Management & Prevention Of Medical Conditions

Coronary Artery Disease

Coronary artery disease is atherosclerosis of the coronary arteries, producing blockages in the vessels which nourish the heart itself. Without adequate blood flow from the coronary arteries, the heart becomes starved of oxygen and vital nutrients it needs to work properly. Your coronary arteries are blood vessels on the heart. Before your teen years, fat can start to deposit in the blood vessel walls. As you get older, the fat builds up. This causes injury to your blood vessel walls. In an attempt to heal itself, the fatty tissues release chemicals that promote the process of healing but make the inner walls of the blood vessel sticky.

Then, other substances, such as inflammatory cells, proteins, and calcium that travel in your bloodstream start sticking to the inside of the vessel walls. The fat and other substances combine to form a material called plaque, which can narrow the flow of blood in the artery (atherosclerosis).

Some plaque is fragile, cracking or tearing, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots accumulate on the injured vessel wall. This causes the artery to narrow even more. Sometimes, the blood clot breaks apart by itself, and blood supply is restored. Over time, the inside of the arteries develop plaques of different sizes.

Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to the heart. However, during times of increased exertion or stress, the new arteries may not be able to supply enough oxygen-rich blood to the heart muscle, causing ischemia of the heart. Coronary artery disease can progress to a point where ischemia occurs even at rest.

In other cases, the blood clot may totally block the blood supply to the heart muscle, causing what is called an acute coronary syndrome.

Some people have symptoms that tell them that they may soon develop an acute coronary syndrome, others may have no symptoms until something happens, and still others have no symptoms of the acute coronary syndrome at all.

Ischemia of the heart can be compared to a cramp in the leg. When someone exercises for a very long time, the muscles in the legs cramp up because they’re starved for oxygen and nutrients. Your heart, also a muscle, needs oxygen and nutrients to keep working. If its blood supply is inadequate to meet the heart muscles needs, ischemia occurs, and you may feel chest pain or other symptoms.

The most common symptom is of coronary artery disease is angina, called or angina pectoris, or simply chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, numbness, fullness, squeezing or painful feeling. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw.

Other symptoms that can occur with coronary artery disease include: shortness of breath, palpitations, a faster heartbeat, weakness or dizziness, nausea and sweating.

Learn to recognize your heart disease symptoms and the situations that cause them. Call your doctor if you begin to have new symptoms or if they become more frequent or severe. If you or someone you are with experience chest discomfort, especially with one or more of the symptoms listed above, don’t wait longer than a few minutes (no more than 5) before calling 9-1-1 to get help.

If you have angina and have been prescribed nitroglycerin, call your doctor or have someone take you to the nearest emergency room if pain persists after taking two doses (taken at five-minute intervals) or after 15 minutes.

Emergency personnel may tell you to chew an aspirin to help break up a possible blood clot, if there is not a medical reason for you to avoid aspirin.

Pulmonary Embolism

Pulmonary embolism is the sudden blockage of a major blood vessel ( in the lung, usually by a blood clot. In most cases, the clots are small and are not deadly, but they can damage the lung. But if the clot is large and stops blood flow to the lung, it can be deadly. Quick treatment could save your life or reduce the risk of future problems.

The most common symptoms are: sudden shortness of breath, sharp chest pain that is worse when you cough or take a deep breath, a cough that brings up pink, foamy mucus. Pulmonary embolism can also cause more general symptoms. For example, you may feel anxious or on edge, sweat a lot, feel lightheaded or faint, or have a fast heart rate or palpitation.

In most cases, pulmonary embolism is caused by a blood clot in the leg that breaks loose and travels to the lungs. A blood clot in a vein close to the skin is not likely to cause problems. But having blood clots in deep veins (deep vein thrombosis) can lead to pulmonary embolism.

Other things can block an artery, such as tumors, air bubbles, amniotic fluid, or fat that is released into the blood vessels when a bone is broken. But these are rare.

Anything that makes you more likely to form blood clots increases your risk of pulmonary embolism. Some people are born with blood that clots too quickly. Other things that can increase your risk include:

• Being inactive for long periods. This can happen when you have to stay in bed after surgery or a serious illness, or when you sit for a long time on a flight or car trip.
• Recent surgery that involved the legs or belly.
• Some diseases, such as cancer, heart failure, stroke, or a severe infection.
• Pregnancy and childbirth (especially if you had a cesarian section).
• Taking birth control pills or hormone therapy.
• Smoking.

You are also at higher risk for blood clots if you are an older adult or extremely overweight.

It may be hard to diagnose pulmonary embolism, because the symptoms are like those of many other problems, such as a heart attack, a panic attack, or pneumonia. A doctor will start by doing a physical exam and asking questions about your past health and your symptoms.

Based on your risk, you might have tests to look for blood clots or rule out other causes of your symptoms. Common tests include blood tests, ultrasound, spiral CT scan, electrocardiogram (EKG, ECG), and MRI.

Doctors usually treat pulmonary embolism with medicines called anticoagulants. They are often called blood thinners, but they don’t really thin the blood. They help prevent new clots and keep existing clots from growing. Most people take anticoagulants for a few months. People at high risk for blood clots may need it for the rest of their lives.

If symptoms are severe and life-threatening, clot-busting drugs called thrombolytics may be used. These medicines can dissolve clots quickly, but they increase the risk of serious bleeding. Another option is surgery to remove the clot (embolectomy).

Some people can’t take blood thinners, or they form clots in spite of taking the medicine. To prevent future problems, they may have a filter put into the large vein (vena cava) that carries blood from the lower body to the heart. A vena cava filter helps keep blood clots from reaching the lungs.

If you have had pulmonary embolism once, you are more likely to have it again. Blood thinners can help reduce your risk, but they increase your risk of bleeding. If your doctor prescribes blood thinners, be sure you understand how to take your medicine safely, and see your doctor for regular blood tests.

Congestive Heart Failure

Heart failure does not mean the heart has stopped working. Rather, it means that the heart’s pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body’s needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming more stiff and thickened. This helps to keep the blood moving for a short while, but in time, the heart muscle walls weaken and are unable to pump as strongly. As a result, the kidneys often respond by causing the body to retain fluid (water) and sodium. If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

Heart failure is caused by many conditions that damage the heart muscle, including:

• Coronary artery disease. Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
• Heart attack. A heart attack may occur when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it. All or part of the heart muscle becomes cut off from its supply of oxygen. A heart attack can damage the heart muscle, resulting in a scarred area that does not function properly.
• Cardiomyopathy. Damage to the heart muscle. Causes include artery or blood flow problems, infections, and alcohol and drug abuse.
• Conditions that overwork the heart. Conditions including high blood pressure (hypertension), heart valve disease, thyroid disease, kidney disease, diabetes or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.

Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn’t contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the ventricle the main pumping chambe” does not relax properly, reducing the amount of blood that can enter the heart.

A test called the ejection fraction (EF) is used measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. The ejection fraction is a measure of the percentage of blood that your heart pumps out with each beat. Your doctor can discuss which condition you have.

In patients with systolic heart failure, the ejection fraction is less than 40%. Imaging studies such as X-ray and an echocardiogram (heart ultrasound) show the heart is enlarged and pumps out less than a normal amount of blood with each beat.

In contrast, patients with diastolic heart failure usually have a normal ejection fraction, normal heart pumping capability, but the imaging studies show that the heart does not fill up with blood properly during the heart relaxation phase that occurs between beats.

In 2001, the American Heart Association (AHA) and American College of Cardiology (ACC) developed the Stages of Heart Failure. These stages, which were updated in 2005, will help you understand that heart failure is often a progressive condition and can worsen over time. They will also help you understand why a new medication was added to your treatment plan and may help you understand why lifestyle changes and other treatments are needed.

The stages classified by the AHA and ACC are different than the New York Heart Association (NYHA) clinical classifications of heart failure that rank patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your doctor what stage of heart failure you are in.

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is often a mix of two diseases:

• Chronic bronchitis. In chronic bronchitis, the airways that carry air to the lungs inflamed and make a lot of mucus. This can narrow or block the airways, making it hard for you to breathe.
• Emphysema. In a healthy person, the tiny air sacs in the lungs are like balloons. As you breathe in and out, they get bigger and smaller to move air through your lungs. But with emphysema, these air sacs are damaged and lose their stretch. Less air gets in and out of the lungs, which makes you feel short of breath.

COPD gets worse over time. You can’t undo the damage to your lungs. But you can take steps to prevent more damage and to feel better.

COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs.

Other things that may put you at risk include breathing chemical fumes, dust, or air pollution over a long period of time. Second hand smoke is also bad.

It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.

You may be more likely to get COPD if you had a lot of serious lung infections when you were a child. People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 antitrypsin deficiency. But this is rare.

The main symptoms are: a long-lasting cough, shortness of breath that gets worse when you exercise.

As COPD gets worse, you may be short of breath even when you do simple things like get dressed or fix a meal. It gets harder to eat or exercise, and breathing takes much more energy. People often lose weight and get weaker.

The only way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.

Your doctor can prescribe treatments that may help you manage your symptoms and feel better.

• Medicines can help you breathe easier. Most of them are inhaled so they go straight to your lungs. If you get an inhaler, it is very important to use it just the way your doctor shows you.
• A lung (pulmonary) rehab program can help you learn to manage your disease. A team of health professionals can provide counseling and teach you how to breathe easier, exercise, and eat well.
• In time, you may need to use oxygen some or most of the time.

People who have COPD are more likely to get lung infections, so you will need to get a flu shot every year. You should also get a pneumonia shot. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably will not be as sick.