Normal heart sounds

Normal heart sounds are produced by heart valves movements during cardiac cycle (events that take place during a heartbeat). There are two  normal heart sounds which are usually heard during heart auscultation: sound 1 and 2. Before we go farther with explanations, it is better to clarify a few elementary terms in order to understand the rest of the description.
Our heart has four chambers called ventricle and atrium, atrium are the heart chambers located in the upper part, while ventricles are located in the lower part:

• there is a right atrium connected to the right ventricle, in this part of the heart there is blood with carbon dioxide, brought by cava veins from tissues; then blood from right atrium flows through tricuspid valve ( it is like a door between the right chambers of the heart, which is open only in specific moments of the cardiac cycle) into right ventricle,
• the left part of the heart has also two chambers-atrium and ventricle, they are separated by mitral valve and contain blood with oxygen, brought from lungs.

So-called right and left heart are separated by a wall called septum, in abnormal situation this wall can be interrupted letting blood to flow from one part of the heart to the other and this situation can also generate ab normal heart sounds, a murmur that we hear during auscultations.
When we listen heartbeats with a stethoscope we can hear the two normal heart sounds 1 and 2, followed by a pause. Next, we will explain a few terms about cardiac cycle: every cardiac cycle has two phases-the contraction called systole and a pause caused diastole. Why are these two phases of the cardiac cycle so important? The atrium contraction will make blood to flow into the ventricle, while ventricle contraction will „throw” the blood into the main arteries, aorta (this artery with its branches supplies with blood and oxygen all the tissues of the body) and pulmonary artery (the blood with carbon dioxide resulted from cell metabolism is brought to lungs to be oxygenated). The pause we hear is nothing else but the time that hearts needs to relax in order to fill the chambers with blood; in this pause heart muscle also receives blood, because as any organ its function depends on the oxygen supply. All these „events” happen very fast and the indirect prove for these are  the normal heart sounds we hear in the auscultation.

Normal heart sounds description

Finally, we get to the point where we can define the meaning of the normal heart sounds 1 and 2. Sound 1 is a low frequency sound heard at the beginning of the ventricular contraction (also called heart systole), and results from mitral and tricuspid valve closure. Once these valves are closed, the ventricle contraction starts, also the pressure in this chamber increases and the blood will flow into the main arteries. Another normal heart sound is sound 2, a high frequency sound, resulted from aortic and pulmonary arteries valve closure, and signifies the beginning of the heart diastole (the pause that follows heart contraction).
Other sounds we may detect in heart auscultation are sound 3 and 4; these are not considered normal heart sounds, with a few exceptions. Sound 3 is heard in the first part of the diastole (heart pause) and may be the result of tachycardia, heart failure etc. Sound 4 appears in the last part of the heart relaxation, in patients with hypertension, myocarditis (heart muscle dysfunction) or mitral valve narrowing
Normal heart sounds are heard in specific areas of the chest called auscultation areas. Another aspect we have to mention is that normal heart sounds can be more intense in younger persons, due to a thinner thoracic wall or in conditions of stress or in effort, because the blood speed increases.
Normal heart sounds indicate a healthy heart?
 Normal heart sounds are not necessary associated with a normal heart function, that’s why, beside this basic examination, doctors look for other signs, investigations, medical history and symptoms.

Please let the doctor decide if you have normal heart sounds, and never try to treat yourself.

Symptoms of congestive heart failure

 
 









Symptoms of congestive heart failure have a great impact on a person’s life, considering this is a progressive and eventually fatal medical condition. Nowadays, in the economic well developed countries, people die because of the heart problems, more then they do from any other cause. It is important to know that symptoms of congestive heart failure have a fluctuating evolution: there are episodes with severe symptoms, followed by long periods of time when the situation is stable, nevertheless, even if people recover from the acute phase, they can’t return to the previous level of functionality. Also, it is very important to mention that is difficult to predict how much time is left to live once the diagnosis is established, because sudden death isn’t uncommon in these patients. Heart failure is not just a disease of an one individual, but a disease that affects the entire family.

What do you know about symptoms of congestive heart failure?

If you are one of the patients suffering from congestive heart failure, you should be informed about the symptoms of congestive heart failure and when to sick medical help. Every readmission to the hospital will increase mortality; there are medical articles that suggest a 20-30% increase of this risk with every readmission. You may experience shortness of breath during effort (exertion dyspnea), during night (nocturnal paroxysmal dyspnea) or even when you rest( in the advanced stages of the congestive heart failure). At the beginning, shortness of breath occurs only during great effort, but in time, daily activities that once were performed very easily, like dressing, shaving, eating etc, can produce shortness of breath and force the patient to give up on his/her social life and depend on other person’s help. Another form of rest dyspnea is orthopnea, meaning that you can’t breathe while lying in the bed and you require elevation of the head with pillows.
Other symptoms of congestive heart failure are palpitations, rapid heart beats, fatigue, fainting, blue coloring of the lips or limb extremities, accumulation of water in the limbs tissues (this  condition is called edema) lungs, pleural and abdominal cavities, heart murmurs.
Because heart can’t deliver enough blood to muscles, patients will experience weakness and heaviness in the limbs. A low blood flow to the kidneys will determine oliguria (diminished amount of urine), this condition appears in advanced stages, when the cardiac output is severely reduced.
Cerebral manifestations of low cardiac output are also symptoms of congestive heart failure: headaches, insomnia, confusion, memory impairment, anxiety or nightmares. In more severe cases, patients experience other symptoms of congestive heart failure that require special medical care: hallucinations, delirium, disorientation.
In the end, we will present a list with a few symptoms of congestive heart failure, which may guide patients to require medical help (they were published in a guide for caregivers, by The Washington Home Center for Palliative Care Studies):

• gain of 3 pounds or more within a few days or a week,
• increased swelling in hands, ankles or feet,
• difficulty breathing at any time or coughing at night,
• decreased urination,
• confusion, dizziness, or faintness,
• nausea or vomiting,
• increased fatigue,
• muscle cramps or weakness,
• any distressing symptom.

For more info on symptoms of congestive heart failure check with your doctor.

Irregular heartbeat causes

Irregular heartbeat causes are very diversified, beginning with heart disease and continuing with electrolyte imbalance or other medical conditions unrelated to heart pathology. Many times we wonder what is the meaning of the palpitations: Is it something wrong? Do I need to see a doctor?
In some cases, irregular heartbeat causes remain uncovered, persons with “healthy” hearts experience palpitations (also called arrhythmia in medical practice). However, each person with these complaints should have a medical examination, in order to exclude a disorder that may cause these symptoms, as we will see next.
A normal heart rate is 60 to 90 beats per minute; if heart rate is under 60 beats/minute, then we have a bradycardia and over 90 beats/minute a tachycardia. Arrhythmia occurs with a normal heart rate, but also with a low or rapid heart rate.
In order to understand the next medical terms, some specifications are necessary: sinus node, atrioventricular node and Purkinje fibers are the heart system (the heart pacemakers) which normally conducts impulse to muscle cells and make the contraction possible; a pacemaker is a group of cells capable of generating electrical impulse and heart contraction;
How many types of irregular heartbeat causes exist in medical practice?

• sinus node dysfunction (one of the pacemakers, located in the atrium is no longer working properly): e.g. sinus bradycardia, sinus node stops, sinus node blocks,
• supraventricular extrasystoles (irregular heart beats generated in the sinus node or atrioventricular node, they occur faster then a normally heart beat and are followed by a pause)
• sinus tachycardia, supraventricular tachycardia (rapid heart rate generated above the ventricular tissue)
• atrial fibrillation and flutter (irregular heart beats generated by multiple atrial pacemakers, others then the normal heart pacemakers)
• ventricular tachycardia (rapid heart beats generated in ventricles), extrasystoles (a premature heart contraction generated by a ventricle pacemaker) and ventricular fibrillation (rapid heart rate, incompatible with life, this is a heart rate that determines cardiac arrest)
• atrioventricular blocks (cardiac impulse is delayed or blocked in the atrioventricular node, and will be received by ventricles later or at all)
• torsade of points (a form of ventricular tachycardia that occurs when there is a potassium deficit)

What are the irregular heartbeat causes?

There are different disorders that can be a cause of irregular heartbeat causes including:

• Coronary artery disease ( coronary vessels that supply heart tissues with blood are blocked, usually by atheroma, the consequence of this blockage will be heart ischemia-the oxygen deprivation of heart tissues- and this can be one of the irregular heartbeat causes),

Atheroma is a swelling of the artery walls determined by an accumulation of lipidis.

• A heart attack it is common among  irregular heartbeat causes,
• Electrolyte imbalances (such as sodium, magnesium or potassium): e.g. a high level of potassium can result in cardiac arrest,
• Heart muscle changes (fibrosis-a conjunctive tissue deposit in the heart muscle- can also affect cells responsible for electrical impulse generation- the pacemakers),
• Healing process after heart surgery,
• Heart failure it is also one of the  irregular heartbeat causes, because in this condition one of the mechanism that heart uses to compensate for its diminished function is sinus tachycardia (if it can’t pump a proper amount of blood, it tries to pump a smaller amount but faster),
• Infection or fever is one of the irregular heartbeat causes, many times associated with sinus tachycardia,
• Anemia, in severe cases produces sinus tachycardia, the heart tries to pump the blood faster, in order to compensate for the lack of red blood cells and hemoglobin, the oxygen carrier,
• Thyroid disease-e.g. hyperthyroidism is associated with rapid heart beats, while hypothyroidism with low heart rate,
• Emotional stress produces irregular heartbeats, specially in people suffering from heart diseases,
• Usage of caffeine, tobacco, and alcohol are related with irregular heartbeat causes.

The usage of drugs is an important problem of the nowadays society, also with a great impact on our body: many times the usage of drugs was mentioned as one of irregular heartbeat causes and there were cases when cocaine consumption determined heart attacks and death.

If you think you have irregular heartbeat causes please see your physician.

Decompensated heart failure

Decompensated heart failure is the term used to define heart incapacity of pumping enough blood in the main arteries, according to the organism needs. What distinguishes decompensated heart failure from a compensated heart failure is the fact that defensive mechanisms are not efficient anymore and the blood amount delivered to the tissues is no longer sufficient, which determines a variety of symptoms as we are going to reveal next.
How do you know you have a decompensated heart failure and if u need to go to the hospital? Decompensated heart failure has different manifestations, as following:

•  when the left heart is inefficient, blood will stagnate into the heart chambers forcing them to enlarge or increase the number of muscle fibers in order to increase cardiac force; this is a defensive mechanism, which will compensate for a while the inefficient function of the heart. Once this mechanism is no longer able to control the situation, blood will stagnate in the lungs, increasing the pressure in the pulmonary vessels and from this point on, pulmonary edema (accumulation of water in the lungs) and pulmonary hypertension may occur. All these manifestations are a sign that the heart can no longer compensate its diminished function, so we are facing a decompensated heart failure.
•  in right heart insufficiency, cardiac muscle won’t be able to pump blood into the pulmonary arteries, so the blood will flow back in the venous system, determining accumulation of water in different tissues (lower limbs, abdomen-ascites, pleural space).

In clinical practice, people with decompensated heart failure will experience important shortness of breath, being unable to breathe while lying (a condition known as orthopnoea), blue color of the lips and limbs extremities, fatigue, palpitations or rapid heart beats, incapacity of performing daily activities. In more advanced cases, hypotension, fainting, ischemia of lower limbs, stroke or renal failure may occur, these manifestations being the consequence of the low blood flow in the arteries that feed the brain, kidney, or limbs.

What is the cause for decompensated heart failure?

There are many causes for decompensated heart failure, the most important ones are the following:

•  hypertension-if patients don’t follow the treatment, high blood pressure will increase the labor of an already weak heart, making it impossible to accomplish body needs,
•  salt intake-will favor water accumulation in the body, increasing blood volume and requesting a higher cardiac labor,
• infections: respiratory infections, heart wall infections like myocarditis,
• heart attacks, arrhythmia,
• weight gain is common cause of decompensated heart failure,
• patients that no longer respect their heart medication,
• patients that continue to smoke, drink alcohol, with high levels of blood lipids etc.

What are the steps to follow in decompensated heart failure ? People in this condition must be admitted to hospital, carefully watched, investigated for different conditions that might have provoked decompensated heart failure and follow a well established therapy (diuretics and cardiotonic medication will be needed in order to eliminate the overload of water and increase cardiac muscle force).
People with heart failure will have a different number of hospital admissions, followed by „free” periods of time, when the symptoms will be stable. However, the compliance to medical recommendations will determine how fast this disease will evolve, together with the other conditions we enumerated above. Despite the correct treatment and compliance of the patient, heart failure will progress until the only option left is cardiac transplant, but the speed of this evolution can be controlled by avoiding the conditions that favor heart failure to decompensate.

Please call your doctor to find out mode about decompensated heart failure.

Heart palpitations anxiety

What is heart palpitations anxiety?

Anxiety and stress are maybe the “third millennium disorders” and it has “no age” as doctors from all medical specialties have to deal patients suffering from these conditions, both young and old. In some point of our life we all suffered or will suffer from stress or anxiety and many of us deal these conditions by themselves for a long time before they finally decide to sick medical help. Those words are so often used today that it may seem they are part of our life and we must accept them as a normal reaction. But this is not how it really is, because anxiety can change our lives dramatically and make us feel sick, unable to perform our daily duties or even things that used to give us pleasure. Many times when we speak of this disorder we think of heart palpitations anxiety, as it is a frequent symptom in people suffering from anxiety. Next we will find out what anxiety and heart palpitations anxiety really mean and how to deal it.
Anxiety is a medical condition defined as a psychological and physiological state characterized by  feelings of fear, worry, dread, psychological tension or stress that can determine emotional, cognitive, somatic and behavioral changes. This disorder can determine multiple symptoms and among them heart palpitations anxiety are more frequently.
How it feels to suffer from heart palpitations anxiety? Living with heart palpitations anxiety is definitely not easy or comfortable. During heart palpitations anxiety u may feel that your heart beats are too fast or irregular, or that your heart stops for a small period. U may feel dizzy or experience shortness of breath (or suffocation sensation) or even faint. In people that already suffer from heart disease, abnormal heart beats can affect the oxygen supply of the heart muscle and determine chest pain or even a heart attack.
Next we will present the case of a 34 years old women suffering from heart palpitations anxiety:
A 34-year-old female presented with a history of anxiety for the past 20 years. When she was 14, her teacher used to embarrass her in front of the class by making her to stand-up until her face turned red and all the class would laugh. In time she becomes very nervous and fearful about social situation and activities that could draw attention to her. In the highschool she had panic attacks everytime she supposed to make presentation and communicate in peers. She describes she experienced profuse sweetening, heart palpitation and rapid heartbeats, burning in the stomach and the need to get away. These symptoms persisted during university and at the age of 25 she finally sought for professional help. The clinical psychologist diagnosed the patient with social phobia, panic disorder, and mild agoraphobia. She underwent  once- or twice-weekly sessions of psychological therapy with great improvement, slowly she could integrate into the social activities and seemed to be “cured”, convincing her therapist to stop the therapy. After 3 years as she attended the medical school, symptoms reappeared, and they were even worse then the first time and she had to seek the help of a psychiatrist and follow a medical treatment.

In conclusion, heart palpitations anxiety together with other manifestations of anxiety are not easy to deal and live with, but medical help will allow patients suffering from this condition to have a better life.

Heart murmurs in adults

What are heart murmurs in adults?

We all read or heard talking about heart murmurs in adults, and many of us are curious to find out if  they have this dysfunction. A few know the true meaning of this condition, that’s why when our physician tells us we have  heart murmurs either we think we suffer from a devastating disease, either we ignore it, but none of this reaction is normal.  Next we will clarify the meaning and the cause for heart murmurs, in order to prepare people that might be diagnosed with this disorder to understand and deal their condition properly.
Heart murmurs in adults refer to the abnormal sounds heard by doctors when they listen to the heartbeats with a stethoscope. In medical practice, hearing  heart murmurs in adults raises the suspicion of heart valve pathology, but sometimes these abnormal heart sounds can occur in other conditions like a defect in the heart wall, anemia, fever etc. When there is no heart modification that can explain the murmurs, they are called functional. Because this condition can occur in other pathologies beside hear disorder, everytime we suspect a heart murmurs in adults we should check its presence with an echocardiography examination.
Heart murmurs affect both children and adults and are recognized as the “noise” heard between the two normal heart sounds. If the murmur occurs after the first heart sound is called systolic, which means it occurs during heart contraction, and if it occurs after the second heart sound is called diastolic and this means it occurs while heart is in its relaxation period. The classification into systolic and diastolic is important because it indicates whether we are facing a valve stenosis (narrowing of the heart valve) or insufficiency (the valves fail to close properly, letting blood to flow back into the heart chambers). There are other classifications for heart murmurs in adults, but those medical terms are more important for the specialists.

 Why do heart murmurs in adults occur and how we deal with them?

 As we explained above, in most of the cases heart murmurs in adults occur when there is a heart pathology:

• heart valve narrowing or closure impairment, in this case the blood flow becomes turbulent and makes a noise that we call it murmur,
• a defect in heart wall-a congenital defect that occurs in children, allowing blood to flow from one side of the heart to the other, determining blood with oxygen and blood with carbone dioxide to mix. Sometimes this condition can remain undiagnosed until late adulthood, because it is a small defect and doesn’t cause symptoms, but in many cases is diagnosed soon after birth, being recognized as a prolonged murmur (noise) heard during heart auscultation and needs surgical correction. Another type of heart murmur heard in children is the one determined by the ductus arteriosus persistence (a connection between aorta and pulmonary artery in the uterine life).
• other condition like anemia or fever can determine heart murmurs in adults, because they determine turbulent blood flow, but this murmur disappears once the condition is treated.

How do we  with deal heart murmurs in adults ? In patients suffering from valve pathology periodically monitoring is important because in time they can lead to heart failure, in order to prevent this, surgical replacement of the valves can be performed. Heart wall defect can also be repaired providing a normal life for these patients, while the causes for functional heart murmurs in adults once treated determine these abnormal heart sounds to disappear.

Heart murmurs in adults are a serious medical condition,  if you think you have it call your doctor.

Ejection fraction heart failure

What is ejection fraction heart failure?
Ejection fraction heart failure it is a term used to describe the amount of blood that heart can deliver to the main arteries. In medical practice, doctors measure the ejection fraction heart failure because this examination offers details about heart function and helps to determine if  there is a heart failure or not. Once the heart function is impaired, the ejection fraction begins to diminish and the systemic consequences of heart failure begin to occur. In early stages, the body will try to compensate the changes appeared due to heart function decrease, but in time these will become obviously.
What are the signs of ejection fraction heart failure?

When you are suffering from heart failure it is important to recognize the problem and look for a doctor as soon as possible, only in this way you can receive the correct treatment which will help the heart to function better and delay farther deterioration. At the beginning, people with diminished ejection fraction heart failure will feel more and more tired, but usually this symptom is wrongly associated with getting old, gaining weight, anemia or simply overlooked. Many people will find it is normal to feel tired during effort, without noticing that a few months ago they were able to perform the same effort without getting tired. Only when tiredness is getting worse and they have to deal it in common daily activities like walking, they begin to feel is something wrong and look for medical help, but in that moment their ejection fraction heart failure is already diminished. There are a lot of people living with diminished ejection fraction heart failure without knowing about this until they have routine medical examination or until symptoms get worse. In time, tiredness is accompanied by shortness of breath, blue coloring of lips, hands, feet, legs begin to swallow due to edema. It is important to report these symptoms to your doctor, because this will help him suspect your heart is not working normally. Diagnosing heart failure is not the last step before patients can start taking medication, it is also very important to find the cause for ejection fraction heart failure deterioration: is it a heart attack, a heart valves pathology, infections of heart walls, ischemia (heart cells don’t receive enough oxygen) ? etc.

Is there any treatment for diminished ejection fraction heart failure?

There are many drugs available that can help heart function better, but there is no cure for this, once the heart failure occurs, heart function and ejection fraction will deteriorate in time. What we can achieve by medication is to delay the progress of heart function impairment, ameliorate symptoms and increase the quality of life. One mistake made by many patients is to think that once they take the prescribed medication, their heart will continue to function normally from that point on, forgetting to fallow a correct diet, without salt and fats, continuing to drink alcohol, smoke, gain weight,  etc.

In patients diagnosed with heart failure, periodically heart function evaluation is very important and one examination that can offer information about the evolution of heart function is ejection fraction heart failure.

Decreased cardiac output

What is a decreased cardiac output?

Decreased cardiac output is a synonymous term used for heart failure or heart insufficiency. In patients suffering from decreased cardiac output or heart failure, the amount of blood that vessels „offer” to the tissues is not enough for the metabolic demands. Decreased cardiac output means that heart can’t function at its proper parameters, even if the heart muscle labor increases and all types of compensating mechanisms are used.
How can doctors tell us if we have a decreased cardiac output?
Decreased cardiac output determines a diminished ejection fraction (a smaller amount of blood is delivered to the aorta and its branches) and can be discovered when your doctor performs an echocardiography. Measuring the ejection fraction periodically will offer information about the heart failure evolution, but is not always correlated with the severity of symptoms. For example, there are patients with severe decreased cardiac output (about 24%) that still can perform common activities without having shortness of breath, chest pain, palpitations or getting tired, while other patients with a higher ejection fraction (and therefore a higher cardiac output) have all the symptoms listed above.

Decreased cardiac output- clinical case report:

After the theoretical part of this article listed above is time to pass to a more practical part, in order to understand what the decreased cardiac output manifestations are and how it can affect people life and daily activities.
Next we will present a case of a 63 years old patient suffering from heart failure, with a decreased cardiac output, so we can have a better image of how life is for a person diagnosed with this disorder.
Case report:
A 63-year-old Caucasian man had a 40 years medical history of diabetes, treated with glyburide 10 mg twice/day. He was also known with coronary heart disease and heart failure (left ventricular ejection fraction 25% determined by echocardiogram, NYHA class II-III), hypercholesterolemia, and chronic renal insufficiency (serum creatinine 1.4-1.8 mg/dl). His drug therapy included aspirin 325 mg/day, digoxin 0.125 mg/day, simvastatin 20 mg at bedtime, metoprolol 50 mg twice/day, and nitroglycerin 0.4 mg sublingually as needed. At that clinic visit, the patient had no other complaints and his heart failure appeared stable. Nine days later he came to the clinic with an increase in weight of 3.6 kg (baseline weight 78.6 kg) complaining of shortness of breath. Physical examination revealed bibasilar rales (pulmonary sounds heard during breathing which may indicate infection, pulmonary edema, allergy or bleeding etc.), +S₃ gallop (abnormal sound heart during heart auscultation, which indicates heart failure), and increased jugular venous distention (JVD-because right heart has a decreased function, blood will flow back into the veins that bring it into the heart chambers), but no lower extremity edema. Again, he reported adherence to drug therapy and no dietary indiscretions.  After treatment adjustment he was released from the hospital, but returned 2 weeks later reporting that his weight increased, and legs edema occurred, while his wife confirmed he had a high sodium intake. Chest radiograph was consistent with pulmonary edema. Fluids were immediately restricted, and the patient was given bumetanide 5 mg intravenously twice/day. By hospital day 2 the patient had lost 4.1 kg by diuresis and  on hospital day 5 his heart failure was stable.
In conclusion, decreased cardiac output is the main manifestation of heart failure and has a great impact in patients’ life (as we saw in the case above).

If you think you have any of the following symptoms of decreased cardiac output contact your hospital.

Inflammatory bowel disease symptoms

Inflammatory bowel disease symptoms are variable, affecting tissues outside digestive system and having an important mark on person’s self esteem; many times patients suffering from this disease are very depressive and unable to perform their activities. When we mention inflammatory bowel disease symptoms we have in mind Chron disease and ulcerative colitis.

Inflammatory bowel disease symptoms list

Inflammatory bowel disease symptoms are represented by digestive symptoms and non-digestive symptoms:

•  diarrhea is the most frequent and annoying symptom among the inflammatory bowel disease symptoms; some patients may have numerous watery stools,
• constipation: this is an often symptom in rectitis, (patients with ulcerative colitis complain of constipation, because this disease affects the rectum at the onset),
• abdominal pain- it is one of the frequent inflammatory bowel disease symptoms, it can be diffuse, or located in the iliac fossa (Chron disease affects, more frequently, the terminal ileum, which is the most distant part of the small intestine, located in the right iliac fossa, while ulcerative colitis affects rectum in most of the cases),
• stool with blood-it is a common finding among inflammatory bowel disease symptoms,
• weigh loss because of the diarrhea, which stops the intestine to absorb nutrients,
• fever, it is the response of the body to the inflammation of the intestine,
• abnormal communication among different parts of the intestine, or among intestine and urinary bladder or vagina (in medical practice this condition is called fistula),
• intestine stenosis (it is one of the inflammatory bowel disease symptoms known as Chron disease)-meaning a narrowing of the intestine lumen,
• blood cells abnormalities: anemia (low number of red blood cells and hemoglobin), a large number of platelets (a condition that predisposes to blood clots),
• deficits of vitamins and other nutrients, due to diarrhea, which favors malabsorption,
• intestine perforation,
• digestive cancer.

Non-digestive inflammatory bowel disease symptoms are represented by different medical conditions: liver disease (cholangiocarcinoma, primitive sclerosing cholangitis), arthritis, myositis (these patients need treatment with cortisone, which can determine, as an adverse effect, myositis), renal failure (due to dehydration), oral ulcerations, stomatitis etc.
How do we diagnose it? Once there is a clinical suspicion, a colonoscopy and intestine biopsy are needed in order to confirm the inflammatory bowel disease and also to distinguish between the two forms of inflammatory bowel disease (for each disease, there is a different histological pattern, the macroscopic aspect and the lesions location are criteria used to confirm which one of the inflammatory bowel disease is responsible for symptoms).
What is the treatment for this disease? Depending on whether there are complications, inflammatory bowel disease can be treated with cortisone (there are schemes of treatment starting with increasing doses of cortisone, which will be diminished gradually once the disease is under control), anti-inflammatory agents (like sulfasalazine), immunosuppressive medication (if the first two types of drugs are not effective) or surgery if there are complications like fistula, stenosis or intestine perforation or if disease can’t be controlled with medication.
What is the evolution of the inflammatory bowel disease? Inflammatory bowel disease symptoms have a fluctuanting evolution; there are periods with symptoms, followed by “free” periods. There are medical scales which can estimate the severity of the disease, using indices like red blood cell sedimentation rate, heart rate, body temperature, numbers of stools per day.

If any of the inflammatory bowel disease symptoms occur do not treat yourself and call a doctor.

Left sided heart failure

Left sided heart failure is the term used to describe the incapacity of the left heart to supply tissues with blood. Left heart has two chambers known as left atrium and ventricle, which communicate thorough the mitral valve. The left atrium (the left upper chamber of the heart) receives oxygenated blood from the lungs, through pulmonary veins and this blood will be delivered to left ventricle (the lower left chamber). The whole amount of blood is pumped by left ventricle in the aorta (which is the main artery of the body) and then into the less large arteries that supply all the tissues and organs (kidney, liver, digestive organs, brain, limbs). Imagine blood flowing in the arteries as a liquid passing through a tube (pipe) and all the factors and interactions between them, which have great influence on the amount of blood that in the end each tissue will get and also the influence on the whole organism: e.g. blood consistency (a viscous blood will allow clots to appear), pressure that blood develops on arterial wall, the influence of arterial walls pressure on blood flow etc.

What is the cause for left sided heart failure?

Left sided heart failure is caused by different pathologies:

• congenital heart diseases,
• heart attack (the ischemia determines cardiac cells to die and a part of the heart is no longer functional),
• coronary heart disease (a chronic ischemia of the heart tissue, a chronic deprivation of oxygen will determine tissues changes in order to adapt to the new condition and in the end cardiomyopathy and left sided heart failure)
• high blood pressure forces the left heart to increase its labor and force, and the only way this can be possible is to increase number of muscle fibers (but the numbers of vessels will remain unchanged, so the same number of vessels will supply a larger number of muscle fibers, which will determine heart ischemia with all the consequences that result from this condition) and increase inside pressure (this pressure will act on heart walls to and will press the vessels which won’t be able to fill enough and this will lead to ischemia)
• another cause of left sided heart failure is heart valves pathology: leaking valves (an amount of blood remains in the heart chambers creating a blood deficit in the tissues and forcing heart, at the next contraction, to throw in the aorta a larger amount of blood, this means a greater labor, which in time will lead to left sided heart failure) or narrow valves (the heart muscle must defeat the obstacle represented by the narrow valves),
• heart muscle infection will determine cardiomyopathy and left sided heart failure,
• excessive alcohol consumption will determine dilated cardiomyopathy and left sided heart failure,
• thyroid dysfunctions,
• heart muscle disorders,
• major cardiac arrhythmia (irregular heart beats).

What happens in the systemic blood circulation, when there is a left sided heart failure?

Left sided heart failure

Compromise of left ventricular function will result in poor systemic circulation: muscle weakness, cool extremities, fatigue, low tolerance to effort, fainting, chest pain, palpitations, rapid heart beats, dizziness, confusion, memory impairment. Backward failure of left ventricle results in pulmonary congestion (blood will remain in the pulmonary veins creating a great pressure and determining shortness of breath, first on exertion and then at rest), hypoxemia (low level of oxygen in the blood), cyanosis (blue coloring of the extremities, because of the hypoxemia), tachypnea (increased rate of breathing), pulmonary edema (because of the great pressure in the pulmonary veins, the fluid from the blood will go through veins walls into the lung). Valvular heart disease may occur due to the increased pressures in heart chambers and pulmonary veins. Another symptom of left sided heart failure is paroxysmal nocturnal dyspnea (sudden and severe breathlessness attack during night, several hours after going to sleep).
If you have signs of left sided heart failure please call an MD for medical advice.

Reperfusion injury

Reperfusion injury has been defined as myocardial tissue blood supply after a period of ischemia. Whether reperfusion merely  accelerates the damage that would have occurred during the initial ischemia  or whether there is a additional injury caused by reperfusion itself is still researched. Although the crucial role of reperfusion injury in revascularization procedures has bees recognized, the etiology and pathogenesis of this phenomenon remain unknown.
Myocardial ischemia accompanied by reperfusion injury followed by complete normalization if it took 5 minutes, by diastolic and systolic dysfunction if ischemia took 15-20 minutes and without return contractile function if ischemia took more than one hour.
The most common cause found in patients who died after reperfusion is hemorrhagic infarction. In myocardial infarction of less than 3 days the cellular response is present throughout the myocardial infarction, in contrast to the distinct zones seen in the non- reperfused myocardial infarctions. Reperfusion itself may produce injury.

The mediators of reperfusion injury

Reperfusion injury

One of the mediators of reperfusion injury is oxygen free radicals. The possible role of reactive oxygen species in reperfusion injury has evolved from our knowledge. They elaborate enzyme systems that rapidly detoxify superoxide and peroxide. The metabolism of reactive oxygen also has damaging effects. The investigators of this event have suspected that even physiological quantities of peroxide may inhibit the aerobic oxidation of pyruvate and thus restrict cellular ATP formation.
Another mediator of reperfusion injury is endothelial dysfunction and microvascular injury. Recent reports indicate that endothelium-dependent relaxation  of coronary microvessels is markedly impaired after ischemia with reperfusion. This microvascular endothelium dysfunction may be caused by blood products or myocardial metabolites that are released during the reperfusion period or by oxygen free radicals.
One of the oldest hypotheses about reperfusion injury involved calcium overload. Other mediators involved in reperfusion injury are altered myocardial metabolism and endogenous protective mechanisms.
There are some cardiovascular risk factors influence reperfusion injury. This are  hypercholesterolemia, very high glucose and hypertension.

Pharmacological methods to attenuate reperfusion injury

There are a number of pharmacological methods for attenuate reperfusion injury. In the treatment of myocardial infarction, restoration of coronary flow as soon as possible is a very important thing to prevent and reduce myocardial necrosis and ischemia. By this treatment ensure a reduction of mortality,  complications and a good prognosis in infarction. Early myocardial reperfusion injury prevent necrosis; in this way systolic and diastolic functions are established and are preventable fatal arrhythmias. In the early hours of  infarction,  reperfusion injury offers the greatest benefits: higher thrombus lysis.
Anti-ischemic therapy and lytic therapy has an important role to reduce myocardial energy demand. There are three revascularizations methods: trombembolitic treatment,  coronary angioplasty and coronary bypass. To thrombolytic treatment add anticoagulant and antithrombotic treatment and GP IIb/IIIa blockers. Thrombolytic agents currently used are streptokinase, tissue plasminogen activator and urokinase.

Conclusion for reperfusion injury

In conclusion the beneficial effect of fast recanalization may be offset by reperfusion injury.