A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.
Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.
Overview
Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.
Get Help Quickly
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms.
The most common heart attack signs and symptoms are:
Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
Shortness of breath may occur with or before chest discomfort.
Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.
If you think you or someone you know may be having a heart attack:
Call 9–1–1 within a few minutes—5 at the most—of the start of symptoms.
If your symptoms stop completely in less than 5 minutes, still call your doctor.
Only take an ambulance to the hospital. Going in a private car can delay treatment.
Take a nitroglycerin pill if your doctor has prescribed this type of medicine.
Outlook
Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.
Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital
Sources : www.nhlbi.nih.gov
Selasa, 08 Juli 2008
Acute Myocardial Infarction
Myocardial infarction is now considered part of a spectrum referred to as acute coronary syndromes, which refers to a range of acute myocardial ischaemia, that also includes unstable angina and non-ST segment elevation myocardial infarction. The new criteria for diagnosing myocardial infarction are an increase in biochemical markers of myocardial necrosis, with at least one of the following:
Ischaemic symptoms
Development of pathological Q waves on the ECG
ECG changes indicative of ischaemia (ST segment elevation or depression)
Coronary artery intervention (e.g. angioplasty)
Epidemiology
Coronary heart disease is the most common cause of death in the UK. CHD is responsible for the deaths of approximately one in five men, and one in six women.1
The average incidence of myocardial infarction for those aged between 30 and 69 years is about 600 per 100,000 for men, and 200 per 100,000 for women.1
A male predominance in incidence exists up to approximately age 70 years, when the sexes converge to equal incidence.
Pre-menopausal women appear to be protected from atherosclerosis. Incidence increases with age and elderly people also tend to have higher rates of morbidity and mortality from their infarcts.
Risk Factors
Non-modifiable risk factors for atherosclerosis: increasing age, male, family history of premature coronary heart disease, premature menopause
Ethnic Group: In the UK, the highest recorded rates of coronary artery disease mortality are in people born in India, Pakistan and Bangladesh2
Modifiable risk factors for atherosclerosis: smoking, diabetes mellitus (and impaired glucose tolerance), hypertension, raised LDL cholesterol, reduced HDL cholesterol, obesity, inactivity
Presentation
Chest pain: three quarters of patients present with characteristic central or epigastric chest pain radiating to the arms, shoulders, neck, or jaw. The pain is described as sub-sternal pressure, squeezing, aching, burning, or even sharp pain. Radiation to the left arm or neck is common. Chest pain may be associated with sweating, nausea, vomiting, dyspnoea, fatigue, or palpitations.
Shortness of breath: may be the patient's anginal equivalent or a symptom of heart failure.
Atypical presentations are common (especially women, older men, people with diabetes, and people from ethnic minorities) e.g. abdominal discomfort or jaw pain; elderly patients may present with altered mental state.
Signs
Examination findings can vary enormously:
Low-grade fever, pale and with cool, clammy skin
Hypotension or hypertension can be observed depending on the extent of the MI
Dyskinetic cardiac impulse (in anterior wall MI) occasionally can be palpated
Third and fourth heart sound, systolic murmur if mitral regurgitation or ventricular septal defect develop, pericardial rub
May be signs of congestive heart failure, including pulmonary rales, peripheral oedema, elevated jugular venous pressure
Differential diagnosis
Consider non-atherosclerotic causes in younger patients or if there is no evidence of atherosclerosis: coronary emboli from sources such as an infected cardiac valve, coronary occlusion secondary to vasculitis, coronary artery spasm, cocaine use, congenital coronary anomalies, coronary trauma, increased oxygen requirement (e.g. hyperthyroidism) or decreased oxygen delivery (e.g. severe anaemia)
Cardiovascular: acute pericarditis, myocarditis, aortic stenosis, aortic dissection, pulmonary embolism
Respiratory: pneumonia, pneumothorax
Gastrointestinal: oesophageal spasm, oesophagitis, gastro-oesophageal reflux, acute gastritis, cholecystitis, pancreatitis
Musculoskeletal chest pain
Investigations
If diagnosis is suspected arrange urgent admission immediately (999 Ambulance).
ECG: may be helpful pre-hospital setting if the diagnosis is uncertain or in a remote area in the assessment for pre-hospital thrombolysis, but otherwise should not delay getting the patient to hospital.
Features that increase the likelihood of infarction: new ST segment elevation; new Q waves; any ST segment elevation; new conduction defect. Other features of ischaemia are ST segment depression and T wave inversion.
In hospital
Full blood count to rule out anaemia; leucocytosis is common; monitor potassium levels (electrolyte disturbances may cause arrhythmias, especially potassium and magnesium); renal function (eGFR) should be measured prior to starting an ACE inhibitor. Lipid profile needs to be obtained at presentation because levels can change after 12-24 hours of an acute illness. Measure CRP and other markers of inflammation.
Cardiac enzymes: cardiac troponins T and I are highly sensitive and specific for cardiac damage. The risk of death from an acute coronary syndrome is directly related to troponin level and patients with no detectable troponins have a good short-term prognosis. Serum levels increase within 3-12 hours from the onset of chest pain, peak at 24-48 hours, and return to baseline over 5-14 days. Myocardial muscle creatine kinase (CK-MB) is found mainly in the heart. CK-MB levels increase within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours. Sensitivity and specificity are not as high as for troponin levels.
Serial ECGs and continuous ECG monitoring in CCU.
Chest x-ray: to assess patient's heart size and the presence or absence of heart failure and pulmonary oedema.
Cardiac catheterisation and angiography: cardiac angiography defines the patient's coronary anatomy and the extent of the disease. Whether all patients with acute myocardial infarction should ideally undergo cardiac catheterization is controversial and present consensus is for angiography only if indicated by recurrent chest pain or significant ischaemia shown by exercise ECG or perfusion imaging. Patients with cardiogenic shock, intractable angina despite medications or severe pulmonary congestion should undergo cardiac catheterization and revascularization immediately.
Echocardiography can define the extent of the infarction and assess overall ventricular function and can identify complications, such as acute mitral regurgitation, left ventricular rupture or pericardial effusion.
Myocardial perfusion scintigraphy using SPECT: NICE recommends that myocardial perfusion scintigraphy using SPECT should be the first test used for:3
People where stress ECG may not give accurate or clear results, e.g. women, people who have certain unusual patterns in the electrical activity of their heart, people with diabetes or people for whom exercise is difficult or impossible.
The diagnosis of people who are less likely to have coronary artery disease and who are at lower risk of having heart problems in the future. The likelihood of a person having coronary artery disease can be assessed by considering a number of factors, e.g. age, sex, ethnic background and family history as well as the results of physical examination and investigations.
As an investigation in people who still have symptoms following a myocardial infarction or despite having had treatment to improve coronary artery blood flow
Prognosis
After a first myocardial infarction:1
23% of people die before reaching hospital
13% die during hospital admission
10% die within the first year following hospital discharge
5% die each year thereafter (this persists indefinitely)
Prognosis correlates with the degree of myocardial necrosis. Greater degrees of myocardial necrosis are associated with a worse prognosis. The degree of myocardial necrosis can be estimated by various factors, e.g.1
The rise in serum troponin T
Degree and extent of ECG changes
Degree of left ventricular dysfunction on echocardiography
Prognosis is worse in women, increasing age, increasing ventricular dysfunction, ventricular dysrhythmias and recurrent infarction. Other indicators of poorer prognosis are delay in reperfusion or unsuccessful reperfusion, anterior infarction, number of leads showing ST elevation, bundle branch block and systolic blood pressure less than 100 mm with tachycardia greater than 100 per minute.
Better prognosis is associated with early reperfusion, inferior wall infarct, preserved LV function, short-term and long-term treatment with beta-blockers, aspirin, statins and ACE inhibitors.
Elderly patients with acute MI are at increased risk of developing complications and should be treated aggressively.
Sources : www.patient.co.uk
Ischaemic symptoms
Development of pathological Q waves on the ECG
ECG changes indicative of ischaemia (ST segment elevation or depression)
Coronary artery intervention (e.g. angioplasty)
Epidemiology
Coronary heart disease is the most common cause of death in the UK. CHD is responsible for the deaths of approximately one in five men, and one in six women.1
The average incidence of myocardial infarction for those aged between 30 and 69 years is about 600 per 100,000 for men, and 200 per 100,000 for women.1
A male predominance in incidence exists up to approximately age 70 years, when the sexes converge to equal incidence.
Pre-menopausal women appear to be protected from atherosclerosis. Incidence increases with age and elderly people also tend to have higher rates of morbidity and mortality from their infarcts.
Risk Factors
Non-modifiable risk factors for atherosclerosis: increasing age, male, family history of premature coronary heart disease, premature menopause
Ethnic Group: In the UK, the highest recorded rates of coronary artery disease mortality are in people born in India, Pakistan and Bangladesh2
Modifiable risk factors for atherosclerosis: smoking, diabetes mellitus (and impaired glucose tolerance), hypertension, raised LDL cholesterol, reduced HDL cholesterol, obesity, inactivity
Presentation
Chest pain: three quarters of patients present with characteristic central or epigastric chest pain radiating to the arms, shoulders, neck, or jaw. The pain is described as sub-sternal pressure, squeezing, aching, burning, or even sharp pain. Radiation to the left arm or neck is common. Chest pain may be associated with sweating, nausea, vomiting, dyspnoea, fatigue, or palpitations.
Shortness of breath: may be the patient's anginal equivalent or a symptom of heart failure.
Atypical presentations are common (especially women, older men, people with diabetes, and people from ethnic minorities) e.g. abdominal discomfort or jaw pain; elderly patients may present with altered mental state.
Signs
Examination findings can vary enormously:
Low-grade fever, pale and with cool, clammy skin
Hypotension or hypertension can be observed depending on the extent of the MI
Dyskinetic cardiac impulse (in anterior wall MI) occasionally can be palpated
Third and fourth heart sound, systolic murmur if mitral regurgitation or ventricular septal defect develop, pericardial rub
May be signs of congestive heart failure, including pulmonary rales, peripheral oedema, elevated jugular venous pressure
Differential diagnosis
Consider non-atherosclerotic causes in younger patients or if there is no evidence of atherosclerosis: coronary emboli from sources such as an infected cardiac valve, coronary occlusion secondary to vasculitis, coronary artery spasm, cocaine use, congenital coronary anomalies, coronary trauma, increased oxygen requirement (e.g. hyperthyroidism) or decreased oxygen delivery (e.g. severe anaemia)
Cardiovascular: acute pericarditis, myocarditis, aortic stenosis, aortic dissection, pulmonary embolism
Respiratory: pneumonia, pneumothorax
Gastrointestinal: oesophageal spasm, oesophagitis, gastro-oesophageal reflux, acute gastritis, cholecystitis, pancreatitis
Musculoskeletal chest pain
Investigations
If diagnosis is suspected arrange urgent admission immediately (999 Ambulance).
ECG: may be helpful pre-hospital setting if the diagnosis is uncertain or in a remote area in the assessment for pre-hospital thrombolysis, but otherwise should not delay getting the patient to hospital.
Features that increase the likelihood of infarction: new ST segment elevation; new Q waves; any ST segment elevation; new conduction defect. Other features of ischaemia are ST segment depression and T wave inversion.
In hospital
Full blood count to rule out anaemia; leucocytosis is common; monitor potassium levels (electrolyte disturbances may cause arrhythmias, especially potassium and magnesium); renal function (eGFR) should be measured prior to starting an ACE inhibitor. Lipid profile needs to be obtained at presentation because levels can change after 12-24 hours of an acute illness. Measure CRP and other markers of inflammation.
Cardiac enzymes: cardiac troponins T and I are highly sensitive and specific for cardiac damage. The risk of death from an acute coronary syndrome is directly related to troponin level and patients with no detectable troponins have a good short-term prognosis. Serum levels increase within 3-12 hours from the onset of chest pain, peak at 24-48 hours, and return to baseline over 5-14 days. Myocardial muscle creatine kinase (CK-MB) is found mainly in the heart. CK-MB levels increase within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours. Sensitivity and specificity are not as high as for troponin levels.
Serial ECGs and continuous ECG monitoring in CCU.
Chest x-ray: to assess patient's heart size and the presence or absence of heart failure and pulmonary oedema.
Cardiac catheterisation and angiography: cardiac angiography defines the patient's coronary anatomy and the extent of the disease. Whether all patients with acute myocardial infarction should ideally undergo cardiac catheterization is controversial and present consensus is for angiography only if indicated by recurrent chest pain or significant ischaemia shown by exercise ECG or perfusion imaging. Patients with cardiogenic shock, intractable angina despite medications or severe pulmonary congestion should undergo cardiac catheterization and revascularization immediately.
Echocardiography can define the extent of the infarction and assess overall ventricular function and can identify complications, such as acute mitral regurgitation, left ventricular rupture or pericardial effusion.
Myocardial perfusion scintigraphy using SPECT: NICE recommends that myocardial perfusion scintigraphy using SPECT should be the first test used for:3
People where stress ECG may not give accurate or clear results, e.g. women, people who have certain unusual patterns in the electrical activity of their heart, people with diabetes or people for whom exercise is difficult or impossible.
The diagnosis of people who are less likely to have coronary artery disease and who are at lower risk of having heart problems in the future. The likelihood of a person having coronary artery disease can be assessed by considering a number of factors, e.g. age, sex, ethnic background and family history as well as the results of physical examination and investigations.
As an investigation in people who still have symptoms following a myocardial infarction or despite having had treatment to improve coronary artery blood flow
Prognosis
After a first myocardial infarction:1
23% of people die before reaching hospital
13% die during hospital admission
10% die within the first year following hospital discharge
5% die each year thereafter (this persists indefinitely)
Prognosis correlates with the degree of myocardial necrosis. Greater degrees of myocardial necrosis are associated with a worse prognosis. The degree of myocardial necrosis can be estimated by various factors, e.g.1
The rise in serum troponin T
Degree and extent of ECG changes
Degree of left ventricular dysfunction on echocardiography
Prognosis is worse in women, increasing age, increasing ventricular dysfunction, ventricular dysrhythmias and recurrent infarction. Other indicators of poorer prognosis are delay in reperfusion or unsuccessful reperfusion, anterior infarction, number of leads showing ST elevation, bundle branch block and systolic blood pressure less than 100 mm with tachycardia greater than 100 per minute.
Better prognosis is associated with early reperfusion, inferior wall infarct, preserved LV function, short-term and long-term treatment with beta-blockers, aspirin, statins and ACE inhibitors.
Elderly patients with acute MI are at increased risk of developing complications and should be treated aggressively.
Sources : www.patient.co.uk
Cardiac Arrest
AHA Recommendation
The American Heart Association urges the public to be prepared for cardiac emergencies:
Know the warning signs of cardiac arrest. During cardiac arrest a victim loses consciousness, stops normal breathing and loses pulse and blood pressure.
Call 9-1-1 immediately to access the emergency medical system if you see any cardiac arrest warning signs.
Give cardiopulmonary resuscitation (CPR) to help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood and oxygen flowing to the heart and brain until defibrillation can be administered.
What is cardiac arrest?
Cardiac arrest is the sudden, abrupt loss of heart function. The victim may or may not have diagnosed heart disease. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death (also called sudden cardiac death) occurs within minutes after symptoms appear.
What causes cardiac arrest?
The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease. Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart. This is called bradycardia.
Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Cardiac arrest can also occur without any known cause.
Can cardiac arrest be reversed?
Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes.
How many people survive cardiac arrest?
No statistics are available for the exact number of cardiac arrests that occur each year. It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30–45 percent.
What can be done to increase the survival rate?
Early CPR and rapid defibrillation combined with early advanced care can result in high long-term survival rates for witnessed cardiac arrest. For instance, in June 1999, automated external defibrillators (AEDs) were mounted 1 minute apart in plain view at Chicago's O'Hare and Midway airports. In the first 10 months, 14 cardiac arrests occurred, with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims (64 percent) were revived with an AED and had no brain damage.
If bystander CPR was initiated more consistently, if AEDs were more widely available, and if every community could achieve a 20 percent cardiac arrest survival rate, an estimated 40,000 more lives could be saved each year. Death from sudden cardiac arrest is not inevitable. If more people react quickly by calling 9-1-1 and performing CPR, more lives can be saved.
Sources : www.americanheart.org
The American Heart Association urges the public to be prepared for cardiac emergencies:
Know the warning signs of cardiac arrest. During cardiac arrest a victim loses consciousness, stops normal breathing and loses pulse and blood pressure.
Call 9-1-1 immediately to access the emergency medical system if you see any cardiac arrest warning signs.
Give cardiopulmonary resuscitation (CPR) to help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood and oxygen flowing to the heart and brain until defibrillation can be administered.
What is cardiac arrest?
Cardiac arrest is the sudden, abrupt loss of heart function. The victim may or may not have diagnosed heart disease. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death (also called sudden cardiac death) occurs within minutes after symptoms appear.
What causes cardiac arrest?
The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease. Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart. This is called bradycardia.
Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Cardiac arrest can also occur without any known cause.
Can cardiac arrest be reversed?
Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes.
How many people survive cardiac arrest?
No statistics are available for the exact number of cardiac arrests that occur each year. It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30–45 percent.
What can be done to increase the survival rate?
Early CPR and rapid defibrillation combined with early advanced care can result in high long-term survival rates for witnessed cardiac arrest. For instance, in June 1999, automated external defibrillators (AEDs) were mounted 1 minute apart in plain view at Chicago's O'Hare and Midway airports. In the first 10 months, 14 cardiac arrests occurred, with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims (64 percent) were revived with an AED and had no brain damage.
If bystander CPR was initiated more consistently, if AEDs were more widely available, and if every community could achieve a 20 percent cardiac arrest survival rate, an estimated 40,000 more lives could be saved each year. Death from sudden cardiac arrest is not inevitable. If more people react quickly by calling 9-1-1 and performing CPR, more lives can be saved.
Sources : www.americanheart.org
Hypertention
Blood pressure above 140/90 constitutes hypertension. Increase in diastolic pressure is more important in the definition of hypertension. As part of our increasing engagement in improving blood pressure measurement we are now undertaking active validation of new blood pressure devices for the measurement of blood pressure. Intracardiac left-to-right shunts (such as a ventricular or atrial septal defect, a hole in the wall between the two ventricles or atria) can cause too much blood flow through the lungs. Hypertension occurs when blood is forced through the arteries at an increased pressure.In patients with diabetes mellitus or kidney disease studies have shown that blood pressure over 130/80 mmHg should be considered a risk factor and warrants treatment. Accordingly, the diagnosis of high blood pressure in an individual is important so that efforts can be made to normalize the blood pressure and, thereby, prevent the complications.Whereas it was previously thought that diastolic blood pressure elevations were a more important risk factor than systolic elevations, it is now known that for individuals older than 50 years of age systolic hypertension represents a greater risk.
Hypertension , commonly referred to as "high blood pressure", is a medical condition where the blood pressure is chronically elevated.The arteries are the vessels that carry blood from the pumping heart to all of the tissues and organs of the body.High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase the blood pressure. Because the risk to an individual patient may correlate with the severity of hypertension, a classification system is essential for making decisions about aggressiveness of treatment or therapeutic interventions. Generally, the higher the blood pressure, the greater the risk. Untreated hypertension affects all organ systems and can shorten one's life expectancy by 10 to 20 years.An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage).This can cause an artery to rupture or the heart to fail under the strain - in the worst case stopping altogether.If the pressure is high enough, eventually the heart can't keep up, and less blood can circulate through the lungs to pick up oxygen.
continuously. Therefore, determinants of blood pressure include factors that affect both cardiac output and arteriolar vascular physiology. The diastolic pressure, which is the bottom number, represents the pressure in the arteries as the heart relaxes after the contraction. Blood is pumped from the heart through the arteries out to our muscles and organs. High blood pressure is a major risk factor for heart disease, congestive heart failure, stroke, impaired vision, and kidney disease. The British Hypertension Society has a track record of producing internationally renowned guidelines for the management of hypertension which are widely adopted in primary care in the UK and elsewhere. Furthermore, changes in vascular wall thickness affect the amplification of peripheral vascular resistance in hypertensive patients and result in reflection of waves back to the aorta, increasing systolic blood pressure.
Causes of Hypertention
The common Causes of Hypertention :
Renal parenchymal disease
Polycystic kidney disease
Vasculitis
Hyperthyroidism and hypothyroidism
There does not appear to be a direct relationship between caffeine and chronic hypertension, even though caffeine intake can cause an acute (rapid but brief) increase in blood pressure.
chronic alcohol abuse
Dangerous expansion of the main artery either in the chest or the abdomen, which becomes weakened and may rupture.
Erythropoietin
Smoking
Lack of Exercise
Secondary causes include certain types of kidney disease, abnormal functioning of certain glands (adrenal glands, thyroid gland, parathyroid glands), chronic intake of certain substances and medications (e.g., alcohol, steroids), and the presence of a rare tumor (e.g., pheochromocytoma, which secretes adrenaline-like substances).
Symptoms of Hypertention
Some are common Symptoms of Hypertention :
Confusion
Vision changes
Cyanosis, a condition in which the baby's skin has a bluish tint, even while they are receiving extra oxygen to breathe
Dizziness
Tiredness
Swelling in the ankles or legs (edema)
Bluish lips and skin (cyanosis)
Angina-like chest pain (crushing chest pain )
Ear noise or buzzing
Nausea and vomiting.
Respiratory distress, including signs such as flaring nostrils and grunting
Treatment of Hypertention
Here is the list of the methods for treating Hypertention :
Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers.
Medications such as hydralazine, minoxidil, diazoxide, or nitroprusside may be required if the blood pressure is very high.
Increase the supply of blood and oxygen to the heart, while reducing its workload.
100 percent supplemental oxygen may be given to your baby through a mask or plastic hood.
Research has shown that this gas is effective in treating PPHN because it relaxes contracted lung blood vessels and improves blood flow to the lungs.
For the compelling indications, other antihypertensive drugs (eg, diuretics, ACE inhibitor, ARB, beta-blocker, calcium channel blocker) may be considered as needed.
Maintain weight at 15 percent or less of desirable weight
Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.
This type of ventilation may improve the oxygen level in the blood if other types of ventilation are not effective.
Sources : www.health-disease.org
Hypertension , commonly referred to as "high blood pressure", is a medical condition where the blood pressure is chronically elevated.The arteries are the vessels that carry blood from the pumping heart to all of the tissues and organs of the body.High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase the blood pressure. Because the risk to an individual patient may correlate with the severity of hypertension, a classification system is essential for making decisions about aggressiveness of treatment or therapeutic interventions. Generally, the higher the blood pressure, the greater the risk. Untreated hypertension affects all organ systems and can shorten one's life expectancy by 10 to 20 years.An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage).This can cause an artery to rupture or the heart to fail under the strain - in the worst case stopping altogether.If the pressure is high enough, eventually the heart can't keep up, and less blood can circulate through the lungs to pick up oxygen.
continuously. Therefore, determinants of blood pressure include factors that affect both cardiac output and arteriolar vascular physiology. The diastolic pressure, which is the bottom number, represents the pressure in the arteries as the heart relaxes after the contraction. Blood is pumped from the heart through the arteries out to our muscles and organs. High blood pressure is a major risk factor for heart disease, congestive heart failure, stroke, impaired vision, and kidney disease. The British Hypertension Society has a track record of producing internationally renowned guidelines for the management of hypertension which are widely adopted in primary care in the UK and elsewhere. Furthermore, changes in vascular wall thickness affect the amplification of peripheral vascular resistance in hypertensive patients and result in reflection of waves back to the aorta, increasing systolic blood pressure.
Causes of Hypertention
The common Causes of Hypertention :
Renal parenchymal disease
Polycystic kidney disease
Vasculitis
Hyperthyroidism and hypothyroidism
There does not appear to be a direct relationship between caffeine and chronic hypertension, even though caffeine intake can cause an acute (rapid but brief) increase in blood pressure.
chronic alcohol abuse
Dangerous expansion of the main artery either in the chest or the abdomen, which becomes weakened and may rupture.
Erythropoietin
Smoking
Lack of Exercise
Secondary causes include certain types of kidney disease, abnormal functioning of certain glands (adrenal glands, thyroid gland, parathyroid glands), chronic intake of certain substances and medications (e.g., alcohol, steroids), and the presence of a rare tumor (e.g., pheochromocytoma, which secretes adrenaline-like substances).
Symptoms of Hypertention
Some are common Symptoms of Hypertention :
Confusion
Vision changes
Cyanosis, a condition in which the baby's skin has a bluish tint, even while they are receiving extra oxygen to breathe
Dizziness
Tiredness
Swelling in the ankles or legs (edema)
Bluish lips and skin (cyanosis)
Angina-like chest pain (crushing chest pain )
Ear noise or buzzing
Nausea and vomiting.
Respiratory distress, including signs such as flaring nostrils and grunting
Treatment of Hypertention
Here is the list of the methods for treating Hypertention :
Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers.
Medications such as hydralazine, minoxidil, diazoxide, or nitroprusside may be required if the blood pressure is very high.
Increase the supply of blood and oxygen to the heart, while reducing its workload.
100 percent supplemental oxygen may be given to your baby through a mask or plastic hood.
Research has shown that this gas is effective in treating PPHN because it relaxes contracted lung blood vessels and improves blood flow to the lungs.
For the compelling indications, other antihypertensive drugs (eg, diuretics, ACE inhibitor, ARB, beta-blocker, calcium channel blocker) may be considered as needed.
Maintain weight at 15 percent or less of desirable weight
Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.
This type of ventilation may improve the oxygen level in the blood if other types of ventilation are not effective.
Sources : www.health-disease.org
Human Immunodeficiency Virus (HIV) Infection
What is HIV? What is AIDS?
HIV (human immunodeficiency virus) is a virus that attacks the immune system, the body’s natural defence system. Without a strong immune system, the body has trouble fighting off disease. Both the virus and the infection it causes are called HIV.
White blood cells are an important part of the immune system. HIV invades and destroys certain white blood cells called CD4+ cells. If too many CD4+ cells are destroyed, the body can no longer defend itself against infection.
The last stage of HIV infection is AIDS (acquired immunodeficiency syndrome). People with AIDS have a low number of CD4+ cells and get infections or cancers that rarely occur in healthy people. These can be deadly.
But having HIV does not mean you have AIDS. Even without treatment, it takes a long time for HIV to progress to AIDS—usually 10 to 12 years. If HIV is diagnosed before it becomes AIDS, medicines can slow or stop the damage to the immune system. With treatment, many people with HIV are able to live long and active lives.
What causes HIV?
HIV infection is caused by the human immunodeficiency virus. You can get HIV from contact with infected blood, semen, or vaginal fluids.
Most people get the virus by having unprotected sex with someone who has HIV.
Another common way of getting the virus is by sharing drug needles with someone who is infected with HIV.
The virus can also be passed from a mother to her baby during pregnancy, birth, or breast-feeding.
HIV doesn't survive well outside the body. So it cannot be spread by casual contact such as kissing or sharing drinking glasses with an infected person.
What are the symptoms?
HIV may not cause symptoms early on. People who do have symptoms may mistake them for the flu or mono. Common early symptoms include:
Fever.
Sore throat.
Headache.
Muscle aches and joint pain.
Swollen glands (swollen lymph nodes).
Skin rash.
Symptoms may appear from a few days to several weeks after a person is first infected. The early symptoms usually go away within 2 to 3 weeks.
After the early symptoms go away, an infected person may not have symptoms again for many years. But during this time, the virus continues to grow in the body and attack the immune system. After a certain point, symptoms reappear and then remain. These symptoms usually include:
Swollen lymph nodes.
Extreme tiredness.
Weight loss.
Fever.
Night sweats.
A doctor may suspect HIV if these symptoms last and no other cause can be found.
How is HIV diagnosed?
The only way to know for sure if you have HIV is to get a blood test. If you have been exposed to HIV, your immune system will make antibodies to try to destroy the virus. Blood tests can find these antibodies in your blood.
Most doctors use two blood tests, called the ELISA and the Western blot assay. If the first ELISA is positive (meaning that HIV antibodies are found), the blood sample is tested again. If the second test is positive, the doctor will do a Western blot to be sure.
It may take as long as 6 months for HIV antibodies to show up in a blood sample. If you think you have been exposed to HIV but you test negative for it:
Get tested again in 6 months to be sure you are not infected.
Meanwhile, take steps to prevent the spread of the virus. If you are infected, you can still pass HIV to another person during this time.
Some people are afraid to be tested for HIV. But if there is any chance you could be infected, it is very important to find out. HIV can be treated. Getting early treatment can slow down the virus and help you stay healthy.
You can get HIV testing in most doctors’ offices, public health units, hospitals, and clinics.
How is it treated?
The standard treatment for HIV is a combination of medicines called highly active antiretroviral therapy (HAART). Antiretroviral medicines slow the rate at which the virus multiplies. Taking these medicines can reduce the amount of virus in your body and help you stay healthy.
It may not be easy to decide the best time to start treatment. There are pros and cons to taking HAART before you have symptoms. Discuss these with your doctor so you understand your choices.
To find out how much damage HIV has done to your immune system, a doctor will do two tests:
CD4+ cell count, which shows how well your immune system is working.
Viral load, which shows the amount of virus in your blood.
If you have no symptoms and your CD4+ cell count is at a healthy level, you may not need treatment yet. Your doctor will repeat the tests on a regular basis to see how you are doing. If you have symptoms, you should consider starting treatment, whatever your CD4+ count is.
After you start treatment, it is important to take your medicines exactly as directed by your doctor. When treatment doesn't work, it is often because HIV has become resistant to the medicine. This can happen if you don't take your medicines correctly. Ask your doctor if you have questions about your treatment.
Treatment has become much easier to follow over the past few years. New combination medicines include two or three different medicines in one pill. Many people with HIV get the treatment they need by taking just one or two pills a day.
To stay as healthy as possible during treatment:
Don't smoke. People with HIV are more likely to have a heart attack or get lung cancer.1, 2 Smoking can increase these risks even more.
Eat a healthy, balanced diet to keep your immune system strong.
Get regular exercise to reduce stress and improve the quality of your life.
Don't use illegal drugs, and limit your use of alcohol.
Learn all you can about HIV so you can take an active role in your treatment. Your doctor can help you understand HIV and how best to treat it. Also, consider joining an HIV support group. Support groups can be a great place to share information and emotions about HIV infection.
How can you prevent HIV?
HIV can be spread by people who don't know they are infected. To protect yourself and others:
Practice safe sex. Use a condom every time you have sex (including oral sex) until you are sure you and your partner are not infected with HIV.
Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you.
Talk to your partner before you have sex the first time. Find out if he or she is at risk for HIV. Get tested together and retested 6 months later. Use condoms in the meantime.
Don't drink a lot of alcohol or use illegal drugs before sex. You might let down your guard and not practice safe sex.
Don't share personal items, such as toothbrushes or razors.
Never share needles or syringes with anyone.
Sources: www.bchealthguide.org
HIV (human immunodeficiency virus) is a virus that attacks the immune system, the body’s natural defence system. Without a strong immune system, the body has trouble fighting off disease. Both the virus and the infection it causes are called HIV.
White blood cells are an important part of the immune system. HIV invades and destroys certain white blood cells called CD4+ cells. If too many CD4+ cells are destroyed, the body can no longer defend itself against infection.
The last stage of HIV infection is AIDS (acquired immunodeficiency syndrome). People with AIDS have a low number of CD4+ cells and get infections or cancers that rarely occur in healthy people. These can be deadly.
But having HIV does not mean you have AIDS. Even without treatment, it takes a long time for HIV to progress to AIDS—usually 10 to 12 years. If HIV is diagnosed before it becomes AIDS, medicines can slow or stop the damage to the immune system. With treatment, many people with HIV are able to live long and active lives.
What causes HIV?
HIV infection is caused by the human immunodeficiency virus. You can get HIV from contact with infected blood, semen, or vaginal fluids.
Most people get the virus by having unprotected sex with someone who has HIV.
Another common way of getting the virus is by sharing drug needles with someone who is infected with HIV.
The virus can also be passed from a mother to her baby during pregnancy, birth, or breast-feeding.
HIV doesn't survive well outside the body. So it cannot be spread by casual contact such as kissing or sharing drinking glasses with an infected person.
What are the symptoms?
HIV may not cause symptoms early on. People who do have symptoms may mistake them for the flu or mono. Common early symptoms include:
Fever.
Sore throat.
Headache.
Muscle aches and joint pain.
Swollen glands (swollen lymph nodes).
Skin rash.
Symptoms may appear from a few days to several weeks after a person is first infected. The early symptoms usually go away within 2 to 3 weeks.
After the early symptoms go away, an infected person may not have symptoms again for many years. But during this time, the virus continues to grow in the body and attack the immune system. After a certain point, symptoms reappear and then remain. These symptoms usually include:
Swollen lymph nodes.
Extreme tiredness.
Weight loss.
Fever.
Night sweats.
A doctor may suspect HIV if these symptoms last and no other cause can be found.
How is HIV diagnosed?
The only way to know for sure if you have HIV is to get a blood test. If you have been exposed to HIV, your immune system will make antibodies to try to destroy the virus. Blood tests can find these antibodies in your blood.
Most doctors use two blood tests, called the ELISA and the Western blot assay. If the first ELISA is positive (meaning that HIV antibodies are found), the blood sample is tested again. If the second test is positive, the doctor will do a Western blot to be sure.
It may take as long as 6 months for HIV antibodies to show up in a blood sample. If you think you have been exposed to HIV but you test negative for it:
Get tested again in 6 months to be sure you are not infected.
Meanwhile, take steps to prevent the spread of the virus. If you are infected, you can still pass HIV to another person during this time.
Some people are afraid to be tested for HIV. But if there is any chance you could be infected, it is very important to find out. HIV can be treated. Getting early treatment can slow down the virus and help you stay healthy.
You can get HIV testing in most doctors’ offices, public health units, hospitals, and clinics.
How is it treated?
The standard treatment for HIV is a combination of medicines called highly active antiretroviral therapy (HAART). Antiretroviral medicines slow the rate at which the virus multiplies. Taking these medicines can reduce the amount of virus in your body and help you stay healthy.
It may not be easy to decide the best time to start treatment. There are pros and cons to taking HAART before you have symptoms. Discuss these with your doctor so you understand your choices.
To find out how much damage HIV has done to your immune system, a doctor will do two tests:
CD4+ cell count, which shows how well your immune system is working.
Viral load, which shows the amount of virus in your blood.
If you have no symptoms and your CD4+ cell count is at a healthy level, you may not need treatment yet. Your doctor will repeat the tests on a regular basis to see how you are doing. If you have symptoms, you should consider starting treatment, whatever your CD4+ count is.
After you start treatment, it is important to take your medicines exactly as directed by your doctor. When treatment doesn't work, it is often because HIV has become resistant to the medicine. This can happen if you don't take your medicines correctly. Ask your doctor if you have questions about your treatment.
Treatment has become much easier to follow over the past few years. New combination medicines include two or three different medicines in one pill. Many people with HIV get the treatment they need by taking just one or two pills a day.
To stay as healthy as possible during treatment:
Don't smoke. People with HIV are more likely to have a heart attack or get lung cancer.1, 2 Smoking can increase these risks even more.
Eat a healthy, balanced diet to keep your immune system strong.
Get regular exercise to reduce stress and improve the quality of your life.
Don't use illegal drugs, and limit your use of alcohol.
Learn all you can about HIV so you can take an active role in your treatment. Your doctor can help you understand HIV and how best to treat it. Also, consider joining an HIV support group. Support groups can be a great place to share information and emotions about HIV infection.
How can you prevent HIV?
HIV can be spread by people who don't know they are infected. To protect yourself and others:
Practice safe sex. Use a condom every time you have sex (including oral sex) until you are sure you and your partner are not infected with HIV.
Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you.
Talk to your partner before you have sex the first time. Find out if he or she is at risk for HIV. Get tested together and retested 6 months later. Use condoms in the meantime.
Don't drink a lot of alcohol or use illegal drugs before sex. You might let down your guard and not practice safe sex.
Don't share personal items, such as toothbrushes or razors.
Never share needles or syringes with anyone.
Sources: www.bchealthguide.org
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