Heart Disease: America's leading Cause of Death – An "Equal Opportunity" Illness by Lawrence Broxmeyer MD

Inflammation plays a crucial role in the pathogenesis of arteriosclerosis, especially in acute coronary syndromes such as happen with a heart attack. And it was the very inability of ‘established’ risk factors such as high blood cholesterol (hypercholesterolemia), high blood pressure (hypertension) and smoking to fully explain the incidence of cardiovascular disease that has resulted in historically repeated calls to search out an infectious cause and the specific microbe behind it. Today, half of US heart victims have acceptable cholesterol levels, including HDL and LDL fractions, and 25% or more have none of the “risk factors” associated with heart disease, including smoking, high blood pressure or obesity, most of which are not inconsistent with being caused by infection to begin with. [1,2] Cholesterol itself was on the rise in Japanese blood during the very decade (1980-1989) when its incidence in coronary heart disease was on its way down. [22] So Nieto stressed the need to continue to look for an infectious disease behind heart disease. [3}

Which Disease?

Ever since a 1988 report of raised antibodies against Chlamydia pneumoniae in patients with heart disease, it was hoped that this microbe might be behind heart disease and atherosclerosis [28] Hurting this was the low incidence of atherosclerosis in the tropics despite Chlamydia’s high frequency there. [29]. Also Loehe, Bittman and other groups concluded that although Chlamydia, on occasion, might be present, it was not a causative factor in heart disease [30], because there was no correlation between the severity or extent of atherosclerosis and the involvement of chlamydial infection. Recently the Chlamydial hypothesis has been subject to a flurry of antibiotic trials, with mixed results, leaving some investigators to conclude that possibly Chlamydia doesn’t even play a role in atherosclerosis. [42] Certainly this was born out in two sizeable trials, one of which [47] had 1,187 participant. In neither trial [48] could any of the commonly thought of bacterial causes of heart problems – Chlamydia pneumonia and Helobacter pylori be correlated with cardiovascular disease. Nor could a virus. Also, in those trials which did show benefit antibiotics used (Azithromycin, Clarithromycin) are first line agents against certain forms of tuberculosis (fowl tuberculosis or Mycobacterium avium). Contrary to common belief, TB infections occur as a mixed infection with “atypical” TB in up to 11% of cases, even in HIV free individuals. [41] Today the antibiotic Rapamycin is used to coat coronary stents. [45] Rapamycin enhances the killing of mycobacteria like tuberculosis by human white blood cells called macrophages. [46]

Historical Associations

The association between active pulmonary tuberculosis and Acute Myocardial Infarction or heart attack has been reported and stubbornly ignored for around four and a half decades. Certainly, TB shares a more striking connection to heart disease than its nearest competitor, Chlamydia pneumonia. CDC maps for cardiovascular disease case rates bear a striking resemblance to comparable state and regional tuberculosis maps. [4,5]

Long before there was such a thing as a ‘heart specialist’ The National Tuberculosis Association created an offshoot called the American Heart Association (AHA). In one of its first bulletins, the American Heart Association came up with a long list of similarities between tuberculosis and heart disease. [17] And Ellis’s 1977 New England Journal of Medicine article [6], confirmed that the mortality rate for TB and heart disease were curiously about the same: 200 to 300 persons per 100,000.

By 1965, Rutgers investigators Livingston and Alexander-Jackson, working with sterile, post-catastrophic coronary artery and muscle specimens, established low-grade tubercular infection, staining ‘acid-fast’ (stains which did not decolorize when acid-alcohol was added) occuring in all ischemic heart specimens. [11] In that same year Russian investigators began generating their own proof that tuberculosis was causative in both atherosclerotic heart disease [18,19,20,21] and acute myocardial infarction (a heart attack) itself. [13,14,15].

Measuring Heart Trouble With Cardiac Enzymes In The Blood

Cases were soon on record of individuals with no cardiac risk factors, presenting with acute onset chest pain, ST elevation on their electrocardiogram (EKG), and elevated cardiac enzymes – all indicative of a heart attack with no other involvement than pulmonary tuberculosis [37]. As with its predecessor creatine kinase (CK-MB), today’s new enzymatic gold standard for detecting a heart attack, the troponins, are elevated in disseminated tuberculosis, an example of which can be found in TB’s role in acute pericarditis. [43]. Acute pericarditis, often not detected either until death was historically linked most commonly to Mycobacterium tuberculosis. In 1951, Christian [44] suggested that viral infection was more responsible for “idiopathic” (of unknown cause) or “benign” pericarditis. Such a viral cause, however, was never substantiated in many cases. Also, when it was found that the fatty substance (phospolipid) phosphatidylinositol  was not only housed itself inside TB’s cell wall, but was a potent coagulant and thrombin former as well – it further raised the question as to whether M. tuberculosis, by its very nature, lays down the conditions for the vessel clogging atherosclerosis behind heart disease and myocardial infarctions or heart attacks. [31]

Livingston and Alexander-Jackson [11] were far from the first ones to document lab evidence that TB can cause heart disease. Hektoen [7], Osler [8], and Schwartz [11], all documented lab and animal evidence to this effect. MacCallum [9] claimed that of all the infectious causes of heart disease, one one, tuberculosis, caused arteriosclerosis. At autopsy MacCallum cited 101 cases of advance tuberculous arteriosclerosis. In separate studies, Kossowsky [13], Tarakanova [14] and Ferrari-Sacco [15] all directly linked heart attacks with pulmonary tuberculosis.

Further evidence

There can no longer be any doubt that tubercular protein HSP-65 is involved in atherosclerosis. Xu [12] used it to cause experimental atherosclerosis in laboratory animals with normal cholesterol. George and Shoenfeld found it not only in atherosclerosis but fatty streak formation in cardiovascular blood vessels. [32] Mukherjee and De Benedictis showed also that the higher the antibodies against such tubercular protein in the body, the higher the possibility of “restenosis” or future closure of heart vessels. Also Afek proved that the higher the amount of tuberculoprotein (HSP-65) administered, the larger the area of vessel clogging atherosclerosis, even despite a low-fat diet. [34] Xu saw similar changes in New Zealand White Rabbits. [35] Xu’s rabbits had normal serum cholesterol, but when injected with tubercular protein, their arteries soon developed the classic features of arteriosclerosis in humans – both with regards to inflammatory cell accumulation and smooth cell proliferation. [IBID]. The only finding missing from Xu’s animals were “foam cells” – fat laden tissue white blood cells called macrophages in which tuberculosis lives and thrives. Xu remedied this by subjecting his animals to a cholesterol rich diet in addition to tubercular protein. this combination produced classic human heart disease, with foam cells. Xu continued to find sustained antibodies to HSP-65 in human subjects with the severe atherosclerosis predictive of mortality. [49] By 2004 Mandal and Xu even confirmed a positive association between high levels of antibodies to HSP-65, which are cytotoxic, and the vexing atrial fibrillation that often accompanies cardiac surgery. [50]

Present day heart disease “markers” have been suggest as indicators of possible heart disease, even in the 25 million US patients who have none of its “risk factors”. These include blood test for C-Reactive Protein (CRP), interleukin-6 and homocysteine [39] – all of which are similarly elevated in tuberculosis. [32,33,34,40,36].

Although blood cholesterol seems an imperfect criterion by itself for determining coronary heart disease, its intimate interaction with TB is unique. Tuberculosis is the only microorganism to depend on cholesterol for its destructive pathogenesis, and it relies upon cholesterol to enter the body’s white blood cell macrophages. [23] The tuberculous bacilli alone is able to produce [24], esterify [25], take up, modify, accumulate [26], and promote the deposition of, and release [27] of cholesterol. The statins, among the most popular drugs in America (Lipitor), inhibit Coenzyme-A compounds, and as such lower serum cholesterol levels. But they do more. Specifically, when macrophages were depleted of cholesterol by these agents, it hinders tuberculosis’s entrance into the body’s macrophages that TB likes to house in, thrive in, and depends upon. [23]

Nieto concludes that the introduction of antibiotic therapies in the 1940’s and 1950’s could have contributed to the decline of heart disease and heart attacks, and so, by 2000, the CDC found that 14% of the cardiologists in Alaska and West Virginia treated heart patients with antibiotics for angina, heat attacks, angioplasty or after by-pass surgery.

Conclusion

In Tuberculosis in Disguise, Rab and Rahman report cases of congestive heart failure and ischemic heart disease (IHD) with chest pain, raised erythrocyte sedimentation rate, leukocytosis (elevated white cell count) and inverted T-waves across the chest leads in an Electrocardiogram – otherwise indistinguishable from a heart attack, which turned out to be miliary (systemic) tuberculosis. [38]

Though more than 120 years have passed since its discovery Mycobacterium tuberculosis is still the leading cause of infectious death globally due to a single infectious agent. At least a staggering 1.7 million around the globe die of tuberculosis each year, while another 1.9 million are infected and at risk for active tubercular disease. [16] The World Health Organization [WHO] estimates that 1/3 of the planet has contracted TB. It would take such a disease of such magnitude to adequately explain the scope of cardiovascular disease, which affects, according to the CDC (Centers for Disease Control) about 61 million people, or almost one-fourth of the population of the US alone. Almost 6 million US hospitalizations each year are due to cardiovascular disease, which has become an equal opportunity disease that is now both the leading cause of death among women as well as the general US population.

There is at least as much, and probably much more evidence that Mycobacteria, particularly Mycobacterium tuberculosis causes cardiovascular disease than there is regarding Chlamydia Pneumoniae. Yet oddly, to this point Chlamydia has been pursued in therapeutic antibiotic trial after trial…………with not one such trial directed towards tuberculosis.

References

1. Benson RL, Smith KG. Experimental arteritis and arteriosclerosis associated with          streptococcal      inoculations. Arch Pathol 1931;12:924–40.

2. Thom DH, Grayston JT. Association of prior infection with Chlamydia    pneumoniae and angiographically demonstrated coronary artery disease. JAMA 1992;268:68–72.

3. Nieto FJ. Infections and atherosclerosis: new clues from an old hypothesis. Am J Epidemiol 1998;148(10):937–48.

4. CDC Map: TB case rates, United States, 2001. Atlanta Georgia: US Department of Health, Education and Welfare CDC; 2001.

5. CDC Map total cardiovascular disease – 1995 death rate. Atlanta Georgia: US Department of Health, Education Welfare CDC; 1995.

6. Ellis JG. Plague tuberculosis and plague atherosclerosis. The New England J Med 1977;296(12):695.

7. Hektoen L. The vascular changes of tuberculous meningitis. J Exper Med 1986:112.

8. Osler W. Diseases of the arteries. In: Osler W, MacCrae T, editors. Modern medicine Its theory and practice in original contributions by Americans and foreign authors, vol. 4. Philadelphia, PA: Lea & Fabiger; 1908. p. 426–47.

9. MacCallum WG. Acute and chronic infections as etiological factors in arteriosclerosis. In: Cowdry EV, editor. Arteriosclerosis A survey of the problem. New York: MacMillan Co; 1933. p. 355–62.

10. Schwartz P. Amyloid degeneration and tuberculosis in the aged. Gerontologia 1972;18(5-6):321–62.

11. Livingston V. Cancer: a new breakthough. Los Angeles: Nash Publishing; 1972.

12.  Xu Q. Dietrich Induction of arteriosclerosis in normocholesterolemic mice and rabbits by immunization with heat shock protein 65. Arterioscler Thromb 1992;12:789–99.

13. Kossowsky WA, Rafii S. Letter: acute myocardial infarction in miliary tuberculosis. Ann Intern Med 1975;82(6):813–4.

14. Tarakanova KN, Terent’eva GM. Myocardial infarct in patients with pulmonary tuberculosis. Probl Tuberk 1972;50(4):90–1.

15. Ferrari-Sacco A, Ferraro U. Myocardial Infarct and Pulmonary Tuberculosis. Discussion of 2 cases of myocardiocoronary disease appearing during hospitalization in a sanatorium. Minerva Cardioangiol 1966;14(8):465–75.

16. Dye C, Scheele S. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. JAMA 1999;282:677–86.

17. AHA Similarity of tuberculosis and heart disease. Bull Am Heart Assoc 1927;2(5):22.

18. Bruade VI. Cardiovascular diseases in conjunction with pulmonary tuberculosis (pathological-anatomical findings). Sov Med 1966;29(12):104–7.

19. Kamyshnikova VS, Kolb VG. Biochemical factors involved in atherogenesis in pulmonary tuberculosis. Probl Tuberk 1984;11:48–52.

20. Kazykhanov NS. Lung tuberculosis in patients with atherosclerosis. Sov Med 1965;28(8):37–44.

21. Kazykhanov NS. Arteriosclerosis in patients with pulmonary tuberculosis. Kardiologiia 1967;7(10):137.

22. Okayama A. Ueshima changes in total serum cholesterol and other risk factors for cardiovascular disease in Japan, 1980–1989. Int J Epidemiol 1993;22:1038–47.

23. Gatfield J, Pieters J. Essential role for cholesterol in entry of mycobacteria in macrophages. Science 2000;288:1647–750.

24. Lamb DC, Kelly DE. A sterol biosynthetic pathway in mycobacterium. FEBS Lett 1998;437(1-2):142–4.

25. Kondo E, Kanai K. Accumulation of cholesterol esters in macrophages incubated with mycobacteria in vitro. Jpn J Med Sci Biol 1976;29(3):123–37.

26. Av-Gay Y, Sobouti R. Cholesterol is accumulated by mycobacteria but its degradation is limited to non-pathogenic Heart disease: the greatest ‘risk’ factor of them all 777 fast growing mycobacteria. Can J Microbiol 2000;46(9):826–31.

27. Kamyshnikov VS, Kolb VG. Lipid metabolism and atherogenesis in tuberculosis in experimental animals. Probl Tuberk 1993;4:53–5.

28. Gurfinkel E, Bozovich G. Chlamydia pneumoniae: inflammation and instability of the atherosclerotic plaque. Atherosclerosis 1998;140(Suppl 1):31–5.

29. Stille W, Dittmann R. Arteriosclerosis as a sequela of chronic Chlamydia pneumoniae infection. Herz 1998;23(3):185–92.

30. Loehe F, Bittmann I. Chlamydia pneumoniae in atherosclerotic lesions of patients undergoing vascular surgery. Ann Vasc Surg 2002;16(4):467–73.

31. Rota S  Rota S  Mycobacterium tuberculosis Complex in Atherosclerosis  Acta. Med. Okayama 59:6 pp.247-251 2005

32. George J, Shoenfeld Y. Enhanced fatty streak formation in C57BL/6J Mice by immunization with heat shock protein-65 arteriosclerosis. Thromb Vasc Biol 1999;19:505–10.

33. Mukherjee M. De Benedictis association of antibodies to heat-shock protein-65 with percutaneous transluminal coronary angioplasty and subsequent restenosis. Thromb Haemost 1996;75(2):258–60.

34. Afek A, George J. Immunization of low-density lipoprotein receptor deficient (LDL-RD) mice with heat shock protein 65 (HSP-65) promotes early atherosclerosis. J Autoimmun 2000;14(2):115–21.

35. Xu Q, Kleindienst R. Increased expression of heat shock protein 65 coincides with a population of infiltrating T lymphocytes in atherosclerotic lesions of rabbits specifically responding to heat shock protein 65. J Clin Invest 1993;91:2693–702.

36. Markkansen T, Levanto A. Folic acid and vitamin B12 in tuberculosis. Scand J Haemat 1967;4:283–91.

37. Bakalli A  Osmani B  Acute myocardial infarction and pulmonary tuberculosis in a young female patient: a case report Cases Journal 1: 246 2008

38.  Rab SM, Rahman M. Tuberculosis in disguise. Brit J Dis Chest 1967;61:90–4.

39. Wilson PW. Homocysteine and coronary heart disease: how great is the hazard? JAMA 2002;288(16):2042–3.

40. Bajaj G, Rattan A. Prognostic value of ‘C’ reactive protein in tuberculosis. Indian Pediatr 1989;26(10):1010–3.

41. Tsukamura M, Mizuno S. Occurrence of Mycobacterium tuberculosis and strains of the Mycobacterium avium- M. intracellulare complex together in the sputum of patients with pulmonary tuberculosis. Tubercle 1981;62:43-46.

42. Pislru S Van de Werf F  Editorial: Antibiotic Therapy for Coronary Artery Disease. Can Wizard Change It All? JAMA. 2003;290: 1515-1516

43.  Imazio M Demichelis B  Cardiac Troponin I in Acute Pericarditis  Journal of the American College of Cardiology Vol.42, No. 12 pp. 2144-2148  2003

44. Christian HA Nearly ten decades of interest in idiopathic pericarditis  Am. Heart J. 42:654 1961

45. Li YL  Wan Z  Comparison of Sirolimus- and Paclitaxel-Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: A Meta-analysis of Randomized Trials. Clin Cardiol. 2010 Sep;33(9):583-90.

46. Floto AF  Sarkar S Perlstein EO Addendum: Small Molecule Enhancers of Rapamycin-Induced TOR Inhibition Promote Autophagy, Reduce Toxicity in Huntington’s Disease Models and Enhance Killing of Mycobacteria by Macrophages. Autophagy  Landes Bioscience 3:6, 620-622; November/December 2007.

47. Haider AW Wilson PW  The association of seropositivity to Helicobacter pylori, Chlamydia pneumonia, and cytomegalovirus with risk of cardiovascular disease: a prospective study. J. Am Coll Cardiol. 2002 Oct 16;40(8):1408-13.

48.  Ridker PM Kundsin RB Prospective study of Chlamydia pneumonia IgG seropositivity and risks of future myocardial infarction. Circulation 1999 Mar 9;99(9):1161-4.

49. Xu Q Kiechl S Association of Serum Antibodies to Heat-Shock Protein 65 With Carotid Atherosclerosis – Clinical Significance Determined in a Follow-Up Study Circulation 1999;100:1169-1174.

50. Mandal K Jahangiri M  Association of Anti-Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial  Fibrillation.  Circulation 2004;110:2588-2590.

 

© 2010

Edema info

Edema is a general term for excess fluid build-up in a specific area of the body, multiple areas of the body, or throughout the body (generalized edema or anasarca). Edema can be temporary or permanent depending on its cause. Edema occurs when there is an imbalance, specifically an excess, of body fluid moving between the blood vessels and body tissues. This excess fluid is retained in the tissues and results in swelling. Pulmonary edema is edema in the lungs, ascites is edema in the abdomen, and edema in the lower extremities is called peripheral edema or dependent edema. Temporary edema, e.g., swelling caused by pregnancy and inactivity, is not usually serious. More persistent and serious cases of edema are usually caused by heart failure, kidney failure, or liver disease. The underlying cause of edema is best determined by a physician. Anyone can have edema but it is more common in individuals who are severely ill.Certain conditions increase the risk of developing edema including abnormal blood flow in the lower extremities (venous insufficiency), immobility, heat, certain medications, salt intake, menstruation, pregnancy, heart failure, kidney disease, thyroid disease, liver disease, and malnutrition. Venous insufficiency affects the feet or ankles and may occur only on one side of the body. Being immobile causes blood to collect in the veins so fluid has more difficulty moving from the tissues back into the circulatory system and edema results. Heat causes blood vessels to expand which makes it easier for fluid to move into surrounding tissues. Excess intake of salt causes retention of fluid. Certain drugs including steroids (drugs that reduce swelling or inflammation), hormones, non-steroidal anti-inflammatory drugs (NSAIDs), and some high blood pressure medicines may contribute to the development of edema. Edema can be a side effect of some medications. Edema may occur as a result of premenstrual syndrome (PMS). Swelling of the hands, feet, and face are common in pregnancy due to increased retention of sodium and water and pressure from the uterus on the veins in the lower extremities. In congestive heart failure, because the heart muscle is weakened, its pumping action is decreased; therefore, fluid builds up in the lungs and other parts of the body. If there is right-sided heart failure, there is swelling in the legs and abdomen. In left-sided heart failure, there is pulmonary edema. Decreased excretion of sodium and fluid occurs in kidney disease causing fluid build-up. Thyroid disease, liver disease, and malnutrition affect movement of fluid in and out of tissues resulting in edema. Symptoms of edema depend on its location and cause. Generally the area affected by edema will be stretched and have a shiny appearance. Edema may be pitting or non-pitting. In pitting edema, pushing on the swollen area with a finger for several seconds will leave an indention on the skin after the pressure is released. The level of indentation determines the degree of pitting edema. Non-pitting edema will not leave an indentation. Clothing and jewelry may feel tight and urine output may be decreased even with normal intake of fluids. In pulmonary edema, symptoms may include shortness of breath, difficulty breathing, and bluish color to the lips and fingernails. In ascites, the abdomen may be distended. Symptoms of peripheral edema include swelling in the lower legs, which worsens after sitting or standing for long periods of time.Treatment is aimed at correcting the underlying cause of edema. The physician may order fluid pills (diuretics) to remove excess fluid. Pulmonary edema requires immediate medical attention since fluid in the lungs impairs oxygen transport from the lungs to the blood system. Edema associated with heart failure may require heart medication or heart surgery. For edema associated with lung disease, quit smoking.If edema is caused by liver disease, avoid alcohol intake. In some cases, edema may be treated by flushing fluids out of the body, i.e., paracentesis for ascites.

Sudden Cardiac Death in Sports: Pre-participation Screening of Athletes

Definition

Sudden death in sport (SD) is defined as natural death that occurs within one hour of onset of symptoms in a fit individual participating in, usually, an elite level sport. Sudden cardiac death contributes to 93% of all sudden deaths in sport. This apparently occurs in a person without previously recognized predisposing cardiovascular conditions. In some instances, pre-existing symptoms may already have been present, but the time and mode of death are unexpected. This excludes cerebrovascular, respiratory, traumatic and drug related causes which are the origin of the other 7% of sudden deaths”. A significant cause of death in contact sports is commotio cordis, which is referred to in one of my other articles.

Incidence

The incidence of SD is estimated to be about one death in 1 in 200000 per year with an average of 300 deaths per year, but the incidence could be higher according to some European studies. An Italian study suggested an incidence of 1.6 – 2.3 per 100000 athletes per year (2.1 per 100000 per year due to cardiovascular causes) and 0.8. This clearly reflects an increased incidence in athletes.

Symptoms

most of cases are asymptomatic

in the rest, symptoms occurring prior to with SD are

i. angina (chest pain)

ii. dyspnoea (breathlessness)

iii. palpitations (awareness of one’s heart beating)

iv. pre syncope or syncope (light headedness or fainting)

Etiology

Cardiovascular causes of sudden death

– Hypertrophic Cardiomyopathy (HCM)non obstructive, obstructive, ischemic, etc – Valvular disease: Aortic stenosis, Mitral Valve Prolapse

– Coronary artery disease

– Congenital anomalies of coronary arteries

– Idiopathic concentric left ventricular hypertrophy

– Aortic rupture

– Right ventricular dysplasia (ARVC)

– Myocarditis: viral, sarcoidosis, amyloidosis

– Arrhythmias and conduction defects Congenital heart disease: Marfan’s, WPW syndrome

– Pulmonary embolisation

Drugs

– QT interval increasing: cisapride, domperidone,chlorpromazine, haloperidol, pimozide, erythromycin and clarithomycin

– epinephrine, ephedrine, cocaine, etc

– performance enhancing: erythropoietin (hyperviscocity & thrombogenesis) anabolics

Commotio cordis (CC)

sudden impact on the precordium, during a vulnerable period of the cardiac cycle cause ventricular fibrillation and sudden death without any visible injury to the sternum or ribs, e.g. contact sport. In 80% of cases of sudden cardiovascular death in athletes, the cause has been identified to be either hypertrophic cardiomyopathy or arrthymogenic right ventricular cardiomyopathy.

Age considerations

In general, in athletes > 35 years of age, atherosclerotic coronary arterial disease is the leading cause while in those < 35, it is often caused by HCM, a silent cardiac condition which gets unmasked during performance.

Geographic considerations in etiology

In the US, hypertrophic cardiomyopathy is the major cause of SD. In contrast, in Europe, cardiac arrhythmias and abnormal cardiac arterial anatomy is supposed to be the leading cause. An interesting statistic is that of all the sudden deaths in the US, 50% were found to be amongst athletes of Afro-American origin. In Asia, on the contrary, (the Philippines, Thailand, Japan), Brugada syndrome seems to be the most common cause of natural death in men younger than 50 years of age. This relates to cardiac arrest occurring during sleep or at rest and not during a sport performance . An importance observation is these cases had been the reports episodes of nightmares occurring prior to the event. This might suggest a role of the sympathetic nervous system.

Risk Stratification of Sudden Cardiovascular Death

Clinical

a. Double apical impulse with each ventricular contraction

b. Carotid jerky double pulsation, called pulses bisferiens

c. Ejection systolic murmur

Laboratory Investigations

Non-invasive

a. ECG: suggestive of LVH, in addition, there is ST segment depression, gross T wave inversions, pathologic Q waves, and suggestion of LBBB, left axis deviation

b. 2D Echocardiography: to measure the thickness of the Left ventricular wall, and the anatomical variations of the Mitral valve

c. Angio–CT

d. MRI

e. Doppler Study: to access the blood flow through the chambers

f. Ambulatory Holter monitoring Invasive Cardiac catheterization: to assess the pressure gradient between the LV and the ascending aorta, in normal heart there being no such difference

Pre-participation screening / exercise testing of athletes

Overwhelming majority of sports researchers agree on the need for preparticipation screening in sports. it is mandatory in the US and Italy. In Australia, it has been made compulsory in some sports. The American Heart Association has laid down specific recommendations for the screening of athletes. These state that ‘some form of pre- participation cardiovascular screening for high school and collegiate athletes is justifiable and compelling, based on ethical, legal and medical grounds’. Noninvasive testing can enhance the diagnostic potential of the standard history and physical examination; however it is not prudent to carry out routine use of tests as 12-lead ECG, echocardiography, or graded exercise for detection of CV disease in large populations of athletes. The Laussane recommendations have also laid down specific guidelines for pre-screening. However, guidelines by different bodies have given rise to a lot of debate and no single guideline can be considered satisfactory.

Treatment

Usually, the underlying mechanism of sudden cardiovascular death is ventricular fibrillation; hence, as such can be treated with defibrillation. Thus in elite sport, up gradation of sport first aid infrastructure, with routine employment of automated external defibrillators (AEDs) is the need of the hour. Keeping in mind the ABC of resuscitation, the surviving sports person is then transported to a referral heath unit for investigation into the causes of the event. Admission to an ICU for observation or management is usually warranted.

Discussion

In general, a lot of research has been done and a lot written about sudden cardiovascular death related to sport, but thanks to different outcomes of various studies, confusion still prevails about the exact definition of the condition, and indeed, what exactly causes it. Although, we know of conditions which may predispose to sudden death, we cannot as yet, on the basis of screening tests or procedures available, say for sure what condition(s) will definitely lead to sudden death. Hence, the major dilemma surrounding banning athletes from competition. On the one hand, there is the ethical issue of preventing risks that can lead to death, while on the other, there is the thought of banning the athlete when you are not sure if his/her heart condition is indeed a pathologic state. One may argue that taking risks is an inherent part of sports, esp. boxing, car racing, etc but life threatening risks should be a strict ‘no-no’. To conclude, exercise or sport may lead to sudden death but the benefits of exercise far outweigh the risks involved. Even in elite athletes, the risk-benefit ratio is to be taken into consideration when disqualifying him or her from competition. It is of paramount importance to judge whether the left ventricular wall thickness is a measure of physiologic adaptation to exercise or relates to a cardiac pathologic state. Physical exercise per say does not cause cardiovascular death. Does it, then, unmask a cardiac condition to cause a heart attack which otherwise would not have occurred had the person not been exercising or playing sport? That is the question for the medical community to answer. With a society dealing with ever increasing medical conditions associated with a sedentary lifestyle and unhealthy dietary habits, humanity can ill afford to be discouraged from participation in sport or exercising under any pretext unless irrefutable proof of exercise causing death exists.

Coenzyme Q10 – A Proven Stroke Treatment in 3 Pills

Coenzyme Q10 – A Proven Stroke Treatment in 3 Pills.

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There are 3 unrefuted scientific treatments that aid stroke recovery.

Coenzyme Q10

Rehabilitation

Time

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Coenzyme Q10 helps stroke victims recover.

“We report an unexpected favorable recovery from a complicated cerebral hemorrhage that is consistent with the remarkable results obtained for animal models of stroke using coenzyme Q10.” (John T.A. Ely, Ph.D.; H.Hugh Fudenberg, M.D.; Emile G. Bliznakov, M.D.; John D.Branch, D.O.).

“Because of increasing worldwide use of Q10, we are able serendipitously to report on possibly the first observation of a human recovering almost completely from unexpected and severe stroke following four weeks of pretreatment with Q10 at a pharmacologic dose commonly employed for a wide variety of disorders.” (John T.A. Ely, Ph.D.; H.Hugh Fudenberg, M.D.; Emile G. Bliznakov, M.D.; John D.Branch, D.O.).

Cells don’t immediately die from a stroke, as was once thought, rather they are heavily compromised due to lack of oxygen. “Neurons within the penumbra are functionally impaired but not yet dead.” (Eng H. Lo, PhD; Michael A. Moskowitz, MD; Thomas P. Jacobs, PhD, 2004).

Coenzyme Q10 is the catalyst of all energy production in each and every cell in the human body. CoQ10 functions in every cell of the body to synthesize energy. The highest concentrations of coenzyme Q10 in the body in descending order is the heart, kidney, liver, pancreas and brain. Supplementing with high dosages of coenzyme Q10 energetically invigorates all cells in the human body, particularly the brain and the heart. In a recent study, CoQ10 ubiquinol produced a 56% increase in cellular energy production in the brain. (Pharmacologyonline. 2009;1:817-25).

Mice fed coenzyme Q10 and induced with stroke had almost no damage compared to the control group. (Dr. Jean Cahn et al 1981).

Mice fed coenzyme Q10 lived 56% longer compared to the control group. (Bliznakov, Biochemical and Clinical Aspects of Coenzyme Q10, 1981).

“We conclude that CoQ10 has a protective effect on the brain from infarction and atrophy induced by ischemic injury in aged and susceptible transgenic mice.” (John T.A. Ely, Ph.D.; H.Hugh Fudenberg, M.D.; Emile G. Bliznakov, M.D.; John D.Branch, D.O.).

“In 26 years of animal model stroke studies, one substance that afforded a markedly higher degree of protection than all others tested was a normal endogenous molecule, coenzyme Q10”. (John T.A. Ely, Ph.D.; H.Hugh Fudenberg, M.D.; Emile G. Bliznakov, M.D.; John D.Branch, D.O.).

“From human clinical trials in cardiology, cancer and infectious disease alone it appears that significant improvements in health and major decreases in cost of health care are associated with Q10 supplementation.” (Langsjoen, PH. Introduction to Coenzyme Q10, 1995. On Univ of Wash).

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Read the science. CoQ10 protects the brain.

“We report an unexpected favorable recovery from a complicated cerebral hemorrhage that is consistent with the remarkable results obtained for animal models of stroke using coenzyme Q10.” (John T.A. Ely, Ph.D.; H.Hugh Fudenberg, M.D.; Emile G. Bliznakov, M.D.; John D.Branch, D.O.).

“We conclude that CoQ10 has a protective effect on the brain from infarction and atrophy induced by ischemic injury in aged and susceptible transgenic mice.” (Geng Li, Liangyu Zoub, Clifford R. Jack Jr. C, Yihong Yang D, Edward S. Yangad, Hong Kong, Department of Neurology, The First Affiliated Hospital, Harbin Medical University, 2005).

“Gerbil survival to 40 days following carotid ligation induction of ischemic stroke, was 45% on Q10, over twice the 20% on naloxone, the second best agent tested (no deaths occurred after day 4 and the experiments were terminated at day 40)”. (Norio Ogawaa, Shuji Tsukamotoa, Yukiko Hirosea and Hiroo Kuroda* a Institute for Neurobiology Okayama University Medical School, Japan 1985).

“CoQ10 supplementation is beneficial in the prevention, treatment or cure of heart disease, stroke, cancer, viral diseases including AIDS, etc. CoQ10 slowed aging markedly, restored youthful thymic response to viruses and tumors, and extended lifespan 50% when given to very old mice.” (Bliznakov, 1973). Safety and efficacy of CoQ10 has been demonstrated in numerous very large clinical trials. (Langsjoen 1995; Langsjoen and Langsjoen 1999; Ely and Krone 2000).

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About coenzyme Q10.

Coenzyme Q10, also known as ubiquinone and ubiquinol (the reduced version that the body uses and thereby the more effective form of coenzyme Q10), is an essential component of the mitochondria, the energy producing unit of each and every cell in the human body. Every single body process and function requires coenzyme Q10. The body uses coenzyme Q10 to produce adenosine triphosphate (ATP), needed for cellular energy production and cell growth. Coenzyme Q10 is also a powerful antioxidant that helps protect cells from damage that could potentially lead to cancer. Coenzyme Q10 is produced by the body with highest concentrations in organs such as the brain, heart, liver, and kidney. After being absorbed into the body, more than 90% of CoQ10 is converted to its active form, known as (CoQH2-10) or ubiquinol. Ubiquinol has strong antioxidant properties. Conditions that cause oxidative stress on the body, like liver disease, decrease the ratio of ubiquinol to CoQ10. Coenzyme Q10 is used as a treatment for numerous conditions and continues to develop a reputation as a miracle vitamin and is recommended and studied as a potential treatment for cardiac, neurologic, oncologic, and immunologic disorders. Coenzyme Q10 production by the body peaks by early 20’s and drops steadily thereafter and drops quicker in disease states. Animal models have proven that coenzyme q10 supplementation not only lengthens life but also enhances the “quality” of life.

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Medical Disclaimer. This article has been written by Stroke Ally for information purposes only. It does not provide medical advice, diagnosis, treatment or care. If you have a health problem, medical emergency, or a general health question, you should contact a physician or other qualified health care provider for consultation, diagnosis and/or treatment. Under no circumstances should you attempt self-diagnosis or treatment based on anything you have seen or read on this website.

Pieckenhagen, Curt Pieckenhagen, Curt-Michael Pieckenhagen

Causes of Heart Attacks – Being a bit overweight can help you live longer

Causes of Heart Attacks – I have always been a bit overweight and was comforted by a new report that suggests that carrying just a few extra pounds may increase my life expectancy.

They have completed the most extensive and comprehensive research to date and analysis of the results of their research used the very latest technology in statistical analysis. Their conclusions have confirmed the results of those found recently in other much smaller surveys.

These showed that people who are a little bit overweight have a better life expectancy than those who are considered to be normal weight. Also those people who are under-weight carry a risk of a shorter than normal life expectancy.

Being overweight has always been listed as one of the Causes of Heart Attacks . But now it seems as if we can all get away with being just a few pounds over what was originally agreed as the Healthy Weight.

Analysing these new results has come up with some surprising findings. The biggest causes of deaths in America is still smoking but being over-weight used to be the second biggest killer and the Signs of Heart Attacks. Now, being over-weight has moved down the list from number 2 to number 7.

It is thought that this is due to more public awareness on What Causes Heart Attacks, diet and lifestyle. More people are looking at their food intake and deciding to eat healthier foods, take measures to keep their cholesterol and blood pressure levels in check, and increase their exercise and energy levels.

Commentators on this new report suggest that maybe the medical community and the government need to review the levels that were originally defined as normal and raise them in line with this new research.

This research only applies to people who are just a bit over-weight. For the people who are considered to be very or morbidly obese then the same old rules apply and this is still one of the major Causes of Heart Attacks .

Information on Heart Disease

Heart disease, also known as cardiovascular disease, includes a number of conditions affecting the heart: congestive heart failure, congenital heart disease, and heart attack, among others. If you don’t know the symptoms, you could be at risk and not even know it. Heart disease is the leading cause of death for men and women in the U.S. Keys to prevention include quitting smoking, improving cholesterol, controlling high blood pressure, maintaining a healthy weight, and exercising.

The heart consists of a muscle (myocardium) that pumps blood, arteries that supply blood to the heart muscle, and valves to ensure that the blood is pumped in the correct direction. At any point in the pumping process, or in any part of the heart, something can go awry. The diseases and conditions affecting the heart are collectively known as heart disease.

Heart disease is the leading cause of death in the United States and is a major cause of disability. Almost 700,000 people die of heart disease in the U.S. each year. That is about 29% of all U.S. deaths. Heart disease is a term that includes several more specific heart conditions. The most common heart disease in the United States is coronary heart disease, which can lead to heart attack.

Chest pain (angina pectoris) occurs, for instance, when the oxygen demand of the heart muscle exceeds the oxygen supply because of that narrowing in the coronary arteries. When the imbalance of oxygen supply lasts for more then a few minutes, heart muscle can begin to die, causing a heart attack (myocardial infarction). This may occur without symptoms (silent heart attack), especially in people with diabetes.

Symptoms of heart disease varies according to the type of heart disease. Unfortunately, some heart diseases cause no symptoms early in its course. When symptoms occur, they vary from person to person. Symptoms may may include chest pain, shortness of breath, weakness and fatigue, palpitations (the sensation of the heart beating in the chest), lightheadedness, and fainting, or feeling about to faint.

A heart attack is an injury to the heart muscle caused by a loss of blood supply. The medical term for heart attack is “myocardial infarction,” often abbreviated MI. A heart attack usually occurs when a blood clot blocks the flow of blood through a coronary artery — a blood vessel that feeds blood to a part of the heart muscle. Interrupted blood flow to your heart can damage or destroy a part of the heart muscle.

After age 50, your health care provider will recommend a screening colonoscopy. This test involves giving you IV sedation to make you sleepy, then passing a very small, flexible scope into your lower intestine (the colon) via your rectum. It can be a bit uncomfortable, but not painful, and the outcome is well worth this discomfort. This is because the provider can directly visualize any colon polyps that are present and remove them. Colon polyps are usually a type called an “adenoma,” which can develop into a cancer.

High blood pressure increases the heart’s workload, causing the heart to enlarge and weaken over time. When high blood pressure exists with obesity, smoking, physical inactivity, high blood cholesterol levels or diabetes, the risk of heart attack increases greatly. Although the cause of most high blood pressure is unknown, it can be controlled.

The risk of coronary heart disease can be reduced by taking steps to prevent and control those adverse factors that put people at greater risk for heart disease and heart attack. Additionally, knowing the signs and symptoms of heart attack, calling 911 right away, and getting to a hospital are crucial to the most positive outcomes after having a heart attack. People who have had a heart attack can also work to reduce their risk of future events.

Tuberculosis is a Contagious Disease

Tuberculosis is a germ infection caused by Mycobacterium tuberculosis which generally affects the lungs, but it can also affect kidneys, lymph nodes, spine, intestinal tract and brain.

Tuberculosis is spreading by air, if an infected person coughs sneezes or shouts, the germs spreading into the air. By inhaling them other people get infected.

After the discovery of the BCG vaccine and of the antibiotic treatment of TB, the number of TB cases declined in the early 1980’s and experts thought that the disease would be eradicated by 2010. But between 1985 and 1991 more and more cases of TB were discovered in US. Since 1992, in US, the number of reported cases declined continuously and so, in 2004 there was a 46% drop of reported cases from 12 years earlier.

One of the reason why tuberculosis has spread so quickly lately is the increased number of patients infected with HIV. HIV leads to a weakened immune system, and so, TB has a free way to develop, and passes quickly from the primarily stage to the secondary stage.
The germ can reactivate if a person has a weakened immune system like in the cases of AIDS, post surgery, after other infections, in miners and foundry workers, and in those who have scars of healed tuberculosis.

Also, the risk of catching TB increases with the frequency of contacting other infected people, with miserable living conditions and with poor nutrition.

Another factor that helps tuberculosis to spread is the fact that some patients do not finish their antibiotic treatment. This treatment must be followed a long period of time (6 to 9 months), and often, if patients feel better they interrupt the treatment, believing that they are cured, but this is only an illusion, because TB germ is still alive, can activate instantly and spread itself to other healthy people. This fact also could lead to the mutation of the germ that becomes multi drug resistant, and does not respond properly to the known treatment, and so, scientists must discover new efficient drugs.

Nowadays people have businesses to take care of, and they have to travel a lot. Tourism as well has developed and gained a lot of interested people in this activity. All these activities can lead to a contamination with the TB bacterium and its transportation back home where healthy people are.

In preventing Tb from spreading, governments need to develop special international measures and communicate with people. Also, regular controls should be made along with the education for health.

So, if you want to find more about tuberculosis treatments or even about mycobacterium tuberculosis please click this link http://www.tuberculosis-center.com

The US Economy Strength

The US economy strength has taken a beating lately due to the financial strain posed by shaky financial markets and the existence of troubled assets across many companies. In fact, the weight of these troubles continues to plague established financial institutions to such a degree that it might be quite a while before the tide turns.

The Treasury might have the authority to purchase troubled assets in an attempt to stem the downward spiral of the US economy, but that doesn’t mean that this strategy is going to be successful. The intentions of the “Emergency Economic Stabilization Act of 2008” might be clear, but they do not come with a guarantee. What does this fact do for the American people? After all, in order to trust that the financial world will straighten itself out and the US economy strength will rebound, one has to have a certain element of faith. Faith in the system seems to be in short supply at the moment.

How many individuals are wondering if the US economy can rebound and gain back its once robust strength? How many companies and corporations is the US government going to have to bail out before the economy takes a turn for the better? These are all good questions that only time will tell.

Certain signs do exist that the US economy retains strength in some areas. In particular, according to the US Treasury, US exports grew over the last four quarters. In fact, the growth, which was boosted by a strong growth in global markets, reached 11 percent. Plus, core inflation remained constant or contained. According to the latest figures from the US Treasury, the consumer price index had risen 2.5 percent over the last twelve months if one excludes things such as the cost of energy and food.

Unfortunately, the US economy shows no strength when it comes to the area of employment. The number of paid workers decreased again in September, more than doubling the decrease that paid employment met with in August in the United States.

The primary goal of the “Emergency Economic Stabilization Act of 2008” is that the package will infuse sufficient capital into troubled financial institutions to allow them to rebound effectively enough to circumvent the downward spiral that is currently going on. It is intended to provide a temporary boost that will help the economy to navigate around the negative drag of the housing market and its woes. This strategy is designed to encourage US economy strength that will far outmaneuver any negative consequences of the troubling financial situation currently facing businesses and corporations in the RS today.

The US government does not intend for the negative aftershocks of a slowing economy to linger. The goal is to have the stimulus package create new growth that increases the US economy’s strength, bringing it back to the robust financial level of better days. Indeed, the long-term growth of the US economy strength is as much a part of the picture as the short-term growth of the US economy strength.

Differentiate ‘Unspecified' Vs.‘Uncertain' Neoplasms — Here's How

Don’t let 238/239 confusion leave medical necessity to chance.

You may feel “uncertain” when choosing a neoplasm code which is for a pathology report — however that doesn’t mean the lesion is uncertain.

Mistaking “uncertain” for “unspecified” might cost you, based on payers’ covered diagnosis lists that influence medical necessity decisions. Take a look at medical billing and coding experts’ explanations and examples to ensure you know the difference.

Know the Big Picture

To know the uncertain/unspecified distinction, you need to comprehend the overall neoplasm diagnostic classification scheme. The ICD-9 neoplasm table differentiates cancers as malignant, benign, uncertain, or unspecified.

Let’s begin with the malignant/benign difference, as that’s the key to understanding the “uncertain” classification. Malignant neoplasms are cancerous, and could be noninvasive (in situ), or invasive.

ICD-9 further subdivides invasive cancers as “primary,” implying that the cancer rises from surrounding cells, or”secondary,” implying that the cancer metastasized (spread) from a primary malignancy located somewhere else in the body.

Depending on location, ICD-9 differentiates the cancer types with different codes. For instance, for the female breast areola you would select from the following ICD-9 codes:

  • 174.0 – (Malignant neoplasm of female breast, nipple and areola)
  • 198.81 – (Secondary malignant neoplasm of breast)
  • 233.0 – (Carcinoma in situ of breast)

Benign neoplasms are cancer-free. For instance, for a fibroadenoma of the breast, you must report 217 (Benignneoplasm of breast).

Tip: Don’t report each benign neoplasm by means of the general benign neoplasm code for that body site, for instance ICD-9 code 219.x (Other benign neoplasm of uterus). Select the code based on the specific description from the pathology report, like fibroid tumor as 218.x (Uterine leiomyoma)

Make Certain It’s Uncertain

Benign and malignant aren’t the lone neoplasm classifications available. Sometimes the pathologist identifies a neoplasm that is currently benign but exhibits characteristics indicating that it might becomemalignant,” Stainton says. Because the tumor has an “unpredictable” behavior, it fits a category called “neoplasm of uncertain behavior.” ICD-9 defines these tumors as “histomorphologically well-defined neoplasms, the subsequent behavior of which cannot be foretold from the present appearance.”

Uncertain is not unspecified: Neoplasms of uncertain behavior have very precise histology that the pathologist describes. They are certainly not unspecified.

Recognize key words: In case the pathology report specifies atypia or dysplasia, the neoplasm is “in transition” from benign to malignant and is thus “uncertain.” In case the process continues and the mass goes untreated, the neoplasm could finally become malignant.

Example: Tubular adenomas of the colon are at risk for becoming malignant. In case the pathology report indicates other biopsy conditions, like high-grade dysplasia, you could report ICD9 codes 235.2 (Neoplasm of uncertain behavior of stomach, intestines, and rectum).

You’ll find the codes for uncertain behavior in the following ICD-9 categories:

  • 235 – (Neoplasm of uncertain behavior of digestive ad respiratory systems)

Pneumonia Prevention

Pneumonia refers to lung inflammation. There are 50 such lung inflammatory ailments. During such situations, the lungs inevitably experience build up of fluids. Several micro-organisms cause pneumonia. Pneumonic inflammation of the lungs occurs due to collection of cellular wastes and blood cells within the air sacs within the lungs. Such pneumonic inflammation creates breathing problems.

possible symptoms may be :

* Fever, which may be less common in older adults.
* Fast heartbeat is one of the primary symptom of pneumonia.
* Feeling very tired or feeling very weak .
* Loss of appetite may occur in case of pneumonia.

Pneumonia is a common type of pulmonary disease that involves inflammation and infection of the lungs, triggering an overproduction of mucus at the level of the respiratory tract. The intensity and the duration of the symptoms generated by pneumonia differ from a person to another, according to factors such as age, overall health and the immune system’s capability of fighting against infections.

Since Pneumonia is a very contagious illness and the infectious agents that cause the disease are transmitted through the air we all breathe, it is very easy to become infected simply through breathing. Given the fact that the respiratory system has its own natural defenses of nasal hairs, mucus and the cilia), some of the microorganisms are still able to penetrate into the lungs and cause both the inflammation and infection.

PNEUMONIA TREATMENT

The Chinese mushrooms cordyceps is available in a tonic formula to support the lungs. Clear lungs from Ridgecrest herbals is a Chinese herbal formula designed to provide nutrients to the lungs. Elderberry has antiviral properties and reduces pneumonia symptoms. Ephedra (ma huang) is beneficial for relief of congestion and coughing. Warning: do not use this herb if you suffer from anxiety, glaucoma, heart disease, high blood pressure, or insomnia, or if you are taking a monoamine oxidase inhibitor.

Pneumonia is diagnosed after a series of x-rays, MRIs and tests done on the mucus or phlegm from the throat. It can also be detected with a blood count test. If there is a high number of white blood cells then that means there is an infection present in the body. Pneumonia caused by bacteria is easily treatable with antibiotics. Pneumonia, as mentioned earlier, can be deadly.

Pneumonia can be caused by viruses, bacteria, or fungus. Bacterial causes of pneumonia are most common. The most common typical bacteria that are found in pneumonia are Streptococcus Pneumoniae, Haemophilus Influenzae, Chlamydia Trachomatis, Mycoplasma Pneumoniae, and Legionella Pneumophila.

I laugh so hard whenever I get spam mails of scammers earning 3digit/4digit/5digit figures just like that for free. There is no way you can earn such amount in a short period of time through the internet just like that. For such a thing to happen, you need hardwork, determination, consistency and microscopic observations. And one of the ways you can apply all these factors in order to achieve great success is through Article networking.

Pneumonia Prevention: There are a few things you can do to help reduce your risk for getting Pneumonia, such as: Washing your hands frequently, Don t smoke, and avoid second-hand smoke, Stay away from those who have a cold or the flu, Drink plenty of fluids, Keep Active, and if your in the Hospital try deep breathing exercises and cough up any mucus or Phlegm to help keep the lungs exercised and clear.

As we noted previously, pneumonia can also be caused by bacterias like those mentioned above. These are treated with antibiotics. If the infection is severe, these will be administered in the hospital and the patient’s breathing and oxygen requirements will be supported too.

Chronic bronchitis is a long-term condition that can last anywhere from three weeks to two years. It always comes with a danger of relapse. In severe cases of chronic bronchitis, the bronchi get dilated, and this makes the patient more vulnerable to all types of infection. Due to its life-threatening nature, it should be taken seriously, and proper medical care should be taken to keep it in check.

Pneumonia involves inflammation and infection of the lungs that triggers an overproduction of mucus at the level of the respiratory tract. Common symptoms of pneumonia are: difficult, shallow breathing, chest pain and discomfort that intensify with deep breaths, wheezing, exacerbated productive cough and moderate to high fever.

The pneumonia symptoms usually depend on its cause, but most of the patients cough, have fever and chest pain. These symptoms appear at all the patients with pneumonia, no matter what caused it.

Pneumonia generally occurs at those who have a weakened immune system, like children, old people and those who have other diseases (HIV, organ transplanted people, cancer, chemotherapy). Smoking, drinking alcohol, working in cold places are also factors of risk.

How And Why Fluid Builds Up In The Lungs

Human lungs are two large organs like a balloon inside the chest cavity located behind the heart and the upper part of the stomach. The lungs and the body’s circulatory system helps in distributed to the internal organs and carbon dioxide push out from the body. Human lungs that are like a pair of spongy organs are normally filled with air and hot fluids. When fluids build up in the lungs, the usual exchange of oxygen and carbon dioxide is prevented from happening, this can cause health problems and even death to an ill fated patient.

The question arises that why fluid buildup in the lungs. A person can have lung water or pulmonary edema when there is a fluid buildup in the alveoli. If there is a fluid buildup around the lungs, it is called pleural or pleurisy effusion.

Symptoms of fluid build-up in lungs

Pleurisy and pulmonary edema have similar causes and symptoms which are as under;
–    Shortness in breath
–    Wheezing sound while breathing
–    Wet bubbling sounds in the chest
–    Weakness
–    Coughs in pink or blood-tinged frothy mucus
–    Fatigue
–    Restlessness and anxiety
–    Racing heart rate or pounding
–    Swelling in feet and ankles
–    Pain in chest or sudden shortness of breath
–    Breathing might stop for a couple of seconds during sleep
–    Other symptoms like fever may occur

Causes of fluid build-up in lungs

Heart ailment is one of the health problems that can cause fluid build-up in the lungs. Circulation problems can be caused by a weak heart. When the heart fails in pumping enough blood, the blood vessels are built up by pressure around the lungs. When this pressure increases, blood steadily leaks from the capillaries, which are tiny blood vessels, into the alveoli in the lungs. A lot of blood seepage can lead to lung water or pulmonary edema.

Pulmonary edema which happens because of bad blood circulation is frequently caused by high blood pressure or a heart disorder. Although other factors not related to bad blood circulation or heart problems can also be a cause of fluid build-up in the lungs. These factors can be smoking, exposure to chemicals like ammonia, chlorine, nitrogen dioxide, working with asbestos, drug abuse, pneumonia, kidney failure, high altitude sickness and pancreatitis.

Fluids in the lungs are not an infectious condition unless it is caused by exposure to toxins. In such cases, everyone else can also be affected by toxins that were exposed to them in the same way as the patient.

Removing fluid from the lungs

Remove the fluid from lungs is the first step in treating this condition. The process is to insert a tube or needle into the lungs and use it for draining the fluid. This method may not by important if the disease is quickly diagnosed cause of the leakage problem is solved. Addressing problems with smoking or encouraging the patient to have a healthy diet is usually involved in this. Severe cases may even require an operation for removing the excess fluid.

Breathing Problems: Causes, Symptoms and Preventions

When you’re short of breath, it’s hard or uncomfortable for you to take in the oxygen your body needs. You may feel as if you’re not getting enough air. Sometimes mild breathing problems are from a stuffy nose or hard exercise. But shortness of breath can also be a sign of a serious disease.

Difficulty in breathing, shortness of breath, breathlessness or dyspnea can have various causes. Episodes of shortness of breath can occur during high levels of activity, like exhaustive exertion, or as a result of environmental conditions such as high altitude or very warm or cold temperatures. Other than these extreme conditions, shortness of breath is commonly a sign of a medical problem.

Most children who take part in baby swimming show no increased incidence of lower respiratory tract infections, ear inflammation (otitis media) or tightness and wheezing in the chest. Between 6-18 months the incidence of lower respiratory tract infections and otitis media were 13 percent and 30 percent respectively, whilst the proportion of children who experienced tightness or wheezing in the chest was 40 percent.

Causes of Breathing Problem

Breathing problems are common symptoms caused by many conditions, iCOPD (chronic obstructive pulmonary disease) a conditions involving bronchitis and emphysema.ncluding asthma, chronic obstructive pulmonary disease (COPD), other lung diseases and heart disease. Most people who have breathing problems are aware of the condition, such as when children struggle to catch their breath during an asthma attack or ex-smokers find themselves easily winded due to emphysema.

Shortness of breath can be caused by many things, including the following:

Asthma

Other lung diseases, including emphysema (say: “em-fa-see-ma”), a lung disease that is caused by smoking

Heart failure that causes fluid to collect in the lungs

Panic attacks

Symptoms Of Breathing Problems

1. Sudden onset of severe shortness of breath: This could be a flare-up of chronic lung disease like COPD, or it might mean an infection such as pneumonia or acute bronchitis or the onset of heart failure.

2. Sudden chest pain: Often sudden chest pain can indicate a heart problem, but it can also signal a lung problem, such as a collapsed lung or blood clot in the lung.

Prevention

* Wear a medical alert tag if you have a pre-existing breathing condition, such as asthma.

* If you have a history of severe allergic reactions, carry an epinephrine pen and wear a medical alert tag. Your doctor will teach you how to use the epi pen.

* If you have asthma or allergies, eliminate household allergy triggers like dust mites and mold.

What might breathing problems indicate in a newborn?

Babies breathe much faster than older children and adults. A newborn’s normal breathing rate is about 40 times each minute. This may slow to 20 to 40 times per minute when the baby is sleeping. The pattern of breathing in a baby may also be different. A baby may breathe fast several times, then have a brief rest for less than 10 seconds, than breathe again.

Bronchitis Treatment

Bronchitis is a respiratory system disease that is mostly found in the cold seasons. This is mainly because bronchitis is caused by viruses that also give us the flu or the cold. Bronchitis can also be caused by a bacteria, but this is not a very common bronchitis case. The bronchial tubes have linings that get inflated when you develop bronchitis.

Bronchitis is something you are likely to have in your lifetime at least once. Since it usually follows a cold or other respiratory condition, most people will develop it in the course of their lifetime.

Home Remedies for Bronchitis

1. Bronchitis treatment with Turmeric
2. Bronchitis treatment with Ginger
3. Bronchitis treatment with Onion
4. Bronchitis treatment with Spinach

In chronic bronchitis, there is inflammation of the mucosal membranes of the bronchial tubes due to infection, a condition that leads to an excess in the production of mucus. This extra mucus disrupts the normal breathing processes by blocking the air passages and preventing the entry of sufficient quantity of air into the lungs.

Severe bronchitis treatment may require the use of oxygen therapy to aid those who are having difficulty breathing and suffering other respiratory problems. There have been severe cases of bronchitis with lungs that were so badly damaged; a transplant was the only possibility for a cure. Obviously, this bronchitis treatment comes with its own set of risks, namely life expectancy and finding a suitable donor.

If you are a smoke or have any problems with your lungs, bronchitis can be a lot more trouble to you than you think. These people may have more than one attacks of bronchitis. Another health problem that increases the risk of bronchitis is malnutrition. This usually happens in small children or older people. Allergies are also a friend of acute bronchitis.

The second way to get bronchitis is by bacteria. However, acute bronchitis caused by fungus is very rare. This type of bronchitis is even more rare than we care to imagine. The most common cause of all in developing acute bronchitis is catching the same virus that also causes the cold.

Symptoms and Diagnosis

Only laboratory tests can tell you whether bronchitis is bacterial, viral, or fungal. Therefore, it is of utmost importance that you visit a doctor as soon as you suspect bronchitis. Physicians will properly diagnose your condition with the help of laboratory test results.

These are the symptoms of acute bronchitis–hacking cough, contracting sensation around the areas of the eye, pain in the chest, breathlessness, and headaches. It is easy to treat viral bronchitis, especially with the help of natural remedies.

Causes of Acute Bronchitis

Bronchitis usually follows a cold. The same virus that is responsible for common cold is also responsible for bronchitis. People also contract acute bronchitis due to continous exposure to irritants that can cause inflammation of the bronchial tubes. The other factors that can cause significant damage to the bronchial tubes are dangerous chemical fumes, smoke, and dust.

Signs of Bronchitis

Acute bronchitis bears a lot of resemblance to common cold. The symptoms include severe coughing, low-grade fever, fatigue, pain in the chest and throat, and wheezing.

The signs of chronic bronchitis includes persistent and productive cough, obstruction of the air passages with mucus, breathlessness, fever, chest pain, and several attacks of acute bronchitis. A chronic bronchitis patient suffers from cough especially during the winter. The cough decreases in intensity during the summer.

Pain – Shoulder Pain Causes, Tests, and Treatments

Painful shoulder conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. Your shoulder is more prone to injuries than other joints because of its wide range of movement.

About 13.7 million people went to the doctor’s office in 2003 for a shoulder problem, including 3.7 million visits for shoulder and upper arm sprains and strains. (Source: National Center for Health Statistics; Centers for Disease Control and Prevention 2003 National Ambulatory Medical Care Survey.)

One of the best ways to avoid injury is to keep physically fit, with a balanced program of aerobic exercise, stretching and strengthening exercises for your whole body. There is a range of exercise programs available from local fitness centers, to online services and even downloads for your MP3 or iPod players.

There are several reasons that cause pain and limit movement of your shoulder joint, including:

1. Rotator cuff disorders

Inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above shoulder level), heavy lifting, trauma, or poor posture. Serious injuries and untreated inflammation of the tendons can cause the rotator cuff to tear.
The pain associated with rotator cuff problems is normally felt at the front or on the outside of your shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain.

2. Rotator cuff tears

It is usually the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones) that tear, but sometimes the tear occurs in the muscle. Severe injuries can cause several of the tendons and muscles to tear. There are special movement tests that your doctor can use to help determine which of the muscles or tendons has been torn.

3. Frozen shoulder

Frozen shoulder, is characterized by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may become worse at night due to inactivity.

The exact cause of this condition is not known, but it sometimes develops following other shoulder injuries. Resting a painful, injured shoulder for too long can cause the shoulder muscles and connective structures to stiffen up, so when a shoulder injury occurs make an effort to keep it loose without putting to much strain on it.

Frozen shoulder can develop spontaneously, particularly if you have thyroid problems or diabetes seem to be at increased risk. Most people with frozen shoulder tend to improve within 2 years, with or without treatment. In the interim, however it can be quite painful.

4. Dislocated shoulder and shoulder instability

A dislocated shoulder is visibly deformed or out of place, and there may be swelling or bruising around the joint. Your shoulder movement will be severely restricted. Your Doctor can usually put the shoulder bone back into place using gentle maneuvers.

If you suffer a dislocation, keep in mind that the shoulder joint sometimes becomes unstable and susceptible to repeated dislocations. This causes pain and unsteadiness when you raise your arm or move it away from your body. Your shoulder may feel as if it is slipping out of place when you lift your arm over your head.

5. Arthritis

Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis will affect the shoulder joint.
Sometimes shoulder pain can be due to problems in your neck or a mixture of several different problems. A visit to your doctor is almost always necessary when it comes to a shoulder problem because in rare instances, shoulder pain may be caused by infection, problems with the nerves, or a tumor located somewhere else in your body.

As with any medical issue, a shoulder problem is generally diagnosed using a three-part process:

• Medical History – You tell your doctor about any injury or other condition that might be causing the pain.

• Physical Examination – Your doctor examines you by feeling for injury and to discover the limits of movement, location of pain, and extent of joint instability.

• Tests – Your doctor may order one or more of the tests for you listed below to make a specific diagnosis.

What tests are needed to determine the cause of your shoulder pain?

Your doctor will determine the cause of your pain based on your symptoms and a physical examination. Where the pain is felt, both at rest and when moving the shoulder, is a clue to the cause of the shoulder pain. Your doctor will also test your shoulder strength and the range of movement in your shoulder joint.

You may need an X-ray, or other scans, such as an ultrasound scan or MRI. Sometimes, an arthroscopy is needed. In this test, your doctor can look inside the shoulder joint using a small telescopic instrument that has a camera on the end. This is not as painful as it sounds.

How your shoulder pain will be treated

In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the extent of your shoulder problem and the level of pain.

Pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) are often used as an initial treatment for shoulder pain. Ibuprofen is the best and Aspirin should be avoided.

Another simple way of easing shoulder pain is by applying a cold pack to your shoulder for 10 minutes at a time three or four times a day. Cold packs will reduce inflammation, and are most helpful when applied for the first few days following a shoulder injury. After that, you can switch to using a heat pack; intermittent applications of heat can help relax the shoulder muscles.

A heat pad used at night when sleeping will keep the shoulder from stiffing up.
You should rest your shoulder for a couple of days after an injury, and if you have dislocated your shoulder, you may need to rest your arm in a sling or splint for several weeks after the joint has been manipulated back into place.

However, with most shoulder problems it isn’t a good idea to rest for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits of disability and pain), you can help prevent the shoulder joint from stiffening up.

Physiotherapy can help treat you shoulder pain.

Physiotherapy can help improve your shoulder strength and flexibility as well as relieve the pain associated with most shoulder problems. Physiotherapists use a variety of different therapies, including massage, ultrasound therapy, laser therapy and electrical nerve stimulation (TENS) — a therapy that uses mild electrical currents to treat pain.

Taping the shoulder joint can also help stabilize it and reduce pain during activities. Your doctor will refer you to a good Physiotherapist is he feels the extent of your injury warrants Physiotherapy.

Physiotherapists can also teach you special rehabilitation exercises to stretch and strengthen the rotator cuff muscles of the shoulder. Exercises that improve your shoulder’s range of movement help reduce the pain and stiffness that occurs after a period of immobility. Range of motion exercises may be followed by resistance exercises and weight training to strengthen the muscles.

Steroid injections can be effective but proceed with caution.

Depending on the cause of your shoulder problem, corticosteroid injections may be given to relieve the pain in the short term. The corticosteroid, which is often mixed with a local anesthetic, reduces inflammation and allows you to move the shoulder more comfortably. Make sure you understand what is involved in this kind of treatment to include the long term effect on your body. The jury is still out on the impact of this type of treatment.

Surgery may be necessary to treat your shoulder problem.

Because most people improve with the above treatments, only about 10 per cent of people with shoulder problems will need to be treated with surgery. People with shoulder instability or rotator cuff problems that are not responding to less invasive treatments may benefit from an operation, and shoulder joint replacement may be considered for people with degenerative arthritis.

There are also some conditions that need to be treated initially with an operation, including some rotator cuff tears and dislocated shoulders that cannot be reduced (put back in) with simple manual maneuvers. Sometimes frozen shoulder is treated with what’s known as manipulation under anesthesia. In this therapy, your shoulder is gently moved while you are under a general anesthetic to help improve its range of motion and of course avoid the treatment pain.

So make sure you do not self-diagnosis your shoulder problem, see your doctor. Keep in mind that it isn’t a good idea to rest it for too long or it will stiffen up. Use Cold and Heat intermittingly to speed up the healing process. Avoid strenuous activities and lifting heavy objects, but remember to move your shoulder to help make sure that you regain full use of the joint by returning to your normal activities as soon as possible and you will regain full use of your shoulder in a reasonable period of time.

But, if you are still experiencing pain, listen to it, it is a signal trying to tell you something is still wrong with your shoulder.

Recovery After Anterior Hip Replacement Surgery

Are you an arthritic? Then, attending rehabilitation sessions would surely help you to get rid of the pain that you experience due to arthritis. These sessions enable the arthritis patients perform some beneficial recreational activities so that they get some relief from their immense hip and knee joint pains. In case, attending all these rehab programs seems ineffective, the inmates should opt for surgical procedures. The effect of this disease is mostly observed on the knee joints as well as hip joints. To deal with the knee joint pains, total knee replacement surgery is undergone, while anterior hip replacement is best for hip joint pain relief.

Total hip replacement surgery approach can be divided into two categories – posterior and anterior. In posterior approach, the surgeons replace the hip from the front side, whereas in case of anterior technique, the hip joint is approached from back. Being less invasive in nature, anterior hip replacement surgery is mostly preferred by the arthritics. As far as recovery after undergoing this operation is concerned, it completely depends upon how an inmate’s overall health responds to it. Based on their health condition, however, the recovery time taken by the patients varies. An anterior hip replacement operation is not only chosen against arthritis pain, but also opted in case of joint dislocations and fractures.

As soon as anterior hip replacement surgery is undergone, the patients are placed on continuous passive motion machines, which strengthens the prosthetic hip joint and ensures its flexibility. For about two to four days, an arthritic is required to stay in the hospital, depending on his rate of recovery from the joint pain. Seeing the slow pace of recovery, some patients might also be prescribed to attend the recreational sessions for few days, which are held at multiple rehab centers. When the inmates are ready to go home after anterior hip replacement, the doctors prescribe some useful exercises and pain medications to be used by them regularly for a certain period of time.

Post-anterior hip replacement exercises that are scheduled by the surgeons are expected to be done by the arthritics without showing any negligence. The occupational therapists are also there to help the inmates learn the different ways in which they could easily perform their daily activities from dressing to putting on shoes, etc. After undergoing anterior hip replacement surgery, you must avoid activities that might threaten your hip joint, leading to its dislocation. Misplacement of the joints is a common scenario, when the patients put enough stress on their new prosthesis.

The type of implant used and the lifestyle adopted and followed by the arthritis patients are the two major factors that will determine the longevity of the prosthesis that replaces their original hip joint during anterior hip replacement. Along with the hip joints, maximum threat is posed on the knee joints when someone is attacked by arthritis. Total knee replacement is the surgical process, in which the original joint is replaced by a gender-specific or normal knee prosthesis. Even in this case, the patients have to avoid physical activities that can dislocate their artificial joint leading to bad health conditions.