How to remove underarm stains
September 4th, 2010
If your problem is dark spots on your armpits, you can apply some of these homemade recipes looking for the most effective for you.
In general the results are seen after about three weeks of application and when you pluck hifratante then applied a cream and wait at least 24 hours to use one of these treatments.
Homemade recipes for removing stains in the armpits
Hydrogen Peroxide (hydrogen peroxide):
Apply every night from 10 volumes hydrogen peroxide on the stain and clean the skin well for 20 days, the morning boric acid cleaned and not use any deodorant by the end of treatment.
Bleaching powder and lime
Mix one tablespoon of powder to lighten hair with the juice of half lemon, to make a paste. Apply on armpits and let cook 5 minutes or until dry. Finally flush (clear) with warm water. Repeat every three days. As dust can cause irritation, try a lower dose.
Lemon to remove stains in the armpits
Daily put lemon juice with a cotton or lemon same areas darkened. Avoid the sun because you can get dirty once more.
Yogurt and oatmeal
Mix a tablespoon of yogurt and oatmeal. Apply to the affected areas and rub gently. After about 5 minutes to clean with water and cream.
Exfoliation
Exfoliate the area of the armpits is simple and effective. It is best done during the daily bath using a natural sponge and soap.
Can also be used exfoliating cream after bathing.
Enriched moisturizers
If the problem is pigmentation creams with active ingredients as strong as retinol, vitamin C and hydroquinone, are a good option.
Glycerin, Lemon and stained armpits oils
Mix in equal proportions a few drops of glycerin, a few drops of lemon juice and few drops of almond or olive oil. Apply it every day before bathing. If you over mix, you can save it in the refrigerator for the next day.
Cream cucumber stains
Make a mixture of 1 teaspoon of cucumber pulp or juice of cucumber, (you can do it in a blender or food processor). Add 2 drops of lemon juice, a pinch of turmeric (also curry or saffron or turmeric powder).
Apply the mixture for 10-20 minutes, once every three days.
Turmeric If you use leaves a yellow stain to remove it or milk unflavored yogurt.
Lemon and baking
Lemon juice applied directly to the armpit is a good home remedy. Is left to work at night for 15 days and may be alternated with bicarbonate.
Other options:
It also helps to remove stains in the armpits using creams or oils rich in vitamin E or a paste of rose water and sandalwood powder.
Some tips to avoid stains in the armpits:
If you expose the armpits to the sun use sunscreen.
Keep these parts of your body hydrated, apply a body cream every day and exfoliate regularly.
Make sure you are drinking enough water and daily multi-vitamins (especially E and K).
Choose preferably deodorant that are fragrance and alcohol.
How to make hair grow fast
September 4th, 2010
Make that hair can grow quickly if we have a healthy and nourished hair from the root. There are many very effective commercial products that use the same basic ingredients that are obtained with the preparation of old home remedies to grow hair.
Here is a list of recipes and household tips to make hair grow faster, you will choose the ones you want.
Olive Oil
Apply olive oil hair every week for thirty minutes and then wash it with warm water normal.
Aloe and honey to make hair grow faster
Remove the pulp to several leaves of aloe, mix with honey and applied to the scalp. Leave on for 20 minutes and wash normally.
Onions for healthy hair
Chop an onion and add it to shampoo. Let stand for two weeks and use the shampoo as normal. Not only accelerates hair growth but it gives you a shine.
Aloe and onion
Prepare a shampoo with aloe and small pieces of onion to wash the hair 2-3 times a week. To increase the effect use rosemary or avocado conditioner to moisturize the hair.
Power Breakfast
One tablespoon of soy lecithin, a tablespoon of wheat germ, one tablespoon of honey, a tablespoon of brewer’s yeast and yogurt. Mix all ingredients with the yogurt and add this recipe home to breakfast every day. In a week you will see how the hair grows very fast and full of strength.
Potato Water
When cooking potatoes, save the water used and the same day use it to rinse your hair.
Pills to make hair grow fast
Buying a box of pills of any brand or type. Take 10 to 15 pills of the box and put them in a plastic bag and gently pound them until they turn into a powder. Gather all the powder and add to the bottle of shampoo you normally use, mix well and let stand for at least a day. Now use that shampoo with the normal frequency.
Rosemary oil
In a bowl, put 1 / 2 cup olive oil and two tablespoons of dried rosemary. Heated in the microwave for 2 minutes. Let stand two or three days, strain and store. Use this preparation to become a massage the scalp after shampooing.
Tomato, Olive Oil and Aloe Vera for thick hair
Another remedy to grow hair using a liquid tomato with a drizzle of olive oil, warm it places throughout the root of the scalp and let it sit for as long as possible, if you add to this mix will result aloe even better.
The moon to make hair grow faster
Just cut the ends every month on the day of first quarter. The court will give strength to the hair and the effects of the moon on all the bodies will encourage growth in the next period.
Hair Nutrition
An egg, a drizzle of olive oil, honey two tablespoons. Apply to the scalp as you massage firmly. Cover the head with a towel for half an hour and wash normally.
Avoid hot water
Rinse hair with cold water or warm but not hot
Another homemade recipe for hair Onion
Chop half red onion, four garlic cloves and two cinnamon sticks. Boil in a pot for fifteen minutes and rinse your hair with this infusion for four days.
Cactus or aloe vera to nourish the hair deeply
Cut several leaves of cactus or aloe into pieces and leave them in water overnight to loosen the dribble. Use the result as a hair rinse, leaving it as long as possible.
Hair cream
Apply a moisturizing cream or gel to shape the hair instead of oil because of the day in the sun is activated by heat and leave the hair
Another home remedy Olive oil for hair growth
Take a teaspoon of olive oil with a glass of milk (to cut the oil taste)
Grape seed oil
Rub the scalp with grapeseed oil. Leave on for a while and then wash. Ideal for applying as a complement to other trick to make hair grow.
Rosemary Water
A daily rinse with rosemary water make hair grow faster.
Hypotension: Symptoms and Diagnosis, Prognosis and Treatment
August 31st, 2010
Low blood pressure (hypertension) blood pressure is too low to cause symptoms such as dizziness and fainting.
The maintenance of blood pressure when it leaves the heart and circulates throughout the body is as essential as maintaining water pressure in the pipes of a home. The pressure should be high enough to carry oxygen and nutrients to body cells and extract from them the products of waste. However, if blood pressure is too high, it can burst a blood vessel and cause bleeding in the brain (cerebral hemorrhage) or other problems.
Conversely, if too low, can not supply enough oxygen and nutrients to cells, or remove debris from them. However, healthy individuals with normal blood pressure, rather low at rest, have a higher life expectancy.
Clearing
There are three factors that determine blood pressure: the amount of blood pumped from the heart, blood volume in blood vessels and their capacity.
The more blood from the heart (cardiac ejection volume) per minute, the higher the blood pressure. The amount of blood pumped may decrease if the heart beats more slowly or your contractions are weak, such as after a heart attack (myocardial infarction). A very fast heartbeat, as well as many other types of arrhythmias, may reduce the heart’s pumping efficiency and volume of expulsion.
The more blood that contains the circulatory system, the higher the blood pressure. If blood is lost from dehydration or bleeding, blood volume decreases and, consequently, lowers blood pressure.
The lower the ability of blood vessels, the higher the blood pressure. Therefore, the widening (dilation) of blood vessels leads to a drop in blood pressure, when they contract, blood pressure increases.
Some sensors, particularly those found in the neck and chest, constantly monitor blood pressure. When they detect a change caused by the action of one of these three factors, the sensors turn result in a change in any of the other factors to compensate for such change and, thus, maintain steady pressure. The nerves conduct signals from these sensors and from the centers of the brain to several of the key bodies:
The heart, to modify the frequency and strength of the pulse (in this way changes the amount of blood pumped).
Kidneys to regulate water excretion (and therefore to adjust the volume of blood in circulation).
Blood vessels to contract or dilate (ie, changing their capacity).
Therefore, if the blood vessels dilate and reduces blood pressure, immediately sensors send signals through the brain to the heart for it to increase the frequency of its pulsations, which will increase the removal of blood. Consequently, blood pressure, suffer little or no change. However, these compensatory mechanisms have limitations. For example, in case of bleeding, heart rate increases, increases the expulsion of blood and blood vessels constrict and reduce their capacity. However, if you lose a lot of blood quickly, clearing mechanisms are insufficient, and blood pressure decreases. If the bleeding stops, the rest of the body fluid tends to enter the bloodstream, it recovers the volume and the pressure rises. Finally, we produce new cells and blood volume is completely restored. Also, a blood transfusion can restore blood volume rapidly.
Hypotension can also be the result of a malfunction in the mechanisms that maintain blood pressure. For example, if a disruption in the ability of nerves to conduct signals, the control mechanisms of compensation may not work correctly.
Fainting
Fainting (syncope) is a sudden and brief loss of consciousness.
It is a symptom due to an inadequate supply of oxygen and other nutrients to the brain, usually caused by a temporary decrease in blood flow. This decrease can occur if the body can not quickly compensate for a sudden drop in blood pressure. For example, if a patient has an abnormal heartbeat, the heart may be unable to sufficiently increase the volume of blood removal to compensate for reduced blood pressure. These people have no symptoms at rest, but, instead, suffer fainting when they make some effort because the body’s oxygen demand increases abruptly is called syncope effort. Often, fainting occurs after making an effort because the heart is barely able to maintain adequate blood pressure during exercise, when exercise is stopped, the heart rate begins to decrease, but the blood vessels of the muscles remain dilated to remove metabolic waste products. The combination of reduced heart stroke volume with the increase in the capacity of the blood vessels causes the blood pressure falls and the person faints.
Obviously, blood volume decreases in case of bleeding. But this also happens when the person is dehydrated by situations such as diarrhea, excessive urination, excessive sweating, which often occurs in untreated diabetes or Addison’s disease.
Fainting can also occur when compensatory mechanisms are interfered with by signals sent through the nerves from other parts of the body. For example, an intestinal cramping can send a signal to the heart via the vagus nerve, which slows the heart rate enough to cause fainting. This type of fainting is called vasovagal syncope, or vasomotor. Many other signals (such as other pain, fear and the sight of blood) can cause this type of fainting.
Fainting motivated by coughing (cough syncope) or urination (micturition syncope) usually occurs when the amount of blood returning to the heart decreases during exercise. Micturition syncope is particularly common in the elderly. Syncope during swallowing can occur in people with diseases of the esophagus.
The cause of fainting can also be a decrease in the number of red blood cells (anemia), a decrease in the concentration of blood sugar (hypoglycemia) or a decrease in levels of carbon dioxide in the blood (hypocapnia) by breathing fast (hyperventilating). Sometimes, anxiety is accompanied by hyperventilation. When the concentration of carbon dioxide decreases, the brain’s blood vessels constrict and you may receive a feeling of faintness without reaching to lose consciousness. The weightlifter syncope is the result of hyperventilation before exercise.
In rare cases, especially in the elderly, fainting can be part of a mild stroke in which blood flow to a part of the brain decreases abruptly.
Symptoms
When the person is standing, prior to fainting, you may notice slight dizziness. When dropped, blood pressure rises in part because the person is lying and often, because the cause of syncope is over. Getting up too quickly can cause a new fainting.
When the cause is an arrhythmia, fainting appears and disappears suddenly. Sometimes they experience palpitations (awareness of heartbeat) just before fainting.
Orthostatic syncope occurs when a person sits or stands too quickly. A similar form of fainting, called syncope “military parades,” occurs when a person stands still for a long time on a hot day. As in this situation, the leg muscles are not being used, do not push blood to the heart and, consequently, it stagnates in the veins of the legs and the blood pressure drops repentinamente.El vasovagal syncope occurs when a person sitting or standing and is often preceded by nausea, weakness, yawning, blurred vision and sweating. Extreme pallor is observed, the pulse becomes very slow and the person faints.
Fainting begins gradually, which is preceded by warning symptoms which gradually disappears, suggests changes in blood chemicals, such as a decrease in the concentration of sugar (hypoglycemia) or the rate of carbon dioxide (hypocapnia ) caused by hyperventilation. Hypocapnia often preceded by a tingling sensation and discomfort in the chest.
Hysterical fainting is not a true syncope. The person only appears to be unconscious, but no abnormalities in heart rate or blood pressure and does not sweat or become pale.
Diagnosis
First, it is necessary to determine the underlying cause of fainting because some causes are more serious than others. Heart disease, such as abnormal heart rhythms or aortic stenosis, can be deadly; other disorders are much less worrisome.
The factors that facilitate the diagnosis are the age of onset of episodes of fainting, the circumstances in which they occur, the warning signs before the episode and maneuvers that help the person recover (like lying down, holding your breath or drink orange juice). The descriptions that bring the witnesses about the episode can be helpful. The doctor also needs to know if you have any other medical condition or taking any drugs, whether prescription or not.
You can play a fainting episode in safe conditions, for example, telling the patient to breathe quickly and deeply. Or, while monitoring the heartbeat with an electrocardiogram (ECG), the doctor may press gently on the carotid sinus (a part of the internal carotid artery that contains sensors that monitor blood pressure).
An electrocardiogram may indicate an underlying heart or lung disease. To find the cause of syncope, uses a Holter monitor, a small device that records heart rhythms for 24 hours while the patient performs normal daily activities. If the arrhythmia coincides with an episode of fainting, it is likely (but not certain) to be the cause.
Other tests such as echocardiography (a technique that produces images using ultrasound), can reveal structural or functional cardiac abnormalities. In addition, blood tests can detect a low concentration of blood sugar (hypoglycemia) or too few red blood cells (anemia). To diagnose epilepsy (which is sometimes confused with fainting), can be an electroencephalogram, a test that shows patterns of electrical brain waves.
Treatment
Usually, the fact is enough to lie to regain consciousness. The elevation of the legs can speed recovery by increasing blood flow to the heart and brain. If you stand up too quickly or is held or carried in an upright position, there may be another episode of fainting.
In young people who do not have heart disease, fainting spells are generally not serious and requires no extensive diagnostic tests or treatment. However, in the elderly, syncope can be caused by several interrelated problems that prevent the heart and blood vessels react to a decrease in blood pressure.
Treatment depends on the cause.
To correct a heart beat too slow, a pacemaker can be implanted surgically, which consists of an electronic device that stimulates the heartbeat. To slow a heart rate too fast can be used drugs. If the problem is an abnormal rhythm (the heart beats irregularly from time to time), may be appealed to the implantation of a defibrillator. You can also treat other causes of fainting (such as hypoglycemia, anemia or low blood volume). Surgical intervention should be considered when syncope is due to valvular disease, irrespective of the age of the person.
Orthostatic Hypotension
Orthostatic hypotension is an excessive reduction of blood pressure by adopting the upright position, causing a decrease in cerebral blood flow and subsequent fainting.
Orthostatic hypotension is not a specific disease, but rather an inability to regulate blood pressure quickly. May be due to various causes.
When a person stands up suddenly, gravity causes a portion of the blood from pooling in the veins of the legs and lower body. The accumulation reduces the amount of blood returning to the heart and therefore the amount pumped. The result is a decrease in blood pressure. In this situation, the body responds quickly: the heart beats faster, the contractions are stronger, the blood vessels constrict and reduce its capacity. When these compensatory responses fail or are slow, orthostatic hypotension occurs.
Episodes of orthostatic hypotension usually occur due to side effects of drugs, especially those that are given to combat cardiovascular problems, especially in the elderly. For example, diuretics, especially strong in high doses, can reduce blood volume due to fluid removed from the body and therefore lower blood pressure. Drugs that dilate blood vessels (such as nitrates, calcium antagonists and inhibitors of angiotensin converting) increase the ability of the vessels and therefore also lower blood pressure. Bleeding or excessive fluid loss from vomiting, diarrhea, excessive sweating, untreated diabetes or Addison’s disease may cause a reduction of circulating blood volume. Arterial sensors that trigger compensatory responses are sometimes impaired by the action of certain drugs such as barbiturates, alcohol and drugs used to treat hypertension and depression. Diseases that damage the nerves that regulate the diameter of blood vessels can also cause orthostatic hypotension. These lesions are a common complication of diabetes, amyloidosis and spinal cord injuries.
Symptoms and Diagnosis
People with orthostatic hypotension usually experienced fainting, light dizziness, confusion or blurred vision when they get up from bed or incorporated abruptly after having been sitting a long time. Fatigue, exercise, alcohol or a heavy meal may exacerbate symptoms. A sharp reduction of blood flow to the brain can cause fainting or even seizures.
When these symptoms, your doctor can diagnose orthostatic hypotension. The diagnosis can be confirmed if blood pressure drops significantly when the patient gets up and returns to normal when lying down. The doctor must then try to determine the cause of orthostatic hypotension.
Prognosis and Treatment
A diabetic with hypertension have a worse prognosis if they also suffer from orthostatic hypotension. When the cause of orthostatic hypotension is a decrease in blood volume, a particular drug or a certain dose of a medication, the disorder can be corrected rápidamente.Cuando there is no treatment for the cause of orthostatic hypotension, it is often possible eliminate or reduce symptoms. People prone to this condition should not be moved or stand up suddenly or stand still for a long time. If hypotension is caused by an accumulation of blood in the legs, elastic compression stockings may be helpful. When orthostatic hypotension is the result of prolonged bed rest, it is possible to improve the situation if it gradually increases the time spent sitting.
To avoid a decrease in blood pressure can be administered ephedrine or phenylephrine. The blood volume can also be increased by increasing the intake of salt and, if necessary, ingesting hormones that cause the withholding of it, such as fludrocortisone. In people without heart failure or hypertension, is recommended to add salt to their meals free or taking salt tablets. Elderly patients with orthostatic hypotension should drink plenty of fluids and little or no alcohol. However, due to retention of salt and fluids, a person can increase rapidly from one to two kilograms in weight and developing heart failure because of the high-salt diet, especially the elderly. If these measures are not effective, other drugs (such as propranolol, dihydroergotamine, indomethacin and metoclopramide) may help prevent orthostatic hypotension, although at the expense of a high risk of side effects.
Pericardial Disease – Acute pericarditis, Chronic Pericarditis: Causes, Symptoms and Diagnosis, Treatment
August 31st, 2010
The pericardium is a double layer bag, flexible and extensible, which envelops the heart. Between the two layers contains a lubricating fluid that allows them to easily slide over one another. The pericardium holds the heart in place, prevents blood from getting too full and protects it from infection. However, the pericardium is not essential to keep alive the body, when removed, produces no substantial change in the heart’s performance.
In rare cases, you may be born without the pericardium or to submit any weak areas or holes. These defects may be dangerous because the heart or major blood vessel may bulge (hernia) through a hole in the pericardium and become trapped and clogged, which can cause death in minutes. Therefore, these defects are usually repaired by surgery, if the repair is not possible, remove the entire pericardium. Aside from birth defects, diseases of the pericardium may result from infections, injuries and tumors that have spread.
Acute pericarditis
Acute pericarditis is a sudden inflammation of the pericardium is often painful and causes the leakage of fluid and blood products such as fibrin, red blood cells and white cells in the pericardial space.
Acute pericarditis occurs by various causes, from viral infections (which can cause pain but are usually short-lived and leave no sequel) to a life-threatening cancer. Other causes include AIDS, myocardial infarction, heart surgery, lupus erythematosus, rheumatoid arthritis, renal failure, injury, radiation and leakage of blood from an aortic aneurysm (dilation of the aorta in pouch). Acute pericarditis can also occur as a side effect caused by certain drugs such as anticoagulants, penicillin, procainamide, phenytoin and phenylbutazone.
Symptoms and Diagnosis
Generally, acute pericarditis causes fever and chest pain that usually extends to the left shoulder and sometimes down to the left arm. This pain can be similar to a heart attack, but tends to worsen when lying down, coughing or breathing deeply. Pericarditis can cause cardiac tamponade, a life-threatening condition.
The diagnosis of acute pericarditis is made from the description of pain and auscultation with a stethoscope placed over the patient’s chest. Pericarditis produces a popping sound similar to the crunch of leather of a shoe. A chest radiograph and an echocardiogram (a test that uses sound waves to create an image of the heart) can show the presence of fluid in the pericardium. The echocardiogram can also reveal the underlying cause (eg, a tumor), and to show the pressure of the pericardial fluid on the right heart chambers, high pressure is a possible warning sign that there is a cardiac tamponade. On the other hand, the blood test can detect some cases of pericarditis (eg, leukemia, AIDS, infections, rheumatic fever and elevated levels of urea as a result of kidney failure).
Prognosis and Treatment
The prognosis depends on the cause of the disease. When pericarditis is caused by a virus or when the cause is unknown, the recovery was achieved between 1 and 3 weeks. Complications delayed recovery or recurrence. If it is a cancer that has invaded the pericardium, survival rarely exceeds 12 to 18 months.
Generally, people with pericarditis should be hospitalized, receive drugs that reduce inflammation and pain (such as aspirin or ibuprofen) is to check the possible occurrence of complications (especially cardiac tamponade). If intense pain are administered opiates (morphine) or a corticosteroid. The drug most commonly used in case of severe pain is prednisone.
Further treatment of acute pericarditis depends on the underlying cause that has provoked. Cancer patients may respond to chemotherapy (anticancer drug) or radiation therapy, but often must be surgical removal of the pericardium. Patients treated with dialysis for kidney failure, tend to respond when changes are made in dialysis programs. Bacterial infections are treated with antibiotics and pericardial pus drained surgically. Moreover, whenever possible, suspending the administration of drugs that can cause pericarditis.
When there are repeated episodes of pericarditis, a viral infection, injury or unknown cause, is indicated aspirin, ibuprofen or corticosteroids. In some cases, colchicine is effective. If drug treatment is not effective, the pericardium is removed surgically.
Chronic Pericarditis
Chronic pericarditis is an inflammation that results from an accumulation of fluid or thickening of the pericardium, which begins gradually and persists for a long time.
In a chronic pericarditis with effusion, is a slow accumulation of fluid in the pericardium. Usually the cause is unknown, but the disease can be caused by cancer, tuberculosis or an underactive thyroid. When the cause is known, should be treated, if cardiac function is normal, the doctor may take an expectant attitude, ie observation.
Chronic constrictive pericarditis is a rare disease that occurs when fibrous tissue develops (similar to a scar) around the heart. Fibrous tissue gradually shrinks, compresses the heart and reduces its size. This compression increases the pressure in the veins that carry blood to the heart because more pressure is needed to fill it. The liquid-tight, leak out and accumulate under the skin in the abdomen and sometimes in the space around the lungs.
Causes
Any condition that causes acute pericarditis can lead to chronic constrictive pericarditis, but usually the cause is unknown. The most common causes are viral infections and those caused by radiation therapy for breast cancer or lymphoma. Chronic constrictive pericarditis may also result from rheumatoid arthritis, lupus erythematosus, prior injury, heart surgery or a bacterial infection. In Africa and India tuberculosis is the most common cause of pericarditis in any form, while it is rare in developed countries.
Symptoms and Diagnosis
The symptoms of chronic pericarditis are dyspnea, cough (because the high pressure in the veins of the leaves causes lung fluid into the air sacs) and fatigue (because the heart reaches prove inadequate). On the other hand, the condition itself is painless. Also often the accumulation of fluid in the abdomen and legs.
The symptoms are key to making the diagnosis of chronic pericarditis, especially if no other reason to explain the reduction in cardiac output (such as hypertension, a coronary artery disease or valve disease). In chronic constrictive pericarditis, the heart is not big on a chest radiograph, whereas in most other heart conditions it was observed an increase in size. About half of cases of chronic constrictive pericarditis seen in chest radiographs, calcium deposits in the pericardium.
Two types of procedures confirm the diagnosis. Cardiac catheterization can be used to measure blood pressure in the chambers and major blood vessels. Furthermore, to determine the thickness of the pericardium, can be used magnetic resonance imaging (MRI) or computed tomography (CT). Normally, the pericardium has a thickness less than 30 millimeters, but in chronic constrictive pericarditis becomes twice or more.
Treatment
Although diuretics (drugs that remove excess fluid) can improve symptoms, the only treatment is surgical removal of the pericardium. Surgery is curative in about 85 percent of cases. However, since the mortality from this operation is 5 to 15 percent, most patients do not operate unless the disease substantially interferes with daily activities.
Endocarditis Heart Disease: Prevention and treatment, Diagnosis, Diagnosis, Causes
August 31st, 2010
Endocarditis is an inflammation of the smooth inner lining of the heart (endocardium), almost always by a bacterial infection.
Infective endocarditis
Infective endocarditis is an infection of the endocardium and heart valves.
Bacteria (or, less commonly, fungi) that enter the bloodstream or rarely contaminate the heart during open heart surgery, they can lodge in the valves of the heart and infect the lining. Abnormal or damaged valves are more prone to infection, but the normal can be infected by some bacteria aggressive, especially when they come in large quantities. The buildup of bacteria and blood clots in the valves (so-called vegetations) can break off and reach vital organs, where they can block the flow of arterial blood. These blockages are very serious and can cause stroke, myocardial infarction, infection and injury to the area are located.
Infective endocarditis can appear suddenly and become fatal within a few days (acute infective endocarditis), or it may develop gradually and almost inapparent over weeks or several months (subacute infective endocarditis).
Causes
Although the blood normally no bacteria, a wound in the skin, inside the mouth or gums (including a wound caused by normal activity such as chewing or brushing teeth) allows a small amount of bacteria entering the bloodstream.
Gingivitis (infection and inflammation of the gums), small skin infections and infections anywhere in the body, allowing the bacteria enter the bloodstream, increasing the risk of endocarditis.
Certain surgical procedures, dental and doctors may also introduce bacteria into the bloodstream, for example, the use of intravenous catheters to administer fluids, nutrients or drugs, a cystoscopy (insertion of a tube to see inside the bladder) or colonoscopy (inserting a tube to look inside the large intestine).
In people with normal heart valves, there is not any damage and white blood cells destroy bacteria. Damaged valves, however, can trap bacteria, which are housed in the endocardium and begin to multiply. Sometimes, during the change of a heart valve with an artificial (prosthetic) can introduce bacteria, which are often resistant to antibiotics. Patients with a birth defect or an abnormality that allows blood to move from side to side of the heart (for example, from one ventricle to the other) also have a higher risk of developing endocarditis.
The presence of certain bacteria in the blood (bacteremia) may not cause immediate symptoms, but it is possible that results in septicemia, ie, a serious blood infection that usually causes fever, chills, tremors, and decreased blood pressure . A person with sepsis has a high risk of developing endocarditis.
The bacteria that cause acute bacterial endocarditis are sometimes aggressive enough to infect normal heart valves, those that cause subacute bacterial endocarditis almost always infect the abnormal valves or injured. It has been shown that the cases of endocarditis usually occurs in people with congenital defects of the heart chambers and valves, in people with artificial valves and valves in older people injured by childhood rheumatic fever or abnormalities of the valve due to age. Those who inject drugs have a high risk of endocarditis because bacteria often are injected directly into the bloodstream through needles, syringes or contaminated drug solutions.
In drug addicts and people who develop endocarditis by prolonged use of a catheter, the inlet valve to the right ventricle (tricuspid valve) is the most often infected. In the other cases of endocarditis, those who become infected are the inlet valve into the left ventricle (mitral valve) or the outlet valve of the ventricle (aortic valve).
In a person with an artificial valve, the risk of infective endocarditis is greatest during the first year after the replacement, after this period, the risk decreases but remains higher than normal. For unknown reasons, the risk is always greater with a valve with an artificial aortic and mitral mechanical valve than with a porcine valve.
Symptoms
Acute bacterial endocarditis usually begins suddenly with high fever (39-40 ° C), rapid heart rate, fatigue, and rapid and extensive lesions of the valves. Fragments of the vegetations arising (emboli) can reach other areas and spread the infection. You can develop pus (abscess) at the base of the infected valve or where it is impacting the pistons.
The valves can be drilled and within days there can be wide leakage of blood through them. In some cases there is shock and kidney and other organs stop functioning (a condition called sepsis syndrome). Finally, arterial infections weaken the walls of blood vessels and cause their destruction. This can be fatal, especially if it occurs in the brain or near the heart.
Subacute bacterial endocarditis can produce symptoms for months before the valve lesions or stroke can deliver a clear diagnosis.
Symptoms include fatigue, mild fever (37.5 ° C to 38.5 ° C), weight loss, sweating and decreased number of red blood cells (anemia). Endocarditis is suspected in a person with fever without clear evidence of infection, if you have a heart murmur or if a breath has changed existing features. You can feel an enlarged spleen. On the skin may appear very small spots that seem tiny freckles, it is also possible to see the white of the eye or under the fingernails of the hand. These spots are areas of tiny blood spills caused by small emboli that have been shed from the heart valves.
Larger emboli can cause stomach pain, sudden blockage of an artery in an arm or leg, heart attack or stroke.
Other symptoms of acute and subacute bacterial endocarditis are chills, joint pain, paleness, rapid heartbeat, painful subcutaneous nodules, confusion and blood in the urine.
The artificial valve endocarditis may be acute or subacute. Compared to a natural valve infection is more likely that infection of an artificial valve from spreading to the heart muscle at the base of the valve and it falls off. In this case, it is necessary to perform emergency surgery to replace the valve because of heart failure due to leakage of blood through the valve can be fatal. On the other hand, it is possible to interrupt the electrical conduction system of the heart, causing a decrease in the frequency of the heartbeat, which could cause a sudden loss of consciousness or even death.
Diagnosis
In suspected acute bacterial endocarditis, the patient should be hospitalized for diagnosis and treatment. Because the symptoms of subacute bacterial endocarditis are at first vague, the infection can damage heart valves and spread to other places before being diagnosed. Subacute endocarditis is not treated as dangerous as acute.
The diagnosis can be suspected from the symptoms, especially when they appear in someone with a predisposition to the disease. The echocardiogram, which is based on the reflection of ultrasound to create images of the heart, you can identify vegetations on the valves and injuries. To identify the bacteria causing the disease, blood samples are removed to make a crop. Since the release of bacteria into the blood in sufficient quantity to be identified only happens intermittently, taken three or more blood samples at different times to increase the likelihood that at least one of them contains enough bacteria to grow in the cultures in the laboratory. In the same laboratory process, tested several antibiotics to choose the most effective against specific bacteria.
Sometimes, it is not possible to isolate any germ from a blood sample.
The reason may be that special techniques are needed to grow certain bacteria or that the patient had previously received antibiotics that did not heal the infection but reduced the amount of bacteria enough to hide their presence. There is still another possibility, namely that no case of endocarditis, but from some other disease with similar symptoms, such as a tumor.
Prevention and treatment
Patients with abnormalities of the heart valves with artificial valves or congenital defects, are given antibiotics as a preventive measure before dental or surgical procedures. Therefore, dentists and surgeons need to know whether a person has had a valve problem.
Although the risk of outbreaks of endocarditis is not very high in the course of a surgical procedure and preventive antibiotics given are not always effective, the consequences are so severe that, generally, the physician recommends the administration of antibiotics, such as caution before applying these procedures.
Treatment almost always requires hospital admission because the administration of high doses of intravenous antibiotics should be at least two weeks. Antibiotics alone do not always cure an infection in an artificial valve. Therefore, sometimes necessitating heart surgery to repair or replace damaged valves and removing vegetation.
Non-infective endocarditis
The non-infective endocarditis is a disease characterized by the formation of blood clots in damaged valves.
The risk of this disease increases in people with systemic lupus erythematosus (an immune system disease), lung cancer, stomach or pancreas, tuberculosis, pneumonia, bone infection or diseases that cause severe weight loss. Like in infective endocarditis, heart valves may leak blood or open incorrectly. There is a high risk of emboli cause a stroke or a myocardial infarction. Although sometimes given drugs to prevent formation of thrombi, studies have not yet confirmed that this is really beneficial.
Heart Tumors: Myxomas and Other Primary Tumors
August 31st, 2010
A tumor is any abnormal growth, cancerous (malignant) or noncancerous (benign). Tumors that originate in the heart are called primary tumors and develop in any tissue. Secondary tumors are those originating elsewhere in the body (such as lung, breast, blood or skin) and then spread (metastasize) to the heart, these are always cancerous. Secondary tumors are between 30 and 40 times more common than primary.
Cardiac tumors may not cause symptoms or cause a malfunction of the heart, similar to other diseases caused by it. Examples of malfunction can be a sudden heart failure, the onset of arrhythmias and sudden drop in blood pressure by bleeding in the pericardium (the membrane that surrounds the heart). Cardiac tumors are difficult to diagnose because its symptoms are common and resemble those of many other diseases. To make the diagnosis, it is necessary that the doctor suspected tumor for some reason. For example, if a person has cancer anywhere in the body but have symptoms of malfunction of the heart, the doctor may suspect the existence of a cardiac tumor.
Myxomas
A myxoma is a noncancerous tumor, usually irregularly shaped and gelatinous consistency.
Half of all primary tumors are myxomas. Three fourths of myxomas are located in the left atrium, the chamber of the heart that receives blood with high oxygen content of the lungs.
In general, the left atrial myxomas have a stem (are pedunculated) and can move freely due to blood flow, like a “balloon” attached. When moving, do it to one side in the vicinity of the mitral valve (which is the passage of the left atrium to left ventricle). This movement can block and unblock the valve intermittently, so that the blood stops its step and also continues intermittently. When the patient is standing, it may cause fainting or episodes of pulmonary congestion and dyspnea, as the force of gravity pushes the tumor into the opening of the valve and may even cover it, on the contrary, when lying occurs symptom relief.
The tumor can damage the mitral valve so that blood to escape through it and produce a heart murmur that is heard with a stethoscope. From the sound of the breath, the physician should consider the effect of leakage of blood from injuries caused by a tumor (which is very rare) or is a common cause, such as rheumatic heart disease .
When off Myxoma fragments or blood clots that form on the surface, they can travel to other organs and block blood vessels. Symptoms depend on what the blocked vessel. For example, a blocked artery in the brain can cause a paralytic stroke, whereas if the blockage is in the lung, cause pain and coughing up blood. Other symptoms of myxomas include fever, weight loss, fingers and feet cold and painful when exposed to cold (Raynaud’s phenomenon), anemia, low platelet count (because they are involved in the clotting process) and symptoms that suggest a serious infection.
Other primary tumors
Other less common tumors of the heart, such as fibromas and rhabdomyomas, grow directly from fibrous tissue cells and muscle. Rhabdomyomas, the second type of primary tumor more importantly, develop in childhood and are associated with a rare disease of this age called tuberous sclerosis. Other primary cardiac tumors, such as cancerous primary tumors, are rare and there is no good treatment for them. Life expectancy for children with these disorders is less than a year.
To diagnose cardiac tumors are used by many tests. Sometimes, the echocardiogram (an ultrasound test that allows delineation of structures) can show an image of the contour of the tumors. The technique uses ultrasound can pass through the chest wall or the esophagus from the inside of it (TEE). Another procedure is the introduction by vein to the heart catheter to inject contrast agents that enable you to draw the tumor on radiographs, but is seldom necessary to resort to this procedure. They are also used computed tomography (CT) and magnetic resonance imaging (MRI). If a tumor is found, removes a small sample with a special catheter, the sample is used to identify the type of tumor and help select the most appropriate treatment.
Surgical removal of a single primary tumor is not cancerous heart is a curative treatment. When there are multiple primary tumors are treated only those who are so great that can not be extracted. The primary and secondary cancers are incurable, only treat their symptoms.
Valvular Heart Disease: Symptoms, Diagnosis and Treatment
August 31st, 2010
The heart has four chambers: two atria or upper small and two large lower chambers or ventricles. Each ventricle has an inlet valve and one outlet through which blood can flow only in one direction. The tricuspid valve opens from the right atrium into the right ventricle and the lung from the right ventricle into the pulmonary arteries. The mitral valve opens from the left atrium into the left ventricle while the aorta is opened from the left ventricle into the aorta.
The malfunction of the heart valves may be due to blood escaping them (valvular regurgitation) or that do not open properly (stenosis). Each disorder can severely disrupt the heart’s pumping ability. Sometimes, a single valve can have both problems.
Mitral valve insufficiency
The mitral valve insufficiency (mitral incompetence) is the backflow of blood through the mitral valve, which does not close properly every time the left ventricle contracts.
When the left ventricle pumps blood from the heart to within the aorta, some blood back into the left atrium, thereby increasing the volume and pressure in this cavity. This situation increases the pressure in the vessels that carry blood from the lungs to the heart and, consequently, fluid (congestion) in the lungs.
Years ago, rheumatic fever used to be the most common cause of mitral regurgitation. But now, rheumatic fever is rare in countries where it has developed a good preventive medicine. For example, in those countries, the use of antibiotics to treat strep throat prevents the disease appears, so currently only rheumatic fever is a common cause of mitral regurgitation in the elderly who could not benefit from appropriate antibiotics during their youth. However, in countries that do not have a sufficiently developed preventive medicine, rheumatic fever is still prevalent and, therefore, is a common cause of mitral regurgitation.
In many developed countries, for example, one of the most common causes of mitral regurgitation is myocardial infarction, which can cause serious injury to the supporting structures of the valve. Another common cause is myxomatous degeneration, a condition in which the valve will gradually weaken until they become too soft.
Symptoms
Moderate mitral regurgitation may be asymptomatic. The disorder can be identified only if the doctor, listening with a stethoscope, you hear a characteristic heart murmur caused by the backflow of blood into the left atrium when the left ventricle contracts.
Because the left ventricle must pump more blood to compensate for the backflow into the left atrium, it expands gradually to increase the strength of each heartbeat. The enlarged ventricle can cause palpitations (awareness of one’s own strong heartbeat), especially when the person is lying on the left side.
The left atrium also tends to expand to accommodate the backflow from the ventricle. A very dilated right atrium often beats rapidly in a disorganized and irregular (atrial fibrillation), which reduces pumping efficiency. In fact, an atrial fibrillation that is not pumping, only shudders, and the lack of proper blood flow causes the formation of blood clots. If a clot breaks can block a smaller artery and cause a stroke or other injury.
Severe mitral regurgitation reduces blood flow to the aorta so as to cause heart failure and, therefore, cough, dyspnea on exertion and swelling in the legs.
Diagnosis
Mitral regurgitation is usually identified by the presence of a distinctive murmur (a sound that is heard with a stethoscope when the left ventricle contracts.)
An electrocardiogram (ECG) and chest radiograph showed left ventricular dilation. The test that provides more information is the echocardiogram, an imaging technique using ultrasound to visualize the defective valve and determine the seriousness of the problem.
Treatment
When the failure is severe, the valve needs to be repaired or replaced before the disorder of the left ventricle can no longer be corrected. It can perform surgery to repair the valve (valvuloplasty) or to replace it with a mechanical or a partially made with a pig valve. The repair of the valve eliminates regurgitation or lowered enough that their symptoms become tolerable and to prevent cardiac injury. Each valve replacement method has its advantages and disadvantages. Although mechanical valves are usually effective, increase the risk of blood clots, so anti-clotting drugs are administered indefinitely to reduce this risk. Valves made in part with pig valves work well and have no risk of causing blood clots, but instead its duration is less. When a replacement valve is defective, it must be replaced immediately.
Atrial fibrillation may also require treatment. Drugs such as beta blockers, digoxin and verapamil slow the heart rate and help control the fibrillation.
The surfaces of the damaged heart valves are prone to serious infections (infectious endocarditis). Anyone with an artificial valve or damaged should take antibiotics before dental or surgical procedure to prevent infection.
Mitral Valve Prolapse
In mitral valve prolapse occurs protrusion of the valve leaflets into the left atrium during ventricular contraction, which may cause reflux (regurgitation) of small amounts of blood into the atrium.
From 2 to 5 percent of the general population has mitral valve prolapse, although this usually does not cause serious heart problems.
Symptoms and Diagnosis
Most people with mitral valve prolapse have no symptoms. Others do have (although they are difficult to explain based only on the mechanical problem), such as chest pain, palpitations, migraine, fatigue and dizziness. In some cases, blood pressure drops below the normal level by joining, in others it may appear slightly irregular heartbeats that cause palpitations (a subjective perception of the heartbeat).
The condition is diagnosed after listening to a typical sound (click) through the stethoscope. Regurgitation is confirmed if during ventricular contraction is heard a murmur. An echocardiogram, an imaging technique using ultrasound, looks prolapse and the severity of heart failure.
Treatment
Most people with mitral valve prolapse do not require treatment. If the heart beats too fast, given a beta blocker to slow the heart rate and reduce the palpitations and other symptoms.
If there is regurgitation, the person should take antibiotics before undergoing dental or surgical procedures because of the risk that bacteria released during such procedures infect the heart valve.
Mitral valve stenosis
The mitral valve stenosis is a narrowing of the mitral valve opening that increases resistance to current flow of blood from the left atrium to left ventricle.
Mitral stenosis is almost always the result of rheumatic fever. In countries with health and care services capable of maintaining adequate preventive measures, mitral stenosis is rare today, except for seniors who suffered rheumatic fever during childhood. In countries with inadequate healthcare infrastructure, rheumatic fever is common and causes stenosis in adults, teenagers and sometimes in children. When rheumatic fever is the cause of mitral valve stenosis, the thin blades (leaflets) that make up the valve is partially fused.
Mitral stenosis can also be congenital. Children born with this disorder rarely live more than two years, unless surgery is practiced. A myxoma (a benign tumor that appears in the left atrium) or a clot can block blood flow in the mitral valve and produce similar effects to the stenosis.
Symptoms and Diagnosis
If the stenosis is severe, the increased pressure in the left atrium and the veins of the lungs causes heart failure and, therefore, fluid accumulates in the lungs (pulmonary edema). If a woman with severe stenosis mitral valve becomes pregnant, heart failure develops rapidly. On the other hand, heart failure is associated with fatigue and shortness of breath. At first, shortness of breath occurs only during physical activity, but gradually the symptoms occur even during rest. In some cases, proper breathing is achieved only when the patient is sitting or lying half on a pair of pillows. A purple shade on the cheeks suggests that a person suffers from mitral valve stenosis. Hypertension in the pulmonary veins can make them or break capillaries and result in bleeding in the lungs, either minor or massive. Finally, the enlargement of the left atrium can cause atrial fibrillation (a rapid, irregular heartbeat).
With a stethoscope you can hear a distinctive murmur when blood passes from the left atrium through the narrowed valve. Unlike a normal valve, which opens quietly, this valve produces a sound similar to a click every time it opens to allow blood flow from the atrium to left ventricle. The diagnosis is confirmed with an electrocardiogram, a chest radiograph showing an enlarged atrium or an echocardiogram (an imaging technique using ultrasound). Sometimes you need a cardiac catheterization to determine the extent and characteristics of the obstruction.
Prevention and treatment
Mitral stenosis can only be prevented by avoiding the occurrence of rheumatic fever, a childhood disease that sometimes occurs after untreated strep throat.
The administration of drugs such as beta blockers, digoxin and verapamil slow the heart rate and controlled atrial fibrillation. If you get heart failure, digoxin also strengthens the heartbeat. Diuretics reduce blood pressure in the lungs by decreasing the volume of blood in circulation.
If drug treatment does not reduce symptoms, it is necessary to repair or replace the valve. You can delay the opening of the valve in a procedure called valvuloplasty. In this procedure, is introduced through an intravenous catheter with a balloon at the tip within the heart. Once located in the valve, the balloon is inflated and the edges are separated in the same place where they merged. The valves can also be separated by an operation, if the valve is too damaged, surgery may be replaced by a mechanical valve or other of porcine origin.
In case of mitral valve stenosis are given antibiotics as a preventive measure before any dental or surgical procedure to reduce the risk of valve infection.
Aortic valve insufficiency
The aortic valve regurgitation (aortic insufficiency, aortic incompetence) is the backflow of blood through the same each time the left ventricle relaxes.
The most frequent causes in general, tended to be rheumatic fever and syphilis, but today, in developed countries that have an appropriate medical facility, these causes are very rare due to the frequent use of antibiotics. In places with inadequate sanitary structure, injuries caused by rheumatic fever are still common. Apart from these infections, the most common cause of aortic valve insufficiency is the weakening of the tissue, usually fibrous and tough, of the valve (myxoid degeneration), a birth defect or other unknown factors. Myxoid degeneration is an inherited disorder of connective tissue weakens the heart valve tissue, causing it to soften and rarely occurs even rupture. Other causes include a bacterial infection or injury. About 2 percent of children and 1 per cent of girls born with two valves instead of three, you may develop mild aortic insufficiency.
Symptoms and Diagnosis
Mild aortic insufficiency does not produce another symptom rather than a characteristic heart murmur that is heard with a stethoscope every time the left ventricle relaxes. When blood is severe regurgitation, the left ventricle receives an increasing blood flow, leading to an increase in size and eventually causes heart failure. It produces dyspnea on exertion or when lying down, especially at night.
By contrast, in the sitting position is favored fluid to drain from the top of the lungs and breathing returns to normal. The person may also feel palpitations (a pounding sensation) due to enlarged ventricular contractions should be stronger. In some cases it appears angina pectoris, especially at night.
The diagnosis is made by auscultation of the characteristic heart murmur, and other signs of aortic valve regurgitation during the physical examination (such as anomalies in the pulse) and the presence of an enlarged heart on chest radiograph. An electrocardiogram may show changes in heart rate and signs of an enlarged left ventricle. The echocardiogram can allow the valve to see injured and highlight the seriousness of the problem.
Treatment
To prevent any infection of the injured valve are given antibiotics before any dental or surgical procedure. This type of precaution should be taken also with mild aortic insufficiency.
A patient who develops symptoms of heart failure should undergo surgery before the left ventricle is damaged irreversibly. In the weeks prior to surgery, heart failure treated with digoxin and inhibitors of angiotensin converting enzyme or other drug that dilates the veins and reduce the heart’s workload. In general, the valve is replaced with a mechanical valve or a pig valve.
Aortic valve stenosis
The aortic valve stenosis is a reduction of the aortic valve opening that increases resistance to the flow of blood from left ventricle to the aorta.
In North America and Western Europe, aortic valve stenosis is a disease that occurs mainly in old age as a result of the development of scarring of the valve and the accumulation of calcium in their shells. When should this cause, aortic stenosis begins after 60 years, but no symptoms until 70 or 80. It can also be caused by rheumatic fever contracted in childhood. In this case, aortic stenosis associated with mitral valve disease, either stenosis, regurgitation or both.
In the youngest, the most common cause is a birth defect. The narrowing of the aortic valve may be asymptomatic in childhood, although disruptive over time. The valve remains the same size, while the heart is enlarged and is pumping large amounts of blood through the small valve. The valve may have two cusps (bicuspid aorta valve) instead of three as is normally or abnormally present a funnel. Over the years, the opening of such valves is difficult because it becomes rigid and narrowed by the buildup of calcium deposits.
Symptoms and Diagnosis
While trying the left ventricle to pump enough blood through the aortic valve narrows, your wall will thicken, resulting in an increased requirement of blood from the coronary arteries. Finally, the blood supply is inadequate and, consequently, angina occurs with exertion. This insufficient supply can injure the heart muscle, so that the amount of blood leaving the heart appears inadequate to the needs of the organism. The resulting heart failure causes fatigue and dyspnea. A person with severe aortic stenosis may faint on exertion because the narrowed valve prevents the ventricle to pump enough blood to the arteries of the muscles, which have been expanded to accept more oxygen-rich blood.
Diagnosis is made after the sounding of a distinctive murmur of the heart through a stethoscope, as well as abnormalities in heart rate and electrocardiogram, and a thickening of the walls of the heart in a chest radiograph. In case of angina, dyspnea, or fainting, performed an echocardiogram (an ultrasound image of the heart) and possibly a cardiac catheterization to identify the cause and the severity of the stenosis.
Treatment
In any adult suffering from fainting, angina pectoris and dyspnea caused by aortic stenosis, this valve must be replaced surgically, preferably before they appear irreparable injury in the left ventricle. The replacement valve may be mechanical or pork. Anyone with a valve replacement should receive antibiotics before undergoing any dental or surgical procedure to prevent possible infection.
In children, if the stenosis is severe operation should be performed even before symptoms appear. It is important to begin treatment early, because sudden death may occur before symptoms appear. For children, are used to repair the valve through surgical intervention and valvuloplasty (valve introduction of a catheter with a balloon on the end, which is then inflated to enlarge the opening) as safe and effective alternative to replacement the valve. Valvuloplasty is also used in frail elderly patients who can not undergo surgery, although the stenosis can develop again. However, valve replacement is usually the treatment of choice for adults of all ages and also the prognosis is excellent.
Tricuspid valve insufficiency
The tricuspid valve regurgitation (tricuspid incompetence) is the blood leaks backward through the tricuspid valve whenever the right ventricle contracts.
In tricuspid regurgitation, when the right ventricle contracts, it not only expels the blood into the lungs, but also pass a certain amount to the right atrium through the valve. This leak through the valve increases the pressure in the right atrium and causes its expansion. This high pressure is transmitted to the veins that drain into the atrium and, as a result, there is a resistance to the arrival of blood from the body and goes to the heart.
The most common cause of tricuspid regurgitation is the resistance to blood flow out of the right ventricle caused by severe lung disease or narrowing of the pulmonary valve (pulmonary valve stenosis). As a compensation mechanism, the right ventricle expands to pump harder and the valve opening is dilated.
Symptoms and Diagnosis
Apart from some specific symptoms such as weakness and fatigue caused by the small amount of blood leaving the heart, the only symptoms are usually present discomfort in the upper right abdomen, due to an enlarged liver and pulsations in the neck, all this is a result of backflow of blood from the heart to the veins. Dilation of the right atrium can cause atrial fibrillation (rapid, irregular heartbeat). Finally, there is a failure and fluid retention occurs, especially in the legs.
The diagnosis is based on the person’s medical history, a physical examination, an electrocardiogram and a chest radiograph. The backflow of blood through the valve causes a murmur that is heard with a stethoscope. An echocardiogram provides a picture of regurgitation and assess the extent of it.
Treatment
Generally, the tricuspid regurgitation requires little or no treatment. But the underlying disease of the lungs or pulmonary valve disease itself in need. Disorders such as arrhythmias and heart failure are usually treated without any surgical practice on the tricuspid valve.
Tricuspid valve stenosis
The tricuspid valve stenosis is a narrowing of the opening of the tricuspid valve that obstructs the flow of blood from the right atrium to right ventricle.
Over the years, tricuspid stenosis causes dilation of the right atrium and right ventricle shrinking. Likewise, it reduces the amount of blood returning to the heart and increases the pressure in the veins carrying the blood.
Most cases are caused by rheumatic fever, increasingly rare in developed countries. Sometimes the cause is a tumor in the right atrium, a connective tissue disease or, in rare cases, a birth defect.
Symptoms, diagnosis and treatment
The symptoms are mild. May be noted palpitations (a sensation of beats) or a throbbing discomfort in the neck and the person may feel tired. There may be a nuisance if the increased abdominal pressure in the veins come to increase the size of the liver.
The murmur caused by tricuspid valve stenosis is heard through a stethoscope. A chest radiograph may reveal an enlarged right atrium, while echo stenosis can see and assess their seriousness. Finally, the electrocardiogram shows changes that indicate an overload of the right atrium.
Tricuspid stenosis is rarely severe enough to require surgery.
Pulmonary valve stenosis
The pulmonary valve stenosis is a narrowing of the pulmonary valve opening that causes a resistance to the passage of blood from right ventricle to the pulmonary arteries.
It occurs rarely in adults and usually is a congenital defect.
Cardiomyopathy: Prognosis and Treatment, Symptoms and Diagnosis,
August 31st, 2010
Cardiomyopathy is a progressive disorder that alters the structure or impair the functioning of the muscular wall of the heart’s lower chambers (ventricles).
Cardiomyopathy can be caused by many diseases known or may be due to unidentified causes.
Dilated congestive cardiomyopathy
Congestive dilated cardiomyopathy is a group of cardiac disorders in which the ventricles are enlarged, but are not able to pump enough blood to the body’s needs and consequently heart failure occurs.
In developed countries, the most common identifiable cause of dilated congestive cardiomyopathy is widespread coronary artery disease. The disease causes an inadequate blood supply to the heart muscle, which can lead to permanent injury. The non-injured heart muscle is stretched to compensate for the loss of pumping action. When this stretch can not adequately compensate for the deficit, there is dilated congestive cardiomyopathy.
An acute inflammation of the heart muscle (myocarditis) caused by a viral infection, can weaken and cause dilated congestive cardiomyopathy (sometimes called viral cardiomyopathy). Infection with Coxsackie B virus is the most common cause of viral cardiomyopathy. Certain chronic hormonal disorders such as diabetes and thyroid disease can also cause dilated congestive cardiomyopathy, and the consumption of certain drugs (like alcohol and cocaine) and drugs (like antidepressants). Alcoholic cardiomyopathy occurs after about 10 years of alcohol abuse. In rare cases, pregnancy or certain connective tissue diseases such as rheumatoid arthritis, can cause dilated congestive cardiomyopathy.
Symptoms and Diagnosis
The initial symptoms of dilated congestive cardiomyopathy (feeling breathlessness during physical exertion and tiring easily) are the result of weakened pumping action of the heart (heart failure). When the cause of cardiomyopathy is an infection, the first symptoms can be sudden fever and similar to the flu. In any case, the heart rate quickens, blood pressure is normal or low, there is fluid retention in legs and abdomen and the lungs fill with fluid.
The enlarged heart makes the heart valves open and close improperly, in the case of tricuspid and mitral valve, there is an abnormal reflux of blood from the ventricles into the atria during systole, in view of not close properly. Improper closure of the valves cause murmurs can be heard with a stethoscope. Finally, injury and stretching of the heart muscle produce abnormally rapid heart rate or slow. These anomalies further alter the heart’s pumping function.
The diagnosis is based on symptoms and physical examination. The electrocardiogram (a test that records the heart’s electrical activity) shows characteristic changes. The echocardiogram (a test that uses sound waves to create an image of cardiac structures) and magnetic resonance imaging (MRI) confirmed the diagnosis. If, despite these procedures, the diagnosis is still uncertain, a more accurate assessment requires a catheter to measure pressures within the heart. During the catheterization, you can extract a sample of tissue for microscopic analysis (biopsy) and thus confirm the diagnosis and often even hear the case.
Prognosis and Treatment
About 70 percent of people with dilated congestive cardiomyopathy die within 5 years of onset of first symptoms, prognosis worsens as the heart’s walls become thinner and heart function declines. Abnormalities in heart rate also indicate a poor prognosis.
According to studies, both sex and ethnic origin play an important role in prognosis. Overall, only half survive men compared with women and people of black ethnicity half compared with those of white ethnicity. About 50 percent of deaths are sudden, probably as a result of cardiac arrhythmia.
Specifically address the underlying cause such as alcohol abuse or infection can prolong life. If the cause is the abuse of alcohol, it is necessary to abstain from alcohol. Antibiotic treatment is indicated if a bacterial infection that produces the sudden inflammation of the heart muscle.
If a person with coronary artery disease, poor blood supply for heart failure can cause angina (chest pain from heart disease), which requires the application of a treatment with nitrates, a beta-blocker or a blocker calcium channel.
Beta-blockers and blockers of calcium channels can reduce the strength of heart contractions. Sufficient rest, adequate sleep and stress reduction help reduce the strain on the heart.
The stagnation of blood in enlarged heart can cause blood clots in the walls of the cavities. To prevent this coagulation, anticoagulant drugs are usually administered.
In general, drugs used to prevent arrhythmias are prescribed in small doses, then increase gradually, as they may reduce the strength of heart contractions. Heart failure is also treated with drugs (an inhibitor of angiotensin converting enzyme, which is often associated with a diuretic).
However, unless the specific cause of dilated congestive cardiomyopathy can be treated, it is likely that heart failure is ultimately fatal. Given this poor prognosis, those with dilated congestive cardiomyopathy are the leading candidates for a heart transplant.
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is a group of heart disorders characterized by ventricular hypertrophy (a thickening of the walls of the ventricles).
Hypertrophic cardiomyopathy is hereditary in certain cases. You can also occur in patients with acromegaly, a disease resulting from the presence of excessive amounts of growth hormone in the blood or in those with pheochromocytoma, a tumor that produces adrenalin. People with neurofibromatosis, a hereditary disease, can also develop hypertrophic cardiomyopathy.
Usually, a thickening of the muscular walls of the heart muscle represents a reaction against an increase in cardiac workload. The most common causes are high blood pressure, narrowing of the aortic valve (aortic valve stenosis) and other disorders that increase the output resistance to blood from the heart. However, patients with hypertrophic cardiomyopathy do not have these conditions. In contrast, the thickening that occurs in this disease is usually due to an inherited genetic abnormality.
The heart thickens and becomes stiffer than normal, resulting in that there is greater resistance to entry of blood from the lungs. One consequence is stagnation of blood in the pulmonary veins, which can cause fluid to accumulate in the lungs and, consequently, there is a chronic breathlessness. Furthermore, when the ventricular walls thicken, can obstruct blood flow and prevent the proper filling of the heart.
Symptoms and Diagnosis
Symptoms include fainting, chest pain, palpitations caused by irregular heartbeat and heart failure with breathlessness. The irregular heartbeat can cause death repentina.El diagnosis is made from physical examination. For example, heart sounds heard with a stethoscope usually are characteristic.
The diagnosis is usually confirmed with an echocardiogram, an electrocardiogram (ECG) or chest radiography. If you are considering surgery, you may need to practice a cardiac catheterization to measure pressures within the heart.
Prognosis and Treatment
Annually, about 4 percent of people with hypertrophic cardiomyopathy. Death usually occurs suddenly, the death due to chronic heart failure is less common. Genetic counseling is recommended if the disorder is inherited and want to have offspring.
Treatment aims to reduce the resistance of the heart to fill with blood between beats. The main treatment is the administration, jointly or separately, beta blockers and antagonists of calcium channels.
The surgical intervention that removes a portion of heart muscle increases the output of blood from the heart, but only occurs in patients with disabling symptoms despite drug treatment. The surgery improves symptoms but does not reduce the risk of death.
Prior to any dental or surgical intervention, antibiotics are given to reduce the risk of infection of the lining of the heart (endocarditis).
Restrictive cardiomyopathy
Restrictive cardiomyopathy is a group of heart muscle disorders characterized by rigidity of the ventricular walls (which are not necessarily thick), which causes a resistance to normal filling with blood between beats.
It is the least common form of cardiomyopathy and shares many features with hypertrophic cardiomyopathy.
Its cause is unknown. In one of his two basic types, the heart muscle is gradually replaced by scar tissue. In the other type, the muscle is infiltrated by an abnormal substance such as white blood cells.
Other causes of infiltration can be amyloidosis and sarcoidosis. If the body contains much iron, it accumulates in the heart muscle, such as iron overload (hemochromatosis). Finally, this cardiomyopathy might also be the result of a tumor invading the heart tissue.
Because the resistance of the heart to filling the pumped volume is sufficient when the person is at rest, but not when the person is making an effort.
Symptoms and Diagnosis
Restrictive cardiomyopathy causes heart failure with dyspnea and swelling of the tissues (edema). Angina and fainting occur less frequently than in hypertrophic cardiomyopathy, but instead are common arrhythmias and palpitations.
Restrictive cardiomyopathy is one of the possible causes being investigated in case a person has heart failure. The diagnosis is mainly based on physical examination, electrocardiogram (ECG) and echocardiogram.
Magnetic resonance imaging (MRI) can provide additional information about the structure of the heart. Accurate diagnosis requires heart catheterization to measure pressure and a heart muscle biopsy (obtain a sample and its analysis under a microscope), which permits identification of the substance that infiltrates.
Prognosis and Treatment
About 70 percent of patients with restrictive cardiomyopathy die within five years of the onset of symptoms. In most cases, there is no effective treatment.
For example, diuretics, which are generally used to treat heart failure, reduce the volume of blood to the heart and worsen the situation rather than improve it.
The drugs commonly used in heart failure to reduce the overhead of the heart are not too useful because it decreases blood pressure.
Sometimes, the cause of restrictive cardiomyopathy can be treated to prevent injuries from worsening heart or even to partially reverse.
For example, blood drawn at regular intervals reduces the amount of iron stored in people with hemochromatosis. In the case of sarcoidosis, we recommend the administration of corticosteroids.
Heart Failure: Causes, Symptoms, Treatment, Diagnosis, Clearing
August 31st, 2010
Heart failure is a serious disease in which the amount of blood pumped by the heart each minute (cardiac output) is insufficient to meet the needs of oxygen and nutrients from food.
The term heart failure means the heart has stopped, as some people think, but actually refers to reducing the heart’s ability to maintain their effectiveness. Heart failure has many causes, among which there are a number of diseases is much more common in older people because they have a higher chance of contracting the diseases that cause it. Although it is a process that slowly gets worse over time, people with this disorder can live for many years. However, 70 percent of patients with this condition die within 10 years from diagnosis.
Causes
Any disease that affects the heart and interfere with the circulation can cause heart failure. Certain diseases can act selectively affecting the heart muscle, impairing its ability to contract and pump. The most common of these is coronary artery disease, which restricts blood flow to the heart muscle and can lead to stroke. Myocarditis (heart muscle infection caused by bacteria, viruses or other microorganisms) also causes serious injury to the heart muscle, as well as diabetes, hyperthyroidism or extreme obesity. A heart valve disease can block blood flow between the chambers of the heart or between the heart and major arteries. Moreover, a valve that does not close properly and allow blood to escape, may cause a backup of it. These situations cause the overload of the heart muscle and thus weaken the force of heart contractions. Other diseases mainly affect the electrical conduction system of the heart and cause heart rates slow, fast or irregular heartbeat, which prevent adequate blood pumping.
If the heart is subjected to a great effort for months or years, is enlarged, as is the case with the biceps after several months of exercise. In principle, this enlargement is accompanied by stronger contractions, but eventually an enlarged heart may decrease its pumping ability and cardiac insufficiency. Likewise, high blood pressure (hypertension) can cause the heart must work harder. This also happens when you must fight to expel the blood through a narrow orifice, usually tight aortic valve. The situation is similar to the extra burden that supports a water pump, when forced to push the water through narrow pipes.
In some people it hardens the pericardium (the thin transparent cover of the heart). This prevents the heart to dilate completely between beats, so the blood is insufficient filling. Although much less frequently, it can also happen that certain diseases that affect other parts of the body excessively increase the demand for oxygen and nutrients by the body, so that the heart, even if normal, is unable to meet this demand higher . The result is the occurrence of heart failure.
The causes of heart failure vary in different regions of the world due to the different diseases that develop in each country. For example, in tropical countries there are some parasites that can lodge in the heart muscle, this causes heart failure at a much younger age than in developed countries.
Clearing
The agency has a number of response mechanisms to compensate for heart failure. The mechanism of initial emergency response (in minutes or hours) is the ‘excitatory state before the action “caused by the release of epinephrine and norepinephrine from the adrenal gland into the blood circulation, norepinephrine is also released by the nerves. The adrenaline and noradrenaline are the main defenses against any sudden stress. In compensated heart failure, make the heart work harder, helping to increase cardiac output and to compensate, to some extent, the problem of pumping. Minute volume can return to normal, although usually at the expense of an increase in heart rate and a stronger heartbeat.
These responses are beneficial to a patient without heart disease who needs short-term increase in cardiac function. But in the case of a person with chronic heart failure, these responses produce a constant demand on the cardiovascular system is already severely injured. In the long term, these growing demands impair heart function.
Another additional corrective mechanism is the retention of salt (sodium) by the kidneys and therefore simultaneously also retains water to keep constant the concentration of sodium in the blood. This additional amount of water increases blood volume in circulation and, in principle, improves cardiac performance. One of the main consequences of fluid retention is that the increased blood volume causes a stretch of heart muscle. This muscle tension undergone more contracts more strongly, as do both an athlete’s muscles before exercise. This is one of the main mechanisms available to the heart to increase its role in heart failure.
However, as it worsens, excess fluid escapes from the circulation and accumulates in various parts of the body, causing swelling (edema). The place is dependent accumulation of excess fluid and the effect of gravity.
Standing, fluid accumulates in the legs and feet. If the person is lying, it accumulates in the back or abdomen. Typically, the sodium and water retention result in increased weight.
The other main mechanism of compensation is the thickening of the heart muscle (hypertrophy). The enlarged heart muscle and can contract with greater force, but ultimately wrong and aggravates heart failure.
Symptoms
People with decompensated heart failure often feel tired and weak when performing physical activity, because the muscles do not receive an adequate blood volume. On the other hand, the swelling can also cause many symptoms. Besides the influence of gravity, the location and the effects of swelling depend also on the side of the heart that is most affected.
Although a disease of one side of the heart always cause heart failure on both sides, often dominated by symptoms of either side.
Right heart failure tends to produce a stagnation of blood that goes to the right side of the heart. This causes swelling in the feet, ankles, legs, liver and abdomen. In contrast, left-sided failure causes fluid accumulation in the lungs (pulmonary edema), causing severe breathlessness. At first, it occurs during physical exertion, but as the disease progresses, it also occurs even at rest. Sometimes the breathlessness is nocturnal, and the fact that lie favored the displacement of fluid into the lungs.
You wake up often struggling for breath or wheezing. The act of sitting causes the liquid out of the lungs and breathing is facilitated. People with heart failure often have to sleep sitting to avoid this effect. Severe fluid buildup (pulmonary edema) is an urgent situation that can be fatal.
Diagnosis
Usually, symptoms are usually sufficient to establish the diagnosis of heart failure. The following findings confirm the initial diagnosis: a weak pulse and often rapid, low blood pressure, certain abnormal heart sounds, an enlarged heart, swollen neck veins, fluid in the lungs, an enlarged liver, rapid weight gain and swelling in the abdomen or legs.
A chest x-ray may show heart enlargement and accumulation of fluid in the lungs.
Often the heart function is evaluated with additional tests, such as an echocardiogram, which uses sound waves to provide an image of the heart, and an electrocardiogram, which examines the electrical activity. You can perform other tests to determine the underlying cause of heart failure.
Treatment
There is no curative treatment in most cases, but may facilitate physical activity, improve the quality of life and prolong survival. The treatment is approached from three angles: the treatment of the underlying cause, the elimination of the factors that contribute to worsening heart failure and his own treatment of it.
Treatment of the underlying cause
By surgery can correct a heart valve close or failure, an abnormal communication between the heart chambers or coronary artery obstruction, all of which can lead to heart failure development. Sometimes the cause can be removed completely without having to resort to surgery. For example, antibiotics can cure an infection. The drugs, surgery or radiotherapy are effective in treating hyperthyroidism. Similarly, the drugs reduce and control high blood pressure.
Elimination of the contributing factors
The factors that aggravate heart failure include smoking and eat too much salt, overweight and alcohol consumption, as well as extreme environmental conditions. We recommend a program to help people quit smoking, make appropriate changes in diet, stop drinking or moderate exercise regularly to improve fitness. In case of more severe heart failure, rest for a few days is an important part of treatment.
Excess dietary salt (sodium) can cause fluid retention that makes ineffective medical treatment. The amount of sodium in the body decreases by limiting the table salt in cooking food and eating salty foods. People with severe heart failure may know the salt content of packaged food by reading labels carefully.
A simple and safe way to see if fluid is retained control weight daily. Fluctuations of more than one kilogram per day should be almost certain to fluid retention. A consistent weight gain and fast (1 kg per day) is a sign that heart failure is worsening. Thus, patients with heart failure should carefully control their weight every day, mainly on rising in the morning after urinating and before breakfast. The variations are easier to observe when using always the same scale and similar clothes and daily weight points in a notebook.
Treatment of heart failure
The best treatment of heart failure is the prevention or control of the underlying cause. But even if this is not possible, the constant advances in the treatment improve the quality of life and prolonged.
Chronic heart failure: when the salt restriction alone does not reduce fluid retention, diuretic drugs are administered to increase urine production and remove the sodium and water from the body through the kidneys.
The reduction of fluids reduces the volume of blood to the heart and thereby reducing the effort it must perform. Usually, diuretics orally ingested when it comes to long-term treatment, but in an emergency are very effective intravenously. Because some diuretics cause an undesirable loss of potassium, can also be given a potassium supplement or a diuretic that does not eliminate potassium.
Digoxin increases the power of each heartbeat and reduces heart rate when it is too fast. The heart rhythm irregularities (arrhythmias), where the beats are too fast, too slow or irregular, are treated with drugs or with an artificial pacemaker. On the other hand, it is often the administration of vasodilators that dilate blood vessels, both arteries, veins, or both at once. Arterial vasodilators dilate the arteries and reduce blood pressure, which in turn reduces the heart’s workload. The venodilators dilate the veins and provide more space for blood that has accumulated and is unable to enter the right heart. This space accessory relieves congestion and reduces the load on the heart. Vasodilators are most commonly used ACE inhibitors (angiotensin converting enzyme). These drugs not only improve symptoms, but also prolong life. The ECA dilate both arteries and veins, while many of the older drugs dilate one or the other to varying degrees. For example, nitroglycerin dilates the veins, while hydralazine dilate the arteries.
The dilated heart chambers and limited contraction can promote blood clot formation inside. The greatest danger lies in the evolution of these clots in their move to the circulation can cause serious injury to other vital organs such as the brain and cause a stroke.
Anticoagulant drugs are important because they prevent the formation of clots in the cardiac chambers.
We are researching a number of new drugs. Like ACE inhibitors, milrinone and amrinone dilate both arteries and veins, likewise, like digoxin, they also increase the contractile force of the heart. These new drugs are used only for short periods in patients who are closely monitored in the hospital because they can cause dangerous irregular heartbeat.
Heart transplantation is indicated in some cases of severe heart failure who do not respond adequately to drug treatment. The mechanical hearts temporary, partial or complete are still in experimental stage and is working hard on performance problems, infections and blood clots.
The cardiomyoplasty is an experimental operation in which a muscle is removed along the back that wraps around the heart and is stimulated by an artificial pacemaker to produce rhythmic contractions. This is the latest operation shows promising experimental and very specific in patients suffering from severe heart failure (ie, cardiac muscle, very weak, has stopped functioning as such).
Acute heart failure: when a sudden buildup of fluid in the lungs (pulmonary edema), breathing is very difficult, so that high concentrations of oxygen delivered through a mask.
The administration of intravenous diuretics and drugs such as digoxin may produce a rapid and dramatic improvement.
Intravenous nitroglycerin or placed under the tongue (sublingual) dilates blood vessels and thus reduces the volume of blood through the lungs. When these measures are unsuccessful, insert a tube into the airways so that breathing can be assisted with a ventilator. In rare situations, apply a tourniquet to three of the four members of the blood temporarily imprison them and reduce the volume of blood returning to the heart, these tourniquets should be exchanged between the members every 10-20 minutes to avoid injuries extremities.
The administration of morphine relieves the anxiety that usually accompanies acute pulmonary edema, decreasing the rate of breathing, reduces heart rate and therefore reduces the overload of the heart. Drugs similar to adrenaline and noradrenaline (such as dopamine and dobutamine) are used to stimulate heart contractions in patients who are hospitalized and need a quick improvement. However, if stimulation of the internal emergency system of the organism itself is too large, sometimes used drugs that have the opposite action (beta-blockers).
Cardiac Arrhythmias: Symptoms, Prognosis and Treatment
August 31st, 2010
The heart is a muscular organ with four chambers designed to work efficiently and continues throughout life. The muscular walls of each chamber contract in a precise sequence during each beat and expel more blood with less effort.
The contraction of the muscle fibers of the heart is controlled by an electric shock through the heart following different paths and at a certain speed. The rhythmic discharge that starts each heartbeat originates in the pacemaker of the heart (sinoatrial node), located on the wall of the right atrium. The speed of these discharges is partly dependent on nerve impulses and the amount of certain hormones in the blood.
The part of the nervous system that automatically regulates the heart rate is the autonomic nervous system, which includes the sympathetic and parasympathetic nervous systems. The sympathetic nervous system increases heart rate, the parasympathetic decreases. The sympathetic system provides the heart with a network of nerves called the sympathetic plexus. The parasympathetic system gets to the heart through a single nerve: the vagus nerve or vagus.
On the other hand, the sympathetic nervous system hormones (adrenaline and noradrenaline) also increase heart rate. Thyroid hormone also exerts the same effect. Too much thyroid hormone causes the heart to beat too quickly, whereas if there is little, it does so very slowly.
The resting heart rate is 60-100 beats per minute. However, they can be considered normal speeds much lower in young adults, especially those in good physical condition. Changes in heart rate are normal. Appear not only the effect of exercise or inactivity, but also by other stimuli, such as pain and emotions. Only when the rate is inappropriately fast (tachycardia) or slow (bradycardia) or when the electrical impulses are abnormal pathways or routes, it is considered that the heart has an abnormal rhythm (arrhythmia). The abnormal rhythm can be regular or irregular.
Traffic routes of electrical stimuli
The electrical impulses from the pacemaker are directed first to the left and right atria, therefore, cause contraction of muscle tissue in a certain sequence that determines the blood to be expelled from the atria to the ventricles. Then, the electrical impulse reaches the atrioventricular node is located between the atria and ventricles. This node holds the shock and slows its transmission to allow the atria to contract completely and the ventricles fill with blood as much as possible during ventricular diastole.
After passing through the atrioventricular node, the electrical impulse reaches the His bundle, a group of fibers that are divided into a left branch to the left ventricle and a right branch to the right ventricle. Thus, the momentum is distributed orderly on the surface of ventricles and initiate its contraction (systole), during which blood is ejected from the heart.
Various anomalies of this system of electrical impulse conduction that cause arrhythmias can range from harmless to severe life-threatening. Each variety has its own cause arrhythmia, while a cause can give rise to various types of arrhythmias. The mild arrhythmias may occur by excessive consumption of alcohol or snuff, by stress or exercise. Hyperactivity or poor performance of the thyroid and some drugs, especially those used for the treatment of pulmonary disease and hypertension, may also alter heart rate and rhythm. The most common cause of arrhythmias is heart disease, including coronary artery disease, malfunctioning valves and heart failure. Sometimes arrhythmias ensue without underlying heart disease or any other cause detectable.
Symptoms
Awareness of own heartbeat (palpitations) varies greatly from person to person. Some people can distinguish abnormal beats and others are able to receive up to a normal heartbeat. Sometimes when lying on the left side, most people perceive the heartbeat. The consciousness of one’s own heartbeat can be disturbing, but usually not the result of an underlying disease. Most often it is due to very strong contractions that appear periodically for various reasons.
The person with a certain type of arrhythmia is prone to the same arrhythmia repeatedly. Some types of arrhythmias cause few or no symptoms but can cause problems. Others do not cause major problems but never, however, do cause symptoms. Often, the nature and severity of underlying heart disease are more important than the arrhythmia itself.
When arrhythmias affect the heart’s ability to pump blood, can cause dizziness, vertigo and fainting (syncope). Arrhythmias that cause these symptoms require immediate attention.
Diagnosis
The description of the symptoms almost always allows a preliminary diagnosis and the severity of the arrhythmia. The most important considerations are whether the beats are fast or slow, regular or irregular, shorter or longer, if they appear vertigo, dizziness or weakness and even loss of consciousness and if the palpitations are associated with chest pain, shortness of breath and other uncomfortable sensations. The doctor also needs to know whether the palpitations occur when the patient is at rest or during unusual or vigorous activity and, furthermore, if they begin and end suddenly or gradually.
In general, I need some additional tests to determine the exact nature of the disease. The electrocardiogram is the main diagnostic test to detect arrhythmias and provides a graphical representation of them.
However, the electrocardiogram (ECG) only shows the heart rate during a short period and arrhythmias are generally intermittent. Therefore, a portable monitor (Holter), which takes over 24 hours, can provide more information. It can record arrhythmias occur sporadically while the patient continues normal daily activities and points in a diary of symptoms detected within 24 hours. If life-threatening arrhythmias, hospitalization is required to carry out this monitoring.
When you suspect the existence of a persistent and potentially fatal arrhythmia, invasive electrophysiological studies may be helpful. To do this, is introduced intravenously into the heart catheter containing a wire. Using a combined electrical stimulation and a sophisticated monitoring can determine the type of arrhythmia and the most likely response to treatment. The most serious arrhythmias can be detected by this technique.
Prognosis and Treatment
The outlook depends in part on whether the arrhythmia starts in the normal heart pacemaker in the atria or the ventricles. In general, starting in the ventricles are more serious, although many of them are not dangerous.
In general, arrhythmias cause no symptoms or interfere with the pumping function of the heart, so the risks are minimal. However, arrhythmias are a source of anxiety when the person becomes aware of them, so they understand their innocuous nature can provide relief. Sometimes, when changing or adjusting the medication dose, or when you stop drinking or practice of vigorous exercise, arrhythmias are more spread out or even cease.
The administration of anti-arrhythmic drugs is very useful in case of intolerable symptoms or pose a risk. There is no single drug that will cure all arrhythmias in all people. Sometimes you have to try several treatments to find one that is satisfactory. In addition, antiarrhythmic drugs can cause side effects and may worsen or even cause arrhythmias.
Artificial pacemakers, electronic devices that act in place of the natural pacemaker was programmed to mimic the normal sequence of the heart. In general, are surgically implanted under the skin of the chest and have wires coming into the heart. Due to low power circuit design and new batteries, these units have a duration of between 8 and 10 years. These new circuits have almost eliminated the risk of interference with car dealers, radar, microwave detectors and airport security. However, other computers can interfere with pacemakers, as the devices used for magnetic resonance imaging (MRI) and diathermy (physical therapy used to warm the muscles).
The most frequent use is given to the pacemaker is to treat a heart rate too slow (bradycardia). When the heart rate decreases below a certain value, the pacemaker begins to emit electrical impulses. In exceptional cases, a pacemaker is used to send a series of pulses to stop an abnormally fast heart rate (tachycardia) and to decrease its speed. These pacemakers are used only in the case of fast rhythms that start in the atria.
Sometimes, the application of electric shock to the heart to stop an abnormal rhythm and restore normal. This method is called cardioversion or defibrillation electroversión. Cardioversion can be used to treat arrhythmias that begin in the atria or the ventricles. Generally, it uses a large device (defibrillator), handled by a specialized team of doctors and nurses, to generate an electric shock to stop an arrhythmia that can cause death. However, it can be surgically implanted a defibrillator the size of a deck of cards. These small devices that automatically detect arrhythmias that can be deadly and emit a discharge, are implanted in people who otherwise might die suddenly stopped his heart. As these defibrillators do not prevent arrhythmias, these people usually also take antiarrhythmic drugs at the same time.
Certain types of arrhythmias are corrected by surgery and other invasive procedures. For example, arrhythmias caused by coronary disease are controlled by angioplasty or bypass surgery coronary artery (bypass). When an arrhythmia is caused by an irritable focus in the heart’s electrical system, this focus may be destroyed or removed. Most often, the focus is destroyed by catheter ablation (RF power output through a catheter inserted into the heart). After a heart attack may occur episodes of ventricular tachycardia that can be fatal. This arrhythmia can be caused by a damaged area of heart muscle that can be identified and extracted by open-heart surgery.
Premature atrial
An atrial premature contraction is a heartbeat caused by electrical activation of the atria before a normal heartbeat.
The atrial extrasystoles occur as extra heartbeats in healthy people and only rarely cause symptoms. The precipitating factors are alcohol consumption and administration of cold preparations that contain drugs that stimulate the sympathetic nervous system (such as ephedrine or pseudoephedrine) or drugs used to treat asthma.
Diagnosis and treatment
Are detected with a physical examination and confirmed by an electrocardiogram (ECG). If treatment is necessary because the ectopic beats occur frequently and generate intolerable palpitations, given a beta blocker to reduce heart rate.
Paroxysmal atrial tachycardia
Paroxysmal atrial tachycardia is a uniform heart rate, fast (160 to 200 beats per minute) that happens all of a sudden and starts in the atria.
There are several mechanisms that produce paroxysmal atrial tachycardias. The rapid rate may be due to premature atrial beats send a pulse through an anomalous pathway to the ventricles.
This fast heart rate usually has a beginning and an end sudden and can last from a few minutes to several hours. Is experienced in most cases as an annoying throbbing and is often accompanied by other symptoms such as weakness. Generally, the heart is normal, these episodes are more unpleasant than dangerous.
Treatment
The episodes of arrhythmia can often be interrupted by one or several maneuvers that stimulate the vagus nerve and that, consequently, reduce the heart rate. These maneuvers, which are usually directed by a physician, include having the patient simulate evacuation efforts, rubbing his neck just below the angle of the jaw (which stimulates the sensitive area of the carotid artery called the carotid sinus) and dip face into a bowl of very cold water. These maneuvers are more effective if they are made just beginning the arrhythmia.
If these procedures do not work, the arrhythmia is usually stopped if the person goes to sleep. But usually, people seek the help of a doctor to end the inning. In general, it is easily stopped administering intravenous doses of verapamil or adenosine. When drugs do not work should be resorted to cardioversion (electric shock applied to the heart).
Prevention is more difficult than the treatment, but there are several drugs that are effective, given alone or in combination. On rare occasions, it may be necessary to destroy an anomalous pathway in the heart through a catheter ablation (RF power through a catheter inserted into the heart).
Atrial fibrillation and flutter
Atrial fibrillation and atrial flutter are very fast electrical impulses that produce a very rapid atrial contraction, which causes the ventricles to contract in a faster and less efficient than normal.
These rhythms may be sporadic or persistent. During atrial fibrillation and flutter, the atrial contractions are so fast that the walls of the atria quiver just, so not having a real contraction, blood is not pumped into the ventricles. In atrial fibrillation, the atrial rhythm is irregular, so the ventricular rhythm is also, in the flutter, atrial and ventricular rhythms are generally uniform. In both cases, the ventricles beat more slowly than the atria because the atrioventricular bundle and can not conduct electrical impulses at speeds as high and only one of every two or four pulses get through. However, still the beating of the ventricles is so fast that they can not completely filled. Therefore, the heart pumps insufficient amounts of blood, lowers blood pressure and there is a potential risk of heart failure appear.
Atrial fibrillation or flutter may occur with no other visible signs of heart disease, but most often be an underlying problem such as rheumatic heart disease, a coronary artery disease, hypertension, alcohol abuse or excessive production of thyroid hormone (hyperthyroidism).
Symptoms and Diagnosis
Symptoms of atrial fibrillation or flutter depend on the frequency with which the ventricles contract. If this is not very fast (less than 120 beats per minute) did not produce symptoms, whereas higher frequencies cause unpleasant palpitations or chest discomfort. In atrial fibrillation, the patient may feel the irregular heart rhythm.
The reduced pumping ability of the heart can cause weakness, fainting and choking. Some people, especially the elderly, develop heart failure, chest pain and shock.
In atrial fibrillation, the atria do not empty completely into the ventricles with each beat, so the blood left inside can become stagnant and clot. Even clots can break off pieces that go into the left ventricle, enter the general circulation and can reach a smaller artery and block it (embolism). However, most often, the pieces of a clot breaks loose shortly after the atrial fibrillation returns to normal rhythm, either spontaneously or through the application of a treatment. The blockage of an artery in the brain can cause a stroke that, in rare cases, the first sign of atrial fibrillation.
The diagnosis of atrial flutter or fibrillation is made from symptoms and is confirmed by an electrocardiogram (ECG). In atrial fibrillation, the pulse is irregular, whereas in atrial flutter has a tendency to be steady but fast.
Treatment
Treatments for atrial fibrillation and atrial flutter aim to control the speed of contraction of the ventricles, to treat the disorder responsible for the abnormal rhythm and restore normal heart rhythm. In atrial fibrillation is provided in addition, a treatment to prevent blood clots and stroke.
First, decrease the ventricular rate to increase the pumping efficiency of the heart. To this effect, digoxin, a drug that slows the impulse conduction to the ventricles. When digoxin is not effective, combined with another drug (a beta-blocker such as propranolol or atenolol, a blocker or calcium channel blockers, such as diltiazem or verapamil), which increases their effectiveness.
Treatment of the underlying disease rarely improves atrial arrhythmias, unless the condition is hyperthyroidism.
Sometimes, atrial flutter or fibrillation may revert to a normal rhythm spontaneously, but more often it is necessary to intervene to get this normal. Although this reversal can be achieved with certain antiarrhythmic drugs, electric shock (cardioversion) is the most effective treatment. The success of the means used depends on the time since the onset of abnormal heart rhythm (the odds of success are lower after six months or more), the degree of dilatation of the ventricles and the seriousness of the disease has reached underlying heart. Although conversion is achieved, the risk of arrhythmia recurrence is high even when given preventive drugs such as quinidine, procainamide, propafenone or flecainide.
If all other treatments are unsuccessful, the atrioventricular node is destroyed using catheter ablation (RF power through a catheter inserted into the heart). This procedure interrupts the conduction from the atria in fibrillation to the ventricles, so that is required to place a permanent artificial pacemaker for the ventricles to contract.
The risk of blood clots is higher in people with atrial fibrillation and left atrial enlargement or mitral valve disease. The risk of a clot breaks loose and causes a stroke is particularly high in patients with intermittent but long-lasting episodes of atrial fibrillation or atrial which has been converted into normal rhythm. Since any person with atrial fibrillation runs the risk of stroke, generally, apply an anticoagulant to prevent clot formation, unless a specific reason not to (for example, hypertension) . However, this treatment carries a risk of bleeding that can lead to hemorrhagic stroke and other bleeding complications. Consequently, the potential benefits and risks must be considered in each individual.
Wolff-Parkinson-White
The Wolff-Parkinson-White is a cardiac arrhythmia in which electrical impulses are conducted over an accessory pathway from the atria to the ventricles, which causes episodes of tachycardia.
The Wolff-Parkinson-White is the most common disorders affecting accessory pathways. Although they are present at birth, only these accessory pathways conduct impulses through the heart at times. They can manifest early, during the first year of life or late, for example, at age 60.
Symptoms and Diagnosis
The Wolff-Parkinson-White cause sudden episodes of tachycardia with palpitations. During the first year of life, babies can begin to show symptoms of heart failure if the episode is prolonged. Sometimes, they seem to run out of breath or lethargic, stop eating well or have quick and visible pulsations in the chest.
The first episodes may occur between 10 and 25 years. Episodes typically begin all of a sudden, often during an exercise. They may last only a few seconds or persist for several hours, rarely more than twelve hours. In a young person and, moreover, with a good health, episodes produce minimal symptoms, but palpitations are annoying and stressful and can cause fainting or heart failure. Tachycardia sometimes is transformed in atrial fibrillation. The latter is particularly dangerous in about one percent of people suffering from Wolff-Parkinson-White, because the accessory pathway can conduct impulses to the ventricles faster more efficiently than normal. The result is a very rapid ventricular rate, which can be fatal. Not only is a very ineffective heart beat so fast, but the rapid heart rate may progress to ventricular fibrillation, which leads to death immediately.
The diagnosis of Wolff-Parkinson-White with or without atrial fibrillation is made by an electrocardiogram (ECG).
Treatment
The episodes of arrhythmia are often interrupted by one or several maneuvers that stimulate the vagus nerve and, consequently, reduce the heart rate. These maneuvers, under medical supervision, are to make similar efforts to escape, rubbing his neck just below the angle of the jaw (which stimulates the sensitive area of the carotid artery called the carotid sinus) and immerse the face in a container ice-cold water. These exercises work best when done just beginning the arrhythmia. If you do not have the desired effect, are given drugs such as verapamil or adenosine intravenously to stop the arrhythmia. For long-term prevention of episodes of tachycardia are given other antiarrhythmic drugs.
Digoxin can be supplied to infants and children under 10 years to suppress episodes of rapid heart rate. Adults should not take digoxin because it speeds up the accessory pathway conduction and increases the risk of ventricular fibrillation. For this reason, the drug is discontinued before reaching puberty.
The destruction through the accessory pathway catheter ablation (RF power through a catheter inserted into the heart) is effective in more than 95 percent of cases. The risk of death during the procedure is less than 1 in 1,000 people. Catheter ablation is particularly useful in young patients, because, otherwise, would face an indefinite treatment with antiarrhythmic drugs.
Premature ventricular
A ventricular extrasystole (premature ventricular contraction) is a heartbeat caused by electrical activation of the ventricles before the normal heartbeat.
This type of arrhythmia is common and not indicative of danger when there is no associated heart disease. However, when often manifest in a person suffering from heart failure, aortic stenosis or has had a heart attack may represent the onset of dangerous arrhythmias such as ventricular fibrillation and cause sudden death.
Symptoms and Diagnosis
The isolated premature ventricular contractions have little effect on the heart’s pumping action, and usually produce no symptoms, unless they are too frequent. The main symptom is the perception of a strong beat or out of place.
The premature ventricular contractions are diagnosed with an electrocardiogram (ECG).
Treatment
In principle, the only treatment is to reduce the causes of stress and avoiding alcohol and prepared for the cold counter containing active ingredients that stimulate the heart. In general, only prescribed drug treatment if symptoms are intolerable or when the heart rate tracing suggests danger. Given its relative safety, beta-blockers are the first choice. However, many patients do not want to take them due to the feeling of laziness that can cause.
After a heart attack, and if frequent premature ventricular contractions can reduce the risk of sudden death taking beta-blockers and undergoing coronary bypass surgery (bypass) to relieve the underlying obstruction. Antiarrhythmic drugs suppress PVCs, but they can also increase the risk of a fatal arrhythmia. They should therefore be used with caution in selected patients after cardiac sophisticated studies and related risk assessment.
Ventricular tachycardia
Ventricular tachycardia is a ventricular rate of at least 120 beats per minute.
Sustained ventricular tachycardia (ventricular tachycardia lasting at least 30 seconds) occurs in several cardiac diseases that cause serious injury to the ventricles. Most often it manifests several weeks or months after a heart attack.
Symptoms and Diagnosis
Ventricular tachycardia is almost always accompanied by palpitations. Sustained ventricular tachycardia can be dangerous and often requires emergency treatment, because the ventricles can not fill properly or exercise its pumping function. Blood pressure tends to decrease and heart failure occurs. Likewise, there is the risk of aggravation of ventricular tachycardia and ventricular fibrillation becomes (a form of cardiac arrest). Although ventricular tachycardia may produce few symptoms, even at frequencies up to 200 beats per minute is extremely dangerous.
The diagnosis of ventricular tachycardia is performed by an electrocardiogram (ECG).
Treatment
Should be treated any episode of ventricular tachycardia that causes symptoms and those longer than 30 seconds, even if they are asymptomatic. When episodes cause a drop in blood pressure below normal values, is needed cardioversion. To suppress the ventricular tachycardia is administered lidocaine or a similar drug intravenously. If episodes of ventricular tachycardia persist, an electrophysiology study is done and tested other drugs. The study results can decide the most effective drug to prevent recurrences. Sustained ventricular tachycardia is caused by a small abnormal area in the ventricles, which can sometimes be removed surgically. In some people with ventricular tachycardia unresponsive to medical therapy, can implant a device called an automatic defibrillator cardioversion.
Ventricular fibrillation
Ventricular fibrillation is an uncoordinated series of contractions and potentially fatal ventricular ineffective very quickly, caused by multiple chaotic electrical impulses.
Ventricular fibrillation is electrically similar to atrial fibrillation, except that it has a much more serious prognosis. In ventricular fibrillation, the ventricles quiver and not simply carry out coordinated contractions. Because the heart does not pump blood, ventricular fibrillation is a form of heart failure and is fatal unless treated immediately.
The causes of ventricular fibrillation are the same as those of heart failure. The most common cause is insufficient blood flow to the heart muscle because of coronary artery disease or stroke. Other causes include shock and very low concentration of potassium in the blood (hypokalemia).
Symptoms and Diagnosis
Ventricular fibrillation causes unconsciousness within seconds. If no treatment is applied immediately, usually produced convulsions and permanent brain damage after 5 minutes, because the oxygen no longer reaches the brain. Then comes death.
The physician considers the diagnosis of ventricular fibrillation in case of sudden collapse. During the scan are not detected no pulse or heartbeat, nor blood pressure is detected. The diagnosis is confirmed with an electrocardiogram (ECG).
Treatment
Ventricular fibrillation should be treated as an emergency. Cardiopulmonary resuscitation (CPR) should be initiated before they pass a few minutes and as soon as possible should be a cardioversion (electric shock applied on the chest). The following drugs are administered to maintain normal heart rhythm.
When ventricular fibrillation occurs within hours of a heart attack and the person is not in shock or have heart failure, immediate cardioversion is successful in 95 percent of cases and the prognosis is good. The shock and heart failure are indicative of serious injuries in the ventricles, when present, even the immediate cardioversion is only a success rate of 30 percent and 70 percent of these survivors died after resuscitation .
Heart block
Heart block is a delay in electrical conduction through the atrioventricular node, located between the atria and ventricles.
Heart block is classified as first-degree block, second degree or third degree, depending on the delay of electrical conduction to the ventricles is mild, intermittent or complete.
In the first-degree heart block, each impulse from the atria reach the ventricles but is delayed a fraction of a second when flowing through the atrioventricular node. This problem is driving asymptomatic. The first-degree heart block is common among well-trained athletes, adolescents, young adults and people with a high activity of the vagus nerve. However, the condition can also be seen in rheumatic fever and cardiac involvement in sarcoidosis and its origin may be the administration of some drugs. The diagnosis is based on observation of conduction delay on an electrocardiogram (ECG).
In the second-degree heart block not all impulses reach the ventricles. This blocking occurs when the heart beats slow or irregular. Some forms of second-degree block progress at the third level.
In the third-degree heart block, the impulses from the atria and ventricles are aimed at completely blocked and the heart rate and rhythm are determined by the activity of the atrioventricular node or the ventricles themselves. Without the stimulation of normal cardiac pacemaker (sinoatrial node), the ventricles beat very slowly, less than 50 beats per minute. The third-degree heart block is a serious arrhythmia that affects the heart’s pumping ability. Fainting (syncope), dizziness and sudden heart failure are common symptoms. When the ventricles beat at a rate greater than 40 beats per minute, symptoms are less severe but include fatigue, low blood pressure when standing and choking. The atrioventricular node and ventricles are not only slow as substitutes for natural pacemaker, but even they are often irregular and inefficient.
Treatment
The first-degree block requires no treatment, even when caused by heart disease. Some cases of second-degree block may require an artificial pacemaker. The third-degree block almost always require an artificial pacemaker. In an emergency you can use a temporary pacemaker until a permanent one can be implemented. Usually, people with this condition require an artificial pacemaker for the rest of his life, although normal rhythms sometimes return after recovering the underlying cause, such as a heart attack.
Sick sinus syndrome
The sinus node disease encompasses a wide variety of abnormalities of the functioning of the natural pacemaker.
This syndrome can produce a persistent slow heartbeat (bradycardia) or a complete blockage between the pacemaker and the atria (sinus arrest), in which case the impulse from the pacemaker does not cause contraction of the atria. When this happens, usually comes into operation an emergency pacemaker located downstream, either in the atrium or the ventricle.
An important subtype of this disease is the bradycardia-tachycardia syndrome, in which rapid atrial rhythms, including atrial fibrillation or flutter, alternating with long periods of slow heart rhythms. All kinds of sick sinus syndrome are particularly common in the elderly.
Symptoms and Diagnosis
Many types of sick sinus syndrome do not cause symptoms, although the cause persistently low heart rates, often weak and tired. When the frequency becomes very slow, even fading occurs. Often, rapid heart rates are perceived as palpitations.
A slow pulse, especially if it is irregular or no pulse with large variations coincide with changes in the activity of the subject, leads to suspect sick sinus syndrome. The characteristic abnormalities of the electrocardiogram (ECG), particularly if they register for a period of 24 hours and are considered along with the symptoms that accompany them generally provide confirmation of the diagnosis.
Treatment
People who have symptoms usually are placed an artificial pacemaker. These pacemakers are used to accelerate the heart rate rather than to decrease. In cases with occasional periods of rapid frequency, may also be necessary administrarción drugs. Therefore, usually the best treatment involves the implantation of a pacemaker with administration of an antiarrhythmic drug, as a beta-blocker or verapamil.