitine deficiencies. Many clinical trials have suggested acetyl-L-carnitine (ALC) and propionyl-L-carnitine (PLC), two naturally occurring carnitine derivates, as potential strategies in the management of peripheral arterial disease (PAD), heart and cerebral ischemia, and congestive heart failure.
  • Chelation therapy is used to rid the body of excess or toxic metals (i.e., in lead poisoning). Studies suggest that EDTA chelation as a treatment for coronary heart disease (CHD).

Complementary Treatment

Relaxation techniques include practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep-breathing exercises. The goal of these techniques is to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure and oxygen consumption, and a feeling of calm and well-being.

Meditation refers to a group of techniques such as mantra meditation, mindfulness meditation, transcendental meditation, and Zen Buddhist meditation. There is evidence that meditation is associated with potentially beneficial health effects.

Yoga has many different styles, some more physically demanding than others. In general, practicing yoga, as well as other forms of regular exercise, leads to several cardiovascular benefits. Yoga typically causes increased heart rate during the act, but following prolonged training, a decrease occurs in exercise-induced heart rate.

Acupuncture is a therapeutic modality anchored in traditional Chinese medicine (which also includes Chinese herbal medicine, moxibustion, cupping, Chinese massage, mind-body therapies such as Qigong and tai chi, and dietary therapy)

 

Reference –

http://www.medicinenet.com/script/main/art.asp?articlekey=3838

http://www.drugs.com/health-guide/high-cholesterol-hypercholesterolemia.html

http://www.uptodate.com/contents/high-cholesterol-and-lipids-hyperlipidemia-beyond-the-basics#H3

http://www.researchgate.net/publication/262817622_A_REVIEW_OF_HYPERLIPIDEMIA_AND_MEDICINAL_PLANTS

https://shcs.ucdavis.edu/topics/hyperlipidemia.html

http://www.aafp.org/afp/2007/1001/p1027.html

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/basics/alternative-medicine/con-20020865

http://ocvalidate.imngmedicalmedia.com/onecount/redirects/index.php?action=get-tokens&return=http%3A%2F%2Fwww.jfponline.com%2Findex.php%3Fid%3D22143%26tx_ttnews%5Btt_news%5D%3D166696

 

February 8, 2017

Hepatopulmonary syndrome (HPS) is considered present when the following triad exists  –

  • Liver disease
  • Impaired oxygenation
  • Intrapulmonary vascular abnormalities, referred to as intrapulmonary vascular dilatations (IPVDs)

The unique pathological feature of hepatopulmonary syndrome (visualized by autopsy) is gross dilatation of the pulmonary precapillary and capillary vessels, as well as an absolute increase in the number of dilated vessels. A few pleural and pulmonary arteriovenous shunts and portopulmonary anastomoses may also be seen.

The hepatopulmonary syndrome results from the formation of microscopic intrapulmonary arteriovenous dilations in patients with chronic liver disease. The mechanism is unknown but is thought to be due to increased hepatic production or decreased hepatic clearance of vasodilators. The vascular dilations cause overperfusion relative to ventilation, leading to hypoxemia, particularly because patients have an increased cardiac output resulting from systemic vasodilation. Because the lesions frequently are more numerous at the lung bases, the hepatopulmonary syndrome can cause platypnea (dyspnea) and orthodeoxia (hypoxemia), which occur when the patient is seated or standing and are relieved by recumbency. Most patients also have characteristic findings of chronic liver disease, such as spider angiomas. About 20% of patients present with pulmonary symptoms alone.

The condition is said to be in two forms:

  • Type I – The condition involves the right to left shunting of the lungs. This is known as the most common type of hepatopulmonary syndrome which basically involves dilatation of the capillaries during the exchange of oxygen. As a result, there is less oxygen containment in the alveoli- where gas exchange is the primary role, and the ventilation process is altered.
  • Type II – This accumulates about 10% of hepatopulmonary syndrome cases. The oxygen exchange is yet again not attained normally, as arteriovenous shunts in the circulatory system have not attained its purpose. The anatomic shunts place the ineffective oxygen exchange, making this type of the syndrome as very grave one.

Causes

Presence of an arteriovenous shunt – This shunt is basically a product from a surgical intervention that provides a vessel indicated to provide a pathway for blood exchange between an artery and vein. This is highly indicated for patients for hemodiaysis.

Impaired function of the alveolocapillary in maintaining the diffusion-perfusion process – The pulmonary vessels are quite affected when a vasodilator takes place and acts in desaturating the oxygen. Making the erythrocytes incapable of providing adequate oxygenated blood.

Ventilation and perfusion process is uneven – When there is an underlying lung condition, it is expected that one will suffer from perfusion problems. In cases of liver cirrhosis, there shall be adecrease in perfusion in specific lung areas as ventilation is poor.

Others – Portal hypertension is considered a significant cause of hepatopulmonary syndrome. The chronic use of substances for vasodilatation can induce the syndrome.

Symptom

Those with hepatopulmonary syndrome are expected to present pulmonary symptoms as well as liver problem manifestations. The following present the characteristics of the disease –

  • Hypoxemia is a prominent presentation. This is most recognizable especially when a person is suffering from liver cirrhosis.
  • Cyanosis is noted among patients. This is described as the bluish or purple discoloration of our skin. The inside membranes or tissues of our body is also affected of the discoloration and is primary caused by a deficient flow of oxygenated blood.
  • Digital clubbing (a known manifestation of hypoxemia and is described as the fingers’ tips are enlarged) is observed. This is due to the lack of oxygenation.
  • Plethora of spider nevi is noted. This is identified as spider angioma where there are small angiomata on the skin. This is the spider-like appearance of the vessels visible on the skin. This is basically a manifestation of a hepatic problem.
  • Platypnea is noted or simply known as dyspnea upon standing.
  • Orthodeoxia is a manifestation. This is the sudden fall of the partial oxygen of the patient while in standing position.
  • Increased Nitric oxide levels. This is noted due to its vasodilator component.
  • Esophageal varices might develop. These are dilated veins found in the esophagus.
  • Increased heart rate is noted as a sign of compensation from hypoxemia.

Treatment

Supplemental O 2 – The main treatment is supplemental O 2 for symptoms. Other therapies, such as somatostatin to inhibit vasodilation, are of modest benefit in only some patients. Coil embolization is virtually impossible because of the number and size of the lesions. Inhaled nitric oxide synthesis inhibitors may be a future treatment option. Hepatopulmonary syndrome may regress after liver transplantation or if the underlying liver disease subsides. Prognosis is poor without treatment.

Nitrous oxide inhibitor is provided. Even though there has been less support with this treatment, it has been found to reverse vasodilatation.

Control of the  hypertension. Providing the suitable treatment for the client is a great help in managing the disease.

Orthotopic liver transplantation. This is considered as a treatment of choice when no other interventions seem to work. This is simply known as liver transplant.

Studies show that there is about 24 months to 5 years of survival rate among the reported cases of HPS. When surgical intervention such as liver transplant has not been performed, the survival rate shall be lower than expected. 

 

Reference –

http://www.hindawi.com/journals/bmri/2013/670139/

http://www.atsjournals.org/doi/full/10.1164/rccm.201302-0245LE#.VrHI8_l97IU

http://lifeinthefastlane.com/ccc/hepatopulmonary-syndrome/

http://www.nature.com/nrgastro/journal/v9/n9/pdf/nrgastro.2012.123.pdf%3FWT.ec_id%3DNRGASTRO-201209

http://ehjcimaging.oxfordjournals.org/content/8/5/408

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673604161072.pdf

https://www.msdmanuals.com/professional/pulmonary-disorders/pulmonary-hypertension/hepatopulmonary-syndrome

 

February 8, 2017

Headaches are one of the most common neurological problems presented to GPs and neurologists. They are painful and debilitating for individuals, an important cause of absence from work or school and a substantial burden on society.

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medicines.

Anyone can experience a headache. Nearly 2 out of 3 children will have a headache by age 15. More than 9 in 10 adults will experience a headache sometime in their life. Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor. Without proper treatment, headaches can be severe and interfere with daily activities. Certain types of headache run in families. Episodes of headache may ease or even disappear for a time and recur later in life. It’s possible to have more than one type of headache at the same time.

Symptoms & Types

There are two types of headaches –

Primary headaches – This occur independently and are not caused by another medical condition. It’s uncertain what sets the process of a primary headache in motion. A cascade of events that affect blood vessels and nerves inside and outside the head causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity (called cortical spreading depression). Migraine, cluster, and tension-type headache are the more familiar types of primary headache.

  • Tension headaches – These are caused by muscle tension in the shoulders, neck, and head. The tension may  come from fatigue, an uncomfortable body position, or emotional stress. Tension headaches typically begin in the  morning or early afternoon and can get worse during the day. They often involve a tight pressure feeling like a band  around the forehead, but pain may spread over the entire head and downward into the neck and shoulders.
  • Cluster headaches – These types of headaches can be very painful. The intensely sharp pain usually involves one side of the head and spreads around the eye. Cluster headaches start suddenly and generally last about an hour. Attacks come in groups hence the name “cluster” occurring several times a day or each week and continuing for 6 to  8 weeks.
  • Migraine headaches – Often marked by intense throbbing head pain… blurred vision with shimmering light specks, dizziness or nausea, sensitivity to light, sound, or odors. Migraines are certainly a different type of headache.

Secondary headaches – These are  symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).

  • Headaches related to high blood pressure – As the blood vessels and circulatory system throughout the body  are affected by high blood pressure, headaches may result. The pain is typified by a throbbing sensation throughout the  head, though the headaches are generally not chronic in nature.
  • Headaches resulting from eye or sinus problems – Sinus congestion or built­up pressure in the eyes due to  glaucoma are examples of the types of physical problems that can occur with your eyes, ears, nose and/or throat that result  in headaches. These headaches will often disappear when the underlying condition is effectively treated.
  • Headaches associated with facial disorders – One such disorder (originally known as temporomandibular joint or TMJ syndrome), now known as myofascial pain dysfunction (MPD), is characterized by a dull aching pain in and  around the ear that is associated with chewing food. The pain may radiate to the side of the scalp causing a headache. Difficulty opening the mouth or a clicking/popping sound in the jaw joint may also be present. Once symptoms are recognized, treatment can be effective.

Causes

Anything that stimulates the pain receptors in a person’s head or neck can cause a headache, including –

  • Stress
  • Muscular tension
  • Dental or jaw problems
  • Infections
  • Diet
  • Eye problems
  • Hormonal influences
  • Medications
  • Disorders of the ear nose or throat
  • Disorders of the nervous system
  • Injury to the head, neck or spine
  • High blood pressure
  • Poor posture – puts unnecessary strain on the muscles of the back and neck
  • Hangover from abuse of alcohol or drugs
  • Temperature – extremes of heat or cold
  • Dehydration – affects blood pressure
  • Noise – especially loud noises
  • Temporal arteritis – inflammation of the artery at the temple, most common in elderly people
  • Arthritis

In rare cases, a headache can be a sign of something more serious, such as:

  • Bleeding in the area between the brain and the thin tissue that covers the brain (subarachnoid hemorrhage)
  • Blood pressure that is very high
  • Brain infection, such as meningitis or encephalitis, or abscess
  • Brain tumor
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Buildup of pressure inside the skull that appears to be, but is not a tumor (pseudomotor cerebri)
  • Carbon monoxide poisoning
  • Lack of oxygen during sleep (sleep apnea)
  • Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm, or stroke

Treatment

Pain reliever — A pain reliever may be recommended first for the treatment of tension type headache. These drugs include –

  • Aspirin
  • Acetaminophen (eg, Tylenol®)
  • Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (eg, Motrin or Advil), indomethacin, or naproxen (eg, Naprosyn or Aleve).

Pain medicine combinations — Mild pain relievers are also available in combination with caffeine, which enhances the drug’s effect. As an example, Excedrin® contains a combination of acetaminophen-aspirin-caffeine. This combination may be recommended if a pain reliever alone does not relieve the headache. However, this combination is not recommended more than nine days per month due to the potential risk of developing medication-overuse headaches.

Antidepressants — Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline.

The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work.

Other treatments — Tricyclic antidepressants are sometimes used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache. (See ‘Lifestyle changes’ below.)

Alternative treatment

Magnesium – Magnesium plays a vital role in multiple physiologic processes and therefore it is a vital component in a healthy diet. It is absorbed through the gastrointestinal tract (gut), with more absorbed when the internal content is lower. Magnesium also appears to facilitate calcium absorption.

Feverfew (Tanacetum parthenium) – Feverfew (Tanacetum parthenium) is a species in the chrysanthemum family, whose dried leaves have long been used as a headache remedy.

Coenzyme Q10 (CoQ10) – Coenzyme Q10 (CoQ10) is often described as a vitamin, or a vitamin-like substance. CoQ10 is involved in the creation of the important substance in the body known as adenosine triphosphate (ATP). ATP serves as the cell’s major energy source and drives a number of biological processes including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.

Riboflavin – Riboflavin, also known as vitamin B2, is found in small amounts in many foods. It is needed for converting food to energy, and like CoQ10 also works as an antioxidant by mopping up the damaging free radicals.

Butterbur (Petasites hybridus) – Butterbur is a perennial shrub, found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams. The common name is attributed to the large leaves being used to wrap butter during warm weather.

Melatonin – There are many reasons melatonin should be beneficial in headache, but no proof exists presently. It has been shown to be useful for insomnia.

Vitamin D3 – Vitamin D deficiency/insufficiency is common and harmful.

Acupuncture – This ancient technique uses hair-thin needles inserted into several areas of the skin at defined points. While the results are mixed, some studies have shown that acupuncture helps reduce the frequency and intensity of chronic headaches.

Biofeedback – Patients might be able to control headaches by becoming more aware of and then changing certain bodily responses, such as muscle tension, heart rate and skin temperature.

Massage – Massage can reduce stress, relieve pain and promote relaxation. Although its value as a headache treatment hasn’t been determined, massage may be particularly helpful if someone has tight muscles in the back of the head, neck and shoulders.

 

Reference –

http://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800

http://www.medicalnewstoday.com/articles/73936.php#signs_and_symptoms

http://www.healthline.com/health/tension-headache#Causes2

https://www.wtamu.edu/webres/File/Student%20Life/Medical%20Services/Headaches.pdf

http://www.ihs-classification.org/_downloads/mixed/International-Headache-Classification-III-ICHD-III-2013-Beta.pdf

http://www.sign.ac.uk/pdf/sign107.pdf

https://www.nice.org.uk/guidance/cg150

 

February 8, 2017

Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory disease of the arteries most commonly involving the kidneys (renal arteries) and neck (carotid arteries). The disease typically presents in women around age 40, but it can occur in all age groups and also in men. Hypertension is the most common presenting finding, although patients may have a variety of symptoms including headaches, dizziness, and in some cases strokes are possible.

The most common form of FMD (known as medial fibroplasia or multifocal disease) is described as a “string-of-beads” due to alternating areas of artery stenosis and dilation. Less common forms (intimal or unifocal) appear as a single area of stenosis that may be mistaken for cholesterol plaque.

FMD can affect any artery, although the neck arteries that supply the brain (carotid and vertebral arteries) and the renal arteries that supply the kidneys are most often involved. The majority of FMD is a disease of middle-aged women, although patients of any age and sex can be affected.

Causes

The cause of FMD is still unknown. However, several factors may play a role in its development. A combination of these factors is likely responsible –

  • Genetics – Research suggests that about 10% of cases appear in families. People who have a family member with FMD may develop the condition in different arteries than their relative, experience a more or less severe version of the disease, or may not develop FMD at all
  • Hormones – FMD is three to four times more common in premenopausal women than in men, suggesting that sex hormones may be involved in its development
  • Abnormal arteries – A lack of oxygen to the artery walls may cause them to form abnormally. Arteries may also be located abnormally within the body, predisposing them to FMD

Risk Factors

  • Sex – Women have a much greater risk of fibromuscular dysplasia than do men.
  • Age – Fibromuscular disorder tends to be diagnosed in people in their early 50s.
  • Smoking – People who smoke appear to have an increased risk of developing fibromuscular dysplasia. For those already diagnosed with the disease, smoking is a risk factor for more serious fibromuscular dysplasia.
  • Family history – FMD appears to have a genetic basis. About 10% of people with FMD have a relative with the condition

Symptoms

In many cases, fibromuscular dysplasia is asymptomatic (i.e., does not cause symptoms). When symptoms do occur, they depend on which artery or arteries are affected and on the severity of the condition. Severe stenosis can cause pain in the area of the body that is supplied by the affected artery.

Fibromuscular dysplasia that develops in the arteries that supply blood to the kidneys (renal arteries) may cause high blood pressure (hypertension) and kidney damage (e.g., ischemic nephropathy). In severe cases, kidney failure can occur.

When fibromuscular dysplasia develops in the arteries that supply blood to the brain (carotid arteries), the condition can cause neurological symptoms, including the following:

  • Blurred vision or vision loss
  • Dizziness (vertigo)
  • Headache
  • Neck pain
  • Ringing in the ears (tinnitus)

Fibromuscular dysplasia that affects the carotid arteries can cause serious complications, such as stroke or brain attack, transient ischemic attack (TIA, “ministroke”), dilation of a blood vessel in the brain (intracranial aneurysm), bleeding in the brain (intracranial hemorrhage), and dissection (tearing) of the blood vessel (e.g., aortic dissection).

When the arteries that supply blood to the gastrointestinal (GI) tract and other abdominal organs (e.g., liver, spleen) are affected by fibromuscular dysplasia, patients may experience abdominal pain and other digestive disorders and weight loss.

Fibromuscular dysplasia that reduces blood flow in the arteries that supply the arms and legs can cause pain, weakness, numbness, and tingling in the extremities and peripheral neuropathy.

Complications

  • High blood pressure – When the arteries become narrowed, blood pressure can increase. High blood pressure (hypertension) is the most common complication of FMD
  • Stroke – A stroke may occur if an aneurysm in one of the carotid arteries ruptures or if one of the carotid arteries dissects, disrupting the flow of blood to the brain
  • A tear in the artery (dissection) -The lining of the artery wall may tear, causing blood to leak into the wall
  • Aneurysm – The pressure of blood flow through a narrowed artery can create a weakened area or bulge in the artery wall called an aneurysm. An aneurysm may rupture, resulting in a life-threatening situation
  • Pain or cramping in lower legs (intermittent claudication) – FMD that affects the arteries in the legs can cause discomfort or pain when walking and exercising
  • Kidney dysfunction or failure – Reduced blood flow to the kidneys can impair kidney function and, in rare cases, lead to kidney failure

Treatment

Medical therapy – The physician may prescribe medications to help control high blood pressure, including ACE inhibitors, beta blockers and calcium channel blockers. People with FMD may also need to take antiplatelet drugs, such as aspirin, to prevent blood clots

Interventional therapy – Physicians may use percutaneous transluminal angioplasty (PTA) to open narrowed sections of arteries. In this technique, a balloon-tipped catheter (thin, flexible tube) is threaded through the affected artery to expand it. PTA is less invasive than open surgery and results in faster recovery times

Surgery – This intervention re-routes blood flow around the diseased artery and may be used in severe cases or when PTA is not an option.

Genetic counseling – Because FMD appears to run in families, women of childbearing age may receive counseling for the genetic basis of the condition. There is not yet a genetic test for FMD.

Psychosocial treatment – FMD often affects young, otherwise healthy women, and coping with it can be difficult. Psychologists or other mental health professionals can offer counseling to help patients deal with the stress and anxiety that may accompany having FMD

Obstetrics/gynecological care – Specialists in obstetrics and gynecology can advise patients with FMD about the use of oral contraceptives, estrogen therapy and other hormone-based medications, which can affect blood flow in the arteries

 

Reference-

http://www.disabilitysecrets.com/resources/disability/disability-and-social-security/getting-social-0

https://www.rareconnect.org/en/community/fibromuscular-dysplasia

http://www.nature.com/ki/journal/v75/n3/full/ki2008232a.html

http://www.strokeassociation.org/STROKEORG/StrokeConnectionMagazine/ReadSCNow/Fibromuscular-Dysplasia-FMD_UCM_461419_Article.jsp#.VqZ5BSp97IU

https://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-arterial-disorders/fibromuscular-dysplasia

http://www.acc.org/latest-in-cardiology/articles/2015/02/27/08/54/fibromuscular-dysplasia-renewed-awareness-and-new-insights?w_nav=LC

https://www.inspire.com/groups/fibromuscular-dysplasia-society-of-america/

http://www.ninds.nih.gov/disorders/fibromuscular_dysplasia/fibromuscular_dysplasia.htm

http://circ.ahajournals.org/content/125/18/e636.full

http://www.fmdsa.org/fmd_info/what_is_fmd

http://www.massgeneral.org/vascularcenter/services/fibromusculardysplasia.aspx

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Expert=336

 

February 8, 2017

Eythema infectiosum is also known as parvovirus infection, slapped cheek disease, or fifth disease is a viral infection. A virus called Parvovirus B19 causes fifth disease. Parvovirus B19 can spread from person to person. It spreads through droplets in the air or on surfaces we touch. Its symptoms include low-grade fever, tiredness, rash on the cheeks (hence “slapped cheek”), and also a rash all over the person’s body.

It is also called fifth disease because it used to be 5th among a common group of childhood diseases with similar rashes – after measles, rubella (German measles), scarlet fever and Dukes’ disease.

Parvovirus continues to be a common childhood infection which tends to be mild and requires either very little or no treatment. If a pregnant woman has a parvovirus infection there is a risk of serious health problems for the developing fetus. Patients with a weakened immune system, as well as those with some types of anemias are at a higher risk of complications. Slapped cheek syndrome only affects humans, although some types of parvovirus can affect animals. The virus cannot jump from animal-to-human or human-to-animal.

There are many types of erythema, including photosensitivity, erythema multiforme, and erythema nodusum. Photosensitivity is caused by a reaction to sunlight and tends to occur when something, such as an infection or a medication, increases your sensitivity to ultraviolet radiation. Erythema multiforme is characterized by raised spots or other lesions on the skin. It is usually caused by a reaction to medications, infections (especially herpes simplex virus), or illness.

A person usually gets sick with fifth disease within 4 to 14 days after getting infected with parvovirus B19.

Causes

Erythema infectiosum is caused by a virus called parvovirus B19.

The virus is transferred from one person to another via airborne droplets from the nose and throat, for example when coughing or sneezing.

An infected pregnant woman can transfer the virus to her unborn baby.

The incubation period for parvovirus B19 is between one and three weeks and the person will be infectious for about a week before the illness actually becomes apparent.

By the time symptoms are present, the person is no longer infectious. There are 50 to 80 per cent of adults who have been infected with B19.

Risk Factors

  • Pregnant women who have not had the disease before.
  • People with a lowered immune defense system.
  • People with chronic anaemia.

Symptoms

Signs of the illness can be quite apparent, but are not always present in all infected individuals. Look out for the following tell-tale signs –

  • At the beginning, symptoms may resemble common cold signs, including headache, general malaise and fever.
  • Within seven to 10 days, a characteristic rash can develop starting on the face (referred to as slapped cheeks). Sometimes, a lace-like rash, often itchy, can develop on the body and involve the arms, buttocks, and thighs.
  • The rash may disappear and then reappear after exposure to heat (i.e. after a bath or shower), sun exposure or after exercising for weeks. However, some children can be infected without ever exhibiting such symptoms.

The following signs and symptoms are possible –

  • Slightly elevated body temperature
  • Fly-like symptoms
  • Runny nose
  • Stuffy nose
  • Fatigue
  • Sore throat
  • Nausea and/or diarrhea (less common)
  • Abdominal pain (less common)
  • Joint pain (less common, usually just in adults)
  • Neurological problems (very rare, and if so, just in adults)
  • Cardiovascular problems (very rare, and if so, just in adults)
  • Blotchy red rash appears on the cheeks. The rash may be itchy, but is very rarely painful.
  • The rash may spread to the body, limbs and the palms of the hands and soles of the feet. The rash may take up to three weeks to go away. Some patients may experience a recurrence of the rash if they are exposed to heat or sunlight.

Complications

  • Polyarthropathy in infected adults (painful, swollen joints)
  • Aplastic crisis or potentially dangerous low blood cell count in patients with haemolytic blood disorders such as autoimmune haemolytic anaemia and sickle cell disease
  • Spontaneous abortion, intrauterine death (9%) or hydrops fetalis in 3% of the offspring of infected pregnant women. This can occur if erythema infectiosum occurs in the first half of pregnancy. Parvovirus B19 does not cause congenital malformations. As the risk of an adverse outcome is low, the infection is not routinely screened for in pregnancy
  • Chronic parvovirus infection in immunodeficient patients, such as organ transplant recipients, causing erythropoietin-resistant anaemia, proteinuria, and glomerulosclerosis in a renal allograft
  • Rarely, encephalitis, hepatitis, non-occlusive bowel infarction, amegakaryocytic thrombocytopaenia, myositis and heart disease

Treatment

Medications

  • Antihistamines for itching
  • Antibiotics – If a person has an infection, though research suggests many cases of erythema can be resolved without antibiotics
  • Antiviral medications such as acyclovir and valacyclovir,
  • Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Burrow’s compresses, a solution used to soothe skin conditions, particularly blisters
  • Corticosteroids, applied to the skin (topically); corticosteroids may also be taken orally to reduce symptoms of erythema nodosum
  • Intravenous immunoglobulin, used experimentally for SJS and TEN
  • Photomodulation therapy, use of a light-emitting diode to accelerate the resolution of erythema

Complementary & Alternative Treatment

Beta-carotene and other carotenoids is often used as a standard treatment for sun sensitivity, although studies have been mixed.

Vitamin B6 help reduce the reaction.

Vitamin C is an antioxidant, so it may provide some protection against skin damage.

Vitamin D help for the sky.

Melatonin: Applying melatonin topically (either alone or in combination with vitamin E) seems to offer some protection against the reaction.

Zinc is necessary for healthy skin and was used in a study along with other prescription medications as a treatment for a severe form of erythema.

Flavonoids – Some of these plant-based antioxidants may protect skin from sun damage in healthy people.

Aloe vera – Used topically for skin inflammation

Goldenseal – Used for infections, including those causing skin lesions.

Sage extract – Applied topically to reduce inflammation.

 

Reference –

https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/erythema-infectiosum-slapped-cheek

http://www2.gnb.ca/content/dam/gnb/Departments/h-s/pdf/en/CDC/FactSheets/FifthDisease-e.pdf

http://www.thechildren.com/health-info/conditions-and-illnesses/understanding-fifth-disease-erythema-infectiosum

http://www.mountsinai.org/patient-care/health-library/diseases-and-conditions/erythema-infectiosum

http://www.caringforkids.cps.ca/handouts/fifth_disease

http://www.medicalnewstoday.com/articles/169853.php

http://patient.info/doctor/parvovirus-infection

http://www.webmd.com/children/guide/understanding-fifth-disease-basics

 

February 8, 2017

Edema is swelling or puffiness of parts of the body caused by fluid retention i.e. excess fluid is trapped in the body’s tissues. Edema happens most often in the feet, ankles, and legs, but can affect other parts of the body, such as the face, hands, and abdomen. It can also involve the entire body.

Normally the body maintains a balance of fluid in tissues by ensuring that the same of amount of water entering the body also leaves it. The circulatory system transports fluid within the body via its network of blood vessels. The fluid, which contains oxygen and nutrients needed by the cells, moves from the walls of the blood vessels into the body’s tissues. After its nutrients are used up, fluid moves back into the blood vessels and returns to the heart. The lymphatic system (a network of channels in the body that carry lymph, a colorless fluid containing white blood cells to fight infection) also absorbs and transports this fluid. In edema, either too much fluid moves from the blood vessels into the tissues, or not enough fluid moves from the tissues back into the blood vessels. This fluid imbalance can cause mild to severe swelling in one or more parts of the body.

There are many types of edema. The most common ones are –

  • Peripheral edema – In the feet (pedal edema), ankles, legs, hands and arms.
  • Cerebral edema – In and around the brain (cerebral edema).
  • Eye edema – In and around the eyes, e.g. macular edema, corneal edema, periorbital edema (puffiness around the eyes. Macular edema is a serious complication of diabetic retinopathy.

Pregnant women and older adults often get edema, but it can happen to anyone. Edema is a symptom, not a disease or disorder. In fact, edema is a normal response to injury. Edema becomes a concern when it persists beyond the inflammatory phase. Widespread, long-term edema can indicate a serious underlying health problem.

Causes

Edema has many possible causes –

  • Blood clots – Clots can cause pooling of fluid and may be accompanied by discoloration and pain. In some instances, clots may cause no pain.
  • Edema can occur as a result of gravity, especially from sitting or standing in one place for too long. Water naturally gets pulled down into your legs and feet.
  • It can happen from a weakening in the valves of the veins in the legs (a condition called venous insufficiency). This problem makes it hard for the veins to push blood back up to the heart, and leads to varicose veins and a buildup of fluid in the legs.
  • Certain diseases — such as congestive heart failure and lung, liver, kidney, and thyroid diseases can cause edema or make it worse.
  • Some drugs, such as medications that you are taking for your blood pressure or to control pain, may cause or worsen edema.
  • An allergic reaction, severe inflammation, burns, trauma, clot(s), or poor nutrition can also cause edema.
  • Too much salt from your diet can make edema worse.
  • Being pregnant can cause edema in the legs as the uterus puts pressure on the blood vessels in the lower trunk of the body.
  • Edema can be a side effect of some medications, including:
    • High blood pressure medications
    • Nonsteroidal anti-inflammatory drugs
    • Steroid drugs
    • Estrogens
    • Certain diabetes medications called thiazolidinediones
  • Menopause – Around the period of the menopause, as well as after, hormone fluctuations can cause fluid retention. Hormone replacement therapy after the menopause can also cause edema.
  • Malnutrition and/or bad diet – Dietitians say low consumption of thiamine (vitamin B1), as well as insufficient vitamins B6 and B5, may contribute toward fluid retention. Low levels of albumin may also play a part – low albumin levels can also be caused by kidney disease.

Symptoms

The fluid build-up may cause swelling in one particular part of the body, after an injury, for example, or may be more general. Generalized edema is usually seen in health disorders such as heart failure or kidney disease. Symptoms include –

  • Swollen and puffy skin
  • Skin discoloration
  • Skin that “pits” when pressed
  • Stiff, tender and painful joints
  • Weight gain or weight loss
  • Raised blood pressure and heart rate

Complications

If left untreated, edema can cause –

  • Increasingly painful swelling
  • Difficulty walking
  • Stiffness
  • Stretched skin, which can become itchy and uncomfortable
  • Increased risk of infection in the swollen area
  • Scarring between layers of tissue
  • Decreased blood circulation
  • Decreased elasticity of arteries, veins, joints and muscles
  • Increased risk of skin ulcers

Treatment

Diuretics – These are drugs that raise the rate of urination, providing a means of forced diuresis. Diuresis is the increased production of urine by the kidney. There are several types of diuretics – they increase the excretion of water from the body in various different ways. Diuretics are not suitable if the patient is pregnant, or has chronic venous insufficiency (weakened valves in the veins of the legs).

Oxygen therapy – Oxygen delivered through the nose may improve poor vision caused by diabetic macular edema.

Antiangiogenesis therapy (controlling blood vessel growth) – The beneficial effects of anti-angiogenesis drugs in the treatment of the glioblastomas (deadly brain tumors) appear to result primarily from the reduction of edema.

Alternative Treatment

Pycnogenol was shown in both pre-clinical and clinical studies to strengthen capillary walls and prevent edema. Research has shown Pycnogenol actually seals the brittle capillaries and stops the outflow of blood into tissue which causes the swellings, edema and microbleedings. Coupled with its anti-inflammatory properties and patent for reducing platelet aggregation, these are the fundamental mechanisms of action behind Pycnogenol for edema.

B vitamins are essential for proper functioning of several metabolic processes in the body and for red blood cell formation. Deficiency of B vitamins, especially vitamins B-1 and B-2, can lead to edema and swelling.

Flavonoids – A new class of largely unstudied vitamins are referred to as flavonoids. They provide the intense flavors in food, such as capsacin in cayenne, and the pigments, such as anthocyanin in blueberries. High doses of flavonoids are demonstrated by controlled studies to effectively reduce edema and aid in many potential causes. The best sources are fresh herbs and spices combined with colored vegetables and fruits.

Thiamine – B1 deficiency is one known cause of fluid retention. The presence of other deficiency side effects suggest positive diagnosis. These include aching and stiff jointed in the swollen areas.

Pantothenic Acid – Vitamin B5 is directly linked to edema. One of the primary functions of this vitamin is the excretion of excess fluids. Deficiency also results in such symptoms as nausea, insomnia, and muscle cramping.

Vitamin B6 is another vitamin linked directly to heart and circulatory health. Failure of the heart and vessel walls to maintain the right amount of pressure results in fluid retention.

Magnesium is needed for nerve conduction and to provide muscular strength. Because it can close some calcium channels on the membranes of neurons, high levels of magnesium can reduce the activity of nerves in the nervous system. Loop diuretics and thiazide diuretics can promote magnesium loss in the kidneys. This is an unfortunate side effect involving another unwanted side effect of diuretics: potassium loss.

Alfalfa – Provides necessary minerals. Has chlorophyll which detoxifies the body.

Calcium – Replenishes minerals lost in the edema correction process.

Cornsilk – Combination of herbs and corn silk that have been known to reduce the formation of sediments in the kidneys and helps to reduce water retention.

Horse Chestnut – Horse Chestnut seed contain Aescin which has helped to effectively reduce post-surgical edema.

Dandelion leaf is itself a diuretic, so it should not be used while taking diuretic medications.

Grape seed extract for antioxidant support. Evidence suggests that using grape seed extract may improve chronic venous insufficiency, which causes swelling when blood pools in the legs.

Acupuncture – Acupuncture may improve fluid balance.

Massage– Therapeutic massage can help lymph nodes drain.

 

Reference –

https://www.nlm.nih.gov/medlineplus/edema.html

http://www.medicalnewstoday.com/articles/159111.php

https://my.clevelandclinic.org/health/diseases_conditions/hic_Edema

http://www.cancer.net/navigating-cancer-care/side-effects/fluid-retention-or-edema

http://www.healthline.com/symptom/swollen-ankle

https://umm.edu/health/medical/altmed/condition/edema

http://www.medscape.com/viewarticle/524606

http://www.cvphysiology.com/Microcirculation/M010.htm

http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/edema.aspx

http://www.drugs.com/health-guide/edema.html

http://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/edema

http://www.fpnotebook.com/renal/Edema/Edm.htm

http://www.news-medical.net/health/What-is-Edema.aspx

http://www.strokecenter.org/professionals/brain-anatomy/cellular-injury-during-ischemia/edema-formation/