A heart attack is one of the severe health issues around the world and is medically termed as myocardial infarction.

What is a Massive Heart Attack?

It is a severe form of a heart attack due to lack of oxygen and inadequate blood supply to the heart muscles that causes damage to a large area of the heart. The electrical impulses are mainly responsible for heartbeats and these impulses become weak and irregular as parts of the heart muscles become dead. The oxygenated blood from the ventricle enters the heart and brain causing massive damages.

A massive heart attack affects a significant portion of the heart muscle or causes an enormous amount of heart damage. It can happen if the blockage in a coronary artery occurs in the large artery that supplies blood to a significant portion of the heart. Moreover, it may also be a result of a complete blockage in the blood flow to the heart.

Outcome of a massive heart attack

Heart attacks can lead to:

1. Collapses
2. Severe cardiac arrest
3. Permanent heart damages

These eventually end up causing myocardial arrhythmia, failure of the heart and a chance of a second heart attack. Also, people might get unconscious and in the worst conditions death of the patient occurs. At times, major heart attacks may have a catastrophic outcome on the patient and studies reveal that in 40 to 50% cases there is an increased death risk after the patient is hospitalized.

Causes of Massive heart attacks

There may be several causes underlying the occurrence of massive heart attack-

• Atherosclerosis (coronary heart disease)
• Blockage of arteries
• Abnormal blood circulation, expansion & contraction of the heart
• Atherosclerosis is a leading cause of major heart attacks
• Impaired expansion & contraction of the heart
• Abnormal blood circulation
• Accumulation of fats due to excessive intake of fatty foods
• High blood sugar levels
• High blood pressure
• Excessive consumption of Smoking & alcohol
• Coronary artery spasms(narrowing of the arteries)
• Coronary microvascular disorder (damage to arteries)
• Vasoconstrictors & stimulant drugs
• Emotional stress
• Exposed to cold environments
• Obesity

Signs and Symptoms of Massive Heart Attack

• Chest pain
• Feeling of tightness in chest
• Breathing problems
• Sweating tendency
• Clothes become wet from perspiration
• Nausea
• Vomiting
• Cold hands & feet
• Lips, nails & tongue turn blue
• Paleness on the face
• Irregular pulse
• Irregular beating of heart
• Low blood pressure
• Fainting
• Restlessness
• Burning sensation in chest
• Arrhythmia
• Unconsciousness
• Dizziness
• Abdominal pain
• Heartburn
• Clammy skin

Chances of Surviving a Massive Heart Attack

In cases of a heart attack, time is the most vital factor. Even a fraction of minutes can turn out to be very critical for the patients leading to death. The person if admitted in emergency departments has a higher chance of survival than the patient who does not receive medical attention and can get a sudden cardiac arrest and die within minutes. However, survival chances may depend on the following factors:

• Extent of damage to the cardiac tissue
• Rapid and quality of treatment
• Quick opening of the artery within the first 6 hours
• Risk of death increases with age
• Medical history also matters (myocardial infarction, shock, arrhythmia, etc. may cause more damage)
• Chances of survival increases after 48 hours pass

Diagnosis of a Massive heart attack

• ECG is the main diagnostic tool to record the electrical responses of the heart
• Blood test to detect enzymes produced by a damaged heart
• Chest X-rays to examine the heart size and arteries
• Tests to check fluid buildup in lungs
• Angiogram to check for blockage of arteries
• Echocardiogram to check the regular beating of heart through sound waves
• MRI and CT scan to recognize the severity of the heart damage

Treatment for Massive heart attack

Heart attack needs serious and immediate medical attention-

• Aspirin is given while waiting for medical attention to prevent blood clotting
• Nitroglycerin before medical treatment for relieving chest pain
• Cardiopulmonary resuscitation or CPR after fainting
• Automatic external defibrillator for restoration of normal heartbeat
• Efforts to save heart muscles after attack
• Regular monitoring of heartbeats
• Adequate oxygen
• Cardioversion in case of arrhythmia
• Anticoagulants for blockage opening

While hospitalized, several medicines may be prescribed to prevent further damages:

• Thrombolytics for dissolving blood clots
• Super aspirins prevents formation of blood clots
• ACE inhibitors saving from further stress

Surgery

• Angioplasty
• Bypass surgery

Risk factors for heart attack

• High cholesterol level
• High blood pressure
• Regular consumption of tobacco
• Diabetes mellitus
• Family history of coronary heart disorders
• Smoking

Prevalence

Unlike females, men are more prone to suffer from massive heart attacks under the age of 75 years. But crossing over, both males and females are equally exposed to cardiac attacks.

Complications

A massive heart attack might have several complications and hazardous impacts:

• Arrhythmia
• Problems in the blood pumping to and from the heart
• Failure of the heart
• Damage to the valves
• Depression or stress
• Fatal rupture of the heart

When to seek medical attendance?

Emergency cases and warning signs of serious problems with heart disease should be considered, and a doctor must be called in when one experiences-

• Severe chest pain
• Serious breathing problems
• Extreme sweating
• Rapid heart rate
• Shortness of breath even during rest
• Arms or legs paralyzed
• Severe headache
• Fainting or being unconscious

Home remedies to relieve heart pain and manage heart palpitations

• Almonds
• Apple cider vinegar
• Having a hot drink
• Application of a cold pack
• Drink lots of water
• Avoid stimulants

Massive Heart Attack Images

Heart attack anatomy

Heart attack illustration

Heart Attack muscle damage

The post Massive Heart Attack | Causes, Symptoms, Diagnosis & Treatment appeared first on Prime Health Channel.

Cryoglobulinemia Definition

It is a condition that is characterized by the presence of large amounts of abnormal proteins in the bloodstream that turn gel-like or thick in cold temperatures. These proteins are known as Cryoglobulins. The term “Cryoglobulinemia” actually refers to the presence in serum of these immunoglobulins that precipitate at a low temperature.

The name “Cryoglobulinemia” literally stands for “cold antibody in the blood”, indicating the chemical properties of the antibodies that lead to this disorder.

Cryoglobulinemia ICD9 Code

The ICD9 Code for this disorder is 273.2.

Cryoglobulinemia Types

Based on the form of antibody that is produced, the condition has been classified into three major types. These are:

Cryoglobulinemia Type I

It is most often associated to cancer of the immune systems or blood. It is caused by monoclonal antibody, generally IgM. It arises at the same time as cancers of the immune system or blood. This type of cancer involves Waldenstrom’s macroglobulinemia, chronic lymphocytic leukemia and Multiple myeloma.

In less common cases, Type I of the disease involves the kidney. This can happen due to formation of clots, or in very rare cases – a thickening of the walls of the capillary in the glomeruli and an elevation in the

Cryoglobulinemia Type II

It arises in people suffering from an autoimmune condition (such as Systemic Lupus Erythematosus or Rheumatoid Arthritis or other diseases caused by dysfunction of the immune system) or a chronic inflammatory disorder like Hepatitis C.

Cryoglobulinemia Type III

It is similar to Type II. Types II and III are referred to as Mixed Cryoglobulinemia. The majority of individuals with Mixed Cryoglobulinemia suffer from a Chronic Hepatitis C infection. Together, Types II and III account for 75% of all cases of Cryoglobulinemia. They comprise of rheumatoid factor (RF), which is generally IgM. In Type II, the RF is monoclonal. It is polyclonal in Type III.

Both types II and III are related with conditions that have chronic internal inflammation. These disorders include autoimmune conditions like Sjorgen’s syndrome and viruses like HIV or Hepatitis C.

Cryoglobulinemia Incidence

In the United States alone, Essential mixed Cryoglobulinemia affects one out of every 100,000 individuals. It is more prevalent in southern Europe and generally manifests in people between 40 and 60 years of age. The disorder is not known to have any racial predilection. The female to male ration for this disorder is 3:1. The mean reported age for the disorder is 42-52 years.

The exact prevalence of this disease remains unknown as yet. The disorder has a greater prevalence in Southern Europe as compared to Northern Europe or Northern America.

Cryoglobulinemia Symptoms

The signs and symptoms of this disorder tend to vary on the basis of the type of the condition that an individual suffers from as well as the organs that are affected.

The signs may usually include the following:

• Joint pain
• Glomerulonephritis
• Difficulty breathing
• Fatigue
• Purpura
• Muscle pain
• Skin ulceration
• Skin death
• Raynaud’s phenomenon

The disorder has many potential symptoms. This is due to the presence of cyoglobulins in the bloodstream, which can affect almost any type of tissue or organ of the body. The precipitation of these abnormal proteins can lead to an obstruction in any blood vessel of the body. Naturally, the signs and symptoms of the condition tend to depend on the location of blood vessel obstruction. However, some of the symptoms are more common in nature than others.

Cryoglobulinemia and Dermatological Disorders

The skin problems associated with Cryoglobulinemia include the following:

Raynaud’s phenomenon

It refers to a discoloration of the toes and fingers that occurs in case of their exposure to a change in temperature.

Purpura

This condition is marked by the development of purple spotted rashes on the legs.

Livedo reticularis

It refers to a blotchy purplish discoloration of the skin resulting from impaired circulation.

Acrocyanosis

It is characterized by blueness of the feet and hands that arise due to an obstruction of the small arteries situated towards the end of toes and fingers.

Cryoglobulinemia Causes

The condition results from the presence of high amounts of antibodies, which get solidified at reduced temperatures due to unknown factors. They can obstruct the blood vessels throughout the body due to being thickened or gel-like in form. This may cause complications that can range from kidney failure to skin rashes.

Cryoglobulinemia belongs to a group of disorders that result in Vasculitis and cause swelling and damage to blood vessels throughout the body.

Certain conditions can be related to the development of this disorder. These include:

• Leukemia
• Multiple myeloma
• Rheumatoid arthritis
• Primary macroglobulinemia
• Systemic lupus erythematosus
• Mycoplasma pneumonia

Cryoglobulinemia Risk Factors

Doctors and researchers have not clearly mentioned any risk factors for this disorder. However, certain individuals are found to be more susceptible to the condition. These include people suffering from autoimmune conditions like Systemic Lupus Erythematosus (SLE), rheumatoid arthritis and primary Sjögren’s syndrome as well as individuals affected by infectious diseases like Hepatitis C and HIV. Essential Cryoglobulinemia has been suggested to arise as a result of Hepatitis C.

Cryoglobulinemia Diagnosis

The diagnosis of this disorder begins with a physical examination of sufferers. Doctors look for signs of spleen and liver inflammation during physical testing. They ask patients whether they are experiencing problems like fatigue, joint pain and red or purple spots on the limbs which are typical signs of the disorder.

The diagnostic tests for this disease include the following:

• Skin biopsy
• Complete blood count (CBC)
• Cryoglobulin test, which may show the presence of cryoglobulins
• Liver function tests, which may show high amounts
• Rheumatoid factor, may come positive in types II and III
• Complement assay, which may show low numbers
• Urinalysis, which may show the presence of blood in the urine in case the kidneys are affected

Other tests may also be used for detecting the disease. These may include the following:

• ESR
• Angiogram
• Hepatitis C test
• Chest x-ray
• Protein electrophoresis – blood
• Nerve conduction tests, to check whether an affected individual is suffering from weakness in the legs or arms

Under a microscope, the glomeruli sample in Types II and III generally exhibit a thickening of the capillary walls in the glomeruli and an elevation in the amount of cells in the body. In some cases, obstruction of the capillary loops from small clots developed by the loose cryoglobulins.

Cryoglobulinemia Differential Diagnosis

The signs and symptoms of this condition appear similar to those of various other disorders. Naturally, physicians should confirm the presence of Cryoglobulinemia by distinguishing its symptoms from those of conditions like:

• Acute Glomerulonephritis
• Diffuse Proliferative Glomerulonephritis
• Chronic Lymphocytic Leukemia
• Churg-Strauss Syndrome
• Cirrhosis
• Giant Cell Arteritis
• Antiphospholipid Syndrome
• Goodpasture Syndrome
• Hemolytic-Uremic Syndrome
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Microscopic Polyangiitis
• Multiple Myeloma
• Viral Hepatitis
• Non-Hodgkin Lymphoma
• Serum Sickness
• Systemic Lupus Erythematosus
• Polyarteritis Nodosa
• Sarcoidosis
• Waldenstrom Hypergammaglobulinemia

Physicians generally confirm the disorder after analyzing the personal and family medical history of sufferers and obtaining results from their blood and urine tests. At times, doctors may conduct biopsy which involves taking small samples of tissue from the body of sufferers.

Cryoglobulinemia Treatment

The treatment of mild forms of the condition depends on its underlying cause. The condition is frequently cured by treating its underlying cause. Mild cases can be cured by preventing exposure to cold temperatures.

In people with Hepatitis C who also suffer from mild or moderate cases of Cryoglobulinemia, standard treatment options for Hepatitis C are generally effective. The condition can, however, show a recurrence when treatment is stopped.

Severe cases of the disease, which involve large regions of skin or vital organs of the body, are cured with corticosteroids and other drugs that suppress the immune system.

Medical treatment for the condition may also involve Plasmapheresis, a technique in which blood plasma is removed from the circulation. It is replaced by donated plasma, protein or fluids.

No effective treatment has yet been determined for cases of Cryoglobulinemia that are associated with Hepatitis C. Short-term use of prednisone, followed by usage of interferon alfa for a period of 6 months, has led to the improvement of liver function. However, relapse of vasculitis and liver disease frequently occurs after stopping the use of interferon alfa.

Cryoglobulinemia Prognosis

The disorder is not usually life-threatening in nature. However, the outcome can be poor in case both the kidneys of a patient are affected. The outcome is worse in sufferers with liver failure, renal disease, malignancies and lymphoproliferative disease. In the majority of cases, the presence of cryoglobulins in the bloodstream does not progress to any life-threatening complication.

Cryoglobulinemia Complications

The possible complications of this disorder include the following:

• Heart disease (rare)
• Bleeding in the digestive tract (rare)
• Liver failure
• Kidney failure
• Skin death
• Infections of ulcers
• Death

In the late stages of the disorder, hepatic and lymphatic malignancies are possible.

Cryoglobulinemia Prevention

There is no specific way to avoid the development of this disease. Some of its symptoms may be prevented by avoiding exposure to cold temperatures. Many cases of Mixed Cryoglobulinemia are related with Hepatitis C. Due to this reason, preventing an Hepatitis C infection may lower the risk of development of Cryoglobulinemia.

Cryoglobulinemia Pictures

The following pictures about Cryoglobulinemia would give you a visual idea about the condition and help you understand the physical appearance of patients of this disorder more vividly.

Picture 1 – Cryoglobulinemia

Picture 2 – Cryoglobulinemia Image

If you or any of your family members has developed Hepatitis C and symptoms of Cryoglobulinemia, which are worsening with time, call your medical care provider on an immediate basis. Prompt diagnosis and treatment can help you have an early recovery from this disorder and avoid all possible complications, even life-threatening ones, associated with the condition.

References:

http://www.patient.co.uk/doctor/Cryoglobulinaemia.htm

http://www.wisegeek.com/what-is-cryoglobulinemia.htm

http://www.mayoclinic.org/cryoglobulinemia/

http://emedicine.medscape.com/article/329255-overview

The post Cryoglobulinemia appeared first on Prime Health Channel.

Thrombocytosis Definition

It is a condition characterized by an excessive production of platelets (thromobocytes) in the body, which play a vital role in blood coagulation or clotting. When resulting from an underlying disease, such as an infection, the disease is referred to as “Reactive Thrombocytosis.”

The disorder is also known by the name “Thrombocythemia.”

Thrombocytosis ICD9 Code

The ICD9 Code for this condition is 289.9.

Thrombocytosis Types

The disorder is broadly classified into the following two types:

Primary Thrombocytosis

It is also known by the names Essential Thrombocythemia, Primary Thrombocythemia and Essential Thrombocytosis. It arises as a result of failure in the production and regulation of platelets and is a symptom of various myeloproliferative conditions.

Secondary Thrombocytosis

It is also referred to as Reactive Thrombocytosis. It is generally an exaggerated psychological response to a primary condition, such as an infection. The infection or any other similar trigger factor leads to a release of cytokines that mediate a rise in the production of platelets.

This is often a temporary problem that disappears once the underlying cause is resolved.

Thrombocytosis Incidence

According to an American study, Primary Thrombocytosis has a reported incidence of 2.38 cases in every 100,000 individuals every year. The prevalence of this form of the disorder is around 30 per 100,000 individuals in a population. The incidence of the Secondary form is highest during the first 3 months after birth. Preterm infants are more susceptible to the disease than term infants.

Thrombocytosis Symptoms

The signs and symptoms of Thrombocytosis are based on the type of the disorder that a person is suffering from.

Primary Thrombocytosis Symptoms

Around one-third of all sufferers of this form are asymptomatic at the time of diagnosis. In sufferers, there is an increase in the amount of circulating platelets due to sustained megakaryocyte proliferation. In certain

Secondary/Reactive Thrombocytosis Symptoms

This form rarely gives rise to any symptoms. The signs are more frequently associated to an underlying condition. If the symptoms of Reactive Thrombocytosis arise, they may involve the following:

• Fainting
• Chest pain
• Weakness
• Headache
• Temporary changes in vision
• Lightheadedness or dizziness
• Numbness or tingling sensation in the hands and feet

As Thrombocytosis is not likely to give rise to any problems, patients are usually aware that they have the disorder unless an elevation in the amount of platelets is revealed in a routine blood test. If the blood exam reveals a high platelet count, a doctor would try to find out the underlying cause.

Thrombocytosis Risk Factors

The susceptibility to this disorder may be increased in case of a recently conducted surgery or the presence of a medical disorder such as anemia.

Thrombocytosis Causes

There is no known cause for Primary Thrombocytosis. In some cases, however, it can arise due to a bone marrow condition in which the bone marrow produces excessively high amounts of the cells that manufacture platelets (megakaryocytes) and leads to the release of too many platelets into the bloodstream.

Secondary Thrombocytosis may arise due to a number of health disorders, such as:

• Allergic reactions
• Hemolytic anemia
• Iron deficiency anemia
• Cancer
• Pancreatitis
• Removal of spleen
• Exercise
• Heart attack
• Kidney disorders or Chronic kidney failure
• Infection
• Surgery
• Loss of blood or acute bleeding
• Inflammatory diseases, such as rheumatoid arthritis

The secondary form of the disorder can also be caused due to certain medications which include:

• Epinephrine
• Tretinoin
• Vincristine

Thrombocytosis Diagnosis

The condition may be diagnosed, often accidentally, after one of the following tests is performed:

Physical exam

If a doctor finds an enlargement of spleen or any signs of infection or some other condition during a physical examination, he or she may recommend sufferers to have a CBC (Complete Blood Count) to assess the amount of platelets.

Blood test

A routine blood test reveals a platelet count that is higher than normal.

Blood smear test

In this exam, a small amount of blood is analyzed under a microscope. This helps find out the status of the platelets in sufferers.

As the platelet count can rise on a temporary basis due to a number of diseases, a physician may repeat the blood tests to check whether the amount of platelets remain high over a period of time.

A 150,000 – 450,000 platelet count per microliter of blood is a normal range for platelets. Doctors tend to look for an underlying disorder if the blood count is higher than 500,000.

In the majority of sufferers, the signs and symptoms of a possible underlying disease can help in diagnosis. A physician may also do the following:

• Test for signs of inflammation
• Check the iron level in blood
• Do a biopsy or a bone marrow aspiration to obtain and analyze samples of bone marrow tissue
• Order genetic testing to help find out whether sufferers have a blood disorder or a bone marrow disease

It is essential for doctors to determine whether or not a patient is suffering from the Essential/Primary or the Secondary form of Thrombocytosis.

Thrombocytosis Differential Diagnosis

The differential diagnosis of Thrombocytosis involves telling the symptoms of both of its forms apart from those of other disorders.

Differential Diagnosis of Primary Thrombocytosis

It involves ensuring the signs are not the result of the following disorders:

• Primary myelofibrosis.
• Myelodysplasia with del(5q).
• Primary thrombocytosis (Essential thrombocytosis).
• Chronic myeloid leukaemia.
• Polycythaemia vera (haematocrit is also raised).
• Atypical chronic myeloid leukaemia.
• Chronic myelomonocytic leukaemia.
• Refractory anaemia (with ring sideroblasts related with marked thrombocytosis).
• Myelodysplastic syndrome/Myeloproliferative neoplasm, unclassifiable (MDS/MPN-U).

Differential Diagnosis of Reactive Thrombocytosis

It includes making sure that sufferers are not actually having any of the diseases mentioned below:

• Hyposplenism
• Iron deficiency
• Haemolysis
• Postoperative
• Haemorrhage
• Post-splenectomy.
• Low birthweight/pre-term infants.
• Tissue damage (such as trauma, fracture and burns).
• Cytokine administration (like Thrombopoietin).
• Rebound following myelosuppressive chemotherapy.
• Malignancy (particularly osteosarcoma and soft -tissue sarcoma)
• Renal disorders (like nephritis or nephrotic syndrome).
• Drug therapy (such as those involving adrenaline and corticosteroids).
• Rebound from other causes (such as with iron deficiency anaemia, recovery phase of idiopathic thrombocytopenic purpura (ITP)).
• Infection (common infective causes include urinary tract infections, gastroenteritis, meningitis, infections of the upper and lower respiratory tract, septic arthritis, generalised sepsis and osteomyelitis).
• Inflammation (such as Henoch-Schönlein purpura, Kawasaki disease, inflammatory bowel disease and Rheumatoid arthritis).

Thrombocytosis Treatment

The treatment for Reactive Thrombocytosis is aimed at treating its underlying cause. The elevation in the amount of platelets may not be long-lasting if the cause is a recent injury or an operation that is the cause of significant loss of blood. If the disorder results from an inflammatory disorder or a chronic infection, the amount of platelets may continue to be high until the disease is successfully managed. In the majority of sufferers, the platelet count tends to come back to normal once the underlying cause is resolved.

In some cases, removal of the spleen may result in the persistence of Thrombocytosis for an entire lifetime. In such patients, a physician may prescribe low doses of Aspirin to help prevent cases of blood-clotting or bleeding. However, these problems rarely occur in Reactive Thrombocytosis.

Thrombocytosis Home Remedies

Patients of this disorder can do better and lower the risk of complications associated to this disease by adopting certain lifestyle modification measures. These include:

• Managing any other health problems already present such as diabetes, high cholesterol and high blood pressure
• Giving up, or at least significantly reducing, smoking or use of other tobacco products
• Avoiding passive smoking
• Consulting a doctor or dentist before taking any blood-thinning medicine to manage the symptoms of Thrombocytosis before undergoing any medical procedure. Such drugs can increase the risk of bleeding during such procedures.
• Avoiding use of over-the-counter analgesics (pain-relieving medications) except Acetaminophen (such as Tylenol) and certain cold medicines that may also contain analgesics. It is important to read the labels properly and have a consultation with a qualified doctor before taking any over-the-counter pain-relievers.

Thrombocytosis Prognosis

The outcome of this disorder depends on various factors, such as:

• The form of the condition one is suffering from
• Age of sufferer
• The nature of treatment and how properly it is being conducted

Those with the primary form of the disorder have a 10-year survival rate ranging between 64-80%. This rate may not be much varied from that of the age-matched general population. Death usually occurs from thrombotic complications. In young female patients, doctors can do little to positively affect the pattern of recurrent miscarriage. However, the outcome is significantly non-dangerous for the life and health of affected women.

In case of the secondary form of the disease, the outcome is generally determined by the primary disease.

Thrombocytosis Complications

If an elevation in the amount of platelets is caused by a bone marrow disease in case of Essential rather than Reactive Thrombocytosis, patients may be at risk of developing blood clots. Some of these can be life-threatening.

Primary Thrombocytosis Complications

Some of the typical complications associated to the primary or essential form of this disease include:

• Thrombosis, which can be acute in nature and have life-threatening consequences for sufferers
• Bleeding, generally from the gastrointestinal (GI) tract, which is usually much less acute
• Progression to Acute Myeloid Leukemia, which happens in 0.5-5% of all sufferers

Secondary Thrombocytosis Complications

The complications can develop from the abnormality of platelets but are more often a result of the primary disease.

Thrombocytosis Pictures

The following images display the pictures of blood samples of Thrombocytosis sufferers as can be seen under a microscope.

Picture 1 – Thrombocytosis

Picture 2 – Thrombocytosis Image

If you suspect yourself, or any of your family members, to be suffering from Thrombocytosis get a blood test done as early as possible. If a blood examination shows a high platelet count and a Thrombocytosis is confirmed by diagnosis, seek treatment on an early basis. Early detection and treatment can help ensure a better management and faster recovery from this disorder.

References:

http://www.mayoclinic.com/health/thrombocytosis/DS01088

http://en.wikipedia.org/wiki/Thrombocytosis

http://www.patient.co.uk/doctor/Thrombocytosis.htm

http://www.wisegeek.com/what-is-thrombocytosis.htm

The post Thrombocytosis appeared first on Prime Health Channel.

Serum sickness Definition

It is an immune system response like an allergy. In this condition, the immune system shows a response to drugs containing injected proteins that are used to cure immune disorders. It may also arise as a result of antiserum, the liquid part of blood containing antibodies administered to protect patients from poisonous substances or germs.

Serum sickness is actually a form of hypersensitivity, particularly immune complex hypersensitivity (Type III).

Serum sickness ICD9 Code

The ICD9 Code for this disease is 999.5.

Serum sickness History

The characteristics of this condition were first reported in 1906 by Bela Schick and Clemens von Pirquet.

Serum sickness Causes

Sometimes, physicians use a blood product known as serum, extracted from animals or humans, to derive medicines that can help prevent infections of acute nature. Antiserums, such as tetanus vaccinations, are used for basic immunizations. Antiserum is manufactured from the plasma of an animal or a person having immunity against a toxic material or an infection. It may be used to protect an individual who has been exposed to a germ that the body of the person has not been vaccinated against.

Although rare, some individuals occasionally show an abnormal response (similar to allergenic response) to particular antiserum injected into them. This unusual response is Serum sickness.

The condition actually occurs as an inflammatory response to substances that it improperly perceives to be a harmful object. Sometimes, the ailment may also arise as a result of blood transfusions or due to the usage of techniques such as platelet transfusions.

The disorder is often considered to be very similar to allergic responses shown by people to antibiotics such as Penicillin. When exposure to the causative substance(s) occur again, the risk of health hazards are also similar in nature.

Serum sickness and Medications

Injected proteins like Rituximab (used to cure cancers and immune disorders) and Antithymocyte globulin (used to cure organ transplant rejection) can lead to Serum sickness responses.

Some of the medicines associated with the development of this disease include:

• Allopurinol
• Cephalosporin
• Captopril
• Barbiturate
• Penicillin
• Phenytoin
• Griseofulvin
• Streptokinase
• Sulfonamides
• Procainamide
• Quinidine

The condition may also arise as a response to certain hormones, vaccines or allergenic extracts.

Other causes

Some other causative agents for this disorder involve the following:

• Products that contain aspirin
• Many other medications
• Snake venom antiserum
• A type of diuretics known as Thiazides
• Barbiturates
• Bee or wasp sting (rare)
• Other antibiotics, including Cephalosporins
• Fluoxetine (Prozac) used for depression

However, Penicillin is regarded as the most common cause of the disorder.

Serum sickness Risk Factors

The risk factors associated with this disease include:

• Intake of a large quantity of snake venom antiserum
• Being injected with antitoxin or one of the medications that are known to result in Serum sickness
• Having a past history of exposure to antitoxin or one of the medications that are known to cause the disease

Serum sickness Symptoms

The signs and symptoms of this disorder include:

• Hives
• Fever
• Rash
• Joint pain
• Itching
• Swollen lymph nodes
• Malaise or general ill-feeling

Usually, the symptoms do not arise until 1-3 weeks after exposure to medications or the first dose of antiserum. Some individuals, however, may develop the signs in 1-3 days in case they have already been exposed to the substance responsible for the condition.

Serum sickness Diagnosis

In case patients have recently been exposed to any type of antiserum, doctors will look for symptoms typical of the condition. The diagnosis of this disorder usually begins with a physical examination. Doctors may look for enlargement of lymph nodes of sufferers and ask whether the affected regions are tender to touch. A urine analysis may show the presence of protein or blood in urine. Blood tests may reveal signs of swelling of blood vessels or immune complexes. In urine tests conducted in the lab, presence of high protein levels or blood may be detected in samples, which can confirm the presence of the ailment.

Serum sickness Differential Diagnosis

Physicians should consider the following problems during the differential diagnosis of Serum sickness:

• Still disease
• Shunt nephritis
• Microscopic polyangiitis
• Dermatitis herpetiformis
• Henoch-Schönlein purpura

Doctors should also ensure that the symptoms experienced by sufferers are those of Serum sickness and not of other disorders, such as:

• Viral Hepatitis
• Cryoglobulinemia
• Sickle Cell Anemia
• Kawasaki Disease
• Infective Endocarditis
• Infectious Mononucleosis
• Leukocytoclastic Vasculitis
• Systemic Lupus Erythematosus
• Poststreptococcal Glomerulonephritis
• Immediate Hypersensitivity Reactions

Serum sickness Treatment

The aim of therapy is to cure the condition arising from the effects of soluble circulating immune complexes forming under excess of antigen. The complexes can arise due to the administration of medicines that cause Serum sickness or Heterologous antisera.

The condition can be cured with the aid of various types of medications, such as:

Antihistamines

These drugs may reduce the duration of the ailment and provide relief from itchiness and rash.

Corticosteroid ointments or creams

These soothing medications for the skin may help alleviate the discomfort associated with rash and itchiness.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These forms of drugs, such as Naproxen or Ibuprofen, may provide relief from pain in the joints. However, physicians should carefully use the NSAIDs as there is risk of kidney damage due to use of these medications. Administration of oral corticosteroids, such as Prednisone, may be prescribed for cases that are acute in nature.

In case the condition arises from the use of some type of medicines, the drug responsible for the disorder should be stopped. Patients should also avoid using that antiserum or medication in the future. In acute cases, physicians may prescribe corticosteroid drugs such as Prednisone. There is usually no need for hospitalization as medications are enough to address and resolve the problems arising due to the disease. Fever associated to the condition usually gets better within 2-3 days of medical treatment.

Serum sickness – Alternative Treatment

The alternative therapies for this disease include:

Acupuncture

The tendency of the body towards allergic hypersensitivity responses can be lowered with the use of acupuncture and traditional Chinese medicine.

Herbs

Patients may notice an improvement in their health with the use of herbs like Cat’s claw, Reishi mushroom, turmeric, Bromelain, Rhodiola, Green tea and Gingko.

Homeopathy

The problems associated with this disorder such as hives and itchiness may be relieved by using homeopathic drugs like Urtica urens, Apis and Rhus toxicodendron.

Nutritional supplements

Certain nutrients may provide support to the immune system and decrease allergic reactions in general. These include eating iron and Vitamin B-rich foods, like dark leafy greens, sea vegetables and whole grains. However, there is no scientific evidence to support the view that nutritional supplements can prove to be effective in curing serum sickness.

Serum sickness – Home Remedy

The home remedial measures for this disorder, which can at least bring about a little improvement in the condition of sufferers, include:

• Drinking 6-8 glasses of filtered water on a daily basis.
• Avoiding refined foods, such as sugar, pasta and white breads.
• Using healthy oils, such as vegetable oil or olive oil, for cooking.
• Voiding beverages like coffee and other stimulants like tobacco and alcohol.

The nutritional deficiencies related with the disorder may be addressed with supplements like:

• Vitamin C
• Omega-3 fatty acids
• Alpha-lipoic acid
• Multivitamins (to be taken daily)
• Resveratrol

Serum sickness Prognosis

The disorder is usually self-limited and resolves within a few days. In cases without involvement of internal organs, the outcome is good. Following proper diagnosis and treatment, the signs and symptoms of this disease generally resolve in a few days. Occasionally, however, death is reported to occur as a result of acute neurological complications or progressive Glomerulonephritis.

Serum sickness Complications

The risk of having a similar response is high in case patients use the antiserum or the drug that cause Serum sickness.

The primary complications associated with this disorder include:

• Swelling of the blood vessels
• An immediate infection of a fatal nature known as Anaphylactic shock
• Inflammation of the arms, face and legs (a condition referred to as Angioedema)

Some other complications arising due to this disorder involve:

• Acute renal failure
• Anaphylaxis
• Vasculitis
• Neuropathy
• Shock
• Glomerulonephritis (rare)

In case of a re-exposure to the material, Serum sickness tends to arise faster – within 1-4 days. Only a very small quantity of the material may produce a severe response.

Serum sickness Prevention

It is not known how a person can prevent the development of this disorder. Future use of causative drug or antiserum should be avoided by those who experience the following problems:

• Serum sickness
• Drug allergy
• Anaphylactic shock

If you have a history of sensitivity to a specific antiserum or drug, talk with your health care provider about it before getting any type of injection. In case of sensitivity to an antiserum, a doctor may use a technique that desensitizes patients to the antiserum, at least on a temporary basis. Before administering an antiserum, a doctor can carry out skin tests to check for serum sensitivity.

Serum sickness Pictures

The following images reveal the appearance of people affected by this disorder.

Picture 1 – Serum sickness

Picture 2 – Serum sickness Image

If you are experiencing the symptoms of Serum sickness and have received antiserum or medication in the past one month, get in touch with a physician and seek immediate diagnosis and treatment. When treated early, the condition shows a good prognosis and patients can attain a quick recovery.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001823/

http://en.wikipedia.org/wiki/Serum_sickness

http://emedicine.medscape.com/article/332032-overview

http://www.umm.edu/altmed/articles/serum-sickness-000149.htm

The post Serum sickness appeared first on Prime Health Channel.

Septic shock Definition

It is a severe condition that arises when an overwhelming infection gives rise to fatally low blood-pressure in sufferers.

The condition is also known by various other names, such as:

• Septicemic shock
• Bacteremic shock
• Endotoxic shock
• Warm shock

Septic shock ICD9 Code

The ICD9 Code for the disorder is 785.52.

Septic shock Incidence

Over the last five decades, the incidence of Septic shock and Sepsis has been on the rise. Around 8.7% of every 1,000 admissions in hospital are for either of these two diseases. Around 2.26% of hospitalized sufferers develop nosocomial or hospital-acquired infections that cause Septic shock.

In the United States, the incidence of this disease is around 200,000 cases in every year.

Septic shock Symptoms

The condition may affect any region of the human body, including organs like:

• Brain
• Heart
• Kidneys
• Liver
• Intestines

The signs and symptoms exhibited by individuals affected by this disorder include the following:

• High or very low body temperature
• Cool, pale arms and legs
• Chills
• Palpitations
• Shortness of breath
• Lightheadedness
• Little or no urine
• Skin rash or discoloration
• Low blood pressure, especially when standing
• Rapid heart rate
• Restlessness, lethargy, agitation or confusion

Septic shock Causes

The disorder can occur due to varied causes. It often affects individuals who are very young or very old in age. It is also common in people suffering from ailments, particularly in case they have a weakened immunity.

The disease may arise due to any form of bacteria. Fungi, and even viruses in rare cases, may also give rise to this disorder. Toxins released by these microbes may lead to tissue damage and may cause low blood pressure as well as poor functioning of the various organs of the human body. According to some researchers, reduced blood flow and impaired organ functioning may occur as a result of blood clots in small arteries. The human body also shows a powerful inflammatory response to the toxins produced by the microbes. Such a response may contribute to the damage of the organs.

What Happens in Septic shock?

The disorder typically starts with an infection, which may occur at any region of the body. As the immune system tries to cure the infection, the process goes awry resulting in the spread of infection. The infection ultimately enters the bloodstream of sufferers. In an attempt to combat the infection, the immune system goes into an overdrive and secretes substances that expand the blood vessels along the way. With the dilation of the blood vessels, blood pressure decreases and the flow of blood to the body is reduced in a drastic manner. In the meantime, toxins from the infection flood the body of sufferers and results in further problems.

In the absence of proper amounts of oxygen, tissues begin to release lactic acid. An accumulation of lactic acid in the body makes the blood highly acidic in nature. As the infection continues to spread, the organs in the body start to fail due to reduced supply of blood and increase in the acidic level of bloodstream. When blood fails to flow in proper amounts to vital bodily organs like the brain and the heart, patients may enter into a comatose state or eventually die.

Septic shock Risk Factors

The risk factors for this disease include:

• Diabetes
• Leukemia
• Lymphoma
• Recent infection
• Conditions such as AIDS that weaken the immune system
• Disorders of the genitourinary system, intestinal system or biliary system
• Long-term use of antibiotics
• Recently conducted medical procedure or surgery
• Recent use of steroid medications
• Indwelling catheters (those kept for extended periods in place, especially urinary catheters and intravenous lines and plastic and metal stents that are used for drainage)

Septic shock Diagnosis

The diagnosis of this disease involves the following:

Consideration of medical history

People with this condition may report of non-specific or vague problems like chills, fever, confusion, anxiety or fatigue. In some cases, patients may be able to describe a particular region where they have sensations of discomfort or pain, such as the abdomen or the throat. Areas in which such problems are experienced may be the site of an underlying infection. Patients may report a recent ailment, operation or any other process that can give rise to the infection.

Physical examination

Alteration in mental functioning is the clinical problem that is most consistently detected during a physical examination of Septic shock sufferers. This may either be as moderate as mild disorientation or more acute in nature such as extreme agitation or even mental bluntness. Other common findings include Hyperventilation and rapid respiration (over 20 breaths per minute). The heart rate is generally elevated over 90 beats every minute. The body temperature may be abnormally low or high. In the early stages of sepsis, the skin may be dry, warm or flushed. However, the skin usually turns cool and mottled as the Septic shock progresses.

In the initial stages of Septic shock, the systolic blood pressure may be over 100 mmHg although it may reduce well below that level as the shock progresses and the heart weakens. The local signs and symptoms may point to the source of the underlying infection. In lung infections, a productive cough and chest pain may be detected. An infection in the intestines or the abdominal cavity may be indicated by the following problems:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain

Infection in the bone or soft tissues may be indicated by problems like noticeable redness, inflammation and pain. However, there is often an absence of localizing symptoms.

Medical tests

Doctors may conduct blood tests to check for the following problems:

• Infection
• Low blood oxygen level
• Disturbances in the acid-base balance of the body
• Poor organ functioning or organ failure

Blood tests may involve:

• CBC (Complete Blood Count) with differential
• Arterial blood gases (ABGs)
• Chemistry panel with renal and liver function studies
• Coagulation studies
• Blood cultures
• Additional Gram stains and cultures from any draining wounds or exudates

An x-ray examination of the chest may reveal problems like Pulmonary edema (fluid in the lungs) or Pneumonia. A urine sample analysis may show an underlying infection in sufferers.

Additional medical studies like blood cultures may not yield positive results for a number of days after the blood has been extracted or for several days after the development of the shock.

Septic shock Differential Diagnosis

The differential diagnosis of the disorder requires physicians to ensure that the symptoms exhibited by sufferers are not the result of the following conditions:

• Acute renal failure
• Anaphylaxis
• Arthritis
• Adrenal crisis
• Cardiogenic shock
• Heatstroke
• Diabetic ketoacidosis
• Myocardial infarction
• Pulmonary embolism
• Hyperthyroidism
• Hemorrhagic shock
• Viral enteritis
• Salicylate toxicity

Septic shock Treatment

This is a medical emergency and should always be treated as one. Patients are generally admitted to the ICU (Intensive Care Unit) of hospital. The treatment of the disease may involve the usage of the following curative options:

• Surgery
• Oxygen
• Dialysis
• Sedatives
• Breathing machine (mechanical ventilation)
• Directly administering fluids into a vein (intravenous administration)
• Medicines to cure low blood pressure, infection, or blood clotting

Some new medications are found to act against the acute inflammatory response observed in Septic shock patients. This may help reduce damage to the organs.

The pressure in the lungs and the heart may be checked by using a technique known as Hemodynamic monitoring. This can only be performed with intensive care nursing and special equipments.

Septic shock Management

The management of this disorder has as many as four aims:

Early recognition and resuscitation

Early recognition and initiation of treatment is the main determinant in the survival of sepsis patients as the disorder is readily reversible in such stages. Rapid administration of intravenous fluids helps restore and maintain blood pressure and is considered to be a mandatory first step in curing septic shock.

Re-establishment of circulation and blood pressure to the tissues

Individuals with septic shock or sepsis need intensive care monitoring including Continuous ECG along with the frequent assessment of the following:

• Blood pressure
• Respiratory rate
• Neurological status
• Color
• Body temperature
• Urine flow (generally by indwelling bladder catheter)

In individuals suffering from severe shock or shock of uncertain or mixed etiology, a catheter may be inserted into the right atrium (central venous pressure catheter) or into the pulmonary artery (pulmonary artery catheter) through the superior vena cava to constantly measure the performance and pressure in the heart. This can serve as a guide for doctors in the administration of fluids and the use of drugs to restore and support blood pressure (inotropes and vasoactive medications).

Provision of optimal supportive care

The following supportive care options are deemed as appropriate:

• Assisted ventilation
• Maintenance of organ function
• Administration of nutrition support (either through gastric tubes or in an intravenous manner)

Septic focus/Timely initiation of treatment

Septic focus aims to obliterate the source of infection. Eradicating the source of infection may include one or more of the following measures:

• Administration of antibiotics
• Drainage of abscesses or infected wounds
• Clearing of lung secretions (Bronchoscopy)
• Surgical resection of infected tissue (resection, removal or debridement)

Other supportive measures involve:

• Administration of H2 receptor inhibitors, to prevent stress ulcers
• Use of anticoagulants, in order to prevent deep vein thrombosis
• Administration of steroids, to compensate for endocrine effects

Acute cases of the disorder may need blood product transfusions or the administration of recombinant human activated protein C, which may help in reducing risks of death (due to the presence of anticoagulant and anti-inflammatory properties).

Septic shock Prognosis

The condition is associated with a high mortality rate. The mortality rate actually depends on various factors, such as:

• Age of patients
• Overall health condition of patients
• Cause of infection
• Number of organs that have suffered failure
• How promptly and aggressively medical therapy has been initiated

In spite of a concerted effort to bring about an improvement in the treatment options and outcome for the disorder, the death rate associated with this condition remains varying between 14.3 – 20%.

The condition has a poorer prognosis when it is related with problems like:

• Persistent low blood pressure
• Organ dysfunction
• Inadequate circulation to the tissues, proved by physical signs like lactic acid build-up, low urine output and changed mental status

Septic shock Complications

The possible complications of this disorder include:

• Cardiac failure
• Respiratory failure
• Central Nervous System (CNS) Dysfunction
• Liver failure
• Acute Renal Failure
• Failure of any other organ
• Tendency to bleed (Disseminated Intravascular Coagulation or DIC)
• Gangrene, possibly resulting in the amputation of a body part

Around 18% of sufferers of this condition develop Adult Respiratory Distress Syndrome (ARDS). DIC arises in approximately 38% of people with this disease. Renal failure occurs in around 50% of all sufferers of septic shock.

Septic shock Prevention

In the majority of cases, this condition cannot be prevented. However, quick curing of bacterial infections can helpful.

Septic shock Recovery

The time for recovery, accommodations and work limitations for sufferers depend on the underlying as well as whether or not there is any defect in the functioning of the organs.

Patients who exhibit symptoms of Septic shock should be immediately rushed to a hospital to seek quick treatment for them. As aforesaid, quick and proper medical cure can help prevent further complications of this disorder and safeguard the health and life of sufferers.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001689/

http://www.mdguidelines.com/septic-shock

http://en.wikipedia.org/wiki/Septic_shock

http://www.wisegeek.org/what-is-septic-shock.htm

The post Septic shock appeared first on Prime Health Channel.

Vasculitis Definition

It refers to a swelling of the blood vessels, occurring due to an attack on the vessels by the immune system of the body. However, the disease often arises as a result of unknown causes.

The condition is also known as Angiitis or Arteritis.

Vasculitis ICD9 Code

The ICD9 Code for this disorder is 447.6.

Vasculitis Incidence

This is a rare disease. Approximately 3,000 individuals in the U.K suffer from any of its forms on an annual basis.

Vasculitis Symptoms

The condition may give rise to a variety of symptoms, as any organ might be affected. If the skin is affected, patients may develop rashes. In case nerves suffer from a lack of blood supply, affected individuals may suffer from an abnormal sensation which may be followed by muscular weakness or loss of sensation.

Picture 1 – Vasculitis

If Vasculitis affects the brain, a stroke may ensue. If it impacts the heart, individuals affected by the disorder may suffer a heart attack. Swelling in the kidney may cause abnormalities that can result in progressive kidney failure. Such abnormalities can be noticed in urine tests.

In some cases, the symptoms might be general in nature and include:

• Fever
• Loss of weight
• Loss of appetite
• Loss of energy

Patients should contact a physician in case of such abnormal symptoms.

Vasculitis Causes

The condition arises when the immune system mistakes the blood vessel cells as foreign objects such as invading microbes, like virus or bacteria. Hence, it acts against the vessels as a natural response. It is not known why this occurs. Many of the types of the disorder occur due to unknown factors and are referred to as Primary Vasculitis. The cases of the disease that have some underlying factor are referred to as Secondary Vasculitis. The underlying causes for the secondary types have been identified. These include:

Certain types of cancers

Cancerous conditions that affect the blood vessels, including Lymphoma and Leukemia, can result in Vasculitis.

Infection

The disorder may also arise in response to an infection. The majority of cases of cryoglobulinemia arise as a result of Hepatitis C viral infection. Certain cases of Polyarteritis nodosa occur in response to Hepatitis C virus infection.

Allergic reaction

Some individuals are found to develop this disorder due to an allergic reaction to some medication.

Some immune system disorders

The condition may also occur as a result of some disorders of the immune system, such as Lupus, Rheumatoid Arthritis or Scleroderma.

The blood vessels affected by this disorder may suffer an inflammation, which can lead to a thickening of the layers of the walls of the blood vessels. This results in a narrowing of the blood vessels and lowers the amount of blood, and consequently the oxygen and important nutrients, reaching the body tissues.

In certain patients, an affected blood vessel may develop a blood clot which can lead to an obstruction in the supply of blood. In some cases, rather than being narrowed, a blood vessel may weaken and develop a bulge (or aneurysm) which is a potentially fatal disorder.

Vasculitis Diagnosis

The diagnosis for this disease usually begins with doctors asking patients about their symptoms, followed by a complete physical examination and analyzing their past medical history. Further diagnostic tests for the disorder include:

Urine tests

Testing urine samples of sufferers may help physicians detect abnormalities, such as higher amounts of protein and red blood cells, which frequently indicate a medical problem. The outcome tends to be poorer if the disease results in kidney problems.

Blood tests

When used to detect Vasculitis, blood tests involve special exams like C-reactive protein tests and Erythrocyte Sedimentation Rate (ESR) to look for signs of swelling. A complete blood count (CBC) can help determine whether or not a patient has enough blood cells. Antineutrophil cytoplasmic antibodies test, an exam for detecting certain antibodies, indicate whether or not the immune system of the sufferer is fighting healthy cells.

Imaging tests

Noninvasive imaging procedures help physicians to find out whether or not larger arteries, like the aorta and its branches have been affected. Such tests include ultrasound, x-ray, Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scans.

Biopsy

This is a surgical process involving removal of a small sample of an organ or blood vessel that has been affected. The affected parts may include the nerve, lung, skin and kidneys. Biopsy helps a physician to examine tissues for signs of Vasculitis.

Angiogram

In this test, a flexible catheter (that appears as a thin straw) is introduced into vein or large artery. Then, a contrast medium or special dye is injected into the catheter. X-ray images are obtained as the dye fills these veins or arteries. The outlines of the blood vessels can be viewed on the resulting images of X-rays.

Vasculitis Differential Diagnosis

The differential diagnosis for the disease includes ensuring the absence of a variety of conditions that may mimic the symptoms of cutaneous Vasculitis. These include:

• Trauma
• Insect bites
• Pigmented lesions
• Pityriasis lichenoides
• Purpura eg due to low platelet count
• Disseminated intravascular coagulopathy

Before arriving at a conclusion, physicians should consider the above conditions and ensure their absence. Not doing this can lead to a misdiagnosis and erroneous treatment on the part of a doctor, jeopardizing the health of sufferers.

Vasculitis Treatment

The treatment for this disorder is specific in nature and depends on the following factors:

• The type of Vasculitis that an individual is found to suffer from
• The severity of the condition
• The general health of sufferers

Certain forms of this disorder, such as Henoch-Schonlein purpura, are found to be self-limiting and resolve on their own. Others, however, need medications to improve.

The medicines used to cure Vasculitis involve:

Steroids

These are useful for addressing the problem of inflammation associated with this disease. Many forms of Vasculitis need to be cured with doses of corticosteroid drugs like Methylprednisolone (Medrol) or Prednisone for control of swelling.

The side effects of steroid treatment can be acute in nature, particularly in cases where the medications are taken for a prolonged duration. The problems may include:

• Diabetes
• Weight gain
• Thinning of bones (Osteoporosis)

Due to this reason, physicians tend to administer patients with the lowest possible doses of steroids to manage the disorder.

Immune system medicines

Acute cases of Vasculitis or those that show poor response to corticosteroids may need to be treated with Cytotoxic medicines that destroy immune cells which lead to swelling. Cytotoxic drugs include cyclophosphamide (Cytoxan) and azathioprine (Azasan, Imuran).

Rituximab (Rituxan) is another medicine that helps slacken the response of the immune system. The drug, along with corticosteroids, has been approved for curing Microscopic polyangiitis and Granulomatosis with Polyangiitis (Wegener’s). Medical researchers have also got some amount of success in using drugs that change the response of the immune system to cure some forms of vasculitis. Medicines that have been used and are still in the testing phase include adalimumab (Humira), anakinra (Kineret), infliximab (Remicade) and mycophenolate (Cellcept).

Patients may seek medical help from the following healthcare providers who specialize in treating Vasculitis:

• Skin doctors (dermatologists)
• Brain and nervous system doctors (neurologists)
• Muscle and Joint doctors (rheumatologists)
• Kidney doctors (nephrologists)
• Heart doctors (cardiologists)
• Eye doctors (ophthalmologists)
• Doctors for infectious diseases
• Lung doctors (pulmonologists)

Before visiting any of the above mentioned medical professionals, sufferers should make a list of:

• All the symptoms that they have been experiencing
• All the medications that they have been using of late, including one or more supplements
• Any recent changes in their life, such as a major stressful event

As appointments are brief, it is better to be well-prepared beforehand to make the most of time and also to avoid missing out any key information.

Vasculitis Management and Support

The management and supportive measures associated to this disease include:

Choosing a healthy diet

Following a healthy diet can help patients prevent possible side effects of medications, such as high blood pressure, diabetes and thinning of bones. Follow a diet that is rich in whole grains, lean meats, fishes, low-fat dairy products and fresh fruits and vegetables. If you are undergoing a corticosteroid therapy, ask your physician to suggest you a good calcium or Vitamin D supplement.

Regular exercise

Performing aerobic exercises on a regular basis, and even walking, can help prevent side effects of corticosteroids like diabetes, high blood pressure and bone loss. It can also be beneficial for vital organs of the body, such as the heart and the lungs. Moreover, many patients find that performing workouts on a regular basis improves their mood and also improves their overall sense of well-being.

Patients who are not used to workouts should begin gradually and then build up over a period of several weeks or months. Your physician can help you plan a workout regimen that is ideal for you.

Vasculitis Complications

The complications for Vasculitis depend on the type of the condition that one suffers from. Generally, the complications include:

Picture 2 – Vasculitis Image

Repeated episodes of Vasculitis

Vasculitis may recur even in cases where the treatment for the disorder is initially successful. In such cases, additional curative measures may be needed. In other cases, the disease may never go away completely and need ongoing treatment.

Organ damage

Certain forms of Vasculitis can be acute in nature and cause damage to major organs.

Some of the common complications involve the following problems:

• Arterial or venous thrombosis
• Central nervous system infarction
• Digital gangrene
• Pulmonary haemorrhage
• Renal insufficiency
• Subglottic stenosis

Vasculitis Prognosis

The outcome of the disorder depends on the degree of end-organ involvement of patients. When the condition is detected and cured on an early basis, the outcome is generally good.

If you suspect yourself to be showing the symptoms of Vasculitis, seek treatment on an immediate basis. Early cure can help you recover faster from the condition while keeping it neglected can do just the opposite and even give rise to life-threatening consequences. Naturally, it is imperative that you consult your family physician and get yourself diagnosed.

References:

http://www.mayoclinic.com/health/vasculitis/DS00513

http://www.nlm.nih.gov/medlineplus/vasculitis.html

http://www.patient.co.uk/doctor/Vasculitis.htm

http://www.medicinenet.com/vasculitis/article.htm

The post Vasculitis appeared first on Prime Health Channel.

Orthostatic Hypotension Definition

It is defined as a type of hypotension (low blood pressure) in which the systolic blood pressure reduces to 20mmHg or more when a person is standing up or stretching. It is generally mild in nature. However, long lasting hypotension postural can give rise to very serious health issues.

This disease is related with conditions like:

• Diabetes
• Addison’s disease
• Autonomic system neuropathies
• Multiple System Atrophy with Orthostatic Hypotension (and other forms of Dysautonomia)

Orthostatic Hypotension ICD9 Code

The ICD9 code for this clinical condition is 458.0.

Orthostatic Hypotension Synonyms

This ailment is also referred to as Postural hypotension. In colloquial language, this disorder is known as dizzy spell or head rush.

Orthostatic Hypotension Incidence

This form of hypotension is more common when there is any kind of injury. An individual is more prone to Orthostatic hypotension if the injury level is at T-6 or more than that. Individuals affected with spinal cord injury can also experience this blood pressure syndrome. Though it can affect anyone, the occurrence of postural orthostatic hypotension increases with age and is prevalent among the elderly.

Orthostatic hypotension is more frequent among the people who take drugs to administer high blood pressure or suffering from autonomic nervous system dysfunction diabetes and atherosclerosis. In a few cases, it also occurs during pregnancy,

Causes of Orthostatic Hypotension

According to human anatomy when you stand up, blood collects in your legs due to the gravitational force. This minimizes the blood pressure level since the blood flowing back to the heart is less. This form of hypotention arises when the normal method of sabotaging low blood pressure is disturbed. Few other reasons which give rise to this chronic blood pressure syndrome include:

Heart problems

A few heart disorders can lower the blood pressure level comprise of heart valve problems, heart valve problems, heart failure and heart attack. Such medical conditions can give rise to orthostatic hypotension, since they restrict the ability of the body to respond quickly to pump adequate blood when required, especially when standing up.

Nervous System Ailments

Certain nervous disorders can disturb the blood pressure system. These include multiple system atrophy (Shy-Drager peripheral neuropathies), Parkinson’s disease and amyloidosis.

Dehydration

The body loses volume during dehydration and leads to low blood pressure. Few conditions which can cause dehydration may include fever, inadequate consumption of fluids, vomiting, diarrhea and arduous exercise along with profuse sweating. Due to loss of blood, even mild type of Orthostatic hypotension can lead to the occurrence of its symptoms.

Diabetes

If diabetes is left untreated, it can cause frequent urination and give rise to dehydration. Severe dehydration can trigger hypotension postural in the body of sufferers.

Symptoms of Orthostatic Hypotension

Orthostatic Hypotension is characterized by lightheadedness or dizziness occurring during change in body posture such as lying down or sitting up. The symptoms which confirm the occurrence of this blood pressure disorder may include:

• Mental confusion
• Bodily dislocation
• Muscle tremors
• Nausea
• Numbness
• Severe or general tingling or fainting
• Dizziness
• Hearing deformation
• Headache
• Pain adjacent to the shoulders and neck
• Euphoria
• Vasovagal syncope in rare cases
• Lightheadedness
• Momentary blindness or dimmed vision

Due to inadequate blood pressure and insufficient blood supply (cerebral perfusion), patients can experience severe outcomes and often complain about a strange warm feeling around the shoulder and head areas after the dizziness goes away.

Diagnosis of Orthostatic Hypotension

The main objective in determining orthostatic hypotension is to find out the underlying cause of its origin. The exact reason of the occurrence will help to evaluate the appropriate treatment for its cure and find out if nervous system, heart or brain problems are causing the blood pressure level to deteriorate. Doctors recommend a number of clinical procedures and tests to determine the existence of Orthostatic hypotension including:

ECG

Electrocardiogram is a noninvasive test which identifies the abnormalities inside the heart along with issues related with oxygen and blood supply to the heart muscle.

Stress Test

Some heart related problems which give rise to low blood pressure are much easy to diagnose when the heart is at work rather than when it is at rest. During exercise, such as while walking on a treadmill, the heart works much faster than normal. In a few cases, medicines are recommended to make the heart work harder for patients who are incapable of performing any exercise. When the heart is working harder and faster, echocardiography or electrocardiography is used to administer it along with the blood pressure level.

Tilt table test

This diagnostic procedure helps to determine how individual body responds to certain changes in position and the changes in the blood pressure level.

Blood Pressure Monitoring

Doctors analyze the difference of blood pressure level when a patient is standing up and sitting down. Doctors diagnose orthostatic hypotension if there is a drop in 20 millimeters of mercury in the systolic blood pressure or 10mm Hg drop in the diastolic pressure.

Valsalva maneuver

It is noninvasive diagnostic procedure which detects the operation of the autonomic nervous system by evaluating the heart rate and blood pressure level after continuous periods of deep breathing.

Blood tests

This procedure helps to determine the overall condition of the health and detects the existence of hypoglycemia or anemia in the body which can lead to low blood pressure levels.

Ambulatory blood pressure and ECG recording

This procedure comprises of blood pressure cuffs for a span of 24 hours which will record the blood pressure fluctuations. A monitor will be attached to enable constant ECG reading.

Orthostatic Hypotension Management

Orthostatic hypotension can be managed by each and every patient. It can be done by simply following the guidelines of respective doctors and taking little precautions. Some suggestions recommended by doctors may include:

• Standing up slowly will enable the blood vessels to contract in a better manner and avoid syncope (fainting)
• By loosening the abdominal muscles and taking deep breaths while rising assists in maintaining a constant oxygen and blood flow to the brain.
• Eating smaller meals throughout the day can help the blood pressure from lowering.
• Avoiding certain body postures such as sitting with knees up to chest which obstruct regular flow of blood and give rise to incidents.
• Extra care should be taken if one attempts to stand after eating.
• When such form of hypotension is caused by hypoyolemia because of certain medicines, the process can be reversed by changing the medicine dose or changing it completely.

Treatment of Orthostatic Hypotension

The treatment for Postural Hypotension is based on its cause. If orthostatic hypotension is mild in nature, the treatment for such type is to lie down or sit when lightheaded felling occurs due to standing. Doctors first try to detect the underlying health problems which include:

• Heart failure
• Dehydration
• Low blood pressure level

Doctors and physicians recommend different types of medications and treating options to cure this form of hypotension including:

Compression stockings

Leotards and elastic stockings are utilized to reduce the pain and heal the swelling of the varicose veins. These help to reduce the warning signs of orthostatic hypotension by minimizing the accumulation of blood in the legs.

Lifestyle Changes

Another effective option for treating this syndrome is by drinking enough fluids (water) and any form of alcohol. Doctors suggest orthostatic hypotension patients to stand up slowly and avoid walking in hot climate. Exercise programs to stiffen the calf muscles and increasing salt in the diet are also recommended by physicians for orthostatic hypotension patients.

Medications

Few medications which are recommended by doctors for the treatment of orthostatic hypotension may include:

• Fludrocortisone
• Midodrine
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Caffeine and epoetin (Epogen, Procrit)
• Pyridostigmine (Mestinon)

Orthostatic Hypotension Prognosis

Orthostatic hypotension may give rise to accidental falls. The prognosis for such patients solely depends on the cause of the syndrome.

Orthostatic Hypotension Prevention

Doctors recommend a few procedures and techniques for the prevention of Orthostatic hypotension. Following the prevention methods would help patients to deal with the complications and problems arising due to this syndrome. Such measures include:

• Avoid bending of the waist and squat your knees to pick up something from the floor.
• Sleeping in an elevating position
• Trying to move slowly from a sitting to standing position.

Orthostatic Hypotension Complications

Mild orthostatic hypotension is a minor irritant whereas the severe form is much more complicated and is present especially in adults. However, a few other additional complications include:

Stroke

Due to reduced supply of blood to the brain, patients are more prone to stroke.

Falls

Patients affected with orthostatic hypotension often experience syncope (fainting) and fall down frequently.

Orthostatic Hypotension Risk Factors

The risk factors for the disease include:

Age

This disorder is more common among the people who are aged 65 and above. Due to aging, baroreceptors cells become incapable to monitor the blood pressure level. Consequently, the heart cannot beat faster and hence blood pressure drops.

Diseases

A few disorders such as Parkinson’s disease along with other heart conditions make a patient more vulnerable to low blood pressure.

Medicines

Individuals who take high blood pressure medicines are more prone to orthostatic hypotension. Such medicines include water pills, beta blockers, tricyclic antidepressants, sildenafi etc.

Exposure to heat

If an individual is exposed to any hot and humid climate, he/she can get dehydrated and give rise to low blood pressure which can trigger orthostatic hypotension.

If you or any of your family member is experiencing the symptoms of Orthostatic hypotension, consult your family physician immediately. Do not neglect the disorder, for it can give rise to a number of severe complications in the body.

References:

http://jnnp.bmj.com/content/65/3/285.full

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

http://en.wikipedia.org/wiki/Orthostatic_hypotension

http://calder.med.miami.edu/pointis/pos.html

The post Orthostatic Hypotension (Postural Hypotension) appeared first on Prime Health Channel.

Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by the presence of unusually low platelet count or thrombocytopenia of an idiopathic or unknown cause. As most cases of ITP seem to be associated to the manufacturing of the antibodies against the platelets, the condition is also known as immune thrombocytopenia or immune thrombocytopenic purpura. ITP can be frequently asymptomatic and only discovered incidentally; however a severely low platelet count might lead to increased chance of purpura and bleeding. Some of the other names for this condition include:

• Morbus haemorrhagicus maculosus
• Splenic thrombocytopenic purpura
• Purpura haemorrhagica
• Thrombocytolytic purpura

Idiopathic Thrombocytopenic Purpura Epidemiology

ITP affects both boys and girls equally, although the gap widens as they tend to become more mature. The ratio of male to female adult patients is around 1:1.2 to 1:7. The average age in which this condition is first detected falls roughly between 56 and 60.

Idiopathic Thrombocytopenic Purpura Classification

ITP can be of two types:

Acute ITP

This form of the disorder develops suddenly and generally follows some viral condition in a child. Acute form of ITP may not require any treatment, if there is low bleeding and the number of platelets does not decrease significantly. The condition generally shows spontaneous improvement and rarely shows any signs of relapse in children.

Chronic ITP

This type of ITP develops over a long time, is much more long lasting and is generally found in adults. The condition may not require treatment if the platelet count does not pose a major risk of bleeding. Participating in various contact sports or handling manual work should be done with care.

Idiopathic Thrombocytopenic Purpura Causes

ITP occurs when certain specific immune system cells develop antibodies against the platelets. Platelets assist in clotting of blood by clumping together and blocking small holes in the damaged blood vessels. Antibodies get attached to the platelets and the spleen damages the platelets carrying the antibodies. The immune system generally protects the body from diseases and infections. However, it destroys the body’s platelets in ITP sufferers. The exact causes for this are not known, although some probable factors have been suggested.

The various probable factors that lead to the development of this disorder have been listed below:

• An abnormal autoantibody (such as immunoglobulin G) binds to platelet membrane leading to the spleen’s removal.
• HIV infections
• Helicobacter pylori infections
• Lymphoproliferative disorders like non-Hodgkin’s lymphoma and chronic lymphocytic leukemia
• Collagen vascular diseases, like Systemic lupus erythematosus
• Drugs like heparin, sulfonamides, quinine
• Toxins like ethanol
• Acute hepatitis
• Herpes group infections
• Relapsing dengue fever
• Hodgkin’s disease
• Tuberculosis

The disease can sometimes have a viral connection in children. In adults, ITP occurs more frequently after some viral infection that develops to a chronic stage (long-term). It can also be induced by the usage of certain drugs, at the time of pregnancy or in association with some autoimmune disorder.

The factors that may increase the risk of development of ITP include:

• Very low platelet count
• Acute viral sickness
• Aging
• Hypersplenism
• Cardiopulmonary bypass
• Antiphospholipid antibody syndrome

Idiopathic Thrombocytopenic Purpura Symptoms

Immune thrombocytopenia might not cause any symptoms (asymptomatic). However, the condition can lead to internal bleeding or bleeding within the body or external bleeding from or underneath the skin. Signs of such bleeding may include:

• Development of bruises or purplish areas over one’s skin or the mucous membranes which are known as purpura; they are caused by sub-dermal bleeding. Reasons for such bleeding are not known.
• Possible development of Hematomas under the skin. These are clusters of clotted or partly clotted blood that grow under the skin and have the look or feeling of a lump.
• Red spots known as petechiae are seen on the skin. They often develop in clusters and may resemble rashes. These spots are also caused by sub-dermal bleeding.
• Bleeding of the gums during a dental work or nosebleeds
• Blood found in one’s stool or urine

Any form of bleeding that is difficult to stop could indicate ITP. This also includes menstrual bleeding that is heavier than normal. Cerebral bleeding is very rare with variable symptoms.

Low platelet count does not directly lead to pain, difficulty in concentration or any other problems. However, it might be linked with tiredness or fatigue.

Idiopathic Thrombocytopenic Purpura Diagnosis

ITP is diagnosed through a procedure of exclusion. Firstly, the doctor will have to conduct a thorough physical examination and determine that no signs of any blood abnormalities are present other than a low platelet count. No physical signs are expected either except for the regular signs of bleeding. The secondary causes, which are seen in about 5 to 10% of all suspected cases of ITP, include:

• Medications
• Leukemia
• Cirrhosis
• Lupus erythematosus
• Hepatitis C
• HIV
• Antiphospholipid syndrome
• Congenital factors
• Onyalai
• Deficiency caused by von Willebrand factor

These factors should be excluded as well. In around 1% of cases, ITP co-exists along with autoimmune hemolytic anemia in a condition commonly referred to as the Evans Syndrome.

The spleen is generally not enlarged even though the platelets are destroyed by splenic macrophages. In fact, the presence of an enlarged spleen must lead a physician to explore other possible factors that might have led to the development of thrombocytopenia. ITP patients normally experience prolonged episodes of bleeding. However, the practice guidelines issued by American Society of Hematology discourages the usage of bleeding time while diagnosing idiopathic thrombocytopenic purpura. The normal bleeding time generally does not exclude platelet disorders.

Bone marrow examination can be performed on the patients who are above 60 years of age and those who show no response to treatment, or if the diagnosis is doubtful. A doctor may find signs of increased production of megakaryocytes while examining the bone marrow, which may conclusively suggest ITP. Analysis of the anti-platelet antibodies can be conducted; although that rests on the preferences of the physician.

The standard tests for the diagnosis of ITP include the following:

• Complete blood count test
• Blood clotting tests like PT and PTT
• Bone marrow biopsies
• Blood smear tests

Idiopathic Thrombocytopenic Purpura Differential Diagnosis

The differential diagnosis for the ITP includes ensuring the absence of the following health issues that might give rise to similar symptoms in sufferers:

• AIDS and other HIV infections
• Disseminated intravascular coagulation

Idiopathic Thrombocytopenic Purpura Treatment

An individual is treated for ITP if his or her blood work shows a platelet count less than 20000 per μl. Patients having a platelet count range between 20000 and 50000 per μl are normally evaluated on a per case basis, and except only in some rare instances, sufferers showing a count above 50000 per μl do not require any treatment. Hospitalization might be recommended for patients with very low platelet counts, and especially so in cases where significant mucocutaneous or internal bleeding has developed. Platelet count less than 10000 per μl is considered as a medical emergency; an affected individual might feel vulnerable to intracerebral or subarachnoid hemorrhage because of some moderate head trauma. Treatment is generally administered under recommendations of a hematologist and might be different for pediatric and adult cases of ITP.

Steroids

Usage of steroids makes up the basic form of treatment for this disorder. This group of medications helps to suppress the immune system. The mode of administration and dosage is determined by platelet count and if there is any active bleeding. Infusions of methylprednisolone or dexamethasone can be carried out in emergency cases. Milder forms may be treated with oral prednisolone or prednisone. After the platelet count has been improved, the dosage of steroids is reduced gradually and relapses if any are monitored. Nearly 60% to 90% of people experience relapses at the time of dosage reduction or cessation. A long-term usage of steroids is not recommended as it can cause various side effects.

Anti-D Immunoglobulin

Treatment of ITP can be conducted by administering Anti-D medications in case of Rh-positive patients. Anti-D or Rho(D) immune globulin is administered intravenously to these patients. It is also normally given to Rh-negative women during their pregnancy or after an Rh-positive infant is born in order to prevent the sensitization to Rh-factor in a newborn. The Anti-D medications have proven their effectiveness on some of the ITP patients. However, the procedure is costly, producing improvements only for a short term and not recommended for the patients recovering from a splenectomy procedure.

Steroid-sparing agents

Immunosuppressant medications like azathioprine and mycophenolate mofetil are growing in popularity due to their effectiveness in handling cases of ITP. In issues like chronic refractory problems where immune pathogenesis has already been established, a chemotherapeutic agent known as vincristine may be used. However, vincristine (a vinca alkaloid) produces serious side effects and hence it should be used only with caution in the treatment of idiopathic thrombocytopenic purpura. This is especially so for children as they are more vulnerable to its ill effects.

Intravenous immunoglobulin can be used in some cases as a mode of treatment for ITP. Although this method of treatment is costly and is effective only for a short period of time, it can be used for patients who are scheduled for surgery, have a critically low count of platelets as well as shown poor response to other forms of treatment to increase platelet count and minimize the bleeding risks.

Thrombopoietin receptor agonists

These are pharmaceutical agents which can be used to cure ITP. They induce production of platelets instead of trying to hinder platelet destruction. Thrombopoietin receptor agonists prevent bruising and bleeding by increasing platelet production in the bone marrow. Romiplostim, sold under the brand name of Nplate and Eltrombopag is available under the names of Promacta and Revolade. These are the examples of two well known thrombopoietin receptor agonists.

Surgery

Removal of spleen or splenectomy can be considered as a surgical option for treating idiopathic thrombocytopenic purpura. The procedure is risky in cases of ITP as it can cause severe bleeding during surgery. Splenectomy can be followed by durable remission in around 60% to 65% cases of ITP, and even less so for older patients. With the advent of various pharmaceutical remedies and steroid therapy, the usage of splenectomy as a mode of treating idiopathic thrombocytopenic purpura has been diminished to a large extent.

Transfusion of Platelets

Platelet transfusion is generally not recommended apart from emergency cases. It is also not effective enough to produce a long-term increase in platelet count. This is due to the fact that the autoimmune mechanism responsible for destroying the platelets also attacks the donor platelets.

Eradication of Helicobacter pylori

People living in areas having a high presence of the Helicobacter pylori bacterium should be targeted for treatment aimed at removal of this microbial agent, as this has shown promise in improving platelet count in many patients. In some cases, it was possible to bring back the platelet count back to normal. Tests like stool antigen testing and urea breath testing are more effective for these patients than tests based on serology. In fact, serology may show false positive results after an IVIG treatment.

There are certain other modes of treatment which are now still at an experimental stage. These include usage of the anti-infective sulfone drug called Dapsone, the chimeric monoclonal antibody known as rituximab and kinase inhibitor known as tamatinib fosdium (R788).

Idiopathic Thrombocytopenic Purpura Treatment Complications

The various treatment procedures used for curing ITP can have certain ill effects on the patients’ overall health. These treatment-related complications have been discussed below:

• Long-term usage of steroids may cause several negative side effects, such as depression, diabetes, increased appetite, weight gain, indigestion, high blood sugar, facial puffiness, indigestion, high blood pressure, chickenpox, cataracts and osteoporosis.
• Vincristine has been known to cause serious side effects and so their usage in case of pediatric patients should be limited.
• The surgical procedure of splenectomy can cause severe bleeding in a patient already affected by idiopathic thrombocytopenic purpura.

Usage of thrombopoietin receptor agonists can have various after-effects, such as:

• Headache
• Dizziness
• Vomiting
• Nausea
• Pain in joints or muscles
• An increased propensity for blood clots

Idiopathic Thrombocytopenic Purpura Prognosis

Proper treatment ensures a high chance that no remission will take place. In some rare cases, ITP can develop into a long-term condition that affects adults and relapse even after a period free of symptoms. The outcome, although generally good, is variable and depends on the intensity of the symptoms. Individuals may respond differently to the same mode of treatment.

Idiopathic Thrombocytopenic Purpura Prevention

Although ITP cannot be prevented, an individual can follow certain recommendations that might help him or her to avoid unnecessary complications. These include:

• Consulting doctor regarding medications that are considered safer. A doctor might advise to stay away from medicines like aspirin and ibuprofen that may affect the platelet count and increase chances of bleeding.
• Taking protection from bleeding or bruising.

Idiopathic Thrombocytopenic Purpura Pictures

Here are some pictures that would give you a clearer idea about the nature of this health condition.

Idiopathic thrombocytopenic purpura develops as a result of extremely low platelet count due to some unknown causes. Although it might be difficult to find out the underlying causes of the disorder, proper treatment can effectively cure an individual of this condition, blocking the risks of a possible relapse.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/000535.htm

http://emedicine.medscape.com/article/779545-overview

http://www.patient.co.uk/health/Idiopathic-Thrombocytopenic-Purpura-%28ITP%29.htm

http://www.itpsupport.org.uk/

The post Idiopathic Thrombocytopenic Purpura appeared first on Prime Health Channel.

Vasovagal syncope Definition

It refers to an episode of fainting or unconsciousness resulting from a hyperactive physical reflex that momentarily retards oxygen flow to the brain. It is this lack of proper oxygen supply to the brain that makes affected individuals lose consciousness.

The disorder is the most common cause of fainting. It is also known by various other names like:

• Common faint
• Reflex syncope
• Neuromediated syncope
• Neurocardiac syncope
• Vasovagal response
• Vasovagal attack
• Neurocardiogenic syncope (NCS)

Vasovagal syncope ICD9 Code

The ICD9 Code for this condition is 780.2.

Vasovagal syncope Incidence

In the general population, the disease is said to have a 22% mean prevalence. The disease can arise at any age. However, it is increasingly been regarded as an important cause of unconsciousness in elderly people.

Vasovagal syncope Symptoms

The condition is typically characterized by sudden loss of consciousness or fainting on the part of sufferers. Prior to fainting, however, patients may suffer from certain other problems. These include:

• Nausea
• Lightheadedness
• Cold, clammy and sweaty skin
• Feeling of warmth
• Paleness of skin
• Tunnel vision, characterized by limiting of the field of vision to let patients see only the objects at the front

Loss of consciousness can be an early sign of a more severe condition, such as brain or heart disorders. Suffering individuals should get in touch with a good physician as early as possible, in case they have not experienced symptoms of fainting before.

Vasovagal syncope Causes

The problem arises when the body reacts aggressively to certain trigger factors. These include severe emotional trauma or the sight of blood. Such triggers lead to a sudden drop in blood pressure and heart rate. The section of the nervous system regulating the blood pressure and heart rate begins to malfunction in response to such trigger factors. The heart rate gets slowed down and the blood vessels present in the legs widen. This results in accumulation of blood in the legs and immediate lowering of blood pressure. The flow of blood to the brain gets reduced, ultimately leading to fainting in sufferers.

The common trigger factors for this condition include:

• Severe emotional distress
• The sight of blood
• Standing for an extended duration
• Exposure to heat
• Drawing out of blood from the body
• Straining, as in bowel movement
• Fear of bodily harm

Vasovagal syncope Diagnosis

The diagnostic tests for this condition include the following exams:

Echocardiogram

This exam involves the use of ultrasound imaging to get a proper view of the heart and search problems, such as those involving the valves, which can result in fainting.

Electrocardiogram

It includes recording the electrical signals produced by the heart of affected individuals. The test helps detect irregularities in cardiac rhythms and other heart problems that can lead to unconsciousness. Patients undergoing this exam may be asked to wear a portable monitor for some time, the span of which can range from a single day to an entire month.

Blood tests

These are useful for physicians to determine the presence of conditions like anemia that can result in, or worsen, the fainting spells in patients.

Exercise stress test

This exam studies cardiac rhythms during a period of workout. The test is generally carried out when patients walk under observation or jog on a treadmill.

Vasovagal syncope Differential Diagnosis

Physicians may recommend certain exams to rule out the presence of severer causes of sudden unconsciousness, such as heart disorders. The differential diagnosis of the disease should include ruling out other disorders that produce identical symptoms. These include:

• Complex partial epilepsy
• Panayiotopoulos syndrome
• Hypoxia, with convulsion
• Hysterical fainting
• Acute blood loss
• Hypoglycemia
• Chronic fatigue syndrome
• Neurodegenerative disorders
• Primary autonomic failure, such as pure autonomic failure or multiple system atrophy

Physicians also keep in mind the effects of intake of drugs and alcohol while evaluating this condition.

If doctors detect no heart-related problems for the fainting episodes, they may suggest patients to go through a tilt-table test. The test involves:

• Lying flat on the back over a table
• Changing the position of the table to tilt the patient upward at several angles
• Monitoring the blood pressure and cardiac rhythm to observe whether the postural change affects sufferers

A tilt-table test provokes NCS symptoms in a controlled setting while the blood pressure and cardiac rhythm are monitored. Following tests, medicines may be prescribed to minimize the symptoms experienced by sufferers.

Vasovagal syncope Treatment

The majority of sufferers of this disease do not require any treatment. Physicians may help affected individuals identify the trigger factors for their fainting episodes and discuss the possible ways to avoid or at least cope with them. If patients experience the problem as frequently as to have their daily activities impaired by it, physicians may suggest one or more remedial measures which include:

Medicines

Certain drugs that can help avoid an occurrence of such episodes of unconsciousness. These involve:

Blood pressure medications

Beta blockers like Metoprolol (Lopressor) are used to cure high blood pressure problems. Such types of drugs are also used very frequently to prevent fainting episodes resulting from NCS as they obstruct some of the signals that can cause loss of consciousness.

Antidepressants

The class of antidepressant drugs, known as SSRIs (Selective Serotonin Reuptake Inhibitors), has also been found to be useful in preventing cases of NCS. Sertraline (Zoloft), Fluoxetine (Prozac) and paroxetine (Paxil) are some of the SSRIs found to yield positive results in the management of NCS.

Blood vessel constrictors

In some patients, NCS can be prevented with the aid of drugs used to cure asthma or blood pressure.

Therapies

Physicians may recommend the use of certain methods to reduce the accumulation of blood in the legs. Such techniques may involve:

• Wearing elastic stockings
• Foot exercises
• Tensing the leg muscles while standing
• Increasing the intake of dietary salt (for people not suffering from high blood pressure)
• Having lots of fluids
• Avoiding standing for long periods, particularly in crowded and hot places

The emotional causes of NCS may need intervention by a professional mental healthcare provider.

Surgery

Inserting an electrical pacemaker can help regulate cardiac rhythm and help some individuals suffering from NCS.

Vasovagal syncope in Children

Children suffering from NCS typically complain of the following problems before having an actual episode of fainting:

• Lightheadedness
• Dizziness
• Nausea
• Changes in hearing or vision
• A feeling of warmth

When kids faint and fall down, they tend to recover quickly. They are fully oriented almost always. However, they may experience nausea, weakness and tiredness for a few hours.

The physical injuries in children heal quickly. Unfortunately, that is not the case in adults. Elderly individuals who get injured due to a fall suffer for a much longer duration. Children who faint during sports activities should not be allowed to get back to strenuous activities until they have been completely evaluated and declared fit by a qualified healthcare provider. Affected kids should be put through the following tests:

• Exercise testing
• Echocardiography
• Cardiac catheterization
• Ambulatory cardiac rhythm monitoring

Even after treatment, kids who have suffered an episode of NCS should be encouraged to improve his or her daily fluid intake. Proper measures should be taken to reduce chronic emotional and physical stresses in NCS-affected children.

In a study conducted in young medical students, half of the girls and a quarter of the boys were found to suffer from at least one episode of fainting.

Vasovagal syncope and Pregnancy

Pregnant women are more susceptible to this condition. In pregnant women, the cardiovascular system goes through rapid changes. They experience lightheadedness as well as an array of other problems like:

• Paleness of skin
• Sweating
• Sensation of hotness
• Yawning
• Nausea
• Hyperventilation (deeper breathing)

These are nothing but the warning signs of NCS. Pregnant women who experience such problems should immediately lie down to prevent themselves from fainting. They should call their midwife or a doctor to share the problems and discuss possible remedial measures. Loss of consciousness during maternity can lead to a fall and carries a possible risk of miscarriage. Naturally, it is important for expecting mothers to seek treatment for this condition.

Vasovagal syncope Complications

This is generally a harmless condition. However, patients may injure themselves by falling down during an episode of fainting caused by this problem. Bodily injuries (such as bruises, broken bones or gashes) caused due to a fall or an accident suffered during unconsciousness can jeopardize health. In rare cases, severe injuries might also lead to the death of sufferers.

Vasovagal syncope Prognosis

Therapy involving medications can prevent future episodes of this nature. However, certain patients continue to suffer from such problems despite the use of medicines. Drugs are found to be ineffective in such cases.

Vasovagal syncope Prevention

It is difficult to prevent the condition as it is not known when an episode of fainting would occur. However, people who suffer from recurrent episodes of fainting associated to NCS tend to become familiar with the warning signs. A person experiencing the problems prior to fainting such as lightheadedness, nausea or tunnel vision should lie down and lift the legs to rest them in a higher place. This would keep the legs at a higher level than that of the brain. The blood flow to the brain would continue due to gravity. If there is no place to lie down, the person should sit down and place the head between the knees until he or she begins to feel better.

While Vasovagal syncope is not a serious problem, it involves a risk of certain complications and can be a warning sign of some other disorder in certain cases. Naturally, people experiencing more than one episodes of such type of sudden unconsciousness should get in touch with a medical professional and discuss possible course of remedy.

References:

http://www.mayoclinic.com/health/vasovagal-syncope/DS00806

http://en.wikipedia.org/wiki/Vasovagal_response

http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health/fainting

http://www.medmerits.com/index.php/article/neurocardiogenic_syncope/P8

http://www.wisegeek.com/what-is-a-vasovagal-syncope.htm

The post Vasovagal syncope appeared first on Prime Health Channel.

Myxoma Definition

It is an uncommon intra-cardiac tumor (or a tumor that is present inside the heart). The left atrial myxoma constitutes 75% of all the occurring myxomas while the right atrial myxoma represents the remaining 25%. Such new growth of tissue is usually a soft irregular shaped jellylike accumulation or a round firm gathering of mass.

These tumors are linked with endocardium, the inner lining of the cardiac. The cells which comprise of the myxoma tumor are spindle-shaped and are rooted in an environment made up of mucopolysaccharides.  Such abnormal growth of tissues is also termed as Atrial myxoma.

Myxoma ICD9 Code

The ICD9 code for this medical condition is 212.7.

Myxoma Incidence

Cardiac Myxoma is considered to be the one of the most common non-malignant tumors affecting the heart. In a few cases, this disorder occurs due to hereditary reasons and affects young individuals. This condition is more prevalent among women and normally affects individuals above the age of 40.

Myxoma Types

Soft tissue myxoma can be differentiated into 9 types:

Picture 1 – Myxoma

Intramuscular myxoma

It is a non-cancerous soft tissue tumor found in the skeletal muscle. Such disorders lack particular symptoms and hence diagnosis of such tumors is quite difficult.

Aggressive angiomyxoma

It is an uncommon lump of mesenchymal mass which develops in the vulvovaginal and perineum region. The tumor is infiltrative in nature and is associated with local recurrence.

Superficial acral fibromyxoma

It is a rare soft tissue neoplasm which is generally found on the hands and feet of adults. This disorder originates from CD34+ fibroblasts and has a predilection for the subungal or periungal regions.

Cutaneous myxoma

It is an infrequent tumor of the subcutis and skin. Such tumors occur among patients suffering from Carney’s syndrome and are more common among men than women, typically middle aged adults.

Juxta-articular myxoma

This form of Myxoma affects the large joints followed by shoulder, ankle and hip. Older patients, with a medical history of osteoarthritis, are more prone to such tumors. Such tumors range between 2- 6 cm in size and generally occur in the knee joints of aged adults.

Angiomyofibroblastoma

It is an uncommon myofibroblastic tumor made up of soft tissues, that normally occurs among females aged 25-50. The tumors are circumscribed round shaped mass that and originate from CD34.

Nerve Sheath Myxoma

Such neoplasm is form of nerve sheath tumor and affects both adults and children. Such tumors have a predilection for the limbs and knees and are generally 2.5 cm in diameter.

Pseudo Myxoma Peritonei

It is a medical condition which occurs due to the production of excess mucin by tumor cells. It fills the abdominal cavity and constricts the liver, kidney and pancreas if left untreated.

Myxoma Causes

Myxoma tumors do not arise due to any causative agents. Atrial myxoma tumors are the result of multipotential mesenchymal cells and may lead to a ball valve-type barrier. Almost 10% of such patients acquire such tumors due to hereditary reasons.

Myxoma Symptoms

The symptoms related with ventricular myxoma arise due to tumor which restricts the usual flow of blood inside the heart chambers. Atrial myxoma symptoms generally occur when the affected patient lies in a specific position. The warning signs of the disorder may be related with the discharge of interleukin by the tumor. The classic signs of the disease may include:

• Breathing problem, especially during the upright position
• Dizziness
• Palpitations
• Sudden death
• Shortness of breath during any physical activity
• Paroxysmal nocturnal dyspnea
• Fainting
• Chest pain

Additional symptoms

Patients affected with such tumors display a number of general symptoms, including:

• Fever
• General discomfort
• Bluishness of the skin
• Clubbing
• Swelling of any of the body part
• Cough
• Cachexia
• Joint pain
• Sensitive fingers, changing colors with cold or stress

Myxoma Diagnosis

The diagnosis of myxoma tumor initiates with the study of the medical history and proper physical examination of the patient. Generally, the physical examination of individuals affected with Atrial myxoma is normal. Ventilation perfusion lung scan should be conducted to rule out the possibility of pulmonary embolism as the primary cause of the disorder. Physical findings may include inspection of the heart to find out the existence of any classic tumor. To confirm the diagnosis of Atrial myxoma, doctors recommend a few diagnostic tests which include:

• Blood electrolytes
• Cardiac enzymes
• Pulse oximetry
• Troponin levels
• Coagulation profile
• Chest x-ray
• Echocardiogram
• Thyroid profile
• Electrocardiogram (EKG or ECG)
• Cardiac monitoring
• Thallium heart scan
• Cardiac catheterization

Myxoma Differential Diagnosis

The differential diagnosis of the disease involves distinguishing its symptoms from those of other medical conditions that include:

• Pulmonary Embolism
• Pulmonary Hypertension, Primary
• Tricuspid Regurgitation
• Mitral Regurgitation
• Mitral Stenosis
• Tricuspid Stenosis

Such tumors which occur inside the heart are not pedunculated in nature and can penetrate inside the muscle of the heart. Such cardiac tumors can be diagnosed with Magnetic Resonance Imaging (MRI).

Myxoma Treatment

According to medical practitioners, these tumors should be removed from the atrium via surgery. If the surgery is not conducted by an expert surgeon, Myxoma tumor may reoccur. After surgery, doctors advise patients to undergo echocardiography for the next 5 years in order to make sure that such lumps do not arise again.

Myxoma Prognosis

Although myxoma tumor is benign in nature, it displays a number of complications. If left untreated, such masses can give rise to embolism (breaking of the tumors cells and moving with the blood). These can restrict the flow of blood or can even cause the tumor cells to develop in a different part of the body. The fragments of the tumor cells can travel to the eye, brain or even limbs. Growth of the tumor inside the heart can restrict the flow of blood via the mitral valve and give rise to various indicators of mitral stenosis. Immediate surgery may be required to save the life of a patient.

Myxoma Complications

If left untreated, such tumors can give rise to a series of complications including:

Picture 2 – Myxoma Image

• Peripheral emboli
• Spread (metastasis) of the tumor
• Arrhythmias
• Pulmonary edema
• Blockage of the mitral heart valve

Myxoma is benign disorder, occurring inside the heart muscles of individuals in the form of tumors. Do not neglect the syndrome, for it can give rise to series of medical complications. If you or any of your family members is experiencing the symptoms of the disease, consult your health care provider immediately.

References:

http://health.nytimes.com/health/guides/disease/atrial-myxoma/overview.html

http://en.wikipedia.org/wiki/Myxoma

http://medical-dictionary.thefreedictionary.com/myxoma

http://www.freemd.com/myxoma/outlook.htm

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