What is exertional dyspnea?

Exertional dyspnea basics

When we hear talking about   exertional dyspnea or in other words “shortness of breath” one must think to the difficulty of breathing when is doing an exercise or easier said, lack of comfort in breathing. But isn’t it normal to experience some kind of dyspnea when we are exercising? Apparently not! In the next article I’m going to explain what is exertional dyspnea, when it appears, when we say this condition is pathological or not and what causes it.
The word “dypnea” is originally composed from two greek words: “dysp” which means hard, heavy, difficult and “pnoia” that means breathing. If we combine these two words we have “hard breathing”also said dyspnea. Dyspnea is a breathing disorder characterized by changing the pace and intensity of respiratory movements.
Exertional dyspnea is frequently overlooked because it can occur to healthy people and is frequent confused with fatigue. It isn’t always a pathological symptom. You can experience exertional dyspnea when you are exercising more than your body is used to, if you have a weight problem (you weigh to much or you are obese), if you are an active smoker, or if the air around you is polluted.
Exertional dyspnea becomes pathological and that means that we should worry and go see a doctor when even if we make the same exercise as we did before we feel like our lungs aren’t getting enough air.

 But how does exertional dyspnea appear ?

Dyspnea due to illness can occur when there is an imbalance between tissue oxygen demand, and the amount of oxygen that the body can provide. Many diseases can give exertional dyspnea , the most common being:

• anemia (lack of blood) - Shortness of breath is accompanied by pale skin

• disease with increased energy consumption (as in cancers with different locations, hyperthyroidism, and uncompensated diabetes
• lung disease (dyspnea by lack of oxygen) of various causes, dyspnea is accompanied by coughing and / or wheezing and  sputum
• heart disease – exertional dyspnea occurs first and then it can occur during  rest or lying down, the patient can also feel palpitations and chest pains
• serious liver disease (cirrhosis) - liver as “laboratory” of the body, shortness of breath occurs in cirrhosis by multiple mechanisms
• severe kidney disease - shortness of breath occurs with changes in fluid and electrolyte balance or anemia (erythropoietin synthesized by  kidney, substance that stimulates the bone marrow to manufacture red blood cells that are the cells that  transport oxygen around the body)
• hypertension – exertional dyspnea  occurs by forcing the heart and the  blood vessel
• obesity (fat in the chest and abdomen pressed, preventing the movement of breath, plus a larger amount of tissue needs a greater amount of oxygen).

As you can see there are many conditions that can  manifest as exertional dyspnea, some of them  really serious diseases and that’s why is very important to go see a doctor whenever you notice changes in your breathing rhythm or you experience respiratory problems.

Fibrillation of the heart

Fibrillation of the heart

In the next part of the article we will discuss about fibrillation of the heart, one type of irregular heart rate and what are the consequences for our body. Our heart is an organ that has a so called „automatism”, an intrinsic property of the cardiac tissue to create its own electric impulse, a signal that allows changes in cell metabolism in order to generate cardiac muscle contraction and therefore pumping blood into the arteries. This electric signal is generated in the sinus node (a structure capable of generating electric signal, located in right atrium) and then conducted through special structures until it reaches the ventricles (heart chambers that pump blood into the arteries). If these structures called pacemakers, can’t function normally, irregular heart rate occurs and one of them is fibrillation of the heart.

 What is fibrillation of the heart ?

What is fibrillation of the heart? And how many types of fibrillation of the heart exist? There are two types of fibrillation of the heart: one is called atrial fibrillation and another ventricular fibrillation. The difference between these types of fibrillation of the heart is not just in name, but also in origin and prognostic. The first type of fibrillation of the heart-the atrial fibrillation-is an irregular heart rate generated in multiple atrial cells (but not in the sinus node which is the „natural” heart pacemaker).
Patients with atrial fibrillation may experience palpitations, shortness of breath, chest pain, dizziness, drowsiness, fainting, but there are some patients that don’t complain of any symptom and they are diagnosed with the occasion of a routine medical check or when the complications occur. Usually, atrial fibrillation allows blood clots to form and they can flow in the arteries and block them, causing a condition known as ischemia: the tissues won’t receive enough blood and oxygen and cells start to die. In this situation, strokes, pulmonary embolism (clots in the pulmonary arteries that can lead to death), limbs ischemia (if untreated it can lead to amputation) can occur and can lead to patient’s death, if immediate  measures aren’t taken. On the electrocardiogram, in atrial fibrillation there is an irregular heart rate, without „P” waves (which are a mark of  heart rate generated by the sinus node) and the frequency of the heart beats can vary: low, average or rapid.
If this arrhythmia was discovered at its beginning, a conversion to the normal heart rate called sinus rhythm can be tried (either using medication or with electric shocks). After this procedure succeeded, other medication is needed in order to maintain the normal heart rate, to control the normal frequency of the heart beats and prevent blood clotting. In some patients, when the beginning of this arrhythmia is unknown, doctors will use only drugs to control the heart rate (beta blockers like metoprolole, atenolol; digoxin-a drug that increases heart contractility and also has antuarrthymic properties, very often used in the treatment of atrial fibrillation, calcium channel blockers like amlodipine, verapamil, diltiazem) and prevent blood clotting. Atrial fibrillation associated with rapid heart rate can be a severe medical condition affecting the level of consciousness and the only way to save patient life is the electrical conversion to the sinus rhythm using electric shocks.
The other type of fibrillation of the heart-ventricular fibrillation is an irregular heart rate generated in the ventricular cells and is not compatible with life, meaning that is one of the heart rate that generates cardiac arrest. Heart stops from beating and emergency measures of resuscitation are needed-cardiac massage alternating with artificial oxygenation of lungs, using facial masks with balloons or orotracheal intubation (which is preferred if it is possible to perform), electric shocks, specific medication like adrenaline, vasopressin, amiodarone. If in 30-45 minutes all these maneuvers are unsuccessfully, then the patient is declared dead.

As we saw above, fibrillation of the heart is a major heart disorder, that requires  special attention, knowledge, maneuvers and skills, since ventricular fibrillation is the most frequent cause of cardiac arrest in adults.

Hyperlipidemia symptoms

What are the hyperlipidemia symptoms ?

Hyperlipidemia represents increasing levels of lipid or lipoproteins in the blood and hyperlipidemia symptoms can be varied from patient to patient. Hyperlipidemia is a metabolic disease and may include changes in cholesterol (blood fat levels), triglycerides (a type of blood fat) or lipoproteins. There are two main types of hyperlipidemia: hypercholesterolemia (which occurs most frequently) and hypertriglyceridemia.  Hyperlipidemia may be a risk factor for atherosclerosis, cardiovascular diseases (coronary artery diseases and peripheral vascular diseases), but can affect other organs such as pancreas.

Hyperlipidemia symptoms

Hyperlipidemia symptoms are usually absent from most of the patients, if this is the only change to the analysis of blood. This can be found at a routine exam that the patient makes. It can remain undiagnosed for many years.
Hyperlipidemia symptoms can include first deposits of cholesterol (known as xanthomas) that form under the skin (especially around the eyes). They may be the only symptom that indicate an increase in blood lipids. They can also form the Achilles tendon and the extensor tendons of the hands. Xanthomas may have varied sizes, from very small to several centimeters. The diagnose of xanthoma can be done by physical examinations and by determining blood cholesterol levels.
Chest pain may be another symptom for hyperlipidemia. This pain can be felt by the patient as chest discomfort located anywhere. Patients go to the doctor for the fear of a heart attack. Hyperlipidemia is a risk factor for atherosclerosis (deposition of fat in the arteries of large and medium) that causes coronary artery diseases manifested primarily through chest pain. Any organ in the thorax may be the source of pain (heart, lungs, esophagus, muscles or nerves).
Another symptom which may be included in the category of hyperlipidemia symptoms is hepatomegaly (increased liver beyond normal size, 12 inches). This may or may not be associated with increased spleen size.
One of the last hyperlipidemia symptoms is abdominal pain. This may occur in the right hypochondrium where it is located the liver or anywhere in the abdomen. Hyperlipidemia occurs in the liver as fatty liver disease caused by the deposition of fat in liver cells. Pain in the abdomen can originate from many organs (stomach, small and large intestines, appendix, spleen, liver or pancreas). Pain may be generalized or may be located in a single point. In many cases patients don’t go to a doctor and expect that the pain to go by itself.
Treatment of hyperlipidemia symptoms

Treatment of hyperlipidemia symptoms can be done with drugs or by dietary changes, weight reduction and exercise. If cholesterol and triglycerides are not very high and patients have no important hyperlipidemia symptoms, doctors advice patients dietary changes by reducing dietary fat, weight loss and moderate exercise daily.
If  lipids values may be lower without drugs then doctors recommend the use statins (drugs used to lower cholesterol) and fibrates (drugs used to lower triglycerides).
Conclusion
In conclusion there are no specific hyperlipidemia symptoms, but if discovered at a routine exam is better to be treated because it can have serious complications.

Marfan syndrome life expectancy

When we talk about Marfan syndrome should really talk about Marfan syndrome life expectancy because it is a disease that undiagnosed, timely can lead to the death of the patients.
Marfan syndrome is a genetic disorder (autosomal dominant) characterized by connective tissue damage. This syndrome includes multiple malformations of organs (bones, eyes, skin, intestines, heart and lungs).

Marfan syndrome symptoms

Most of the visible signs or symptoms occur in the skeletal system. The patients  suffering from Marfan syndrome are taller than patients without the disease and arachnodactyly ( very thin and long fingers). Another anomaly in the skeletal system is pectus excavatus (deformity of the anterior wall of the chest which penetrates inside sternum) and scoliosis (abnormality of the spine that consists of spine deformity in the form of the letter S). Other signs include abnormal joint flexibility and sometimes pain in joint.
The most important signs and symptoms  associated with Marfan syndrome are the cardiovascular symptoms. This are mitral or aortic valve prolapse (the most common heart valve abnormality) and aneurysm of the aorta.  Many patients with Marfan syndrom have some type of vision problems of which the most important are myopia (a visual anomaly in which distant objects appear blurred), glaucoma and cataracts. This can severely influence Marfan syndrome life expectancy.

Marfan syndrome life expectancy

Marfan syndrome life expectancy may be different from patient to patient. There is no treatment for the Marfan syndrome, but life expectancy may be influenced by monitoring and treatment of complications that can occur. Marfan syndrome life expectancy increased lately because of the advancement in medical techniques and appearance of new treatments.
Best way to expend Marfan syndrome life expectancy is tracking the aneurysm of the aorta and mitral valve prolapse. This is done by a cardiologist annual control for monitoring the health of the heart valves and the aorta. This is done by performing an ECG or another radiological method for the visualization of the anomaly (such as CT or MRI image). The goal of treatment in Marfan syndrome is to slow the progression of the aortic dilatation and to prevent the dissection of the aorta. Another goal of the treatment is to eliminate arrythmias and diminuate the heart rate.
The skeletal manifestations of this syndrome are also important for Marfan syndrome life expectancy. They can be serious and can affect patients life. To solve these problems are used different kinds of pain medication or muscle relaxants.
Because some of the Marfan symptoms of the spine may be asymptomatic, but serious if are not treated, they can be solved by surgery and thus increase the Marfan syndrome life expectancy.
Lung damage involves spontaneous pneumothorax and Marfan syndrome life expectancy depends on the volume of air in the pleural space.  It may resolve by itself or can be made by chest drainage.
Conclusion

Today patients with this syndrome needs to know is not the end of life and Marfan syndrome life expectancy can be good if patients are addressed in time to the doctor.

Heart palpitations after eating

Heart palpitations after eating are one of the causes of heart palpitations seen in patients. This may be normal under certain conditions, but if it is associated with other symptoms can be a problem for the patients.
After you read this article you know which are the mechanisms, symptoms, causes, treatments and preventions of heart palpitations after eating.
Heart palpitations after eating are fast heart beats that occurs after eating and may or may not feel the patient. Heart palpitations may be due to cardiac or extracardiac. Very important is the severity of the heart palpitations after eating. They can be without hemodynamic significance (just heart palpitations and anxiety)  or hemodynamically significant, considered severe (with low blood sugar, syncope, chest pain and difficulty of breathing).

Mechanism of heart palpitations after eating  

After eating a meal, need for blood in the stomach and surrounding organs increases and thus aids digestion. In this process of digestion and absorption of food, increased heart rate may be undetectable or may be felt as palpitations. If you want to see if you have heart palpitations    you have to measure your pulse rate. This can be done at any hand with the index and the middle finger of the wrist from the other hand. If the pulse rate is over 90 -100 beats and it is maintained over this values,  the patient should consult a doctor.

Other symptoms that accompany heart palpitations after eating

This are nausea, dizziness, fatigue, asthenia, chest pain, shortness of breath  and discomfort in abdominal region felt as feeling bloated. After dinner heart palpitations after eating can may the patient inability to sleep in peace at night and this may be a very important problem for the patient.

Causes of heart palpitations after eating

There are many causes for this condition. One of this is hiatal hernia, which is a condition that upper part of the stomach enters into the thorax. For this, patients with hiatal hernia should avoid lying position for at least two hours after a meal.
Today an important cause for heart palpitations after eating is obesity. More persons are obese due to environmental factors (a sedentary lifestyle, a diet high in sugar, fast food). In this persons suffering from obesity, the heart must work harder to pump the blood to the stomach. Severe anemia is another cause for heart palpitations after eating. In this patients hemoglobin value are very low and may be accompanied by low serum ferritin values. This palpitations are often accompanied with fatigue, asthenia and adinamie.
There are also hormonal imbalances that cause heart palpitations after eating. Patients with hyperthyroidism (disease of the thyroid gland with overproduction of thyroid hormones).

Treatment of heart palpitations after eating

There is no specific treatment for patients with heart palpitations after eating. They must have a lifestyle adapted for prevent heart palpitations. For example:

• Have frequent meals and few quantitative
• Not have a sedentary lifestyle
• Not have a diet high in sugar and caffeine
• To conduct periodic reviews to prevent severe anemia or hyperthyroidism

If heart palpitations after eating continue after prevention methods the patients should consult a doctor.

Leaking heart valve

Mortality and morbidity thought leaking heart valve are  an important part of cardiovascular pathology.  The main changes in  the study of leaking heart valve involves an evaluation of their function and etiology.
So, rheumatic etiology is declining, while the degenerative and ischemic etiology is growing.
Clinical evaluation methods have the same value (family history, physical examination), but some paraclinical methods ( cardiac ultrasound and Doppler) have an important role.

Types of leaking heart valve

Leaking heart valve may occur at the four heart valve: mitral valve, aortic valve, pulmonary valve and tricuspid valve.
The most common type of leaking heart valve is mitral regurgitation. It is characterized by regurgitation of blood in systole ( contraction of heart) from the left ventricle into the left atrium. There are two causes of mitral regurgitation: acute and chronic. The etiology of mitral regurgitation can be inflammatory, but also degenerative and structural. Chronic mitral regurgitation lead to expansion of left atrium.   Echocardiography provides important information in mitral regurgitation.
Another type of leaking heart valve is aortic regurgitation. It is incomplete closure of aortic valve in diastole (relaxation of heart). Aortic valves are affected primary by acute articular rheumatism, infectious endocarditis and degeneration and it can be acute or chronic.
Two other leaking heart valve are tricuspid regurgitation and pulmonary regurgitation. Tricuspid regurgitation is characterized by regurgitation of blood in systole from the right ventricle into the right atrium because of the incomplete closure of the tricuspid orifice.

Leaking heart valve symptoms

Symptoms of patients with   leaking heart valve depends on regurgitation grade and how to install (suddenly or gradually). Patients with small regurgitation can be asymptomatic. There are some  common  symptoms to the patients with leaking heart valve:
-          dyspnea on effort (shortness of breath or air hunger);
-          cough;
-          angina pectoris on effort (chest pain on effort) or at rest;
-          heart murmur;
-          heart palpitations (heart beats more than 90 per minute);
-          asthenia and adinamie;
-          fatigue;
-          rarely may occur syncope;
-          pale skin on  clinical examination.

Leaking heart valve diagnosis

Positive clinical diagnosis is based on present of heart murmur (systolic or diastolic) with different characters. Most used methods for diagnosis leaking heart valve are echocardiography, chest radiography, electrocardiography and Doppler exam.

Treatment and evolution of patients with leaking heart valve

Treatment of asymptomatic patients with leaking heart valve is not necessary. To the patients with symptoms should avoid exercise and salt. There are also treatments with drugs and surgery for leaking heart valve.
Evolution and prognosis of leaking heart valve depend on the importance blood reflux, of how to install (acute or chronic) and of the etiology. Patients with small or average regurgitation may remain asymptomatic a long time, but patients with complications (infectious endocarditis, atrial fibrillation) have obvious symptoms. Patients with acute leaking heart valve have serious prognosis.

Heart attack symptoms in women over 40

Cardiovascular diseases and especially ischemic cardiomyopathy and heart attack are some
of the causes of mortality and morbidity in both women and men, but heart attack symptoms
in women over 40 may differ from those of men.
Of certain statistical date cardiovascular disease is the first cause of the mortality in women.
Risk factors for heart attack
There are several risk factors that cause different heart attack symptoms in women over 40 :

• Obesity, high blood pressure and hypercholesterolemia (increasing the percentage of fat
  in the blood) especially triglycerides.
• Another risk factor is use of oral contraceptives and
  menopause.
• A small percentage of patients who use oral contraceptives appear hypertension
  unrelated to dose contraceptive. However, patients with controlled hypertension may use
  oral contraceptives, but under supervision. If the consumption of oral contraceptives added
  smoking the risk of heart attack increase. If we compare mortality rates of cardiovascular
  disease in men and women over 40 will see a significant increase in mortality after
  menopause.

Heart attack symptoms in women over 40

Today, there are several features of heart attack symptoms in women over 40. The main heart
attack symptoms in women over 40 is not chest pain, but dyspnea which represent shortness
of breath. This symptoms may appear a few hours, days or months before heart attack
symptoms. Most minim discomfort may be an atypical sign or a symptom for heart attack.
One of these is atypical chest pain for which women do not go to the doctor only if the is
persistent and upset the patient. Sometimes heart attack symptoms in women over 40 may be
the absence of pain. Absence of pain can be attributed to nervous or mental disorders. But,
heart attack symptoms in women over 40 like atypical chest pain have a worse prognostic
then men.
Unusual fatigue is another heart attack symptoms in women over 40. This fatigue can be felt
as a state of drowsiness. Patients may not take into account this symptom believing that it is
simply missing out of sleep, an infection with a virus or adverse effect of another drug and not
present at the doctor. Patients may be associated nausea, sweating and chills.
Pain in the calf may be a sign for deep vein thrombosis which may eventually lead to heart
attack. This is another heart attack symptoms in women over 40 which occurs predominantly
in patients with hormone therapy, smokers, who just had surgery or in patients who have
been on a plane flight. If pain is sudden or gradual, patients should consult their doctor
immediately.
Other symptoms or signs for heart attack may be serious and can lead to death of patients if they are not recognized in time.
So how do you know if you have a heart attack?

At the early signs or symptoms, the patients must go to the doctor because they can be heart attack symptoms in women over 40 and their persistence can lead to death.