category_1_x_diseases_conditions.id,category_1.id,category_1.ts,category_1.title,diseases_conditions.id,diseases_conditions.ts,diseases_conditions.title,diseases_conditions.diseases_conditions_detail,diseases_conditions.last_update
1,1,"2018-02-02 04:25:06",a,1,"2018-02-02 05:02:49",ARDS,"What Is ARDS?
ARDS, or acute respiratory distress syndrome, is a lung condition that leads to low oxygen levels in the blood. ARDS can be life threatening because your body's organs need oxygen-rich blood to work well.
People who develop ARDS often are very ill with another disease or have major injuries. They might already be in the hospital when they develop ARDS.
Overview
To understand ARDS, it helps to understand how the lungs work. When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries (KAP-ih-lare-ees) run through the walls of the air sacs. Oxygen passes from the air sacs into the capillaries and then into the bloodstream. Blood carries the oxygen to all parts of the body, including the body's organs.
In ARDS, infections, injuries, or other conditions cause fluid to build up in the air sacs. This prevents the lungs from filling with air and moving enough oxygen into the bloodstream.
As a result, the body's organs (such as the kidneys and brain) don't get the oxygen they need. Without oxygen, the organs may not work well or at all.
People who develop ARDS often are in the hospital for other serious health problems. Rarely, people who aren't hospitalized have health problems that lead to ARDS, such as severe pneumonia.
If you have trouble breathing, call your doctor right away. If you have severe shortness of breath, call 9–1–1.
Outlook
More people are surviving ARDS now than in the past. One likely reason for this is that treatment and care for the condition have improved. Survival rates for ARDS vary depending on age, the underlying cause of ARDS, associated illnesses, and other factors.
Some people who survive recover completely. Others may have lasting damage to their lungs and other health problems.
Researchers continue to look for new and better ways to treat ARDS.
Other Names for ARDS
In the past, ARDS was called stiff lung, shock lung, and wet lung.
What Causes ARDS?
Many conditions or factors can directly or indirectly injure the lungs and lead to ARDS. Some common ones are:
Severe
bleeding caused by an injury to the body.
An injury to the
chest or head, like a severe blow.
It's not clear why some very sick or seriously injured people develop ARDS and others don't. Researchers are trying to find out why ARDS develops and how to prevent it.
Who Is at Risk for ARDS?
People at risk for ARDS have a condition or illness that can directly or indirectly injure their lungs.
Direct Lung Injury
Conditions that can directly injure the lungs include:
Using a
ventilator. This is a machine that supports breathing; however, the pressure from a ventilator sometimes can injure the
lungs.
Nearly drowning.
Indirect Lung Injury
Conditions that can indirectly injure the lungs include:
An injury to the
chest or head, such as a severe blow.
Fat embolism (EM-bo-lizm). This is a condition in which fat blocks an
artery. A physical injury, like a
broken bone, can lead to a fat embolism.
Drug reaction.
What Are the Signs and Symptoms of ARDS?
The first signs and symptoms of ARDS are feeling like you can't get enough air into your lungs, rapid breathing, and a low blood oxygen level.
Other signs and symptoms depend on the cause of ARDS. They may occur before ARDS develops. For example, if pneumonia is causing ARDS, you may have a cough and fever before you feel short of breath.
Sometimes people who have ARDS develop signs and symptoms such as low blood pressure, confusion, and extreme tiredness. This may mean that the body's organs, such as the kidneys and heart, aren't getting enough oxygen-rich blood.
People who develop ARDS often are in the hospital for other serious health problems. Rarely, people who aren't hospitalized have health problems that lead to ARDS, such as severe pneumonia.
If you have trouble breathing, call your doctor right away. If you have severe shortness of breath, call 9–1–1.
Complications From ARDS
If you have ARDS, you can develop other medical problems while in the hospital. The most common problems are:
Infections. Being in the hospital and lying down for a long time can put you at risk for infections, such as
pneumonia. Being on a
ventilator also puts you at higher risk for infections.
A
pneumothorax (
collapsed lung). This is a condition in which air or gas collects in the space around the
lungs. This can cause one or both lungs to collapse. The air pressure from a ventilator can cause this condition.
Lung
scarring. ARDS causes the
lungs to become stiff (scarred). It also makes it hard for the lungs to expand and fill with air. Being on a ventilator also can cause lung scarring.
Blood clots. Lying down for long
periods can cause blood clots to form in your body. A blood clot that forms in a
vein deep in your body is called a
deep vein thrombosis. This type of blood clot can break off, travel through the bloodstream to the
lungs, and block blood flow. This condition is called
pulmonary embolism.
How Is ARDS Diagnosed?
Your doctor will diagnose ARDS based on your medical history, a physical exam, and test results.
Physical Exam
ARDS may cause abnormal breathing sounds, such as crackling. Your doctor will listen to your lungs with a stethoscope to hear these sounds.
He or she also will listen to your heart and look for signs of extra fluid in other parts of your body. Extra fluid may mean you have heart or kidney problems.
Your doctor will look for a bluish color on your skin and lips. A bluish color means your blood has a low level of oxygen. This is a possible sign of ARDS.
Diagnostic Tests
You may have ARDS or another condition that causes similar symptoms. To find out, your doctor may recommend one or more of the following tests.
Initial Tests
The first tests done are:
An arterial
blood gas test. This
blood test measures the
oxygen level in your blood using a sample of blood taken from an
artery. A low blood oxygen level might be a sign of ARDS.
A
sputum culture. This test is used to study the spit you've coughed up from your
lungs. A sputum culture can help find the cause of an
infection.
Other Tests
Other tests used to diagnose ARDS include:
Chest computed tomography (to-MOG-rah-fee) scan, or
chest CT scan. This test uses a computer to create detailed pictures of your
lungs. A chest CT scan may show lung problems, such as fluid in the lungs, signs of
pneumonia, or a
tumor.
Heart tests that look for signs of
heart failure. Heart failure is a condition in which the heart can't pump enough
blood to meet the body's needs. This condition can cause fluid to build up in your
lungs.
How Is ARDS Treated?
ARDS is treated in a hospital's intensive care unit. Current treatment approaches focus on improving blood oxygen levels and providing supportive care. Doctors also will try to pinpoint and treat the underlying cause of the condition.
Oxygen Therapy
One of the main goals of treating ARDS is to provide oxygen to your lungs and other organs (such as your brain and kidneys). Your organs need oxygen to work properly.
Oxygen usually is given through nasal prongs or a mask that fits over your mouth and nose. However, if your oxygen level doesn't rise or it's still hard for you to breathe, your doctor will give you oxygen through a breathing tube. He or she will insert the flexible tube through your mouth or nose and into your windpipe.
Before inserting the tube, your doctor will squirt or spray a liquid medicine into your throat (and possibly your nose) to make it numb. Your doctor also will give you medicine through an intravenous (IV) line in your bloodstream to make you sleepy and relaxed.
The breathing tube will be connected to a machine that supports breathing (a ventilator). The ventilator will fill your lungs with oxygen-rich air.
Your doctor will adjust the ventilator as needed to help your lungs get the right amount of oxygen. This also will help prevent injury to your lungs from the pressure of the ventilator.
You'll use the breathing tube and ventilator until you can breathe on your own. If you need a ventilator for more than a few days, your doctor may do a tracheotomy (tra-ke-OT-o-me).
This procedure involves making a small cut in your neck to create an opening to the windpipe. The opening is called a tracheostomy (TRA-ke-OS-to-me). Your doctor will place the breathing tube directly into the windpipe. The tube is then connected to the ventilator.
For more information, go to the Health Topics Oxygen Therapy article.
Supportive Care
Supportive care refers to treatments that help relieve symptoms, prevent complications, or improve quality of life. Supportive approaches used to treat ARDS include:
Living With ARDS
Some people fully recover from ARDS. Others continue to have health problems. After you go home from the hospital, you may have one or more of the following problems:
Shortness of breath. After
treatment, many people who have ARDS recover close-to-normal lung function within 6 months. For others, it may take longer. Some people have breathing problems for the rest of their lives.
Problems with memory and thinking clearly. Certain medicines and a low
blood oxygen level can cause these problems.
These health problems may go away within a few weeks, or they may last longer. Talk with your doctor about how to deal with these issues. Also, see the suggestions below.
Getting Help
You can take steps to recover from ARDS and improve your quality of life. For example, ask your family and friends for help with everyday activities.
If you smoke, quit. Smoking can worsen lung problems. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke and other lung irritants, such as harmful fumes.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general tips on how to quit smoking.
Go to pulmonary rehabilitation (rehab) if your doctor recommends it. Rehab might include exercise training, education, and counseling. Rehab can teach you how to return to normal activities and stay active.
Your rehab team might include doctors, nurses, and other specialists. They will work with you to create a program that meets your needs.
Emotional Issues and Support
Living with ARDS may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking with a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with ARDS. You can see how other people who have the same symptoms have coped with them. Talk to your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. However, many questions remain about various diseases and conditions, including ARDS.
The NHLBI continues to support research to learn more. For example, NHLBI-supported research on ARDS includes studies that explore:
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to ARDS, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Alpha-1 Antitrypsin Deficiency?
Alpha-1 antitrypsin (an-tee-TRIP-sin) deficiency, or AAT deficiency, is a condition that raises your risk for lung disease (especially if you smoke) and other diseases.
Some people who have severe AAT deficiency develop emphysema (em-fi-SE-ma)—often when they're only in their forties or fifties. Emphysema is a serious lung disease in which damage to the airways makes it hard to breathe.
A small number of people who have AAT deficiency develop cirrhosis (sir-RO-sis) and other serious liver diseases.
Cirrhosis is a disease in which the liver becomes scarred. The scarring prevents the organ from working well. In people who have AAT deficiency, cirrhosis and other liver diseases usually occur in infancy and early childhood.
A very small number of people who have AAT deficiency have a rare skin disease called necrotizing panniculitis (pa-NIK-yu-LI-tis). This disease can cause painful lumps under or on the surface of the skin.
This article focuses on AAT deficiency as it relates to lung disease.
Overview
Alpha-1 antitrypsin, also called AAT, is a protein made in the liver. Normally, the protein travels through the bloodstream. It helps protect the body's organs from the harmful effects of other proteins. The lungs are one of the main organs that the AAT protein protects.
AAT deficiency occurs if the AAT proteins made in the liver aren't the right shape. They get stuck inside liver cells and can't get into the bloodstream.
As a result, not enough AAT proteins travel to the lungs to protect them. This increases the risk of lung disease. Also, because too many AAT proteins are stuck in the liver, liver disease can develop.
Severe AAT deficiency occurs if blood levels of the AAT protein fall below the lowest amount needed to protect the lungs.
AAT deficiency is an inherited condition. ""Inherited"" means it's passed from parents to children through genes.
Doctors don't know how many people have AAT deficiency. Many people who have the condition may not know they have it. Estimates of how many people have AAT deficiency range from about 1 in every 1,600 people to about 1 in every 5,000 people.
Outlook
People who have AAT deficiency may not have serious complications, and they may live close to a normal lifespan.
Among people with AAT deficiency who have a related lung or liver disease, about 3 percent die each year.
Smoking is the leading risk factor for life-threatening lung disease if you have AAT deficiency. Smoking or exposure to tobacco smoke increases the risk of earlier lung-related symptoms and lung damage. If you have severe AAT deficiency, smoking can shorten your life by as much as 20 years.
AAT deficiency has no cure, but treatments are available. Treatments often are based on the type of disease you develop.
What Causes Alpha-1 Antitrypsin Deficiency?
Alpha-1 antitrypsin (AAT) deficiency is an inherited disease. ""Inherited"" means it's passed from parents to children through genes.
Children who have AAT deficiency inherit two faulty AAT genes, one from each parent. These genes tell cells in the body how to make AAT proteins.
In AAT deficiency, the AAT proteins made in the liver aren't the right shape. Thus, they get stuck in the liver cells. The proteins can't get to the organs in the body that they protect, such as the lungs. Without the AAT proteins protecting the organs, diseases can develop.
The most common faulty gene that can cause AAT deficiency is called PiZ. If you inherit two PiZ genes (one from each parent), you'll have AAT deficiency.
If you inherit a PiZ gene from one parent and a normal AAT gene from the other parent, you won't have AAT deficiency. However, you might pass the PiZ gene to your children.
Even if you inherit two faulty AAT genes, you may not have any related complications. You may never even realize that you have AAT deficiency.
Who Is at Risk for Alpha-1 Antitrypsin Deficiency?
Alpha-1 antitrypsin (AAT) deficiency occurs in all ethnic groups. However, the condition occurs most often in White people of European descent.
AAT deficiency is an inherited condition. ""Inherited"" means the condition is passed from parents to children through genes.
If you have bloodline relatives with known AAT deficiency, you're at increased risk for the condition. Even so, it doesn't mean that you'll develop one of the diseases related to the condition.
Some risk factors make it more likely that you'll develop lung disease if you have AAT deficiency. Smoking is the leading risk factor for serious lung disease if you have AAT deficiency. Your risk for lung disease also may go up if you're exposed to dust, fumes, or other toxic substances.
What Are the Signs and Symptoms of Alpha-1 Antitrypsin Deficiency?
The first lung-related symptoms of alpha-1 antitrypsin (AAT deficiency may include shortness of breath, less ability to be physically active, and wheezing. These signs and symptoms most often begin between the ages of 20 and 40.
Other signs and symptoms may include repeated lung infections, tiredness, a rapid heartbeat upon standing, vision problems, and weight loss.
Some people who have severe AAT deficiency develop emphysema (em-fi-SE-ma)—often when they're only in their forties or fifties. Signs and symptoms of emphysema include problems breathing, wheezing, and a chronic (ongoing) cough.
At first, many people who have AAT deficiency are diagnosed with asthma. This is because wheezing also is a symptom of asthma. Also, people who have AAT deficiency respond well to asthma medicines.
How Is Alpha-1 Antitrypsin Deficiency Diagnosed?
Alpha-1 antitrypsin (AAT) deficiency usually is diagnosed after you develop a lung or liver disease that's related to the condition.
Your doctor may suspect AAT deficiency if you have signs or symptoms of a serious lung condition, especially emphysema, without any obvious cause. He or she also may suspect AAT deficiency if you develop emphysema when you're 45 years old or younger.
Specialists Involved
Many doctors may be involved in the diagnosis of AAT deficiency. These include primary care doctors, pulmonologists (lung specialists), and hepatologists (liver specialists).
To diagnose AAT deficiency, your doctor will:
Diagnostic Tests
Your doctor may recommend tests to confirm a diagnosis of AAT deficiency. He or she also may recommend tests to check for lung- or liver-related conditions.
A genetic test is the most certain way to check for AAT deficiency. This test will show whether you have faulty AAT genes.
A blood test also may be used. This test checks the level of AAT protein in your blood. If the level is a lot lower than normal, it's likely that you have AAT deficiency.
Lung-Related Tests
If you have a lung disease related to AAT deficiency, your doctor may recommend lung function tests and high-resolution computed tomography (to-MOG-rah-fee) scanning, also called CT scanning.
Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. These tests may show how severe your lung disease is and how well treatment is working.
High-resolution CT scanning uses x rays to create detailed pictures of parts of the body. A CT scan can show whether you have emphysema or another lung disease and how severe it is.
How Is Alpha-1 Antitrypsin Deficiency Treated?
Alpha-1 antitrypsin (AAT) deficiency has no cure, but its related lung diseases have many treatments. Most of these treatments are the same as the ones used for a lung disease called COPD (chronic obstructive pulmonary disease).
If you have symptoms related to AAT deficiency, your doctor may recommend:
Medicines called inhaled bronchodilators (brong-ko-di-LA-tors) and inhaled steroids. These medicines help open your airways and make breathing easier. They also are used to treat
asthma and COPD.
Flu and pneumococcal (noo-mo-KOK-al) vaccines to protect you from illnesses that could make your condition worse. Prompt
treatment of lung infections also can help protect your
lungs.
Pulmonary rehabilitation (rehab). Rehab involves
treatment by a team of experts at a special clinic. In rehab, you'll learn how to manage your condition and function at your best.
A
lung transplant. A
lung transplant may be an option if you have severe breathing problems. If you have a good chance of surviving the transplant
surgery, you may be a candidate for it.
Augmentation (og-men-TA-shun) therapy is a treatment used only for people who have AAT-related lung diseases. This therapy involves getting infusions of the AAT protein. The infusions raise the level of the protein in your blood and lungs.
Not enough research has been done to show how well this therapy works. However, some research suggests that this therapy may slow the development of AAT deficiency in people who don't have severe disease.
People who have AAT deficiency and develop related liver or skin diseases will be referred to doctors who treat those diseases.
Future Treatments
Researchers are working on possible treatments that will target the faulty AAT genes and replace them with healthy genes. These treatments are in the early stages of development.
Researchers also are studying therapies that will help misshapen AAT proteins move from the liver into the bloodstream. They're also studying a type of augmentation therapy in which the AAT protein is inhaled instead of injected into a vein.
If you're interested in new treatments, ask your doctor about ongoing clinical trials for AAT deficiency.
How Can Alpha-1 Antitrypsin Deficiency Be Prevented?
You can't prevent alpha-1 antitrypsin (AAT) deficiency because the condition is inherited (passed from parents to children through genes).
If you inherit two faulty AAT genes, you'll have AAT deficiency. Even so, you may never develop one of the diseases related to the condition.
You can take steps to prevent or delay lung diseases related to AAT deficiency. One important step is to quit smoking. If you don't smoke, don't start.
Talk with your doctor about programs and products that can help you quit smoking. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include basic information about how to quit smoking.
Also, try to avoid secondhand smoke and places with dust, fumes, or other toxic substances that you may inhale.
Check your living and working spaces for things that may irritate your lungs. Examples include flower and tree pollen, ash, allergens, air pollution, wood burning stoves, paint fumes, and fumes from cleaning products and other household items.
If you have a lung disease related to AAT deficiency, ask your doctor whether you might benefit from augmentation therapy. This is a treatment in which you receive infusions of AAT protein.
Augmentation therapy raises the level of AAT protein in your blood and lungs. (For more information, go to ""How Is Alpha-1 Antitrypsin Deficiency Treated?"")
Living With Alpha-1 Antitrypsin Deficiency
People who have alpha-1 antitrypsin (AAT) deficiency don't always develop serious lung or liver diseases. This means that you can have AAT deficiency and not even know it.
If you already know you have AAT deficiency, you probably also have a related lung or liver disease. Ongoing medical care and lifestyle changes can help you manage your health.
Ongoing Medical Care
If you have AAT deficiency, you'll need ongoing medical care. Talk with your doctor about how often you should schedule medical visits.
Take all of your medicines as prescribed, and follow your treatment plan. Get flu and pneumococcal vaccines to protect you from illnesses that may worsen your condition. If you have a lung infection, get treatment right away.
You also should get treatment right away for any breathing problems. If treatment includes pulmonary rehabilitation, work with your health care team to learn how to manage your condition and function at your best.
Lifestyle Changes
Quit Smoking and Avoid Lung Irritants
If you smoke, quit. If you don't smoke, don't start. Smoking is the leading risk factor for life-threatening lung disease if you have AAT deficiency.
Talk with your doctor about programs and products that can help you quit smoking. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include basic information about how to quit smoking.
Also, try to avoid secondhand smoke and other lung irritants, such as dust, fumes, or toxins. Check your living and working spaces for things that may irritate your lungs. Examples include flower and tree pollen, ash, allergens, air pollution, wood burning stoves, paint fumes, and fumes from cleaning products and other household items.
Because AAT deficiency is inherited, your children may have the condition or carry the gene for it. Advise them to avoid smoking and to stay away from places where they might inhale irritants or toxins.
Follow a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the NHLBI's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Also, talk with your doctor about whether it's safe for you to drink alcohol.
Be Physically Active
Try to do physical activity regularly. Talk with your doctor about how much and what types of activity are safe for you.
For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
These resources provide information about the benefits of physical activity.
Reduce Stress
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Relaxation techniques—such as meditation, yoga, breathing exercises, and muscle relaxation—can help you cope with stress.
Emotional Issues and Support
Living with AAT deficiency may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with AAT deficiency. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to alpha-1 antitrypsin deficiency, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Anemia?
Anemia (uh-NEE-me-uh) is a condition in which your blood has a lower than normal number of red blood cells.
Anemia also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that gives blood its red color. This protein helps red blood cells carry oxygen from the lungs to the rest of the body.
If you have anemia, your body doesn't get enough oxygen-rich blood. As a result, you may feel tired or weak. You also may have other symptoms, such as shortness of breath, dizziness, or headaches.
Severe or long-lasting anemia can damage your heart, brain, and other organs in your body. Very severe anemia may even cause death.
Outlook
Many types of anemia can be mild, short term, and easily treated. You can even prevent some types with a healthy diet. Other types can be treated with dietary supplements.
However, certain types of anemia can be severe, long lasting, and even life threatening if not diagnosed and treated.
If you have signs or symptoms of anemia, see your doctor to find out whether you have the condition. Treatment will depend on the cause of the anemia and how severe it is.
Other Names for Anemia
There are many types of anemia with specific causes and traits. Some of these include:
What Causes Anemia?
The three main causes of anemia are:
For some people, the condition is caused by more than one of these factors.
Lack of Red Blood Cell Production
Both acquired and inherited conditions and factors can prevent your body from making enough red blood cells. ""Acquired"" means you aren't born with the condition, but you develop it. ""Inherited"" means your parents passed the gene for the condition on to you.
Acquired conditions and factors that can lead to anemia include poor diet, abnormal hormone levels, some chronic (ongoing) diseases, and pregnancy.
Aplastic anemia also can prevent your body from making enough red blood cells. This condition can be acquired or inherited.
Hormones
Your body needs the hormone erythropoietin (eh-rith-ro-POY-eh-tin) to make red blood cells. This hormone stimulates the bone marrow to make these cells. A low level of this hormone can lead to anemia.
High Rates of Red Blood Cell Destruction
Both acquired and inherited conditions and factors can cause your body to destroy too many red blood cells. One example of an acquired condition is an enlarged or diseased spleen.
The spleen is an organ that removes wornout red blood cells from the body. If the spleen is enlarged or diseased, it may remove more red blood cells than normal, causing anemia.
Examples of inherited conditions that can cause your body to destroy too many red blood cells include sickle cell anemia, thalassemias, and lack of certain enzymes. These conditions create defects in the red blood cells that cause them to die faster than healthy red blood cells.
Hemolytic anemia is another example of a condition in which your body destroys too many red blood cells. Inherited or acquired conditions or factors can cause hemolytic anemia. Examples include immune disorders, infections, certain medicines, or reactions to blood transfusions.
Who Is at Risk for Anemia?
Anemia is a common condition. It occurs in all age, racial, and ethnic groups. Both men and women can have anemia. However, women of childbearing age are at higher risk for the condition because of blood loss from menstruation.
Anemia can develop during pregnancy due to low levels of iron and folic acid (folate) and changes in the blood. During the first 6 months of pregnancy, the fluid portion of a woman's blood (the plasma) increases faster than the number of red blood cells. This dilutes the blood and can lead to anemia.
During the first year of life, some babies are at risk for anemia because of iron deficiency. At-risk infants include those who are born too early and infants who are fed breast milk only or formula that isn't fortified with iron. These infants can develop iron deficiency by 6 months of age.
Infants between 1 and 2 years of age also are at risk for anemia. They may not get enough iron in their diets, especially if they drink a lot of cow's milk. Cow's milk is low in the iron needed for growth.
Drinking too much cow's milk may keep an infant or toddler from eating enough iron-rich foods or absorbing enough iron from foods.
Older adults also are at increased risk for anemia. Researchers continue to study how the condition affects older adults. Many of these people have other medical conditions as well.
Major Risk Factors
Factors that raise your risk for anemia include:
What Are the Signs and Symptoms of Anemia?
The most common symptom of anemia is fatigue (feeling tired or weak). If you have anemia, you may find it hard to find the energy to do normal activities.
Other signs and symptoms of anemia include:
Shortness of breath
Coldness in the
hands and feet
These signs and symptoms can occur because your heart has to work harder to pump oxygen-rich blood through your body.
Mild to moderate anemia may cause very mild symptoms or none at all.
Complications of Anemia
Some people who have anemia may have arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. Over time, arrhythmias can damage your heart and possibly lead to heart failure.
Anemia also can damage other organs in your body because your blood can't get enough oxygen to them.
Anemia can weaken people who have cancer or HIV/AIDS. This can make their treatments not work as well.
Anemia also can cause many other health problems. People who have kidney disease and anemia are more likely to have heart problems. With some types of anemia, too little fluid intake or too much loss of fluid in the blood and body can occur. Severe loss of fluid can be life threatening.
How Is Anemia Diagnosed?
Your doctor will diagnose anemia based on your medical and family histories, a physical exam, and results from tests and procedures.
Because anemia doesn't always cause symptoms, your doctor may find out you have it while checking for another condition.
Medical and Family Histories
Your doctor may ask whether you have any of the common signs or symptoms of anemia. He or she also may ask whether you've had an illness or condition that could cause anemia.
Let your doctor know about any medicines you take, what you typically eat (your diet), and whether you have family members who have anemia or a history of it.
Physical Exam
Your doctor will do a physical exam to find out how severe your anemia is and to check for possible causes. He or she may:
Listen to your
lungs for rapid or uneven breathing
Your doctor also may do a pelvic or rectal exam to check for common sources of blood loss.
Diagnostic Tests and Procedures
You may have various blood tests and other tests or procedures to find out what type of anemia you have and how severe it is.
Complete Blood Count
Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood.
The test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels might be lower in certain racial and ethnic populations. Your doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results might be a sign of anemia, another blood disorder, an infection, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells and a clue as to the cause of your anemia. In iron-deficiency anemia, for example, red blood cells usually are smaller than normal.
Other Tests and Procedures
If the CBC results show that you have anemia, you may need other tests, such as:
Hemoglobin electrophoresis (e-lek-tro-FOR-e-sis). This test looks at the different types of hemoglobin in your
blood. The test can help diagnose the type of
anemia you have.
A reticulocyte (re-TIK-u-lo-site) count. This test measures the number of young
red blood cells in your blood. The test shows whether your
bone marrow is making red blood cells at the correct rate.
Tests for the level of
iron in your
blood and body. These tests include serum iron and serum ferritin tests. Transferrin level and total iron-binding capacity tests also measure iron levels.
Because anemia has many causes, you also might be tested for conditions such as kidney failure, lead poisoning (in children), and vitamin deficiencies (lack of vitamins, such as B12 and folic acid).
If your doctor thinks that you have anemia due to internal bleeding, he or she may suggest several tests to look for the source of the bleeding. A test to check the stool for blood might be done in your doctor's office or at home. Your doctor can give you a kit to help you get a sample at home. He or she will tell you to bring the sample back to the office or send it to a laboratory.
If blood is found in the stool, you may have other tests to find the source of the bleeding. One such test is endoscopy (en-DOS-ko-pe). For this test, a tube with a tiny camera is used to view the lining of the digestive tract.
Your doctor also may want to do bone marrow tests. These tests show whether your bone marrow is healthy and making enough blood cells.
How Is Anemia Treated?
Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may include dietary changes or supplements, medicines, procedures, or surgery to treat blood loss.
Dietary Changes and Supplements
Low levels of vitamins or iron in the body can cause some types of anemia. These low levels might be the result of a poor diet or certain diseases or conditions.
To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron.
Iron
Your body needs iron to make hemoglobin. Your body can more easily absorb iron from meats than from vegetables or other foods. To treat your anemia, your doctor may suggest eating more meat—especially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish.
Nonmeat foods that are good sources of iron include:
Spinach and other dark green leafy vegetables
Tofu
Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
Dried fruits, such as prunes, raisins, and apricots
Prune juice
Iron-fortified cereals and breads
You can look at the Nutrition Facts label on packaged foods to find out how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.
Iron also is available as a supplement. It's usually combined with multivitamins and other minerals that help your body absorb iron.
Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow's milk, and infants who are fed breast milk only or formula that isn't fortified with iron.
Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.
Folic Acid
Folic acid (folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.
Good sources of folic acid include:
Spinach and other dark green leafy vegetables
Black-eyed peas and dried beans
Eggs
Bananas, oranges, orange juice, and some other fruits and juices
Vitamin C
Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.
If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work.
Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.
Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.
Medicines
Your doctor may prescribe medicines to help your body make more red blood cells or to treat an underlying cause of anemia. Some of these medicines include:
Surgery
If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.
If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes wornout red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing Go to:
What Is an Aneurysm?
An aneurysm (AN-u-rism) is a balloon-like bulge in an artery. Arteries are blood vessels that carry oxygen-rich blood to your body.
Arteries have thick walls to withstand normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or injure artery walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.
An aneurysm can grow large and rupture (burst) or dissect. A rupture causes dangerous bleeding inside the body. A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.
Both rupture and dissection often are fatal.
Types of Aneurysms
Aortic Aneurysms
The two types of aortic aneurysm are abdominal aortic aneurysm and thoracic aortic aneurysm. Some people have both types.
Abdominal Aortic Aneurysms
An aneurysm that occurs in the abdominal portion of the aorta is called an abdominal aortic aneurysm (AAA). Most aortic aneurysms are AAAs.
These aneurysms are found more often now than in the past because of computed tomography (to-MOG-rah-fee) scans, or CT scans, done for other medical problems.
Small AAAs rarely rupture. However, AAAs can grow very large without causing symptoms. Routine checkups and treatment for an AAA can help prevent growth and rupture.
Thoracic Aortic Aneurysms
An aneurysm that occurs in the chest portion of the aorta (above the diaphragm, a muscle that helps you breathe) is called a thoracic aortic aneurysm (TAA).
TAAs don't always cause symptoms, even when they're large. Only half of all people who have TAAs notice any symptoms. TAAs are found more often now than in the past because of chest CT scans done for other medical problems.
With a common type of TAA, the walls of the aorta weaken and a section close to the heart enlarges. As a result, the valve between the heart and the aorta can't close properly. This allows blood to leak back into the heart.
A less common type of TAA can develop in the upper back, away from the heart. A TAA in this location may result from an injury to the chest, such as from a car crash.
What Causes an Aneurysm?
The force of blood pushing against the walls of an artery combined with damage or injury to the artery’s walls can cause an aneurysm.
Many conditions and factors can damage and weaken the walls of the aorta and cause aortic aneurysms. Examples include aging, smoking, high blood pressure, and atherosclerosis (ath-er-o-skler-O-sis). Atherosclerosis is the hardening and narrowing of the arteries due to the buildup of a waxy substance called plaque (plak).
Rarely, infections—such as untreated syphilis (a sexually transmitted infection)—can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that inflame the blood vessels, such as vasculitis (vas-kyu-LI-tis).
A family history of aneurysms also may play a role in causing aortic aneurysms.
In addition to the factors above, certain genetic conditions may cause thoracic aortic aneurysms (TAAs). Examples of these conditions include Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome (the vascular type), and Turner syndrome.
These genetic conditions can weaken the body’s connective tissues and damage the aorta. People who have these conditions tend to develop aneurysms at a younger age than other people. They’re also at higher risk for rupture and dissection.
Trauma, such as a car accident, also can damage the walls of the aorta and lead to TAAs.
Researchers continue to look for other causes of aortic aneurysms. For example, they’re looking for genetic mutations (changes in the genes) that may contribute to or cause aneurysms.
Who Is at Risk for an Aneurysm?
Certain factors put you at higher risk for an aortic aneurysm. These factors include:
Age. The risk for abdominal
aortic aneurysms increases as you get older. These aneurysms are more likely to occur in people who are aged 65 or older.
Smoking. Smoking can damage and weaken the walls of the
aorta.
Having a bicuspid aortic valve can raise the risk of having a thoracic aortic aneurysm. A bicuspid aortic valve has two leaflets instead of the typical three.
Car accidents or trauma also can injure the arteries and increase the risk for aneurysms.
If you have any of these risk factors, talk with your doctor about whether you need screening for aneurysms.
What Are the Signs and Symptoms of an Aneurysm?
The signs and symptoms of an aortic aneurysm depend on the type and location of the aneurysm. Signs and symptoms also depend on whether the aneurysm has ruptured (burst) or is affecting other parts of the body.
Aneurysms can develop and grow for years without causing any signs or symptoms. They often don't cause signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow.
Abdominal Aortic Aneurysms
Most abdominal aortic aneurysms (AAAs) develop slowly over years. They often don't cause signs or symptoms unless they rupture. If you have an AAA, your doctor may feel a throbbing mass while checking your abdomen.
When symptoms are present, they can include:
Deep pain in your back or the side of your
abdomenSteady, gnawing pain in your
abdomen that lasts for hours or days
If an AAA ruptures, symptoms may include sudden, severe pain in your lower abdomen and back; nausea (feeling sick to your stomach) and vomiting; constipation and problems with urination; clammy, sweaty skin; light-headedness; and a rapid heart rate when standing up.
Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work well. Shock can be fatal if it’s not treated right away.
Thoracic Aortic Aneurysms
A thoracic aortic aneurysm (TAA) may not cause symptoms until it dissects or grows large. If you have symptoms, they may include:
Shortness of breath and/or trouble breathing or
swallowing
A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.
If a TAA ruptures or dissects, you may feel sudden, severe, sharp or stabbing pain starting in your upper back and moving down into your abdomen. You may have pain in your chest and arms, and you can quickly go into shock.
If you have any symptoms of TAA or aortic dissection, call 9–1–1. If left untreated, these conditions may lead to organ damage or death.
How Is an Aneurysm Diagnosed?
If you have an aortic aneurysm but no symptoms, your doctor may find it by chance during a routine physical exam. More often, doctors find aneurysms during tests done for other reasons, such as chest or abdominal pain.
If you have an abdominal aortic aneurysm (AAA), your doctor may feel a throbbing mass in your abdomen. A rapidly growing aneurysm about to rupture (burst) can be tender and very painful when pressed. If you're overweight or obese, it may be hard for your doctor to feel even a large AAA.
If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.
Specialists Involved
Your primary care doctor may refer you to a cardiothoracic or vascular surgeon for diagnosis and treatment of an aortic aneurysm.
A cardiothoracic surgeon does surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon does surgery on the aorta and other blood vessels, except those of the heart and brain.
Diagnostic Tests and Procedures
To diagnose and study an aneurysm, your doctor may recommend one or more of the following tests.
Ultrasound and Echocardiography
Ultrasound and echocardiography (echo) are simple, painless tests that use sound waves to create pictures of the structures inside your body. These tests can show the size of an aortic aneurysm, if one is found.
Computed Tomography Scan
A computed tomography scan, or CT scan, is a painless test that uses x rays to take clear, detailed pictures of your organs.
During the test, your doctor will inject dye into a vein in your arm. The dye makes your arteries, including your aorta, visible on the CT scan pictures.
Your doctor may recommend this test if he or she thinks you have an AAA or a thoracic aortic aneurysm (TAA). A CT scan can show the size and shape of an aneurysm. This test provides more detailed pictures than an ultrasound or echo.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test works well for detecting aneurysms and pinpointing their size and exact location.
Angiography
Angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your arteries. This test shows the amount of damage and blockage in blood vessels.
Aortic angiography shows the inside of your aorta. The test may show the location and size of an aortic aneurysm.
How Is an Aneurysm Treated?
Aortic aneurysms are treated with medicines and surgery. Small aneurysms that are found early and aren’t causing symptoms may not need treatment. Other aneurysms need to be treated.
The goals of treatment may include:
Treatment for an aortic aneurysm is based on its size. Your doctor may recommend routine testing to make sure an aneurysm isn't getting bigger. This method usually is used for aneurysms that are smaller than 5 centimeters (about 2 inches) across.
How often you need testing (for example, every few months or every year) is based on the size of the aneurysm and how fast it's growing. The larger it is and the faster it's growing, the more often you may need to be checked.
Surgery
Your doctor may recommend surgery if your aneurysm is growing quickly or is at risk of rupture or dissection.
The two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.
Open Abdominal or Open Chest Repair
The standard and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. This surgery involves a major incision (cut) in the abdomen or chest.
General anesthesia (AN-es-THE-ze-ah) is used during this procedure. The term “anesthesia” refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.
During the surgery, the aneurysm is removed. Then, the section of aorta is replaced with a graft made of material such as Dacron® or Teflon.® The surgery takes 3 to 6 hours; you’ll remain in the hospital for 5 to 8 days.
If needed, repair of the aortic heart valve also may be done during open abdominal or open chest surgery.
It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Most patients make a full recovery.
Endovascular Repair
In endovascular repair, the aneurysm isn't removed. Instead, a graft is inserted into the aorta to strengthen it. Surgeons do this type of surgery using catheters (tubes) inserted into the arteries; it doesn't require surgically opening the chest or abdomen. General anesthesia is used during this procedure.
The surgeon first inserts a catheter into an artery in the groin (upper thigh) and threads it to the aneurysm. Then, using an x ray to see the artery, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm.
The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta. This helps prevent the aneurysm from rupturing.
The recovery time for endovascular repair is less than the recovery time for open abdominal or open chest repair. However, doctors can’t repair all aortic aneurysms with endovascular repair. The location or size of an aneurysm may prevent the use of a stent graft.
How Can an Aneurysm Be Prevented?
The best way to prevent an aortic aneurysm is to avoid the factors that put you at higher risk for one. You can’t control all aortic aneurysm risk factors, but lifestyle changes can help you lower some risks.
For example, if you smoke, try to quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article.
Another important lifestyle change is following a healthy diet. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute’s (NHLBI’s) Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources include general information about healthy eating.
Be as physically active as you can. Talk with your doctor about the amounts and types of physical activity that are safe for you. For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI’s ""Your Guide to Physical Activity and Your Heart.""
Work with your doctor to control medical conditions such as high blood pressure and high blood cholesterol. Follow your treatment plans and take all of your medicines as your doctor prescribes.
Screening for Aneurysms
Although you may not be able to prevent an aneurysm, early diagnosis and treatment can help prevent rupture and dissection.
Aneurysms can develop and grow large before causing any signs or symptoms. Thus, people who are at high risk for aneurysms may benefit from early, routine screening.
Your doctor may recommend routine screening if you’re:
If you’re at risk, but not in one of these high-risk groups, ask your doctor whether screening will benefit you.
Living With an Aneurysm
If you have an aortic aneurysm, following your treatment plan and having ongoing medical care are important. Early diagnosis and treatment can help prevent rupture and dissection.
Your doctor may advise you to avoid heavy lifting or physical exertion. If your job requires heavy lifting, you may be advised to change jobs.
Also, try to avoid emotional crises. Strong emotions can cause blood pressure to rise, which increases the risk of rupture or dissection. Call your doctor if an emotional crisis occurs.
Your doctor may prescribe medicines to treat your aneurysm. Medicines can lower your blood pressure, relax your blood vessels, and lower the risk that the aneurysm will rupture (burst). Take all of your medicines exactly as your doctor prescribes.
If you have a small aneurysm that isn’t causing pain, you may not need treatment. However, aneurysms can develop and grow large before causing any symptoms. Thus, people who are at high risk for aneurysms may benefit from early, routine screening.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of various diseases and conditions, as well as ways to prevent, diagnose, or treat them.
The NHLBI continues to support research aimed at learning more about various diseases and conditions, including aneurysms. For example, the NHLBI currently is supporting a study on exercise therapy and aneurysms. The study’s goal is to find out whether exercise can limit the growth of small abdominal aortic aneurysms in older adults.
Ongoing research often depends on the willingness of volunteers to take part in clinical trials. Go to:
What Is Angina?
Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD).
CHD is the most common type of heart disease in adults. It occurs if a waxy substance called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.
![]()
Plaque Buildup in an Artery. Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of a normal artery. Figure B shows an artery with plaque buildup. The inset image shows a cross-section of an artery with plaque (more...)
Plaque narrows and stiffens the coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle, causing chest pain. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow, which can cause a heart attack.
Angina also can be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the heart’s smallest coronary arteries. In coronary MVD, plaque doesn't create blockages in the arteries like it does in CHD.
Studies have shown that coronary MVD is more likely to affect women than men. Coronary MVD also is called cardiac syndrome X and nonobstructive CHD.
Types of Angina
The major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments.
Stable Angina
Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.)
If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.
Stable angina isn't a heart attack, but it suggests that a heart attack is more likely to happen in the future.
Unstable Angina
Unstable angina doesn't follow a pattern. It may occur more often and be more severe than stable angina. Unstable angina also can occur with or without physical exertion, and rest or medicine may not relieve the pain.
Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.
Variant (Prinzmetal's) Angina
Variant angina is rare. A spasm in a coronary artery causes this type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It usually happens between midnight and early morning. Medicine can relieve this type of angina.
Microvascular Angina
Microvascular angina can be more severe and last longer than other types of angina. Medicine may not relieve this type of angina.
Overview
Experts believe that nearly 7 million people in the United States suffer from angina. The condition occurs equally among men and women.
Angina can be a sign of CHD, even if initial tests don't point to the disease. However, not all chest pain or discomfort is a sign of CHD.
Other conditions also can cause chest pain, such as:
Aortic dissection (tearing of a major
artery)
All chest pain should be checked by a doctor.
What Causes Angina?
Underlying Causes
Angina usually is a symptom of coronary heart disease (CHD). This means that the underlying causes of angina generally are the same as the underlying causes of CHD.
Research suggests that CHD starts when certain factors damage the inner layers of the coronary arteries. These factors include:
Plaque may begin to build up where the arteries are damaged. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis).
Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Some plaque is hard and stable and causes the arteries to become narrow and stiff. This can greatly reduce blood flow to the heart and cause angina.
Other plaque is soft and more likely to rupture (break open) and cause blood clots. Blood clots can partially or totally block the coronary arteries and cause angina or a heart attack.
Immediate Causes
Many factors can trigger angina pain, depending on the type of angina you have.
Stable Angina
Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low, such as when you're sitting.
However, with physical exertion—like walking up a hill or climbing stairs—the heart works harder and needs more oxygen.
Other triggers of stable angina include:
Variant Angina
A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina can occur in people who have CHD and in those who don’t.
The coronary arteries can spasm as a result of:
Who Is at Risk for Angina?
Angina is a symptom of an underlying heart problem. It’s usually a symptom of coronary heart disease (CHD), but it also can be a symptom of coronary microvascular disease (MVD). So, if you’re at risk for CHD or coronary MVD, you’re also at risk for angina.
The major risk factors for CHD and coronary MVD include:
For more detailed information about CHD and coronary MVD risk factors, visit the Health Topics Coronary Heart Disease, Coronary Heart Disease Risk Factors, and Coronary Microvascular Disease articles.
People sometimes think that because men have more heart attacks than women, men also suffer from angina more often. In fact, overall, angina occurs equally among men and women.
Microvascular angina, however, occurs more often in women. About 70 percent of the cases of microvascular angina occur in women around the time of menopause.
Unstable angina occurs more often in older adults. Variant angina is rare; it accounts for only about 2 out of 100 cases of angina. People who have variant angina often are younger than those who have other forms of angina.
What Are the Signs and Symptoms of Angina?
Pain and discomfort are the main symptoms of angina. Angina often is described as pressure, squeezing, burning, or tightness in the chest. The pain or discomfort usually starts behind the breastbone.
Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. The pain may feel like indigestion. Some people say that angina pain is hard to describe or that they can't tell exactly where the pain is coming from.
Signs and symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness also may occur.
Women are more likely to feel discomfort in the neck, jaw, throat, abdomen, or back. Shortness of breath is more common in older people and those who have diabetes. Weakness, dizziness, and confusion can mask the signs and symptoms of angina in elderly people.
Symptoms also vary based on the type of angina you have.
Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor. Chest pain that lasts longer than a few minutes and isn't relieved by rest or angina medicine may be a sign of a heart attack. Call 9–1–1 right away.
Stable Angina
The pain or discomfort:
Occurs when the
heart must work harder, usually during physical exertion
Doesn't come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like
chest pain that spreads to the
arms, back, or other areas
Unstable Angina
The pain or discomfort:
Often occurs at rest, while sleeping at night, or with little physical exertion
Comes as a surprise
Is more severe and lasts longer than stable
angina (as long as 30 minutes)
Usually isn’t relieved by rest or medicine
May get worse over time
Variant Angina
The pain or discomfort:
Microvascular Angina
The pain or discomfort:
May be more severe and last longer than other types of
angina pain
May occur with shortness of breath,
sleep problems,
fatigue, and lack of energy
Often is first noticed during routine daily activities and times of mental
stress
How Is Angina Diagnosed?
The most important issues to address when you go to the doctor with chest pain are:
What's causing the
chest pain
Angina is a symptom of an underlying heart problem, usually coronary heart disease (CHD). The type of angina pain you have can be a sign of how severe the CHD is and whether it's likely to cause a heart attack.
If you have chest pain, your doctor will want to find out whether it's angina. He or she also will want to know whether the angina is stable or unstable. If it's unstable, you may need emergency medical treatment to try to prevent a heart attack.
To diagnose chest pain as stable or unstable angina, your doctor will do a physical exam, ask about your symptoms, and ask about your risk factors for and your family history of CHD or other heart diseases.
Your doctor also may ask questions about your symptoms, such as:
What brings on the pain or discomfort and what relieves it?
What does the pain or discomfort feel like (for example, heaviness or tightness)?
How often does the pain occur?
Where do you feel the pain or discomfort?
How severe is the pain or discomfort?
How long does the pain or discomfort last?
Diagnostic Tests and Procedures
If your doctor thinks that you have unstable angina or that your angina is related to a serious heart condition, he or she may recommend one or more tests.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack. However, some people who have angina have normal EKGs.
Stress Testing
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.
When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:
Shortness of breath or
chest pain
Abnormal changes in your
heart rhythm or your heart's electrical activity
As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats.
Computed Tomography Angiography
Computed tomography (to-MOG-rah-fee) angiography (CTA) uses dye and special x rays to show blood flow through the coronary arteries. This test is less invasive than coronary angiography with cardiac catheterization.
For CTA, a needle connected to an intravenous (IV) line is put into a vein in your hand or arm. Dye is injected through the IV line during the scan. You may have a warm feeling when this happens. The dye highlights your blood vessels on the CT scan pictures.
Sticky patches called electrodes are put on your chest. The patches are attached to an EKG machine to record your heart's electrical activity during the scan.
The CT scanner is a large machine that has a hollow, circular tube in the middle. You lie on your back on a sliding table. The table slowly slides into the opening of the machine.
Inside the scanner, an x-ray tube moves around your body to take pictures of different parts of your heart. A computer puts the pictures together to make a three-dimensional (3D) picture of the whole heart.
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CHD.
Your doctor may recommend a blood test to check the level of a protein called C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk for CHD and heart attack.
Your doctor also may recommend a blood test to check for low levels of hemoglobin (HEE-muh-glow-bin) in your blood. Hemoglobin is an iron-rich protein in red blood cells. It helps the blood cells carry oxygen from the lungs to all parts of your body. If your hemoglobin level is low, you may have a condition called anemia (uh-NEE-me-uh).
How Is Angina Treated?
Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation (rehab), and other therapies. The main goals of treatment are to:
Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. If lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.
Unstable angina is an emergency condition that requires treatment in a hospital.
Lifestyle Changes
Making lifestyle changes can help prevent episodes of angina. You can:
Slow down or take rest breaks if physical exertion triggers
angina.
Avoid large meals and rich foods that leave you feeling stuffed if heavy meals trigger
angina.
Try to avoid situations that make you upset or stressed if emotional
stress triggers
angina. Learn ways to handle stress that can't be avoided.
You also can make lifestyle changes that help lower your risk for coronary heart disease. One of the most important changes is to quit smoking. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s (NHLBI’s) ""Your Guide to a Healthy Heart.""
Following a healthy diet is another important lifestyle change. A healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.
A healthy diet includes a variety of fruits and vegetables (including beans and peas). It also includes whole grains, lean meats, poultry without skin, seafood, and fat-free or low-fat milk and dairy products. A healthy diet also is low in sodium (salt), added sugars, solid fats, and refined grains.
For more information about following a healthy diet, go to the NHLBI’s “Your Guide to Lowering Your Blood Pressure With DASH” and the U.S. Department of Agriculture’s ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Other important lifestyle changes include:
Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you. For more information, go to the Health Topics
Physical Activity and Your Heart article.
Maintaining a healthy weight. If you’re
overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control
CHD risk factors.
Taking all medicines as your doctor prescribes, especially if you have
diabetes.
What Is Antiphospholipid Antibody Syndrome?
Antiphospholipid (AN-te-fos-fo-LIP-id) antibody syndrome (APS) is an autoimmune disorder. Autoimmune disorders occur if the body's immune system makes antibodies that attack and damage tissues or cells.
Antibodies are a type of protein. They usually help defend the body against infections. In APS, however, the body makes antibodies that mistakenly attack phospholipids—a type of fat.
Phospholipids are found in all living cells and cell membranes, including blood cells and the lining of blood vessels.
When antibodies attack phospholipids, cells are damaged. This damage causes blood clots to form in the body's arteries and veins. (These are the vessels that carry blood to your heart and body.)
Usually, blood clotting is a normal bodily process. Blood clots help seal small cuts or breaks on blood vessel walls. This prevents you from losing too much blood. In APS, however, too much blood clotting can block blood flow and damage the body's organs.
Overview
Some people have APS antibodies, but don't ever have signs or symptoms of the disorder. Having APS antibodies doesn't mean that you have APS. To be diagnosed with APS, you must have APS antibodies and a history of health problems related to the disorder.
APS can lead to many health problems, such as stroke, heart attack, kidney damage, deep vein thrombosis (throm-BO-sis), and pulmonary embolism (PULL-mun-ary EM-bo-lizm).
APS also can cause pregnancy-related problems, such as multiple miscarriages, a miscarriage late in pregnancy, or a premature birth due to eclampsia (ek-LAMP-se-ah). (Eclampsia, which follows preeclampsia, is a serious condition that causes seizures in pregnant women.)
Very rarely, some people who have APS develop many blood clots within weeks or months. This condition is called catastrophic antiphospholipid syndrome (CAPS).
People who have APS also are at higher risk for thrombocytopenia (THROM-bo-si-to-PE-ne-ah). This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets (PLATE-lets). Antibodies destroy the platelets, or they’re used up during the clotting process. Mild to serious bleeding can occur with thrombocytopenia.
APS can be fatal. Death may occur as a result of large blood clots or blood clots in the heart, lungs, or brain.
Outlook
APS can affect people of any age. However, it's more common in women and people who have other autoimmune or rheumatic (ru-MAT-ik) disorders, such as lupus. (""Rheumatic"" refers to disorders that affect the joints, bones, or muscles.)
APS has no cure, but medicines can help prevent its complications. Medicines are used to stop blood clots from forming. They also are used to keep existing clots from getting larger. Treatment for APS is long term.
If you have APS and another autoimmune disorder, it's important to control that condition as well. When the other condition is controlled, APS may cause fewer problems.
Other Names for Antiphospholipid Antibody Syndrome
Who Is at Risk for Antiphospholipid Antibody Syndrome?
Antiphospholipid antibody syndrome (APS) can affect people of any age. The disorder is more common in women than men, but it affects both sexes.
APS also is more common in people who have other autoimmune or rheumatic disorders, such as lupus. (""Rheumatic"" refers to disorders that affect the joints, bones, or muscles.)
About 10 percent of all people who have lupus also have APS. About half of all people who have APS also have another autoimmune or rheumatic disorder.
Some people have APS antibodies, but don't ever have signs or symptoms of the disorder. Having APS antibodies doesn't mean that you have APS. To be diagnosed with APS, you must have APS antibodies and a history of health problems related to the disorder.
However, people who have APS antibodies without signs or symptoms are at risk of developing APS. Health problems, other than autoimmune disorders, that can trigger blood clots include:
Smoking
Prolonged bed rest
What Are the Signs and Symptoms of Antiphospholipid Antibody Syndrome?
The signs and symptoms of antiphospholipid antibody syndrome (APS) are related to abnormal blood clotting. The outcome of a blood clot depends on its size and location.
Blood clots can form in, or travel to, the arteries or veins in the brain, heart, kidneys, lungs, and limbs. Clots can reduce or block blood flow, damaging the body's organs and possibly causing death.
Major Signs and Symptoms
Major signs and symptoms of blood clots include:
Chest pain and shortness of breath
Pain, redness, warmth, and swelling in the
limbsSpeech changes
Blood clots can lead to stroke, heart attack, kidney damage, deep vein thrombosis, and pulmonary embolism.
Pregnant women who have APS are at higher risk for miscarriages, stillbirths, and other pregnancy-related problems, such as preeclampsia.
Preeclampsia is high blood pressure that occurs during pregnancy. This condition may progress to eclampsia. Eclampsia is a serious condition that causes seizures in pregnant women.
Some people who have APS may develop thrombocytopenia. This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets.
Mild to serious bleeding causes the major signs and symptoms of thrombocytopenia. Bleeding can occur inside the body (internal bleeding) or underneath the skin or from the surface of the skin (external bleeding).
Other Signs and Symptoms
Other signs and symptoms of APS include chronic (ongoing) headaches, memory loss, and heart valve problems. Some people who have APS also get a lacy-looking red rash on their wrists and knees.
How Is Antiphospholipid Antibody Syndrome Diagnosed?
Your doctor will diagnose antiphospholipid antibody syndrome (APS) based on your medical history and the results from blood tests.
Specialists Involved
A hematologist often is involved in the care of people who have APS. This is a doctor who specializes in diagnosing and treating blood diseases and disorders.
You may have APS and another autoimmune disorder, such as lupus. If so, a doctor who specializes in that disorder also may provide treatment.
Many autoimmune disorders that occur with APS also affect the joints, bones, or muscles. Rheumatologists specialize in treating these types of disorders.
Medical History
Some people have APS antibodies but no signs or symptoms of the disorder. Having APS antibodies doesn't mean that you have APS. To be diagnosed with APS, you must have APS antibodies and a history of health problems related to the disorder.
APS can lead to many health problems, including stroke, heart attack, kidney damage, deep vein thrombosis, and pulmonary embolism.
APS also can cause pregnancy-related problems, such as multiple miscarriages, a miscarriage late in pregnancy, or a premature birth due to eclampsia. (Eclampsia, which follows preeclampsia, is a serious condition that causes seizures in pregnant women.)
Blood Tests
Your doctor can use blood tests to confirm a diagnosis of APS. These tests check your blood for any of the three APS antibodies: anticardiolipin, beta-2 glycoprotein I (β2GPI), and lupus anticoagulant.
The term ""anticoagulant"" (AN-te-ko-AG-u-lant) refers to a substance that prevents blood clotting. It may seem odd that one of the APS antibodies is called lupus anticoagulant. The reason for this is because the antibody slows clotting in lab tests. However, in the human body, it increases the risk of blood clotting.
To test for APS antibodies, a small blood sample is taken. It's often drawn from a vein in your arm using a needle. The procedure usually is quick and easy, but it may cause some short-term discomfort and a slight bruise.
You may need a second blood test to confirm positive results. This is because a single positive test can result from a short-term infection. The second blood test often is done 12 weeks or more after the first one.
How Is Antiphospholipid Antibody Syndrome Treated?
Antiphospholipid antibody syndrome (APS) has no cure. However, medicines can help prevent complications. The goals of treatment are to prevent blood clots from forming and keep existing clots from getting larger.
You may have APS and another autoimmune disorder, such as lupus. If so, it's important to control that condition as well. When the other condition is controlled, APS may cause fewer problems.
Research is ongoing for new ways to treat APS.
Medicines
Anticoagulants, or ""blood thinners,"" are used to stop blood clots from forming. They also may keep existing blood clots from getting larger. These medicines are taken as either a pill, an injection under the skin, or through a needle or tube inserted into a vein (called intravenous, or IV, injection).
Warfarin and heparin are two blood thinners used to treat APS. Warfarin is given in pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube. There are different types of heparin. Your doctor will discuss the options with you.
Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once the warfarin starts to work, the heparin is stopped.
Aspirin also thins the blood and helps prevent blood clots. Sometimes aspirin is used with warfarin. Other times, aspirin might be used alone.
Blood thinners don't prevent APS. They simply reduce the risk of further blood clotting. Treatment with these medicines is long term. Discuss all treatment options with your doctor.
Side Effects
The most common side effect of blood thinners is bleeding. This happens if the medicine thins your blood too much. This side effect can be life threatening.
Sometimes the bleeding is internal (inside your body). People treated with blood thinners usually need regular blood tests, called PT and PTT tests, to check how well their blood is clotting.
These tests also show whether you're taking the right amount of medicine. Your doctor will check to make sure that you're taking enough medicine to prevent clots, but not so much that it causes bleeding.
Talk with your doctor about the warning signs of internal bleeding and when to seek emergency care. (For more information, go to ""Living With Antiphospholipid Antibody Syndrome."")
Treatment During Pregnancy
Pregnant women who have APS can have successful pregnancies. With proper treatment, these women are more likely to carry their babies to term.
Pregnant women who have APS usually are treated with heparin or heparin and low-dose aspirin. Warfarin is not used as a treatment during pregnancy because it can harm the fetus.
Babies whose mothers have APS are at higher risk for slowed growth while in the womb. If you're pregnant and have APS, you may need to have extra ultrasound tests (sonograms) to check your baby’s growth. An ultrasound test uses sound waves to look at the growing fetus.
Treatment for Other Medical Conditions
People who have APS are at increased risk for thrombocytopenia. This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets. Platelets help the blood clot.
If you have APS, you'll need regular complete blood counts (a type of blood test) to count the number of platelets in your blood.
Thrombocytopenia is treated with medicines and medical procedures. For more information, go to the Health Topics Thrombocytopenia article.
If you have other health problems, such as heart disease or diabetes, work with your doctor to manage them.
Living With Antiphospholipid Antibody Syndrome
Antiphospholipid antibody syndrome (APS) has no cure. However, you can take steps to control the disorder and prevent complications.
Take all medicines as your doctor prescribes and get ongoing medical care. Talk with your doctor about healthy lifestyle changes and any concerns you have.
Medicines
You may need to take anticoagulants, or ""blood thinners,"" to prevent blood clots or to keep them from getting larger. You should take these medicines exactly as your doctor prescribes.
Tell your doctor about all other medicines you're taking, including over-the-counter or herbal medicines. Some medicines, including over-the-counter ibuprofen or aspirin, can thin your blood. Your doctor may not want you to take two medicines that thin your blood because of the risk of bleeding.
Women who have APS shouldn't use birth control or hormone therapy that contains estrogen. Estrogen increases the risk of blood clots. Talk with your doctor about other options.
Ongoing Medical Care
If you have APS, getting regular medical checkups is important. Have blood tests done as your doctor directs. These tests help track how well your blood is clotting.
The medicines used to treat APS increase the risk of bleeding. Bleeding might occur inside your body (internal bleeding) or underneath the skin or from the surface of the skin (external bleeding). Know the warning signs of bleeding, so you can get help right away. They include:
Increased menstrual flow
Bright red
vomit or vomit that looks like coffee grounds
Bright red
blood in your stools or black, tarry stools
Pain in your
abdomen or severe pain in your head
Sudden changes in vision
Sudden loss of movement in your
limbsMemory loss or confusion
A lot of bleeding after a fall or injury or easy bruising or bleeding also might mean that your blood is too thin. Ask your doctor about these warning signs and when to seek emergency care.
Lifestyle Changes
Talk with your doctor about lifestyle changes that can help you stay healthy. Ask him or her whether your diet may affect your medicines. Some foods or drinks may increase or decrease the effects of warfarin.
Ask your doctor what amount of alcohol is safe for you to drink if you're taking medicine. If you smoke, talk with your doctor about programs and products that can help you quit. Smoking can damage your blood vessels and raise your risk for many health problems.
APS medicines might increase your risk of bleeding. Thus, your doctor may advise you to avoid activities that have a high risk of injury, such as some contact sports.
Other Concerns
Pregnancy
APS can raise the risk of pregnancy-related problems. Talk with your doctor about how to manage your APS if you're pregnant or planning a pregnancy.
With proper treatment, women who have APS are more likely to carry babies to term than women whose APS isn't treated.
Surgery
If you need surgery, your doctor may adjust your medicines before, during, and after the surgery to prevent dangerous bleeding.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to APS, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Aplastic Anemia?
Aplastic anemia (a-PLAS-tik uh-NEE-me-uh) is a blood disorder in which the body's bone marrow doesn't make enough new blood cells. Bone marrow is a sponge-like tissue inside the bones. It makes stem cells that develop into red blood cells, white blood cells, and platelets (PLATE-lets).
Red blood cells carry oxygen to all parts of your body. They also carry carbon dioxide (a waste product) to your lungs to be exhaled. White blood cells help your body fight infections. Platelets are blood cell fragments that stick together to seal small cuts or breaks on blood vessel walls and stop bleeding.
It's normal for blood cells to die. The lifespan of red blood cells is about 120 days. White blood cells live less than a day. Platelets live about 6 days. As a result, your bone marrow must constantly make new blood cells.
If your bone marrow can't make enough new blood cells, many health problems can occur. These problems include irregular heartbeats called arrhythmias (ah-RITH-me-ahs), an enlarged heart, heart failure, infections, and bleeding. Severe aplastic anemia can even cause death.
Overview
Aplastic anemia is a type of anemia. The term ""anemia"" usually refers to a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). This iron-rich protein helps carry oxygen to your body.
In people who have aplastic anemia, the body doesn't make enough red blood cells, white blood cells, and platelets. This is because the bone marrow's stem cells are damaged. (Aplastic anemia also is called bone marrow failure.)
Many diseases, conditions, and factors can damage the stem cells. These conditions can be acquired or inherited. ""Acquired"" means you aren't born with the condition, but you develop it. ""Inherited"" means your parents passed the gene for the condition to you.
In many people who have aplastic anemia, the cause is unknown.
What Causes Aplastic Anemia?
Damage to the bone marrow's stem cells causes aplastic anemia. When stem cells are damaged, they don't grow into healthy blood cells.
The cause of the damage can be acquired or inherited. ""Acquired"" means you aren't born with the condition, but you develop it. ""Inherited"" means your parents passed the gene for the condition to you.
Acquired aplastic anemia is more common, and sometimes it's only temporary. Inherited aplastic anemia is rare.
In many people who have aplastic anemia, the cause is unknown. Some research suggests that stem cell damage may occur because the body's immune system attacks its own cells by mistake.
Acquired Causes
Many diseases, conditions, and factors can cause aplastic anemia, including:
Toxins, such as pesticides, arsenic, and benzene.
Medicines, such as
chloramphenicol (an antibiotic rarely used in the United States).
Sometimes, cancer from another part of the body can spread to the bone and cause aplastic anemia.
Inherited Causes
Certain inherited conditions can damage the stem cells and lead to aplastic anemia. Examples include Fanconi anemia, Shwachman-Diamond syndrome, dyskeratosis (DIS-ker-ah-TO-sis) congenita, and Diamond-Blackfan anemia.
Who Is at Risk for Aplastic Anemia?
Aplastic anemia is a rare but serious blood disorder. People of all ages can develop aplastic anemia. However, it's most common in adolescents, young adults, and the elderly. Men and women are equally likely to have aplastic anemia.
The disorder is two to three times more common in Asian countries.
Your risk of aplastic anemia is higher if you:
For more information, go to ""What Causes Aplastic Anemia?""
What Are the Signs and Symptoms of Aplastic Anemia?
Lower than normal numbers of red blood cells, white blood cells, and platelets cause most of the signs and symptoms of aplastic anemia.
Signs and Symptoms of Low Blood Cell Counts
White Blood Cells
White blood cells help fight infections. Signs and symptoms of a low white blood cell count include fevers, frequent infections that can be severe, and flu-like illnesses that linger.
Paroxysmal Nocturnal Hemoglobinuria
Some people who have aplastic anemia have a red blood cell disorder called paroxysmal (par-ok-SIZ-mal) nocturnal hemoglobinuria (HE-mo-glo-bi-NOO-re-ah), or PNH. Most people who have PNH don't have any signs or symptoms.
If symptoms do occur, they may include:
Shortness of breath
Swelling or pain in the
abdomen or swelling in the legs caused by
blood clots
In people who have aplastic anemia and PNH, either condition can develop first.
How Is Aplastic Anemia Diagnosed?
Your doctor will diagnose aplastic anemia based on your medical and family histories, a physical exam, and test results.
Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan for you.
Specialists Involved
If your primary care doctor thinks you have aplastic anemia, he or she may refer you to a hematologist. A hematologist is a doctor who specializes in treating blood diseases and disorders.
Medical and Family Histories
Your doctor may ask questions about your medical history, such as whether:
Your doctor also may ask whether any of your family members have had anemia or other blood disorders.
Physical Exam
Your doctor will do a physical exam to check for signs of aplastic anemia. He or she will try to find out how severe the disorder is and what's causing it.
The exam may include checking for pale or yellowish skin and signs of bleeding or infection. Your doctor may listen to your heart and lungs for abnormal heartbeats and breathing sounds. He or she also may feel your abdomen to check the size of your liver and feel your legs for swelling.
Diagnostic Tests
Many tests are used to diagnose aplastic anemia. These tests help:
Complete Blood Count
Often, the first test used to diagnose aplastic anemia is a complete blood count (CBC). The CBC measures many parts of your blood.
This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein in red blood cells. It carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels varies in certain racial and ethnic populations. Your doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of aplastic anemia, an infection, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. The results may be a clue as to the cause of your anemia.
Reticulocyte Count
A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have aplastic anemia have low reticulocyte levels.
How Is Aplastic Anemia Treated?
Treatments for aplastic anemia include blood transfusions, blood and marrow stem cell transplants, and medicines. These treatments can prevent or limit complications, relieve symptoms, and improve quality of life.
Blood and marrow stem cell transplants may cure the disorder in some people who are eligible for a transplant. Removing a known cause of aplastic anemia, such as exposure to a toxin, also may cure the condition.
Who Needs Treatment
People who have mild or moderate aplastic anemia may not need treatment as long as the condition doesn't get worse. People who have severe aplastic anemia need medical treatment right away to prevent complications.
People who have very severe aplastic anemia need emergency medical care in a hospital. Very severe aplastic anemia can be fatal if it's not treated right away.
Blood and Marrow Stem Cell Transplants
A blood and marrow stem cell transplant replaces damaged stem cells with healthy ones from another person (a donor).
During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells.
Blood and marrow stem cell transplants may cure aplastic anemia in people who can have this type of treatment. The transplant works best in children and young adults with severe aplastic anemia who are in good health and who have matched donors.
Older people may be less able to handle the treatments needed to prepare the body for the transplant. They're also more likely to have complications after the transplant.
If you have aplastic anemia, talk with your doctor about whether a blood and marrow stem cell transplant is an option for you.
Medicines
If you have aplastic anemia, your doctor may prescribe medicines to:
Medicines To Stimulate Bone Marrow
Man-made versions of substances that occur naturally in the body can stimulate the bone marrow to make more blood cells. Examples of these types of medicines include erythropoietin and colony-stimulating factors.
These medicines have some risks. You and your doctor will work together to decide whether the benefits of these medicines outweigh the risks. If this treatment works well, it can help you avoid the need for blood transfusions.
Medicines To Suppress the Immune System
Research suggests that aplastic anemia may sometimes occur because the body's immune system attacks its own cells by mistake. For this reason, your doctor may prescribe medicines to suppress your immune system.
These medicines allow your bone marrow to start making blood cells again. They also may help you avoid the need for blood transfusions.
Medicines that suppress the immune system don't cure aplastic anemia. However, they can relieve its symptoms and reduce complications. These medicines often are used for people who can't have blood and marrow stem cell transplants or who are waiting for transplants.
Three medicines—often given together—can suppress the body's immune system. They are antithymocyte globulin (ATG), cyclosporine, and methylprednisolone.
It may take a few months to notice the effects of these medicines. Most often, as blood cell counts rise, symptoms lessen. Blood cell counts in people who respond well to these medicines usually don't reach normal levels. However, the blood cell counts often are high enough to allow people to do their normal activities.
People who have aplastic anemia may need long-term treatment with these medicines.
Medicines that suppress the immune system can have side effects. They also may increase the risk of developing leukemia (lu-KE-me-ah) or myelodysplasia (MI-e-lo-dis-PLA-ze-ah; MDS). Leukemia is a cancer of the blood cells. MDS is a condition in which the bone marrow makes too many faulty blood cells.
Medicines To Prevent and Treat Infections
If you have aplastic anemia, you might be at risk for infections due to low white blood cell counts. Your doctor may prescribe antibiotic and antiviral medicines to prevent and treat infections.
Living With Aplastic Anemia
With prompt and proper care, most people who have aplastic anemia can be successfully treated, and some may be cured.
Most people who have the disorder are able to go back to their normal routines after treatment. However, it may take some time to get good results from treatment. You may need repeated treatments, or you may need to try several treatments to find one that works.
Get ongoing medical care to make sure the disorder doesn't worsen and to check for possible complications.
Ongoing Care
Treatment for aplastic anemia may cause side effects or complications. Talk with your doctor about how to cope with these issues.
People who have aplastic anemia might be at higher risk for infections due to low white blood cell counts. Ask your doctor about ways to lower your risk for infection. For example, you may want to:
Know the signs of infection, such as fever. Call your doctor right away if you think you have an infection.
Physical Activity
Talk with your doctor about what types and amounts of physical activity are safe for you. You may want to avoid activities that cause chest pain or shortness of breath. You also may want to stay away from activities that could result in injuries and bleeding, such as contact sports.
Support Groups
You or your family members may find it helpful to know about resources that can give you emotional support and information about aplastic anemia.
Your doctor or hospital social worker may have information about counseling and support services. They also may be able to refer you to support groups that offer help with financial planning, because treatment for aplastic anemia can be costly.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
Researchers have learned a lot about anemia and other blood diseases and conditions over the years. That knowledge has led to advances in medical knowledge and care.
Many questions remain about blood diseases and conditions, including aplastic anemia. The NHLBI continues to support research aimed at learning more about these illnesses.
For example, NHLBI-supported research on aplastic anemia includes studies that explore:
How certain medicines and
therapies can help treat
aplastic anemia and improve quality of life for people who have the disorder
What Is an Arrhythmia?
An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
A heartbeat that is too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that is too slow is called bradycardia (bray-de-KAR-de-ah).
Most arrhythmias are harmless, but some can be serious or even life threatening. During an arrhythmia, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
Understanding the Heart's Electrical System
To understand arrhythmias, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat.
With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.
Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the heart's upper right chamber, the right atrium (AY-tree-um). In a healthy adult heart at rest, the SA node fires off an electrical signal to begin a new heartbeat 60 to 100 times a minute.
From the SA node, the electrical signal travels through special pathways in the right and left atria. This causes the atria to contract and pump blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls).
The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down just a little, allowing the ventricles time to finish filling with blood.
The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. This pathway divides into a right bundle branch and a left bundle branch. The signal goes down these branches to the ventricles, causing them to contract and pump blood to the lungs and the rest of the body.
The ventricles then relax, and the heartbeat process starts all over again in the SA node. (For more information about the heart's electrical system, including detailed animations, go to the Health Topics How the Heart Works article.)
A problem with any part of this process can cause an arrhythmia. For example, in atrial fibrillation (A-tre-al fi-bri-LA-shun), a common type of arrhythmia, electrical signals travel through the atria in a fast and disorganized way. This causes the atria to quiver instead of contract.
Outlook
There are many types of arrhythmia. Most arrhythmias are harmless, but some are not. The outlook for a person who has an arrhythmia depends on the type and severity of the arrhythmia.
Even serious arrhythmias often can be successfully treated. Most people who have arrhythmias are able to live normal, healthy lives.
Types of Arrhythmia
The four main types of arrhythmia are premature (extra) beats, supraventricular (SU-prah-ven-TRIK-yu-lar) arrhythmias, ventricular arrhythmias, and bradyarrhythmias (bray-de-ah-RITH-me-ahs).
Premature (Extra) Beats
Premature beats are the most common type of arrhythmia. They're harmless most of the time and often don't cause any symptoms.
When symptoms do occur, they usually feel like fluttering in the chest or a feeling of a skipped heartbeat. Most of the time, premature beats need no treatment, especially in healthy people.
Premature beats that occur in the atria (the heart's upper chambers) are called premature atrial contractions, or PACs. Premature beats that occur in the ventricles (the heart's lower chambers) are called premature ventricular contractions, or PVCs.
In most cases, premature beats happen naturally. However, some heart diseases can cause premature beats. They also can happen because of stress, too much exercise, or too much caffeine or nicotine.
Supraventricular Arrhythmias
Supraventricular arrhythmias are tachycardias (fast heart rates) that start in the atria or atrioventricular (AV) node. The AV node is a group of cells located between the atria and the ventricles.
Types of supraventricular arrhythmias include atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff-Parkinson-White (WPW) syndrome.
Atrial Fibrillation
AF is the most common type of serious arrhythmia. It involves a very fast and irregular contraction of the atria.
In AF, the heart's electrical signals don't begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins.
The signals don't travel normally. They may spread throughout the atria in a rapid, disorganized way. This causes the walls of the atria to quiver very fast (fibrillate) instead of beating normally. As a result, the atria aren't able to pump blood into the ventricles the way they should.
The animation below shows what happens during AF. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how the heart's electrical signal can start outside of the sinoatrial node. This can cause the atria to beat very fast and irregularly.
In AF, electrical signals can travel through the atria at a rate of more than 300 per minute. Some of these abnormal signals can travel to the ventricles, causing them to beat too fast and with an irregular rhythm. AF usually isn't life threatening, but it can be dangerous if it causes the ventricles to beat very fast.
AF has two major complications—stroke and heart failure.
In AF, blood can pool in the atria, causing blood clots to form. If a clot breaks off and travels to the brain, it can cause a stroke. Blood-thinning medicines that reduce the risk of stroke are an important part of treatment for people who have AF.
Heart failure occurs if the heart can't pump enough blood to meet the body's needs. AF can lead to heart failure because the ventricles are beating very fast and can't completely fill with blood. Thus, they may not be able to pump enough blood to the lungs and body.
Damage to the heart's electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure, coronary heart disease, and rheumatic heart disease. Inflammation also is thought to play a role in the development of AF.
Other conditions also can lead to AF, including an overactive thyroid gland (too much thyroid hormone produced) and heavy alcohol use. The risk of AF increases with age.
Sometimes AF and other supraventricular arrhythmias can occur for no obvious reason.
Atrial Flutter
Atrial flutter is similar to AF. However, the heart's electrical signals spread through the atria in a fast and regular—instead of irregular—rhythm. Atrial flutter is much less common than AF, but it has similar symptoms and complications.
Paroxysmal Supraventricular Tachycardia
PSVT is a very fast heart rate that begins and ends suddenly. PSVT occurs because of problems with the electrical connection between the atria and the ventricles.
In PSVT, electrical signals that begin in the atria and travel to the ventricles can reenter the atria, causing extra heartbeats. This type of arrhythmia usually isn't dangerous and tends to occur in young people. It can happen during vigorous physical activity.
A special type of PSVT is called Wolff-Parkinson-White syndrome. WPW syndrome is a condition in which the heart's electrical signals travel along an extra pathway from the atria to the ventricles.
This extra pathway disrupts the timing of the heart's electrical signals and can cause the ventricles to beat very fast. This type of arrhythmia can be life threatening.
The animation below shows what happens during Wolff-Parkinson-White syndrome. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how an extra, abnormal electrical pathway in the heart disrupts the normal timing of the heart's electrical signal, causing the atria and ventricles to beat too fast.
Ventricular Arrhythmias
These arrhythmias start in the heart's lower chambers, the ventricles. They can be very dangerous and usually require medical care right away.
Ventricular arrhythmias include ventricular tachycardia and ventricular fibrillation (v-fib). Coronary heart disease, heart attack, a weakened heart muscle, and other problems can cause ventricular arrhythmias.
Ventricular Tachycardia
Ventricular tachycardia is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer.
A few beats of ventricular tachycardia often don't cause problems. However, episodes that last for more than a few seconds can be dangerous. Ventricular tachycardia can turn into other, more serious arrhythmias, such as v-fib.
Ventricular Fibrillation
V-fib occurs if disorganized electrical signals make the ventricles quiver instead of pump normally. Without the ventricles pumping blood to the body, sudden cardiac arrest and death can occur within a few minutes.
To prevent death, the condition must be treated right away with an electric shock to the heart called defibrillation (de-fib-rih-LA-shun).
V-fib may occur during or after a heart attack or in someone whose heart is already weak because of another condition.
The animation below shows ventricular fibrillation. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how disorganized electrical signals in the heart's ventricles make them pump abnormally and quiver.
Torsades de pointes (torsades) is a type of v-fib that causes a unique pattern on an EKG (electrocardiogram) test. Certain medicines or imbalanced amounts of potassium, calcium, or magnesium in the bloodstream can cause this condition.
People who have long QT syndrome are at increased risk for torsades. People who have this condition need to be careful about taking certain antibiotics, heart medicines, and over-the-counter products.
Bradyarrhythmias
Bradyarrhythmias occur if the heart rate is slower than normal. If the heart rate is too slow, not enough blood reaches the brain. This can cause you to pass out.
In adults, a heart rate slower than 60 beats per minute is considered a bradyarrhythmia. Some people normally have slow heart rates, especially people who are very physically fit. For them, a heartbeat slower than 60 beats per minute isn't dangerous and doesn't cause symptoms. But in other people, serious diseases or other conditions may cause bradyarrhythmias.
Bradyarrhythmias can be caused by:
An imbalance of chemicals or other substances in the
blood, such as
potassium
Arrhythmias in Children
Children's heart rates normally decrease as they get older. A newborn's heart beats between 95 to 160 times a minute. A 1-year-old's heart beats between 90 to 150 times a minute, and a 6- to 8-year-old's heart beats between 60 to 110 times a minute.
A baby or child's heart can beat fast or slow for many reasons. Like adults, when children are active, their hearts will beat faster. When they're sleeping, their hearts will beat slower. Their heart rates can speed up and slow down as they breathe in and out. All of these changes are normal.
Some children are born with heart defects that cause arrhythmias. In other children, arrhythmias can develop later in childhood. Doctors use the same tests to diagnose arrhythmias in children and adults.
Treatments for children who have arrhythmias include medicines, defibrillation (electric shock), surgically implanted devices that control the heartbeat, and other procedures that fix abnormal electrical signals in the heart.
Other Names for Arrhythmia
What Causes an Arrhythmia?
An arrhythmia can occur if the electrical signals that control the heartbeat are delayed or blocked. This can happen if the special nerve cells that produce electrical signals don't work properly. It also can happen if the electrical signals don't travel normally through the heart.
An arrhythmia also can occur if another part of the heart starts to produce electrical signals. This adds to the signals from the special nerve cells and disrupts the normal heartbeat.
Smoking, heavy alcohol use, use of some drugs (such as cocaine or amphetamines), use of some prescription or over-the-counter medicines, or too much caffeine or nicotine can lead to arrhythmias in some people.
Strong emotional stress or anger can make the heart work harder, raise blood pressure, and release stress hormones. Sometimes these reactions can lead to arrhythmias.
A heart attack or other condition that damages the heart's electrical system also can cause arrhythmias. Examples of such conditions include high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland (too much or too little thyroid hormone produced), and rheumatic heart disease.
Congenital (kon-JEN-ih-tal) heart defects can cause some arrhythmias, such as Wolff-Parkinson-White syndrome. The term ""congenital” means the defect is present at birth.
Sometimes the cause of arrhythmias is unknown.
Who Is at Risk for an Arrhythmia?
Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, and the number is rising.
Most serious arrhythmias affect people older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias.
Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can even cause arrhythmias as a side effect.
Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardia (PSVT), including Wolff-Parkinson-White syndrome, is more common in young people. PSVT is a fast heart rate that begins and ends suddenly.
Major Risk Factors
Arrhythmias are more common in people who have diseases or conditions that weaken the heart, such as:
Heart tissue that's too thick or stiff or that hasn't formed normally
Other conditions also can raise the risk for arrhythmias, such as:
Several other risk factors also can raise your risk for arrhythmias. Examples include heart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream.
What Are the Signs and Symptoms of an Arrhythmia?
Many arrhythmias cause no signs or symptoms. When signs or symptoms are present, the most common ones are:
More serious signs and symptoms include:
Sweating
Shortness of breath
How Are Arrhythmias Diagnosed?
Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical exam, and the results from tests and procedures.
Specialists Involved
Doctors who specialize in the diagnosis and treatment of heart diseases include:
Pediatric
cardiologists. These doctors diagnose and treat babies, children, and youth who have
heart problems.
Medical and Family Histories
To diagnose an arrhythmia, your doctor may ask you to describe your symptoms. He or she may ask whether you feel fluttering in your chest and whether you feel dizzy or light-headed.
Your doctor also may ask whether you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including whether anyone in your family:
Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and supplements.
Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you've had emotional stress or anger.
Physical Exam
During a physical exam, your doctor may:
Diagnostic Tests and Procedures
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. It's the most common test used to diagnose arrhythmias.
An EKG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart.
A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test.
To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.
Holter and Event Monitors
A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
Some event monitors are able to send data about your heart's electrical activity to a central monitoring station. Technicians at the station review the information and send it to your doctor. You also can use the device to report any symptoms you're having.
You can wear an event monitor for weeks or until symptoms occur.
Other Tests
Other tests also are used to help diagnose arrhythmias.
Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia.
Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged.
Echocardiography. This test uses sound waves to create a moving picture of your heart. Echocardiography (echo) provides information about the size and shape of your heart and how well your heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several types of echo, including stress echo. This test is done both before and after a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (CHD).
A transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach.
Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast.
The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.
Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals.
Your doctor can use the wire to electrically stimulate your heart and trigger an arrhythmia. This allows your doctor to see whether an antiarrhythmia medicine can stop the problem.
Catheter ablation, a procedure used to treat some arrhythmias, may be done during an EPS.
Tilt table testing. This test sometimes is used to help find the cause of fainting spells. You lie on a table that moves from a lying down to an upright position. The change in position may cause you to faint.
Your doctor watches your symptoms, heart rate, EKG reading, and blood pressure throughout the test. He or she may give you medicine and then check your response to the medicine.
Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your Go to:
What Are Asbestos-Related Lung Diseases?
Asbestos-related lung diseases are diseases caused by exposure to asbestos (as-BES-tos) fibers. Asbestos is a mineral that, in the past, was widely used in many industries.
Asbestos is made up of tiny fibers that can escape into the air. When breathed in, these fibers can stay in your lungs for a long time. If the fibers build up in your lungs, they can lead to:
Pleural plaque. In this condition, the
tissue around the
lungs and
diaphragm (the
muscle below your lungs) thickens and hardens. This tissue is called the
pleura. Pleural plaque usually causes no symptoms. Rarely, as the pleura thickens, it can trap and compress part of the lung. This may show up as a mass on an x-ray image.
Asbestosis (as-bes-TOE-sis). In this condition, the lung
tissue becomes scarred. People who have asbestosis are at greater risk for
lung cancer, especially if they smoke.
Asbestos also can cause cancer in the lining of the abdominal cavity. This lining is known as the peritoneum (PER-ih-to-NE-um).
![]()
Asbestos-Related Lung Diseases. Figure A shows the location of the lungs, airways, pleura, and diaphragm in the body. Figure B shows lungs with asbestos-related diseases, including pleural plaque, lung cancer, asbestosis, plaque on the diaphragm, and (more...)
Overview
Until the 1970s, asbestos was widely used in many industries in the United States. For example, it was used to insulate pipes, boilers, and ships; make brakes; strengthen cement; and fireproof many items, such as drywall.
People who worked around asbestos during that time are at risk for asbestos-related lung diseases. People at highest risk include:
Unprotected workers who made, installed, or removed products containing asbestos. People who worked near others who did these jobs also are at risk.
Family members of workers who were exposed to asbestos. Family members may have breathed in asbestos fibers that workers brought home on their clothes, shoes, or bodies.
People who live in areas with large deposits of asbestos in the soil. This risk is limited to areas where the deposits were disturbed and asbestos fibers got into the air.
Asbestos fibers also can be released into the air when older buildings containing asbestos-made products are destroyed. Removing these products during building renovations also can release asbestos fibers into the air.
Generally, being around asbestos-made products isn’t a danger as long as the asbestos is enclosed. This prevents the fibers from getting into the air.
People in the United States are less likely to have asbestos-related lung diseases now because the mineral is no longer widely used.
The use of asbestos is heavily restricted, and rules and standards are now in place to protect workers and others from asbestos exposure. Asbestos is found in only a few new products, such as gaskets used in brakes.
However, many countries do not yet restrict asbestos use. People in those countries are still exposed to the mineral.
Outlook
The outlook for people who have asbestos-related lung diseases can vary. It will depend on which disease a person has and how much it has damaged the lungs.
No treatments can reverse the effects of asbestos on your lungs. However, treatments may help relieve symptoms, slow the progress of the disease, and prevent complications.
If you've been exposed to asbestos, let your doctor know. He or she can watch you for signs of asbestos-related problems and start treatment early, if needed. Early treatment may help prevent or delay complications.
Quitting smoking and making other lifestyle changes may help people who are at high risk for asbestos-related lung diseases. These lifestyle changes may prevent more serious diseases, such as cancer.
What Causes Asbestos-Related Lung Diseases?
Significant exposure to asbestos fibers causes asbestos-related lung diseases. ""Significant"" usually means you were exposed for at least several months to visible dust from the fibers.
Asbestos fibers are very small. When you breathe in, they can get stuck deep in your lungs. The fibers remain in your lung tissue for a long time and may cause scarring and inflammation. This can lead to pleural plaque and widespread pleural thickening, pleural effusion, asbestosis, lung cancer, or mesothelioma.
Generally, asbestos-related lung diseases develop 10 to 40 or more years after a person has been exposed to asbestos.
Being around products that contain asbestos isn't a danger, as long as the asbestos is enclosed. This prevents the fibers from getting into the air.
Who Is at Risk for Asbestos-Related Lung Diseases?
Until the late 1970s, asbestos was widely used in many industries in the United States. During that time, workplace rules to ensure workers' safety around asbestos weren't required by law.
Asbestos was used in or with many products. Examples include steam pipes, boilers, furnaces, and furnace ducts; wallboard; floor and ceiling tiles; wood-burning stoves and gas fireplaces; car brakes, clutches, and gaskets; railroad engines; roofing and shingles; and wall-patching materials and paints.
Asbestos also was used in many other products, such as fireproof gloves, ironing board covers, cooking pot handles, and hairdryers.
Anyone employed for a prolonged period in mining, milling, making, or installing asbestos products before the late 1970s is at risk for asbestos-related lung diseases. Some examples of these workers include:
In general, the risk is greatest for people who worked with asbestos and were exposed for at least several months to visible dust from asbestos fibers. The risk for asbestos-related lung diseases also depends on:
How much asbestos you were exposed to.
How long you were exposed to asbestos, and how often during that time you were in direct contact with it.
The size, shape, and chemical makeup of the asbestos fibers. Different types of asbestos fibers can affect the
lungs differently. For example, chrysotile asbestos (a curly
fiber) is less likely to cause
mesothelioma than amphibole asbestos (a straight fiber).
Your personal risks, such as smoking or having an existing
lung disease.
Family members of people exposed to asbestos on the job also may be at risk. Family members may have breathed in asbestos fibers that were brought home on workers’ clothes, shoes, and bodies.
People who live in areas that have large deposits of asbestos in the soil also are at risk for asbestos-related lung diseases. However, this risk is limited to areas where the deposits were disturbed and asbestos fibers got into the air.
Asbestos fibers also can be released into the air when older buildings containing asbestos-made products are destroyed. Removing the products, such as during a building renovation, also can release asbestos fibers into the air.
Generally, being around asbestos-made products isn’t a danger, as long as the asbestos is enclosed. This prevents the fibers from getting into the air.
People in the United States are less likely to develop asbestos-related lung diseases today than in the past. This is because the mineral no longer is widely used. Also, where asbestos is still used, rules and standards are now in place to protect workers and others from asbestos exposure.
What Are the Signs and Symptoms of Asbestos-Related Lung Diseases?
The signs and symptoms of asbestos-related lung diseases vary. They depend on which disease you have and how much it has damaged your lungs. Signs and symptoms may not appear for 10 to 40 or more years after exposure to asbestos.
If you have pleural plaque, you may not have any signs or symptoms. Pleural effusion may cause pain on one side of the chest. Both conditions often are found with a chest x ray. These conditions may occur earlier than other asbestos-related lung diseases.
The main symptom of asbestosis is shortness of breath with physical exertion. You also may have a dry cough and feel tired. If your doctor listens to your lungs with a stethoscope, he or she may hear a crackling sound when you breathe in.
The symptoms of lung cancer may include a worsening cough or a cough that won't go away, trouble breathing, ongoing chest pain, and coughing up blood. Other symptoms of lung cancer include frequent lung infections, fatigue (tiredness), and weight loss without a known cause.
Symptoms of mesothelioma include shortness of breath and chest pain due to pleural effusion.
How Are Asbestos-Related Lung Diseases Diagnosed?
Your doctor will diagnose an asbestos-related lung disease based on your past exposure to asbestos, your symptoms, a physical exam, and test results.
Specialists Involved
Your primary care doctor, such as a family doctor or internist, may provide ongoing care if you have an asbestos-related lung disease. Other specialists also may be involved in your care, including a:
Exposure to Asbestos
Your doctor will want to know about your history of asbestos exposure. He or she may ask about your work history and your spouse's or other family members’ work histories.
Your doctor also may ask about your location and surroundings. For example, he or she may ask about areas of the country where you've lived.
If you know you were exposed to asbestos, your doctor may ask questions to find out:
How much asbestos you were exposed to. For example, were you surrounded by visible asbestos dust?
How long you were exposed to asbestos and how often during that time you were in direct contact with it.
Symptoms
Your doctor may ask whether you have any symptoms, such as shortness of breath or coughing. The symptoms of asbestos-related lung diseases vary. They depend on which disease you have and how much it has damaged your lungs.
Your doctor also may ask whether you smoke. Smoking, along with asbestos exposure, raises your risk for lung cancer.
Physical Exam
Your doctor will listen to your breathing with a stethoscope to find out whether your lungs are making any strange sounds.
If you have a pleural effusion with a lot of fluid buildup, your doctor might hear a dull sound when he or she taps on your chest. Or, he or she might have trouble hearing any breathing sounds. If you have asbestosis, your doctor may hear a crackling sound when you breathe in.
Your doctor will check your legs for swelling, which may be a sign of lung-related problems. He or she also will check your fingers and toes for clubbing.
Clubbing is the widening and rounding of the fingertips and toes. Clubbing most often is linked to heart and lung diseases that cause lower-than-normal blood oxygen levels.
Chest X Ray
A chest x ray is the most common test for detecting asbestos-related lung diseases. This painless test creates pictures of the structures inside your chest, such as the lungs.
A chest x ray can’t detect asbestos fibers in the lungs. However, it can show asbestos-related diseases, such as pleural plaque and pleural effusion. Pleural effusion also can be a sign of a more severe disease, such as mesothelioma.
A chest x ray also can show asbestosis. Often the lung tissue will appear very white on the x-ray pictures. The size, shape, location, and degree of whiteness can help your doctor figure out how much lung damage you have. Severe asbestosis may affect the whole lung and have a honeycomb look on the x-ray pictures.
If you have lung cancer, a chest x ray may show masses or abnormal fluid.
If you have mesothelioma, a chest x ray will show thickening of the pleura. The pleura is the tissue around the lungs and diaphragm (the muscle below your lungs). The chest x ray also will usually show signs of pleural effusion in people who have mesothelioma.
Other Diagnostic Tests
To help confirm a chest x-ray finding, or to find out how much lung damage you have, you may have more tests.
Chest Computed Tomography Scan
A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is a painless test that creates precise pictures of the structures inside your chest, such as your lungs. A CT scan is a type of x ray, but its pictures show more detail than standard chest x-ray pictures.
A chest CT scan may be very helpful for finding asbestosis in its earliest stages, before a standard chest x ray can detect it.
Lung Function Tests
Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.
These tests can show whether your lung function is impaired. They also can help your doctor track your disease over time.
Biopsy
The only way to confirm a diagnosis of lung cancer or mesothelioma is for a pathologist to check samples of your lung cells or tissues. A pathologist is a doctor who identifies diseases by studying cells and tissues under a microscope.
Doctors have many ways to collect tissue samples. One way is through bronchoscopy (bron-KOS-ko-pee). For this procedure, your doctor will pass a thin, flexible tube through your nose (or sometimes your mouth), down your throat, and into your airways. He or she will then take a sample of tissue from your lungs.
If your doctor thinks you have mesothelioma, you may have a thoracoscopy (thor-ah-KOS-ko-pee). For this procedure, you'll be given medicine so you don't feel any pain.
Your doctor will make a small cut through your chest wall. He or she will put a thin tube with a light on it into your chest between two ribs. This allows your doctor to see inside your chest and get tissue samples.
How Are Asbestos-Related Lung Diseases Treated?
No treatments can reverse the effects of asbestos on your lungs. However, treatments may help relieve symptoms and prevent or delay complications. If you have lung cancer, treatments may help slow the progress of the disease.
Treatments for Pleural Plaque, Pleural Effusion, and Asbestosis
If you have pleural plaque, pleural effusion, or asbestosis and you smoke, your doctor will advise you to quit smoking. People who have these conditions can lower their risk for lung cancer if they quit smoking.
Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart.” Although these resources focus on heart health, they include general information about how to quit smoking.
If you have trouble breathing or shortness of breath and a very low blood oxygen level, your doctor may recommend oxygen therapy. For this treatment, you're given oxygen through nasal prongs or a mask. Oxygen therapy may be done at home or in a hospital or other health facility.
If excess fluid around the lungs (pleural effusion) is making it hard for you to breathe, thoracentesis (THOR-ah-sen-TE-sis) may help. For this procedure, your doctor will insert a thin needle or plastic tube into the space between your lungs and chest wall. He or she will then draw out the excess fluid.
Treatments for Lung Cancer and Mesothelioma
If you have lung cancer or mesothelioma, your treatment may include surgery, chemotherapy, radiation therapy, and/or targeted therapy. (Targeted therapy uses medicines or other substances to find and attack specific lung cancer cells without harming normal cells.)
Your doctor may prescribe medicines to prevent fluid buildup, ease pain, or relieve other complications of your disease.
If you have lung cancer or mesothelioma, talk with your doctor about whether you should get flu and pneumonia vaccines. These vaccines can help lower your risk for lung infections.
How Can Asbestos-Related Lung Diseases Be Prevented?
You can prevent asbestos-related lung diseases by limiting your exposure to asbestos fibers. If your job requires you to work around asbestos, make sure to follow workplace rules for handling it. For example, make sure that air levels are measured, and wear a proper respirator to avoid breathing in asbestos fibers.
If you live in a house or work in a building that has pipes or other products containing asbestos, you generally don’t need to take special precautions. Being around products that contain asbestos isn’t a danger, as long as the asbestos is enclosed. This prevents the fibers from getting into the air.
If you smoke, quit. Smoking greatly increases your risk of lung cancer if you have pleural plaque, pleural effusion, or asbestosis. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart.” Although these resources focus on heart health, they include general information about how to quit smoking.
Living With Asbestos-Related Lung Diseases
The outlook for people who have asbestos-related lung diseases varies. It will depend on which disease a person has and how much it has damaged the lungs.
No treatments can reverse the effects of asbestos on your lungs. However, treatments may help relieve symptoms and prevent complications. If you have lung cancer, treatments may help slow the progress of the disease.
Ongoing Care
If you have an asbestos-related lung disease, you'll need routine followup care for the rest of your life. This may include chest x rays and lung function tests every 3 to 5 years.
Follow your treatment plan as your doctor prescribes. Call your doctor if you notice new or worsening symptoms.
Talk with your doctor about whether you should get flu and pneumonia vaccines. These vaccines can help lower your risk for lung infections. Avoiding lung infections can help prevent other, more serious complications.
If you smoke, quit. Smoking raises your risk for lung cancer if you have pleural plaque, pleural effusion, or asbestosis. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart.” Although these resources focus on heart health, they include general information about how to quit smoking.
Emotional Issues and Support
Living with an asbestos-related lung disease may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with an asbestos-related lung disease. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials for asbestos-related lung diseases, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Asthma?
Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.
Overview
To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes them swollen and very sensitive. They tend to react strongly to certain inhaled substances.
When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.
This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.
![]()
Asthma. Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.
Sometimes asthma symptoms are mild and go away on their own or after minimal treatment with asthma medicine. Other times, symptoms continue to get worse.
When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. Asthma attacks also are called flareups or exacerbations (eg-zas-er-BA-shuns).
Treating symptoms when you first notice them is important. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.
Outlook
Asthma has no cure. Even when you feel fine, you still have the disease and it can flare up at any time.
However, with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.
If you have asthma, you can take an active role in managing the disease. For successful, thorough, and ongoing treatment, build strong partnerships with your doctor and other health care providers.
What Causes Asthma?
The exact cause of asthma isn't known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:
If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) might make your airways more reactive to substances in the air.
Some factors might be more likely to cause asthma in certain people than in others. Researchers continue to explore what causes asthma.
The Hygiene Hypothesis
One theory researchers have for what causes asthma is called the hygiene hypothesis. They believe that our Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood.
Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children's immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.
Who Is at Risk for Asthma?
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.
Young children who often wheeze and have respiratory infections—as well as certain other risk factors—are at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.
Among children, more boys have asthma than girls. But among adults, the disease affects men and women equally. It's not clear whether or how sex and sex hormones play a role in causing asthma.
Most, but not all, people who have asthma have allergies.
Some people develop asthma because of contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma.
What Are the Signs and Symptoms of Asthma?
Common signs and symptoms of asthma include:
Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn't always mean that you have asthma. The best way doctors have to diagnose asthma is to use a lung function test, ask about medical history (including type and frequency of symptoms), and do a physical exam.
The type of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine.
Severe symptoms can be fatal. Thus, treating symptoms when you first notice them is important, so they don’t become severe.
With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.
What Causes Asthma Symptoms To Occur?
Many things can trigger or worsen asthma symptoms. Your doctor will help you find out which things (called triggers) may cause your asthma to flare up if you come in contact with them. Triggers can include:
Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions should be treated as part of an overall asthma care plan.
Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you might not be on the list. Talk with your doctor about the things that seem to make your asthma worse.
How Is Asthma Diagnosed?
Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.
Your doctor also will figure out the severity of your asthma—that is, whether it's intermittent, mild, moderate, or severe. The treatment your doctor prescribes will depend on the level of severity.
Your doctor may recommend that you see an asthma specialist if:
You need special tests to help diagnose
asthmaYou need more than one kind of medicine or higher doses of medicine to control your
asthma, or if you have overall problems getting your asthma well controlled
Medical and Family Histories
Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur.
Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.
Your doctor also may want to know what factors seem to trigger your symptoms or worsen them. For more information about possible asthma triggers, go to ""What Are the Signs and Symptoms of Asthma?""
Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.
Physical Exam
Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema).
Keep in mind that you can still have asthma even if you don't have these signs when your doctor examines you.
Diagnostic Tests
Lung Function Test
Your doctor will use a test called spirometry (spi-ROM-eh-tre) to check how your lungs are working. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out.
Your doctor may give you medicine and then retest you to see whether the results have improved.
If your test results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your doctor will likely diagnose you with asthma.
Other Tests
Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:
Diagnosing Asthma in Young Children
Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (infants to children 5 years old) can be hard to diagnose.
Sometimes it's hard to tell whether a child has asthma or another childhood condition. The symptoms of asthma are similar to the symptoms of other conditions.
Also, many young children who wheeze when they get colds or respiratory infections don't go on to have asthma. A child may wheeze because he or she has small airways that become narrow during colds or respiratory infections. The airways grow as the child grows, so wheezing no longer occurs as the child gets older.
A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:
One or both parents have
asthmaThe child wheezes even when he or she doesn't have a cold or other
infection
The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it's hard to do lung function tests in children younger than 5 years. Thus, doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis.
Doctors also may use a 4–6 week trial of asthma medicines to see how well a child responds.
How Is Asthma Treated and Controlled?
Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:
To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or older—and younger children who are able—should take an active role in their asthma care.
Taking an active role to control your asthma involves:
Working with your doctor to treat other conditions that can interfere with
asthma management.
Avoiding things that worsen your
asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
Working with your doctor and other health care providers to create and follow an
asthma action plan.
An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed.
Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or ""rescue,"" medicines relieve asthma symptoms that may flare up.
Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.
Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma.
Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.
Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will be adjusted to meet their special needs.
Follow an Asthma Action Plan
You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room.
If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.
Go to the National Heart, Lung, and Blood Institute's (NHLBI's) ""Asthma Action Plan"" for a sample plan.
Avoid Things That Can Worsen Your Asthma
Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them. (For more information about asthma triggers, go to ""What Are the Signs and Symptoms of Asthma?"")
For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.
One possible asthma trigger you shouldn’t avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
The NHLBI offers many useful tips for controlling asthma triggers. For more information, go to page 2 of NHLBI's ""Asthma Action Plan.""
If your asthma symptoms are clearly related to allergens, and you can't avoid exposure to those allergens, your doctor may advise you to get allergy shots.
You may need to see a specialist if you're thinking about getting allergy shots. These shots can lessen or prevent your asthma symptoms, but they can't cure your asthma.
Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Your doctor will treat these conditions as well.
Medicines
Your doctor will consider many things when deciding which asthma medicines are best for you. He or she will check to see how well a medicine works for you. Then, he or she will adjust the dose or medicine as needed.
Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs.
Not all inhalers are used the same way. Ask your doctor or another health care provider to show you the right way to use your inhaler. Review the way you use your inhaler at every medical visit.
Long-Term Control Medicines
Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines don't give you quick relief from symptoms.
Inhaled corticosteroids. Inhaled corticosteroids are the preferred medicine for long-term control of asthma. They're the most effective option for long-term relief of the inflammation and swelling that makes your airways sensitive to certain inhaled substances.
Reducing inflammation helps prevent the chain reaction that causes asthma symptoms. Most people who take these medicines daily find they greatly reduce the severity of symptoms and how often they occur.
Inhaled corticosteroids generally are safe when taken as prescribed. These medicines are different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren't habit-forming, even if you take them every day for many years.
Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects.
One common side effect from inhaled corticosteroids is a mouth infection called thrush. You might be able to use a spacer or holding chamber on your inhaler to avoid thrush. These devices attach to your inhaler. They help prevent the medicine from landing in your mouth or on the back of your throat.
Check with your doctor to see whether a spacer or holding chamber should be used with the inhaler you have. Also, work with your health care team if you have any questions about how to use a spacer or holding chamber. Rinsing your mouth out with water after taking inhaled corticosteroids also can lower your risk for thrush.
If you have severe asthma, you may have to take corticosteroid pills or liquid for short periods to get your asthma under control.
If taken for long periods, these medicines raise your risk for cataracts and osteoporosis (OS-te-o-po-RO-sis). A cataract is the clouding of the lens in your eye. Osteoporosis is a disorder that makes your bones weak and more likely to break.
Your doctor may have you add another long-term asthma control medicine so he or she can lower your dose of corticosteroids. Or, your doctor may suggest you take calcium and vitamin D pills to protect your bones.
Other long-term control medicines. Other long-term control medicines include:
Cromolyn. This medicine is taken using a device called a
nebulizer. As you breathe in, the nebulizer sends a fine mist of medicine to your
lungs. Cromolyn helps prevent airway
inflammation.
Omalizumab (anti-IgE). This medicine is given as a
shot (
injection) one or two times a month. It helps prevent your body from reacting to
asthma triggers, such as
pollen and dust. Anti-IgE might be used if other asthma medicines have not worked well.
Inhaled long-acting beta2-agonists. These medicines open the airways. They might be added to low-dose inhaled corticosteroids to improve
asthma control. Inhaled long-acting beta2-agonists should never be used for long-term asthma control unless they're used with inhaled corticosteroids.
Leukotriene modifiers. These medicines are taken by
mouth. They help block the chain reaction that increases
inflammation in your airways.
If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine.
Long-term control medicines can have side effects. Talk with your doctor about these side effects and ways to reduce or avoid them.
With some medicines, like theophylline, your doctor will check the level of medicine in your blood. This helps ensure that you’re getting enough medicine to relieve your asthma symptoms, but not so much that it causes dangerous side effects.
Quick-Relief Medicines
All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonists are the first choice for quick relief.
These medicines act quickly to relax tight muscles around your airways when you're having a flareup. This allows the airways to open up so air can flow through them.
You should take your quick-relief medicine when you first notice asthma symptoms. If you use this medicine more than 2 days a week, talk with your doctor about your asthma control. You may need to make changes to your asthma action plan.
Carry your quick-relief inhaler with you at all times in case you need it. If your child has asthma, make sure that anyone caring for him or her has the child's quick-relief medicines, including staff at the child's school. They should understand when and how to use these medicines and when to seek medical care for your child.
You shouldn't use quick-relief medicines in place of prescribed long-term control medicines. Quick-relief medicines don't reduce inflammation.
Track Your Asthma
To track your asthma, keep records of your symptoms, check your peak flow number using a peak flow meter, and get regular asthma checkups.
Record Your Symptoms
You can record your asthma symptoms in a diary to see how well your treatments are controlling your asthma.
Asthma is well controlled if:
You have symptoms no more than 2 days a week, and these symptoms don't wake you from
sleep more than 1 or 2 nights a month.
You can do all your normal activities.
You take quick-relief medicines no more than 2 days a week.
You have no more than one
asthma attack a year that requires you to take corticosteroids by
mouth.
Your peak flow doesn't drop below 80 percent of your personal best number.
If your asthma isn't well controlled, contact your doctor. He or she may need to change your asthma action plan.
Use a Peak Flow Meter
This small, hand-held device shows how well air moves out of your lungs. You blow into the device and it gives you a score, or peak flow number. Your score shows how well your lungs are working at the time of the test.
Your doctor will tell you how and when to use your peak flow meter. He or she also will teach you how to take your medicines based on your score.
Your doctor and other health care providers may ask you to use your peak flow meter each morning and keep a record of your results. You may find it very useful to record peak flow scores for a couple of weeks before each medical visit and take the results with you.
When you're first diagnosed with asthma, it's important to find your ""personal best"" peak flow number. To do this, you record your score each day for a 2- to 3-week period when your asthma is well-controlled. The highest number you get during that time is your personal best. You can compare this number to future numbers to make sure your asthma is controlled.
Your peak flow meter can help warn you of an asthma attack, even before you notice symptoms. If your score shows that your breathing is getting worse, you should take your quick-relief medicines the way your asthma action plan directs. Then you can use the peak flow meter to check how well the medicine worked.
Get Asthma Checkups
When you first begin treatment, you'll see your doctor about every 2 to 6 weeks. Once your asthma is controlled, your doctor may want to see you from once a month to twice a year.
During these checkups, your doctor may ask whether you've had an asthma attack since the last visit or any changes in symptoms or peak flow measurements. He or she also may ask about your daily activities. This information will help your doctor assess your level of asthma control.
Your doctor also may ask whether you have any problems or concerns with taking your medicines or following your asthma action plan. Based on your answers to these questions, your doctor may change the dose of your medicine or give you a new medicine.
If your control is very good, you might be able to take less medicine. The goal is to use the least amount of medicine needed to control your asthma.
Emergency Care
Most people who have asthma, including many children, can safely manage their symptoms by following their asthma action plans. However, you might need medical attention at times.
Call your doctor for advice if:
Call 9–1–1 for emergency care if:
At the hospital, you'll be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.
Asthma Treatment for Special Groups
The treatments described above generally apply to all people who have asthma. However, some aspects of treatment differ for people in certain age groups and those who have special needs.
What Is Atelectasis?
Atelectasis (at-uh-LEK-tuh-sis) is a condition in which one or more areas of your lungs collapse or don't inflate properly. If only a small area or a few small areas of lung are affected, you may have no signs or symptoms.
If a large area or several large areas of lung are affected, they may not be able to deliver enough oxygen to your blood. This can cause symptoms and complications.
Overview
To understand atelectasis, it helps to understand how the lungs work. Your lungs are organs in your chest that allow your body to take in oxygen from the air. They also help remove carbon dioxide (a waste gas that can be toxic) from your body.
When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries (KAP-ih-lare-ees) run through the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the air sacs. This process is called gas exchange.
The air sacs must remain open and filled with air for gas exchange to work well. Surfactant (sur-FAK-tant), a liquid that coats the inside of the lungs, helps the air sacs stay open. Deep breathing and coughing also help keep the air sacs open. (Coughing helps clear mucus and other substances from your airways.)
In atelectasis, part of the lung collapses or doesn't inflate. The air sacs in that part of the lung no longer fill with air. As a result, they can't take part in gas exchange.
If only a small area or a few small areas of lung are affected, you may have no signs or symptoms. This is because the rest of the lung can bring in enough oxygen to make up for the collapsed part.
If atelectasis affects a large area or several large areas of lung, your body's organs and tissues might not get enough oxygen-rich blood.
Conditions and factors that keep the lungs from fully expanding and filling with air can cause atelectasis. For example, atelectasis is common after surgery.
The medicine used during some types of surgery to make you sleep can decrease or stop your normal effort to breathe and urge to cough. Sometimes, especially after chest or abdominal surgery, pain may keep you from taking deep breaths. As a result, part of your lungs may collapse or not inflate well.
Outlook
The outlook for atelectasis depends on its cause. In adults, atelectasis often is short term. The collapsed air sacs slowly refill with air once the cause of the atelectasis is resolved.
If atelectasis persists, it may prevent the lungs from properly clearing mucus. This can lead to infections, such as pneumonia.
Atelectasis usually isn't life threatening. However, if it affects a large area of the lungs—especially in a baby, small child, or someone who has another lung disease or illness—it can be fatal if not treated quickly.
Other Names for Atelectasis
What Causes Atelectasis?
Atelectasis can occur if the lungs can't fully expand and fill with air. Atelectasis has many causes.
Conditions and Factors That Prevent Deep Breathing and Coughing
Conditions and factors that prevent deep breathing and coughing can cause atelectasis. For example, if you're taking shallow breaths or breathing with the help of a ventilator, your lungs don't fill with air in the normal way.
Normally, when you take a deep breath, the base (bottom) and the back of your lungs fill with air first. However, if you're taking shallow breaths or using a ventilator, air may not make it all the way to the air sacs at the bottom of your lungs. Thus, these air sacs won't inflate well.
Atelectasis is common after surgery. The medicine used during some types of surgery to make you sleep can decrease or stop your normal effort to breathe and urge to cough. Sometimes, especially after chest or abdominal surgery, pain may keep you from taking deep breaths. As a result, part of your lung may collapse or not inflate well.
Pressure from outside the lungs also can make it hard to take deep breaths. Many factors can cause pressure outside the lungs. Examples include a tumor, a tight body cast, a bone deformity, or pleural effusion (fluid buildup between the ribs and the lungs).
Lung conditions and other medical disorders that affect your ability to breathe deeply or cough also may lead to atelectasis. One example is respiratory distress syndrome (RDS).
RDS is a breathing disorder that affects some newborns. It's more common in premature infants because their lungs aren't able to make enough surfactant. Surfactant is a liquid that coats the inside of the lungs and helps keep the air sacs open. Without enough surfactant, part of the lungs may collapse.
Other lung conditions and medical disorders that can cause atelectasis include pneumonia, lung cancer, and neuromuscular diseases. Rarely, asthma, COPD (chronic obstructive pulmonary disease), and cystic fibrosis are associated with atelectasis.
Migrating atelectasis in newborns is rare and might be caused by neuromuscular diseases. ""Migrating"" means that the part of the lung that collapses will change depending on the position of the baby.
An Airway Blockage
An airway blockage also can cause atelectasis. A blockage might be due to a foreign object (such as an inhaled peanut), a mucus plug, lung cancer, or a poorly placed breathing tube from a ventilator.
When a blockage occurs, the air that's already in the air sacs is absorbed into the bloodstream. New air can't get past the blockage to refill the air sacs, so the affected area of lung deflates.
Who Is at Risk for Atelectasis?
You might be at risk for atelectasis if you can't take deep breaths or cough, or if you have an airway blockage.
Conditions that can increase your risk for atelectasis include:
Surgery in which you're given medicine to make you
sleep. This medicine can decrease or stop your normal effort to breathe and urge to
cough.
Being on a
ventilator (a machine that supports breathing).
A blockage in your airway due to a foreign object, a
mucus plug,
lung cancer, or a poorly placed breathing tube.
People who have one of the conditions above and who smoke or are obese are at greater risk for atelectasis than people who don't smoke or aren't obese.
Infants and toddlers (birth to 3 years old) who have risk factors for atelectasis seem to develop the condition more easily than adults.
What Are the Signs and Symptoms of Atelectasis?
Atelectasis likely won't cause signs or symptoms if it only affects a small area of lung.
If atelectasis affects a large area of lung, especially if it occurs suddenly, it may cause a low level of oxygen in your blood. As a result, you may feel short of breath. Your heart rate and breathing rate may increase, and your skin and lips may turn blue.
Other symptoms might be related to the underlying cause of the atelectasis (for example, chest pain due to surgery).
If your child has atelectasis, you may notice that he or she seems agitated, anxious, or scared.
How Is Atelectasis Diagnosed?
Your doctor will diagnose atelectasis based on your signs and symptoms and the results from tests and procedures. Atelectasis might be detected as a result of a chest x ray done for an underlying lung condition.
Atelectasis usually is diagnosed by a radiologist, pulmonologist (lung specialist), emergency medicine physician, or a primary care doctor (such as a pediatrician, internal medicine specialist, or family practitioner).
Diagnostic Tests and Procedures
The most common test used to diagnose atelectasis is a chest x ray. A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.
Your doctor also may recommend a chest computed tomography (to-MOG-rah-fee) scan, or chest CT scan. This test creates precise pictures of the structures in your chest. A chest CT scan is a type of x ray. However, the pictures from a chest CT scan show more details than pictures from a standard chest x ray.
Atelectasis often resolves without treatment. If the condition is severe or lasts a long time and your doctor thinks it's caused by an airway blockage, he or she may use bronchoscopy (bron-KOS-ko-pee). This procedure is used to look inside your airway.
During the procedure, your doctor passes a thin, flexible tube called a bronchoscope through your nose (or sometimes your mouth), down your throat, and into your airway. If you have a breathing tube, the bronchoscope can be passed through the tube to your airway.
A light and small camera on the bronchoscope allow your doctor to see inside your airway. Your doctor also can remove blockages during the procedure.
How Is Atelectasis Treated?
The main goals of treating atelectasis are to treat the cause of the condition and to reexpand the collapsed lung tissue. Treatment may vary based on the underlying cause of the atelectasis.
Atelectasis Caused by Surgery
If atelectasis is caused by surgery, your doctor may recommend that you take the following steps to fully expand your lungs:
Perform deep breathing exercises. These exercises are very important after
surgery. While in the hospital, you may use a device called an incentive spirometer. This device measures how much air you're
breathing in and how fast you're breathing in. Using this device encourages you to breathe deeply and slowly.
Change your position. Sit up or walk around as soon as possible after
surgery (with your doctor's permission).
Make an effort to
cough.
Coughing helps clear
mucus and other substances from your airways.
Your doctor also may suggest using positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP). Both devices use mild air pressure to help keep the airways and air sacs open.
Atelectasis Caused by Pressure From Outside the Lungs
If pressure from outside the lungs is causing atelectasis, your doctor will treat the cause of the pressure. For example, if the cause is a tumor or fluid buildup, your doctor will remove the tumor or fluid. This will allow your lung to fully expand.
Atelectasis Caused by a Blockage
If a blockage is causing atelectasis, you'll receive treatment to remove the blockage or relieve it. If the blockage is from an inhaled object, such as a peanut, your doctor will remove it during bronchoscopy. (For more information, go to ""How Is Atelectasis Diagnosed?"")
If a mucus plug is blocking your airways, your doctor may use suction to remove it. Other treatments also can help clear excess mucus from the lungs, such as:
Chest clapping or percussion. This
treatment involves pounding your chest and back over and over with your
hands or a device to loosen the
mucus from your
lungs so you can
cough it up.
Postural drainage. For this
treatment, your bed may be tilted so that your head is lower than your
chest. This allows
mucus to drain more easily.
Medicines. Your doctor may prescribe medicines to help open your airways or loosen
mucus.
Atelectasis Caused by a Lung Condition or Other Medical Disorder
If a lung condition or other medical disorder us causing atelectasis, your doctor will treat the underlying cause with medicines, procedures, or other therapies.
How Can Atelectasis Be Prevented?
Not smoking before surgery can lower your risk of atelectasis. If you smoke, ask your doctor how far in advance of your surgery you should quit smoking.
After surgery, your doctor may recommend that you take the following steps to fully expand your lungs:
Perform deep breathing exercises. These exercises are very important after
surgery. While in the hospital, you may use a device called an incentive spirometer. This device measures how much air you're
breathing in and how fast you're breathing in. Using this device encourages you to breathe deeply and slowly.
Change your position. Sit up or walk around as soon as possible after
surgery (with your doctor's permission).
Make an effort to
cough.
Coughing helps clear
mucus and other substances from your airways.
If deep breathing is painful, your doctor may prescribe medicines to control the pain. This can make it easier for you to take deep breaths and fully expand your lungs.
Your doctor also might suggest using positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP). Both devices use mild air pressure to help keep the airways and air sacs open.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to your disease or condition, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Atherosclerosis?
Atherosclerosis (ath-er-o-skler-O-sis) is a disease in which plaque (plak) builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.
![]()
Atherosclerosis. Figure A shows a normal artery with normal blood flow. Figure B shows an artery with plaque buildup.
Overview
The cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors.
You can control some risk factors, such as lack of physical activity, smoking, and an unhealthy diet. Others you can't control, such as age and a family history of heart disease.
Some people who have atherosclerosis have no signs or symptoms. They may not be diagnosed until after a heart attack or stroke.
The main treatment for atherosclerosis is lifestyle changes. You also may need medicines and medical procedures. These treatments, along with ongoing medical care, can help you live a healthier life.
Outlook
Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem.
You may be able to prevent or delay atherosclerosis and the diseases it can cause. Making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis and live a long, healthy life.
Other Names for Atherosclerosis
What Causes Atherosclerosis?
The exact cause of atherosclerosis isn't known. However, studies show that atherosclerosis is a slow, complex disease that may start in childhood. It develops faster as you age.
Atherosclerosis may start when certain factors damage the inner layers of the arteries. These factors include:
Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. Eventually, an area of plaque can rupture (break open).
When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. Clots narrow the arteries even more, limiting the flow of oxygen-rich blood to your body.
Depending on which arteries are affected, blood clots can worsen angina (chest pain) or cause a heart attack or stroke.
Researchers continue to look for the causes of atherosclerosis. They hope to find answers to questions such as:
Why and how do the
arteries become damaged?
How does
plaque develop and change over time?
Who Is at Risk for Atherosclerosis?
Coronary heart disease (atherosclerosis of the coronary arteries) is the #1 killer of both men and women in the United States.
The exact cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors. The more risk factors you have, the more likely it is that you'll develop atherosclerosis.
You can control most risk factors and help prevent or delay atherosclerosis. Other risk factors can't be controlled.
Major Risk Factors
Diabetes. With this disease, the body's
blood sugar level is too high because the body doesn't make enough
insulin or doesn't use its insulin properly.
Unhealthy diet. An unhealthy diet can raise your risk for
atherosclerosis. Foods that are high in saturated and
trans fats,
cholesterol, sodium (salt), and
sugar can worsen other atherosclerosis risk factors.
Older age. As you get older, your risk for
atherosclerosis increases.
Genetic or lifestyle factors cause
plaque to build up in your
arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk increases after age 45. In women, the risk increases after age 55.
Family history of early
heart disease. Your risk for
atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
Although age and a family history of early heart disease are risk factors, it doesn't mean that you'll develop atherosclerosis if you have one or both. Controlling other risk factors often can lessen genetic influences and prevent atherosclerosis, even in older adults.
Studies show that an increasing number of children and youth are at risk for atherosclerosis. This is due to a number of causes, including rising childhood obesity rates.
Emerging Risk Factors
Scientists continue to study other possible risk factors for atherosclerosis.
High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for atherosclerosis and heart attack. High levels of CRP are a sign of inflammation in the body.
Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow.
People who have low CRP levels may develop atherosclerosis at a slower rate than people who have high CRP levels. Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk for atherosclerosis.
High levels of triglycerides (tri-GLIH-seh-rides) in the blood also may raise the risk for atherosclerosis, especially in women. Triglycerides are a type of fat.
Studies are under way to find out whether genetics may play a role in atherosclerosis risk.
Other Factors That Affect Atherosclerosis
Other factors also may raise your risk for atherosclerosis, such as:
Stress. Research shows that the most commonly reported ""trigger"" for a
heart attack is an emotionally upsetting event, especially one involving anger.
Alcohol. Heavy drinking can damage the
heart muscle and worsen other risk factors for
atherosclerosis. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.
What Are the Signs and Symptoms of Atherosclerosis?
Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency, such as a heart attack or stroke.
Some people may have signs and symptoms of the disease. Signs and symptoms will depend on which arteries are affected.
Coronary Arteries
The coronary arteries supply oxygen-rich blood to your heart. If plaque narrows or blocks these arteries (a disease called coronary heart disease, or CHD), a common symptom is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
Other symptoms of CHD are shortness of breath and arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat.
Plaque also can form in the heart's smallest arteries. This disease is called coronary microvascular disease (MVD). Symptoms of coronary MVD include angina, shortness of breath, sleep problems, fatigue (tiredness), and lack of energy.
How Is Atherosclerosis Diagnosed?
Your doctor will diagnose atherosclerosis based on your medical and family histories, a physical exam, and test results.
Specialists Involved
If you have atherosclerosis, a primary care doctor, such as an internist or family practitioner, may handle your care. Your doctor may recommend other health care specialists if you need expert care, such as:
Physical Exam
During the physical exam, your doctor may listen to your arteries for an abnormal whooshing sound called a bruit (broo-E). Your doctor can hear a bruit when placing a stethoscope over an affected artery. A bruit may indicate poor blood flow due to plaque buildup.
Your doctor also may check to see whether any of your pulses (for example, in the leg or foot) are weak or absent. A weak or absent pulse can be a sign of a blocked artery.
Diagnostic Tests
Your doctor may recommend one or more tests to diagnose atherosclerosis. These tests also can help your doctor learn the extent of your disease and plan the best treatment.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage caused by CHD. The test also can show signs of a previous or current heart attack.
Ankle/Brachial Index
This test compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. This test can help diagnose P.A.D.
Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
Computed Tomography Scan
A computed tomography (CT) scan creates computer-generated pictures of the heart, brain, or other areas of the body. The test can show hardening and narrowing of large arteries.
A cardiac CT scan also can show whether calcium has built up in the walls of the coronary (heart) arteries. This may be an early sign of CHD.
Stress Testing
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast.
When your heart is working hard, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:
Shortness of breath or
chest pain
Abnormal changes in your
heart rhythm or your heart's electrical activity
As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats.
Angiography
Angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the inside of your arteries. This test can show whether plaque is blocking your arteries and how severe the blockage is.
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. Dye that can be seen on an x-ray picture is injected through the catheter into the arteries. By looking at the x-ray picture, your doctor can see the flow of blood through your arteries.
Other Tests
Other tests are being studied to see whether they can give a better view of plaque buildup in the arteries. Examples of these tests include magnetic resonance imaging (MRI) and positron emission tomography (PET).
How Is Atherosclerosis Treated?
Treatments for atherosclerosis may include lifestyle changes, medicines, and medical procedures or surgery.
The goals of treatment include:
Relieving symptoms
Reducing risk factors in an effort to slow or stop the buildup of
plaqueLowering the risk of
blood clots forming
Lifestyle Changes
Making lifestyle changes often can help prevent or treat atherosclerosis. For some people, these changes may be the only treatment needed.
Follow a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.
For information about healthy eating, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy eating, physical activity, and weight control.
Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high blood cholesterol. TLC is a three-part program that includes a healthy","June 11, 2014."
13,1,"2018-02-02 04:25:06",a,13,"2018-02-02 05:06:15","Atrial Fibrillation","
What Is Atrial Fibrillation?
Atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
AF occurs if rapid, disorganized electrical signals cause the heart's two upper chambers—called the atria (AY-tree-uh)—to fibrillate. The term ""fibrillate"" means to contract very fast and irregularly.
In AF, blood pools in the atria. It isn't pumped completely into the heart's two lower chambers, called the ventricles (VEN-trih-kuls). As a result, the heart's upper and lower chambers don't work together as they should.
People who have AF may not feel symptoms. However, even when AF isn't noticed, it can increase the risk of stroke. In some people, AF can cause chest pain or heart failure, especially if the heart rhythm is very rapid.
AF may happen rarely or every now and then, or it may become an ongoing or long-term heart problem that lasts for years.
Understanding the Heart's Electrical System
To understand AF, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat.
With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.
Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium. In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to 100 times a minute. (This rate may be slower in very fit athletes.)
From the SA node, the electrical signal travels through the right and left atria. It causes the atria to contract and pump blood into the ventricles.
The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down slightly, allowing the ventricles time to finish filling with blood.
The electrical signal then leaves the AV node and travels to the ventricles. It causes the ventricles to contract and pump blood to the lungs and the rest of the body. The ventricles then relax, and the heartbeat process starts all over again in the SA node.
For more information about the heart's electrical system and detailed animations, go to the Health Topics How the Heart Works article.
Understanding the Electrical Problem in Atrial Fibrillation
In AF, the heart's electrical signals don't begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don't travel normally. They may spread throughout the atria in a rapid, disorganized way. This can cause the atria to fibrillate.
The faulty signals flood the AV node with electrical impulses. As a result, the ventricles also begin to beat very fast. However, the AV node can't send the signals to the ventricles as fast as they arrive. So, even though the ventricles are beating faster than normal, they aren't beating as fast as the atria.
Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AF, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.
If this happens, blood isn't pumped into the ventricles as well as it should be. Also, the amount of blood pumped out of the ventricles to the body is based on the random atrial beats.
The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.
Most of the symptoms of AF are related to how fast the heart is beating. If medicines or age slow the heart rate, the symptoms are minimized.
AF may be brief, with symptoms that come and go and end on their own. Or, the condition may be ongoing and require treatment. Sometimes AF is permanent, and medicines or other treatments can't restore a normal heart rhythm.
The animation below shows atrial fibrillation. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how the heart's electrical signal can begin somewhere other than the sinoatrial node. This causes the atria to beat very fast and irregularly.
Outlook
People who have AF can live normal, active lives. For some people, treatment can restore normal heart rhythms.
For people who have permanent AF, treatment can help control symptoms and prevent complications. Treatment may include medicines, medical procedures, and lifestyle changes.
Types of Atrial Fibrillation
Paroxysmal Atrial Fibrillation
In paroxysmal (par-ok-SIZ-mal) atrial fibrillation (AF), the faulty electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe. They stop within about a week, but usually in less than 24 hours.
Persistent Atrial Fibrillation
Persistent AF is a condition in which the abnormal heart rhythm continues for more than a week. It may stop on its own, or it can be stopped with treatment.
Permanent Atrial Fibrillation
Permanent AF is a condition in which a normal heart rhythm can't be restored with treatment. Both paroxysmal and persistent AF may become more frequent and, over time, result in permanent AF.
Other Names for Atrial Fibrillation
A fib
Auricular fibrillation
What Causes Atrial Fibrillation?
Atrial fibrillation (AF) occurs if the heart's electrical signals don't travel through the heart in a normal way. Instead, they become very rapid and disorganized.
Damage to the heart's electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure and coronary heart disease.
The risk of AF increases as you age. Inflammation also is thought to play a role in causing AF.
Sometimes, the cause of AF is unknown.
Who Is at Risk for Atrial Fibrillation?
Atrial fibrillation (AF) affects millions of people, and the number is rising. Men are more likely than women to have the condition. In the United States, AF is more common among Whites than African Americans or Hispanic Americans.
The risk of AF increases as you age. This is mostly because your risk for heart disease and other conditions that can cause AF also increases as you age. However, about half of the people who have AF are younger than 75.
AF is uncommon in children.
Major Risk Factors
AF is more common in people who have:
Rheumatic (ru-MAT-ik)
heart disease
Pericarditis (PER-i-kar-DI-tis; a condition in which the membrane, or
sac, around your
heart is inflamed)
Sick
sinus syndrome (a condition in which the
heart's electrical signals don't fire properly and the
heart rate slows down; sometimes the heart will switch back and forth between a slow rate and a fast rate)
AF also is more common in people who are having heart attacks or who have just had surgery.
Other Risk Factors
Other conditions that raise your risk for AF include hyperthyroidism (too much thyroid hormone), obesity, diabetes, and lung disease.
Certain factors also can raise your risk for AF. For example, drinking large amounts of alcohol, especially binge drinking, raises your risk. Even modest amounts of alcohol can trigger AF in some people. Caffeine or psychological stress also may trigger AF in some people.
Some data suggest that people who have sleep apnea are at greater risk for AF. Sleep apnea is a common disorder that causes one or more pauses in breathing or shallow breaths while you sleep.
Metabolic syndrome also raises your risk for AF. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke.
Research suggests that people who receive high-dose steroid therapy are at increased risk for AF. This therapy is used for asthma and some inflammatory conditions. It may act as a trigger in people who have other AF risk factors.
Genetic factors also may play a role in causing AF. However, their role isn't fully known.
What Are the Signs and Symptoms of Atrial Fibrillation?
Atrial fibrillation (AF) usually causes the heart's lower chambers, the ventricles, to contract faster than normal.
When this happens, the ventricles can't completely fill with blood. Thus, they may not be able to pump enough blood to the lungs and body. This can lead to signs and symptoms, such as:
Atrial Fibrillation Complications
AF has two major complications—stroke and heart failure.
Stroke
During AF, the heart's upper chambers, the atria, don't pump all of their blood to the ventricles. Some blood pools in the atria. When this happens, a blood clot (also called a thrombus) can form.
If the clot breaks off and travels to the brain, it can cause a stroke. (A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus.)
Blood-thinning medicines that reduce the risk of stroke are an important part of treatment for people who have AF.
![]()
Atrial Fibrillation and Stroke. The illustration shows how a stroke can occur during atrial fibrillation. A blood clot (thrombus) can form in the left atrium of the heart. If a piece of the clot breaks off and travels to an artery in the brain, it can (more...)
Heart Failure
Heart failure occurs if the heart can't pump enough blood to meet the body's needs. AF can lead to heart failure because the ventricles are beating very fast and can't completely fill with blood. Thus, they may not be able to pump enough blood to the lungs and body.
Fatigue and shortness of breath are common symptoms of heart failure. A buildup of fluid in the lungs causes these symptoms. Fluid also can build up in the feet, ankles, and legs, causing weight gain.
Lifestyle changes, medicines, and procedures or surgery (rarely, a mechanical heart pump or heart transplant) are the main treatments for heart failure.
How Is Atrial Fibrillation Diagnosed?
Atrial fibrillation (AF) is diagnosed based on your medical and family histories, a physical exam, and the results from tests and procedures.
Sometimes AF doesn't cause signs or symptoms. Thus, it may be found during a physical exam or EKG (electrocardiogram) test done for another purpose.
If you have AF, your doctor will want to find out what is causing it. This will help him or her plan the best way to treat the condition.
Specialists Involved
Primary care doctors often are involved in the diagnosis and treatment of AF. These doctors include family practitioners and internists.
Doctors who specialize in the diagnosis and treatment of heart disease also may be involved, such as:
Medical and Family Histories
Your doctor will likely ask questions about your:
Signs and symptoms. What symptoms are you having? Have you had
palpitations? Are you dizzy or short of breath? Are your feet or
ankles swollen (a possible sign of
heart failure)? Do you have any
chest pain?
Family's
medical history. Does anyone in your family have a history of AF? Has anyone in your family ever had
heart disease or
high blood pressure? Has anyone had
thyroid problems? Does your family have a history of other illnesses or health problems?
Diagnostic Tests and Procedures
EKG
An EKG is a simple, painless test that records the heart's electrical activity. It's the most useful test for diagnosing AF.
An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.
A standard EKG only records the heartbeat for a few seconds. It won't detect AF that doesn't happen during the test. To diagnose paroxysmal AF, your doctor may ask you to wear a portable EKG monitor that can record your heartbeat for longer periods.
The two most common types of portable EKGs are Holter and event monitors.
Holter and Event Monitors
A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period. You wear small patches called electrodes on your chest. Wires connect these patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
You wear the Holter monitor while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
You can wear an event monitor for weeks or until symptoms occur.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast.
Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
This test sometimes is called transthoracic (trans-thor-AS-ik) echocardiography. It's painless and noninvasive (no instruments are inserted into the body). For the test, a device called a transducer is moved back and forth over your chest. The device sends special sound waves through your chest wall to your heart.
The sound waves bounce off the structures of your heart, and a computer converts them into pictures on a screen.
Transesophageal Echocardiography
Transesophageal (trans-e-SOF-ah-ge-al) echo, or TEE, uses sound waves to take pictures of your heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach.
Your heart's upper chambers, the atria, are deep in your chest. They often can't be seen very well using transthoracic echo. Your doctor can see the atria much better using TEE.
During this test, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus. You'll likely be given medicine to help you relax during the procedure.
TEE is used to detect blood clots that may be forming in the atria because of AF.
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show fluid buildup in the lungs and signs of other AF complications.
How Is Atrial Fibrillation Treated?
Treatment for atrial fibrillation (AF) depends on how often you have symptoms, how severe they are, and whether you already have heart disease. General treatment options include medicines, medical procedures, and lifestyle changes.
Goals of Treatment
The goals of treating AF include:
Preventing
blood clots from forming, thus lowering the risk of
stroke.
Controlling how many times a minute the
ventricles contract. This is called rate control. Rate control is important because it allows the ventricles enough time to completely fill with
blood. With this approach, the abnormal
heart rhythm continues, but you feel better and have fewer symptoms.
Restoring a normal
heart rhythm. This is called rhythm control. Rhythm control allows the
atria and
ventricles to work together to efficiently pump
blood to the body.
Who Needs Treatment for Atrial Fibrillation?
People who have AF but don't have symptoms or related heart problems may not need treatment. AF may even go back to a normal heart rhythm on its own. (This also can occur in people who have AF with symptoms.)
In some people who have AF for the first time, doctors may choose to use an electrical procedure or medicine to restore a normal heart rhythm.
Repeat episodes of AF tend to cause changes to the heart's electrical system, leading to persistent or permanent AF. Most people who have persistent or permanent AF need treatment to control their heart rate and prevent complications.
Specific Types of Treatment
Blood Clot Prevention
People who have AF are at increased risk for stroke. This is because blood can pool in the heart's upper chambers (the atria), causing a blood clot to form. If the clot breaks off and travels to the brain, it can cause a stroke.
Preventing blood clots from forming is probably the most important part of treating AF. The benefits of this type of treatment have been proven in multiple studies.
Doctors prescribe blood-thinning medicines to prevent blood clots. These medicines include warfarin (Coumadin®), dabigatran, heparin, and aspirin.
People taking blood-thinning medicines need regular blood tests to check how well the medicines are working.
Rhythm Control
Restoring and maintaining a normal heart rhythm is a treatment approach recommended for people who aren't doing well with rate control treatment. This treatment also may be used for people who have only recently started having AF. The long-term benefits of rhythm control have not been proven conclusively yet.
Doctors use medicines or procedures to control the heart's rhythm. Patients often begin rhythm control treatment in a hospital so that their hearts can be closely watched.
The longer you have AF, the less likely it is that doctors can restore a normal heart rhythm. This is especially true for people who have had AF for 6 months or more.
Restoring a normal rhythm also becomes less likely if the atria are enlarged or if any underlying heart disease worsens. In these cases, the chance that AF will recur is high, even if you're taking medicine to help convert AF to a normal rhythm.
Medicines. Medicines used to control the heart rhythm include amiodarone, sotalol, flecainide, propafenone, dofetilide, and ibutilide. Sometimes older medicines—such as quinidine, procainamide, and disopyramide—are used.
Your doctor will carefully tailor the dose and type of medicines he or she prescribes to treat your AF. This is because medicines used to treat AF can cause a different kind of arrhythmia.
These medicines also can harm people who have underlying diseases of the heart or other organs. This is especially true for patients who have an unusual heart rhythm problem called Wolff-Parkinson-White syndrome.
Your doctor may start you on a small dose of medicine and then gradually increase the dose until your symptoms are controlled. Medicines used for rhythm control can be given regularly by injection at a doctor's office, clinic, or hospital. Or, you may routinely take pills to try to control AF or prevent repeat episodes.
If your doctor knows how you'll react to a medicine, a specific dose may be prescribed for you to take on an as-needed basis if you have an episode of AF.
Procedures. Doctors use several procedures to restore a normal heart rhythm. For example, they may use electrical cardioversion to treat a fast or irregular heartbeat. For this procedure, low-energy shocks are given to your heart to trigger a normal rhythm. You're temporarily put to sleep before you receive the shocks.
Electrical cardioversion isn't the same as the emergency heart shocking procedure often seen on TV programs. It's planned in advance and done under carefully controlled conditions.
Before doing electrical cardioversion, your doctor may recommend transesophageal echocardiography (TEE). This test can rule out the presence of blood clots in the atria. If clots are present, you may need to take blood-thinning medicines before the procedure. These medicines can help get rid of the clots.
Catheter ablation (ab-LA-shun) may be used to restore a normal heart rhythm if medicines or electrical cardioversion don't work. For this procedure, a wire is inserted through a vein in the leg or arm and threaded to the heart.
Radio wave energy is sent through the wire to destroy abnormal tissue that may be disrupting the normal flow of electrical signals. An electrophysiologist usually does this procedure in a hospital. Your doctor may recommend a TEE before catheter ablation to check for blood clots in the atria.
Sometimes doctors use catheter ablation to destroy the atrioventricular (AV) node. The AV node is where the heart's electrical signals pass from the atria to the ventricles (the heart's lower chambers). This procedure requires your doctor to surgically implant a device called a pacemaker, which helps maintain a normal heart rhythm.
Research on the benefits of catheter ablation as a treatment for AF is still ongoing. (For more information, go to the ""Clinical Trials"" section of this article.)
Another procedure to","June 11, 2014."
14,2,"2018-02-02 04:25:06",b,14,"2018-02-02 05:06:33",Bronchiectasis,"
What Is Bronchiectasis?
Bronchiectasis (brong-ke-EK-tah-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. The airways are tubes that carry air in and out of your lungs.
Bronchiectasis often is caused by an infection or other condition that injures the walls of the airways or prevents the airways from clearing mucus. Mucus is a slimy substance. It helps remove inhaled dust, bacteria, and other small particles from the airways.
In bronchiectasis, your airways slowly lose their ability to clear out mucus. The mucus builds up, and bacteria begin to grow. This leads to repeated, serious lung infections.
Each infection causes more damage to the airways. Over time, the airways can't properly move air in and out of the lungs. As a result, the body's vital organs might not get enough oxygen.
Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis (at-eh-LEK-tah-sis), and heart failure.
![]()
Bronchiectasis. Figure A shows a cross-section of the lungs with normal airways and widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis.
Overview
Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs.
The initial lung damage that leads to bronchiectasis often begins in childhood. However, symptoms may not occur until months or even years after you start having repeated lung infections.
In the United States, common childhood infections—such as whooping cough and measles—used to cause many cases of bronchiectasis. However, these causes are now less common because of vaccines and antibiotics.
Now bronchiectasis usually is due to a medical condition that injures the airway walls or prevents the airways from clearing mucus. Examples of such conditions include cystic fibrosis and primary ciliary (SIL-e-ar-e) dyskinesia (dis-kih-NE-ze-ah), or PCD.
Bronchiectasis that affects only one part of the lung may be caused by a blockage rather than a medical condition.
Bronchiectasis can be congenital (kon-JEN-ih-tal) or acquired. Congenital bronchiectasis affects infants and children. It's the result of a problem with how the lungs form in a fetus.
Acquired bronchiectasis occurs as a result of another condition or factor. This type of bronchiectasis can affect adults and older children. Acquired bronchiectasis is more common than the congenital type.
Outlook
Currently, bronchiectasis has no cure. However, with proper care, most people who have it can enjoy a good quality of life.
Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor starts treating bronchiectasis and any underlying conditions, the better your chances of preventing further lung damage.
Other Names for Bronchiectasis
What Causes Bronchiectasis?
Damage to the walls of the airways usually is the cause of bronchiectasis. A lung infection may cause this damage. Examples of lung infections that can lead to bronchiectasis include:
Conditions that damage the airways and raise the risk of lung infections also can lead to bronchiectasis. Examples of such conditions include:
Immunodeficiency disorders, such as common variable immunodeficiency and, less often,
HIV and AIDS.
Disorders that affect
cilia (SIL-e-ah) function, such as
primary ciliary dyskinesia. Cilia are small, hair-like structures that line your airways. They help clear
mucus (a slimy substance) out of your airways.
Other conditions, such as an airway blockage, also can lead to bronchiectasis. Many things can cause a blockage, such as a growth or a noncancerous tumor. An inhaled object, such as a piece of a toy or a peanut that you inhaled as a child, also can cause an airway blockage.
A problem with how the lungs form in a fetus may cause congenital bronchiectasis. This condition affects infants and children.
Who Is at Risk for Bronchiectasis?
People who have conditions that damage the lungs or increase the risk of lung infections are at risk for bronchiectasis. Such conditions include:
Immunodeficiency disorders, such as common variable immunodeficiency and, less often,
HIV and AIDS.
Disorders that affect
cilia function, such as
primary ciliary dyskinesia. Cilia are small, hair-like structures that line your airways. They help clear
mucus (a slimy substance) out of your airways.
Bronchiectasis can develop at any age. Overall, two-thirds of people who have the condition are women. However, in children, the condition is more common in boys than in girls.
What Are the Signs and Symptoms of Bronchiectasis?
The initial airway damage that leads to bronchiectasis often begins in childhood. However, signs and symptoms may not appear until months or even years after you start having repeated lung infections.
The most common signs and symptoms of bronchiectasis are:
If your doctor listens to your lungs with a stethoscope, he or she may hear abnormal lung sounds.
Over time, you may have more serious symptoms. You may cough up blood or bloody mucus and feel very tired. Children may lose weight or not grow at a normal rate.
Complications of Bronchiectasis
Severe bronchiectasis can lead to other serious health conditions, such as respiratory failure and atelectasis.
Respiratory failure is a condition in which not enough oxygen passes from your lungs into your blood. The condition also can occur if your lungs can't properly remove carbon dioxide (a waste gas) from your blood.
Respiratory failure can cause shortness of breath, rapid breathing, and air hunger (feeling like you can't breathe in enough air). In severe cases, signs and symptoms may include a bluish color on your skin, lips, and fingernails; confusion; and sleepiness.
Atelectasis is a condition in which one or more areas of your lungs collapse or don't inflate properly. As a result, you may feel short of breath. Your heart rate and breathing rate may increase, and your skin and lips may turn blue.
If bronchiectasis is so advanced that it affects all parts of your airways, it may cause heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs.
The most common signs and symptoms of heart failure are shortness of breath or trouble breathing, tiredness, and swelling in the ankles, feet, legs, abdomen, and veins in the neck.
How Is Bronchiectasis Diagnosed?
Your doctor may suspect bronchiectasis if you have a daily cough that produces large amounts of sputum (spit).
To find out whether you have bronchiectasis, your doctor may recommend tests to:
Diagnostic Tests and Procedures
Chest CT Scan
A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is the most common test for diagnosing bronchiectasis.
This painless test creates precise pictures of your airways and other structures in your chest. A chest CT scan can show the extent and location of lung damage. This test gives more detailed pictures than a standard chest x ray.
Chest X Ray
This painless test creates pictures of the structures in your chest, such as your heart and lungs. A chest x ray can show areas of abnormal lung and thickened, irregular airway walls.
Other Tests
Your doctor may recommend other tests, such as:
Lung function tests. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your
lungs deliver
oxygen to your
blood. Lung function tests help show how much lung damage you have.
Bronchoscopy
If your bronchiectasis doesn't respond to treatment, your doctor may recommend bronchoscopy (bron-KOS-ko-pee). Doctors use this procedure to look inside the airways.
During bronchoscopy, a flexible tube with a light on the end is inserted through your nose or mouth into your airways. The tube is called a bronchoscope. It provides a video image of your airways. You'll be given medicine to numb your upper airway and help you relax during the procedure.
Bronchoscopy can show whether you have a blockage in your airways. The procedure also can show the source of any bleeding in your airways.
How Is Bronchiectasis Treated?
Bronchiectasis often is treated with medicines, hydration, and chest physical therapy (CPT). Your doctor may recommend surgery if the bronchiectasis is isolated to a section of lung or you have a lot of bleeding.
If the bronchiectasis is widespread and causing respiratory failure, your doctor may recommend oxygen therapy.
The goals of treatment are to:
Early diagnosis and treatment of the underlying cause of bronchiectasis may help prevent further lung damage.
In addition, any disease associated with the bronchiectasis, such as cystic fibrosis or immunodeficiency, also should be treated.
Medicines
Your doctor may prescribe antibiotics, bronchodilators, expectorants, or mucus-thinning medicines to treat bronchiectasis.
Antibiotics
Antibiotics are the main treatment for the repeated lung infections that bronchiectasis causes. Oral antibiotics often are used to treat these infections.
For hard-to-treat infections, your doctor may prescribe intravenous (IV) antibiotics. These medicines are given through an IV line inserted into your arm. Your doctor may help you arrange for a home care provider to give you IV antibiotics at home.
Expectorants and Mucus-Thinning Medicines
Your doctor may prescribe expectorants and mucus thinners to help you cough up mucus.
Expectorants help loosen the mucus in your lungs. They often are combined with decongestants, which may provide extra relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up.
For some of these treatments, little information is available to show how well they work.
Hydration
Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. Good hydration helps keep airway mucus moist and slippery, which makes it easier to cough up.
Chest Physical Therapy
CPT also is called physiotherapy (FIZ-e-o-THER-ah-pe) or chest clapping or percussion. This technique is generally performed by a respiratory therapist but can be done by a trained member of the family. It involves the therapist pounding your chest and back over and over with his or her hands or a device. Doing this helps loosen the mucus from your lungs so you can cough it up.
You can sit with your head tilted down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.
Some people find CPT hard or uncomfortable to do. Several devices can help with CPT, such as:
An electric
chest clapper, known as a mechanical percussor.
An inflatable
therapy vest that uses high-frequency air waves to force
mucus toward your upper airways so you can
cough it up.
A small handheld device that you breathe out through. It causes vibrations that dislodge the
mucus.
A mask that creates vibrations to help break loose
mucus from your airway walls.
Some of these methods and devices are popular with patients and doctors, but little information is available on how well they actually work. Choice usually is based on convenience and cost.
Several breathing techniques also are used to help move mucus to the upper airway so it can be coughed up. These techniques include forced expiration technique (FET) and active cycle breathing (ACB).
FET involves forcing out a couple of breaths and then doing relaxed breathing. ACB is FET that involves deep breathing exercises.
Other Treatments
Depending on your condition, your doctor also may recommend bronchodilators, inhaled corticosteroids, oxygen therapy, or surgery.
Bronchodilators
Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are inhaled medicines. You will use an inhaler or a nebulizer to breathe in a fine mist of medicine.
Inhaled bronchodilators work quickly because the medicine goes straight to your lungs. Your doctor may recommend that you use a bronchodilator right before you do CPT.
Inhaled Corticosteroids
If you also have wheezing or asthma with your bronchiectasis, your doctor may prescribe inhaled corticosteroids (used to treat inflammation in the airways).
Oxygen Therapy
Oxygen therapy can help raise low blood oxygen levels. For this treatment, you'll receive oxygen through nasal prongs or a mask. Oxygen therapy can be done at home, in a hospital, or in another health facility. (For more information, go to the Health Topics Oxygen Therapy article.)
Surgery
Your doctor may recommend surgery if no other treatments have helped and only one part of your airway is affected. If you have major bleeding in your airway, your doctor may recommend surgery to remove part of your airway or a procedure to control the bleeding.
In very rare instances of severe bronchiectasis, your doctor may recommend that you receive a lung transplant replacing your diseased lungs with a healthy set of lungs.
How Can Bronchiectasis Be Prevented?
To prevent bronchiectasis, it's important to prevent the lung infections and lung damage that can cause it.
Childhood vaccines for measles and whooping cough prevent infections related to these illnesses. These vaccines also reduce complications from these infections, such as bronchiectasis.
Avoiding toxic fumes, gases, smoke, and other harmful substances also can help protect your lungs.
Proper treatment of lung infections in children also may help preserve lung function and prevent lung damage that can lead to bronchiectasis.
Stay alert to keep children (and adults) from inhaling small objects (such as pieces of toys and food that might stick in a small airway). If you think you, your child, or someone else has inhaled a small object, seek prompt medical care.
In some cases, treating the underlying cause of bronchiectasis can slow or prevent its progression.
Living With Bronchiectasis
Early diagnosis and treatment of bronchiectasis can prevent further damage to your lungs. People who have bronchiectasis should have ongoing care and try to follow a healthy lifestyle.
Ongoing Care
If you have bronchiectasis, work closely with your doctor to learn how to improve your quality of life. This involves learning as much as you can about bronchiectasis and any underlying conditions that you have.
Take steps to avoid lung infections. Ask your doctor about getting flu and pneumonia vaccines. Wash your hands often to lower your risk of getting viruses and bacterial infections.
Healthy Lifestyle
Following a healthy lifestyle is important for overall health and well-being. For example, if you smoke, try to quit. Smoking harms nearly every organ in your body, including your lungs.
Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general information about how to quit smoking.
You also can protect your airways by avoiding toxic fumes, gases, and other harmful substances.
A healthy lifestyle also involves following a healthy diet. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
Staying hydrated also is important. Drinking plenty of fluids, especially water, helps prevent airway mucus from becoming thick and sticky.
For more information about following a healthy diet, go to the NHLBI's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Try to be as physically active as you can. Physical activity, such as walking and swimming, can help loosen mucus. Ask your doctor what types and amounts of activity are safe for you.
Emotional Support
People who have chronic lung diseases are more prone to depression, anxiety, and other emotional problems. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with bronchiectasis. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent or treat these diseases.
The NHLBI continues to support research aimed at learning more about airway inflammation, mucus buildup, and new therapies to treat lung disease. For example, NHLBI-supported research related to bronchiectasis includes studies that explore:
Whether daily inhaled salt-water mist may be helpful in clearing
mucus among people who have
bronchiectasis and other lung conditions.
Much of this research depends on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to bronchiectasis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
","June 11, 2014."
15,2,"2018-02-02 04:25:06",b,15,"2018-02-02 05:06:45",Bronchitis,"
What Is Bronchitis?
Bronchitis (bron-KI-tis) is a condition in which the bronchial tubes become inflamed. These tubes carry air to your lungs. (For more information about the bronchial tubes and airways, go to the Health Topics How the Lungs Work article.)
People who have bronchitis often have a cough that brings up mucus. Mucus is a slimy substance made by the lining of the bronchial tubes. Bronchitis also may cause wheezing (a whistling or squeaky sound when you breathe), chest pain or discomfort, a low fever, and shortness of breath.
![]()
Bronchitis. Figure A shows the location of the lungs and bronchial tubes in the body. Figure B is an enlarged, detailed view of a normal bronchial tube. Figure C is an enlarged, detailed view of a bronchial tube with bronchitis. The tube is inflamed and contains (more...)
Overview
The two main types of bronchitis are acute (short term) and chronic (ongoing).
Acute Bronchitis
Infections or lung irritants cause acute bronchitis. The same viruses that cause colds and the flu are the most common cause of acute bronchitis. These viruses are spread through the air when people cough. They also are spread through physical contact (for example, on hands that have not been washed).
Sometimes bacteria cause acute bronchitis.
Acute bronchitis lasts from a few days to 10 days. However, coughing may last for several weeks after the infection is gone.
Several factors increase your risk for acute bronchitis. Examples include exposure to tobacco smoke (including secondhand smoke), dust, fumes, vapors, and air pollution. Avoiding these lung irritants as much as possible can help lower your risk for acute bronchitis.
Most cases of acute bronchitis go away within a few days. If you think you have acute bronchitis, see your doctor. He or she will want to rule out other, more serious health conditions that require medical care.
Chronic Bronchitis
Chronic bronchitis is an ongoing, serious condition. It occurs if the lining of the bronchial tubes is constantly irritated and inflamed, causing a long-term cough with mucus. Smoking is the main cause of chronic bronchitis.
Viruses or bacteria can easily infect the irritated bronchial tubes. If this happens, the condition worsens and lasts longer. As a result, people who have chronic bronchitis have periods when symptoms get much worse than usual.
Chronic bronchitis is a serious, long-term medical condition. Early diagnosis and treatment, combined with quitting smoking and avoiding secondhand smoke, can improve quality of life. The chance of complete recovery is low for people who have severe chronic bronchitis.
Other Names for Bronchitis
What Causes Bronchitis?
Acute Bronchitis
Infections or lung irritants cause acute bronchitis. The same viruses that cause colds and the flu are the most common cause of acute bronchitis. Sometimes bacteria can cause the condition.
Certain substances can irritate your lungs and airways and raise your risk for acute bronchitis. For example, inhaling or being exposed to tobacco smoke, dust, fumes, vapors, or air pollution raises your risk for the condition. These lung irritants also can make symptoms worse.
Being exposed to a high level of dust or fumes, such as from an explosion or a big fire, also may lead to acute bronchitis.
Who Is at Risk for Bronchitis?
Bronchitis is a very common condition. Millions of cases occur every year.
Elderly people, infants, and young children are at higher risk for acute bronchitis than people in other age groups.
People of all ages can develop chronic bronchitis, but it occurs more often in people who are older than 45. Also, many adults who develop chronic bronchitis are smokers. Women are more than twice as likely as men to be diagnosed with chronic bronchitis.
Smoking and having an existing lung disease greatly increase your risk for bronchitis. Contact with dust, chemical fumes, and vapors from certain jobs also increases your risk for the condition. Examples include jobs in coal mining, textile manufacturing, grain handling, and livestock farming.
Air pollution, infections, and allergies can worsen the symptoms of chronic bronchitis, especially if you smoke.
What Are the Signs and Symptoms of Bronchitis?
Acute Bronchitis
Acute bronchitis caused by an infection usually develops after you already have a cold or the flu. Symptoms of a cold or the flu include sore throat, fatigue (tiredness), fever, body aches, stuffy or runny nose, vomiting, and diarrhea.
The main symptom of acute bronchitis is a persistent cough, which may last 10 to 20 days. The cough may produce clear mucus (a slimy substance). If the mucus is yellow or green, you may have a bacterial infection as well. Even after the infection clears up, you may still have a dry cough for days or weeks.
Other symptoms of acute bronchitis include wheezing (a whistling or squeaky sound when you breathe), low fever, and chest tightness or pain.
If your acute bronchitis is severe, you also may have shortness of breath, especially with physical activity.
Chronic Bronchitis
The signs and symptoms of chronic bronchitis include coughing, wheezing, and chest discomfort. The coughing may produce large amounts of mucus. This type of cough often is called a smoker's cough.
How Is Bronchitis Diagnosed?
Your doctor usually will diagnose bronchitis based on your signs and symptoms. He or she may ask questions about your cough, such as how long you've had it, what you're coughing up, and how much you cough.
Your doctor also will likely ask:
Whether you've recently had a cold or the
fluWhether you smoke or spend time around others who smoke
Whether you've been exposed to dust, fumes, vapors, or air pollution
Your doctor will use a stethoscope to listen for wheezing (a whistling or squeaky sound when you breathe) or other abnormal sounds in your lungs. He or she also may:
Test the
oxygen levels in your
blood using a sensor attached to your fingertip or toe
How Is Bronchitis Treated?
The main goals of treating acute and chronic bronchitis are to relieve symptoms and make breathing easier.
If you have acute bronchitis, your doctor may recommend rest, plenty of fluids, and aspirin (for adults) or acetaminophen to treat fever.
Antibiotics usually aren't prescribed for acute bronchitis. This is because they don't work against viruses—the most common cause of acute bronchitis. However, if your doctor thinks you have a bacterial infection, he or she may prescribe antibiotics.
A humidifier or steam can help loosen mucus and relieve wheezing and limited air flow. If your bronchitis causes wheezing, you may need an inhaled medicine to open your airways. You take this medicine using an inhaler. This device allows the medicine to go straight to your lungs.
Your doctor also may prescribe medicines to relieve or reduce your cough and treat your inflamed airways (especially if your cough persists).
If you have chronic bronchitis and also have been diagnosed with COPD (chronic obstructive pulmonary disease), you may need medicines to open your airways and help clear away mucus. These medicines include bronchodilators (inhaled) and steroids (inhaled or pill form).
If you have chronic bronchitis, your doctor may prescribe oxygen therapy. This treatment can help you breathe easier, and it provides your body with needed oxygen.
One of the best ways to treat acute and chronic bronchitis is to remove the source of irritation and damage to your lungs. If you smoke, it's very important to quit.
Talk with your doctor about programs and products that can help you quit smoking. Try to avoid secondhand smoke and other lung irritants, such as dust, fumes, vapors, and air pollution.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general information about how to quit smoking.
How Can Bronchitis Be Prevented?
You can't always prevent acute or chronic bronchitis. However, you can take steps to lower your risk for both conditions. The most important step is to quit smoking or not start smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general information about how to quit smoking.
Also, try to avoid other lung irritants, such as secondhand smoke, dust, fumes, vapors, and air pollution. For example, wear a mask over your mouth and nose when you use paint, paint remover, varnish, or other substances with strong fumes. This will help protect your lungs.
Wash your hands often to limit your exposure to germs and bacteria. Your doctor also may advise you to get a yearly flu shot and a pneumonia vaccine.
Living With Chronic Bronchitis
If you have chronic bronchitis, you can take steps to control your symptoms. Lifestyle changes and ongoing care can help you manage the condition.
Lifestyle Changes
The most important step is to not start smoking or to quit smoking. Talk with your doctor about programs and products that can help you quit.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general information about how to quit smoking.
Also, try to avoid other lung irritants, such as secondhand smoke, dust, fumes, vapors, and air pollution. This will help keep your lungs healthy.
Wash your hands often to lower your risk for a viral or bacterial infection. Also, try to stay away from people who have colds or the flu. See your doctor right away if you have signs or symptoms of a cold or the flu.
Follow a healthy diet and be as physically active as you can. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, and fat-free or low-fat milk or milk products. A healthy diet also is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
For more information about following a healthy diet, go to the NHLBI's Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources include general advice about healthy eating.
Ongoing Care
See your doctor regularly and take all of your medicines as prescribed. Also, talk with your doctor about getting a yearly flu shot and a pneumonia vaccine.
If you have chronic bronchitis, you may benefit from pulmonary rehabilitation (PR). PR is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.
People who have chronic bronchitis often breathe fast. Talk with your doctor about a breathing method called pursed-lip breathing. This method decreases how often you take breaths, and it helps keep your airways open longer. This allows more air to flow in and out of your lungs so you can be more physically active.
To do pursed-lip breathing, you breathe in through your nostrils. Then you slowly breathe out through slightly pursed lips, as if you're blowing out a candle. You exhale two to three times longer than you inhale. Some people find it helpful to count to two while inhaling and to four or six while exhaling.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to bronchitis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Bronchopulmonary Dysplasia?
Bronchopulmonary (BRONG-ko-PUL-mo-NAR-e) dysplasia (dis-PLA-ze-ah), or BPD, is a serious lung condition that affects infants. BPD mostly affects premature infants who need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube).
Most infants who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000 grams) at birth, and have breathing problems. Infections that occur before or shortly after birth also can contribute to BPD.
Some infants who have BPD may need long-term breathing support from nasal continuous positive airway pressure (NCPAP) machines or ventilators.
Overview
Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). RDS is a breathing disorder that mostly affects premature newborns. These infants' lungs aren't fully formed or aren't able to make enough surfactant (sur-FAK-tant).
Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so an infant can breathe in air once he or she is born.
Without surfactant, the lungs collapse, and the infant has to work hard to breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. Without proper treatment, the lack of oxygen may damage the infant's brain and other organs.
Babies who have RDS are treated with surfactant replacement therapy. They also may need oxygen therapy. Shortly after birth, some babies who have RDS also are treated with NCPAP or ventilators (machines that support breathing).
Often, the symptoms of RDS start to improve slowly after about a week. However, some babies get worse and need more oxygen or breathing support from NCPAP or a ventilator.
If premature infants still require oxygen therapy by the time they reach their original due dates, they're diagnosed with BPD.
Outlook
Advances in care now make it possible for more premature infants to survive. However, these infants are at high risk for BPD.
Most babies who have BPD get better in time, but they may need treatment for months or even years. They may continue to have lung problems throughout childhood and even into adulthood. There's some concern about whether people who had BPD as babies can ever have normal lung function.
As children who have BPD grow, their parents can help reduce the risk of BPD complications. Parents can encourage healthy eating habits and good nutrition. They also can avoid cigarette smoke and other lung irritants.
Other Names for Bronchopulmonary Dysplasia
What Causes Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia (BPD) develops as a result of an infant's lungs becoming irritated or inflamed.
The lungs of premature infants are fragile and often aren't fully developed. They can easily be irritated or injured within hours or days of birth. Many factors can damage premature infants' lungs.
Ventilation
Newborns who have breathing problems or can't breathe on their own may need ventilator support. Ventilators are machines that use pressure to blow air into the airways and lungs.
Although ventilator support can help premature infants survive, the machine's pressure might irritate and harm the babies' lungs. For this reason, doctors only recommend ventilator support when necessary.
High Levels of Oxygen
Newborns who have breathing problems might need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube). This treatment helps the infants' organs get enough oxygen to work well.
However, high levels of oxygen can inflame the lining of the lungs and injure the airways. Also, high levels of oxygen can slow lung development in premature infants.
Infections
Infections can inflame the lungs. As a result, the airways narrow, which makes it harder for premature infants to breathe. Lung infections also increase the babies' need for extra oxygen and breathing support.
Heredity
Studies show that heredity may play a role in causing BPD. More studies are needed to confirm this finding.
Who Is at Risk for Bronchopulmonary Dysplasia?
The more premature an infant is and the lower his or her birth weight, the greater the risk of bronchopulmonary dysplasia (BPD).
Most infants who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000 grams) at birth, and have breathing problems. Infections that occur before or shortly after birth also can contribute to BPD.
The number of babies who have BPD is higher now than in the past. This is because of advances in care that help more premature infants survive.
Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). However, some babies who have mild RDS or don't have RDS also develop BPD. These babies often have very low birth weights and one or more other conditions, such as patent ductus arteriosus (PDA) and sepsis.
PDA is a heart problem that occurs soon after birth in some babies. Sepsis is a serious bacterial infection in the bloodstream.
What Are the Signs and Symptoms of Bronchopulmonary Dysplasia?
Many babies who develop bronchopulmonary dysplasia (BPD) are born with serious respiratory distress syndrome (RDS). The signs and symptoms of RDS at birth are:
Rapid, shallow breathing
Sharp pulling in of the
chest below and between the
ribs with each breath
Grunting sounds
Babies who have RDS are treated with surfactant replacement therapy. They also may need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube).
Shortly after birth, some babies who have RDS also are treated with nasal continuous positive airway pressure (NCPAP) or ventilators (machines that support breathing).
Often, the symptoms of RDS start to improve slowly after about a week. However, some babies get worse and need more oxygen or breathing support from NCPAP or a ventilator.
A first sign of BPD is when premature infants—usually those born more than 10 weeks early—still need oxygen therapy by the time they reach their original due dates. These babies are diagnosed with BPD.
Infants who have severe BPD may have trouble feeding, which can lead to delayed growth. These babies also may develop:
How Is Bronchopulmonary Dysplasia Diagnosed?
Infants who are born early—usually more than 10 weeks before their due dates—and still need oxygen therapy by the time they reach their original due dates are diagnosed with bronchopulmonary dysplasia (BPD).
BPD can be mild, moderate, or severe. The diagnosis depends on how much extra oxygen a baby needs at the time of his or her original due date. It also depends on how long the baby needs oxygen therapy.
To help confirm a diagnosis of BPD, doctors may recommend tests, such as:
A
chest x ray. A
chest x ray takes pictures of the structures inside the chest, such as the
heart and
lungs. In severe cases of BPD, this test may show large areas of air and signs that the lungs are inflamed or infected. A chest x ray also can detect problems such as a
collapsed lung and show whether the lungs are developing normally.
Blood tests.
Blood tests can show whether an infant has enough
oxygen in his or her blood. Blood tests also can help determine whether an
infection is causing an infant's breathing problems.
How Is Bronchopulmonary Dysplasia Treated?
Preventive Measures
If your doctor thinks you're going to give birth too early, he or she may give you injections of a corticosteroid medicine.
The medicine can speed up surfactant production in your baby. Surfactant is a liquid that coats the inside of the lungs. It helps keep the lungs open so your infant can breathe in air once he or she is born.
Corticosteroids also can help your baby's lungs, brain, and kidneys develop more quickly while he or she is in the womb.
Premature babies who have very low birth weights also might be given corticosteroids within the first few days of birth. Doctors sometimes prescribe inhaled nitric oxide shortly after birth for babies who have very low birth weights. This treatment can help improve the babies' lung function.
These preventive measures may help reduce infants' risk of respiratory distress syndrome (RDS), which can lead to BPD.
Treatment for Respiratory Distress Syndrome
The goals of treating infants who have RDS include:
Treatment of RDS usually begins as soon as an infant is born, sometimes in the delivery room. Most infants who have signs of RDS are quickly moved to a neonatal intensive care unit (NICU). They receive around-the-clock treatment from health care professionals who specialize in treating premature infants.
Treatments for RDS include surfactant replacement therapy, breathing support with nasal continuous positive airway pressure (NCPAP) or a ventilator, oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube), and medicines to treat fluid buildup in the lungs.
For more information about RDS treatments, go to the Health Topics Respiratory Distress Syndrome article.
Treatment for Bronchopulmonary Dysplasia
Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU.
Such treatment usually includes:
Using radiant warmers or incubators to keep infants warm and reduce the risk of
infection.
Ongoing monitoring of
blood pressure,
heart rate, breathing, and temperature through sensors taped to the babies' bodies.
Giving fluids and
nutrients through needles or tubes inserted into the infants'
veins. This helps prevent
malnutrition and promotes growth. Nutrition is vital to the growth and development of the
lungs. Later, babies may be given
breast milk or infant formula through feeding tubes that are passed through their
noses or
mouths and into their
throats.
Checking fluid intake to make sure that fluid doesn't build up in the babies'
lungs.
As BPD improves, babies are slowly weaned off NCPAP or ventilators until they can breathe on their own. These infants will likely need oxygen therapy for some time.
If your infant has moderate or severe BPD, echocardiography might be done every few weeks to months to check his or her pulmonary artery pressure.
If your child needs long-term ventilator support, he or she will likely get a tracheostomy (TRA-ke-OS-toe-me). A tracheostomy is a surgically made hole. It goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your child's doctor will put the breathing tube from the ventilator through the hole.
Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has some advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.)
Long-term use of an endotracheal tube can damage the trachea. This damage may need to be corrected with surgery later. A tracheostomy can allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.
While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your child's muscles and clear mucus out of his or her lungs.
Infants who have BPD may spend several weeks or months in the hospital. This allows them to get the care they need.
Before your baby goes home, learn as much as you can about your child's condition and how it's treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital.
Your child will likely continue on all or some of the treatments that were started at the hospital, including:
Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist might be involved in his or her care.
Seek out support from family, friends, and hospital staff. Ask the case manager or social worker at the hospital about what you'll need after your baby leaves the hospital.
The doctors and nurses can assist with questions about your infant's care. Also, you may want to ask whether your community has a support group for parents of premature infants.
How Can Bronchopulmonary Dysplasia Be Prevented?
Taking steps to ensure a healthy pregnancy might prevent your infant from being born before his or her lungs have fully developed. These steps include:
If your doctor thinks that you're going to give birth too early, he or she may give you injections of a corticosteroid medicine.
The medicine can speed up surfactant production in your baby. Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so your infant can breathe in air once he or she is born.
Usually, within about 24 hours of your taking this medicine, the baby's lungs start making enough surfactant. This will reduce the infant's risk of respiratory distress syndrome (RDS), which can lead to bronchopulmonary dysplasia (BPD).
Corticosteroids also can help your baby's lungs, brain, and kidneys develop more quickly while he or she is in the womb.
If your baby does develop RDS, it will probably be fairly mild. If the RDS isn't mild, BPD will likely develop.
Living With Bronchopulmonary Dysplasia
Caring for a premature infant can be challenging. You may have:
Emotional pain, including feelings of guilt, anger, and
depression.
A lack of control over the situation.
Problems bonding with your baby while he or she is in the neonatal intensive care unit (NICU).
Frustration that you can't breastfeed your infant right away. (You can pump and store your
breast milk for later use.)
Complex schedules that require you to regularly give your child medicines and keep frequent medical appointments.
Take Steps To Manage Your Situation
You can take steps to help yourself during this difficult time. For example, take care of your health so that you have enough energy to deal with the situation.
Learn as much as you can about what goes on in the NICU. You can help your baby during his or her stay there and begin to bond with the baby before he or she comes home.
Learn as much as you can about your infant's condition and what's involved in daily care. This will allow you to ask questions and feel more confident about your ability to care for your baby at home.
Seek support from family, friends, and hospital staff. Ask the case manager or social worker at the hospital about what you'll need after the baby leaves the hospital. The doctors and nurses can assist with questions about your infant's care. Also, you may want to ask whether your community has a support group for parents of premature infants.
Parents are encouraged to visit their baby in the NICU as much as possible. Spend time talking to your baby and holding and touching him or her (when allowed).
Ongoing Care and Health Issues
Infants who have bronchopulmonary dysplasia (BPD) may have health problems even after they leave the hospital. They may continue to need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube) or breathing support from a ventilator.
A pulmonary specialist might be involved in your child's long-term care and treatment.
Infants who need long-term ventilator support may need a tracheostomy. A tracheostomy is a surgically made hole in the front of the neck. Doctors can put a breathing tube directly into the windpipe through the hole, rather than putting the tube through the nose or mouth.
Babies who have BPD might be at increased risk for some health problems throughout infancy and early childhood. They might be more likely to get colds, the flu, and other infections, which can be life threatening. If these children develop respiratory infections, they may need to be treated in a hospital.
Babies who have BPD also may have trouble swallowing. As a result, food can get stuck in their airways. This condition is called aspiration, and it can cause an infection. Children who have BPD may need help from a specialist to learn how to swallow correctly.
Babies who were diagnosed with BPD also may have delayed growth during their first 2 years. Children who survive BPD usually are smaller than other children of the same age.
Children who have BPD may continue to have lung problems throughout childhood and even into adulthood. These problems can include underdeveloped lungs and asthma. Babies with very severe BPD also may have other problems, such as:
Apnea. This is a condition in which breathing stops for short
periods.
Poor coordination and
muscle tone.
Delayed speech and problems with vision and
hearing.
Learning problems.
Gastroesophageal (GAS-tro-eh-SOF-ah-JE-al) reflux disease (GERD). This is a condition in which the
stomach's contents back up into the
esophagus during or after a feeding. The esophagus is the passage leading from the
mouth to the stomach. GERD may lead to
aspiration.
The risk of these health problems is higher in infants who are very small at birth. If your child has BPD, talk with his or her doctor about your child's risk for these problems.
You can take steps to help manage your child's BPD and help him or her recover.
Call your child's doctor if you notice any signs or symptoms of
respiratory infection. Examples include irritability,
fever, stuffy
nose,
cough, changes in breathing patterns, and wheezing.
Try to prevent infections. Wash your
hands often, and discourage visits from family and friends who are sick. Keep your baby away from large daycare centers and crowds to avoid
colds, the
flu, and other infections.
Don't smoke in your home. Keep your baby away from cigarette smoke, dust, pollution, and other lung irritants.
Make sure that your baby and your other children get their childhood vaccines and other
treatments recommended by their doctors.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent or treat these diseases.
Many more questions remain about lung diseases, including bronchopulmonary dysplasia (BPD). The NHLBI continues to support research to learn more. For example, NHLBI-supported research on BPD includes studies that explore:
Genetic factors and other factors that might help predict whether an infant is at risk of developing BPD
Much of the NHLBI's research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.
When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.
If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to BPD , talk with your doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is COPD?
COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive disease that makes it hard to breathe. ""Progressive"" means the disease gets worse over time.
COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.
Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dust—also may contribute to COPD.
Overview
To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial (BRONG-ke-al) tubes or airways.
Within the lungs, your bronchial tubes branch into thousands of smaller, thinner tubes called bronchioles (BRONG-ke-ols). These tubes end in bunches of tiny round air sacs called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries (KAP-ih-lare-ees) run through the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide (a waste gas) moves from the capillaries into the air sacs. This process is called gas exchange.
The airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.
In COPD, less air flows in and out of the airways because of one or more of the following:
In the United States, the term ""COPD"" includes two main conditions—emphysema (em-fih-SE-ma) and chronic bronchitis (bron-KI-tis). (Note: The Health Topics article about bronchitis discusses both acute and chronic bronchitis.)
In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.
In chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken. Lots of thick mucus forms in the airways, making it hard to breathe.
Most people who have COPD have both emphysema and chronic bronchitis. Thus, the general term ""COPD"" is more accurate.
Outlook
COPD is a major cause of disability, and it's the third leading cause of death in the United States. Currently, millions of people are diagnosed with COPD. Many more people may have the disease and not even know it.
COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.
Most of the time, COPD is diagnosed in middle-aged or older adults. The disease isn't passed from person to person—you can't catch it from someone else.
COPD has no cure yet, and doctors don't know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.
What Causes COPD?
Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.
In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.
Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)
Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver.
Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly.
Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing. However, if not, COPD can develop.
Who Is at Risk for COPD?
The main risk factor for COPD is smoking. Most people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke.
Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include secondhand smoke, air pollution, and chemical fumes and dust from the environment or workplace. (Secondhand smoke is smoke in the air from other people smoking.)
Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. For example, this may happen if a person has alpha-1 antitrypsin deficiency, a genetic condition.
What Are the Signs and Symptoms of COPD?
At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include:
An ongoing
cough or a
cough that produces a lot of
mucus (often called ""smoker's cough"")
Shortness of breath, especially with physical activity
Wheezing (a whistling or squeaky sound when you breathe)
If you have COPD, you also may have colds or the flu (influenza) often.
Not everyone who has the symptoms above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can find out whether you have COPD.
If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.
Over time, symptoms may become severe enough to see a doctor. For example, you may get short of breath during physical exertion.
The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking.
Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance.
Some severe symptoms may require treatment in a hospital. You—with the help of family members or friends, if you're unable—should seek emergency care if:
You're having a hard time catching your breath or talking.
Your
lips or fingernails turn blue or gray. (This is a sign of a low
oxygen level in your
blood.)
You're not mentally alert.
Your heartbeat is very fast.
The recommended
treatment for symptoms that are getting worse isn't working.
How Is COPD Diagnosed?
Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.
Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dust.
If you have an ongoing cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD.
Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD.
Lung Function Tests
Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.
The main test for COPD is spirometry (spi-ROM-eh-tre). Other lung function tests, such as a lung diffusion capacity test, also might be used. (For more information, go to the Health Topics Lung Function Tests article.)
Spirometry
During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer.
The machine measures how much air you breathe out. It also measures how fast you can blow air out.
![]()
Spirometry. The image shows how spirometry is done. The patient takes a deep breath and then blows hard into a tube connected to a spirometer. The spirometer measures the amount of air breathed out. It also measures how fast the air is blown out.
Your doctor may have you inhale medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine.
Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals.
The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms.
Other Tests
Your doctor may recommend other tests, such as:
An arterial
blood gas test. This
blood test measures the
oxygen level in your blood using a sample of blood taken from an
artery. The results from this test can show how severe your COPD is and whether you need
oxygen therapy.
How Is COPD Treated?
COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease.
The goals of COPD treatment include:
Relieving your symptoms
Slowing the progress of the disease
Improving your
exercise tolerance (your ability to stay active)
Preventing and treating complications
Improving your overall health
To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders.
Lifestyle Changes
Quit Smoking and Avoid Lung Irritants
Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
Also, try to avoid secondhand smoke and places with dust, fumes, or other toxic substances that you may inhale.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include basic information about how to quit smoking.
Other Lifestyle Changes
If you have COPD, you may have trouble eating enough because of your symptoms, such as shortness of breath and fatigue. (This issue is more common with severe disease.)
As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections.
Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements.
Also, talk with your doctor about what types of activity are safe for you. You may find it hard to be active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
Medicines
Bronchodilators
Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.
Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day.
Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care team to show you the correct way to use your inhaler.
If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur.
If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.
Combination Bronchodilators Plus Inhaled Glucocorticosteroids (Steroids)
If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation.
In general, using inhaled steroids alone is not a preferred treatment.
Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6 weeks to 3 months to see whether the addition of the steroid helps relieve your breathing problems.
Vaccines
Flu Shots
The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot.
Pneumococcal Vaccine
This vaccine lowers your risk for pneumococcal pneumonia (NU-mo-KOK-al nu-MO-ne-ah) and its complications. People who have COPD are at higher risk for pneumonia than people who don't have COPD. Talk with your doctor about whether you should get this vaccine.
Pulmonary Rehabilitation
Pulmonary rehabilitation (rehab) is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.
Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities.
Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs.
Oxygen Therapy
If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, you're given oxygen through nasal prongs or a mask.
You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them:
Surgery
Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines.
Surgeries for people who have COPD that's mainly related to emphysema include bullectomy (bul-EK-toe-me) and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD.
Bullectomy
When the walls of the air sacs are destroyed, larger air spaces called bullae (BUL-e) form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs.
Lung Volume Reduction Surgery
In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.
Lung Transplant
During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.
A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections. The surgery can cause death if the body rejects the transplanted lung.
If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery.
Managing Complications
COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, the flu, or a lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more coughing, changes in the color or amount of your sputum (spit), and a fever.
Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection and other medicines, such as bronchodilators and inhaled steroids, to help you breathe.
Some severe symptoms may require treatment in a hospital. For more information, go to ""What Are the Signs and Symptoms of COPD?""
How Can COPD Be Prevented?
You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progress of the disease.
Prevent COPD Before It Starts
The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
Also, try to avoid lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is smoke in the air from other people smoking.)
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include basic information about how to quit smoking.
Prevent Complications and Slow the Progress of COPD
If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progress of the disease. You also should avoid exposure to the lung irritants mentioned above.
Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms.
Talk with your doctor about whether and when you should get flu (influenza) and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.
Living With COPD
COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:
Avoid Lung Irritants
If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include basic information about how to quit smoking.
Also, try to avoid lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is smoke in the air from other people smoking.)
Keep these irritants out of your home. If your home is painted or sprayed for insects, have it done when you can stay away for a while.
Keep your windows closed and stay at home (if possible) when there's a lot of air pollution or dust outside.
Get Ongoing Care
If you have COPD, it's important to get ongoing medical care. Take all of your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring a list of all the medicines you're taking when you have medical checkups.
Talk with your doctor about whether and when you should get flu (influenza) and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.
Manage COPD and Its Symptoms
You can do things to help manage COPD and its symptoms. For example:
Do activities slowly.
Put items that you need often in one place that's easy to reach.
Find very simple ways to cook, clean, and do other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things.
Ask for help moving things around in your house so that you won't need to climb stairs as often.
Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.
Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks.
Prepare for Emergencies
If you have COPD, know when and where to seek help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. (For more information on severe symptoms, go to ""What Are the Signs and Symptoms of COPD?"")
Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms.
Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you're taking.
Emotional Issues and Support
Living with COPD may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also might help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent and treat these diseases.
Many more questions remain about chronic lung diseases, including COPD. The NHLBI continues to support research aimed at learning more about these diseases. For example, NHLBI-supported research on COPD includes studies that explore:
How certain medicines and other
therapies can help treat COPD and improve quality of life for people who have the disease
Whether
genetic factors increase the risk of lung damage that can lead to COPD
Whether a self-managed physical activity program is cost effective and can help people who have COPD function better
How a coping skills training program can improve quality of life for people who have COPD and their caregivers
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to COPD, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Cardiogenic Shock?
Cardiogenic (kar-dee-oh-JE-nik) shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs. The condition is a medical emergency and is fatal if not treated right away.
The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack. However, not everyone who has a heart attack has cardiogenic shock. In fact, on average, only about 7 percent of people who have heart attacks develop the condition.
If cardiogenic shock does occur, it's very dangerous. When people die from heart attacks in hospitals, cardiogenic shock is the most common cause of death.
What Is Shock?
The medical term ""shock"" refers to a state in which not enough blood and oxygen reach important organs in the body, such as the brain and kidneys. Shock causes very low blood pressure and may be life threatening.
Shock can have many causes. Cardiogenic shock is only one type of shock. Other types of shock include hypovolemic (hy-po-vo-LEE-mik) shock and vasodilatory (VAZ-oh-DILE-ah-tor-e) shock.
Hypovolemic shock is a condition in which the heart can’t pump enough blood to the body because of severe blood loss.
In vasodilatory shock, the blood vessels suddenly relax. When the blood vessels are too relaxed, blood pressure drops and blood flow becomes very low. Without enough blood pressure, blood and oxygen don’t reach the body’s organs.
A bacterial infection in the bloodstream, a severe allergic reaction, or damage to the nervous system (brain and nerves) may cause vasodilatory shock.
When a person is in shock (from any cause), not enough blood and oxygen are reaching the body's organs. If shock lasts more than a few minutes, the lack of oxygen starts to damage the body’s organs. If shock isn't treated quickly, it can cause permanent organ damage or death.
Some of the signs and symptoms of shock include:
If you think that you or someone else is in shock, call 9–1–1 right away for emergency treatment. Prompt medical care can save your life and prevent or limit damage to your body’s organs.
Outlook
In the past, almost no one survived cardiogenic shock. Now, about half of the people who go into cardiogenic shock survive. This is because of prompt recognition of symptoms and improved treatments, such as medicines and devices. These treatments can restore blood flow to the heart and help the heart pump better.
In some cases, devices that take over the pumping function of the heart are used. Implanting these devices requires major surgery.
What Causes Cardiogenic Shock?
Immediate Causes
Cardiogenic shock occurs if the heart suddenly can't pump enough oxygen-rich blood to the body. The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack.
This damage prevents the heart’s main pumping chamber, the left ventricle (VEN-trih-kul), from working well. As a result, the heart can't pump enough oxygen-rich blood to the rest of the body.
In about 3 percent of cardiogenic shock cases, the heart’s lower right chamber, the right ventricle, doesn’t work well. This means the heart can't properly pump blood to the lungs, where it picks up oxygen to bring back to the heart and the rest of the body.
Without enough oxygen-rich blood reaching the body’s major organs, many problems can occur. For example:
If
organs don't get enough
oxygen-rich
blood, they won't work well.
Cells in the organs die, and the organs may never work well again.
As some
organs stop working, they may cause problems with other bodily functions. This, in turn, can worsen shock. For example:
If the
kidneys aren't working well, the levels of important chemicals in the body change. This may cause the
heart and other
muscles to become even weaker, limiting
blood flow even more.
If the
liver isn't working well, the body stops making
proteins that help the
blood clot. This can lead to more
bleeding if the shock is due to blood loss.
How well the brain, kidneys, and other organs recover will depend on how long a person is in shock. The less time a person is in shock, the less damage will occur to the organs. This is another reason why emergency treatment is so important.
Underlying Causes
The underlying causes of cardiogenic shock are conditions that weaken the heart and prevent it from pumping enough oxygen-rich blood to the body.
Heart Attack
Most heart attacks occur as a result of coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque (plak) narrows or blocks the coronary (heart) arteries.
Plaque reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.
Conditions Caused by Heart Attack
Heart attacks can cause some serious heart conditions that can lead to cardiogenic shock. One example is ventricular septal rupture. This condition occurs if the wall that separates the ventricles (the heart’s two lower chambers) breaks down.
The breakdown happens because cells in the wall have died due to a heart attack. Without the wall to separate them, the ventricles can’t pump properly.
Heart attacks also can cause papillary muscle infarction or rupture. This condition occurs if the muscles that help anchor the heart valves stop working or break because a heart attack cuts off their blood supply. If this happens, blood doesn't flow correctly between the heart’s chambers. This prevents the heart from pumping properly.
Other Heart Conditions
Serious heart conditions that may occur with or without a heart attack can cause cardiogenic shock. Examples include:
Life-threatening
arrhythmias (ah-RITH-me-ahs). These are problems with the rate or rhythm of the heartbeat.
Pericardial tamponade (per-ih-KAR-de-al tam-po-NADE). This is too much fluid or
blood around the
heart. The fluid squeezes the
heart muscle so it can't pump properly.
Pulmonary Embolism
Pulmonary embolism (PE) is a sudden blockage in a lung artery. This condition usually is caused by a blood clot that travels to the lung from a vein in the leg. PE can damage your heart and other organs in your body.
Who Is at Risk for Cardiogenic Shock?
The most common risk factor for cardiogenic shock is having a heart attack. If you've had a heart attack, the following factors can further increase your risk for cardiogenic shock:
Women who have heart attacks are at higher risk for cardiogenic shock than men who have heart attacks.
What Are the Signs and Symptoms of Cardiogenic Shock?
A lack of oxygen-rich blood reaching the brain, kidneys, skin, and other parts of the body causes the signs and symptoms of cardiogenic shock.
Some of the typical signs and symptoms of shock usually include at least two or more of the following:
Any of these alone is unlikely to be a sign or symptom of shock.
If you or someone else is having these signs and symptoms, call 9–1–1 right away for emergency treatment. Prompt medical care can save your life and prevent or limit organ damage.
How Is Cardiogenic Shock Diagnosed?
The first step in diagnosing cardiogenic shock is to identify that a person is in shock. At that point, emergency treatment should begin.
Once emergency treatment starts, doctors can look for the specific cause of the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.
Tests and Procedures To Diagnose Shock and Its Underlying Causes
EKG (Electrocardiogram)
An EKG is a simple test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular).
An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. Doctors use EKGs to diagnose severe heart attacks and monitor the heart's condition.
Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of the heart. The test provides information about the size and shape of the heart and how well the heart chambers and valves are working.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
Cardiac Enzyme Test
When cells in the heart die, they release enzymes into the blood. These enzymes are called markers or biomarkers. Measuring these markers can show whether the heart is damaged and the extent of the damage.
Coronary Angiography
Coronary angiography (an-jee-OG-ra-fee) is an x-ray exam of the heart and blood vessels. The doctor passes a catheter (a thin, flexible tube) through an artery in the leg or arm to the heart. The catheter can measure the pressure inside the heart chambers.
Dye that can be seen on an x-ray image is injected into the bloodstream through the tip of the catheter. The dye lets the doctor study the flow of blood through the heart and blood vessels and see any blockages.
Blood Tests
Some blood tests also are used to help diagnose cardiogenic shock, including:
Arterial
blood gas measurement. For this test, a blood sample is taken from an
artery. The sample is used to measure
oxygen,
carbon dioxide, and pH (acidity) levels in the blood. Certain levels of these substances are associated with shock.
How Is Cardiogenic Shock Treated?
Cardiogenic shock is life threatening and requires emergency medical treatment. The condition usually is diagnosed after a person has been admitted to a hospital for a heart attack. If the person isn't already in a hospital, emergency treatment can start as soon as medical personnel arrive.
The first goal of emergency treatment for cardiogenic shock is to improve the flow of blood and oxygen to the body’s organs.
Sometimes both the shock and its cause are treated at the same time. For example, doctors may quickly open a blocked blood vessel that's damaging the heart. Often, this can get the patient out of shock with little or no additional treatment.
Emergency Life Support
Emergency life support treatment is needed for any type of shock. This treatment helps get oxygen-rich blood flowing to the brain, kidneys, and other organs.
Restoring blood flow to the organs keeps the patient alive and may prevent long-term damage to the organs. Emergency life support treatment includes:
Providing breathing support if needed. A
ventilator might be used to protect the airway and provide the patient with extra
oxygen. A ventilator is a machine that supports breathing.
Giving the patient fluids, including
blood and blood products, through a needle inserted in a
vein (when the shock is due to blood loss). This can help get more blood to major
organs and the rest of the body. This
treatment usually isn’t used for
cardiogenic shock because the
heart can't pump the blood that's already in the body. Also, too much fluid is in the
lungs, making it hard to breathe.
Medicines
During and after emergency life support treatment, doctors will try to find out what’s causing the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.
Treatment for cardiogenic shock will depend on its cause. Doctors may prescribe medicines to:
Prevent
blood clots from forming
Medical Devices
Medical devices can help the heart pump and improve blood flow. Devices used to treat cardiogenic shock may include:
An intra-aortic balloon pump. This device is placed in the
aorta, the main
blood vessel that carries blood from the
heart to the body. A balloon at the tip of the device is inflated and deflated in a rhythm that matches the heart’s pumping rhythm. This allows the weakened
heart muscle to pump as much blood as it can, which helps get more blood to vital
organs, such as the
brain and
kidneys.
A
left ventricular assist device (LVAD). This device is a battery-operated pump that takes over part of the
heart’s pumping action. An LVAD helps the heart pump
blood to the body. This device may be used if damage to the left
ventricle, the heart’s main pumping
chamber, is causing shock.
Medical Procedures and Surgery
Sometimes medicines and medical devices aren't enough to treat cardiogenic shock.
Medical procedures and surgery can restore blood flow to the heart and the rest of the body, repair heart damage, and help keep a patient alive while he or she recovers from shock.
Surgery also can improve the chances of long-term survival. Surgery done within 6 hours of the onset of shock symptoms has the greatest chance of improving survival.
The types of procedures and surgery used to treat underlying causes of cardiogenic shock include:
Heart transplant. This type of
surgery rarely is done during an emergency situation like
cardiogenic shock because of other available options. Also, doctors need to do very careful testing to make sure a patient will benefit from a
heart transplant and to find a matching heart from a donor. Still, in some cases, doctors may recommend a transplant if they feel it's the best way to improve a patient's chances of long-term survival.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, the NHLBI sponsored a study to find out whether early treatment to open blocked coronary arteries could reduce in-hospital deaths from cardiogenic shock.
The study results supported such treatment in people younger than 75 who have cardiogenic shock caused by a heart attack.
Many more questions remain about heart diseases and conditions, including cardiogenic shock. The NHLBI continues to support research aimed at learning more about these diseases and conditions.
Research often depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to cardiogenic shock, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Cardiomyopathy?
Cardiomyopathy (KAR-de-o-mi-OP-ah-thee) refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms, and treatments.
In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue.
As cardiomyopathy worsens, the heart becomes weaker. It's less able to pump blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or irregular heartbeats called arrhythmias (ah-RITH-me-ahs). In turn, heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen.
The weakening of the heart also can cause other complications, such as heart valve problems.
Overview
The main types of cardiomyopathy are:
Arrhythmogenic (ah-rith-mo-JEN-ik) right ventricular
dysplasia (dis-PLA-ze-ah)
Other types of cardiomyopathy sometimes are referred to as ""unclassified cardiomyopathy.""
Cardiomyopathy can be acquired or inherited. ""Acquired"" means you aren't born with the disease, but you develop it due to another disease, condition, or factor. ""Inherited"" means your parents passed the gene for the disease on to you. Many times, the cause of cardiomyopathy isn't known.
Cardiomyopathy can affect people of all ages. However, people in certain age groups are more likely to have certain types of cardiomyopathy. This article focuses on cardiomyopathy in adults.
Outlook
Some people who have cardiomyopathy have no signs or symptoms and need no treatment. For other people, the disease develops quickly, symptoms are severe, and serious complications occur.
Treatments for cardiomyopathy include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure. These treatments can control symptoms, reduce complications, and stop the disease from getting worse.
Types of Cardiomyopathy
Dilated Cardiomyopathy
Dilated cardiomyopathy is the most common type of the disease. It mostly occurs in adults aged 20 to 60. Men are more likely than women to have this type of cardiomyopathy.
Dilated cardiomyopathy affects the heart's ventricles (VEN-trih-kuls) and atria (AY-tree-uh). These are the lower and upper chambers of the heart, respectively.
The disease often starts in the left ventricle, the heart's main pumping chamber. The heart muscle begins to dilate (stretch and become thinner). This causes the inside of the chamber to enlarge. The problem often spreads to the right ventricle and then to the atria as the disease gets worse.
When the heart chambers dilate, the heart muscle doesn't contract normally. Also, the heart can't pump blood very well. Over time, the heart becomes weaker and heart failure can occur.
Common symptoms of heart failure include shortness of breath, fatigue (tiredness), and swelling of the ankles, feet, legs, abdomen, and veins in the neck.
Dilated cardiomyopathy also can lead to heart valve problems, arrhythmias (irregular heartbeats), and blood clots in the heart.
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is very common and can affect people of any age. About 1 out of every 500 people has HCM. It affects men and women equally.
HCM is a common cause of sudden cardiac arrest (SCA) in young people, including young athletes.
HCM occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thicken. Despite this thickening, the ventricle size often remains normal. However, the thickening may block blood flow out of the ventricle. If this happens, the condition is called obstructive hypertrophic cardiomyopathy.
Sometimes, the septum thickens and bulges into the left ventricle. This also can block blood flow out of the left ventricle. (The septum is the wall that divides the left and right sides of the heart.)
If a blockage occurs, the ventricle must work hard to pump blood to the body. Symptoms can include chest pain, dizziness, shortness of breath, or fainting.
HCM also can affect the heart's mitral (MI-trul) valve, causing blood to leak backward through the valve.
Sometimes the thickened heart muscle doesn't block blood flow out of the left ventricle. This is called nonobstructive hypertrophic cardiomyopathy. The entire ventricle may thicken, or the thickening may happen only at the bottom of the heart. The right ventricle also may be affected.
In both types of HCM (obstructive and nonobstructive), the thickened muscle makes the inside of the left ventricle smaller, so it holds less blood. The walls of the ventricle also may stiffen. As a result, the ventricle is less able to relax and fill with blood.
These changes can raise blood pressure in the ventricles and the blood vessels of the lungs. Changes also occur to the cells in the damaged heart muscle. This may disrupt the heart's electrical signals and lead to arrhythmias.
Some people who have HCM have no signs or symptoms. The disease doesn't affect their lives. Others have severe symptoms and complications. For example, they may have shortness of breath, serious arrhythmias, or an inability to exercise.
Rarely, people who have HCM can have SCA during very vigorous physical activity. The physical activity can trigger dangerous arrhythmias. If you have HCM, ask your doctor what types and amounts of physical activity are safe for you.
Arrhythmogenic Right Ventricular Dysplasia
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare type of cardiomyopathy. ARVD occurs if the muscle tissue in the right ventricle dies and is replaced with scar tissue.
This process disrupts the heart's electrical signals and causes arrhythmias. Symptoms include palpitations and fainting after physical activity. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)
ARVD usually affects teens or young adults. It can cause SCA in young athletes.
Other Names for Cardiomyopathy
Other Names for Dilated Cardiomyopathy
Alcoholic
cardiomyopathy. This term is used when overuse of alcohol causes the disease.
Peripartum
cardiomyopathy. This term is used when the disease develops in a woman shortly before or after she gives birth.
Other Names for Hypertrophic Cardiomyopathy
Other Names for Restrictive Cardiomyopathy
Other Names for Arrhythmogenic Right Ventricular Dysplasia
What Causes Cardiomyopathy?
Cardiomyopathy can be acquired or inherited. ""Acquired"" means you aren't born with the disease, but you develop it due to another disease, condition, or factor.
""Inherited"" means your parents passed the gene for the disease on to you. Researchers continue to look for the genetic links to cardiomyopathy. They also continue to explore how these links cause or contribute to the various types of the disease.
Many times, the cause of cardiomyopathy isn't known. This often is the case when the disease occurs in children.
Dilated Cardiomyopathy
The cause of dilated cardiomyopathy often isn't known. As many as one-third of the people who have dilated cardiomyopathy inherit it from their parents.
Certain diseases, conditions, and substances also can cause the disease, such as:
Restrictive Cardiomyopathy
Certain diseases, conditions, and factors can cause restrictive cardiomyopathy, including:
Hemochromatosis (HE-mo-kro-mah-TOE-sis). This is a disease in which too much
iron builds up in your body. The extra iron is toxic to the body and can damage the
organs, including the
heart.
Sarcoidosis (sar-koy-DOE-sis). This disease causes
inflammation and can affect various
organs in the body. Researchers believe that an abnormal immune response may cause
sarcoidosis. This abnormal response causes tiny lumps of
cells to form in the body's organs, including the
heart.
Arrhythmogenic Right Ventricular Dysplasia
Researchers think that arrhythmogenic right ventricular dysplasia is an inherited disease.
Who Is at Risk for Cardiomyopathy?
People of all ages and races can have cardiomyopathy. However, certain types of the disease are more common in certain groups.
Dilated cardiomyopathy is more common in African Americans than Whites. This type of the disease also is more common in men than women.
Teens and young adults are more likely than older people to have arrhythmogenic right ventricular dysplasia, although it's rare in both groups.
Major Risk Factors
Certain diseases, conditions, or factors can raise your risk for cardiomyopathy. Major risk factors include:
Some people who have cardiomyopathy never have signs or symptoms. Thus, it's important to identify people who may be at high risk for the disease. This can help prevent future problems, such as serious arrhythmias (irregular heartbeats) or SCA.
How Is Cardiomyopathy Diagnosed?
Your doctor will diagnose cardiomyopathy based on your medical and family histories, a physical exam, and the results from tests and procedures.
Specialists Involved
Often, a cardiologist or pediatric cardiologist diagnoses and treats cardiomyopathy. A cardiologist specializes in diagnosing and treating heart diseases. A pediatric cardiologist is a cardiologist who treats children.
Physical Exam
Your doctor will use a stethoscope to listen to your heart and lungs for sounds that may suggest cardiomyopathy. These sounds may even suggest a certain type of the disease.
For example, the loudness, timing, and location of a heart murmur may suggest obstructive hypertrophic cardiomyopathy. A ""crackling"" sound in the lungs may be a sign of heart failure. (Heart failure often develops in the later stages of cardiomyopathy.)
Physical signs also help your doctor diagnose cardiomyopathy. Swelling of the ankles, feet, legs, abdomen, or veins in your neck suggests fluid buildup, a sign of heart failure.
Your doctor may notice signs and symptoms of cardiomyopathy during a routine exam. For example, he or she may hear a heart murmur, or you may have abnormal test results.
Diagnostic Tests
Your doctor may recommend one or more of the following tests to diagnose cardiomyopathy.
Blood Tests
During a blood test, a small amount of blood is taken from your body. It's often drawn from a vein in your arm using a needle. The procedure usually is quick and easy, although it may cause some short-term discomfort.
Blood tests give your doctor information about your heart and help rule out other conditions.
Chest X Ray
A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged. A chest x ray also can show whether fluid is building up in your lungs.
EKG (Electrocardiogram)
An EKG is a simple test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
This test is used to detect and study many heart problems, such as heart attacks, arrhythmias (irregular heartbeats), and heart failure. EKG results also can suggest other disorders that affect heart function.
A standard EKG only records the heartbeat for a few seconds. It won't detect problems that don't happen during the test.
To diagnose heart problems that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.
Holter and Event Monitors
Holter and event monitors are small, portable devices. They record your heart's electrical activity while you do your normal daily activities. A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period.
An event monitor records your heart's electrical activity only at certain times while you're wearing it. For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
Echocardiography
Echocardiography (echo) is a test that uses sound waves to create a moving picture of your heart. The picture shows how well your heart is working and its size and shape.
There are several types of echo, including stress echo. This test is done as part of a stress test (see below). Stress echo can show whether you have decreased blood flow to your heart, a sign of coronary heart disease.
Another type of echo is transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE. TEE provides a view of the back of the heart.
For this test, a sound wave wand is put on the end of a special tube. The tube is gently passed down your throat and into your esophagus (the passage leading from your mouth to your stomach). Because this passage is right behind the heart, TEE can create detailed pictures of the heart's structures.
Before TEE, you're given medicine to help you relax, and your throat is sprayed with numbing medicine.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.
These tests may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.
Diagnostic Procedures
You may have one or more medical procedures to confirm a diagnosis or to prepare for surgery (if surgery is planned). These procedures may include cardiac catheterization (KATH-e-ter-i-ZA-shun), coronary angiography (an-jee-OG-ra-fee), or myocardial (mi-o-KAR-de-al) biopsy.
Cardiac Catheterization
This procedure checks the pressure and blood flow in your heart's chambers. The procedure also allows your doctor to collect blood samples and look at your heart's arteries using x-ray imaging.
During cardiac catheterization, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to study the inside of your arteries for blockages.
Coronary Angiography
This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an x ray is injected into your coronary arteries. The dye lets your doctor study blood flow through your heart and blood vessels.
Dye also may be injected into your heart chambers. This allows your doctor to study the pumping function of your heart.
Myocardial Biopsy
For this procedure, your doctor removes a piece of your heart muscle. This can be done during cardiac catheterization. The heart muscle is studied under a microscope to see whether changes in cells have occurred. These changes may suggest cardiomyopathy.
Myocardial biopsy is useful for diagnosing some types of cardiomyopathy.
Genetic Testing
Some types of cardiomyopathy run in families. Thus, your doctor may suggest genetic testing to look for the disease in your parents, brothers and sisters, or other family members.
Genetic testing can show how the disease runs in families. It also can find out the chances of parents passing the genes for the disease on to their children.
Genetic testing also may be useful if your doctor thinks you have cardiomyopathy, but you don't yet have signs or symptoms. If the test shows you have the disease, your doctor can start treatment early, when it may work best.
How Is Cardiomyopathy Treated?
People who have cardiomyopathy but no signs or symptoms may not need treatment. Sometimes, dilated cardiomyopathy that comes on suddenly may even go away on its own.
For other people who have cardiomyopathy, treatment is needed. Treatment depends on the type of cardiomyopathy you have, the severity of your symptoms and complications, and your age and overall health.
The main goals of treating cardiomyopathy include:
Managing any conditions that cause or contribute to the disease
Controlling signs and symptoms so that you can live as normally as possible
Stopping the disease from getting worse
Treatments may include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias (irregular heartbeats), and/or a nonsurgical procedure.
Lifestyle Changes
Your doctor may suggest lifestyle changes to manage a condition that's causing your cardiomyopathy. These changes can help reduce symptoms.
Healthy Diet and Physical Activity
A healthy diet and physical activity are part of a healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and grains; half of your grains should come from whole-grain products.
Choose foods that are low in saturated fat, trans fat, and Go to:
What Is Carotid Artery Disease?
Carotid (ka-ROT-id) artery disease is a disease in which a waxy substance called plaque (plak) builds up inside the carotid arteries. You have two common carotid arteries, one on each side of your neck. They each divide into internal and external carotid arteries.
The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.
![]()
Carotid Arteries. Figure A shows the location of the right carotid artery in the head and neck. Figure B shows the inside of a normal carotid artery that has normal blood flow. Figure C show the inside of a carotid artery that has plaque buildup and reduced (more...)
Carotid artery disease is serious because it can cause a stroke, also called a “brain attack.” A stroke occurs if blood flow to your brain is cut off.
If blood flow is cut off for more than a few minutes, the cells in your brain start to die. This impairs the parts of the body that the brain cells control. A stroke can cause lasting brain damage; long-term disability, such as vision or speech problems or paralysis (an inability to move); or death.
Outlook
Carotid artery disease causes more than half of the strokes that occur in the United States. Other conditions, such as certain heart problems and bleeding in the brain, also can cause strokes.
Lifestyle changes, medicines, and medical procedures can help prevent or treat carotid artery disease and may reduce the risk of stroke.
If you think you're having a stroke, you need urgent treatment. Call 9–1–1 right away if you have symptoms of a stroke. Do not drive yourself to the hospital.
You have the best chance for full recovery if treatment to open a blocked artery is given within 4 hours of symptom onset. The sooner treatment occurs, the better your chances of recovery.
What Causes Carotid Artery Disease?
Carotid artery disease seems to start when damage occurs to the inner layers of the carotid arteries. Major factors that contribute to damage include:
When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.
The plaque in an artery can crack or rupture. If this happens, blood cell fragments called platelets will stick to the site of the injury and may clump together to form blood clots.
The buildup of plaque or blood clots can severely narrow or block the carotid arteries. This limits the flow of oxygen-rich blood to your brain, which can cause a stroke.
Who Is at Risk for Carotid Artery Disease?
Certain traits, conditions, or habits may raise your risk for carotid artery disease. These conditions are known as risk factors. The more risk factors you have, the more likely you are to get the disease. Some risk factors you can control, but others you can't.
The major risk factors for carotid artery disease, listed below, also are the major risk factors for coronary heart disease (also called coronary artery disease) and peripheral arterial disease.
Diabetes. With this disease, the body's
blood sugar level is too high because the body doesn't make enough
insulin or doesn't use its insulin properly. People who have diabetes are four times more likely to have
carotid artery disease than people who don't have diabetes.
Older age. As you get older, your risk for
carotid artery disease increases.
Genetic or lifestyle factors cause
plaque to build up in your
arteries as you age. Before age 75, the risk is greater in men than women. However, after age 75, the risk is greater in women.
Having any of these risk factors doesn't guarantee that you'll develop carotid artery disease. However, if you know that you have one or more risk factors, you can take steps to help prevent or delay the disease.
Steps include following a healthy lifestyle and taking medicines as your doctor prescribes. (For more information, go to “How Can Carotid Artery Disease Be Prevented?”)
If you have plaque buildup in your carotid arteries, you also may have plaque buildup in other arteries. People who have carotid artery disease also are at increased risk for coronary heart disease.
What Are the Signs and Symptoms of Carotid Artery Disease?
Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks a carotid artery. Signs and symptoms may include a bruit (broo-E), a transient ischemic attack (TIA), or a stroke.
Bruit
During a physical exam, your doctor may listen to your carotid arteries with a stethoscope. He or she may hear a whooshing sound called a bruit. This sound may suggest changed or reduced blood flow due to plaque buildup. To find out more, your doctor may recommend tests.
Not all people who have carotid artery disease have bruits.
Transient Ischemic Attack (Mini-Stroke)
For some people, having a TIA, or “mini-stroke,” is the first sign of carotid artery disease. During a mini-stroke, you may have some or all of the symptoms of a stroke. However, the symptoms usually go away on their own within 24 hours.
The symptoms may include:
Even if the symptoms stop quickly, you should see a doctor right away. Call 9–1–1 for help. Do not drive yourself to the hospital. It's important to get checked and to get treatment started as soon as possible.
A mini-stroke is a warning sign that you're at high risk of having a stroke. You shouldn't ignore these symptoms. About one-third of people who have mini-strokes will later have strokes. Getting medical care can help find possible causes of a mini-stroke and help you manage risk factors. These actions might prevent a future stroke.
Although a mini-stroke may warn of a stroke, it doesn't predict when a stroke will happen. A stroke may occur days, weeks, or even months after a mini-stroke. In about half of the cases of strokes that follow TIAs, the strokes occur within 1 year.
Stroke
The symptoms of a stroke are the same as those of a mini-stroke, but the results are not. A stroke can cause lasting brain damage; long-term disability, such as vision or speech problems or paralysis (an inability to move); or death. Most people who have strokes have not previously had warning mini-strokes.
Getting treatment for a stroke right away is very important. You have the best chance for full recovery if treatment to open a blocked artery is given within 4 hours of symptom onset. The sooner treatment occurs, the better your chances of recovery.
Call 9–1–1 for help as soon as symptoms occur. Do not drive yourself to the hospital. It's very important to get checked and to get treatment started as soon as possible.
Make those close to you aware of stroke symptoms and the need for urgent action. Learning the signs and symptoms of a stroke will allow you to help yourself or someone close to you lower the risk of brain damage or death due to a stroke.
How Is Carotid Artery Disease Diagnosed?
Your doctor will diagnose carotid artery disease based on your medical history, a physical exam, and test results.
Physical Exam
To check your carotid arteries, your doctor will listen to them with a stethoscope. He or she will listen for a whooshing sound called a bruit. This sound may indicate changed or reduced blood flow due to plaque buildup. To find out more, your doctor may recommend tests.
Diagnostic Tests
The following tests are common for diagnosing carotid artery disease. If you have symptoms of a mini-stroke or stroke, your doctor may use other tests as well.
Carotid Angiography
Carotid angiography (an-jee-OG-ra-fee) is a special type of x ray. This test may be used if the ultrasound results are unclear or don't give your doctor enough information.
For this test, your doctor will inject a substance (called contrast dye) into a vein, most often in your leg. The dye travels to your carotid arteries and highlights them on x-ray pictures.
Magnetic Resonance Angiography
Magnetic resonance angiography (MRA) uses a large magnet and radio waves to take pictures of your carotid arteries. Your doctor can see these pictures on a computer screen.
For this test, your doctor may give you contrast dye to highlight your carotid arteries on the pictures.
Computed Tomography Angiography
Computed tomography (to-MOG-rah-fee) angiography, or CT angiography, takes x-ray pictures of the body from many angles. A computer combines the pictures into two- and three-dimensional images.
For this test, your doctor may give you contrast dye to highlight your carotid arteries on the pictures.
How Is Carotid Artery Disease Treated?
Treatments for carotid artery disease may include lifestyle changes, medicines, and medical procedures. The goals of treatment are to stop the disease from getting worse and to prevent a stroke.
Your treatment will depend on your symptoms, how severe the disease is, and your age and overall health.
Lifestyle Changes
Making lifestyle changes can help prevent carotid artery disease or keep it from getting worse. For some people, these changes may be the only treatment needed:
Follow a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.
For information about healthy eating, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy eating, physical activity, and controlling your weight.
Therapeutic Lifestyle Changes (TLC). Your doctor may recommend a three-part program called TLC if you have high blood cholesterol. TLC includes a healthy diet, physical activity, and weight management.
With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found mainly in meat, poultry, and dairy products. No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.
You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the different kinds of fat in prepared foods can be found on the foods' Nutrition Facts labels.
Foods high in soluble fiber also are part of a healthy diet. They help block the digestive tract from absorbing cholesterol. These foods include:
Whole-grain cereals such as oatmeal and oat bran
Fruits such as apples, bananas, oranges, pears, and prunes
Legumes such as
kidney beans, lentils, chick peas, black-eyed peas, and lima beans
A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.
Fish are an important part of a healthy diet. They're a good source of omega-3 fatty acids, which help lower blood cholesterol levels. Try to have about two fish meals every week. Fish high in omega-3 fatty acids are salmon, tuna (canned or fresh), and mackerel.
You also should try to limit the amount of sodium (salt) that you eat. Too much sodium can raise your risk of high blood pressure. Choose low-sodium and ""no added salt"" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in an item.
Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.
For more information about TLC, go to the NHLBI's “Your Guide to Lowering Your Cholesterol With TLC.”
Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium.
DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber.
The DASH eating plan is a good healthy eating plan, even for those who don't have high blood pressure. For more information, go to the NHLBI's ""Your Guide to Lowering Your Blood Pressure With DASH.""
Be Physically Active
Regular physical activity can lower many carotid artery disease risk factors, including LDL (""bad"") cholesterol, high blood pressure, and excess weight.
Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL cholesterol is the “good” cholesterol that helps prevent plaque buildup.
Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.
People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.
For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Although the Health Topics article and “Your Guide” booklet focus on heart health, they include information that applies to general health and well-being.
Maintain a Healthy Weight
Maintaining a healthy weight can lower your risk for carotid artery disease and stroke. Even a modest weight gain can increase your risk of having a stroke.
If you're overweight, aim to reduce your weight by 7 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for carotid artery disease and other health problems.
After the first year, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25.
BMI measures your weight in relation to your height. A BMI between 25 and 29.9 is considered overweight for adults. A BMI of 30 or more is considered obese for adults. A BMI of less than 25 is the goal for preventing and treating carotid artery disease.
You can measure your BMI using the NHLBI's online calculator, or your health care provider can measure your BMI.
For more information about losing weight or maintaining a healthy weight, go to the Health Topics Overweight and Obesity article.
Quit Smoking
If you smoke or use tobacco, quit. Smoking can damage your arteries and raise your risk for stroke and other health problems. Also, try to avoid secondhand smoke.
Talk with your doctor about programs and products that can help you quit. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general information about how to quit smoking.
The U.S. Department of Health and Human Services also has information about how to quit smoking.
Medicines
You may need medicines to treat diseases and conditions that damage the carotid arteries. High blood pressure, high blood cholesterol, and diabetes can worsen carotid artery disease.
Some people can control these risk factors with lifestyle changes. Others also need medicines to achieve and maintain control.
You may need anticlotting medicines to prevent blood clots from forming in your carotid arteries and causing a stroke. Damage and plaque buildup make blood clots more likely.
Aspirin and clopidogrel are two common anticlotting medicines. They stop platelets from clumping together to form clots. These medicines are a mainstay of treatment for people who have known carotid artery disease.
Your health care team will help find a treatment plan that's right for you. Sticking to this plan will help avoid further harm to your carotid arteries.
If you have a stroke due to a blood clot, you may be given a clot-dissolving, or clot-busting, medicine. This type of medicine must be given within 4 hours of symptom onset.
The sooner treatment occurs, the better your chances of recovery. Thus, it's important to know the signs and symptoms of a stroke and call 9–1–1 right away for emergency care.
Medical Procedures
You may need a medical procedure to treat carotid artery disease. Doctors use one of two methods to open narrowed or blocked carotid arteries: carotid endarterectomy (END-ar-ter-EK-to-me) and carotid artery angioplasty and stenting.
Carotid Endarterectomy
Carotid endarterectomy is mainly for people whose carotid arteries are blocked 50 percent or more.
For the procedure, a surgeon will make a cut in your neck to reach the narrowed or blocked carotid artery. Next, your surgeon will make a cut in the blocked part of the artery and remove the artery's inner lining.
Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the cut in your neck.
![]()
Carotid Endarterectomy. The illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery that has plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery (more...)
Carotid Artery Angioplasty and Stenting
Doctors use a procedure called angioplasty (AN-jee-oh-plas-tee) to widen the carotid arteries and restore blood flow to the brain.
A thin tube with a deflated balloon on the end is threaded through a blood vessel in your neck to the narrowed or blocked carotid artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery.
A stent (a small mesh tube) is then put in the artery to support the inner artery wall. The Go to:
What Is Childhood Interstitial Lung Disease?
Childhood interstitial (in-ter-STISH-al) lung disease, or chILD, is a broad term for a group of rare lung diseases that can affect babies, children, and teens. These diseases have some similar symptoms, such as chronic cough, rapid breathing, and shortness of breath.
These diseases also harm the lungs in similar ways. For example, they damage the tissues that surround the lungs' alveoli (al-VEE-uhl-eye; air sacs) and bronchial tubes (airways). Sometimes these diseases directly damage the air sacs and airways.
The various types of chILD can decrease lung function, reduce blood oxygen levels, and disturb the breathing process.
Overview
Researchers have only begun to study, define, and understand chILD in the last decade. Currently, they don't know how many children have chILD. They also don't know how many children have each type of chILD.
Diagnosing chILD and its specific diseases is hard because chILD is rare and complex. Also, chILD is a broad term for a group of diseases with similar symptoms—it's not a precise diagnosis.
Interstitial lung disease (ILD) also occurs in adults. However, the cause of ILD in adults may be different than the cause in children. Some types of chILD are similar to the adult forms of the disease. They may even have the same names as the adult forms, such as hypersensitivity pneumonitis (noo-mo-NI-tis), immunodeficiency-associated lung disease, and bronchiolitis (brong-ke-o-LI-tis) obliterans.
However, research shows that the course and outcomes of these diseases often are very different for children than for adults.
Some ILDs only occur in children. They include:
Outlook
Each form of chILD may differ in its severity and how it's treated. Thus, getting a correct diagnosis is vital for understanding and treating your child's illness.
You may want to consult a pediatric pulmonologist. This is a doctor who specializes in diagnosing and treating children who have lung diseases and conditions. This doctor's training and experience can help him or her diagnose chILD.
The outlook for children who have chILD also depends on the specific type of disease they have. Some diseases are very severe and lead to early death. Others are chronic (long-term) diseases that parents and the child's medical team must work together to manage.
At this time, chILD has no cure. However, some children who have certain diseases, such as NEHI, may slowly improve over time.
Researchers are now starting to learn more about the causes of chILD. They're also trying to find distinct patterns and traits for the various forms of chILD. This information may help doctors better understand these diseases.
Types of Childhood Interstitial Lung Disease
The broad term ""childhood interstitial lung disease"" (chILD) refers to a group of rare lung diseases that can affect babies, children, and teens. Some of these diseases are more common in certain age groups.
Diseases more common in infancy include:
Diseases more common in children older than 2 years of age and teens include:
Other primary disorders:
Pulmonary vascular disorders (haemangiomatosis)
ILD associated with systemic disease processes:
Histiocytosis
Storage diseases
The various types of chILD can affect many parts of the lungs, including the alveoli (air sacs), bronchial tubes (airways), and capillaries. (Capillaries are the tiny blood vessels that surround the air sacs.) The structures of the lung that chILD may affect are shown in the illustration below.
![]()
Normal Lungs and Lung Structures. Figure A shows the location of the lungs and airways in the body. Figure B is a detailed view of the lung structures that childhood interstitial lung disease may affect, such as the bronchioles, neuroendocrine cells, (more...)
Other Names for Childhood Interstitial Lung Disease
What Causes Childhood Interstitial Lung Disease?
Researchers don't yet know all of the causes of childhood interstitial lung disease (chILD). Many times, these diseases have no clear cause.
Some conditions and factors that may cause or lead to chILD include:
Inherited conditions, such as surfactant disorders. Surfactant is a liquid that coats the inside of the
lungs. It helps with breathing and may help protect the lungs from bacterial and
viral infections.
Aspiration (as-pih-RA-shun). This term refers to
inhaling substances—such as food, liquid, or
vomit—into the
lungs. Inhaling these substances can injure the lungs. Aspiration may occur in children who have
swallowing problems or gastroesophageal (GAS-tro-eh-so-fa-JE-al) reflux disease (GERD). GERD occurs if acid from the
stomach backs up into the
throat.
Exposure to substances in the environment that can irritate the
lungs, such as
molds and chemicals.
Who Is at Risk for Childhood Interstitial Lung Disease?
Childhood interstitial lung disease (chILD) is rare. Most children are not at risk for chILD. However, some factors increase the risk of developing chILD. These risk factors include:
Having an inherited surfactant disorder or a
family history of this type of disorder. Surfactant is a liquid that coats the inside of the
lungs. It helps with breathing and may help protect the lungs from bacterial and
viral infections.
Having an
immune system disorder. The immune system protects the body against
bacteria,
viruses, and
toxins. Children who have immune system disorders aren't able to fight illness and disease as well as children who have healthy
immune systems.
Being exposed to substances in the environment that can irritate the
lungs, such as
molds and chemicals.
Certain types of chILD are more common in infants and young children, while others can occur in children of any age. For more information, go to ""Types of Childhood Interstitial Lung Disease.""
The risk of death seems to be higher for children who have chILD and pulmonary hypertension, developmental or growth disorders, bone marrow transplants, or certain surfactant problems.
What Are the Signs and Symptoms of Childhood Interstitial Lung Disease?
Childhood interstitial lung disease (chILD) has many signs and symptoms because the disease has many forms. Signs and symptoms may include:
If your child has any of these signs and symptoms, contact his or her doctor. The doctor may refer you to a pediatric pulmonologist. This is a doctor who specializes in diagnosing and treating children who have lung diseases and conditions.
How Is Childhood Interstitial Lung Disease Diagnosed?
Doctors diagnose childhood interstitial lung disease (chILD) based on a child's medical and family histories and the results from tests and procedures. To diagnose chILD, doctors may first need to rule out other diseases as the cause of a child's symptoms.
Early diagnosis of chILD may help doctors stop or even reverse lung function problems. Often though, doctors find chILD hard to diagnose because:
There are many types of the disease and a range of underlying causes
The disease's signs and symptoms are the same as those for many other diseases
The disease may coexist with other diseases
Going to a pediatric pulmonologist who has experience with chILD is helpful. A pediatric pulmonologist is a doctor who specializes in diagnosing and treating children who have lung diseases and conditions.
Medical and Family Histories
Your child's medical history can help his or her doctor diagnose chILD. The doctor may ask whether your child:
Has severe breathing problems that occur often.
Has had severe lung infections.
Had serious lung problems as a newborn.
Has been exposed to possible lung irritants in the environment, such as birds,
molds, dusts, or chemicals.
The doctor also may ask how old your child was when symptoms began, and whether other family members have or have had severe lung diseases. If they have, your child may have an inherited form of chILD.
Diagnostic Tests and Procedures
No single test can diagnose the many types of chILD. Thus, your child's doctor may recommend one or more of the following tests. For some of these tests, infants and young children may be given medicine to help them relax or sleep.
Lung function tests. These tests measure how much air your child can breathe in and out, how fast he or she can breathe air out, and how well your child's
lungs deliver
oxygen to the
blood. Lung function tests can assess the severity of
lung disease. Infants and young children may need to have these tests at a center that has special equipment for children.
Bronchoalveolar lavage (BRONG-ko-al-VE-o-lar lah-VAHZH). For this procedure, the doctor injects a small amount of
saline (salt water) through a tube inserted in the child's
lungs. The fluid helps bring up
cells from the
tissues around the air
sacs. The doctor can then look at these cells under a microscope. This procedure can help detect an
infection, lung injury,
bleeding,
aspiration, or an airway problem.
Various tests for systemic diseases linked to chILD. Systemic diseases are diseases that involve many of the body's
organs.
If these tests don't provide enough information, your child's doctor may recommend a lung biopsy. A lung biopsy is the most reliable way to diagnose chILD and the specific disease involved.
A lung biopsy is a surgical procedure that's done in a hospital. Before the biopsy, your child will receive medicine to make him or her sleep.
During the biopsy, the doctor will take small samples of lung tissue from several places in your child's lungs. This often is done using video-assisted thoracoscopy (thor-ah-KOS-ko-pe).
For this procedure, the doctor inserts a small tube with a light and camera (endoscope) into your child's chest through small cuts between the ribs. The endoscope provides a video image of the lungs and allows the doctor to collect tissue samples.
After the biopsy, the doctor will look at these samples under a microscope.
How Is Childhood Interstitial Lung Disease Treated?
Childhood interstitial lung disease (chILD) is rare, and little research has been done on how to treat it. At this time, chILD has no cure. However, some children who have certain diseases, such as neuroendocrine cell hyperplasia of infancy, may slowly improve over time.
Current treatment approaches include supportive therapy, medicines, and, in the most serious cases, lung transplants.
Supportive Therapy
Supportive therapy refers to treatments that help relieve symptoms or improve quality of life. Supportive approaches used to relieve common chILD symptoms include:
Bronchodilators. These medications relax the
muscles around your child’s airways, which helps open the airways and makes breathing easier.
Breathing devices. Children who have severe disease may need
ventilators or other devices to help them breathe easier.
Extra nutrition. This
treatment can help improve your child's growth and help him or her gain weight. Close monitoring of growth is especially important.
Techniques and devices to help relieve lung congestion. These may include
chest physical therapy (CPT) or wearing a vest that helps move
mucus (a sticky substance) to the upper airways so it can be coughed up. CPT may involve pounding the chest and back over and over with your
hands or a device to loosen mucus in the
lungs so that your child can
cough it up.
Medicines
Corticosteroids are a common treatment for many children who have chILD. These medicines help reduce lung inflammation.
Other medicines can help treat specific types or causes of chILD. For example, antimicrobial medicines can treat a lung infection. Acid-blocking medicines can prevent acid reflux, which can lead to aspiration.
How Can Childhood Interstitial Lung Disease Be Prevented?
At this time, most types of childhood interstitial lung disease (chILD) can't be prevented. People who have a family history of inherited (genetic) interstitial lung disease may want to consider genetic counseling. A counselor can explain the risk of children inheriting chILD.
You and your child can take steps to help prevent infections and other illnesses that worsen chILD and its symptoms. For example:
Try to keep your child away from people who are sick. Even a
common cold can cause problems for someone who has chILD.
Talk with your child's doctor about vaccines that your child needs, such as an annual
flu shot. Make sure everyone in your household gets all of the vaccines that their doctors recommend.
Talk with your child's doctor about how to prevent your child from getting
respiratory syncytial (sin-SIT-e-al) virus. This common virus leads to cold and
flu symptoms for most people. However, it can make children who have
lung diseases very sick.
Avoid exposing your child to air pollution,
tobacco smoke, and other substances that can irritate his or her
lungs. Strongly advise your child not to smoke now or in the future.
Living With Childhood Interstitial Lung Disease
Caring for a child who has childhood interstitial lung disease (chILD) can be challenging. However, you can take steps to help your child manage his or her disease.
Make sure your child gets ongoing care and seek support to help you, your child, and your other family members cope with the effects of chILD on daily life.
Ongoing Care
Work with your child's health care team to manage your child's symptoms and keep him or her as healthy as possible.
This team may include doctors, nurses, dietitians, social workers, physical therapists, and home health aides. Each of these specialists may have services that can help you and your child cope with his or her lung disease.
You also can take other steps to help manage your child's care. For example:
Give your child all of his or her prescribed medicines. Make sure to take your child to all followup medical visits.
Work with your child's health care team to ensure that your child is getting good nutrition. Your child's health care team also can suggest physical activities that meet your child's needs.
Ask your child's doctor about warning signs of worsening
lung disease and when to seek emergency medical care. Agree on a plan of action if these warning signs occur.
Keep complete records of your child's care and any instructions you receive. This information can help you manage care at home and inform various doctors about your child's
medical history and status.
Many children who have chILD need oxygen therapy to help them breathe easier. Portable oxygen units can make it easier for your child to move around and do many daily activities.
If your child's doctor prescribes oxygen therapy, work with a home equipment provider to make sure you have the supplies and equipment you need. Trained personnel will show you how to use the equipment correctly and safely.
Ongoing Support
Your child may need support to help other people in his or her life understand the special needs related to chILD. For example, you may want to talk with your child's teachers about your child's illness. You can work with the teachers to decide how to meet your child's special school-related needs.
You also may want to alert relatives, caregivers, friends, and parents of friends about your child's illness. Let them know about your child's usual care and any signs or symptoms that require emergency care.
Taking care of yourself also is important. Managing your child's disease and ongoing care can be stressful. You and your family members may feel sad, guilty, or overwhelmed.
Social workers and mental health providers can help you cope with your feelings and provide support. They also can connect you with family support groups. Taking part in a support group can show you how other people have coped with chILD.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.
When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.
If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to childhood interstitial lung disease, talk with your doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
- What Is Childhood Interstitial Lung Disease?
- Types of Childhood Interstitial Lung Disease
- Other Names for Childhood Interstitial Lung Disease
- What Causes Childhood Interstitial Lung Disease?
- Who Is at Risk for Childhood Interstitial Lung Disease?
- What Are the Signs and Symptoms of Childhood Interstitial Lung Disease?
- How Is Childhood Int","June 11, 2014."
22,3,"2018-02-02 04:25:06",c,22,"2018-02-02 05:08:48","Congenital Heart Defects","
What Are Congenital Heart Defects?
Congenital (kon-JEN-ih-tal) heart defects are problems with the heart's structure that are present at birth. These defects can involve:
The interior walls of the
heartThe valves inside the
heart
Congenital heart defects change the normal flow of blood through the heart.
There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms.
Congenital heart defects are the most common type of birth defect. They affect 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with congenital heart defects.
Many of these defects are simple conditions. They need no treatment or are easily fixed. Some babies are born with complex congenital heart defects. These defects require special medical care soon after birth.
The diagnosis and treatment of complex heart defects has greatly improved over the past few decades. As a result, almost all children who have complex heart defects survive to adulthood and can live active, productive lives.
Most people who have complex heart defects continue to need special heart care throughout their lives. They may need to pay special attention to how their condition affects issues such as health insurance, employment, birth control and pregnancy, and other health issues.
In the United States, more than 1 million adults are living with congenital heart defects.
How the Heart Works
To understand congenital heart defects, it's helpful to know how a healthy heart works. Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.
![]()
A Healthy Heart Cross-Section. The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which (more...)
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-
pid) valve is in the right side of the
heart, between the right atrium and the right
ventricle.
The mitral (MI-trul) valve is in the left side of the
heart, between the left atrium and the left
ventricle.
The aortic (ay-OR-tik) valve is in the left side of the
heart, between the left
ventricle and the entrance to the
aorta. This
artery carries
blood from the heart to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a ""lub-DUB"" sound that a doctor can hear using a stethoscope.
The first sound—the ""lub""—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the
ventricles contract, or squeeze, and pump
blood out of the
heart.
The second sound—the ""DUB""—is made by the aortic and
pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the
ventricles relax and fill with
blood pumped into them by the
atria.
Veins
The veins also are major blood vessels connected to your heart.
For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.
Types of Congenital Heart Defects
With congenital heart defects, some part of the heart doesn’t form properly before birth. This changes the normal flow of blood through the heart.
There are many types of congenital heart defects. Some are simple, such as a hole in the septum. The hole allows blood from the left and right sides of the heart to mix. Another example of a simple defect is a narrowed valve that blocks blood flow to the lungs or other parts of the body.
Other heart defects are more complex. They include combinations of simple defects, problems with the location of blood vessels leading to and from the heart, and more serious problems with how the heart develops.
Examples of Simple Congenital Heart Defects
Holes in the Heart (Septal Defects)
The septum is the wall that separates the chambers on left and right sides of the heart. The wall prevents blood from mixing between the two sides of the heart. Some babies are born with holes in the septum. These holes allow blood to mix between the two sides of the heart.
Atrial septal defect (ASD). An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. The hole allows oxygen-rich blood from the left atrium to flow into the right atrium, instead of flowing into the left ventricle as it should. Many children who have ASDs have few, if any, symptoms.
![]()
Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect. Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with an atrial septal defect. The hole allows oxygen-rich blood from the left atrium to mix (more...)
ASDs can be small, medium, or large. Small ASDs allow only a little blood to leak from one atrium to the other. They don't affect how the heart works and don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood.
Medium and large ASDs allow more blood to leak from one atrium to the other. They’re less likely to close on their own.
About half of all ASDs close on their own over time. Medium and large ASDs that need treatment can be repaired using a catheter procedure or open-heart surgery.
Ventricular septal defect (VSD). A VSD is a hole in the part of the septum that separates the ventricles—the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle into the right ventricle, instead of flowing into the aorta and out to the body as it should.
![]()
Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect Cross-Section of a Normal Heart and a Heart With a Ventricular Septal Defect. Figure A shows the structure and blood flow inside a normal heart. Figure B shows two common locations (more...)
VSDs can be small, medium, or large. Small VSDs don't cause problems and may close on their own. Medium VSDs are less likely to close on their own and may require treatment.
Large VSDs allow a lot of blood to flow from the left ventricle to the right ventricle. As a result, the left side of the heart must work harder than normal. Extra blood flow increases blood pressure in the right side of the heart and the lungs.
The heart’s extra workload can cause heart failure and poor growth. If the hole isn't closed, high blood pressure can scar the arteries in the lungs.
Doctors use open-heart surgery to repair VSDs.
Patent Ductus Arteriosus
Patent ductus arteriosus (PDA) is a fairly common heart defect that can occur soon after birth. In PDA, abnormal blood flow occurs between the aorta and the pulmonary artery.
Before birth, these arteries are connected by a blood vessel called the ductus arteriosus. This blood vessel is an essential part of fetal blood circulation. Within minutes or up to a few days after birth, the ductus arteriosus closes.
In some babies, however, the ductus arteriosus remains open (patent). The opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries.
A heart murmur might be the only sign of PDA. (A heart murmur is an extra or unusual sound heard during a heartbeat.) Other signs and symptoms can include shortness of breath, poor feeding and growth, tiring easily, and sweating with exertion.
PDA is treated with medicines, catheter-based procedures, and surgery. Small PDAs often close without treatment.
Narrowed Valves
Simple congenital heart defects also can involve the heart's valves. These valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart (the aorta and the pulmonary artery).
Valves can have the following types of defects:
Stenosis (steh-NO-sis). This defect occurs if the flaps of a valve thicken, stiffen, or fuse together. As a result, the valve cannot fully open. Thus, the
heart has to work harder to pump
blood through the valve.
Atresia (ah-TRE-ze-AH). This defect occurs if a valve doesn't form correctly and lacks a hole for
blood to pass through. Atresia of a valve generally results in more complex
congenital heart disease.
Regurgitation (re-GUR-jih-TA-shun). This defect occurs if a valve doesn't close tightly. As a result,
blood leaks back through the valve.
The most common valve defect is pulmonary valve stenosis, which is a narrowing of the pulmonary valve. This valve allows blood to flow from the right ventricle into the pulmonary artery. The blood then travels to the lungs to pick up oxygen.
Pulmonary valve stenosis can range from mild to severe. Most children who have this defect have no signs or symptoms other than a heart murmur. Treatment isn't needed if the stenosis is mild.
In babies who have severe pulmonary valve stenosis, the right ventricle can get very overworked trying to pump blood to the pulmonary artery. These infants may have signs and symptoms such as rapid or heavy breathing, fatigue (tiredness), and poor feeding. Older children who have severe pulmonary valve stenosis may have symptoms such as fatigue while exercising.
Some babies may have pulmonary valve stenosis and PDA or ASDs. If this happens, oxygen-poor blood can flow from the right side of the heart to the left side. This can cause cyanosis (si-ah-NO-sis). Cyanosis is a bluish tint to the skin, lips, and fingernails. It occurs because the oxygen level in the blood leaving the heart is below normal.
Severe pulmonary valve stenosis is treated with a catheter procedure.
Example of a Complex Congenital Heart Defect
Complex congenital heart defects need to be repaired with surgery. Advances in treatment now allow doctors to successfully repair even very complex congenital heart defects.
The most common complex heart defect is tetralogy of Fallot (teh-TRAL-o-je of fah-LO), which is a combination of four defects:
A large VSD.
Right ventricular
hypertrophy (hi-PER-tro-fe). In this defect, the
muscle of the right
ventricle is thicker than usual because it has to work harder than normal.
In tetralogy of Fallot, not enough blood is able to reach the lungs to get oxygen, and oxygen-poor blood flows to the body.
![]()
Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect Cross-Section of a Normal Heart and a Heart With a Ventricular Septal Defect Cross-Section of a Normal Heart and a Heart With Tetralogy of Fallot. Figure A shows the structure and (more...)
Babies and children who have tetralogy of Fallot have episodes of cyanosis, which can be severe. In the past, when this condition wasn't treated in infancy, older children would get very tired during exercise and might faint. Tetralogy of Fallot is repaired in infancy now to prevent these problems.
Tetralogy of Fallot must be repaired with open-heart surgery, either soon after birth or later in infancy. The timing of the surgery will depend on how narrow the pulmonary artery is.
Children who have had this heart defect repaired need lifelong medical care from a specialist to make sure they stay as healthy as possible.
Other Names for Congenital Heart Defects
What Are the Signs and Symptoms of Congenital Heart Defects?
Many congenital heart defects cause few or no signs and symptoms. A doctor may not even detect signs of a heart defect during a physical exam.
Some heart defects do cause signs and symptoms. They depend on the number, type, and severity of the defects. Severe defects can cause signs and symptoms, usually in newborns. These signs and symptoms may include:
Rapid breathing
Cyanosis (a bluish tint to the
skin,
lips, and fingernails)
Congenital heart defects don't cause chest pain or other painful symptoms.
Heart defects can cause heart murmurs (extra or unusual sounds heard during a heartbeat). Doctors can hear heart murmurs using a stethoscope. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs.
Normal growth and development depend on a normal workload for the heart and normal flow of oxygen-rich blood to all parts of the body. Babies who have congenital heart defects may have cyanosis and tire easily while feeding. As a result, they may not gain weight or grow as they should.
Older children who have congenital heart defects may get tired easily or short of breath during physical activity.
Many types of congenital heart defects cause the heart to work harder than it should. With severe defects, this can lead to heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Symptoms of heart failure include:
How Are Congenital Heart Defects Diagnosed?
Severe congenital heart defects generally are diagnosed during pregnancy or soon after birth. Less severe defects often aren't diagnosed until children are older.
Minor defects often have no signs or symptoms. Doctors may diagnose them based on results from a physical exam and tests done for another reason.
Specialists Involved
Pediatric cardiologists are doctors who specialize in the care of babies and children who have heart problems. Cardiac surgeons are specialists who repair heart defects using surgery.
Physical Exam
During a physical exam, the doctor will:
Look for signs of a
heart defect, such as cyanosis (a bluish tint to the
skin,
lips, or fingernails), shortness of breath, rapid breathing, delayed growth, or signs of
heart failure
Diagnostic Tests
Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen.
Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.
Echo is an important test for both diagnosing a heart problem and following the problem over time. The test can show problems with the heart's structure and how the heart is reacting to those problems. Echo will help your child's cardiologist decide if and when treatment is needed.
During pregnancy, if your doctor suspects that your baby has a congenital heart defect, fetal echo can be done. This test uses sound waves to create a picture of the baby's heart while the baby is still in the womb.
Fetal echo usually is done at about 18 to 22 weeks of pregnancy. If your child is diagnosed with a congenital heart defect before birth, your doctor can plan treatment before the baby is born.
EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can detect if one of the heart's chambers is enlarged, which can help diagnose a heart problem.
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged. It also can show whether the lungs have extra blood flow or extra fluid, a sign of heart failure.
Pulse Oximetry
For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood.
Cardiac Catheterization
During cardiac catheterization (","June 11, 2014."
23,3,"2018-02-02 04:25:06",c,23,"2018-02-02 05:09:00","Coronary Heart Disease","
What Is Coronary Heart Disease?
Coronary heart disease (CHD) is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). The buildup of plaque occurs over many years.
![]()
Atherosclerosis. Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. (more...)
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.
Outlook
CHD is the most common type of heart disease. In the United States, CHD is the #1 cause of death for both men and women. Lifestyle changes, medicines, and medical procedures can help prevent or treat CHD. These treatments may reduce the risk of related health problems.
Other Names for Coronary Heart Disease
Ischemic (is-KE-mik)
heart disease
Who Is at Risk for Coronary Heart Disease?
In the United States, coronary heart disease (CHD) is the #1 cause of death for both men and women. Each year, more than 400,000 Americans die from CHD.
Certain traits, conditions, or habits may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.
You can control many risk factors, which may help prevent or delay CHD.
Major Risk Factors
Diabetes. With this disease, the body's
blood sugar level is too high because the body doesn't make enough
insulin or doesn't use its insulin properly.
Unhealthy diet. An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and
trans fats,
cholesterol, sodium (salt), and
sugar can worsen other risk factors for CHD.
Older age.
Genetic or lifestyle factors cause
plaque to build up in your
arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk for CHD increases after age 45. In women, the risk for CHD increases after age 55.
Family history of early
heart disease. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.
Although older age and a family history of early heart disease are risk factors, it doesn't mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults.
Emerging Risk Factors
Researchers continue to study other possible risk factors for CHD.
High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk of CHD and heart attack. High levels of CRP are a sign of inflammation in the body.
Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls may trigger inflammation and help plaque grow.
Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of CHD and heart attack.
High levels of triglycerides (tri-GLIH-seh-rides) in the blood also may raise the risk of CHD, especially in women. Triglycerides are a type of fat.
Other Risks Related to Coronary Heart Disease
Other conditions and factors also may contribute to CHD, including:
Stress. Research shows that the most commonly reported ""trigger"" for a
heart attack is an emotionally upsetting event, especially one involving anger.
Alcohol. Heavy drinking can damage the
heart muscle and worsen other CHD risk factors. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.
For more detailed information, go to the Health Topics Coronary Heart Disease Risk Factors article.
What Are the Signs and Symptoms of Coronary Heart Disease?
A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure. When you have heart failure, your heart can't pump enough blood to meet your body’s needs. Fluid builds up in your lungs, making it hard to breathe.
The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.
Signs and Symptoms of Heart Problems Related to Coronary Heart Disease
Some people who have CHD have no signs or symptoms—a condition called silent CHD. The disease might not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).
Heart Attack
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. This can happen if an area of plaque in a coronary artery ruptures (breaks open).
Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. If a clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
![]()
Heart With Muscle Damage and a Blocked Artery. Figure A shows the location of the heart in the body. Figure B is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure C is a cross-section of the (more...)
The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.
The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.
The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.
Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) might be a sign of a heart attack. If you don’t know whether your chest pain is angina or a heart attack, call 9–1–1.
All chest pain should be checked by a doctor.
Other common signs and symptoms of a heart attack include:
Upper body discomfort in one or both
arms, the back,
neck,
jaw, or upper part of the
stomachShortness of breath, which may occur with or before
chest discomfort
For more information, go to the Health Topics Heart Attack article.
Heart Failure
Heart failure is a condition in which your heart can't pump enough blood to meet your body’s needs. Heart failure doesn't mean that your heart has stopped or is about to stop working.
The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, and veins in the neck.
All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
For more information, go to the Health Topics Heart Failure article.
Arrhythmia
An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast.
Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations (pal-pih-TA-shuns).
Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA usually causes death if it's not treated within minutes.
For more information, go to the Health Topics Arrhythmia article.
How Is Coronary Heart Disease Diagnosed?
Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures.
No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Stress Testing
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to raise your heart rate.
When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:
Shortness of breath or
chest pain
Abnormal changes in your
heart rhythm or your heart's electrical activity
If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).
As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.
Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
Coronary Angiography and Cardiac Catheterization
Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors show that you're likely to have CHD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.
Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter.
How Is Coronary Heart Disease Treated?
Treatments for coronary heart disease (CHD) include lifestyle changes, medicines, and medical procedures. Treatment goals may include:
Lifestyle Changes
Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes might be the only treatment that some people need.
Follow a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.
For information about healthy eating, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy eating, physical activity, and controlling your weight.
Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high blood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management.
With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.
You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods' Nutrition Facts labels.
Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:
Whole-grain cereals such as oatmeal and oat bran
Fruits such as apples, bananas, oranges, pears, and prunes
Legumes such as
kidney beans, lentils, chick peas, black-eyed peas, and lima beans
A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.
A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.
You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and ""no added salt"" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.
Try to limit drinks that contain alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.
For more information about TLC, go to the NHLBI's ""Your Guide to Lowering Your Cholesterol With TLC.""
Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart h","June 11, 2014."
24,3,"2018-02-02 04:25:06",c,24,"2018-02-02 05:09:20","Coronary Heart Disease Risk Factors","
What Are Coronary Heart Disease Risk Factors?
Coronary heart disease risk factors are conditions or habits that raise your risk of coronary heart disease (CHD) and heart attack. These risk factors also increase the chance that existing CHD will worsen.
CHD, also called coronary artery disease, is a condition in which a waxy substance called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
Plaque narrows the arteries and reduces blood flow to your heart muscle. Reduced blood flow can cause chest pain, especially when you're active. Eventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque.
If the clot becomes large enough, it can block the flow of oxygen-rich blood to the portion of heart muscle fed by the artery. Blocked blood flow to the heart muscle causes a heart attack.
Overview
There are many known CHD risk factors. You can control some risk factors, but not others. Risk factors you can control include:
The risk factors you can't control are age, gender, and family history of CHD.
Many people have at least one CHD risk factor. Your risk of CHD and heart attack increases with the number of risk factors you have and their severity. Also, some risk factors put you at greater risk of CHD and heart attack than others. Examples of these risk factors include smoking and diabetes.
Many CHD risk factors start during childhood. This is even more common now because many children are overweight and don't get enough physical activity. Some CHD risk factors can even develop within the first 10 years of life.
Researchers continue to study and learn more about CHD risk factors.
Outlook
CHD is the #1 killer of both women and men in the United States. Following a healthy lifestyle can help you and your children prevent or control many CHD risk factors.
Because many lifestyle habits begin during childhood, parents and families should encourage their children to make heart healthy choices. For example, you and your children can lower your risk of CHD if you maintain a healthy weight, follow a healthy diet, do physical activity regularly, and don't smoke.
On average, people at low risk of CHD live nearly 10 years longer than people at high risk of CHD.
If you already have CHD, lifestyle changes can help you control your risk factors. This may prevent CHD from worsening. Even if you're in your seventies or eighties, a healthy lifestyle can lower your risk of dying from CHD.
If lifestyle changes aren't enough, your doctor may recommend other treatments to help control your risk factors.
Your doctor can help you find out whether you have CHD risk factors. He or she also can help you create a plan for lowering your risk of CHD, heart attack, and other heart problems.
If you have children, talk with their doctors about their heart health and whether they have CHD risk factors. If they do, ask your doctor to help create a treatment plan to reduce or control these risk factors.
Coronary Heart Disease Risk Factors
High Blood Cholesterol and Triglyceride Levels
Cholesterol
High blood cholesterol is a condition in which your blood has too much cholesterol—a waxy, fat-like substance. The higher your blood cholesterol level, the greater your risk of coronary heart disease (CHD) and heart attack.
Cholesterol travels through the bloodstream in small packages called lipoproteins (LI-po-pro-teens). Two major kinds of lipoproteins carry cholesterol throughout your body:
High-density
lipoproteins (HDL).
HDL cholesterol sometimes is called ""good"" cholesterol. This is because it helps remove cholesterol from your
arteries. A low HDL cholesterol level raises your risk of CHD.
Many factors affect your cholesterol levels. For example, after menopause, women's LDL cholesterol levels tend to rise, and their HDL cholesterol levels tend to fall. Other factors—such as age, gender, diet, and physical activity—also affect your cholesterol levels.
Healthy levels of both LDL and HDL cholesterol will prevent plaque from building up in your arteries. Routine blood tests can show whether your blood cholesterol levels are healthy. Talk with your doctor about having your cholesterol tested and what the results mean.
Children also can have unhealthy cholesterol levels, especially if they're overweight or their parents have high blood cholesterol. Talk with your child's doctor about testing your child' cholesterol levels.
To learn more about high blood cholesterol and how to manage the condition, go to the Health Topics High Blood Cholesterol article.
Triglycerides
Triglycerides are a type of fat found in the blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of CHD, especially in women.
High Blood Pressure
""Blood pressure"" is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. ""Systolic"" refers to blood pressure when the heart beats while pumping blood. ""Diastolic"" refers to blood pressure when the heart is at rest between beats.
You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
All levels above 120/80 mmHg raise your risk of CHD. This risk grows as blood pressure levels rise. Only one of the two blood pressure numbers has to be above normal to put you at greater risk of CHD and heart attack.
Often, high blood pressure has no signs or symptoms. However, the condition can be detected using a simple test that involves placing a blood pressure cuff around your arm.
Most adults should have their blood pressure checked at least once a year. If you have high blood pressure, you'll likely need to be checked more often. Talk with your doctor about how often you should have your blood pressure checked.
Children also can develop high blood pressure, especially if they're overweight. Your child's doctor should check your child's blood pressure at each routine checkup.
In children, blood pressure normally rises with age and body size. Newborns often have very low blood pressure numbers, while older teens have numbers similar to adults. The ranges for normal blood pressure and high blood pressure generally are lower for youth than for adults.
Your child should have routine blood pressure checks starting at 3 years of age. To find out whether a child has high blood pressure, a doctor will compare the child's blood pressure numbers to average numbers for his or her age, gender, and height.
Both children and adults are more likely to develop high blood pressure if they're overweight or have diabetes.
For more information about high blood pressure and how to manage the condition, go to the Health Topics High Blood Pressure article.
Overweight and Obesity
The terms ""overweight"" and ""obesity"" refer to body weight that's greater than what is considered healthy for a certain height. More than two-thirds of American adults are overweight, and almost one-third of these adults are obese.
The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.
You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.
Overweight is defined differently for children and teens than it is for adults. Children are still growing, and boys and girls mature at different rates. Thus, BMIs for children and teens compare their heights and weights against growth charts that take age and gender into account. This is called BMI-for-age percentile.
For more information about BMI-for-age percentile, go to the Centers for Disease Control and Prevention's (CDC's) BMI-for-age calculator.
Being overweight or obese can raise your risk of CHD and heart attack. This is mainly because overweight and obesity are linked to other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, and diabetes.
For more information, go to the Health Topics Overweight and Obesity article.
Smoking
Smoking tobacco or long-term exposure to secondhand smoke raises your risk of CHD and heart attack.
Smoking triggers a buildup of plaque in your arteries. Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack.
Some research shows that smoking raises your risk of CHD in part by lowering HDL cholesterol levels.
The more you smoke, the greater your risk of heart attack. Studies show that if you quit smoking, you cut your risk of heart attack in half within a year. The benefits of quitting smoking occur no matter how long or how much you've smoked.
Most people who smoke start when they're teens. Parents can help prevent their children from smoking by not smoking themselves. Talk with your child about the health dangers of smoking and ways to overcome peer pressure to smoke.
For more information, including tips on how to quit smoking, go to the Health Topics Smoking and Your Hear t article and the NHLBI's ""Your Guide to a Healthy Heart.""
For more information about children and smoking, go to the U.S. Department of Health and Human Services' (HHS') Kids and Smoking Web page and the CDC's Smoking and Tobacco Use Web page.
Lack of Physical Activity
Inactive people are nearly twice as likely to develop CHD as those who are active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.
It's important for children and adults to make physical activity part of their daily routines. One reason many Americans aren't active enough is because of hours spent in front of TVs and computers doing work, schoolwork, and leisure activities.
Some experts advise that children and teens should reduce screen time because it limits time for physical activity. They recommend that children aged 2 and older should spend no more than 2 hours a day watching TV or using a computer (except for school work).
Being physically active is one of the most important things you can do to keep your heart healthy. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you will benefit.
For more information, go to HHS' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Unhealthy Diet
An unhealthy diet can raise your risk of CHD. For example, foods that are high in saturated and trans fats and cholesterol raise LDL cholesterol. Thus, you should try to limit these foods.
Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Cholesterol is found in eggs, many meats, dairy products, commercial baked goods, and certain types of shellfish.
It's also important to limit foods that are high in sodium (salt) and added sugars. A high-salt diet can raise your risk of high blood pressure.
Added sugars will give you extra calories without nutrients like vitamins and minerals. This can cause you to gain weight, which raises your risk of CHD. Added sugars are found in many desserts, canned fruits packed in syrup, fruit drinks, and nondiet sodas.
You also should try to limit how much alcohol you drink. Too much alcohol will raise your blood pressure. It also will add calories, which can cause weight gain.
Stress
Stress and anxiety may play a role in causing CHD. Stress and anxiety also can trigger your arteries to tighten. This can raise your blood pressure and your risk of heart attack.
The most commonly reported trigger for a heart attack is an emotionally upsetting event, especially one involving anger. Stress also may indirectly raise your risk of CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.
Age
As you get older, your risk of CHD and heart attack rises. This is in part due to the slow buildup of plaque inside your heart arteries, which can start during childhood.
In men, the risk of CHD increases faster after age 45. In women, the risk of CHD increases faster after age 55.
Most people have some plaque buildup in their heart arteries by the time they're in their seventies. However, only about 25 percent of those people have chest pain, heart attacks, or other signs of CHD.
Gender
Before age 55, women have a lower risk of CHD than men. This is because before menopause, estrogen provides women some protection against CHD. After age 55, however, the risk of CHD increases similarly in both women and men.
Some risk factors may affect CHD risk differently in women than in men. For example, diabetes raises the risk of CHD more in women.
Also, some risk factors for heart disease only affect women, such as preeclampsia (pre-e-KLAMP-se-ah). Preeclampsia is a condition that can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.
Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk of preeclampsia.)
Family History
Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.
However, having a family history of CHD doesn't mean that you will have it too. This is especially true if your affected family member smoked or had other CHD risk factors that were not well treated.
Making lifestyle changes and taking medicines to treat other risk factors often cen lessen genetic influences and stop or slow the progress of CHD.
How To Prevent and Control Coronary Heart Disease Risk Factors
You can prevent and control many coronary heart disease (CHD) risk factors with lifestyle changes and medicines. Examples of these controllable risk factors include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factors—such as age, gender, and family history—can't be controlled.
To reduce your risk of CHD and heart attack, try to control each risk factor you can. The good news is that many lifestyle changes help control several CHD risk factors at the same time. For example, physical activity may lower your blood pressure, help control diabetes and prediabetes, reduce stress, and help control your weight.
A Lifelong Approach
Many lifestyle habits begin during childhood. Thus, parents and families should encourage their children to make heart healthy choices, such as following a healthy diet and being physically active. Make following a healthy lifestyle a family goal.
To achieve this goal, you should learn about key health measures, such as weight, body mass index (BMI), waist circumference, and your child's BMI-for-age percentile. For more information about BMI in adults and children, go to ""Coronary Heart Disease Risk Factors.""
Be aware of your and your family members' blood pressure, blood cholesterol, and blood sugar levels. Once you know these numbers, you can work to bring them into, or keep them within, a healthy range.
Making lifestyle changes can be hard. But if you make these changes as a family, it may be easier for everyone to prevent or control their CHD risk factors.
For tips on how to help your children adopt healthy habits, visit the National Heart, Lung, and Blood Institute's (NHLBI's) We Can!® Ways to Enhance Children's Activity & Nutrition Web site.
Lifestyle Changes
A healthy lifestyle can lower the risk of CHD. If you already have CHD, a healthy lifestyle may prevent it from getting worse. A healthy lifestyle includes:
Following a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. To lower your risk of CHD and heart attack, you and your family should follow a diet that is:
Low in saturated and
trans fats.
Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Both types of
fat raise your low-density
lipoprotein (LDL), or ""bad,""
cholesterol level.
High in the types of
fat found in fish and olive
oil. These
fats are rich in omega-3
fatty acids. Omega-3 fatty acids lower your risk of
heart attack, in part by helping prevent
blood clots.
High in
fiber. Fiber is found in whole grains, fruits, and vegetables. A fiber-rich diet not only helps lower your
LDL cholesterol level, but also provides
nutrients that may help protect against CHD.
Research suggests that drinking small to moderate amounts of alcohol regularly also can lower your risk of CHD. One drink a day can lower your risk by raising your high-density lipoprotein (HDL), or ""good,"" cholesterol level. One drink is a glass of wine, beer, or a small amount of hard liquor.
If you don't drink, this isn't a recommendation to start using alcohol. If you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful, you shouldn't drink.
Also, too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride level. In women, even one drink a day may raise the risk of certain types of cancer.
Teach your children how to make healthy food choices. For example, have them help you shop for and make healthy foods. Set a good example by following the same heart healthy diet that you ask your children to follow.
For more information about following a healthy diet, go to the NHLBI's Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" ""Your Guide to Lowering Your Blood Pressure With DASH,"" and ""Your Guide to Lowering Your Cholesterol With TLC."" All of these resources provide general information about healthy eating.
Being Physically Active
You don't have to be an athlete to lower your risk of CHD. You can benefit from as little as 60 minutes of moderate-intensity aerobic activity per week.
For major health benefits, adults should do at least 150 minutes (2.5 hours) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week.
Another option is to do a combination of both. A general rule is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity.
The more active you are, the more you'll benefit. If you're obese, or if you haven't been active in the past, start physical activity slowly and build up the intensity over time.
Children and youth should do 60 minutes or more of physical activity every day. A great way to encourage physical activity is to do it as a family. You also may want to limit your children's TV, video, and computer time to encourage them to be more active.
If you have CHD or symptoms such as chest pain and dizziness, talk with your doctor before you start a new exercise plan. Find out how much and what kinds of physical activity are safe for you. Avoid exercising outdoors when air pollution levels are high or the temperature is very hot or cold.
For more information about physical activity, go to the U.S. Department of Health and Human Services' (HHS') ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Maintaining a Healthy Weight
Following a healthy diet and being physically active can help you maintain a healthy weight. Controlling your weight helps you control CHD risk factors.
If you're overweight or obese, try to lose weight. A loss of just 5 to 10 percent of your current weight can lower your risk of CHD.
To lose weight, cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Don't feel that you have to finish the entrees served at restaurants. Many restaurant portions are oversized and have too many calories for the average person.
For overweight children and teens, slowing the rate of weight gain is important. However, reduced-calorie diets aren't advised, unless approved by a doctor.
Quitting Smoking
If you smoke, quit. Smoking can raise your risk of CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
You can help your children avoid smoking or quit smoking. Talk with them about the health effects of smoking. Teach them how to handle peer pressure to smoke.
Teens who have parents who smoke are more likely to smoke themselves. Set a good example by not smoking or quitting smoking. Set firm rules about no tobacco use in your home.
If you have a child who smokes, help him or her create a plan to quit. Offer your child information and resources on how to quit. Stress the natural rewards that come with quitting, such as freedom from addiction, better fitness and sports performance, and improved appearance. Reinforce the decision to quit with praise.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart.""
For more information about children and smoking, go to HHS' Kids and Smoking Web page and the Centers for Disease Control and Prevention's Smoking and Tobacco Use Web page.
Managing Stress
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress.
Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.
Other Lifestyle Concerns
If making lifestyle changes is hard for you, try taking things one step at a time. Learn about the benefits of lifestyle changes. Talk with your doctor, and read some of the resources in ""Links to Other Information About Coronary Heart Disease Risk Factors .""
Figure out what's stopping you from making or sticking to your lifestyle changes. Try to find ways to overcome these issues. For example, if you're too tired to exercise after work, you may want to try working out before you go to work.
Make a plan to carry out your lifestyle changes that includes specific, realistic goals. Act on your plan and work toward your goals. You may want to do so with the help of a support group or supportive friends and family.
Reward yourself for the gains you've made. Think about what you need to do to maintain your lifestyle changes and avoid unhealthy habits.
Don't give up if you go off your diet or exercise plan or start smoking again. Instead, find out what you need to do to get back on track so you can meet your goals. Many people find that it takes more than one try to make long-term lifestyle changes.
Changing the eating and activity habits of children takes time. Start with small, easy steps. For example, cut out after-dinner snacks or go for an after-dinner walk instead of watching TV.
Set a good example, and try to get your children involved in choosing a new healthy step to take each day. If you make lifestyle changes a group effort, it will make them easier.
Medicines
Sometimes lifestyle changes aren't enough to control your blood pressure, cholesterol levels, or other CHD risk factors. Your doctor also may prescribe medicines. For example, you may need medicines to:
Take your medicines as prescribed. Don't cut back on the dosage unless your doctor tells you to. If you have side effects or other problems related to your medicines, talk with your doctor. He or she may be able to provide other options.
You should still follow a heart healthy lifestyle, even if you take medicines to control your CHD risk factors.
____________ ® We Can! is a registered trademark of HHS.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about coronary heart disease (CHD) risk factors, as well as ways to prevent or treat them.
The NHLBI continues to support research aimed at learning more about CHD risk factors. For example, NHLBI-supported research includes studies that explore:
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat vari","June 11, 2014."
25,3,"2018-02-02 04:25:06",c,25,"2018-02-02 05:09:40","Coronary Microvascular Disease","
What Is Coronary Microvascular Disease?
Coronary microvascular disease (MVD) is heart disease that affects the tiny coronary (heart) arteries. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased.
Coronary MVD is different from traditional coronary heart disease (CHD), also called coronary artery disease. In CHD, a waxy substance called plaque (plak) builds up in the large coronary arteries.
Plaque narrows the heart's large arteries and reduces the flow of oxygen-rich blood to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can mostly or completely block blood flow through a coronary artery.
In coronary MVD, however, the heart's tiny arteries are affected. Plaque doesn't create blockages in these vessels as it does in the heart's large arteries.
Overview
Studies have shown that women are more likely than men to have coronary MVD. Many researchers think the disease is caused by a drop in estrogen levels during menopause combined with traditional heart disease risk factors.
Both men and women who have coronary MVD often have diabetes or high blood pressure. Some people who have coronary MVD may have inherited heart muscle diseases.
Diagnosing coronary MVD has been a challenge for doctors. Standard tests used to diagnose CHD aren't designed to detect coronary MVD. More research is needed to find the best diagnostic tests and treatments for the disease.
Outlook
Most of what is known about coronary MVD comes from the National Heart, Lung, and Blood Institute's Wise study (Women's Ischemia Syndrome Evaluation).
The WISE study started in 1996. The goal of the study was to learn more about how heart disease develops in women.
Currently, research is ongoing to learn more about the role of hormones in heart disease and to find better ways to diagnose coronary MVD.
Studies also are under way to learn more about the causes of coronary MVD, how to treat the disease, and the expected health outcomes for people with coronary MVD.
Other Names for Coronary Microvascular Disease
What Causes Coronary Microvascular Disease?
The same risk factors that cause atherosclerosis (ATH-er-o-skler-O-sis) may cause coronary microvascular disease (MVD). Atherosclerosis is a disease in which plaque builds up inside the arteries.
Risk factors for atherosclerosis include:
Diabetes. This is a disease in which the body's
blood sugar level is too high because the body doesn't make enough
insulin or doesn't use its insulin properly.
Unhealthy diet. An unhealthy diet can raise your risk for
atherosclerosis. Foods that are high in saturated and
trans fats,
cholesterol, sodium (salt), and
sugar can worsen other atherosclerosis risk factors.
Older age. As you get older, your risk for
atherosclerosis increases.
Genetic or lifestyle factors cause
plaque to build up in your
arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs and symptoms. In men, the risk increases after age 45. In women, the risk increases after age 55.
Family history of early
heart disease. Your risk of
atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
In women, coronary MVD also may be linked to low estrogen levels occurring before or after menopause. Also, the disease may be linked to anemia or conditions that affect blood clotting. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.
Researchers continue to explore other possible causes of coronary MVD.
What Are the Signs and Symptoms of Coronary Microvascular Disease?
The signs and symptoms of coronary microvascular disease (MVD) often differ from the signs and symptoms of traditional coronary heart disease (CHD).
Many women with coronary MVD have angina (an-JI-nuh or AN-juh-nuh). Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
Angina also is a common symptom of CHD. However, the angina that occurs in coronary MVD may differ from the typical angina that occurs in CHD. In coronary MVD, the chest pain usually lasts longer than 10 minutes, and it can last longer than 30 minutes. Typical angina is more common in women older than 65.
Other signs and symptoms of coronary MVD are shortness of breath, sleep problems, fatigue (tiredness), and lack of energy.
Coronary MVD symptoms often are first noticed during routine daily activities (such as shopping, cooking, cleaning, and going to work) and times of mental stress. It's less likely that women will notice these symptoms during physical activity (such as jogging or walking fast).
This differs from CHD, in which symptoms often first appear while a person is being physically active—such as while jogging, walking on a treadmill, or going up stairs.
How Is Coronary Microvascular Disease Diagnosed?
Your doctor will diagnose coronary microvascular disease (MVD) based on your medical history, a physical exam, and test results. He or she will check to see whether you have any risk factors for heart disease.
For example, your doctor may measure your weight and height to check for overweight or obesity. He or she also may recommend tests for high blood cholesterol, metabolic syndrome, and diabetes.
Your doctor may ask you to describe any chest pain, including when it started and how it changed during physical activity or periods of stress. He or she also may ask about other symptoms, such as fatigue (tiredness), lack of energy, and shortness of breath. Women may be asked about their menopausal status.
Specialists Involved
Cardiologists and doctors who specialize in family and internal medicine might help diagnose and treat coronary MVD. Cardiologists are doctors who specialize in diagnosing and treating heart diseases and conditions.
Diagnostic Tests
The risk factors for coronary MVD and traditional coronary heart disease (CHD) often are the same. Thus, your doctor may recommend tests for CHD, such as:
Coronary angiography (an-jee-OG-rah-fee). This test uses dye and special x rays to show the insides of your
coronary arteries. Coronary angiography can show
plaque buildup in the large coronary arteries. This test often is done during a
heart attack to help find blockages in the coronary arteries.
Unfortunately, standard tests for CHD aren't designed to detect coronary MVD. These tests look for blockages in the large coronary arteries. Coronary MVD affects the tiny coronary arteries.
If test results show that you don't have CHD, your doctor might still diagnose you with coronary MVD. This could happen if signs are present that not enough oxygen is reaching your heart's tiny arteries.
Coronary MVD symptoms often first occur during routine daily tasks. Thus, your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index (DASI). The questionnaire will ask you how well you're able to do daily activities, such as shopping, cooking, and going to work.
The DASI results will help your doctor decide which kind of stress test you should have. The results also give your doctor information about how well blood is flowing through your coronary arteries.
Your doctor also may recommend blood tests, including a test for anemia. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.
Research is ongoing for better ways to detect and diagnose coronary MVD. Currently, researchers have not agreed on the best way to diagnose the disease.
How Can Coronary Microvascular Disease Be Prevented?
No specific studies have been done on how to prevent coronary microvascular disease (MVD).
Researchers don't yet known how or in what way preventing coronary MVD differs from preventing coronary heart disease (CHD). Coronary MVD affects the tiny coronary arteries, while CHD affects the large coronary arteries.
Taking action to control heart disease risk factors can help prevent or delay CHD. You can't control some risk factors, such as older age and family history of heart disease. However, you can take steps to prevent or control other risk factors, such as high blood pressure, overweight and obesity, high blood cholesterol, diabetes, and smoking.
Lifestyle changes and ongoing care can help you lower your risk for heart disease.
Lifestyle Changes
Following a healthy diet is an important part of a heart healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
The National Heart, Lung, and Blood Institute's (NHLBI's) Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) are two programs that promote healthy eating.
If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control heart disease risk factors.
Be as physically active as you can. Physical activity can improve your fitness level and your health. People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you'll benefit.
For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
If you smoke, quit. Smoking can damage and tighten your blood vessels. It also can raise your risk for heart disease and heart attack and worsen other heart disease risk factors.
Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. For more information about quitting smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart.""
Learn how to manage stress, relax, and cope with problems. This can improve your emotional and physical health. Physical activity, medicine, and relaxation therapy can help relieve stress. You also may want to consider taking part in a stress management program.
Ongoing Care
Learn more about heart disease and the traits, conditions, and habits that can raise your risk for it. Talk with your doctor about your risk factors for heart disease and how to control them.
If lifestyle changes aren't enough, your doctor may prescribe medicines to control your risk factors. Take all of your medicines as your doctor advises.
Know your numbers—ask your doctor for these three tests, and have the results explained to you:
Know your body mass index (BMI) and waist measurement. BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.
In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.
To measure your waistline, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. A waist measurement of 35 inches or more for women and 40 inches or more for men is a risk factor for heart disease and other health problems.
Know your family history of heart disease. If you or someone in your family has heart disease, tell your doctor.
Living With Coronary Microvascular Disease
If you have coronary microvascular disease (MVD), you can take action to control it. Follow the steps described in ""How Can Coronary Microvascular Disease Be Prevented?""
Coronary MVD, like traditional coronary heart disease, increases your risk for a heart attack. If you have signs or symptoms of a heart attack, call 9–1–1 at once.
These signs and symptoms may include chest pain, upper body discomfort, shortness of breath, and nausea (feeling sick to your stomach). For more detailed information about the warning signs of a heart attack, go to the section on warning signs below.
Ongoing Care
If you have coronary MVD, see your doctor regularly to make sure the disease isn't getting worse. Work with your doctor to keep track of your cholesterol, blood pressure, and blood sugar levels. This will help your doctor adjust your treatment as needed.
You may need to see a cardiologist (heart specialist) in addition to your primary care doctor. Talk with your doctor about how often you should schedule office visits or blood tests. Between those visits, call your doctor if you have any new symptoms or your symptoms worsen.
You should:
Know your symptoms and how and when to seek medical help.
Be able to describe the usual pattern of your symptoms.
Know which medicines you take and when and how to take them.
Know how to control your symptoms, including
angina.
Know the limits of your physical activity.
Learn ways to avoid or cope with
stress.
Warning Signs
If you have coronary MVD, learn the warning signs of a heart attack. The signs and symptoms of a heart attack include:
Chest pain or discomfort. This involves uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.
Upper body discomfort in one or both
arms, the back,
neck,
jaw, or upper part of the
stomach.
Shortness of breath, which may occur with or before
chest discomfort.
If you think you're having a heart attack, call 9–1–1 at once. Early treatment can prevent or limit damage to your heart muscle. Do not drive to the hospital or let someone else drive you. Instead, call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.
Let the people you see regularly know you're at risk for a heart attack. They can seek emergency care if you suddenly faint, collapse, or have other severe symptoms.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about heart disease, its risk factors, and ways to prevent and treat the disease.
The NHLBI continues to support research aimed at learning more about heart disease, including coronary microvascular disease (MVD). For example, NHLBI-supported research includes studies that:
Examine
heart attack risks and recovery in young women (aged 18–55)
Explore whether taking daily
vitamin D or fish
oil (omega-3) supplements reduces the risk of
heart disease and other conditions
Examine the role that
hormones play in women's
heart disease risk
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to coronary microvascular disease, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Cough?
A cough is a natural reflex that protects your lungs. Coughing helps clear your airways of lung irritants, such as smoke and mucus (a slimy substance). This helps prevent infections. A cough also can be a symptom of a medical problem.
Prolonged coughing can cause unpleasant side effects, such as chest pain, exhaustion, light-headedness, and loss of bladder control. Coughing also can interfere with sleep, socializing, and work.
Overview
Coughing occurs when the nerve endings in your airways become irritated. The airways are tubes that carry air into and out of your lungs. Certain substances (such as smoke and pollen), medical conditions, and medicines can irritate these nerve endings.
A cough can be acute, subacute, or chronic, depending on how long it lasts.
An acute cough lasts less than 3 weeks. Common causes of an acute cough are a common cold or other upper respiratory (RES-pi-rah-tor-e) infections. Examples of other upper respiratory infections include the flu, pneumonia (nu-MO-ne-ah), and whooping cough.
A subacute cough lasts 3 to 8 weeks. This type of cough remains even after a cold or other respiratory infection is over.
A chronic cough lasts more than 8 weeks. Common causes of a chronic cough are upper airway cough syndrome (UACS); asthma; and gastroesophageal (GAS-tro-eh-so-fa-JE-al) reflux disease, or GERD.
""UACS"" is a term used to describe conditions that inflame the upper airways and cause a cough. Examples include sinus infections and allergies. These conditions can cause mucus to run down your throat from the back of your nose. This is called postnasal drip.
Asthma is a long-term lung disease that inflames and narrows the airways. GERD occurs if acid from your stomach backs up into your throat.
Outlook
The best way to treat a cough is to treat its cause. For example, asthma is treated with medicines that open the airways.
Your doctor may recommend cough medicine if the cause of your cough is unknown and the cough causes a lot of discomfort. Cough medicines may harm children. If your child has a cough, talk with his or her doctor about how to treat it.
What Causes Cough?
Coughing occurs when the nerve endings in your airways become irritated. Certain irritants and allergens, medical conditions, and medicines can irritate these nerve endings.
Irritants and Allergens
An irritant is something you're sensitive to. For example, smoking or inhaling secondhand smoke can irritate your lungs. Smoking also can lead to medical conditions that can cause a cough. Other irritants include air pollution, paint fumes, or scented products like perfumes or air fresheners.
An allergen is something you're allergic to, such as dust, animal dander, mold, or pollens from trees, grasses, and flowers.
Coughing helps clear your airways of irritants and allergens. This helps prevent infections.
Medical Conditions
Many medical conditions can cause acute, subacute, or chronic cough.
Common causes of an acute cough are a common cold or other upper respiratory infections. Examples of other upper respiratory infections include the flu, pneumonia, and whooping cough. An acute cough lasts less than 3 weeks.
A lingering cough that remains after a cold or other respiratory infection is gone often is called a subacute cough. A subacute cough lasts 3 to 8 weeks.
Common causes of a chronic cough are upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD). A chronic cough lasts more than 8 weeks.
""UACS"" is a term used to describe conditions that inflame the upper airways and cause a cough. Examples include sinus infections and allergies. These conditions can cause mucus (a slimy substance) to run down your throat from the back of your nose. This is called postnasal drip.
Asthma is a long-term lung disease that inflames and narrows the airways. GERD is a condition in which acid from your stomach backs up into your throat.
Other conditions that can cause a chronic cough include:
Bronchiectasis (brong-ke-EK-tah-sis). This is a condition in which damage to the airways causes them to widen and become flabby and scarred. This prevents the airways from properly moving
mucus out of your
lungs. An
infection or other condition that injures the walls of the airways usually causes bronchiectasis.
Lung cancer. In rare cases, a
chronic cough is due to lung cancer. Most people who develop lung cancer smoke or used to smoke.
Who Is At Risk for Cough?
People at risk for cough include those who:
Are exposed to things that irritate their airways (called irritants) or things that they're allergic to (called
allergens). Examples of irritants are cigarette smoke, air pollution, paint fumes, and scented products. Examples of allergens are dust, animal dander,
mold, and
pollens from trees, grasses, and flowers.
Women are more likely than men to develop a chronic cough. For more information about the substances and conditions that put you at risk for cough, go to ""What Causes Cough?""
What Are the Signs and Symptoms of Cough?
When you cough, mucus (a slimy substance) may come up. Coughing helps clear the mucus in your airways from a cold, bronchitis, or other condition. Rarely, people cough up blood. If this happens, you should call your doctor right away.
A cough may be a symptom of a medical condition. Thus, it may occur with other signs and symptoms of that condition. For example, if you have a cold, you may have a runny or stuffy nose. If you have gastroesophageal reflux disease, you may have a sour taste in your mouth.
A chronic cough can make you feel tired because you use a lot of energy to cough. It also can prevent you from sleeping well and interfere with work and socializing. A chronic cough also can cause headaches, chest pain, loss of bladder control, sweating, and, rarely, fractured ribs.
How Is the Cause of Cough Diagnosed?
Your doctor will diagnose the cause of your cough based on your medical history, a physical exam, and test results.
Medical History
Your doctor will likely ask questions about your cough. He or she may ask how long you've had it, whether you're coughing anything up (such as mucus, a slimy substance), and how much you cough.
Your doctor also may ask:
Whether you've recently had a cold or the
flu.
Whether you smoke or spend time around others who smoke.
Whether you've been around air pollution, a lot of dust, or fumes.
Physical Exam
To check for signs of problems related to cough, your doctor will use a stethoscope to listen to your lungs. He or she will listen for wheezing (a whistling or squeaky sound when you breathe) or other abnormal sounds.
Diagnostic Tests
Your doctor may recommend tests based on the results of your medical history and physical exam. For example, if you have symptoms of GERD, your doctor may recommend a pH probe. This test measures the acid level of the fluid in your throat.
Other tests may include:
Lung function tests. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your
lungs deliver
oxygen to your
blood. Lung function tests can help diagnose
asthma and other conditions.
How Is Cough Treated?
The best way to treat a cough is to treat its cause. However, sometimes the cause is unknown. Other treatments, such as medicines and a vaporizer, can help relieve the cough itself.
Treating the Cause of a Cough
Acute and Subacute Cough
An acute cough lasts less than 3 weeks. Common causes of an acute cough are a common cold or other upper respiratory infections. Examples of other upper respiratory infections include the flu, pneumonia, and whooping cough. An acute cough usually goes away after the illness that caused it is over.
A subacute cough lasts 3 to 8 weeks. This type of cough remains even after a cold or other respiratory infection is over.
Studies show that antibiotics and cold medicines can't cure a cold. However, your doctor may prescribe medicines to treat another cause of an acute or subacute cough. For example, antibiotics may be given for pneumonia.
Chronic Cough
A chronic cough lasts more than 8 weeks. Common causes of a chronic cough are upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD).
""UACS"" is a term used to describe conditions that inflame the upper airways and cause a cough. Examples include sinus infections and allergies. These conditions can cause mucus (a slimy substance) to run down your throat from the back of your nose. This is called postnasal drip.
If you have a sinus infection, your doctor may prescribe antibiotics. He or she also may suggest you use a medicine that you spray into your nose. If allergies are causing your cough, your doctor may advise you to avoid the substances that you're allergic to (allergens) if possible.
If you have asthma, try to avoid irritants and allergens that make your asthma worse. Take your asthma medicines as your doctor prescribes.
GERD occurs if acid from your stomach backs up into your throat. Your doctor may prescribe a medicine to reduce acid in your stomach. You also may be able to relieve GERD symptoms by waiting 3 to 4 hours after a meal before lying down, and by sleeping with your head raised.
Smoking also can cause a chronic cough. If you smoke, it's important to quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. The Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart"" booklet have more information about how to quit smoking.
Other causes of a chronic cough include respiratory infections, chronic bronchitis, bronchiectasis, lung cancer, and heart failure. Treatments for these causes may include medicines, procedures, and other therapies. Treatment also may include avoiding irritants and allergens and quitting smoking.
If your chronic cough is due to a medicine you're taking, your doctor may prescribe a different medicine.
Treating the Cough Rather Than the Cause
Coughing is important because it helps clear your airways of irritants, such as smoke and mucus (a slimy substance). Coughing also helps prevent infections.
Cough medicines usually are used only when the cause of the cough is unknown and the cough causes a lot of discomfort.
Medicines can help control a cough and make it easier to cough up mucus. Your doctor may recommend medicines such as:
Other treatments also may relieve an irritated throat and loosen mucus. Examples include using a cool-mist humidifier or steam vaporizer and drinking enough fluids. Examples of fluids are water, soup, and juice. Ask your doctor how much fluid you need.
Cough in Children
No evidence shows that cough and cold medicines help children recover more quickly from colds. These medicines can even harm children. Talk with your child's doctor about your child's cough and how to treat it.
Living With Cough
If you have a cough, you can take steps to recover from the condition that's causing the cough. You also can take steps to relieve your cough. Ongoing care and lifestyle changes can help you.
Ongoing Care
Follow the treatment plan your doctor gives you for treating the cause of your cough. Take all medicines as your doctor prescribes. If you're using antibiotics, continue to take the medicine until it's all gone. You may start to feel better before you finish the medicine, but you should continue to take it.
Ask your doctor about ways to relieve your cough. He or she may recommend cough medicines. These medicines usually are used only when the cause of a cough is unknown and the cough is causing a lot of discomfort.
A cool-mist humidifier or steam vaporizer may help relieve an irritated throat and loosen mucus. Getting enough fluids (for example, water, soup, or juice) may have the same effect. Ask your doctor about how much fluid you need.
Your doctor will let you know when to schedule followup care.
Lifestyle Changes
If you smoke, quit. Ask your doctor about programs and products that can help you quit smoking. The Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's ""Your Guide to a Healthy Heart"" booklet have more information about how to quit smoking.
Try to avoid irritants and allergens that make you cough. Examples of irritants include cigarette smoke, air pollution, paint fumes, and scented products like perfumes or air fresheners. Examples of allergens include dust, animal dander, mold, and pollens from trees, grasses, and flowers.
Follow a healthy diet and be as physically active as you can. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, and fat-free or low-fat milk or milk products. A healthy diet also is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources include general advice about healthy eating.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to your disease or condition, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
","June 11, 2014."
27,3,"2018-02-02 04:25:06",c,27,"2018-02-02 05:10:10","Cystic Fibrosis","
What Is Cystic Fibrosis?
Cystic fibrosis (SIS-tik fi-BRO-sis), or CF, is an inherited disease of the secretory (see-KREH-tor-ee) glands. Secretory glands include glands that make mucus and sweat.
""Inherited"" means the disease is passed from parents to children through genes. People who have CF inherit two faulty genes for the disease—one from each parent. The parents likely don't have the disease themselves.
CF mainly affects the lungs, pancreas, liver, intestines, sinuses, and sex organs.
Overview
Mucus is a substance made by tissues that line some organs and body cavities, such as the lungs and nose. Normally, mucus is a slippery, watery substance. It keeps the linings of certain organs moist and prevents them from drying out or getting infected.
If you have CF, your mucus becomes thick and sticky. It builds up in your lungs and blocks your airways. (Airways are tubes that carry air in and out of your lungs.)
The buildup of mucus makes it easy for bacteria to grow. This leads to repeated, serious lung infections. Over time, these infections can severely damage your lungs.
The thick, sticky mucus also can block tubes, or ducts, in your pancreas (an organ in your abdomen). As a result, the digestive enzymes that your pancreas makes can't reach your small intestine.
These enzymes help break down food. Without them, your intestines can't fully absorb fats and proteins. This can cause vitamin deficiency and malnutrition because nutrients pass through your body without being used. You also may have bulky stools, intestinal gas, a swollen belly from severe constipation, and pain or discomfort.
CF also causes your sweat to become very salty. Thus, when you sweat, you lose large amounts of salt. This can upset the balance of minerals in your blood and cause many health problems. Examples of these problems include dehydration (a lack of fluid in your body), increased heart rate, fatigue (tiredness), weakness, decreased blood pressure, heat stroke, and, rarely, death.
If you or your child has CF, you're also at higher risk for diabetes or two bone-thinning conditions called osteoporosis (OS-te-o-po-RO-sis) and osteopenia (OS-te-o-PEE-nee-uh).
CF also causes infertility in men, and the disease can make it harder for women to get pregnant. (The term ""infertility"" refers to the inability to have children.)
Outlook
The symptoms and severity of CF vary. If you or your child has the disease, you may have serious lung and digestive problems. If the disease is mild, symptoms may not show up until the teen or adult years.
The symptoms and severity of CF also vary over time. Sometimes you'll have few symptoms. Other times, your symptoms may become more severe. As the disease gets worse, you'll have more severe symptoms more often.
Lung function often starts to decline in early childhood in people who have CF. Over time, damage to the lungs can cause severe breathing problems. Respiratory failure is the most common cause of death in people who have CF.
As treatments for CF continue to improve, so does life expectancy for those who have the disease. Today, some people who have CF are living into their forties or fifties, or longer.
Early treatment for CF can improve your quality of life and increase your lifespan. Treatments may include nutritional and respiratory therapies, medicines, exercise, and other treatments.
Your doctor also may recommend pulmonary rehabilitation (PR). PR is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.
Other Names for Cystic Fibrosis
What Causes Cystic Fibrosis?
A defect in the CFTR gene causes cystic fibrosis (CF). This gene makes a protein that controls the movement of salt and water in and out of your body's cells. In people who have CF, the gene makes a protein that doesn't work well. This causes thick, sticky mucus and very salty sweat.
Research suggests that the CFTR protein also affects the body in other ways. This may help explain other symptoms and complications of CF.
More than a thousand known defects can affect the CFTR gene. The type of defect you or your child has may affect the severity of CF. Other genes also may play a role in the severity of the disease.
How Is Cystic Fibrosis Inherited?
Every person inherits two CFTR genes—one from each parent. Children who inherit a faulty CFTR gene from each parent will have CF.
Children who inherit one faulty CFTR gene and one normal CFTR gene are ""CF carriers."" CF carriers usually have no symptoms of CF and live normal lives. However, they can pass the faulty CFTR gene to their children.
The image below shows how two parents who are both CF carriers can pass the faulty CFTR gene to their children.
Who Is at Risk for Cystic Fibrosis?
Cystic fibrosis (CF) affects both males and females and people from all racial and ethnic groups. However, the disease is most common among Caucasians of Northern European descent.
CF also is common among Latinos and American Indians, especially the Pueblo and Zuni. The disease is less common among African Americans and Asian Americans.
More than 10 million Americans are carriers of a faulty CF gene. Many of them don't know that they're CF carriers.
What Are the Signs and Symptoms of Cystic Fibrosis?
The signs and symptoms of cystic fibrosis (CF) vary from person to person and over time. Sometimes you'll have few symptoms. Other times, your symptoms may become more severe.
One of the first signs of CF that parents may notice is that their baby's skin tastes salty when kissed, or the baby doesn't pass stool when first born.
Most of the other signs and symptoms of CF happen later. They're related to how CF affects the respiratory, digestive, or reproductive systems of the body.
![]()
Cystic Fibrosis. Figure A shows the organs that cystic fibrosis can affect. Figure B shows a cross-section of a normal airway. Figure C shows an airway with cystic fibrosis. The widened airway is blocked by thick, sticky mucus that contains blood and bacteria. (more...)
Respiratory System Signs and Symptoms
People who have CF have thick, sticky mucus that builds up in their airways. This buildup of mucus makes it easier for bacteria to grow and cause infections. Infections can block the airways and cause frequent coughing that brings up thick sputum (spit) or mucus that's sometimes bloody.
People who have CF tend to have lung infections caused by unusual germs that don't respond to standard antibiotics. For example, lung infections caused by bacteria called mucoid Pseudomonas are much more common in people who have CF than in those who don't. An infection caused by these bacteria may be a sign of CF.
People who have CF have frequent bouts of sinusitis (si-nu-SI-tis), an infection of the sinuses. The sinuses are hollow air spaces around the eyes, nose, and forehead. Frequent bouts of bronchitis (bron-KI-tis) and pneumonia (nu-MO-ne-ah) also can occur. These infections can cause long-term lung damage.
As CF gets worse, you may have more serious problems, such as pneumothorax (noo-mo-THOR-aks) or bronchiectasis (brong-ke-EK-ta-sis).
Some people who have CF also develop nasal polyps (growths in the nose) that may require surgery.
Digestive System Signs and Symptoms
In CF, mucus can block tubes, or ducts, in your pancreas (an organ in your abdomen). These blockages prevent enzymes from reaching your intestines.
As a result, your intestines can't fully absorb fats and proteins. This can cause ongoing diarrhea or bulky, foul-smelling, greasy stools. Intestinal blockages also may occur, especially in newborns. Too much gas or severe constipation in the intestines may cause stomach pain and discomfort.
A hallmark of CF in children is poor weight gain and growth. These children are unable to get enough nutrients from their food because of the lack of enzymes to help absorb fats and proteins.
As CF gets worse, other problems may occur, such as:
Pancreatitis (PAN-kre-ah-TI-tis). This is a condition in which the
pancreas become inflamed, which causes pain.
Reproductive System Signs and Symptoms
Men who have CF are infertile because they're born without a vas deferens. The vas deferens is a tube that delivers sperm from the testes to the penis.
Women who have CF may have a hard time getting pregnant because of mucus blocking the cervix or other CF complications.
Other Signs, Symptoms, and Complications
Other signs and symptoms of CF are related to an upset of the balance of minerals in your blood.
CF causes your sweat to become very salty. As a result, your body loses large amounts of salt when you sweat. This can cause dehydration (a lack of fluid in your body), increased heart rate, fatigue (tiredness), weakness, decreased blood pressure, heat stroke, and, rarely, death.
CF also can cause clubbing and low bone density. Clubbing is the widening and rounding of the tips of your fingers and toes. This sign develops late in CF because your lungs aren't moving enough oxygen into your bloodstream.
Low bone density also tends to occur late in CF. It can lead to bone-thinning disorders called osteoporosis and osteopenia.
How Is Cystic Fibrosis Diagnosed?
Doctors diagnose cystic fibrosis (CF) based on the results from various tests.
Newborn Screening
All States screen newborns for CF using a genetic test or a blood test. The genetic test shows whether a newborn has faulty CFTR genes. The blood test shows whether a newborn's pancreas is working properly.
Sweat Test
If a genetic test or blood test suggests CF, a doctor will confirm the diagnosis using a sweat test. This test is the most useful test for diagnosing CF. A sweat test measures the amount of salt in sweat.
For this test, the doctor triggers sweating on a small patch of skin on an arm or leg. He or she rubs the skin with a sweat-producing chemical and then uses an electrode to provide a mild electrical current. This may cause a tingling or warm feeling.
Sweat is collected on a pad or paper and then analyzed. The sweat test usually is done twice. High salt levels confirm a diagnosis of CF.
Other Tests
If you or your child has CF, your doctor may recommend other tests, such as:
Genetic tests to find out what type of CFTR defect is causing your CF.
A
chest x ray. This test creates pictures of the structures in your
chest, such as your
heart,
lungs, and
blood vessels. A chest x ray can show whether your lungs are inflamed or scarred, or whether they trap air.
A
sinus x ray. This test may show signs of
sinusitis, a complication of CF.
A
sputum culture. For this test, your doctor will take a sample of your sputum (spit) to see whether
bacteria are growing in it. If you have bacteria called mucoid Pseudomonas, you may have more advanced CF that needs aggressive
treatment.
Prenatal Screening
If you're pregnant, prenatal genetic tests can show whether your fetus has CF. These tests include amniocentesis (AM-ne-o-sen-TE-sis) and chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS).
In amniocentesis, your doctor inserts a hollow needle through your abdominal wall into your uterus. He or she removes a small amount of fluid from the sac around the baby. The fluid is tested to see whether both of the baby's CFTR genes are normal.
In CVS, your doctor threads a thin tube through the vagina and cervix to the placenta. The doctor removes a tissue sample from the placenta using gentle suction. The sample is tested to see whether the baby has CF.
Cystic Fibrosis Carrier Testing
People who have one normal CFTR gene and one faulty CFTR gene are CF carriers. CF carriers usually have no symptoms of CF and live normal lives. However, carriers can pass faulty CFTR genes on to their children.
If you have a family history of CF or a partner who has CF (or a family history of it) and you're planning a pregnancy, you may want to find out whether you're a CF carrier.
A genetics counselor can test a blood or saliva sample to find out whether you have a faulty CF gene. This type of testing can detect faulty CF genes in 9 out of 10 cases.
How Is Cystic Fibrosis Treated?
Cystic fibrosis (CF) has no cure. However, treatments have greatly improved in recent years. The goals of CF treatment include:
Preventing and controlling lung infections
Loosening and removing thick, sticky
mucus from the
lungsPreventing or treating blockages in the
intestinesProviding enough nutrition
Preventing dehydration (a lack of fluid in the body)
Depending on the severity of CF, you or your child may be treated in a hospital.
Specialists Involved
If you or your child has CF, you may be treated by a CF specialist. This is a doctor who is familiar with the complex nature of CF.
Often, a CF specialist works with a medical team of nurses, physical therapists, dietitians, and social workers. CF specialists often are located at major medical centers.
The United States also has more than 100 CF Care Centers. These centers have teams of doctors, nurses, dietitians, respiratory therapists, physical therapists, and social workers who have special training related to CF care. Most CF Care Centers have pediatric and adult programs or clinics.
For more information about CF Care Centers, go to the Cystic Fibrosis Foundation's Care Center Network Web page.
Treatment for Lung Problems
The main treatments for lung problems in people who have CF are chest physical therapy (CPT), exercise, and medicines. Your doctor also may recommend a pulmonary rehabilitation (PR) program.
Chest Physical Therapy
CPT also is called chest clapping or percussion. It involves pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so that you can cough it up.
You might sit down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.
Some people find CPT hard or uncomfortable to do. Several devices have been developed that may help with CPT, such as:
An electric
chest clapper, known as a mechanical percussor.
An inflatable
therapy vest that uses high-frequency airwaves to force the
mucus that's deep in your
lungs toward your upper airways so you can
cough it up.
A small, handheld device that you exhale through. The device causes vibrations that dislodge the
mucus.
A mask that creates vibrations that help break the
mucus loose from your airway walls.
Breathing techniques also may help dislodge mucus so you can cough it up. These techniques include forcing out a couple of short breaths or deeper breaths and then doing relaxed breathing. This may help loosen the mucus in your lungs and open your airways.
Exercise
Aerobic exercise that makes you breathe harder can help loosen the mucus in your airways so you can cough it up. Exercise also helps improve your overall physical condition.
However, CF causes your sweat to become very salty. As a result, your body loses large amounts of salt when you sweat. Thus, your doctor may recommend a high-salt diet or salt supplements to maintain the balance of minerals in your blood.
If you exercise regularly, you may be able to cut back on your CPT. However, you should check with your doctor first.
Medicines
If you have CF, your doctor may prescribe antibiotics, anti-inflammatory medicines, bronchodilators, or medicines to help clear the mucus. These medicines help treat or prevent lung infections, reduce swelling and open up the airways, and thin mucus. If you have mutations in a gene called G551D, which occurs in about 5 percent of people who have CF, your doctor may prescribe the oral medicine ivacaftor (approved for people with CF who are 6 years of age and older).
Antibiotics are the main treatment to prevent or treat lung infections. Your doctor may prescribe oral, inhaled, or intravenous (IV) antibiotics.
Oral antibiotics often are used to treat mild lung infections. Inhaled antibiotics may be used to prevent or control infections caused by the bacteria mucoid Pseudomonas. For severe or hard-to-treat infections, you may be given antibiotics through an IV tube (a tube inserted into a vein). This type of treatment may require you to stay in a hospital.
Anti-inflammatory medicines can help reduce swelling in your airways due to ongoing infections. These medicines may be inhaled or oral.
Bronchodilators help open the airways by relaxing the muscles around them. These medicines are inhaled. They're often taken just before CPT to help clear mucus out of your airways. You also may take bronchodilators before inhaling other medicines into your lungs.
Your doctor may prescribe medicines to reduce the stickiness of your mucus and loosen it up. These medicines can help clear out mucus, improve lung function, and prevent worsening lung symptoms.
Pulmonary Rehabilitation
Your doctor may recommend PR as part of your treatment plan. PR is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.
PR doesn't replace medical therapy. Instead, it's used with medical therapy and may include:
PR has many benefits. It can improve your ability to function and your quality of life. The program also may help relieve your breathing problems. Even if you have advanced lung disease, you can still benefit from PR.
For more information, go to the Health Topics Pulmonary Rehabilitation article.
Treatment for Digestive Problems
CF can cause many digestive problems, such as bulky stools, intestinal gas, a swollen belly, severe constipation, and pain or discomfort. Digestive problems also can lead to poor growth and development in children.
Nutritional therapy can improve your strength and ability to stay active. It also can improve growth and development in children. Nutritional therapy also may make you strong enough to resist some lung infections. A nutritionist can help you create a nutritional plan that meets your needs.
In addition to having a well-balanced diet that's rich in calories, fat, and protein, your nutritional therapy may include:
Other treatments for digestive problems may include enemas and mucus-thinning medicines to treat intestinal blockages. Sometimes surgery is needed to remove an intestinal blockage.
Your doctor also may prescribe medicines to reduce your stomach acid and help oral pancreatic enzymes work better.
Treatments for Cystic Fibrosis Complications
A common complication of CF is diabetes. The type of diabetes associated with CF often requires different treatment than other types of diabetes.
Another common CF complication is the bone-thinning disorder osteoporosis. Your doctor may prescribe medicines that prevent your bones from losing their density.
Living With Cystic Fibrosis
If you or your child has cystic fibrosis (CF), you should learn as much as you can about the disease. Work closely with your doctors to learn how to manage CF.
Ongoing Care
Having ongoing medical care by a team of doctors, nurses, and respiratory therapists who specialize in CF is important. These specialists often are located at major medical centers or CF Care Centers.
The United States has more than 100 CF Care Centers. Most of these centers have pediatric and adult programs or clinics. For more information about CF Care Centers, go to the Cystic Fibrosis Foundation's Care Center Network Web page.
It's standard to have CF checkups every 3 months. Talk with your doctor about whether you should get an annual flu shot and other vaccines. Take all of your medicines as your doctor prescribes. In between checkups, be sure to contact your doctor if you have:
Transition of Care
Better treatments for CF allow people who have the disease to live longer now than in the past. Thus, the move from pediatric care to adult care is an important step in treatment.
If your child has CF, encourage him or her to learn about the dis","June 11, 2014."
28,4,"2018-02-02 04:25:06",d,28,"2018-02-02 05:10:28","Deep Vein Thrombosis","
What Is Deep Vein Thrombosis?
Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.
Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.
A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus (EM-bo-lus). It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.
PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.
Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. Blood clots also can form in veins closer to the skin's surface. However, these clots won't break off and cause PE.
The animation below shows a deep vein blood clot. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how a blood clot in a deep vein of the leg can break off, travel to the lungs, and block blood flow.
Other Names for Deep Vein Thrombosis
Thrombophlebitis.
Venous thrombosis.
What Causes Deep Vein Thrombosis?
Blood clots can form in your body's deep veins if:
A
vein's inner lining is damaged. Injuries caused by physical, chemical, or biological factors can damage the
veins. Such factors include
surgery, serious injuries,
inflammation, and immune responses.
Blood flow is sluggish or slow. Lack of motion can cause sluggish or slow blood flow. This may occur after
surgery, if you're ill and in bed for a long time, or if you're traveling for a long time.
Your
blood is thicker or more likely to clot than normal. Some inherited conditions (such as factor V Leiden) increase the risk of
blood clotting.
Hormone therapy or birth control pills also can increase the risk of clotting.
Who Is at Risk for Deep Vein Thrombosis?
The risk factors for deep vein thrombosis (DVT) include:
Your risk for DVT increases if you have more than one of the risk factors listed above.
What Are the Signs and Symptoms of Deep Vein Thrombosis?
The signs and symptoms of deep vein thrombosis (DVT) might be related to DVT itself or pulmonary embolism (PE). See your doctor right away if you have signs or symptoms of either condition. Both DVT and PE can cause serious, possibly life-threatening problems if not treated.
Deep Vein Thrombosis
Only about half of the people who have DVT have signs and symptoms. These signs and symptoms occur in the leg affected by the deep vein clot. They include:
Swelling of the leg or along a
vein in the leg
Pain or tenderness in the leg, which you may feel only when standing or walking
Increased warmth in the area of the leg that's swollen or painful
Red or discolored
skin on the leg
Pulmonary Embolism
Some people aren't aware of a deep vein clot until they have signs and symptoms of PE. Signs and symptoms of PE include:
Rapid breathing and a fast heart rate also may be signs of PE.
How Is Deep Vein Thrombosis Diagnosed?
Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, a physical exam, and test results. He or she will identify your risk factors and rule out other causes of your symptoms.
For some people, DVT might not be diagnosed until after they receive emergency treatment for pulmonary embolism (PE).
Medical History
To learn about your medical history, your doctor may ask about:
Physical Exam
Your doctor will check your legs for signs of DVT, such as swelling or redness. He or she also will check your blood pressure and your heart and lungs.
Diagnostic Tests
Your doctor may recommend tests to find out whether you have DVT.
Common Tests
The most common test for diagnosing deep vein blood clots is ultrasound. This test uses sound waves to create pictures of blood flowing through the arteries and veins in the affected leg.
Your doctor also may recommend a D-dimer test or venography (ve-NOG-rah-fee).
A D-dimer test measures a substance in the blood that's released when a blood clot dissolves. If the test shows high levels of the substance, you may have a deep vein blood clot. If your test results are normal and you have few risk factors, DVT isn't likely.
Your doctor may suggest venography if an ultrasound doesn't provide a clear diagnosis. For venography, dye is injected into a vein in the affected leg. The dye makes the vein visible on an x-ray image. The x ray will show whether blood flow is slow in the vein, which may suggest a blood clot.
Other Tests
Other tests used to diagnose DVT include magnetic resonance imaging (MRI) and computed tomography (to-MOG-rah-fee), or CT, scanning. These tests create pictures of your organs and tissues.
You may need blood tests to check whether you have an inherited blood clotting disorder that can cause DVT. This may be the case if you have repeated blood clots that are not related to another cause. Blood clots in an unusual location (such as the liver, kidney, or brain) also may suggest an inherited clotting disorder.
If your doctor thinks that you have PE, he or she may recommend more tests, such as a lung ventilation perfusion scan (VQ scan). A lung VQ scan shows how well oxygen and blood are flowing to all areas of the lungs.
For more information about diagnosing PE, go to the Health Topics Pulmonary Embolism article.
How Is Deep Vein Thrombosis Treated?
Doctors treat deep vein thrombosis (DVT) with medicines and other devices and therapies. The main goals of treating DVT are to:
Stop the
blood clot from getting bigger
Prevent the
blood clot from breaking off and moving to your
lungsReduce your chance of having another
blood clot
Medicines
Your doctor may prescribe medicines to prevent or treat DVT.
Anticoagulants
Anticoagulants (AN-te-ko-AG-u-lants) are the most common medicines for treating DVT. They're also known as blood thinners.
These medicines decrease your blood's ability to clot. They also stop existing blood clots from getting bigger. However, blood thinners can't break up blood clots that have already formed. (The body dissolves most blood clots with time.)
Blood thinners can be taken as a pill, an injection under the skin, or through a needle or tube inserted into a vein (called intravenous, or IV, injection).
Warfarin and heparin are two blood thinners used to treat DVT. Warfarin is given in pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube. There are different types of heparin. Your doctor will discuss the options with you.
Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once the warfarin starts to work, the heparin is stopped.
Pregnant women usually are treated with just heparin because warfarin is dangerous during pregnancy.
Treatment for DVT using blood thinners usually lasts for 6 months. The following situations may change the length of treatment:
If your
blood clot occurred after a short-term risk (for example,
surgery), your
treatment time may be shorter.
If you have certain other illnesses, such as
cancer, you may need to take
blood thinners for as long as you have the illness.
The most common side effect of blood thinners is bleeding. Bleeding can happen if the medicine thins your blood too much. This side effect can be life threatening.
Sometimes the bleeding is internal (inside your body). People treated with blood thinners usually have regular blood tests to measure their blood's ability to clot. These tests are called PT and PTT tests.
These tests also help your doctor make sure you're taking the right amount of medicine. Call your doctor right away if you have easy bruising or bleeding. These may be signs that your medicines have thinned your blood too much.
Thrombin Inhibitors
These medicines interfere with the blood clotting process. They're used to treat blood clots in patients who can't take heparin.
Thrombolytics
Doctors prescribe these medicines to quickly dissolve large blood clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.
Other Types of Treatment
Vena Cava Filter
If you can't take blood thinners or they're not working well, your doctor may recommend a vena cava filter.
The filter is inserted inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. However, the filter doesn't stop new blood clots from forming.
Graduated Compression Stockings
Graduated compression stockings can reduce leg swelling caused by a blood clot. These stockings are worn on the legs from the arch of the foot to just above or below the knee.
Compression stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.
There are three types of compression stockings. One type is support pantyhose, which offer the least amount of pressure.
The second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.
Prescription-strength compression hose offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies. However, a specially trained person needs to fit you for these stockings.
Talk with your doctor about how long you should wear compression stockings.
How Can Deep Vein Thrombosis Be Prevented?
You can take steps to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). If you're at risk for these conditions:
If you've had DVT or PE before, you can help prevent future blood clots. Follow the steps above and:
Contact your doctor at once if you have any signs or symptoms of DVT or PE. For more information, go to ""What Are the Signs and Symptoms of Deep Vein Thrombosis?""
Travel Tips
The risk of developing DVT while traveling is low. The risk increases if the travel time is longer than 4 hours or you have other DVT risk factors.
During long trips, it may help to:
Walk up and down the aisles of the bus, train, or airplane. If traveling by car, stop about every hour and walk around.
Move your legs and flex and stretch your feet to improve
blood flow in your calves.
Wear loose and comfortable clothing.
Drink plenty of fluids and avoid alcohol.
If you have risk factors for DVT, your doctor may advise you to wear compression stockings while traveling. Or, he or she may suggest that you take a blood-thinning medicine before traveling.
Living With Deep Vein Thrombosis
If you've had a deep vein blood clot, you're at greater risk for another one. During treatment and after:
Ongoing Health Care Needs
DVT often is treated with blood-thinning medicines. These medicines can thin your blood too much and cause bleeding (sometimes inside the body). This side effect can be life threatening.
Bleeding can occur in the digestive system or the brain. Signs and symptoms of bleeding in the digestive system include:
Bright red
vomit or vomit that looks like coffee grounds
Bright red
blood in your stools or black, tarry stools
Signs and symptoms of bleeding in the brain include:
If you have any of these signs or symptoms, seek medical care right away. If you have a lot of bleeding after a fall or injury, call 9–1–1. This could be a sign that your DVT medicines have thinned your blood too much.
You might want to wear a medical ID bracelet or necklace that states you're at risk of bleeding. If you're injured, the ID will alert medical personnel of your condition.
Talk with your doctor before taking any medicines other than your DVT medicines. This includes over-the-counter medicines. Aspirin, for example, also can thin your blood. Taking two medicines that thin your blood may raise your risk of bleeding.
Ask your doctor about how your diet affects these medicines. Foods that contain vitamin K can change how warfarin (a blood-thinning medicine) works. Vitamin K is found in green, leafy vegetables and some oils, like canola and soybean oils. Your doctor can help you plan a balanced and healthy diet.
Discuss with your doctor whether drinking alcohol will interfere with your medicines. Your doctor can tell you what amount of alcohol is safe for you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
Researchers have learned a lot about blood disorders over the years. That knowledge has led to advances in medical knowledge and care. However, many questions remain about various blood disorders, including deep vein thrombosis (DVT).
The NHLBI continues to support research aimed at learning more about DVT. For example, NHLBI-supported research includes studies that:
Analyze
genetic factors to determine the best doses of
blood-thinning medicines for certain populations
Explore whether a
catheter procedure to dissolve deep
vein blood clots can help improve outcomes for people who have DVT
Much of the NHLBI's research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to deep vein thrombosis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
","June 11, 2014."
29,4,"2018-02-02 04:25:06",d,29,"2018-02-02 05:10:47","Diabetic Heart Disease","
What Is Diabetic Heart Disease?
The term ""diabetic heart disease"" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes:
Are at higher risk for
heart disease
Have additional causes of
heart disease
May develop
heart disease at a younger age
May have more severe
heart disease
What Heart Diseases Are Involved in Diabetic Heart Disease?
DHD may include coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy (KAR-de-o-mi-OP-ah-thee).
Heart Failure
Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. The term “heart failure” doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
If you have heart failure, you may tire easily and have to limit your activities. CHD can lead to heart failure by weakening the heart muscle over time.
Overview
People who have type 1 or type 2 diabetes can develop DHD. The higher a person's blood sugar level is, the higher his or her risk of DHD.
Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease, just like smoking, high blood pressure, and high blood cholesterol. In fact, people who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks.
Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Although research is ongoing, it's clear that diabetes and other conditions—such as overweight and obesity and metabolic syndrome—interact to cause harmful physical changes to the heart.
Third, diabetes raises the risk of earlier and more severe heart problems. Also, people who have DHD tend to have less success with some heart disease treatments, such as coronary artery bypass grafting and angioplasty (AN-jee-oh-plas-tee).
Outlook
If you have diabetes, you can lower your risk of DHD. Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors.
Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity can lower your blood pressure, help control your blood sugar level and your weight, and reduce stress.
It's also very important to follow your treatment plan for diabetes and see your doctor for ongoing care.
If you already have DHD, follow your treatment plan as your doctors advises. This may help you avoid or delay serious problems, such as a heart attack or heart failure.
What Causes Diabetic Heart Disease?
At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes.
Researchers continue to study these processes because all of the details aren't yet known.
Coronary Atherosclerosis
Atherosclerosis is a disease in which plaque builds up inside the arteries. The exact cause of atherosclerosis isn't known. However, studies show that it is a slow, complex disease that may start in childhood. The disease develops faster as you age.
Coronary atherosclerosis may start when certain factors damage the inner layers of the coronary (heart) arteries. These factors include:
Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. This reduces the flow of oxygen-rich blood to your heart muscle.
Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.
Blood clots narrow the coronary arteries even more. This limits the flow of oxygen-rich blood to your heart and may worsen angina (chest pain) or cause a heart attack.
Metabolic Syndrome
Metabolic syndrome is the name for a group of risk factors that raises your risk of both CHD and type 2 diabetes.
If you have three or more of the five metabolic risk factors, you have metabolic syndrome. The risk factors are:
It's unclear whether these risk factors have a common cause or are mainly related by their combined effects on the heart.
Obesity seems to set the stage for metabolic syndrome. Obesity can cause harmful changes in body fats and how the body uses insulin.
Chronic (ongoing) inflammation also may occur in people who have metabolic syndrome. Inflammation is the body's response to illness or injury. It may raise your risk of CHD and heart attack. Inflammation also may contribute to or worsen metabolic syndrome.
Research is ongoing to learn more about metabolic syndrome and how metabolic risk factors interact.
The Interaction of Coronary Heart Disease, High Blood Pressure, and Diabetes
Each of these risk factors alone can damage the heart. CHD reduces the flow of oxygen-rich blood to your heart muscle. High blood pressure and diabetes may cause harmful changes in the structure and function of the heart.
Having CHD, high blood pressure, and diabetes is even more harmful to the heart. Together, these conditions can severely damage the heart muscle. As a result, the heart has to work harder than normal. Over time, the heart weakens and isn’t able to pump enough blood to meet the body’s needs. This condition is called heart failure.
As the heart weakens, the body may release proteins and other substances into the blood. These proteins and substances also can harm the heart and worsen heart failure.
Who Is at Risk for Diabetic Heart Disease?
People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don't have diabetes, people who have the disease are more likely to:
The higher your blood sugar level is, the higher your risk of DHD. (A higher than normal blood sugar level is a risk factor for heart disease even in people who don't have diabetes.)
Type 2 diabetes raises your risk of having “silent” heart disease—that is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Other Risk Factors
Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don't. You can control most of these risk factors, but some you can't.
For a more detailed discussion of these risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article.
Risk Factors You Can Control
Prediabetes. This is a condition in which your
blood sugar level is higher than normal, but not as high as it is in
diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop
type 2 diabetes within 10 years.
Unhealthy diet. An unhealthy diet can raise your risk of
heart disease. Foods that are high in saturated and
trans fats,
cholesterol, sodium (salt), and
sugar can worsen other heart disease risk factors.
Stress. Stress and
anxiety can trigger your
arteries to tighten. This can raise your
blood pressure and your risk of having a
heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke or overeat foods high in
fat and
sugar.
Risk Factors You Can't Control
Age. As you get older, your risk of
heart disease and
heart attack rises. In men, the risk of heart disease increases after age 45. In women, the risk increases after age 55. In people who have
diabetes, the risk of heart disease increases after age 40.
Gender. Before age 55, women seem to have a lower risk of
heart disease than men. After age 55, however, the risk of heart disease increases similarly in both women and men.
Family history of early
heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
What Are the Signs and Symptoms of Diabetic Heart Disease?
Some people who have diabetic heart disease (DHD) may have no signs or symptoms of heart disease. This is called “silent” heart disease. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Thus, people who have diabetes should have regular medical checkups. Tests may reveal a problem before they're aware of it. Early treatment can reduce or delay related problems.
Some people who have DHD will have some or all of the typical symptoms of heart disease. Be aware of the symptoms described below and seek medical care if you have them.
If you think you're having a heart attack, call 9–1–1 right away for emergency care. Treatment for a heart attack works best when it's given right after symptoms occur.
Coronary Heart Disease
A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
See your doctor if you think you have angina. He or she may recommend tests to check your coronary arteries and to see whether you have CHD risk factors.
Other CHD signs and symptoms include nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness.
Some people don't realize they have CHD until they have a heart attack. A heart attack occurs if a blood clot forms in a coronary artery and blocks blood flow to part of the heart muscle.
The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.
The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. Shortness of breath may occur with or before chest discomfort.
Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms include nausea, vomiting, light-headedness or sudden dizziness, breaking out in a cold sweat, sleep problems, fatigue, and lack of energy.
Some heart attack symptoms are similar to angina symptoms. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.
If you don't know whether your chest pain is angina or a heart attack, call 9–1–1 right away for emergency care.
Not everyone who has a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. Also, diabetes-related nerve damage can interfere with pain signals in the body. As a result, some people who have diabetes may have heart attacks without symptoms.
Heart Failure
The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins in your neck. As the heart weakens, heart failure symptoms worsen.
People who have heart failure can live longer and more active lives if the condition is diagnosed early and they follow their treatment plans. If you have any form of DHD, talk with your doctor about your risk of heart failure.
Diabetic Cardiomyopathy
Diabetic cardiomyopathy may not cause symptoms in its early stages. Later, you may have weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet.
How Is Diabetic Heart Disease Diagnosed?
Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures.
Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms.
Initial Tests
No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests.
Blood Pressure Measurement
To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.
Most often, you'll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records your heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress.
During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you can’t exercise, you may be given medicine to raise your heart rate.
Urinalysis
For this test, you'll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD.
Other Tests and Procedures
Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD.
For more information about other tests and procedures, go to the diagnosis sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.
How Is Diabetic Heart Disease Treated?
Diabetic heart disease (DHD) is treated with lifestyle","June 11, 2014."
30,4,"2018-02-02 04:25:06",d,30,"2018-02-02 05:10:58","Disseminated Intravascular Coagulation","
What Is Disseminated Intravascular Coagulation?
Disseminated intravascular coagulation (ko-ag-u-LA-shun), or DIC, is a condition in which blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body's organs.
In DIC, the increased clotting uses up platelets (PLATE-lets) and clotting factors in the blood. Platelets are blood cell fragments that stick together to seal small cuts and breaks on blood vessel walls and stop bleeding. Clotting factors are proteins needed for normal blood clotting.
With fewer platelets and clotting factors in the blood, serious bleeding can occur. DIC can cause internal and external bleeding.
Internal bleeding occurs inside the body. External bleeding occurs underneath or from the skin or mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)
DIC can cause life-threatening bleeding.
Overview
To understand DIC, it helps to understand the body's normal blood clotting process. Your body has a system to control bleeding. When small cuts or breaks occur on blood vessel walls, your body activates clotting factors. These clotting factors, such as thrombin and fibrin, work with platelets to form blood clots.
Blood clots seal the small cuts or breaks on the blood vessel walls. After bleeding stops and the vessels heal, your body breaks down and removes the clots.
Some diseases and conditions can cause clotting factors to become overactive, leading to DIC. These diseases and conditions include:
Serious complications of
pregnancy and childbirth
Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.
The two types of DIC are acute and chronic. Acute DIC develops quickly (over hours or days) and must be treated right away. The condition begins with excessive blood clotting in the small blood vessels and quickly leads to serious bleeding.
Chronic DIC develops slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC. Chronic DIC causes excessive blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.
Treatment for DIC involves treating the clotting and bleeding problems and the underlying cause of the condition.
People who have acute DIC may need blood transfusions, medicines, and other life-saving measures. People who have chronic DIC may need medicines to help prevent blood clots from forming in their small blood vessels.
Outlook
The outlook for DIC depends on its severity and underlying cause. Acute DIC can damage the body's organs and even cause death if it's not treated right away. Chronic DIC also can damage the body's organs.
Researchers are looking for ways to prevent DIC or diagnose it early. They're also studying the use of various clotting proteins and medicines to treat the condition.
Other Names for Disseminated Intravascular Coagulation
What Causes Disseminated Intravascular Coagulation?
Some diseases and conditions can disrupt the body's normal blood clotting process and lead to disseminated intravascular coagulation (DIC). These diseases and conditions include:
Serious complications of
pregnancy and childbirth
Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.
The two types of DIC are acute and chronic. Acute DIC begins with clotting in the small blood vessels and quickly leads to serious bleeding. Chronic DIC causes blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.
Similar Clotting Conditions
Two other conditions cause blood clotting in the small blood vessels. However, their causes and treatments differ from those of DIC.
These conditions are thrombotic thrombocytopenic purpura (throm-BOT-ik throm-bo-cy-toe-PEE-nick PURR-purr-ah), or TTP, and hemolytic-uremic syndrome (HUS). HUS is more common in children than adults. It's also more likely to cause kidney damage than TTP.
Who Is at Risk for Disseminated Intravascular Coagulation?
Disseminated intravascular coagulation (DIC) is the result of an underlying disease or condition. People who have one or more of the following conditions are most likely to develop DIC:
Serious complications of
pregnancy and childbirth
People who are bitten by poisonous snakes (such as rattlesnakes and other vipers), or those who have frostbite or burns, also are at risk for DIC.
What Are the Signs and Symptoms of Disseminated Intravascular Coagulation?
Signs and symptoms of disseminated intravascular coagulation (DIC) depend on its cause and whether the condition is acute or chronic.
Acute DIC develops quickly (over hours or days) and is very serious. Chronic DIC develops more slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC.
With acute DIC, blood clotting in the blood vessels usually occurs first, followed by bleeding. However, bleeding may be the first obvious sign. Serious bleeding can occur very quickly after developing acute DIC. Thus, emergency treatment in a hospital is needed.
Blood clotting also occurs with chronic DIC, but it usually doesn't lead to bleeding. Sometimes chronic DIC has no signs or symptoms.
Signs and Symptoms of Excessive Blood Clotting
In DIC, blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels. This can cause the following signs and symptoms:
Pain, redness, warmth, and swelling in the lower leg if
blood clots form in the deep
veins of your leg.
Signs and Symptoms of Bleeding
In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal and external bleeding.
Internal Bleeding
Internal bleeding can occur in your body's organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:
Blood in your stools from
bleeding in your
intestines or
stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking
iron supplements also can cause dark, tarry stools.)
External Bleeding
External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)
External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.
![]()
Purpura and Petechiae. The photograph shows purpura (bruises) and petechiae (dots) on the skin. Bleeding under the skin causes the purple, brown, and red colors of the purpura and petechiae.
Other signs of external bleeding include:
Prolonged
bleeding, even from minor cuts.
Heavy or extended menstrual
bleeding in women.
How Is Disseminated Intravascular Coagulation Diagnosed?
Your doctor will diagnose disseminated intravascular coagulation (DIC) based on your medical history, a physical exam, and test results. Your doctor also will look for the cause of DIC.
Acute DIC requires emergency treatment. The condition can be life threatening if it's not treated right away. If you have signs or symptoms of severe bleeding or blood clots, call 9–1–1 right away.
Medical History and Physical Exam
Your doctor will ask whether you have or have had any diseases or conditions that can trigger DIC. For more information about these diseases and conditions, go to ""What Causes Disseminated Intravascular Coagulation?""
Your doctor will ask about signs and symptoms of blood clots and bleeding. He or she also will do a physical exam to look for signs and symptoms of blood clots and internal and external bleeding. For example, your doctor may look for bleeding from your gums.
Diagnostic Tests
To diagnose DIC, your doctor may recommend blood tests to look at your blood cells and the clotting process. For these tests, a small amount of blood is drawn from a blood vessel, usually in your arm.
Tests for Clotting Factors and Clotting Time
The following tests examine the proteins active in the blood clotting process and how long it takes them to form a blood clot.
PT and PTT tests. These tests measure how long it takes
blood clots to form.
Serum
fibrinogen. Fibrinogen is a
protein that helps the
blood clot. This test measures how much fibrinogen is in your blood.
Fibrin degradation. After
blood clots dissolve, substances called fibrin degradation products are left
behind in the blood. This test measures the amount of these substances in the blood.
How Is Disseminated Intravascular Coagulation Treated?
Treatment for disseminated intravascular coagulation (DIC) depends on its severity and cause. The main goals of treating DIC are to control bleeding and clotting problems and treat the underlying cause.
Acute Disseminated Intravascular Coagulation
People who have acute DIC may have severe bleeding that requires emergency treatment in a hospital. Treatment may include blood transfusions, medicines, and oxygen therapy. (Oxygen is given through nasal prongs, a mask, or a breathing tube.)
A blood transfusion is a safe, common procedure. You receive blood through an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to replace blood loss due to an injury, surgery, or illness.
Blood is made up of various parts, including red blood cells, white blood cells, platelets, and plasma. Some blood transfusions involve whole blood (blood with all of its parts). More often though, only some parts of blood are transfused.
If you have DIC, you may be given platelets and clotting factors, red blood cells, and plasma (the liquid part of blood).
Chronic Disseminated Intravascular Coagulation
People who have chronic DIC are more likely to have blood clotting problems than bleeding. If you have chronic DIC, your doctor may treat you with medicines called anticoagulants, or blood thinners.
Blood thinners help prevent blood clots from forming. They also keep existing blood clots from getting larger.
Living With Disseminated Intravascular Coagulation
If you have disseminated intravascular coagulation (DIC), ask your doctor how often you should schedule followup care and blood tests. Blood tests help track how well your blood is clotting.
You may need to take blood-thinning medicines (blood thinners) to help prevent blood clots or to keep existing clots from getting larger. If you take blood thinners, let everyone on your health care team know.
Blood thinners may thin your blood too much and cause bleeding. A lot of bleeding after a fall or injury or easy bruising or bleeding may mean that your blood is too thin.
Call your doctor right away if you have any signs of bleeding. If you have severe bleeding, call 9–1–1 right away.
Also, you should talk with your doctor before using any over-the-counter medicines or products, such as vitamins, supplements, or herbal remedies. Some of these products also can affect blood clotting and bleeding. For example, aspirin and ibuprofen may thin your blood too much. This can increase your risk of bleeding.
If you need surgery, your doctor may adjust the amount of medicine you take before, during, and after the surgery to prevent bleeding. This also may happen for dental work, but it's less common.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to disseminated intravascular coagulation, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Endocarditis?
Endocarditis (EN-do-kar-DI-tis) is an infection of the inner lining of the heart chambers and valves. This lining is called the endocardium (en-do-KAR-de-um). The condition also is called infective endocarditis (IE).
The term ""endocarditis"" also is used to describe an inflammation of the endocardium due to other conditions. This article only discusses endocarditis related to infection.
IE occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. The infection can damage your heart and cause serious and sometimes fatal complications.
IE can develop quickly or slowly; it depends on what type of germ is causing it and whether you have an underlying heart problem. When IE develops quickly, it's called acute infective endocarditis. When it develops slowly, it's called subacute infective endocarditis.
Overview
IE mainly affects people who have:
People who have normal heart valves also can have IE. However, the condition is much more common in people who have abnormal hearts.
Certain factors make it easier for bacteria to enter your bloodstream. These factors put you at higher risk for IE. For example, poor dental hygiene and unhealthy teeth and gums increase your risk for the infection.
Other risk factors include using intravenous (IV) drugs, having a catheter (tube) or another medical device in your body for long periods, and having a history of IE.
Common symptoms of IE are fever and other flu-like symptoms. Because the infection can affect people in different ways, the signs and symptoms vary. IE also can cause problems in many other parts of the body besides the heart.
If you're at high risk for IE, seek medical care if you have signs or symptoms of the infection, especially a fever that persists or unexplained fatigue (tiredness).
Outlook
IE is treated with antibiotics for several weeks. You also may need heart surgery to repair or replace heart valves or remove infected heart tissue.
Most people who are treated with the proper antibiotics recover. But if the infection isn't treated, or if it persists despite treatment (for example, if the bacteria are resistant to antibiotics), it's usually fatal.
If you have signs or symptoms of IE, see your doctor as soon as you can, especially if you have abnormal heart valves.
What Causes Endocarditis?
Infective endocarditis (IE) occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. Certain factors increase the risk of this happening.
A common underlying factor in IE is a structural heart defect, especially f aulty heart valves. Usually your immune system will kill germs in your bloodstream. However, if your heart has a rough lining or abnormal valves, the invading germs can attach and multiply in the heart.
Other factors also can play a role in causing IE. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition.
Having a catheter (tube) or another medical device inserted through your skin, especially for long periods, also can allow bacteria to enter your bloodstream. People who use intravenous (IV) drugs also are at risk for IE because of the germs on needles and syringes.
Bacteria also may spread to the blood and heart from infections in other parts of the body, such as the gut, skin, or genitals.
Endocarditis Complications
As the bacteria or other germs multiply in your heart, they form clumps with other cells and matter found in the blood. These clumps are called vegetations (vej-eh-TA-shuns).
As IE worsens, pieces of the vegetations can break off and travel to almost any other organ or tissue in the body. There, the pieces can block blood flow or cause a new infection. As a result, IE can cause a range of complications.
Central Nervous System Complications
These complications occur in as many as 20 to 40 percent of people who have IE. Central nervous system complications most often occur when bits of the vegetation, called emboli (EM-bo-li), break away and lodge in the brain.
The emboli can cause local infections called brain abscesses. Or, they can cause a more widespread brain infection called meningitis (men-in-JI-tis).
Emboli also can cause strokes or seizures. This happens if they block blood vessels or affect the brain's electrical signals. These complications can cause long-term damage to the brain and may even be fatal.
Complications in Other Organs
IE also can affect other organs in the body, such as the lungs, kidneys, and spleen.
Lungs. The lungs are especially at risk when IE affects the right side of the heart. This is called right-sided infective endocarditis.
A vegetation or blood clot going to the lungs can cause a pulmonary embolism (PE) and lung damage. A PE is a sudden blockage in a lung artery.
Other lung complications include pneumonia and a buildup of fluid or pus around the lungs.
Kidneys. IE can cause kidney abscesses and kidney damage. The infection also can inflame the internal filtering structures of the kidneys.
Signs and symptoms of kidney complications include back or side pain, blood in the urine, or a change in the color or amount of urine. In some cases, IE can cause kidney failure.
Spleen. The spleen is an organ located in the left upper part of the abdomen near the stomach. In some people who have IE, the spleen enlarges (especially in people who have long-term IE). Sometimes emboli also can damage the spleen.
Signs and symptoms of spleen problems include pain or discomfort in the upper left abdomen and/or left shoulder, a feeling of fullness or the inability to eat large meals, and hiccups.
Who Is At Risk for Endocarditis?
Infective endocarditis (IE) is an uncommon condition that can affect both children and adults. It's more common in men than women.
IE typically affects people who have abnormal hearts or other conditions that put them at risk for the infection. Sometimes IE does affect people who were healthy before the infection.
Major Risk Factors
The germs that cause IE tend to attach and multiply on damaged, malformed, or artificial (man-made) heart valves and implanted medical devices. Certain conditions put you at higher risk for IE. These include:
IV drug use, especially if needles are shared or reused, contaminated substances are injected, or the
skin isn't properly cleaned before
injection.
What Are the Signs and Symptoms of Endocarditis?
Infective endocarditis (IE) can cause a range of signs and symptoms that can vary from person to person. Signs and symptoms also can vary over time in the same person.
Signs and symptoms differ depending on whether you have an underlying heart problem, the type of germ causing the infection, and whether you have acute or subacute IE.
Signs and symptoms of IE may include:
Shortness of breath or a
cough that won't go away.
Skin changes such as:
Overall paleness.
Small, painful, red or purplish bumps under the
skin on the
fingers or toes.
Small, dark, painless flat spots on the
palms of the
hands or the soles of the feet.
Nausea (feeling sick to your
stomach),
vomiting, a decrease in appetite, a sense of fullness with discomfort on the upper left side of the
abdomen, or weight loss with or without a change in appetite.
Swelling in the feet, legs, or
abdomen.
How Is Endocarditis Diagnosed?
Your doctor will diagnose infective endocarditis (IE) based on your risk factors, your medical history and signs and symptoms, and test results.
Diagnosis of IE often is based on many factors, rather than a single positive test result, sign, or symptom.
Diagnostic Tests
Blood Tests
Blood cultures are the most important blood tests used to diagnose IE. Blood is drawn several times over a 24-hour period. It's put in special culture bottles that allow bacteria to grow.
Doctors then identify and test the bacteria to see which antibiotics will kill them. Sometimes the blood cultures don't grow any bacteria, even if a person has IE. This is called culture-negative endocarditis, and it requires antibiotic treatment.
Other blood tests also are used to diagnose IE. For example, a complete blood count may be used to check the number of red and white blood cells in your blood. Blood tests also may be used to check your immune system and to check for inflammation.
Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create pictures of your heart. Two types of echo are useful in diagnosing IE.
Transthoracic (tranz-thor-AS-ik) echo. For this painless test, gel is applied to the skin on your chest. A device called a transducer is moved around on the outside of your chest.
This device sends sound waves called ultrasound through your chest. As the ultrasound waves bounce off your heart, a computer converts them into pictures on a screen.
Your doctor uses the pictures to look for vegetations, areas of infected tissue (such as an abscess), and signs of heart damage.
Because the sound waves have to pass through skin, muscle, tissue, bone, and lungs, the pictures may not have enough detail. Thus, your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE).
Transesophageal echo. For TEE, a much smaller transducer is attached to the end of a long, narrow, flexible tube. The tube is passed down your throat. Before the procedure, you're given medicine to help you relax, and your throat is sprayed with numbing medicine.
The doctor then passes the transducer down your esophagus (the passage from your mouth to your stomach). Because this passage is right behind the heart, the transducer can get detailed pictures of the heart's structures.
EKG
An EKG is a simple, painless test that detects your heart's electrical activity. The test shows how fast your heart is beating, whether your heart rhythm is steady or irregular, and the strength and timing of electrical signals as they pass through your heart.
An EKG typically isn't used to diagnose IE. However, it may be done to see whether IE is affecting your heart's electrical activity.
For this test, soft, sticky patches called electrodes are attached to your chest, arms, and legs. You lie still while the electrodes detect your heart's electrical signals. A machine records these signals on graph paper or shows them on a computer screen. The entire test usually takes about 10 minutes.
How Is Endocarditis Treated?
Infective endocarditis (IE) is treated with antibiotics and sometimes with heart surgery.
Antibiotics
Antibiotics usually are given for 2 to 6 weeks through an intravenous (IV) line inserted into a vein. You're often in a hospital for at least the first week or more of treatment. This allows your doctor to make sure the medicine is helping.
If you're allowed to go home before the treatment is done, the antibiotics are almost always continued by vein at home. You'll need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment.
You also will need close medical followup, usually by a team of doctors. This team often includes a doctor who specializes in infectious diseases, a cardiologist (heart specialist), and a heart surgeon.
Surgery
Sometimes surgery is needed to repair or replace a damaged heart valve or to help clear up IE. For example, IE caused by fungi often requires surgery. This is because this type of IE is harder to treat than IE caused by bacteria.
How Can Endocarditis Be Prevented?
If you're at risk for infective endocarditis (IE), you can take steps to prevent the infection and its complications.
Brush and floss your
teeth regularly, and have regular dental checkups.
Germs from a
gum infection can enter your bloodstream.
Avoid body piercing, tattoos, and other procedures that may allow
germs to enter your bloodstream.
Research shows that not everyone at risk for IE needs to take antibiotics before routine dental exams and certain other dental and medical procedures.
Let your health care providers, including your dentist, know if you're at risk for IE. They can tell you whether you need antibiotics before exams and procedures.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to infective endocarditis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Excessive Blood Clotting?
Excessive blood clotting is a condition in which blood clots form too easily or don't dissolve properly. Normally, blood clots form to seal small cuts or breaks on blood vessel walls and stop bleeding.
Slow blood flow in the blood vessels also can cause blood clots to form. For example, if a blood vessel narrows, blood may slow down as it moves through the vessel.
Excessive blood clotting has many causes. Problems with the blood, blood vessel defects, or other factors can cause the condition. Regardless of the cause, blood clots can limit or block blood flow. This can damage the body's organs and may even cause death.
Outlook
The outlook and treatment for excessive blood clotting depend on the cause of the blood clots, how severe they are, and how well they can be controlled.
Life-threatening blood clots are treated as emergencies. Medicines that thin the blood are used as routine treatment for blood clotting problems. Some people must take these medicines for the rest of their lives.
With medicines and ongoing care, many people who have excessive blood clotting can successfully manage it.
Other Names for Excessive Blood Clotting
What Causes Excessive Blood Clotting?
To understand what causes excessive blood clotting, it helps to understand the body's normal blood clotting process.
Normally, blood clots form to seal small cuts or breaks on blood vessel walls and stop bleeding. After the bleeding has stopped and healing has occurred, the body breaks down and removes the clots.
Blood clotting is a complex process, but it mainly involves:
The inner layer of
cells lining the
blood vessels. These cells play a major role in causing blood clots to form.
Platelets (PLATE-lets). These small
blood cell fragments can stick together to form clots.
Excessive blood clotting can occur if the body's clotting process is altered or wrongly triggered. Blood clots can form in, or travel to, the arteries or veins in the brain, heart, kidneys, lungs, and limbs. (Arteries and veins are the blood vessels that carry blood to your heart and body.)
Certain diseases and conditions, genetic mutations, medicines, and other factors can cause excessive blood clotting.
Diseases and Conditions
Many diseases and conditions can cause the blood to clot too much or prevent blood clots from dissolving properly. Certain diseases and conditions are more likely to cause clots to form in certain areas of the body.
Bone Marrow Disorders
Some bone marrow disorders can cause your body to make too many blood cells that can lead to blood clots. Examples include polycythemia vera (POL-e-si-THE-me-ah VE-ra), or PV, and thrombocythemia (THROM-bo-si-THE-me-ah).
PV is a rare blood disease in which your body makes too many red blood cells. These extra red blood cells make your blood thicker than normal. This slows the flow of blood through your small blood vessels, which can cause blood clots to form.
Thrombocythemia is a condition in which your body makes too many platelets. The platelets can stick together to form blood clots.
Problems With Blood Clot Breakdown
After a blood clot has done its job, the body normally breaks down the fibrin that holds the clot together.
Several rare genetic and acquired conditions affect the fibrin network that holds blood clots together. Thus, the clots don't break down properly, and they remain in the body longer than needed.
In one condition, for example, the body's fibrin is abnormal and resists being broken down. In another condition, the body has a decreased amount of plasmin. This protein helps break down fibrin.
Excessive Blood Clotting That Mainly Affects the Heart and Brain
Any condition that damages the smooth inner surface of the blood vessels can trigger blood clotting. Many of these conditions are acquired. However, some genetic problems also can damage the inner surface of the blood vessels.
Certain diseases, conditions, or factors can trigger excessive blood clotting mainly in the arteries and veins of the heart and brain.
Atherosclerosis. Atherosclerosis is a disease in which a waxy substance called plaque builds up inside your arteries. Over time, the plaque may rupture (break open). Platelets clump together to form blood clots at the site of the damage. Atherosclerosis is a major cause of damage to the blood vessel walls.
Vasculitis. Vasculitis (vas-kyu-LI-tis) is a disorder that causes the body's blood vessels to become inflamed. Platelets may stick to areas where the blood vessels are damaged and form blood clots. Vasculitis also is a major cause of damage to the blood vessel walls.
Diabetes. Diabetes increases the risk of plaque buildup in the arteries, which can cause dangerous blood clots. Nearly 80 percent of people who have diabetes will eventually die of clot-related causes. Many of these deaths are related to complications with the heart and blood vessels.
Heart failure. Heart failure is a condition in which the heart is damaged or weakened. As a result, it can't pump enough blood to meet the body's needs. Heart failure slows blood flow, which can cause blood clots to form.
Atrial fibrillation. Atrial fibrillation (A-tre-al fih-brih-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat. AF can cause blood to pool in the upper chambers of the heart. This can cause blood clots to form.
Overweight and obesity. Overweight and obesity refer to body weight that's greater than what is considered healthy for a certain height. These conditions can lead to atherosclerosis, which increases the risk of blood clots.
Metabolic syndrome. Some research shows that people who have metabolic syndrome are at increased risk for excessive blood clotting. Metabolic syndrome is the name for a group of risk factors that increases your chance of having heart disease and other health problems.
Excessive Blood Clotting That Mainly Affects the Limbs
Blood clots can form in the veins deep in the limbs. This condition is called deep vein thrombosis (DVT). DVT usually affects the deep veins of the legs.
A blood clot in a deep vein can break off and travel through the bloodstream. If the clot travels to the lungs and blocks blood flow, the condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.
Certain diseases, conditions, or factors can trigger excessive blood clotting mainly in the deep veins of the limbs. Examples include:
Hospitalization for major
surgery, a serious medical illness, trauma, or
broken bones. If you're not able to be active for long
periods,
blood flow in your
veins slows down. As a result, blood clots may form in your legs.
""Coach class."" This term refers to a situation in which you must stay in one position for a long time, such as in a car or plane. Staying in one position can slow
blood flow and lead to blood clots in the legs.
Medicines
Some medicines can disrupt the body's normal blood clotting process. Medicines containing the female hormone estrogen are linked to an increased risk of blood clots. Examples of medicines that may contain estrogen include birth control pills and hormone therapy.
Heparin is a medicine commonly used to prevent blood clots. But, in some people, the medicine can cause blood clots and a low platelet count. This condition is called heparin-induced thrombocytopenia (HIT).
HIT rarely occurs outside of a hospital because heparin usually is given in hospitals. In HIT, the body's immune system attacks the heparin and a protein on the surface of the platelets. This attack prompts the platelets to start forming blood clots.
Other Factors That Can Alter the Blood Clotting Process
Many other factors also can alter the clotting process and lead to excessive blood clotting. Common examples include:
Smoking. Smoking raises the risk of unwanted
blood clots and makes it more likely that
platelets will stick together. Smoking also damages the lining of the
blood vessels, which can cause blood clots to form.
Increased homocysteine levels. Homocysteine is an
amino acid linked to a high risk of vascular disease. Increased levels of this substance may damage the inner lining of the
arteries.
Pregnancy. Women are more likely to develop
blood clots when they're pregnant. This is because they have more
platelets and
clotting factors in their blood during pregnancy. Also, during pregnancy, the
uterus compresses the
veins. This slows blood flow, which can lead to blood clots.
HIV and HIV
treatments. The risk of
blood clots is highest in HIV patients who have infections, are taking certain medicines, have been hospitalized, or are older than 45.
Dehydration. This is a condition in which your body doesn't have enough fluids. This condition causes your
blood vessels to narrow and your blood to thicken, which raises your risk for blood clots.
What Are the Signs and Symptoms of Excessive Blood Clotting?
Signs and symptoms of excessive blood clotting depend on where the clots form. For example, symptoms of a blood clot in the heart or lungs may include chest pain, shortness of breath, and upper body discomfort in the arms, back, neck, or jaw. These symptoms may suggest a heart attack or pulmonary embolism (PE).
Signs and symptoms of a blood clot in the deep veins of the leg may include pain, redness, warmth, and swelling in the lower leg. These signs and symptoms may suggest deep vein thrombosis (DVT).
Signs and symptoms of a blood clot in the brain may include headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking or understanding speech. These signs and symptoms may suggest a stroke.
If you have signs or symptoms of a heart attack, PE, or stroke, call 9–1–1 right away. If you have signs or symptoms of DVT, call your doctor right away. The cause of the blood clot needs to be found and treated as soon as possible.
Complications of Blood Clots
Blood clots can form in, or travel to, the arteries or veins in the brain, heart, kidneys, lungs, and limbs. Blood clots can limit or block blood flow. This can damage the body's organs and cause many problems. Sometimes blood clots can be fatal.
Kidney Problems and Kidney Failure
A blood clot in the kidneys can lead to kidney problems or kidney failure. Kidney failure occurs if the kidneys can no longer remove fluids and waste from your body. This causes a buildup of these fluids and waste in your body, high blood pressure, and other health problems.
Pulmonary Embolism
If a blood clot travels from a deep vein in the body to the lungs, it's called a pulmonary embolism, or PE. PE is a serious condition that can damage your lungs and other organs and cause low oxygen levels in your blood.
For more information, go to the Health Topics Pulmonary Embolism article.
Deep Vein Thrombosis
A blood clot in a vein deep in your arm or leg can cause pain, swelling, redness, or increased warmth in the affected limb. This type of clot is called deep vein thrombosis, or DVT. Deep vein clots can break off, travel to the lungs, and cause PE.
For more information, go to the Health Topics Deep Vein Thrombosis article.
How Is Excessive Blood Clotting Diagnosed?
If your doctor thinks that you have excessive blood clotting based on your signs and symptoms, he or she will look for the cause of the condition.
Your doctor will ask about your medical and family histories, do a physical exam, and review the results from tests.
Your primary care doctor may refer you to a hematologist. This is a doctor who specializes in diagnosing and treating blood diseases and disorders.
Medical and Family Histories
Your doctor may ask you detailed questions about your medical history and your family's medical history. He or she may ask whether you or a blood relative:
Has a history of repeated
blood clots before age 40
Physical Exam
Your doctor will do a physical exam to see how severe your blood clotting problem is and to look for a possible cause.
Diagnostic Tests
Your doctor may recommend blood tests to look at your blood cells and the clotting process. If he or she thinks you have a genetic condition, you may need more blood tests.
Tests to find the cause of excessive blood clotting might be delayed for weeks or even months while you receive treatment for a blood clot.
Tests for Clotting Factors and Clotting Time
You also may need blood tests that look at the proteins active in the blood clotting process and how long it takes them to form a blood clot.
Clotting proteins or factors react with each other along two pathways called the intrinsic and extrinsic pathways. (A pathway is a string of chemical reactions that always occur in a certain order.) The two pathways join in a common pathway to make a fibrin network that holds blood clots together.
PT test. This test looks at the extrinsic and common pathways to measure how long it takes
blood clots to form. People who have
excessive blood clotting may take the medicine
warfarin to prolong their clotting times.
A PTT test. This test looks at the intrinsic and common pathways to measure how long it takes
blood clots to form. People also may take blood thinners, like
heparin, to slow their clotting times.
How Is Excessive Blood Clotting Treated?
Excessive blood clotting is treated with medicines. Depending on the size and location of the clot(s), you may need emergency treatment or routine treatment.
What Is Fanconi Anemia?
Fanconi anemia (fan-KO-nee uh-NEE-me-uh), or FA, is a rare, inherited blood disorder that leads to bone marrow failure. The disorder also is called Fanconi’s anemia.
FA prevents your bone marrow from making enough new blood cells for your body to work normally. FA also can cause your bone marrow to make many faulty blood cells. This can lead to serious health problems, such as leukemia (a type of blood cancer).
Although FA is a blood disorder, it also can affect many of your body's organs, tissues, and systems. Children who inherit FA are at higher risk of being born with birth defects. FA also increases the risk of some cancers and other serious health problems.
FA is different from Fanconi syndrome. Fanconi syndrome affects the kidneys. It's a rare and serious condition that mostly affects children.
Children who have Fanconi syndrome pass large amounts of key nutrients and chemicals through their urine. These children may have serious health and developmental problems.
Outlook
People who have FA have a greater risk than other people for some cancers. About 10 percent of people who have FA develop leukemia.
People who have FA and survive to adulthood are much more likely than others to develop cancerous solid tumors.
The risk of solid tumors increases with age in people who have FA. These tumors can develop in the mouth, tongue, throat, or esophagus (eh-SOF-ah-gus). (The esophagus is the passage leading from the mouth to the stomach.)
Women who have FA are at much greater risk than other women of developing tumors in the reproductive organs.
FA is an unpredictable disease. The average lifespan for people who have FA is between 20 and 30 years. The most common causes of death related to FA are bone marrow failure, leukemia, and solid tumors.
Advances in care and treatment have improved the chances of surviving longer with FA. Blood and marrow stem cell transplant is the major advance in treatment. However, even with this treatment, the risk of some cancers is greater in people who have FA.
What Causes Fanconi Anemia?
Fanconi anemia (FA) is an inherited disease. The term “inherited” means that the disease is passed from parents to children through genes. At least 13 faulty genes are associated with FA. FA occurs when both parents pass the same faulty FA gene to their child.
People who have only one faulty FA gene are FA ""carriers."" Carriers don't have FA, but they can pass the faulty gene to their children.
If both of your parents have a faulty FA gene, you have:
If only one of your parents has a faulty FA gene, you won't have the disorder. However, you have a 50 percent chance of being an FA carrier and passing the gene to any children you have.
Who Is at Risk for Fanconi Anemia?
Fanconi anemia (FA) occurs in all racial and ethnic groups and affects men and women equally.
In the United States, about 1 out of every 181 people is an FA carrier. This carrier rate leads to about 1 in 130,000 people being born with FA.
Two ethnic groups, Ashkenazi Jews and Afrikaners, are more likely than other groups to have FA or be FA carriers.
Ashkenazi Jews are people who are descended from the Jewish population of Eastern Europe. Afrikaners are White natives of South Africa who speak a language called Afrikaans. This ethnic group is descended from early Dutch, French, and German settlers.
In the United States, 1 out of 90 Ashkenazi Jews is an FA carrier, and 1 out of 30,000 is born with FA.
Major Risk Factors
FA is an inherited disease—that is, it's passed from parents to children through genes. At least 13 faulty genes are associated with FA. FA occurs if both parents pass the same faulty FA gene to their child.
Children born into families with histories of FA are at risk of inheriting the disorder. Children whose mothers and fathers both have family histories of FA are at even greater risk. A family history of FA means that it's possible that a parent carries a faulty gene associated with the disorder.
Children whose parents both carry the same faulty gene are at greatest risk of inheriting FA. Even if these children aren't born with FA, they're still at risk of being FA carriers.
Children who have only one parent who carries a faulty FA gene also are at risk of being carriers. However, they're not at risk of having FA.
What Are the Signs and Symptoms of Fanconi Anemia?
Major Signs and Symptoms
Your doctor may suspect you or your child has Fanconi anemia (FA) if you have signs and symptoms of:
FA is an inherited disorder—that is, it's passed from parents to children through genes. If a child has FA, his or her brothers and sisters also should be tested for the disorder.
Bone Marrow Failure
When your bone marrow fails, it can't make enough red blood cells, white blood cells, and platelets. This can cause many problems that have various signs and symptoms.
With too few red blood cells, you can develop anemia. In FA, the size of your red blood cells also can be much larger than normal. This makes it harder for the cells to work well.
With too few white blood cells, you're at risk for infections. Infections also may last longer and be more serious than normal.
With too few platelets, you may bleed and bruise easily, suffer from internal bleeding, or have petechiae (pe-TEE-kee-ay). Petechiae are tiny red or purple spots on the skin. Bleeding in small blood vessels just below your skin causes these spots.
In some people who have FA, the bone marrow makes a lot of harmful, immature white blood cells called blasts. Blasts don't work like normal blood cells. As they build up, they prevent the bone marrow from making enough normal blood cells.
A large number of blasts in the bone marrow can lead to a type of blood cancer called acute myeloid leukemia (AML).
Birth Defects
Many birth defects can be signs of FA. These include:
Bone or skeletal defects. FA can cause missing, oddly shaped, or three or more
thumbs.
Arm bones, hips, legs,
hands, and toes may not form fully or normally. People who have FA may have a curved
spine, a condition called
scoliosis (sco-le-O-sis).
Eye and
ear defects. The
eyes,
eyelids, and
ears may not have a normal shape. Children who have FA also might be born deaf.
Skin discoloration. This includes coffee-colored areas or odd-looking patches of lighter skin.
Kidney problems. A child who has FA might be born with a missing kidney or
kidneys that aren't shaped normally.
Developmental Problems
Other signs and symptoms of FA are related to physical and mental development. They include:
Signs and Symptoms of Fanconi Anemia in Adults
Some signs and symptoms of FA may develop as you or your child gets older. Women who have FA may have some or all of the following:
Men who have FA may have sex organs that are less developed than normal. They also may be less fertile than men who don't have the disease.
How Is Fanconi Anemia Diagnosed?
People who have Fanconi anemia (FA) are born with the disorder. They may or may not show signs or symptoms of it at birth. For this reason, FA isn't always diagnosed when a person is born. In fact, most people who have the disorder are diagnosed between the ages of 2 and 15 years.
The tests used to diagnose FA depend on a person's age and symptoms. In all cases, medical and family histories are an important part of diagnosing FA. However, because FA has many of the same signs and symptoms as other diseases, only genetic testing can confirm its diagnosis.
Specialists Involved
A geneticist is a doctor or scientist who studies how genes work and how diseases and traits are passed from parents to children through genes.
Geneticists do genetic testing for FA. They also can provide counseling about how FA is inherited and the types of prenatal (before birth) testing used to diagnose it.
An obstetrician may detect birth defects linked to FA before your child is born. An obstetrician is a doctor who specializes in providing care for pregnant women.
After your child is born, a pediatrician also can help find out whether your child has FA. A pediatrician is a doctor who specializes in treating children and teens.
A hematologist (blood disease specialist) also may help diagnose FA.
Family and Medical Histories
FA is an inherited disease. Some parents are aware that their family has a medical history of FA, even if they don't have the disease.
Other parents, especially if they're FA carriers, may not be aware of a family history of FA. Many parents may not know that FA can be passed from parents to children.
Knowing your family medical history can help your doctor diagnose whether you or your child has FA or another condition with similar symptoms.
If your doctor thinks that you, your siblings, or your children have FA, he or she may ask you detailed questions about:
If you know your family has a history of FA, or if your answers to your doctor's questions suggest a possible diagnosis of FA, your doctor will recommend further testing.
Diagnostic Tests and Procedures
The signs and symptoms of FA aren't unique to the disease. They're also linked to many other diseases and conditions, such as aplastic anemia. For this reason, genetic testing is needed to confirm a diagnosis of FA. Genetic tests for FA include the following.
Chromosome Breakage Test
This is the most common test for FA. It's available only in special laboratories (labs). It shows whether your chromosomes (long chains of genes) break more easily than normal.
Skin cells sometimes are used for the test. Usually, though, a small amount of blood is taken from a vein in your arm using a needle. A technician combines some of the blood cells with certain chemicals.
If you have FA, the chromosomes in your blood sample break and rearrange when mixed with the test chemicals. This doesn't happen in the cells of people who don't have FA.
Cytometric Flow Analysis
Cytometric flow analysis, or CFA, is done in a lab. This test examines how chemicals affect your chromosomes as your cells grow and divide. Skin cells are used for this test.
A technician mixes the skin cells with chemicals that can cause the chromosomes in the cells to act abnormally. If you have FA, your cells are much more sensitive to these chemicals.
The chromosomes in your skin cells will break at a high rate during the test. This doesn't happen in the cells of people who don't have FA.
Mutation Screening
A mutation is an abnormal change in a gene or genes. Geneticists and other specialists can examine your genes, usually using a sample of your skin cells. With special equipment and lab processes, they can look for gene mutations that are linked to FA.
Diagnosing Different Age Groups
Before Birth (Prenatal)
If your family has a history of FA and you get pregnant, your doctor may want to test you or your fetus for FA.
Two tests can be used to diagnose FA in a developing fetus: amniocentesis (AM-ne-o-sen-TE-sis) and chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS). Both tests are done in a doctor's office or hospital.
Amniocentesis is done 15 to 18 weeks after a pregnant woman's last period. A doctor uses a needle to remove a small amount of fluid from the sac around the fetus. A technician tests chromosomes (chains of genes) from the fluid sample to see whether they have faulty genes associated with FA.
CVS is done 10 to 12 weeks after a pregnant woman's last period. A doctor inserts a thin tube through the vagina and cervix to the placenta (the temporary organ that connects the fetus to the mother).
The doctor removes a tissue sample from the placenta using gentle suction. The tissue sample is sent to a lab to be tested for genetic defects associated with FA.
Childhood and Later
Some people who have FA are not born with birth defects. Doctors may not diagnose them with the disorder until signs of bone marrow failure or cancer occur. This usually happens within the first 10 years of life.
Signs of bone marrow failure most often begin between the ages of 3 and 12 years, with 7 to 8 years as the most common ages. However, 10 percent of children who have FA aren't diagnosed until after 16 years of age.
If your bone marrow is failing, you may have signs of aplastic anemia. FA is one type of aplastic anemia.
In aplastic anemia, your bone marrow stops making or doesn't make enough of all three types of blood cells: red blood cells, white blood cells, and platelets.
Aplastic anemia can be inherited or acquired after birth through exposure to chemicals, radiation, or medicines.
Doctors diagnose aplastic anemia using:
A reticulocyte (re-TIK-u-lo-site) count. This test counts the number of new
red blood cells in your blood to see whether your
bone marrow is making red blood cells at the proper rate.
If you or your child is diagnosed with aplastic anemia, your doctor will want to find the cause. If your doctor suspects you have FA, he or she may recommend genetic testing.
For more information, go to the Health Topics Aplastic Anemia article.
How Is Fanconi Anemia Treated?
Doctors decide how to treat Fanconi anemia (FA) based on a person's age and how well the person's bone marrow is making new blood cells.
Goals of Treatment
Long-term treatments for FA can:
Cure the
anemia. Damaged
bone marrow cells are replaced with healthy ones that can make enough of all three types of
blood cells on their own.
—Or—
Treat the symptoms without curing the cause. This is done using medicines and other substances that can help your body make more
blood cells for a limited time.
Screening and Short-Term Treatment
Even if you or your child has FA, your bone marrow might still be able to make enough new blood cells. If so, your doctor might suggest frequent blood count checks so he or she can watch your condition.
Your doctor will probably want you to have bone marrow tests once a year. He or she also will screen you for any signs of cancer or tumors.
If your blood counts begin to drop sharply and stay low, your bone marrow might be failing. Your doctor may prescribe antibiotics to help your body fight infections. In the short term, he or she also may want to give you blood transfusions to increase your blood cell counts to normal levels.
However, long-term use of blood transfusions can reduce the chance that other treatments will work.
Long-Term Treatment
The four main types of long-term treatment for FA are:
Blood and Marrow Stem Cell Transplant
A blood and marrow stem cell transplant is the current standard treatment for patients who have FA that's causing major bone marrow failure. Healthy stem cells from another person, called a donor, are used to replace the faulty cells in your bone marrow.
If you're going to receive stem cells from another person, your doctor will want to find a donor whose stem cells match yours as closely as possible.
Stem cell transplants are most successful in younger people who:
During the transplant, you'll get donated stem cells in a procedure that's like a blood transfusion. Once the new stem cells are in your body, they travel to your bone marrow and begin making new blood cells.
A successful stem cell transplant will allow your body to make enough of all three types of blood cells.
Even if you've had a stem cell transplant to treat FA, you’re still at risk for some types of blood cancer and cancerous solid tumors. Your doctor will check your health regularly after the procedure.
For more information about stem cell transplants—including finding a donor, having the procedure, and learning about the risks—go to the Health Topics Blood and Marrow Stem Cell Transplant article.
Synthetic Growth Factors
Your doctor may choose to treat your FA with growth factors. These are substances found in your body, but they also can be man-made.
Growth factors help your body make more red and white blood cells. Growth factors that help your body make more platelets still are being studied.
More research is needed on growth factor treatment for FA. Early results suggest that growth factors may have fewer and less serious side effects than androgens.
Gene Therapy
Researchers are looking for ways to replace faulty FA genes with normal, healthy genes. They hope these genes will make proteins that can repair and protect your bone marrow cells. Early results of this therapy hold promise, but more research is needed.
Surgery
FA can cause birth defects that affect the arms, thumbs, hips, legs, and other parts of the body. Doctors may recommend surgery to repair some defects.
For example, your child might be born with a ventricular septal defect—a hole or defect in the wall that separates the lower chambers of the heart. His or her doctor may recommend surgery to close the hole so the heart can work properly.
Children who have FA also may need surgery to correct digestive system problems that can harm their nutrition, growth, and survival.
One of the most common problems is an FA-related birth defect in which the trachea (windpipe), which carries air to the lungs, is connected to the esophagus, which carries food to the stomach.
This can cause serious breathing, swallowing, and eating problems and can lead to lung infections. Surgery is needed to separate the two organs and allow normal eating and breathing.
What Is a Heart Attack?
A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. If blood flow isn't restored quickly, the section of heart muscle begins to die.
Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent disabilities.
Heart attack treatment works best when it's given right after symptoms occur. If you think you or someone else is having a heart attack (even if you're not fully sure), call 9–1–1 right away.
Overview
Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis). The buildup of plaque occurs over many years.
Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
![]()
Heart With Muscle Damage and a Blocked Artery. Figure A shows a heart with dead heart muscle caused by a heart attack. Figure B is a cross-section of a coronary artery with plaque buildup and a blood clot.
A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.
Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias (ah-RITH-me-ahs).
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.
Don't Wait—Get Help Quickly
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's given right after symptoms occur.
Many people aren't sure what's wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:
Chest pain or discomfort. Most
heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like
heartburn or
indigestion.
Upper body discomfort. You may feel pain or discomfort in one or both
arms, the back,
shoulders,
neck,
jaw, or upper part of the
stomach (above the belly button).
Shortness of breath. This may be your only symptom, or it may occur before or along with
chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.
Other possible symptoms of a heart attack include:
Breaking out in a cold
sweatFeeling unusually tired for no reason, sometimes for days (especially if you are a woman)
Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)
Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.
Quick Action Can Save Your Life: Call 9–1–1
If you think you or someone else may be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care. Acting fast can save your life.
Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment.
Outlook
Each year, close to 1 million people in the United States have heart attacks, and many of them die. CHD, which often results in heart attacks, is the leading killer of both men and women in the United States.
Many more people could survive or recover better from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.
Other Names for a Heart Attack
Coronary thrombosis
Coronary occlusion
What Causes a Heart Attack?
Coronary Heart Disease
A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. Most heart attacks occur as a result of coronary heart disease (CHD).
CHD is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart.
When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Coronary Artery Spasm
A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.
What causes a coronary artery to spasm isn't always clear. A spasm may be related to:
Taking certain drugs, such as
cocaineExposure to extreme cold
Cigarette smoking
The animation below shows how plaque buildup or a coronary artery spasm can lead to a heart attack. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how blocked blood flow in a coronary artery can lead to a heart attack.
Who Is at Risk for a Heart Attack?
Certain risk factors make it more likely that you'll develop coronary heart disease (CHD) and have a heart attack. You can control many of these risk factors.
Risk Factors You Can't Control
Risk factors that you can't control include:
Age. The risk of
heart disease increases for men after age 45 and for women after age 55 (or after
menopause).
Family history of early
heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
What Are the Symptoms of a Heart Attack?
Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic.
The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:
Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
The most common symptom, in both men and women, is
chest pain or discomfort.
Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.
Most Common Symptoms
The most common warning symptoms of a heart attack for both men and women are:
Chest pain or discomfort. Most
heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like
heartburn or
indigestion. The feeling can be mild or severe.
Upper body discomfort. You may feel pain or discomfort in one or both
arms, the back,
shoulders,
neck,
jaw, or upper part of the
stomach (above the belly button).
Shortness of breath. This may be your only symptom, or it may occur before or along with
chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.
The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest.
Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.
All chest pain should be checked by a doctor.
Other Common Symptoms
Pay attention to these other possible symptoms of a heart attack:
Breaking out in a cold
sweatFeeling unusually tired for no reason, sometimes for days (especially if you are a woman)
Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)
Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur.
The more signs and symptoms you have, the more likely it is that you're having a heart attack.
Quick Action Can Save Your Life: Call 9–1–1
The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly—sometimes within hours, days, or weeks of a heart attack.
Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why:
Every minute matters. Never delay calling 9–1–1 to take aspirin or do anything else you think might help.
How Is a Heart Attack Diagnosed?
Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results.
Diagnostic Tests
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
An EKG can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack.
Blood Tests
During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack.
Commonly used blood tests include troponin tests, CK or CK–MB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time.
How Is a Heart Attack Treated?
Early treatment for a heart attack can prevent or limit damage to the heart muscle. Acting fast, at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital.
Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include:
Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments to try to promptly restore blood flow to the heart. The two main treatments are ""clot-busting"" medicines and percutaneous coronary intervention (PCI), sometimes referred to as coronary angioplasty, a procedure used to open blocked coronary arteries.
Clot-Busting Medicines
Thrombolytic medicines, also called ""clot busters,"" are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible.
Percutaneous Coronary Intervention
PCI is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called coronary angioplasty.
A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel, usually in the groin (upper thigh), to the narrowed or blocked coronary artery.
Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.
During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after the procedure.
For more information, go to the Health Topics Coronary Angioplasty article.
Other Treatments for Heart Attack
Medicines
Anticoagulants. Anticoagulants, or ""
blood thinners,"" prevent blood clots from forming in your
arteries. These medicines also keep existing clots from getting larger.
Anticlotting medicines. Anticlotting medicines stop
platelets from clumping together and forming unwanted
blood clots. Examples of anticlotting medicines include
aspirin and
clopidogrel.
You also may be given medicines to relieve pain and anxiety, treat arrhythmias (which often occur during a heart attack), or lower your cholesterol (these medicines are called statins).
Treatment After You Leave the Hospital
Most people spend several days in the hospital after a heart attack. When you leave the hospital, treatment doesn't stop. At home, your treatment may include daily medicines and cardiac rehabilitation (rehab). Your doctor may want you to have a flu shot and pneumococcal vaccine each year.
Your doctor also may recommend lifestyle changes, including following a heart healthy diet, being physically active, maintaining a healthy weight, and quitting smoking. Taking these steps can lower your chances of having another heart attack.
Cardiac Rehabilitation
Your doctor may recommend cardiac rehab to help you recover from a heart attack and to help prevent another heart attack. Almost everyone who has had a heart attack can benefit from rehab.
Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.
The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.
Rehab has two parts:
Exercise training. This part helps you learn how to exercise safely, strengthen your
muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
Education, counseling, and training. This part of rehab helps you understand your
heart condition and find ways to reduce your risk of future heart problems. The rehab team will help you learn how to cope with the
stress of adjusting to a new lifestyle and deal with your fears about the future.
For more information, go to the Health Topics Cardiac Rehabilitation article.
How Can a Heart Attack Be Prevented?
Lowering your risk factors for coronary heart disease (CHD) can help you prevent a heart attack. (For more information about risk factors, go to ""Who Is at Risk for a Heart Attack?"")
Even if you already have CHD, you can still take steps to lower your risk for a heart attack. These steps involve following a heart healthy lifestyle and getting ongoing care.
Heart Healthy Lifestyle
Following a healthy diet is an important part of a heart healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugars.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources provide general information about healthy eating.
If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan that involves diet and physical activity. Controlling your weight helps you control risk factors for CHD and heart attack.
Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.
For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
If you smoke, quit. Smoking can raise your risk of CHD and Go to:
What Is Heart Block?
Heart block is a problem that occurs with the heart's electrical system. This system controls the rate and rhythm of heartbeats. (""Rate"" refers to the number of times your heart beats per minute. ""Rhythm"" refers to the pattern of regular or irregular pulses produced as the heart beats.)
With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood.
Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart.
Overview
Heart block is a type of arrhythmia (ah-RITH-me-ah). An arrhythmia is any problem with the rate or rhythm of the heartbeat.
Some people are born with heart block, while others develop it during their lifetimes. If you're born with the condition, it's called congenital (kon-JEN-ih-tal) heart block. If the condition develops after birth, it's called acquired heart block.
Doctors might detect congenital heart block before or after a baby is born. Certain diseases that may occur during pregnancy can cause heart block in a baby. Some congenital heart defects also can cause heart block. Congenital heart defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects.
Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage.
The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block.
Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. It maps the data on a graph for the doctor to review.
Outlook
The symptoms and severity of heart block depend on which type you have. First-degree heart block may not cause any severe symptoms.
Second-degree heart block may result in the heart skipping a beat or beats. This type of heart block also can make you feel dizzy or faint.
Third-degree heart block limits the heart's ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal.
A medical device called a pacemaker is used to treat third-degree heart block and some cases of second-degree heart block. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers typically are not used to treat first-degree heart block.
All types of heart block may increase your risk for other arrhythmias, such as atrial fibrillation (A-tre-al fih-brih-LA-shun). Talk with your doctor to learn more about the signs and symptoms of arrhythmias.
Understanding the Heart's Electrical System and EKG Results
Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. An EKG records the strength and timing of electrical signals as they pass through the heart.
The data are recorded on a graph so your doctor can study your heart's electrical activity. Different parts of the graph show each step of an electrical signal's journey through the heart.
![]()
EKG. The image shows the standard setup for an EKG. In figure A, a normal heart rhythm recording shows the electrical pattern of a regular heartbeat. In figure B, a patient lies in a bed with EKG electrodes attached to his chest, upper arms, and legs. (more...)
Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium (AY-tree-um), which is the upper right chamber of the heart. (Your heart has two upper chambers and two lower chambers.)
In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to 100 times a minute.
From the SA node, the signal travels through the right and left atria. This causes the atria to contract, which helps move blood into the heart's lower chambers, the ventricles (VEN-trih-kuls). The electrical signal moving through the atria is recorded as the P wave on the EKG.
The electrical signal passes between the atria and ventricles through a group of cells called the atrioventricular (AV) node. The signal slows down as it passes through the AV node. This slowing allows the ventricles enough time to finish filling with blood. On the EKG, this part of the process is the flat line between the end of the P wave and the beginning of the Q wave.
The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. From there, the signal travels into the right and left bundle branches. The signal spreads quickly across your heart's ventricles, causing them to contract and pump blood to your lungs and the rest of your body. This process is recorded as the QRS waves on the EKG.
The ventricles then recover their normal electrical state (shown as the T wave on the EKG). The muscle stops contracting to allow the heart to refill with blood. This entire process continues over and over with each new heartbeat.
The animation below shows how your heart's electrical system works and how an EKG records your heart's electrical activity. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how an electrical signal moves through your heart and how an EKG records your heart's electrical activity.
For more information about the heart's electrical system, go to the Health Topics How the Heart Works article.
Types of Heart Block
Some people are born with heart block (congenital), while others develop it during their lifetimes (acquired). Acquired heart block is more common than congenital heart block.
The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block.
Second-Degree Heart Block
In this type of heart block, electrical signals between the atria and ventricles are slowed to a large degree. Some signals don't reach the ventricles. On an EKG, the pattern of QRS waves doesn't follow each P wave as it normally would.
If an electrical signal is blocked before it reaches the ventricles, they won't contract and pump blood to the lungs and the rest of the body.
Second-degree heart block is divided into two types: Mobitz type I and Mobitz type II.
Mobitz Type I
In this type (also known as Wenckebach's block), the electrical signals are delayed more and more with each heartbeat, until the heart skips a beat. On the EKG, the delay is shown as a line (called the PR interval) between the P and QRS waves. The line gets longer and longer until the QRS waves don't follow the next P wave.
Sometimes people who have Mobitz type I feel dizzy or have other symptoms. This type of second-degree heart block is less serious than Mobitz type II.
The animation below shows how your heart's electrical system works. It also shows what happens during second-degree Mobitz type I heart block. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
The first part of this animation is the same as the animation in the section on understanding the heart's electrical system and EKG results. If you want to skip directly to the frames on Mobitz type I heart block, click the ""skip intro"" link above the start, pause, and replay buttons.
![]()
The first part of the animation shows how an electrical signal moves through your heart and how an EKG records your heart's electrical activity. The second part of the animation shows how a pause in the heart's electrical signal can delay or block the (more...)
Mobitz Type II
In second-degree Mobitz type II heart block, some of the electrical signals don't reach the ventricles. However, the pattern is less regular than it is in Mobitz type I. Some signals move between the atria and ventricles normally, while others are blocked.
On an EKG, the QRS wave follows the P wave at a normal speed. Sometimes, though, the QRS wave is missing (when a signal is blocked).
Mobitz type II is less common than type I, but it's usually more severe. Some people who have type II need medical devices called pacemakers to maintain their heart rates.
Third-Degree Heart Block
In this type of heart block, none of the electrical signals reach the ventricles. This type also is called complete heart block or complete AV block.
When complete heart block occurs, special areas in the ventricles may create electrical signals to cause the ventricles to contract. This natural backup system is slower than the normal heart rate and isn't coordinated with the contraction of the atria. On an EKG, the normal pattern is disrupted. The P waves occur at a faster rate, and it isn't coordinated with the QRS waves.
Complete heart block can result in sudden cardiac arrest and death. This type of heart block often requires emergency treatment. A temporary pacemaker might be used to keep the heart beating until you get a long-term pacemaker.
What Causes Heart Block?
Heart block has many causes. Some people are born with the disorder (congenital), while others develop it during their lifetimes (acquired).
Acquired Heart Block
Many factors can cause acquired heart block. Examples include:
Rheumatic (roo-MAT-ik)
fever.
Other diseases may increase the risk of heart block. Examples include sarcoidosis (sar-koy-DOE-sis) and the degenerative muscle disorders Lev's disease and Lenegre's disease.
Certain types of surgery also may damage the heart's electrical system and lead to heart block.
Exposure to toxic substances and taking certain medicines—including digitalis, beta blockers, and calcium channel blockers—also may cause heart block. Doctors closely watch people who are taking these medicines for signs of problems.
Some types of heart block have been linked to genetic mutations (changes in the genes).
An overly active vagus nerve also can cause heart block. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate.
Sometimes acquired heart block will go away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery.
If medicine is causing heart block, the disorder may go away if the medicine is stopped or the dosage is lowered. (Always talk with your doctor before you change the way you take your medicines.)
Who Is at Risk for Heart Block?
The risk factors for congenital and acquired heart block are different.
Acquired Heart Block
Acquired heart block can occur in people of any age. However, most types of the condition are more common in older people. This is because many of the risk factors are more common in older people.
People who have a history of heart disease or heart attacks are at increased risk for heart block. Examples of heart disease that can lead to heart block include heart failure, coronary heart disease, and cardiomyopathy (heart muscle diseases).
Other diseases also may raise the risk of heart block, such as sarcoidosis and the degenerative muscle disorders Lev's disease and Lenegre's disease.
Exposure to toxic substances or taking certain medicines, such as digitalis, also can raise your risk for heart block.
Well-trained athletes and young people are at higher risk for first-degree heart block caused by an overly active vagus nerve. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate.
What Are the Signs and Symptoms of Heart Block?
Signs and symptoms depend on the type of heart block you have. First-degree heart block may not cause any symptoms.
Signs and symptoms of second- and third-degree heart block include:
These symptoms may suggest other health problems as well. If these symptoms are new or severe, call 9–1–1 or have someone drive you to the hospital emergency room. If you have milder symptoms, talk with your doctor right away to find out whether you need prompt treatment.
How Is Heart Block Diagnosed?
Heart block might be diagnosed as part of a routine doctor's visit or during an emergency situation. (Third-degree heart block often is an emergency.)
Your doctor will diagnose heart block based on your family and medical histories, a physical exam, and test results.
Specialists Involved
Your primary care doctor might be involved in diagnosing heart block. However, if you have the condition, you might need to see a heart specialist. Heart specialists include:
Pediatric
cardiologists (doctors who diagnose and treat babies and children who have
heart problems)
Electrophysiologists (
cardiologists or pediatric cardiologists who specialize in the
heart's electrical system)
Family and Medical Histories
Your doctor may ask whether:
You have any health problems, such as
heart disease
Any of your family members have been diagnosed with
heart block or other health problems
You're taking any medicines, including herbal products and prescription and over-the-counter medicines
You smoke or use alcohol or drugs
Your doctor also may ask about other health habits, such as how physically active you are.
Physical Exam
During the physical exam, your doctor will listen to your heart. He or she will listen carefully for abnormal rhythms or heart murmurs (extra or unusual sounds heard during heartbeats).
Your doctor also may:
Check your
pulse to find out how fast your
heart is beating
Check for swelling in your legs or feet, which could be a sign of an enlarged
heart or
heart failure
Diagnostic Tests and Procedures
EKG (Electrocardiogram)
Doctors usually use an EKG (electrocardiogram) to help diagnose heart block. This simple test detects and records the heart's electrical activity.
An EKG shows how fast the heart is beating and its rhythm (steady or irregular). The test also records the strength and timing of electrical signals as they pass through the heart.
The data are recorded on a graph. Different types of heart block have different patterns on the graph. (For more information, go to ""Types of Heart Block."")
A standard EKG only records the heart's activity for a few seconds. To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor.
The most common types of portable EKGs are Holter and event monitors. Your doctor may have you use one of these monitors to diagnose first- or second-degree heart block.
Holter and Event Monitors
A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
You may wear an event monitor for 1 to 2 months, or as long as it takes to get a recording of your heart during symptoms.
Electrophysiology Study
For some cases of heart block, doctors may do electrophysiology studies (EPS). During this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals.
How Is Heart Block Treated?
Treatment depends on the type of heart block you have. If you have first-degree heart block, you may not need treatment.
If you have second-degree heart block, you may need a pacemaker. A pacemaker is a small device that's placed under the skin of your chest or abdomen. This device uses electrical pulses to prompt the heart to beat at a normal rate.
If you have third-degree heart block, you will need a pacemaker. In an emergency, a temporary pacemaker might be used until you can get a long-term device. Most people who have third-degree heart block need pacemakers for the rest of their lives.
Some people who have third-degree congenital heart block don't need pacemakers for many years. Others may need pacemakers at a young age or during infancy.
If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block. If heart block is detected in a fetus, the mother might be given medicine to reduce the fetus' risk of developing serious heart block.
Sometimes acquired heart block goes away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery.
Also, if a medicine is causing heart block, the condition may go away if the medicine is stopped or the dosage is lowered. (Always talk with your doctor before you change the way you take your medicines.)
Living With Heart Block
First-degree heart block may not cause any symptoms or require treatment. However, some research has shown that people who have first-degree heart block might be at higher risk for atrial fibrillation (AF) in the future.
AF is a type of arrhythmia. It occurs if rapid, disorganized electrical signals cause the heart's upper chambers to contract very fast and irregularly.
If you've been diagnosed with first-degree heart block, ask your doctor whether you need to take any special steps to control it.
Your doctor can tell you whether you need ongoing care or whether you need to change the way you take certain medicines.
If you have second-degree heart block that doesn't require a pacemaker, talk with your doctor about keeping your heart healthy. Your doctor will tell you whether you need ongoing care for your condition.
Living With a Pacemaker
People who have third-degree heart block and some people who have second-degree heart block need pacemakers. These devices use electrical pulses to prompt the heart to beat at a normal rate.
If you have a pacemaker, you should take special care to avoid things that may interfere with it. Avoid close or prolonged contact with electrical devices and devices that have strong magnetic fields. These objects can keep your pacemaker from working properly.
Let all of your doctors, dentists, and medical technicians know that you have a pacemaker. You also should notify airport screeners.
Your doctor can give you a card that states what kind of pacemaker you have. Carry this card in your wallet. You may want to wear a medical ID bracelet or necklace that states that you have a pacemaker.
Certain medical procedures can disrupt pacemakers. Examples include MRI (magnetic resonance imaging), electrocauterization during surgery, and shock-wave lithotripsy to get rid of kidney stones.
Your doctor may need to check your pacemaker several times a year to make sure it's working well. Some pacemakers must be checked in the doctor's office, but others can be checked over the phone.
Ask your doctor about what types of physical activity are safe for you. A pacemaker usually won't limit you from doing sports and physical activity. But you may need to avoid full-contact sports, such as football, that can damage the pacemaker.
For more information about living with a pacemaker, go to the Health Topics Pacemaker article.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart block, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
How Does Heart Disease Affect Women?
In the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)—the most common type of heart disease—is the #1 killer of both men and women in the United States.
Other types of heart disease, such as coronary microvascular disease (MVD) and broken heart syndrome, also pose a risk for women. These disorders, which mainly affect women, are not as well understood as CHD. However, research is ongoing to learn more about coronary MVD and broken heart syndrome.
This article focuses on CHD and its complications. However, it also includes general information about coronary MVD and broken heart syndrome.
Coronary Heart Disease
CHD is a disease in which plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis).
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque can harden or rupture (break open).
Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
![]()
Heart With Muscle Damage and a Blocked Artery. Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot (more...)
Plaque also can develop within the walls of the coronary arteries. Tests that show the insides of the coronary arteries may look normal in people who have this pattern of plaque. Studies are under way to see whether this type of plaque buildup occurs more often in women than in men and why.
In addition to angina and heart attack, CHD can cause other serious heart problems. The disease may lead to heart failure, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), and sudden cardiac arrest (SCA).
Coronary Microvascular Disease
Coronary MVD is heart disease that affects the heart's tiny arteries. This disease is also called cardiac syndrome X or nonobstructive CHD. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased.
![]()
Heart With Muscle Damage and a Blocked Artery Coronary Microvascular Disease. Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B shows a large coronary artery with (more...)
Women are more likely than men to have coronary MVD. Many researchers think that a drop in estrogen levels during menopause combined with other heart disease risk factors causes coronary MVD.
Although death rates from heart disease have dropped in the last 30 years, they haven't dropped as much in women as in men. This may be the result of coronary MVD.
Standard tests for CHD are not designed to detect coronary MVD. Thus, test results for women who have coronary MVD may show that they are at low risk for heart disease.
Research is ongoing to learn more about coronary MVD and its causes.
Broken Heart Syndrome
Women are also more likely than men to have a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to severe (but often short-term) heart muscle failure.
Broken heart syndrome is also called stress-induced cardiomyopathy (KAR-de-o-mi-OP-ah-thee) or takotsubo cardiomyopathy.
Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms and test results. However, there's no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.
Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have previously been healthy.
Outlook
Women tend to have CHD about 10 years later than men. However, CHD remains the #1 killer of women in the United States.
The good news is that you can control many CHD risk factors. CHD risk factors are conditions or habits that raise your risk for CHD and heart attack. These risk factors also can increase the chance that existing CHD will worsen.
Lifestyle changes, medicines, and medical or surgical procedures can help women lower their risk for CHD. Thus, early and ongoing CHD prevention is important.
More information about heart disease in women is available through the National Heart, Lung, and Blood Institute's The Heart Truth® campaign.
____________
®The Heart Truth and its logo are registered trademarks of the U.S. Department of Health and Human Services (HHS).
Other Names for Heart Disease
Who Is at Risk for Heart Disease?
Certain traits, conditions, or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk factors. Risk factors also increase the chance that existing CHD will worsen.
Women generally have the same CHD risk factors as men. However, some risk factors may affect women differently than men. For example, diabetes raises the risk of CHD more in women. Also, some risk factors, such as birth control pills and menopause, only affect women.
There are many known CHD risk factors. Your risk for CHD and heart attack rises with the number of risk factors you have and their severity. Risk factors tend to ""gang up"" and worsen each other's effects.
Having just one risk factor doubles your risk for CHD. Having two risk factors increases your risk for CHD fourfold. Having three or more risk factors increases your risk for CHD more than tenfold.
Also, some risk factors, such as smoking and diabetes, put you at greater risk for CHD and heart attack than others.
More than 75 percent of women aged 40 to 60 have one or more risk factors for CHD. Many risk factors start during childhood; some even develop within the first 10 years of life. You can control most risk factors, but some you can't.
For more information about CHD risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article. To find out whether you're at risk for CHD, talk with your doctor or health care provider.
Risk Factors You Can Control
Smoking
Smoking is the most powerful risk factor that women can control. Smoking tobacco or long-term exposure to secondhand smoke raises your risk for CHD and heart attack.
Smoking exposes you to carbon monoxide. This chemical robs your blood of oxygen and triggers a buildup of plaque in your arteries.
Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack. The more you smoke, the greater your risk for a heart attack.
Even women who smoke fewer than two cigarettes a day are at increased risk for CHD.
High Blood Pressure
Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.
Women who have blood pressure greater than 120/80 mmHg are at increased risk for CHD. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
High blood pressure is defined differently for people who have diabetes or chronic kidney disease. If you have one of these diseases, work with your doctor to set a healthy blood pressure goal.
Diabetes and Prediabetes
Diabetes is a disease in which the body's blood sugar level is too high. This is because the body doesn't make enough insulin or doesn't use its insulin properly.
Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. Over time, a high blood sugar level can lead to increased plaque buildup in your arteries.
Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. Prediabetes puts you at higher risk for both diabetes and CHD.
Diabetes and prediabetes raise the risk of CHD more in women than in men. In fact, having diabetes doubles a woman's risk of developing CHD.
Before menopause, estrogen provides women some protection against CHD. However, in women who have diabetes, the disease counters the protective effects of estrogen.
Overweight and Obesity
The terms ""overweight"" and ""obesity"" refer to body weight that's greater than what is considered healthy for a certain height.
The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.
You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.
Studies suggest that where extra weight occurs on the body may predict CHD risk better than BMI. Women who carry much of their fat around the waist are at greatest risk for CHD. These women have ""apple-shaped"" figures.
Women who carry most of their fat on their hips and thighs—that is, those who have ""pear-shaped"" figures—are at lower risk for CHD.
To fully know how excess weight affects your CHD risk, you should know your BMI and waist measurement. If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches, you're at increased risk for CHD.
If your waist measurement divided by your hip measurement is greater than 0.9, you're also at increased risk for CHD.
Studies also suggest that women whose weight goes up and down dramatically (typically due to unhealthy dieting) are at increased risk for CHD. These swings in weight can lower HDL cholesterol levels.
Metabolic Syndrome
Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors:
A large waistline. Having extra
fat in the waist area is a greater risk factor for CHD than having extra fat in other parts of the body, such as on the hips.
A lower than normal
HDL cholesterol level (or you're on medicine to treat low HDL cholesterol).
Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups. The condition affects White women and men about equally.
Birth Control Pills
Women who smoke and take birth control pills are at very high risk for CHD, especially if they're older than 35. For women who take birth control pills but don't smoke, the risk of CHD isn't fully known.
Unhealthy Diet
An unhealthy diet can raise your risk for CHD. For example, foods that are high in saturated and trans fats and cholesterol raise your LDL cholesterol level. A high-sodium (salt) diet can raise your risk for high blood pressure.
Foods with added sugars will give you extra calories without nutrients, such as vitamins and minerals. This can cause you to gain weight, which raises your risk for CHD.
Too much alcohol also can cause you to gain weight, and it will raise your blood pressure.
Stress or Depression
Stress may play a role in causing CHD. Stress can trigger your arteries to narrow. This can raise your blood pressure and your risk for a heart attack.
Getting upset or angry also can trigger a heart attack. Stress also may indirectly raise your risk for CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.
People who are depressed are two to three times more likely to develop CHD than people who are not. Depression is twice as common in women as in men.
Sleep Apnea
Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour.
Typically, normal breathing starts again after the pause, sometimes with a loud snort or choking sound. Major signs of sleep apnea are snoring and daytime sleepiness.
When you stop breathing, the lack of oxygen triggers your body's stress hormones. This causes blood pressure to rise and makes the blood more likely to clot.
Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack or stroke.
Women are more likely to develop sleep apnea after menopause.
Risk Factors You Can't Control
Age and Menopause
As you get older, your risk for CHD and heart attack rises. This is due in part to the slow buildup of plaque inside your heart arteries, which can start during childhood.
Before age 55, women have a lower risk for CHD than men. Estrogen provides women with some protection against CHD before menopause. After age 55, however, the risk of CHD increases in both women and men.
You may have gone through early menopause, either naturally or because you had your ovaries removed. If so, you're twice as likely to develop CHD as women of the same age who aren't yet menopausal.
Another reason why women are at increased risk for CHD after age 55 is that middle age is when you tend to develop other CHD risk factors.
Women who have gone through menopause also are at increased risk for broken heart syndrome. (For more information, go to the section on emerging risk factors below.)
Family History
Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.
Also, a family history of stroke—especially a mother's stroke history—can help predict the risk of heart attack in women.
Having a family history of CHD or stroke doesn't mean that you'll develop heart disease. This is especially true if your affected family member smoked or had other risk factors that were not well treated.
Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences and prevent or delay heart problems.
Preeclampsia
Preeclampsia (pre-e-KLAMP-se-ah) is a condition that develops during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.
These signs usually occur during the second half of pregnancy and go away after delivery. However, your risk of developing high blood pressure later in life increases after having preeclampsia.
Preeclampsia also is linked to an increased lifetime risk of heart disease, including CHD, heart attack, and heart failure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk for preeclampsia.)
If you had preeclampsia during pregnancy, you're twice as likely to develop heart disease as women who haven't had the condition. You're also more likely to develop heart disease earlier in life.
Preeclampsia is a heart disease risk factor that you can't control. However, if you've had the condition, you should take extra care to try and control other heart disease risk factors.
The more severe your preeclampsia was, the greater your risk for heart disease. Let your doctor know that you had preeclampsia so he or she can assess your heart disease risk and how to reduce it.
Emerging Risk Factors
Research suggests that inflammation plays a role in causing CHD. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow.
High blood levels of a protein called C-reactive protein (CRP) are a sign of inflammation in the body. Research suggests that women who have high blood levels of CRP are at increased risk for heart attack.
Also, some inflammatory diseases, such as lupus and rheumatoid arthritis, may increase the risk for CHD.
Some studies suggest that women who have migraine headaches may be at greater risk for CHD. This is especially true for women who have migraines with auras (visual disturbances), such as flashes of light or zig-zag lines.
Low bone density and low intake of folate and vitamin B6 also may raise a woman's risk for CHD.
More research is needed to find out whether calcium supplements with or without vitamin D affect CHD risk. You may want to talk with your doctor to find out whether these types of supplements are right for you.
Researchers are just starting to learn about broken heart syndrome risk factors. Most women who have this disorder are White and have gone through menopause.
Many of these women have other heart disease risk factors, such as high blood pressure, high blood cholesterol, diabetes, and smoking. However, these risk factors tend to be less common in women who have broken heart syndrome than in women who have CHD.
What Are the Signs and Symptoms of Heart Disease?
The signs and symptoms of coronary heart disease (CHD) may differ between women and men. Some women who have CHD have no signs or symptoms. This is called silent CHD.
Silent CHD may not be diagnosed until a woman has signs and symptoms of a heart attack, heart failure, or an arrhythmia (irregular heartbeat).
Other women who have CHD will have signs and symptoms of the disease.
![]()
Heart Disease Signs and Symptoms. The illustration shows the major signs and symptoms of coronary heart disease.
A common symptom of CHD is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.
In men, angina often feels like pressure or squeezing in the chest. This feeling may extend to the arms. Women can also have these angina symptoms. But women also tend to describe a","June 11, 2014."
37,7,"2018-02-02 04:25:06",h,37,"2018-02-02 05:13:09","Heart Failure","
What Is Heart Failure?
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. In some cases, the heart can't fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems.
The term ""heart failure"" doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
Overview
Heart failure develops over time as the heart's pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.
Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if the heart can't pump enough oxygen-rich blood to the rest of the body.
Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness).
The leading causes of heart failure are diseases that damage the heart. Examples include coronary heart disease (CHD), high blood pressure, and diabetes.
Outlook
Heart failure is a very common condition. About 5.1 million people in the United States have heart failure.
Both children and adults can have the condition, although the symptoms and treatments differ. This article focuses on heart failure in adults.
Currently, heart failure has no cure. However, treatments—such as medicines and lifestyle changes—can help people who have the condition live longer and more active lives. Researchers continue to study new ways to treat heart failure and its complications.
Other Names for Heart Failure
What Causes Heart Failure?
Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It isn't able to fill with and/or pump blood as well as it should.
As the heart weakens, certain proteins and substances might be released into the blood. These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.
Who Is at Risk for Heart Failure?
About 5.8 million people in the United States have heart failure. The number of people who have this condition is growing.
Heart failure is more common in:
People who are 65 years old or older. Aging can weaken the
heart muscle. Older people also may have had diseases for many years that led to
heart failure. Heart failure is a leading cause of hospital stays among people on Medicare.
African Americans. African Americans are more likely to have
heart failure than people of other races. They're also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure.
Children who have congenital heart defects also can develop heart failure. These defects occur if the heart, heart valves, or blood vessels near the heart don't form correctly while a baby is in the womb.
Congenital heart defects can make the heart work harder. This weakens the heart muscle, which can lead to heart failure.
Children don't have the same symptoms of heart failure or get the same treatments as adults. This article focuses on heart failure in adults.
What Are the Signs and Symptoms of Heart Failure?
The most common signs and symptoms of heart failure are:
All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
As your heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat.
Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that's worse at night and when you're lying down. This cough may be a sign of acute pulmonary edema (e-DE-ma). This is a condition in which too much fluid builds up in your lungs. The condition requires emergency treatment.
![]()
Heart Failure Signs and Symptoms. The image shows the major signs and symptoms of heart failure.
How Is Heart Failure Diagnosed?
Your doctor will diagnose heart failure based on your medical and family histories, a physical exam, and test results. The signs and symptoms of heart failure also are common in other conditions. Thus, your doctor will:
Early diagnosis and treatment can help people who have heart failure live longer, more active lives.
Medical and Family Histories
Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure.
Your doctor also will ask about your symptoms. He or she will want to know which symptoms you have, when they occur, how long you've had them, and how severe they are. Your answers will help show whether and how much your symptoms limit your daily routine.
Physical Exam
During the physical exam, your doctor will:
Listen to your
heart for sounds that aren't normal
Listen to your
lungs for the sounds of extra fluid buildup
Diagnostic Tests
No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more tests.
Your doctor also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG may show whether the walls in your heart's pumping chambers are thicker than normal. Thicker walls can make it harder for your heart to pump blood. An EKG also can show signs of a previous or current heart attack.
BNP Blood Test
This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure.
Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves work.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and heart muscle damage caused by lack of blood flow.
Echo might be done before and after a stress test (see below). A stress echo can show how well blood is flowing through your heart. The test also can show how well your heart pumps blood when it beats.
Doppler Ultrasound
A Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test often is done with echo to give a more complete picture of blood flow to the heart and lungs.
Doctors often use Doppler ultrasound to help diagnose right-side heart failure.
Holter Monitor
A Holter monitor records your heart's electrical activity for a full 24- or 48-hour period, while you go about your normal daily routine.
You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
Nuclear Heart Scan
A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.
During a nuclear heart scan, a safe, radioactive substance called a tracer is injected into your bloodstream through a vein. The tracer travels to your heart and releases energy. Special cameras outside of your body detect the energy and use it to create pictures of your heart.
A nuclear heart scan can show where the heart muscle is healthy and where it's damaged.
A positron emission tomography (PET) scan is a type of nuclear heart scan. It shows the level of chemical activity in areas of your heart. This test can help your doctor see whether enough blood is flowing to these areas. A PET scan can show blood flow problems that other tests might not detect.
Coronary Angiography
Coronary angiography (an-jee-OG-rah-fee) usually is done with cardiac catheterization. A dye that can be seen on x ray is injected into your bloodstream through the tip of the catheter.
The dye allows your doctor to see the flow of blood to your heart muscle. Angiography also shows how well your heart is pumping.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast.
You may walk or run on a treadmill or pedal a bicycle. If you can't exercise, you may be given medicine to raise your heart rate.
Heart tests, such as nuclear heart scanning and echo, often are done during stress testing.
Cardiac MRI
Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and a computer to create pictures of your heart as it's beating. The test produces both still and moving pictures of your heart and major blood vessels.
A cardiac MRI can show whether parts of your heart are damaged. Doctors also have used MRI in research studies to find early signs of heart failure, even before symptoms appear.
How Is Heart Failure Treated?
Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition).
The goals of treatment for all stages of heart failure include:
Treatments usually include lifestyle changes, medicines, and ongoing care. If you have severe heart failure, you also may need medical procedures or surgery.
Lifestyle Changes
Simple changes can help you feel better and control heart failure. The sooner you make these changes, the better off you'll likely be.
A Heart Healthy Diet
Following a heart healthy diet is an important part of managing heart failure. In fact, not having a proper diet can make heart failure worse. Ask your doctor and health care team to create an eating plan that works for you.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt) and solid fats (saturated fat and trans fatty acids). Too much salt can cause extra fluid to build up in your body, making heart failure worse. Saturated fat and trans fatty acids can cause unhealthy blood cholesterol levels, which are a risk factor for heart disease.
A healthy diet also is low in added sugars and refined grains. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.
A balanced, nutrient-rich diet can help your heart work better. Getting enough potassium is important for people who have heart failure. Some heart failure medicines deplete the potassium in your body. Lack of potassium can cause very rapid heart rhythms that can lead to sudden death.
Potassium is found in foods like white potatoes and sweet potatoes, greens (such as spinach), bananas, many dried fruits, and white beans and soybeans.
Talk with your health care team about getting the correct amount of potassium. Too much potassium also can be harmful.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Fluid Intake
It's important for people who have heart failure to drink the correct amounts and types of fluid. Drinking too much fluid can worsen heart failure. Also, if you have heart failure, you shouldn't drink alcohol.
Talk with your doctor about what amounts and types of fluid you should have each day.
Other Lifestyle Changes
Taking steps to control risk factors for CHD, high blood pressure, and diabetes will help control heart failure. For example:
Lose weight if you're
overweight or obese. Work with your health care team to lose weight safely.
Be
physically active (as your doctor advises) to become more fit and stay as active as possible.
Quit
smoking and avoid using illegal drugs. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid
secondhand smoke. Smoking and drugs can worsen
heart failure and harm your health.
Get enough rest.
Medicines
Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure:
Diuretics (water or fluid pills) help reduce fluid buildup in your
lungs and swelling in your feet and
ankles.
Aldosterone
antagonists trigger the body to get rid of salt and water through
urine. This lowers the volume of
blood that the
heart must pump.
Isosorbide dinitrate/
hydralazine hydrochloride helps relax your
blood vessels so your
heart doesn't work as hard to pump blood. Studies have shown that this medicine can reduce the risk of death in African Americans. More studies are needed to find out whether this medicine will benefit other racial groups.
Ongoing Care
You should watch for signs that heart failure is getting worse. For example, weight gain may mean that fluids are building up in your body. Ask your doctor how often you should check your weight and when to report weight changes.
Getting medical care for other related conditions is important. If you have diabetes or high blood pressure, work with your health care team to control these conditions. Have your blood sugar level and blood pressure checked. Talk with your doctor about when you should have tests and how often to take measurements at home.
Try to avoid respiratory infections like the flu and pneumonia. Talk with your doctor or nurse about getting flu and pneumonia vaccines.
Many people who have severe heart failure may need treatment in a hospital from time to time. Your doctor may recommend oxygen therapy (oxygen given through nasal prongs or a mask). Oxygen therapy can be given in a hospital or at home.
Medical Procedures and Surgery
As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery.
If you have heart damage and severe heart failure symptoms, your doctor might recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).
In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart's pumping. To correct this problem, your doctor might implant a CRT device (a type of pacemaker) near your heart.
This device helps both sides of your heart contract at the same time, which can decrease heart failure symptoms.
Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, these heartbeats can cause sudden cardiac arrest. Your doctor might implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.
People who have severe","June 11, 2014."
38,7,"2018-02-02 04:25:06",h,38,"2018-02-02 05:13:28","Heart Murmur","
What Is a Heart Murmur?
A heart murmur is an extra or unusual sound heard during a heartbeat. Murmurs range from very faint to very loud. Sometimes they sound like a whooshing or swishing noise.
Normal heartbeats make a ""lub-DUPP"" or ""lub-DUB"" sound. This is the sound of the heart valves closing as blood moves through the heart. Doctors can hear these sounds and heart murmurs using a stethoscope.
Overview
The two types of heart murmurs are innocent (harmless) and abnormal.
Innocent heart murmurs aren't caused by heart problems. These murmurs are common in healthy children. Many children will have heart murmurs heard by their doctors at some point in their lives.
People who have abnormal heart murmurs may have signs or symptoms of heart problems. Most abnormal murmurs in children are caused by congenital (kon-JEN-ih-tal) heart defects. These defects are problems with the heart's structure that are present at birth.
In adults, abnormal heart murmurs most often are caused by acquired heart valve disease. This is heart valve disease that develops as the result of another condition. Infections, diseases, and aging can cause heart valve disease.
Outlook
A heart murmur isn't a disease, and most murmurs are harmless. Innocent murmurs don't cause symptoms. Having one doesn't require you to limit your physical activity or do anything else special. Although you may have an innocent murmur throughout your life, you won't need treatment for it.
The outlook and treatment for abnormal heart murmurs depend on the type and severity of the heart problem causing them.
How the Heart Works
The heart is a muscle about the size of your fist. It works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.
![]()
A Healthy Heart Cross-Section. Figure 1 shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to (more...)
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-
pid) valve is in the right side of the
heart, between the right atrium and the right
ventricle.
The mitral (MI-trul) valve is in the left side of the
heart, between the left atrium and the left
ventricle.
The aortic (ay-OR-tik) valve is in the left side of the
heart, between the left
ventricle and the entrance to the
aorta. This
artery carries
blood from the heart to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a ""lub-DUB"" sound that a doctor can hear using a stethoscope.
The first sound—the ""lub""—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the
ventricles contract, or squeeze, and pump
blood out of the
heart.
The second sound—the ""DUB""—is made by the aortic and
pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the
ventricles relax and fill with
blood pumped into them by the
atria.
Veins
The veins also are major blood vessels connected to your heart.
For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.
Other Names for a Heart Murmur
What Causes Heart Murmurs?
Innocent Heart Murmurs
Why some people have innocent heart murmurs and others do not isn't known. Innocent murmurs are simply sounds made by blood flowing through the heart's chambers and valves, or through blood vessels near the heart.
Extra blood flow through the heart also may cause innocent heart murmurs. After childhood, the most common cause of extra blood flow through the heart is pregnancy. This is because during pregnancy, women's bodies make extra blood. Most heart murmurs that occur in pregnant women are innocent.
Abnormal Heart Murmurs
Congenital heart defects or acquired heart valve disease often are the cause of abnormal heart murmurs.
Congenital Heart Defects
Congenital heart defects are the most common cause of abnormal heart murmurs in children. These defects are problems with the heart's structure that are present at birth. They change the normal flow of blood through the heart.
Congenital heart defects can involve the interior walls of the heart, the valves inside the heart, or the arteries and veins that carry blood to and from the heart. Some babies are born with more than one heart defect.
Heart valve problems, septal defects (also called holes in the heart), and diseases of the heart muscle such as hypertrophic cardiomyopathy are common heart defects that cause abnormal heart murmurs.
Examples of valve problems are narrow valves that limit blood flow or leaky valves that don't close properly. Septal defects are holes in the wall that separates the right and left sides of the heart. This wall is called the septum.
A hole in the septum between the heart's two upper chambers is called an atrial septal defect. A hole in the septum between the heart's two lower chambers is called a ventricular septal defect.
Hypertrophic (hi-per-TROF-ik) cardiomyopathy (kar-de-o-mi-OP-ah-thee) (HCM) occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thicken. The thickening may block blood flow out of the ventricle. If a blockage occurs, the ventricle must work hard to pump blood to the body. HCM also can affect the heart’s mitral valve, causing blood to leak backward through the valve.
![]()
Heart Defects That Can Cause Abnormal Heart Murmurs. Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with leaking and narrowed valves. Figure C shows a heart with a ventricular septal defect.
For more information, go to the Health Topics Congenital Heart Defects article.
Acquired Heart Valve Disease
Acquired heart valve disease often is the cause of abnormal heart murmurs in adults. This is heart valve disease that develops as the result of another condition.
Many conditions can cause heart valve disease. Examples include heart conditions and other disorders, age-related changes, rheumatic (ru-MAT-ik) fever, and infections.
Heart conditions and other disorders. Certain conditions can stretch and distort the heart valves, such as:
Damage and scar tissue from a heart attack or injury to the heart.
Advanced high blood pressure and heart failure. These conditions can enlarge the heart or its main arteries.
Age-related changes. As you get older, calcium deposits or other deposits may form on your heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow. This stiffening and thickening of the valve is called sclerosis (skle-RO-sis).
Rheumatic fever. The bacteria that cause strep throat, scarlet fever, and, in some cases, impetigo (im-peh-TI-go) also can cause rheumatic fever. This serious illness can develop if you have an untreated or not fully treated streptococcal (strep infection.
Rheumatic fever can damage and scar the heart valves. The symptoms of this heart valve damage often don't occur until many years after recovery from rheumatic fever.
Today, most people who have strep infections are treated with antibiotics before rheumatic fever develops. It's very important to take all of the antibiotics your doctor prescribes for strep throat, even if you feel better before the medicine is gone.
Infections. Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but sometimes life-threatening infection is called infective endocarditis (EN-do-kar-DI-tis), or IE.
IE is more likely to develop in people who already have abnormal blood flow through a heart valve because of heart valve disease. The abnormal blood flow causes blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.
IE can worsen existing heart valve disease.
What Are the Signs and Symptoms of a Heart Murmur?
People who have innocent (harmless) heart murmurs don't have any signs or symptoms other than the murmur itself. This is because innocent heart murmurs aren't caused by heart problems.
People who have abnormal heart murmurs may have signs or symptoms of the heart problems causing the murmurs. These signs and symptoms may include:
Poor eating and failure to grow normally (in infants)
Shortness of breath, which may occur only with physical exertion
Excessive sweating with minimal or no exertion
A bluish color on the
skin, especially on the fingertips and
lipsSwelling or sudden weight gain
Signs and symptoms depend on the problem causing the heart murmur and its severity.
How Is a Heart Murmur Diagnosed?
Doctors use a stethoscope to listen to heart sounds and hear heart murmurs. They may detect heart murmurs during routine checkups or while checking for another condition.
If a congenital heart defect causes a murmur, it's often heard at birth or during infancy. Abnormal heart murmurs caused by other heart problems can be heard in patients of any age.
Specialists Involved
Primary care doctors usually refer people who have abnormal heart murmurs to cardiologists or pediatric cardiologists for further care and testing.
Cardiologists are doctors who specialize in diagnosing and treating heart problems in adults. Pediatric cardiologists specialize in diagnosing and treating heart problems in children.
Physical Exam
Your doctor will carefully listen to your heart or your child's heart with a stethoscope to find out whether a murmur is innocent or abnormal. He or she will listen to the loudness, location, and timing of the murmur. This will help your doctor diagnose the cause of the murmur.
Your doctor also may:
Do a complete physical exam. He or she will look for signs of illness or physical problems. For example, your doctor may look for a bluish color on your
skin. In infants, doctors may look for delayed growth and feeding problems.
Ask about your symptoms, such as
chest pain, shortness of breath (especially with physical exertion),
dizziness, or
fainting.
Evaluating Heart Murmurs
When evaluating a heart murmur, your doctor will pay attention to many things, such as:
How
faint or loud the sound is. Your doctor will grade the
murmur on a scale of 1 to 6 (1 is very faint and 6 is very loud).
When the sound occurs in the cycle of the heartbeat.
Where the sound is heard in the
chest and whether it also can be heard in the
neck or back.
Whether the sound has a high, medium, or low pitch.
How long the sound lasts.
How breathing, physical activity, or a change in body position affects the sound.
Diagnostic Tests and Procedures
If your doctor thinks you or your child has an abnormal heart murmur, he or she may recommend one or more of the following tests.
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test is done to find the cause of symptoms, such as shortness of breath and chest pain.
EKG
An EKG (electrocardiogram) is a simple test that detects and records the heart's electrical activity. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
This test is used to detect and locate the source of heart problems. The results from an EKG also may be used to rule out certain heart problems.
Echocardiography
Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test shows the size and shape of your heart and how well your heart's chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several types of echo, including a stress echo. This test is done both before and after a stress test. During this test, you exercise to make your heart work hard and beat fast. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast. Echo is used to take pictures of your heart before you exercise and as soon as you finish.
Stress echo shows whether you have decreased blood flow to your heart (a sign of coronary heart disease).
How Is a Heart Murmur Treated?
A heart murmur isn't a disease. It's an extra or unusual sound heard during the heartbeat. Thus, murmurs themselves don't require treatment. However, if an underlying condition is causing a heart murmur, your doctor may recommend treatment for that condition.
Innocent (Harmless) Heart Murmurs
Healthy children who have innocent (harmless) heart murmurs don't need treatment. Their heart murmurs aren't caused by heart problems or other conditions.
Pregnant women who have innocent heart murmurs due to extra blood volume also don't need treatment. Their heart murmurs should go away after pregnancy.
Abnormal Heart Murmurs
If you or your child has an abnormal heart murmur, your doctor will recommend treatment for the disease or condition causing the murmur.
Some medical conditions, such as anemia or hyperthyroidism, can cause heart murmurs that aren't related to heart disease. Treating these conditions should make the heart murmur go away.
If a congenital heart defect is causing a heart murmur, treatment will depend on the type and severity of the defect. Treatment may include medicines or surgery. For more information about treatments for congenital heart defects, go to the Health Topics Congenital Heart Defects article.
If acquired heart valve disease is causing a heart murmur, treatment usually will depend on the type, amount, and severity of the disease.
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can treat symptoms and help delay complications. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
For more information about treatments for heart valve disease, go to the Health Topics Heart Valve Disease article.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart murmurs or other heart diseases or conditions, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Are Palpitations?
Palpitations (pal-pi-TA-shuns) are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast. You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.
Outlook
Palpitations are very common. They usually aren't serious or harmful, but they can be bothersome. If you have them, your doctor can decide whether you need treatment or ongoing care.
What Causes Palpitations?
Many things can cause palpitations. You may have these feelings even when your heart is beating normally or somewhat faster than normal.
Most palpitations are harmless and often go away on their own. However, some palpitations are signs of a heart problem. Sometimes the cause of palpitations can't be found.
If you start having palpitations, see your doctor to have them checked.
Causes Not Related to Heart Problems
Strong Emotions
You may feel your heart pounding or racing during anxiety, fear, or stress. You also may have these feelings if you're having a panic attack.
Vigorous Physical Activity
Intense activity can make your heart feel like it’s beating too hard or too fast, even though it's working normally. Intense activity also can cause occasional premature (extra) heartbeats.
Medical Conditions
Some medical conditions can cause palpitations. These conditions can make the heart beat faster or stronger than usual. They also can cause premature (extra) heartbeats.
Examples of these medical conditions include:
Medicines and Stimulants
Many medicines can trigger palpitations because they can make the heart beat faster or stronger than usual. Medicines also can cause premature (extra) heartbeats.
Examples of these medicines include:
Medicines to prevent
arrhythmias. Medicines used to treat irregular
heart rhythms can sometimes cause other irregular heart rhythms.
Over-the-counter medicines that act as stimulants also may cause palpitations. These include decongestants (found in cough and cold medicines) and some herbal and nutritional supplements.
Caffeine, nicotine (found in tobacco), alcohol, and illegal drugs (such as cocaine and amphetamines) also can cause palpitations.
Causes Related to Heart Problems
Some palpitations are symptoms of arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. However, less than half of the people who have palpitations have arrhythmias.
During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. An arrhythmia happens if some part of the heart's electrical system doesn't work as it should.
Palpitations are more likely to be related to an arrhythmia if you:
Who Is at Risk for Palpitations?
Some people may be more likely than others to have palpitations. People at increased risk include those who:
Women who are pregnant, menstruating, or perimenopausal also may be at higher risk for palpitations because of hormonal changes. Some palpitations that occur during pregnancy may be due to anemia.
For more information about these risk factors, go to ""What Causes Palpitations?""
What Are the Signs and Symptoms of Palpitations?
Symptoms of palpitations include feelings that your heart is:
You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.
Palpitations often are harmless, and your heart is working normally. However, these feelings can be a sign of a more serious problem if you also:
Feel dizzy or confused
Are light-headed, think you may
faint, or do faint
Have trouble breathing
Have pain, pressure, or tightness in your
chest,
jaw, or
armsFeel short of breath
Have unusual sweating
Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if your palpitations:
Start to occur more often or are more noticeable or bothersome
Occur with other symptoms, such as those listed above
Your doctor will want to check whether your palpitations are the symptom of a heart problem, such as an arrhythmia (irregular heartbeat).
How Are Palpitations Diagnosed?
First, your doctor will want to find out whether your palpitations are harmless or related to a heart problem. He or she will ask about your symptoms and medical history, do a physical exam, and recommend several basic tests.
This information may point to a heart problem as the cause of your palpitations. If so, your doctor may recommend more tests. These tests will help show what the problem is, so your doctor can decide how to treat it.
The cause of palpitations may be hard to diagnose, especially if symptoms don't occur regularly.
Specialists Involved
Several types of doctors may work with you to diagnose and treat your palpitations. These include a:
Primary care doctor
Cardiologist (a doctor who specializes in diagnosing and treating
heart diseases and conditions)
Electrophysiologist (a
cardiologist who specializes in the
heart's electrical system)
Medical History
Your doctor will ask questions about your palpitations, such as:
Your doctor also may ask about your use of caffeine, alcohol, supplements, and illegal drugs.
Physical Exam
Your doctor will take your pulse to find out how fast your heart is beating and whether its rhythm is normal. He or she also will use a stethoscope to listen to your heartbeat.
Your doctor may look for signs of conditions that can cause palpitations, such as an overactive thyroid.
Diagnostic Tests
Often, the first test that's done is an EKG (electrocardiogram). This simple test records your heart's electrical activity.
An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.
Even if your EKG results are normal, you may still have a medical condition that's causing palpitations. If your doctor suspects this is the case, you may have blood tests to gather more information about your heart's structure, function, and electrical system.
Holter or Event Monitor
A standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't happen during the test. To diagnose problems that come and go, your doctor may have you wear a Holter or event monitor.
A Holter monitor records the heart’s electrical activity for a full 24- or 48-hour period. You wear patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
During the 24- or 48-hour period, you do your usual daily activities. You use a notebook to record any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
You can wear an event monitor for weeks or until symptoms occur.
Echocardiography
Echocardiography uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.
How Are Palpitations Treated?
Treatment for palpitations depends on their cause. Most palpitations are harmless and often go away on their own. In these cases, no treatment is needed.
Avoiding Triggers
Your palpitations may be harmless but bothersome. If so, your doctor may suggest avoiding things that trigger them. For examples, your doctor may advise you to:
Avoid illegal drugs, such as
cocaine and amphetamines.
Avoid medicines that act as stimulants, such as
cough and cold medicines and some herbal and nutritional supplements.
Treating Medical Conditions That May Cause Palpitations
Work with your doctor to control medical conditions that can cause palpitations, such as an overactive thyroid. If you're taking medicine that's causing palpitations, your doctor will try to find a different medicine for you.
If your palpitations are caused by an arrhythmia (irregular heartbeat), your doctor may recommend medicines or procedures to treat the problem. For more information, go to the Health Topics Arrhythmia article.
How Can Palpitations Be Prevented?
You can take steps to prevent palpitations. Try to avoid things that trigger them. For example:
Avoid illegal drugs, such as
cocaine and amphetamines.
Avoid medicines that act as stimulants, such as
cough and cold medicines and some herbal and nutritional supplements.
Also, work with your doctor to treat medical conditions that can cause palpitations.
Living With Palpitations
Most palpitations are harmless and often go away on their own. Treatment usually isn’t needed in these cases. Your doctor may advise you to avoid triggers for palpitations. (For more information, go to ""How Are Palpitations Treated?"")
Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if they get worse, start to occur more often, become more noticeable or bothersome, or occur with other symptoms.
Your doctor will tell you about other signs and symptoms to be aware of and when to seek emergency care.
A medical condition or heart problem might be the cause of your palpitations. If so, your doctor will give you advice and treatment for your condition.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to palpitations, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.
What Is Heart Valve Disease?
Heart valve disease occurs if one or more of your heart valves don't work well. The heart has four valves: the tricuspid (tri-CUSS-pid), pulmonary (PULL-mun-ary), mitral (MI-trul), and aortic (ay-OR-tik) valves.
These valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through your heart's four chambers and to the rest of your body.
![]()
Healthy Heart Cross-Section. Figure A shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the (more...)
Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or to let blood leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood.
Overview
How the Heart Valves Work
At the start of each heartbeat, blood returning from the body and lungs fills the atria (the heart's two upper chambers). The mitral and tricuspid valves are located at the bottom of these chambers. As the blood builds up in the atria, these valves open to allow blood to flow into the ventricles (the heart's two lower chambers).
After a brief delay, as the ventricles begin to contract, the mitral and tricuspid valves shut tightly. This prevents blood from flowing back into the atria.
As the ventricles contract, they pump blood through the pulmonary and aortic valves. The pulmonary valve opens to allow blood to flow from the right ventricle into the pulmonary artery. This artery carries blood to the lungs to get oxygen.
At the same time, the aortic valve opens to allow blood to flow from the left ventricle into the aorta. The aorta carries oxygen-rich blood to the body. As the ventricles relax, the pulmonary and aortic valves shut tightly. This prevents blood from flowing back into the ventricles.
For more information about how the heart pumps blood and detailed animations, go to the Health Topics How the Heart Works article.
Heart Valve Problems
Heart valves can have three basic kinds of problems: regurgitation (re-GUR-jih-TA-shun), stenosis (ste-NO-sis), and atresia (a-TRE-ze-ah).
Regurgitation, or backflow, occurs if a valve doesn't close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or into an artery.
In the United States, backflow most often is due to prolapse. ""Prolapse"" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve.
Stenosis occurs if the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening. As a result, not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.
Atresia occurs if a heart valve lacks an opening for blood to pass through.
Some people are born with heart valve disease, while others acquire it later in life. Heart valve disease that develops before birth is called congenital (kon-JEN-ih-tal) heart valve disease. Congenital heart valve disease can occur alone or with other congenital heart defects.
Congenital heart valve disease often involves pulmonary or aortic valves that don't form properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly.
Acquired heart valve disease usually involves aortic or mitral valves. Although the valves are normal at first, problems develop over time.
Both congenital and acquired heart valve disease can cause stenosis or backflow.
Outlook
Many people have heart valve defects or disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems.
For other people, heart valve disease slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots, or death due to sudden cardiac arrest (SCA).
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can relieve many of its symptoms and complications.
These treatments also can lower your risk of developing a life-threatening condition, such as stroke or SCA. Eventually, you may need to have your faulty heart valve repaired or replaced.
Some types of congenital heart valve disease are so severe that the valve is repaired or replaced during infancy, childhood, or even before birth. Other types may not cause problems until middle-age or older, if at all.
Other Names for Heart Valve Disease
Aortic regurgitation
Mitral regurgitation
Pulmonic regurgitation
Pulmonic valve disease
Tricuspid regurgitation
What Causes Heart Valve Disease?
Heart conditions and other disorders, age-related changes, rheumatic fever, or infections can cause acquired heart valve disease. These factors change the shape or flexibility of once-normal valves.
The cause of congenital heart valve disease isn't known. It occurs before birth as the heart is forming. Congenital heart valve disease can occur alone or with other types of congenital heart defects.
Heart Conditions and Other Disorders
Certain conditions can stretch and distort the heart valves, such as:
Age-Related Changes
Men older than 65 and women older than 75 are prone to developing calcium and other types of deposits on their heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow through the valve (stenosis).
The aortic valve is especially prone to this problem. The deposits look similar to the plaque deposits seen in people who have atherosclerosis. Some of the same processes may cause both atherosclerosis and heart valve disease.
Infections
Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but serious infection is called infective endocarditis (EN-do-kar-DI-tis), or IE.
The germs can enter the bloodstream through needles, syringes, or other medical devices and through breaks in the skin or gums. Often, the body's defenses fight off the germs and no infection occurs. Sometimes these defenses fail, which leads to IE.
IE can develop in people who already have abnormal blood flow through a heart valve as the result of congenital or acquired heart valve disease. The abnormal blood flow causes blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.
IE can worsen existing heart valve disease.
Other Conditions and Factors Linked To Heart Valve Disease
Many other conditions and factors are linked to heart valve disease. However, the role they play in causing heart valve disease often isn't clear.
Diet medicines. The use of
fenfluramine and
phentermine (""fen-phen"") has sometimes been linked to
heart valve problems. These problems typically stabilize or improve after the medicine is stopped.
Radiation
therapy. Radiation therapy to the
chest area can cause
heart valve disease. This therapy is used to treat
cancer. Heart valve disease due to radiation therapy may not cause symptoms until years after the therapy.
Who Is at Risk for Heart Valve Disease?
Older age is a risk factor for heart valve disease. As you age, your heart valves thicken and become stiffer. Also, people are living longer now than in the past. As a result, heart valve disease has become an increasing problem.
People who have a history of infective endocarditis (IE), rheumatic fever, heart attack, or heart failure—or previous heart valve disease—also are at higher risk for heart valve disease. In addition, having risk factors for IE, such as intravenous drug use, increases the risk of heart valve disease.
You're also at higher risk for heart valve disease if you have risk factors for coronary heart disease. These risk factors include high blood cholesterol, high blood pressure, smoking, insulin resistance, diabetes, overweight or obesity, lack of physical activity, and a family history of early heart disease.
Some people are born with an aortic valve that has two flaps instead of three. Sometimes an aortic valve may have three flaps, but two flaps are fused together and act as one flap. This is called a bicuspid or bicommissural aortic valve. People who have this congenital condition are more likely to develop aortic heart valve disease.
What Are the Signs and Symptoms of Heart Valve Disease?
How Is Heart Valve Disease Diagnosed?
Your primary care doctor may detect a heart murmur or other signs of heart valve disease. However, a cardiologist usually will diagnose the condition. A cardiologist is a doctor who specializes in diagnosing and treating heart problems.
To diagnose heart valve disease, your doctor will ask about your signs and symptoms. He or she also will do a physical exam and look at the results from tests and procedures.
Physical Exam
Your doctor will listen to your heart with a stethoscope. He or she will want to find out whether you have a heart murmur that's likely caused by a heart valve problem.
Your doctor also will listen to your lungs as you breathe to check for fluid buildup. He or she will check for swollen ankles and other signs that your body is retaining water.
Tests and Procedures
Echocardiography (echo) is the main test for diagnosing heart valve disease. But an EKG (electrocardiogram) or chest x ray commonly is used to reveal certain signs of the condition. If these signs are present, echo usually is done to confirm the diagnosis.
Your doctor also may recommend other tests and procedures if you're diagnosed with heart valve disease. For example, you may have cardiac catheterization, (KATH-eh-ter-ih-ZA-shun), stress testing, or cardiac MRI (magnetic resonance imaging). These tests and procedures help your doctor assess how severe your condition is so he or she can plan your treatment.
EKG
This simple test detects and records the heart's electrical activity. An EKG can detect an irregular heartbeat and signs of a previous heart attack. It also can show whether your heart chambers are enlarged.
An EKG usually is done in a doctor's office.
Chest X Ray
This test can show whether certain sections of your heart are enlarged, whether you have fluid in your lungs, or whether calcium deposits are present in your heart.
A chest x ray helps your doctor learn which type of valve defect you have, how severe it is, and whether you have any other heart problems.
Echocardiography
Echo uses sound waves to create a moving picture of your heart as it beats. A device called a transducer is placed on the surface of your chest.
The transducer sends sound waves through your chest wall to your heart. Echoes from the sound waves are converted into pictures of your heart on a computer screen.
Echo can show:
Your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, to get a better image of your heart.
During TEE, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). From there, your doctor can get detailed pictures of your heart.
You'll likely be given medicine to help you relax during this procedure.
Cardiac Catheterization
For this procedure, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Your doctor uses x-ray images to guide the catheter.
Through the catheter, your doctor does diagnostic tests and imaging that show whether backflow is occurring through a valve and how fully the valve opens. You'll be given medicine to help you relax, but you will be awake during the procedure.
Your doctor may recommend cardiac catheterization if your signs and symptoms of heart valve disease aren't in line with your echo results.
The procedure also can help your doctor assess whether your symptoms are due to specific valve problems or coronary heart disease. All of this information helps your doctor decide the best way to treat you.
Stress Test
During stress testing, you exercise to make your heart work hard and beat fast while heart tests and imaging are done. If you can't exercise, you may be given medicine to raise your heart rate.
A stress test can show whether you have signs and symptoms of heart valve disease when your heart is working hard. It can help your doctor assess the severity of your heart valve disease.
Cardiac MRI
Cardiac MRI uses a powerful magnet and radio waves to make detailed images of your heart. A cardiac MRI image can confirm information about valve defects or provide more detailed information.
This information can help your doctor plan your treatment. An MRI also may be done before heart valve surgery to help your surgeon plan for the surgery.
How Is Heart Valve Disease Treated?
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
The goals of treating heart valve disease might include:
Preventing, Treating, or Relieving the Symptoms of Other Related Heart Conditions
To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Your doctor may ask you to limit physical activities that make you short of breath and tired. He or she also may ask that you limit competitive athletic activity, even if the activity doesn't leave you unusually short of breath or tired.
Your doctor may prescribe medicines to:
Thin the
blood and prevent clots (if you have a man-made replacement valve). These medicines also are prescribed for mitral
stenosis or other valve defects that raise the risk of blood clots.
Protecting Heart Valves From Further Damage
If you've had previous heart valve disease and now have a man-made valve, you may be at risk for a heart infection called infective endocarditis (IE). This infection can worsen your heart valve disease.
One of the most common causes of IE is poor dental hygiene. To prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you've had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Repairing or Replacing Heart Valves
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn't causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on many factors, including:
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of IE after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.
However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
Repairing Heart Valves
Heart surgeons can repair heart valves by:
Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients.
Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure for doing it.
Balloon valvuloplasty. Heart valves that don't fully open (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee). This procedure also is called balloon valvotomy (val-VOT-o-me).
During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.
You're awake dur","June 11, 2014."
41,7,"2018-02-02 04:25:06",h,41,"2018-02-02 05:14:16",Hemochromatosis,"
What Is Hemochromatosis?
Hemochromatosis (HE-mo-kro-ma-TO-sis) is a disease in which too much iron builds up in your body (iron overload). Iron is a mineral found in many foods.
Too much iron is toxic to your body. It can poison your organs and cause organ failure. In hemochromatosis, iron can build up in most of your body's organs, but especially in the liver, heart, and pancreas.
Too much iron in the liver can cause an enlarged liver, liver failure, liver cancer, or cirrhosis (sir-RO-sis). Cirrhosis is scarring of the liver, which causes the organ to not work well.
Too much iron in the heart can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs) and heart failure. Too much iron in the pancreas can lead to diabetes.
If hemochromatosis isn't treated, it may even cause death.
Overview
The two types of hemochromatosis are primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron you absorb from food. Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload.
Most people who have primary hemochromatosis inherit it from their parents. If you inherit two hemochromatosis genes—one from each parent—you're at risk for iron overload and signs and symptoms of the disease. The two faulty genes cause your body to absorb more iron than usual from the foods you eat.
Hemochromatosis is one of the most common genetic disorders in the United States. However, not everyone who has hemochromatosis has signs or symptoms of the disease.
Estimates of how many people develop signs and symptoms vary greatly. Some estimates suggest that as many as half of all people who have the disease don't have signs or symptoms.
The severity of hemochromatosis also varies. Some people don't have complications, even with high levels of iron in their bodies. Others have severe complications or die from the disease.
Certain factors can affect the severity of the disease. For example, a high intake of vitamin C can make hemochromatosis worse. This is because vitamin C helps your body absorb iron from food.
Alcohol use can worsen liver damage and cirrhosis caused by hemochromatosis. Conditions such as hepatitis also can further damage or weaken the liver.
Outlook
The outlook for people who have hemochromatosis largely depends on how much organ damage they have at the time of diagnosis. Early diagnosis and treatment of the disease are important.
Treatment may help prevent, delay, or sometimes reverse complications of the disease. Treatment also may lead to better quality of life.
For people who are diagnosed and treated early, a normal lifespan is possible. If left untreated, hemochromatosis can lead to severe organ damage and even death.
Other Names for Hemochromatosis
What Causes Hemochromatosis?
The two types of hemochromatosis are primary and secondary. Each type has a different cause.
Primary Hemochromatosis
Primary hemochromatosis is caused by a defect in the genes that control how much iron you absorb from food. This form of the disease sometimes is called hereditary or classical hemochromatosis. Primary hemochromatosis is more common than the secondary form of the disease.
The genes usually involved in primary hemochromatosis are called HFE genes. Faulty HFE genes cause the body to absorb too much iron. If you inherit two copies of the faulty HFE gene (one from each parent), you're at risk for iron overload and signs and symptoms of hemochromatosis.
If you inherit one faulty HFE gene and one normal HFE gene, you're a hemochromatosis ""carrier."" Carriers usually don't develop the disease. However, they can pass the faulty gene on to their children. Estimates suggest that about 1 in 10 people in the United States are hemochromatosis carriers.
If two parents are carriers of the faulty HFE gene, then each of their children has a 1 in 4 chance of inheriting two faulty HFE genes.
Although less common, other faulty genes also can cause hemochromatosis. Researchers continue to study what changes to normal genes may cause the disease.
Secondary Hemochromatosis
Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload. Examples of such diseases and conditions include:
Other factors also can cause secondary hemochromatosis, including:
Who Is at Risk for Hemochromatosis?
Hemochromatosis is one of the most common genetic diseases in the United States. It's most common in Caucasians of Northern European descent. The disease is less common in African Americans, Hispanics, Asians, and American Indians.
Primary hemochromatosis is more common in men than in women. Also, older people are more likely to develop the disease than younger people. In fact, signs and symptoms usually don't occur in men until they're 40 to 60 years old.
In women, signs and symptoms usually don't occur until after the age of 50 (after menopause). Young children rarely develop hemochromatosis.
Inheriting two faulty HFE genes (one from each parent) is the major risk factor for hemochromatosis. However, many people who have two copies of the faulty gene don't develop signs or symptoms of the disease.
Alcoholism is another risk factor for hemochromatosis. A family history of certain diseases and conditions also puts you at higher risk for hemochromatosis. Examples of such diseases and conditions include heart attack, liver disease, diabetes, arthritis, and erectile dysfunction (impotence).
What Are the Signs and Symptoms of Hemochromatosis?
Hemochromatosis can affect many parts of the body and cause various signs and symptoms. Many of the signs and symptoms are similar to those of other diseases.
Signs and symptoms of hemochromatosis usually don't occur until middle age. Women are more likely to have general symptoms first, such as fatigue (tiredness). In men, complications such as diabetes or cirrhosis (scarring of the liver) often are the first signs of the disease.
Signs and symptoms also vary based on the severity of the disease. Common signs and symptoms of hemochromatosis include joint pain, fatigue, general weakness, weight loss, and stomach pain.
Not everyone who has hemochromatosis has signs or symptoms of the disease. Estimates of how many people develop signs and symptoms vary greatly. Some estimates suggest that as many as half of all people who have the disease don't have signs or symptoms.
Hemochromatosis Complications
If hemochromatosis isn't found and treated early, iron builds up in your body and can lead to:
Changes in
skin color that make the skin look gray or bronze
How Is Hemochromatosis Diagnosed?
Your doctor will diagnose hemochromatosis based on your medical and family histories, a physical exam, and the results from tests and procedures.
The disease sometimes is detected while checking for other diseases or conditions, such as arthritis, liver disease, diabetes, heart disease, or erectile dysfunction (impotence).
Specialists Involved
Family doctors and internal medicine specialists may diagnose and treat hemochromatosis. Other doctors also may be involved in diagnosing and treating the disease, including:
Hematologists (
blood disease specialists)
Endocrinologists (
gland system specialists)
Hepatologists (
liver specialists)
Medical and Family Histories
To learn about your medical and family histories, your doctor may ask:
Diagnostic Tests and Procedures
Your doctor may recommend one or more tests or procedures to diagnose hemochromatosis.
Blood Tests
In hemochromatosis, the amount of iron in your body may be too high, even though the level of iron in your blood is normal. Certain blood tests can help your doctor find out how much iron is in your body.
During these tests, a sample of blood is taken from your body. It's usually drawn from a vein in your arm using a needle. The procedure usually is quick and easy, although it may cause some short-term discomfort.
The blood tests you have may include transferrin saturation (TS), serum ferritin level, and liver function tests.
Transferrin is a protein that carries iron in the blood. The TS test shows how much iron the transferrin is carrying. This helps your doctor find out how much iron is in your body.
Your doctor may test your serum ferritin level if your TS level is high. A serum ferritin level test shows how much iron is stored in your body's organs. A buildup of iron may suggest hemochromatosis.
You may have liver function tests to check for damage to your liver. Liver damage may be a sign of hemochromatosis. If you have hemochromatosis, liver function tests may show the severity of the disease.
Blood tests alone can't diagnose hemochromatosis. Thus, your doctor may recommend other tests as well.
Liver Biopsy
During a liver biopsy, your doctor numbs an area near your liver and then removes a small sample of liver tissue using a needle. The tissue is then looked at under a microscope.
A liver biopsy can show how much iron is in your liver. This procedure also can help your doctor diagnose liver damage (for example, scarring and cancer). Liver biopsies are less common now than in the past.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) is a safe test that uses radio waves, magnets, and a computer to create pictures of your organs. An MRI may be done to show the amount of iron in your liver.
Superconducting Quantum Interference Device
A superconducting quantum interference device (SQuID) is a machine that uses very sensitive magnets to measure the amount of iron in your liver. This machine is available at only a few medical centers.
How Is Hemochromatosis Treated?
Treatments for hemochromatosis include therapeutic phlebotomy (fleh-BOT-o-me), iron chelation (ke-LAY-shun) therapy, dietary changes, and treatment for complications.
The goals of treating hemochromatosis include:
Therapeutic Phlebotomy
Therapeutic phlebotomy is a procedure that removes blood (and iron) from your body. A needle is inserted into a vein, and your blood flows through an airtight tube into a sterile container or bag.
The process is similar to donating blood; it can be done at blood donation centers, hospital donation centers, or a doctor's office.
In the first stage of treatment, about 1 pint of blood is removed once or twice a week. After your iron levels return to normal, you may continue phlebotomy treatments. However, you may need them less often—typically every 2–4 months.
As long as treatment continues, which often is for the rest of your life, you'll need frequent blood tests to check your iron levels.
Iron Chelation Therapy
Iron chelation therapy uses medicine to remove excess iron from your body. This treatment is a good option for people who can't have routine blood removal.
The medicine used in iron chelation therapy is either injected or taken orally (by mouth). Injected iron chelation therapy is done at a doctor's office. Oral iron chelation therapy can be done at home.
Dietary Changes
Your doctor may suggest that you change your diet if you have hemochromatosis. You may be advised to:
Avoid taking
iron, including iron pills, iron
injections, or multivitamins that contain iron.
Limit your intake of
vitamin C. Vitamin C helps your body absorb
iron from food. Talk with your doctor about how much vitamin C is safe for you.
Avoid uncooked fish and shellfish. Some fish and shellfish contain
bacteria that can cause infections in people who have
chronic diseases, such as
hemochromatosis.
Limit alcohol intake. Drinking alcohol increases the risk of
liver disease. It also can make existing liver disease worse.
Treatment for Complications
Your doctor may prescribe other treatments as needed for complications such as liver disease, heart problems, or diabetes.
Living With Hemochromatosis
The outlook for people who have hemochromatosis largely depends on how much organ damage has already occurred at the time of diagnosis. Early diagnosis and treatment of the disorder are important.
Treatment may help prevent, delay, or sometimes reverse complications of the disorder. Treatment also may lead to higher energy levels and better quality of life. With early diagnosis and treatment, a normal lifespan is possible.
If organ damage has already occurred, treatment may prevent further damage and improve life expectancy. However, treatment may not be able to reverse existing damage.
If hemochromatosis isn't treated, it can lead to severe organ damage or even death.
What To Expect After Treatment
People have different responses to treatment. Some people who have frequent therapeutic phlebotomy may feel very tired. People who have advanced disease or who are getting intense treatment that weakens them may need help with daily tasks and activities.
At first, you may need to have therapeutic phlebotomy often. How long you'll need this treatment depends on how much extra iron is in your body.
After the initial treatment period, you may need ongoing treatment two to six times a year. This will help prevent the iron from building up again.
Ongoing Care
If you have hemochromatosis, getting ongoing care is important. Ongoing care may include:
If you need routine phlebotomy, you may have to change your usual work times to schedule your treatments. You also may have to change your work schedule to allow for periods of fatigue (tiredness) or recovery, especially if your treatment weakens you.
Emotional Issues and Support
Living with hemochromatosis may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with hemochromatosis. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Screening Family Members for Hemochromatosis
Parents, grandparents, brothers and sisters, and children (blood relatives) of a person who has hemochromatosis may be at risk for the disease. Talk with your doctor to see whether your relatives should have their iron levels checked.
Your doctor may recommend genetic testing to show whether family members are at risk for the disease. If a relative already has been diagnosed with hemochromatosis, a genetic test can show whether he or she has the primary (inherited) form of the disease.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to hemochromatosis, talk with your doctor. You also can visit the following Web sites to learn more about cli","June 11, 2014."
42,7,"2018-02-02 04:25:06",h,42,"2018-02-02 05:14:36","Hemolytic Anemia","
What Is Hemolytic Anemia?
Hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) is a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over.
Red blood cells are disc-shaped and look like doughnuts without holes in the center. These cells carry oxygen to your body. They also remove carbon dioxide (a waste product) from your body.
Red blood cells are made in the bone marrow—a sponge-like tissue inside the bones. They live for about 120 days in the bloodstream and then die.
White blood cells and platelets (PLATE-lets) also are made in the bone marrow. White blood cells help fight infections. Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding.
When blood cells die, the body's bone marrow makes more blood cells to replace them. However, in hemolytic anemia, the bone marrow can't make red blood cells fast enough to meet the body's needs.
Hemolytic anemia can lead to many health problems, such as fatigue (tiredness), pain, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), an enlarged heart, and heart failure.
Outlook
There are many types of hemolytic anemia. Treatment and outlook depend on what type you have and how severe it is. The condition can develop suddenly or slowly. Symptoms can range from mild to severe.
Hemolytic anemia often can be successfully treated or controlled. Mild hemolytic anemia may need no treatment at all. Severe hemolytic anemia requires prompt and proper treatment, or it may be fatal.
Inherited forms of hemolytic anemia are lifelong conditions that may require ongoing treatment. Acquired forms of hemolytic anemia may go away if the cause of the condition is found and corrected.
Types of Hemolytic Anemia
There are many types of hemolytic anemia. The condition can be inherited or acquired. ""Inherited"" means your parents passed the gene for the condition on to you. ""Acquired"" means you aren't born with the condition, but you develop it.
Inherited Hemolytic Anemias
With inherited hemolytic anemias, one or more of the genes that control red blood cell production are faulty. This can lead to problems with the hemoglobin, cell membrane, or enzymes that maintain healthy red blood cells.
The abnormal cells may be fragile and break down while moving through the bloodstream. If this happens, an organ called the spleen may remove the cell debris from the bloodstream.
Thalassemias
Thalassemias (thal-a-SE-me-ahs) are inherited blood disorders in which the body doesn't make enough of certain types of hemoglobin. This causes the body to make fewer healthy red blood cells than normal.
Thalassemias most often affect people of Southeast Asian, Indian, Chinese, Filipino, Mediterranean, or African origin or descent.
Hereditary Spherocytosis
In this condition, a defect in the surface membrane (the outer covering) of red blood cells causes them to have a sphere, or ball-like, shape. These blood cells have a lifespan that's shorter than normal.
Hereditary spherocytosis (SFER-o-si-to-sis) is the most common cause of hemolytic anemia among people of Northern European descent.
Hereditary Elliptocytosis (Ovalocytosis)
Like hereditary spherocytosis, this condition also involves a problem with the cell membrane. In this condition, the red blood cells are elliptic (oval) in shape. They aren't as flexible as normal red blood cells, and they have a shorter lifespan.
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
In G6PD deficiency, the red blood cells are missing an important enzyme called G6PD. G6PD is part of the normal chemistry inside red blood cells.
In G6PD deficiency, if red blood cells come into contact with certain substances in the bloodstream, the missing enzyme causes the cells to rupture (burst) and die.
Many factors can trigger the breakdown of the red blood cells. Examples include taking sulfa or antimalarial medicines; being exposed to naphthalene, a substance found in some moth balls; eating fava beans; or having an infection.
G6PD deficiency mostly affects males of African or Mediterranean descent. In the United States, the condition is more common among African Americans than Caucasians.
Pyruvate Kinase Deficiency
In this condition, the body is missing an enzyme called pyruvate (PI-ru-vate) kinase. Not having enough of this enzyme causes red blood cells to break down easily.
This disorder is more common among the Amish than other groups.
Acquired Hemolytic Anemias
With acquired hemolytic anemias, your red blood cells may be normal. However, some other disease or factor causes the body to destroy red blood cells and remove them from the bloodstream.
The destruction of the red blood cells occurs in the bloodstream or, more commonly, in the spleen.
Immune Hemolytic Anemia
In immune hemolytic anemia, your immune system destroys your red blood cells. The three main types of immune hemolytic anemia are autoimmune, alloimmune, and drug-induced.
Autoimmune hemolytic anemia (AIHA). In this condition, your immune system makes antibodies (proteins) that attack your red blood cells. Why this happens isn't known.
AIHA accounts for half of all cases of hemolytic anemia. AIHA may come on very quickly and become serious.
Having certain diseases or infections can raise your risk for AIHA. Examples include:
Epstein-Barr virus
Cytomegalovirus
HIV
AIHA also can develop after you have a blood and marrow stem cell transplant.
In some types of AIHA, the antibodies made by the body are called warm antibodies. This means they're active (that is, they destroy red blood cells) at warm temperatures, such as body temperature.
In other types of AIHA, the body makes cold-reactive antibodies. These antibodies are active at cold temperatures.
Cold-reactive antibodies can become active when parts of the body, such as the hands or feet, are exposed to temperatures lower than 32 to 50 degrees Fahrenheit (0 to 10 degrees Celsius).
Warm antibody AIHA is more common than cold antibody AIHA.
Alloimmune hemolytic anemia. This type of hemolytic anemia occurs if your body makes antibodies against red blood cells that you get from a blood transfusion. This can happen if the transfused blood is a different blood type than your blood.
This type of hemolytic anemia also can occur during pregnancy if a woman has Rh-negative blood and her baby has Rh-positive blood. ""Rh-negative"" and ""Rh-positive"" refer to whether your blood has Rh factor. Rh factor is a protein on red blood cells.
For more information, go to the Health Topics Rh Incompatibility article.
Drug-induced hemolytic anemia. Certain medicines can cause a reaction that develops into hemolytic anemia. Some medicines, such as penicillin, bind to red blood cell surfaces and can cause antibodies to develop.
Other medicines cause hemolytic anemia in other ways. Examples of these medicines include chemotherapy, acetaminophen, quinine and antimalarial medicines, anti-inflammatory medicines, and levodopa.
Mechanical Hemolytic Anemias
Physical damage to red blood cell membranes can cause them to break down faster than normal. Damage may be due to:
Preeclampsia (pre-e-KLAMP-se-ah) or eclampsia. Preeclampsia is
high blood pressure during
pregnancy. Eclampsia, which follows preeclampsia, is a serious condition that causes
seizures in pregnant women.
Blood cell damage also may occur in the limbs as a result of doing strenuous activities, such as taking part in marathons.
Other Causes of Damage to Red Blood Cells
Certain infections and substances also can damage red blood cells and lead to hemolytic anemia. Examples include malaria and blackwater fever, tick-borne diseases, snake venom, and toxic chemicals.
Other Names for Hemolytic Anemia
What Causes Hemolytic Anemia?
The immediate cause of hemolytic anemia is the early destruction of red blood cells. This means that red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over.
Many diseases, conditions, and factors can cause the body to destroy its red blood cells. These causes can be inherited or acquired. ""Inherited"" means your parents passed the gene for the condition on to you. ""Acquired"" means you aren't born with the condition, but you develop it.
Sometimes, the cause of hemolytic anemia isn't known.
For more information about the specific causes of hemolytic anemia, go to ""Types of Hemolytic Anemia.""
Acquired Hemolytic Anemias
In acquired hemolytic anemias, the body makes normal red blood cells. However, a disease, condition, or other factor destroys the cells. Examples of conditions that can destroy the red blood cells include:
Immune disorders
Infections
Hypersplenism (HI-per-
SPLEEN-izm; an enlarged spleen)
Who Is at Risk for Hemolytic Anemia?
Hemolytic anemia can affect people of all ages and races and both sexes. Some types of hemolytic anemia are more likely to occur in certain populations than others.
For example, glucose-6-phosphate dehydrogenase (G6PD) deficiency mostly affects males of African or Mediterranean descent. In the United States, the condition is more common among African Americans than Caucasians.
In the United States, sickle cell anemia mainly affects African Americans.
What Are the Signs and Symptoms of Hemolytic Anemia?
The signs and symptoms of hemolytic anemia will depend on the type and severity of the disease.
People who have mild hemolytic anemia often have no signs or symptoms. More severe hemolytic anemia may cause many signs and symptoms, and they may be serious.
Many of the signs and symptoms of hemolytic anemia apply to all types of anemia.
Signs and Symptoms of Hemolytic Anemia
Leg Ulcers and Pain
In people who have sickle cell anemia, the sickle-shaped cells can clog small blood vessels and block blood flow. This can cause leg sores and pain throughout the body.
A Severe Reaction to a Blood Transfusion
You may develop hemolytic anemia due to a blood transfusion. This can happen if the transfused blood is a different blood type than your blood.
Signs and symptoms of a severe reaction to a transfusion include fever, chills, low blood pressure, and shock. (Shock is a life-threatening condition that occurs if the body isn't getting enough blood flow.)
How Is Hemolytic Anemia Diagnosed?
Your doctor will diagnose hemolytic anemia based on your medical and family histories, a physical exam, and test results.
Specialists Involved
Primary care doctors, such as a family doctor or pediatrician, may help diagnose and treat hemolytic anemia. Your primary care doctor also may refer you to a hematologist. This is a doctor who specializes in diagnosing and treating blood diseases and disorders.
Doctors and clinics that specialize in treating inherited blood disorders, such as sickle cell anemia and thalassemias, also may be involved.
If your hemolytic anemia is inherited, you may want to consult a genetic counselor. A counselor can help you understand your risk of having a child who has the condition. He or she also can explain the choices that are available to you.
Medical and Family Histories
To find the cause and severity of hemolytic anemia, your doctor may ask detailed questions about your symptoms, personal medical history, and your family medical history.
He or she may ask whether:
You or anyone in your family has had problems with
anemia You've recently had any illnesses or medical conditions
You take any medicines, and which ones
You've been exposed to certain chemicals or substances
Physical Exam
Your doctor will do a physical exam to check for signs of hemolytic anemia. He or she will try to find out how severe the condition is and what's causing it.
The exam may include:
Diagnostic Tests and Procedures
Many tests are used to diagnose hemolytic anemia. These tests can help confirm a diagnosis, look for a cause, and find out how severe the condition is.
Complete Blood Count
Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood.
This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels may vary in certain racial and ethnic populations. Your doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of hemolytic anemia, a different blood disorder, an infection, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. The results may be a clue as to the cause of your anemia.
Other Names for Hemophilia
Hemophilia B
Christmas disease
Factor IX deficiency
What Causes Hemophilia?
If you have inherited hemophilia, you're born with the disorder. It's caused by a defect in one of the genes that determine how the body makes blood clotting factor VIII or IX. These genes are located on the X chromosomes (KRO-muh-somz).
Chromosomes come in pairs. Females have two X chromosomes, while males have one X and one Y chromosome. Only the X chromosome carries the genes related to clotting factors.
A male who has a faulty hemophilia gene on his X chromosome will have hemophilia. A female must have the faulty gene on both of her X chromosomes to have hemophilia, which is very rare.
If a female has the faulty gene on only one of her X chromosomes, she is a ""hemophilia carrier.” Carriers don't have hemophilia, but they can pass the faulty gene to their children.
Below are two examples of how the hemophilia gene is inherited.
![]()
Inheritance Pattern for Hemophilia—Example 1. The image shows one example of how the hemophilia gene is inherited. In this example, the father doesn't have hemophilia (that is, he has two normal chromosomes—X and Y). The mother is a carrier (more...)
![]()
Inheritance Pattern for Hemophilia—Example 1 Inheritance Pattern for Hemophilia—Example 2. The image shows one example of how the hemophilia gene is inherited. In this example, the father has hemophilia (that is, his X chromosome is faulty). (more...)
Females who are hemophilia carriers usually have enough clotting factors from their one normal X chromosome to prevent serious bleeding problems. However, up to 50 percent of carriers may have an increased risk of bleeding.
Very rarely, a girl is born with hemophilia. This can happen if her father has hemophilia and her mother is a carrier.
Some males who have the disorder are born to mothers who aren't carriers. In these cases, a mutation (random change) occurs in the gene as it is passed to the child.
What Are the Signs and Symptoms of Hemophilia?
The major signs and symptoms of hemophilia are excessive bleeding and easy bruising.
Excessive Bleeding
The extent of bleeding depends on how severe the hemophilia is.
Children who have mild hemophilia may not have signs unless they have excessive bleeding from a dental procedure, an accident, or surgery. Males who have severe hemophilia may bleed heavily after circumcision.
Bleeding can occur on the body's surface (external bleeding) or inside the body (internal bleeding).
Signs of external bleeding may include:
Signs of internal bleeding may include:
Bleeding in the Joints
Bleeding in the knees, elbows, or other joints is another common form of internal bleeding in people who have hemophilia. This bleeding can occur without obvious injury.
At first, the bleeding causes tightness in the joint with no real pain or any visible signs of bleeding. The joint then becomes swollen, hot to touch, and painful to bend.
Swelling continues as bleeding continues. Eventually, movement in the joint is temporarily lost. Pain can be severe. Joint bleeding that isn't treated quickly can damage the joint.
Bleeding in the Brain
Internal bleeding in the brain is a very serious complication of hemophilia. It can happen after a simple bump on the head or a more serious injury. The signs and symptoms of bleeding in the brain include:
How Is Hemophilia Diagnosed?
If you or your child appears to have a bleeding problem, your doctor will ask about your personal and family medical histories. This will reveal whether you or your family members, including women and girls, have bleeding problems. However, some people who have hemophilia have no recent family history of the disease.
You or your child also will likely have a physical exam and blood tests to diagnose hemophilia. Blood tests are used to find out:
How long it takes for your
blood to clot
The test results will show whether you have hemophilia, what type of hemophilia you have, and how severe it is.
Hemophilia A and B are classified as mild, moderate, or severe, depending on the amount of clotting factor VIII or IX in the blood.
The severity of symptoms can overlap between the categories. For example, some people who have mild hemophilia may have bleeding problems almost as often or as severe as some people who have moderate hemophilia.
Severe hemophilia can cause serious bleeding problems in babies. Thus, children who have severe hemophilia usually are diagnosed during the first year of life. People who have milder forms of hemophilia may not be diagnosed until they're adults.
The bleeding problems of hemophilia A and hemophilia B are the same. Only special blood tests can tell which type of the disorder you or your child has. Knowing which type is important because the treatments are different.
Pregnant women who are known hemophilia carriers can have the disorder diagnosed in their unborn babies as early as 12 weeks into their pregnancies.
Women who are hemophilia carriers also can have ""preimplantation diagnosis"" to have children who don't have hemophilia.
For this process, women have their eggs removed and fertilized by sperm in a laboratory. The embryos are then tested for hemophilia. Only embryos without the disorder are implanted in the womb.
How Is Hemophilia Treated?
Treatment With Replacement Therapy
The main treatment for hemophilia is called replacement therapy. Concentrates of clotting factor VIII (for hemophilia A) or clotting factor IX (for hemophilia B) are slowly dripped or injected into a vein. These infusions help replace the clotting factor that's missing or low.
Clotting factor concentrates can be made from human blood. The blood is treated to prevent the spread of diseases, such as hepatitis. With the current methods of screening and treating donated blood, the risk of getting an infectious disease from human clotting factors is very small.
To further reduce the risk, you or your child can take clotting factor concentrates that aren't made from human blood. These are called recombinant clotting factors. Clotting factors are easy to store, mix, and use at home—it only takes about 15 minutes to receive the factor.
You may have replacement therapy on a regular basis to prevent bleeding. This is called preventive or prophylactic (PRO-fih-lac-tik) therapy. Or, you may only need replacement therapy to stop bleeding when it occurs. This use of the treatment, on an as-needed basis, is called demand therapy.
Demand therapy is less intensive and expensive than preventive therapy. However, there's a risk that bleeding will cause damage before you receive the demand therapy.
Complications of Replacement Therapy
Complications of replacement therapy include:
Antibodies to the clotting factor. Antibodies can destroy the clotting factor before it has a chance to work. This is a very serious problem. It prevents the main treatment for hemophilia (replacement therapy) from working.
These antibodies, also called inhibitors, develop in about 20–30 percent of people who have severe hemophilia A. Inhibitors develop in 2–5 percent of people who have hemophilia B.
When antibodies develop, doctors may use larger doses of clotting factor or try different clotting factor sources. Sometimes the antibodies go away.
Researchers are studying new ways to deal with antibodies to clotting factors.
Viruses from human clotting factors. Clotting factors made from human blood can carry the viruses that cause HIV/AIDS and hepatitis. However, the risk of getting an infectious disease from human clotting factors is very small due to:
Careful screening of
blood donors
Testing of donated
blood products
Treating donated
blood products with a detergent and heat to destroy
viruses
Damage to joints, muscles, and other parts of the body. Delays in treatment can cause damage such as:
Bleeding into a
joint. If this happens many times, it can lead to changes in the shape of the joint and impair the joint's function.
Swelling of the membrane around a
joint.
Pain, swelling, and redness of a
joint.
Pressure on a
joint from swelling, which can destroy the joint.
Home Treatment With Replacement Therapy
You can do both preventive (ongoing) and demand (as-needed) replacement therapy at home. Many people learn to do the infusions at home for their child or for themselves. Home treatment has several advantages:
Discuss options for home treatment with your doctor or your child's doctor. A doctor or other health care provider can teach you the steps and safety procedures for home treatment. Hemophilia treatment centers are another good resource for learning about home treatment (discussed in ""Living With Hemophilia”).
Doctors can surgically implant vein access devices to make it easier for you to access a vein for treatment with replacement therapy. These devices can be helpful if treatment occurs often. However, infections can be a problem with these devices. Your doctor can help you decide whether this type of device is right for you or your child.
Other Types of Treatment
Desmopressin
Desmopressin (DDAVP) is a man-made hormone used to treat people who have mild hemophilia A. DDAVP isn't used to treat hemophilia B or severe hemophilia A.
DDAVP stimulates the release of stored factor VIII and von Willebrand factor; it also increases the level of these proteins in your blood. Von Willebrand factor carries and binds factor VIII, which can then stay in the bloodstream longer.
DDAVP usually is given by injection or as nasal spray. Because the effect of this medicine wears off if it's used often, the medicine is given only in certain situations. For example, you may take this medicine prior to dental work or before playing certain sports to prevent or reduce bleeding.
Antifibrinolytic Medicines
Antifibrinolytic medicines (including tranexamic acid and epsilon aminocaproic acid) may be used with replacement therapy. They're usually given as a pill, and they help keep blood clots from breaking down.
These medicines most often are used before dental work or to treat bleeding from the mouth or nose or mild intestinal bleeding.
Treatment of a Specific Bleeding Site
Pain medicines, steroids, and physical therapy may be used to reduce pain and swelling in an affected joint. Talk with your doctor or pharmacist about which medicines are safe for you to take.
Which Treatment Is Best for You?
The type of treatment you or your child receives depends on several things, including how severe the hemophilia is, the activities you'll be doing, and the dental or medical procedures you'll be having.
Mild
hemophilia—Replacement
therapy usually isn't needed for mild hemophilia. Sometimes, though, DDAVP is given to raise the body's level of factor VIII.
Moderate
hemophilia—You may need replacement
therapy only when
bleeding occurs or to prevent bleeding that could occur when doing certain activities. Your doctor also may recommend DDAVP prior to having a procedure or doing an activity that increases the risk of bleeding.
Severe
hemophilia—You usually need replacement
therapy to prevent
bleeding that could damage your
joints,
muscles, or other parts of your body. Typically, replacement therapy is given at home two or three times a week. This preventive therapy usually is started in patients at a young age and may need to continue for life.
For both types of hemophilia, getting quick treatment for bleeding is important. Quick treatment can limit damage to your body. If you or your child has hemophilia, learn to recognize signs of bleeding.
Other family members also should learn to watch for signs of bleeding in a child who has hemophilia. Children sometimes ignore signs of bleeding because they want to avoid the discomfort of treatment.
Living With Hemophilia
If you or your child has hemophilia, you can take steps to prevent bleeding problems. Thanks to improvements in treatment, a child who has hemophilia today is likely to live a normal lifespan.
Hemophilia Treatment Centers
The Federal Government funds a nationwide network of hemophilia treatment centers (HTCs). These centers are an important resource for people who have hemophilia and their families.
The medical experts at HTCs provide treatment, education, and support. They can teach you or your family members how to do home treatments. Center staff also can provide your doctor with information.
People who get care at HTCs are less likely than those who get care elsewhere to have bleeding complications and hospitalizations. They're also more likely to have a better quality of life. This may be due to the centers' emphasis on bleeding prevention and the education and support provided to patients and their caregivers.
More than 100 federally funded HTCs are located throughout the United States. Many HTCs are located at major university medical and research centers. The hemophilia teams at these centers include:
Nurse coordinators
Pediatricians (doctors who treat children) and adult and pediatric hematologists (doctors who specialize in
blood disorders)
Social workers (who can help with financial issues, transportation, mental health, and other issues)
Dentists
To find an HTC located near you, go to the directory of HTCs on the Centers for Disease Control and Prevention's Web site. Many people who have hemophilia go to HTCs for annual checkups, even if it means traveling some distance to do so.
At an HTC, you or your child may be able to take part in clinical research and benefit from the latest hemophilia research findings. The HTC team also will work with your local health care providers to help meet your needs or your child's needs.
Ongoing Care
If you have hemophilia, you can take steps to avoid complications. For example:
It's a good idea to keep a record of all previous treatments. Be sure to take this information with you to medical appointments and to the hospital or emergency room.
If Your Child Is Diagnosed With Hemophilia
You may have emotional, financial, social, or other strains as you adjust to having a child who has hemophilia. Learn all you can about the disorder and get the support you need.
Talk with doctors and other health care providers about treatment, prevention of bleeding, and what to do during an emergency.
The care teams at HTCs can provide your child with treatment and help educate and support you. The social worker on the team can help with emotional issues, financial and transportation problems, and other concerns.
Seek the many resources available through the Web, books, and other materials, including those provided by national and local hemophilia organizations.
Look into support groups that offer a variety of activities for children who have hemophilia and for family members. Some groups offer summer camps for children who have hemophilia. Ask your doctor, nurse coordinator, or social worker about these groups and camps.
Challenges will occur as your child grows and becomes more active. In addition to treatment and regular health and dental care, your child needs information about hemophilia that he or she can understand.
Children who have hemophilia also need ongoing support, and they need to be reassured that the condition isn't their fault.
Young children who have hemophilia need extra protection from things in the home and elsewhere that could cause injuries and bleeding:
Protect toddlers with kneepads, elbow pads, and protective helmets. All children should wear safety helmets when riding tricycles or bicycles.
Be sure to use the safety belts and straps in highchairs, car seats, and strollers to protect your child from
falls.
Remove furniture with sharp corners or pad them while your child is a toddler.
Keep out of reach or locked away small and sharp objects and other items that could cause
bleeding or harm.
Check play equipment and outdoor play areas for possible hazards.
You also should learn how to examine your child for and recognize signs of bleeding. Learn to prepare for bleeding episodes when they occur. Keep a cold pack in the freezer ready to use as directed or to take along with you to treat bumps and bruises.
Popsicles work fine when there is minor bleeding in the mouth. You also might want to keep a bag ready to go with items you'll need if you must take your child to the emergency room or elsewhere.
Be sure that anyone who is responsible for your child knows that he or she has Go to:
What Is Cholesterol?
To understand high blood cholesterol (ko-LES-ter-ol), it helps to learn about cholesterol. Cholesterol is a waxy, fat-like substance that’s found in all cells of the body.
Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. However, cholesterol also is found in some of the foods you eat.
Cholesterol travels through your bloodstream in small packages called lipoproteins (lip-o-PRO-teens). These packages are made of fat (lipid) on the inside and proteins on the outside.
Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important.
LDL cholesterol sometimes is called “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. (Arteries are blood vessels that carry blood from your heart to your body.)
HDL cholesterol sometimes is called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body.
What Is High Blood Cholesterol?
High blood cholesterol is a condition in which you have too much cholesterol in your blood. By itself, the condition usually has no signs or symptoms. Thus, many people don’t know that their cholesterol levels are too high.
People who have high blood cholesterol have a greater chance of getting coronary heart disease, also called coronary artery disease. (In this article, the term “heart disease” refers to coronary heart disease.)
The higher the level of LDL cholesterol in your blood, the GREATER your chance is of getting heart disease. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease.
Coronary heart disease is a condition in which plaque (plak) builds up inside the coronary (heart) arteries. Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Atherosclerosis
![]()
Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. The buildup of (more...)
Over time, plaque hardens and narrows your coronary arteries. This limits the flow of oxygen-rich blood to the heart.
Eventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina (an-JI-nuh or AN-juh-nuh) or a heart attack may occur.
Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious problems or death.
Plaque also can build up in other arteries in your body, such as the arteries that bring oxygen-rich blood to your brain and limbs. This can lead to problems such as carotid artery disease, stroke, and peripheral arterial disease (P.A.D.).
Outlook
Lowering your cholesterol may slow, reduce, or even stop the buildup of plaque in your arteries. It also may reduce the risk of plaque rupturing and causing dangerous blood clots.
![]()
The image focuses on high cholesterol in women and explains how high cholesterol increases the risk of developing heart disease. An estimated 1 in 2 women has high or borderline high cholesterol. The image also lists the ranges of total cholesterol numbers (more...)
Other Names for High Blood Cholesterol
What Causes High Blood Cholesterol?
Many factors can affect the cholesterol levels in your blood. You can control some factors, but not others.
Factors You Can Control
Diet
Cholesterol is found in foods that come from animal sources, such as egg yolks, meat, and cheese. Some foods have fats that raise your cholesterol level.
For example, saturated fat raises your low-density lipoprotein (LDL) cholesterol level more than anything else in your diet. Saturated fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
Trans fatty acids (trans fats) raise your LDL cholesterol and lower your high-density lipoprotein (HDL cholesterol. Trans fats are made when hydrogen is added to vegetable oil to harden it. Trans fats are found in some fried and processed foods.
Limiting foods with cholesterol, saturated fat, and trans fats can help you control your cholesterol levels.
Physical Activity and Weight
Lack of physical activity can lead to weight gain. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level. (Total cholesterol is a measure of the total amount of cholesterol in your blood, including LDL and HDL.)
Routine physical activity can help you lose weight and lower your LDL cholesterol. Being physically active also can help you raise your HDL cholesterol level.
Factors You Can’t Control
Age and Sex
Starting at puberty, men often have lower levels of HDL cholesterol than women. As women and men age, their LDL cholesterol levels often rise. Before age 55, women usually have lower LDL cholesterol levels than men. However, after age 55, women can have higher LDL levels than men.
What Are the Signs and Symptoms of High Blood Cholesterol?
High blood cholesterol usually has no signs or symptoms. Thus, many people don't know that their cholesterol levels are too high.
If you're 20 years old or older, have your cholesterol levels checked at least once every 5 years. Talk with your doctor about how often you should be tested.
How Is High Blood Cholesterol Diagnosed?
Your doctor will diagnose high blood cholesterol by checking the cholesterol levels in your blood. A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you’ll need to fast (not eat or drink anything but water) for 9 to 12 hours.
The lipoprotein panel will give your doctor information about your:
LDL cholesterol. LDL, or “bad,” cholesterol is the main source of cholesterol buildup and blockages in the
arteries.
Triglycerides (tri-GLIH-seh-rides). Triglycerides are a type of
fat found in your
blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of
coronary heart disease, especially in women.
If it’s not possible to have a lipoprotein panel, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels.
Testing for total and HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if your HDL cholesterol is less than 40 mg/dL, your doctor will likely recommend that you have a lipoprotein panel. (Cholesterol is measured as milligrams (mg) of cholesterol per deciliter (dL) of blood.)
The tables below show total, LDL, and HDL cholesterol levels and their corresponding categories. See how your cholesterol numbers compare to the numbers in the tables below.
Triglycerides also can raise your risk for heart disease. If your triglyceride level is borderline high (150–199 mg/dL) or high (200 mg/dL or higher), you may need treatment.
Factors that can raise your triglyceride level include:
How Is High Blood Cholesterol Treated?
High blood cholesterol is treated with lifestyle changes and medicines. The main goal of treatment is to lower your low-density lipoprotein (LDL) cholesterol level enough to reduce your risk for coronary heart disease, heart attack, and other related health problems.
Your risk for heart disease and heart attack goes up as your LDL cholesterol level rises and your number of heart disease risk factors increases.
Some people are at high risk for heart attacks because they already have heart disease. Other people are at high risk for heart disease because they have diabetes or more than one heart disease risk factor.
Talk with your doctor about lowering your cholesterol and your risk for heart disease. Also, check the list to find out whether you have risk factors that affect your LDL cholesterol goal:
You can use the NHLBI 10-Year Risk Calculator to find your risk score. The score, given as a percentage, refers to your chance of having a heart attack in the next 10 years.
Based on your medical history, number of risk factors, and risk score, figure out your risk of getting heart disease or having a heart attack using the table below.
View in own window
| If You Have | You Are in Category | Your LDL Goal Is |
|---|
| Heart disease, diabetes, or a risk score higher than 20% | I. High risk* | Less than 100 mg/dL |
| Two or more risk factors and a risk score of 10–20% | II. Moderately high risk | Less than 130 mg/dL |
| Two or more risk factors and a risk score lower than 10% | III. Moderate risk | Less than 130 mg/dL |
| One or no risk factors | IV. Low to moderate risk | Less than 160 mg/dL |
After following the above steps, you should have an idea about your risk for heart disease and heart attack. The two main ways to lower your cholesterol (and, thus, your heart disease risk) include:
Medicines. If
cholesterol-lowering medicines are needed, they’re used with the TLC program to help lower your
LDL cholesterol level.
Your doctor will set your LDL goal. The higher your risk for heart disease, the lower he or she will set your LDL goal. Using the following guide, you and your doctor can create a plan for treating your high blood cholesterol.
Category I, high risk, your LDL goal is less than 100 mg/dL.*
View in own window
| Your LDL Level | Treatment |
|---|
| If your LDL level is 100 or higher | You will need to begin the TLC diet and take medicines as prescribed. |
| Even if your LDL level is below 100 | You should follow the TLC diet to keep your LDL level as low as possible. |
Category II, moderately high risk, your LDL goal is less than 130 mg/dL
View in own window
| Your LDL Level | Treatment |
|---|
| If your LDL level is 130 mg/dL or higher | You will need to begin the TLC diet. |
| If your LDL level is 130 mg/dL or higher after 3 months on the TLC diet | You may need medicines along with the TLC diet. |
| If your LDL level is less than 130 mg/dL | You will need to follow a heart healthy diet. |
Category III, moderate risk, your LDL goal is less than 130 mg/dL.
View in own window
| Your LDL Level | Treatment |
|---|
| If your LDL level is 130 mg/dL or higher | You will need to begin the TLC diet. |
| If your LDL level is 160 mg/dL or higher after 3 months on the TLC diet | You may need medicines along with the TLC diet. |
| If your LDL level is less than 130 mg/dL | You will need to follow a heart healthy diet. |
Category IV, low to moderate risk, your LDL goal is less than 160 mg/dL.
View in own window
| Your LDL Level | Treatment |
|---|
| If your LDL level is 160 mg/dL or higher | You will need to begin the TLC diet. |
| If your LDL level is 160 mg/dL or higher after 3 months on the TLC diet | You may need medicines along with the TLC diet. |
| If your LDL level is less than 160 mg/dL | You will need to follow a heart healthy diet. |
Lowering Cholesterol Using Therapeutic Lifestyle Changes
TLC is a set of lifestyle changes that can help you lower your LDL cholesterol. The main parts of the TLC program are a healthy diet, weight management, and physical activity.
The TLC Diet
With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.
You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods' Nutrition Facts labels.
Foods high in soluble fiber also are part of the TLC diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:
Whole-grain cereals such as oatmeal and oat bran
Fruits such as apples, bananas, oranges, pears, and prunes
Legumes such as
kidney beans, lentils, chick peas, black-eyed peas, and lima beans
A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.
A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.
You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and ""no added salt"" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.
Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.
For more information about TLC, go to the National Heart, Lung, and Blood Institute’s (NHLBI’s) ""Your Guide to Lowering Your Cholesterol With TLC.""
Cholesterol-Lowering Medicines
In addition to lifestyle changes, your doctor may prescribe medicines to help lower your cholesterol. Even with medicines, you should continue the TLC program.
Medicines can help control high blood cholesterol, but they don’t cure it. Thus, you must continue taking your medicine to keep your cholesterol level in the recommended range.
The five major types of cholesterol-lowering medicines are statins, bile acid sequestrants (seh-KWES-trants), nicotinic (nick-o-TIN-ick) acid, fibrates, and ezetimibe.
Statins work well at lowering
LDL cholesterol. These medicines are safe for most people. Rare side effects include
muscle and
liver problems.
Bile acid sequestrants also help lower
LDL cholesterol. These medicines usually aren’t prescribed as the only medicine to lower cholesterol. Sometimes they’re prescribed with statins.
While you’re being treated for high blood cholesterol, you’ll need ongoing care. Your doctor will want to make sure your cholesterol levels are controlled. He or she also will want to check for other health problems.
If needed, your doctor may prescribe medicines for other health problems. Take all medicines exactly as your doctor prescribes. The combination of medicines may lower your risk for heart disease and heart attack.
While trying to manage your Go to:
What Is High Blood Pressure?
High blood pressure (HBP) is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems.
""Blood pressure"" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.
Overview
About 1 in 3 adults in the United States has HBP. The condition itself usually has no signs or symptoms. You can have it for years without knowing it. During this time, though, HBP can damage your heart, blood vessels, kidneys, and other parts of your body.
Knowing your blood pressure numbers is important, even when you're feeling fine. If your blood pressure is normal, you can work with your health care team to keep it that way. If your blood pressure is too high, treatment may help prevent damage to your body's organs.
Blood Pressure Numbers
Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-ah-STOL-ik) pressures. ""Systolic"" refers to blood pressure when the heart beats while pumping blood. ""Diastolic"" refers to blood pressure when the heart is at rest between beats.
You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
The table below shows normal blood pressure numbers for adults. It also shows which numbers put you at greater risk for health problems.
Categories for Blood Pressure Levels in Adults (measured in millimeters of mercury, or mmHg)
View in own window
| Category | Systolic (top number) | | Diastolic (bottom number) |
|---|
| Normal | Less than 120 | And | Less than 80 |
|---|
| Prehypertension | 120–139 | Or | 80–89 |
|---|
| High blood pressure | | | |
|---|
| Stage 1 | 140–159 | Or | 90–99 |
|---|
| Stage 2 | 160 or higher | Or | 100 or higher |
|---|
The ranges in the table apply to most adults (aged 18 and older) who don't have short-term serious illnesses.
Blood pressure doesn't stay the same all the time. It lowers as you sleep and rises when you wake up. Blood pressure also rises when you're excited, nervous, or active. If your numbers stay above normal most of the time, you're at risk for health problems. The risk grows as blood pressure numbers rise. ""Prehypertension"" means you may end up with HBP, unless you take steps to prevent it.
If you're being treated for HBP and have repeat readings in the normal range, your blood pressure is under control. However, you still have the condition. You should see your doctor and follow your treatment plan to keep your blood pressure under control.
Your systolic and diastolic numbers may not be in the same blood pressure category. In this case, the more severe category is the one you're in. For example, if your systolic number is 160 and your diastolic number is 80, you have stage 2 HBP. If your systolic number is 120 and your diastolic number is 95, you have stage 1 HBP.
If you have diabetes or chronic kidney disease, HBP is defined as 130/80 mmHg or higher. HBP numbers also differ for children and teens. (For more information, go to ""How Is High Blood Pressure Diagnosed?"")
Outlook
Blood pressure tends to rise with age. Following a healthy lifestyle helps some people delay or prevent this rise in blood pressure.
People who have HBP can take steps to control it and reduce their risk for related health problems. Key steps include following a healthy lifestyle, having ongoing medical care, and following your treatment plan.
![]()
The image focuses on high blood pressure in women and explains how high blood pressure increases the risk of heart disease. An estimated 1 in 3 women has high blood pressure, and the condition is dangerous because it often causes no symptoms. The image (more...)
Other Names for High Blood Pressure
High blood pressure (HBP) also is called hypertension (HI-per-TEN-shun).
When HBP has no known cause, it might be called essential hypertension, primary hypertension, or idiopathic (id-ee-o-PATH-ick) hypertension.
When another condition causes HBP, it's sometimes called secondary hypertension.
Some people only have high systolic blood pressure. This condition is called isolated systolic hypertension (ISH). Many older adults have this condition. ISH can cause as much harm as HBP in which both numbers are too high.
What Causes High Blood Pressure?
Blood pressure tends to rise with age, unless you take steps to prevent or control it.
Some medical problems—such as chronic kidney disease, thyroid disease, and sleep apnea—may cause blood pressure to rise. Some medicines also may raise your blood pressure. Examples include asthma medicines (for example, corticosteroids) and cold-relief products.
Other medicines also can cause high blood pressure (HBP). If you have HBP, let your doctor know about all of the medicines you take, including over-the-counter products.
In some women, birth control pills, pregnancy, or hormone therapy (HT) may cause blood pressure to rise.
Women taking birth control pills usually have a small rise in both systolic and diastolic blood pressures. If you already have HBP and want to use birth control pills, make sure your doctor knows about your HBP. Talk with him or her about how often you should have your blood pressure checked and how to control it while taking the pill.
Taking HT to reduce the symptoms of menopause can cause a small rise in systolic blood pressure. If you already have HBP and want to start using HT, talk with your doctor about the risks and benefits. If you decide to take hormones, find out how to control your blood pressure and how often you should have it checked.
Children younger than 10 years old who have HBP often have another condition that's causing it (such as kidney disease). Treating the underlying condition may resolve the HBP.
The older a child is when HBP is diagnosed, the more likely he or she is to have essential hypertension. This means that doctors don't know what's causing the HBP.
Who Is at Risk for High Blood Pressure?
High blood pressure (HBP) is a common condition. In the United States, about 1 in 3 adults has HBP.
Certain traits, conditions, and habits can raise your risk for HBP. The major risk factors for HBP are described below.
Older Age
Blood pressure tends to rise with age. About 65 percent of Americans aged 60 or older have HBP.
Isolated systolic hypertension (ISH) is the most common form of HBP in older adults. ISH occurs when only systolic blood pressure (the top number) is high. About 2 out of 3 people over age 60 with HBP have ISH.
HBP doesn't have to be a routine part of aging. You can take steps to keep your blood pressure at a normal level. (For more information, go to ""How Is High Blood Pressure Treated?"")
Race/Ethnicity
HBP can affect anyone. However, it's more common in African American adults than in Caucasian or Hispanic American adults. In relation to these groups, African Americans:
HBP risks vary among different groups of Hispanic American adults. For instance, Puerto Rican American adults have higher rates of HBP-related death than all other Hispanic groups and Caucasians. However, Cuban Americans have lower rates of HBP-related death than Caucasians.
Overweight or Obesity
You're more likely to develop prehypertension or HBP if you're overweight or obese. The terms ""overweight"" and ""obesity"" refer to body weight that's greater than what is considered healthy for a certain height.
Gender
Men and women are equally likely to develop HBP during their lifetimes. However, before age 45, men are more likely to have HBP than women. After age 65, the condition is more likely to affect women than men.
Also, men younger than 55 are more likely to have uncontrolled HBP than women. However, after age 65, women are more likely to have uncontrolled HBP.
Unhealthy Lifestyle Habits
Many unhealthy lifestyle habits can raise your risk for HBP, including:
Other Risk Factors
A family history of HBP raises your risk for the condition. Long-lasting stress also can put you at risk for HBP.
You're also more likely to develop HBP if you have prehypertension. Prehypertension means that your blood pressure is in the 120–139/80–89 mmHg range.
Risk Factors for Children and Teens
Prehypertension and HBP are becoming more common in children and teens. This is due in part to a rise in overweight and obesity among children and teens.
African American and Mexican American youth are more likely to have HBP and prehypertension than Caucasian youth. Also, boys are at higher risk for HBP than girls.
Like adults, children and teens need to have routine blood pressure checks, especially if they're overweight.
What Are the Signs and Symptoms of High Blood Pressure?
High blood pressure (HBP) itself usually has no signs or symptoms. Rarely, headaches may occur.
You can have HBP for years without knowing it. During this time, the condition can damage your heart, blood vessels, kidneys, and other parts of your body.
Some people only learn that they have HBP after the damage has caused problems, such as coronary heart disease, stroke, or kidney failure.
Knowing your blood pressure numbers is important, even when you're feeling fine. If your blood pressure is normal, you can work with your health care team to keep it that way. If your blood pressure is too high, you can take steps to lower it. Lowering your blood pressure will help reduce your risk for related health problems.
Complications of High Blood Pressure
When blood pressure stays high over time, it can damage the body. HBP can cause:
Blood vessels in the
eyes to burst or bleed. This may lead to vision changes or blindness.
How Is High Blood Pressure Diagnosed?
High blood pressure (HBP) is diagnosed using a blood pressure test. This test will be done several times to make sure the results are correct. If your numbers are high, your doctor may have you return for repeat tests to check your blood pressure over time.
If your blood pressure is 140/90 mmHg or higher over time, your doctor will likely diagnose you with HBP. If you have diabetes or chronic kidney disease, a blood pressure of 130/80 mmHg or higher is considered HBP.
The ranges for HBP in children are different, as discussed below.
How Is Blood Pressure Tested?
A blood pressure test is easy and painless. This test is done at a doctor's office or clinic.
To prepare for the test:
Don't drink coffee or smoke cigarettes for 30 minutes prior to the test. These actions may cause a short-term rise in your
blood pressure.
Sit for 5 minutes before the test. Movement can cause short-term rises in
blood pressure.
To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.
Most often, you will sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.
Diagnosing High Blood Pressure in Children and Teens
Doctors measure blood pressure in children and teens the same way they do in adults. Your child should have routine blood pressure checks starting at 3 years of age.
Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers, while older teens have numbers similar to adults.
The ranges for normal blood pressure and HBP generally are lower for youth than for adults. To find out whether a child has HBP, a doctor will compare the child's blood pressure numbers to average numbers for his or her age, gender, and height.
For more information, go to the National Heart, Lung, and Blood Institute's ""A Pocket Guide to Blood Pressure Measurement in Children.""
What Does a Diagnosis of High Blood Pressure Mean?
If you're diagnosed with HBP, your doctor will prescribe treatment. Your blood pressure will be tested again to see how the treatment affects it.
Once your blood pressure is under control, you'll still need treatment. ""Under control"" means that your blood pressure numbers are in the normal range. Your doctor will likely recommend routine blood pressure tests. He or she can tell you how often you should be tested.
The sooner you find out about HBP and treat it, the better. Early treatment may help you avoid problems such as heart attack, stroke, and kidney failure.
How Is High Blood Pressure Treated?
High blood pressure (HBP) is treated with lifestyle changes and medicines.
Most people who have HBP will need lifelong treatment. Sticking to your treatment plan is important. It can help prevent or delay problems related to HBP and help you live and stay active longer.
For more tips on controlling your blood pressure, go to the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to Lowering Blood Pressure.""
Lifestyle Changes
Healthy lifestyle habits can help you control HBP. These habits include:
If you combine healthy lifestyle habits, you can achieve even better results than taking single steps.
You may find it hard to make lifestyle changes. Start by making one healthy lifestyle change and then adopt others.
Some people can control their blood pressure with lifestyle changes alone, but many people can't. Keep in mind that the main goal is blood pressure control.
If your doctor prescribes medicines as a part of your treatment plan, keep up your healthy lifestyle habits. They will help you better control your blood pressure.
Following a Healthy Diet
Your doctor may recommend the DASH (Dietary Approaches to Stop Hypertension) eating plan if you have HBP. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium (salt).
DASH also focuses on fat-free or low-fat dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber.
To help control HBP, you should limit the amount of salt that you eat. This means choosing low-sodium and no added salt foods and seasonings at the table and while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in an item. You should eat no more than about 1 teaspoon of salt a day.
Also, try to limit alcoholic drinks. Too much alcohol will raise your blood pressure. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day. One drink is a glass of wine, beer, or a small amount of hard liquor.
For more information, go to the NHLBI's ""Your Guide to Lowering Your Blood Pressure With DASH.""
Being Physically Active
Routine physical activity can lower HBP and reduce your risk for other health problems. Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.
People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.
For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Maintaining a Healthy Weight
Maintaining a healthy weight can help you control HBP and reduce your risk for other health problems.
If you're overweight or obese, aim to reduce your weight by 5 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for health problems related to HBP.
To lose weight, cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Don't feel that you have to finish the entrees served at restaurants. Many restaurant portions are oversized and have too many calories for the average person.
After your first year of treatment, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat.
A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for controlling blood pressure.
You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.
For more information about losing weight and keeping it off, go to the Health Topics Overweight and Obesity article.
Quit Smoking
If you smoke or use tobacco, quit. Smoking can damage your blood vessels and raise your risk for HBP. Smoking also can worsen health problems related to HBP.
Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart.""
Managing Stress
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
Physical activity helps some people cope with stress. Other people listen to music or focus on something calm or peaceful to reduce stress. Some people learn yoga, tai chi, or how to meditate.
Medicines
Today's blood pressure medicines can safely help most people control their blood pressure. These medicines are easy to take. The side effects, if any, tend to be minor.
If you have side effects from your medicines, talk with your doctor. He or she might adjust the doses or prescribe other medicines. You shouldn't decide on your own to stop taking your medicines.
Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body to lower blood pressure. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one.
Diuretics
Diuretics sometimes are called water pills. They help your kidneys flush excess water and salt from your body. This reduces the amount of fluid in your blood, and your blood pressure goes down.
Diuretics often are used with other HBP medicines and sometimes combined into one pill.
Treatment for Children and Teens
If another condition is causing your child's HBP, treating it often resolves the HBP. When the cause of a child or teen's HBP isn't known, the first line of treatment is lifestyle changes (as it is for adults).
If lifestyle changes don't control blood pressure, children and teens also may need to take medicines. Most of the medicines listed above for adults have special doses for children.
How Can High Blood Pressure Be Prevented?
If You Have Normal Blood Pressure
If you don't have high blood pressure (HBP), you can take steps to prevent it. Healthy lifestyle habits can help you maintain normal blood pressure.
Many people who adopt these healthy lifestyle habits are able to prevent or delay HBP. The more lifestyle changes you make, the more likely you are to lower your blood pressure and avoid related health problems.
For more information about healthy lifestyle habits, go to ""How Is High Blood Pressure Treated?""
If You Have High Blood Pressure
If you have HBP, you can still take steps to prevent the long-term problems it can cause. Healthy lifestyle habits (listed above) and medicines can help you live a longer, more active life.
Follow the treatment plan your doctor prescribes to control your blood pressure. Treatment can help you prevent or delay coronary heart disease, stroke, kidney disease, and other health problems.
Children and Teens
A healthy lifestyle also can help prevent HBP in children and teens. Key steps include having a child:
Follow a healthy diet that focuses on plenty of fruits, vegetables, and, for children older than 4 years old, low-
fat dairy products. A healthy diet also is low in saturated and
trans fats and salt.
Be active for at least 1 to 2 hours per day. Limit screen time in
front of the TV or computer to 2 hours per day at most.
Maintain a healthy weight. If your child is
overweight, ask his or her doctor about how your child can safely lose weight.
Make these healthy habits part of a family health plan to help your child adopt and maintain a healthy lifestyle.
Living With High Blood Pressure
If you have high blood pressure (HBP), you'll need to treat and control it for life. This means making lifestyle changes, taking prescribed medicines, and getting ongoing medical care.
Treatment can help control blood pressure, but it will not cure HBP. If you stop treatment, your blood pressure and risk for related health problems will rise.
For a healthy future, follow your treatment plan closely. Work with your health care team for lifelong blood pressure control.
Medicines
Take all blood pressure medicines that your doctor prescribes. Know the names and doses of your medicines and how to take them. If you have questions about your medicines, talk with your doctor or pharmacist.
Make sure you refill your medicines before they run out. Take your medicines exactly as your doctor directs—don't skip days or cut pills in half.
If you're having side effects from your medicines, talk with your doctor. He or she may need to adjust the doses or prescribe other medicines. You shouldn't decide on your own to stop taking your medicines.
Ongoing Care
If you have HBP, have medical checkups or tests as your doctor advises. Your doctor may need to change or add medicines to your treatment plan over time. Routine checkups allow your doctor to change your treatment right away if your blood pressure goes up again.
Keeping track of your blood pressure is important. Have your blood pressure checked on t","June 11, 2014."
46,7,"2018-02-02 04:25:06",h,46,"2018-02-02 05:15:51","Holes in the Heart","
What Are Holes in the Heart?
Holes in the heart are simple congenital (kon-JEN-ih-tal) heart defects. Congenital heart defects are problems with the heart's structure that are present at birth. These defects change the normal flow of blood through the heart.
The heart has two sides, separated by an inner wall called the septum. With each heartbeat, the right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the body.
The septum prevents mixing of blood between the two sides of the heart. However, some babies are born with holes in the upper or lower septum.
A hole in the septum between the heart's two upper chambers is called an atrial septal defect (ASD). A hole in the septum between the heart's two lower chambers is called a ventricular septal defect (VSD).
ASDs and VSDs allow blood to pass from the left side of the heart to the right side. Thus, oxygen-rich blood mixes with oxygen-poor blood. As a result, some oxygen-rich blood is pumped to the lungs instead of the body.
Over the past few decades, the diagnosis and treatment of ASDs and VSDs have greatly improved. Children who have simple congenital heart defects can survive to adulthood. They can live normal, active lives because their heart defects close on their own or have been repaired.
How the Heart Works
To understand holes in the heart, it's helpful to know how a healthy heart works. Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.
The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs to the rest of the body.
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-
pid) valve is in the right side of the
heart, between the right atrium and the right
ventricle.
The mitral (MI-trul) valve is in the left side of the
heart, between the left atrium and the left
ventricle.
The aortic (ay-OR-tik) valve is in the left side of the
heart, between the left
ventricle and the entrance to the
aorta. This
artery carries
blood from the heart to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a ""lub-DUB"" sound that a doctor can hear using a stethoscope.
The first sound—the ""lub""—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the
ventricles contract, or squeeze, and pump
blood out of the
heart.
The second sound—the ""DUB""—is made by the aortic and
pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the
ventricles relax and fill with
blood pumped into them by the
atria.
Veins
The veins also are major blood vessels connected to your heart.
For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.
Types of Holes in the Heart
Atrial Septal Defect
An atrial septal defect (ASD) is a hole in the part of the septum that separates the atria. (The atria are the upper chambers of the heart.)
An ASD allows oxygen-rich blood to flow from the left atrium into the right atrium, instead of flowing into the left ventricle as it should. So, instead of going to the body, the oxygen-rich blood is pumped back to the lungs, where it has just been.
Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with an atrial septal defect. The hole allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood from the right atrium.
An ASD can be small, medium, or large. Small ASDs allow only a little blood to flow from one atrium to the other. Small ASDs don't affect how the heart works and don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood.
Medium and large ASDs allow more blood to leak from one atrium to the other. They're less likely to close on their own.
Most children who have ASDs have no symptoms, even if they have large ASDs.
The three major types of ASDs are:
Secundum. This defect is in the middle of the
atrial septum and is the most common form of
ASD. About 8 out of every 10 babies born with ASDs have secundum defects. At least half of all secundum ASDs close on their own. However, this is less likely if the defect is large.
Primum. This defect is in the lower part of the
atrial septum. Primum defects often occur with
heart valve problems. These defects aren't very common, and they don't close on their own.
Sinus venosus. This defect is in the upper part of the
atrial septum. It's close to where a large
vein (the
superior vena cava) brings
oxygen-poor
blood from the upper body to the right atrium. Sinus venosus defects are rare, and they don't close on their own.
Atrial Septal Defect Complications
If an ASD isn't repaired, the extra blood flow to the right side of the heart and lungs may cause heart problems. Most of these problems don't occur until adulthood, often around age 30 or later.
Possible complications include:
Right heart failure. An
ASD causes the right side of the
heart to work harder because it has to pump extra
blood to the
lungs. Over time, the heart may become tired from this extra work and not pump well.
Stroke. Usually, the
lungs filter out small
blood clots that can form on the right side of the
heart. Sometimes, though, a blood clot can pass from the right atrium to the left atrium through an
ASD and be pumped out to the body. The clot can travel to an
artery in the
brain, block blood flow, and cause a
stroke.
These problems develop over many years and rarely occur in infants and children. They also are rare in adults because most ASDs close on their own or are repaired in early childhood.
Ventricular Septal Defect
A ventricular septal defect (VSD) is a hole in the part of the septum that separates the ventricles. (The ventricles are the lower chambers of the heart.)
A VSD allows oxygen-rich blood to flow from the left ventricle into the right ventricle, instead of flowing into the aorta as it should. So, instead of going to the body, the oxygen-rich blood is pumped back to the lungs, where it has just been.
Figure A shows the structure and blood flow inside a normal heart. Figure B shows two common locations for a ventricular septal defect. The defect allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle.
An infant who is born with a VSD may have one or more holes in the wall that separates the two ventricles. The defect also may occur alone or with other congenital heart defects.
Doctors will classify a VSD based on the:
Size of the defect.
Location of the defect.
Number of defects.
Presence or absence of a ventricular septal
aneurysm—a thin flap of
tissue on the
septum. This tissue is harmless and can help a VSD close on its own.
VSDs can be small, medium, or large. Small VSDs don't cause problems and may close on their own. Small VSDs sometimes are called restrictive VSDs because they allow only a small amount of blood to flow between the ventricles. Small VSDs don't cause any symptoms.
Medium VSDs are less likely to close on their own. They may cause symptoms in infants and children. Surgery may be needed to close medium VSDs.
Large VSDs allow a lot of blood to flow from the left ventricle to the right ventricle. They're sometimes called nonrestrictive VSDs. Large VSDs likely won't close completely on their own, but they may get smaller over time.
Large VSDs often cause symptoms in infants and children. Surgery usually is needed to close large VSDs.
VSDs are found in different parts of the septum.
Membranous VSDs are located near the
heart valves. These VSDs can close at any time.
Muscular VSDs are found in the lower part of the
septum. They're surrounded by
muscle, and most close on their own during early childhood.
Inlet VSDs are located close to where
blood enters the
ventricles. They're less common than membranous and muscular VSDs.
Outlet VSDs are found in the part of the
ventricle where
blood leaves the
heart. These are the rarest type of VSD.
Ventricular Septal Defect Complications
Over time, if a VSD isn't repaired, it may cause heart problems. A medium or large VSD can cause:
Heart failure. Infants who have large VSDs may develop heart failure. This is because the left side of the heart pumps
blood into the right
ventricle in addition to its normal work of pumping blood to the body. The increased workload on the heart also increases the
heart rate and the body's demand for energy.
Growth failure, especially in infants. A baby may not be able to eat enough to keep up with his or her body's increased energy demands. As a result, the baby may lose weight or not grow and develop normally.
What Are the Signs and Symptoms of Holes in the Heart?
Atrial Septal Defect
Many babies who are born with atrial septal defects (ASDs) have no signs or symptoms. However, as they grow, these children may be small for their age.
When signs and symptoms do occur, a heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat.
Often, a heart murmur is the only sign of an ASD. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Doctors can listen to heart murmurs and tell whether they're harmless or signs of heart problems.
If a large ASD isn't repaired, the extra blood flow to the right side of the heart can damage the heart and lungs and cause heart failure. This generally doesn't occur until adulthood. Signs and symptoms of heart failure include:
Ventricular Septal Defect
Babies born with ventricular septal defects (VSDs) usually have heart murmurs. Murmurs may be the first and only sign of a VSD. Heart murmurs often are present right after birth in many infants. However, the murmurs may not be heard until the babies are 6 to 8 weeks old.
Most newborns who have VSDs don't have heart-related symptoms. However, babies who have medium or large VSDs can develop heart failure. Signs and symptoms of heart failure usually occur during the baby's first 2 months of life.
The signs and symptoms of heart failure due to VSD are similar to those listed above for ASD, but they occur in infancy.
A major sign of heart failure in infancy is poor feeding and growth. VSD signs and symptoms are rare after infancy. This is because the defects either decrease in size on their own or they're repaired.
How Are Holes in the Heart Diagnosed?
Doctors usually diagnose holes in the heart based on a physical exam and the results from tests and procedures. The exam findings for an atrial septal defect (ASD) often aren't obvious. Thus, the diagnosis sometimes isn't made until later in childhood or even in adulthood.
Ventricular septal defects (VSDs) cause a very distinct heart murmur. Because of this, a diagnosis usually is made in infancy.
Specialists Involved
Doctors who specialize in diagnosing and treating heart problems are called cardiologists. Pediatric cardiologists take care of babies and children who have heart problems. Cardiac surgeons repair heart defects using surgery.
Diagnostic Tests and Procedures
Your child's doctor may recommend several tests to diagnose an ASD or VSD. These tests also will help the doctor figure out the location and size of the defect.
Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. The sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen.
Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.
Echo is an important test for both diagnosing a hole in the heart and following the problem over time. Echo can show problems with the heart's structure and how the heart is reacting to the problems. This test will help your child's cardiologist decide whether and when treatment is needed.
EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart.
An EKG can detect whether one of the heart's chambers is enlarged, which can help diagnose a heart problem.
Pulse Oximetry
Pulse oximetry shows the level of oxygen in the blood. A small sensor is attached to a finger or ear. The sensor uses light to estimate how much oxygen is in the blood.
How Are Holes in the Heart Treated?
Many holes in the heart don't need treatment, but some do. Those that do often are repaired during infancy or early childhood. Sometimes adults are treated for holes in the heart if problems develop.
The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health.
Treating an Atrial Septal Defect
If a child has an atrial septal defect (ASD), routine checkups are done to see whether it closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life.
Your child's doctor will let you know how often your child should have checkups. For an ASD, frequent checkups aren't needed.
If an ASD requires treatment, catheter or surgical procedures are used to close the hole. Doctors often decide to close ASDs in children who still have medium- or large-sized holes by the time they're 2 to 5 years old.
Catheter Procedure
Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, doctors can use catheter procedures to close secundum ASDs. These are the most common type of ASD.
Before a catheter procedure, your child is given medicine so he or she will sleep and not feel any pain. Then, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh). He or she threads the tube to the Go to:
What Is Hypersensitivity Pneumonitis?
Hypersensitivity pneumonitis (noo-mo-NI-tis), or HP, is a disease in which the lungs become inflamed from breathing in foreign substances, such as molds, dusts, and chemicals. These substances also are known as antigens (AN-tih-jens).
People are exposed to antigens at home, while at work, and in other settings. However, most people who breathe in these substances don't develop HP.
Overview
To understand HP, it helps to understand how the lungs work. When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries run through the walls of the air sacs. When air reaches the air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. The capillaries connect to a network of arteries and veins that move blood through your body.
In HP, the air sacs become inflamed and may fill with fluid. This makes it harder for oxygen to pass through the air sacs and into the bloodstream.
The two main types of HP are acute (short-term) and chronic (ongoing). Both types can develop as a result of repeatedly breathing in an antigen.
Over time, your lungs can become sensitive to that antigen. If this happens, they'll become inflamed, which can lead to symptoms and may even cause long-term lung damage.
With acute HP, symptoms usually occur within 2–9 hours of exposure to an antigen you're sensitive to. Acute HP can cause chills, body aches, coughing, and chest tightness. After hours or days of no contact with the antigen, symptoms usually go away.
If acute HP isn't found and treated early, chronic HP may develop. Symptoms of chronic HP occur slowly, over months. Chronic HP can cause a worsening cough, shortness of breath with physical activity, fatigue (tiredness), and weight loss. Severe HP may cause clubbing (a widening and rounding of the tips of the fingers or toes).
With chronic HP, symptoms may continue and/or worsen, even after avoiding the antigen. Sometimes, chronic HP can cause long-term lung damage, such as pulmonary fibrosis (PULL-mun-ary fi-BRO-sis). This is a condition in which tissue deep in your lungs becomes scarred over time.
Outlook
Avoiding or reducing your contact with antigens can help prevent and treat HP. For example, cleaning heating and ventilation filters can help reduce your contact with mold. Wetting compost prior to handling it can reduce contact with harmful dust.
If HP is caught early, avoiding the antigen that caused it may be the only treatment you need. If you have chronic HP, your doctor may prescribe medicines to reduce lung inflammation.
Researchers continue to study why some people develop HP after being exposed to antigens, while others don't. They're also looking for better ways to quickly pinpoint which antigens are causing HP in people who are believed to have the disease.
Other Names for Hypersensitivity Pneumonitis
What Causes Hypersensitivity Pneumonitis?
Repeatedly breathing in foreign substances can cause hypersensitivity pneumonitis (HP). Examples of these substances include molds, dusts, and chemicals. (Mold often is the cause of HP.) These substances also are known as antigens.
Over time, your lungs can become sensitive to antigens. If this happens, your lungs will become inflamed, which can lead to symptoms and may even cause long-term lung damage.
Antigens may be found in the home, workplace, or in other settings. Antigens can come from many sources, such as:
Bird droppings
Humidifiers, heating systems, and hot tubs
Liquid chemicals used in the landscaping and florist industries
Moldy hay, straw, and grain
Chemicals released during the production of plastics and electronics, and chemicals released during painting
Mold released during lumber milling, construction, and wood stripping
Who Is At Risk for Hypersensitivity Pneumonitis?
People who repeatedly breathe in foreign substances are at risk for hypersensitivity pneumonitis (HP). These substances, which also are known as antigens, include molds, dusts, and chemicals. However, most people who breathe in these substances don't develop HP.
People at increased risk include:
Farm and dairy cattle workers
People who use hot tubs often
People who are exposed to
molds or dusts from humidifiers, heating systems, or wet carpeting
Bird fanciers (people who keep pet birds) and poultry handlers
Florists and landscapers, especially those who use liquid chemicals on lawns and gardens
People who work in grain and flour processing and loading
Lumber milling, construction, wood stripping, and paper and wallboard workers
People who make plastics or electronics, and those who paint or work with other chemicals
What Are the Signs and Symptoms of Hypersensitivity Pneumonitis?
Signs and symptoms of hypersensitivity pneumonitis (HP) depend on whether the disease is acute (short-term) or chronic (ongoing).
Acute Hypersensitivity Pneumonitis
With acute HP, symptoms usually occur within 2–9 hours of exposure to an antigen you're sensitive to. (An antigen is a substance that your body reacts against, such as molds, dusts, and chemicals.)
Acute HP can cause chills, body aches, coughing, and chest tightness. After hours or days of no contact with the antigen, symptoms usually go away.
Chronic Hypersensitivity Pneumonitis
If acute HP isn't found and treated early, chronic HP may develop. With chronic HP, symptoms occur slowly, over months. Chronic HP can cause a worsening cough, shortness of breath with physical activity, fatigue (tiredness), and weight loss.
Some symptoms may continue and/or worsen, even after avoiding the antigen. Chronic HP can cause long-term lung damage, such as pulmonary fibrosis. This is a condition in which tissue deep in your lungs becomes scarred over time.
Clubbing also may occur if HP is severe. Clubbing is the widening and rounding of the tips of the fingers or toes. A low level of oxygen in the blood causes this condition.
How Is Hypersensitivity Pneumonitis Diagnosed?
To diagnose hypersensitivity pneumonitis (HP), your doctor must pinpoint the antigen that's causing the disease and its source. (An antigen is a substance that your body reacts against, such as molds, dusts, and chemicals.)
Your doctor will ask you detailed questions about:
Your current and past jobs
Your hobbies and leisure activities
The types of places where you spend time
Your exposure to damp and moldy places
Your doctor also will do a physical exam and look at test results to diagnose HP.
Physical Exam
During the physical exam, your doctor will ask about your signs and symptoms, such as coughing and weight loss. Your doctor also will look for signs of HP. For example, he or she will listen to your lungs with a stethoscope for abnormal breathing sounds. HP can cause a crackling sound when you breathe.
Your doctor also may look for signs of pulmonary fibrosis, a possible complication of chronic (ongoing) HP. Pulmonary fibrosis is a condition in which tissue deep in your lungs becomes scarred over time.
Your doctor also may check for clubbing. Clubbing is the widening and rounding of the tips of the fingers or toes. A low level of oxygen in the blood causes this condition.
Diagnostic Tests and Procedures
To help diagnose HP, your doctor may recommend or more of the following tests or procedures.
Lung Function Tests
Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs can deliver oxygen to your blood. One of these tests is spirometry (spi-ROM-eh-tre).
During this test, a technician will ask you to take a deep breath. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out.
Pulse Oximetry
This test measures the amount of oxygen in your blood. A small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood.
Challenge Test
During this test, you're re-exposed to the suspected antigen. Then, you'll be watched for signs and symptoms of HP.
Bronchoscopy
For bronchoscopy (bron-KOS-ko-pee), your doctor passes a thin, flexible tube through your nose (or sometimes your mouth), down your throat, and into your airways. At the tip of the tube are a light and mini-camera. This allows your doctor to see your windpipe and airways.
Your doctor may insert forceps (a device used to grab or hold things) through the tube to collect a tissue sample. You'll be given medicine to make you relaxed and sleepy during the procedure.
Bronchoalveolar Lavage
During bronchoscopy, your doctor may inject a small amount of salt water (saline) through the tube into your lungs. This method is called bronchoalveolar lavage (BRONG-ko-al-VE-o-lar lah-VAHZH).
This fluid washes the lungs and helps bring up cells from the airways and the area around the air sacs. Your doctor will look at these cells under a microscope.
Surgical Lung Biopsy
To confirm a diagnosis of HP, your doctor may do a surgical lung biopsy. Your doctor can use a biopsy to rule out other causes of symptoms and check the condition of your lungs.
For a surgical lung biopsy, your doctor takes samples of lung tissue from several places in your lungs. He or she then looks at them under a microscope. Your doctor may use one of the following methods to get lung tissue samples.
Video-assisted thoracoscopy (thor-ah-KOS-ko-pee). For this procedure, your doctor inserts a small, lighted tube with a camera (endoscope) into your chest through small cuts between your ribs.
The endoscope provides a video image of your lungs and allows your doctor to collect tissue samples. This procedure is done in a hospital. You'll be given medicine to help you sleep through the procedure.
Thoracotomy (thor-ah-KOT-o-me). For this procedure, your doctor removes a few small pieces of lung tissue through a cut in the chest wall between your ribs. Thoracotomy is done in a hospital. You'll be given medicine to help you sleep through the procedure.
How Is Hypersensitivity Pneumonitis Treated?
The best way to treat hypersensitivity pneumonitis (HP) is to avoid the antigen that caused it. (An antigen is a substance that your body reacts against, such as molds, dusts, and chemicals.)
In acute (short-term) HP, symptoms usually go away once you're no longer in contact with the antigen. In chronic (ongoing) HP, you may need medicines to relieve your symptoms.
People who have chronic HP may develop pulmonary fibrosis. This is a condition in which tissue deep in your lungs becomes scarred over time. People who have this condition may need further treatment, such as oxygen therapy and pulmonary rehabilitation (rehab).
Avoiding Antigens
Once the antigen that caused the HP and its source are found, you can take steps to avoid it. If HP is caught early, avoiding the antigen may be the only treatment you need.
Avoiding an antigen may be easier at home than at work. For example, if your pet bird, moldy carpet, or hot tub is the source of the antigen, you can remove it from your home. If your heating system is the source of the antigen, you can have your system properly serviced.
However, if the antigen is at work, you may need to talk with your supervisor about your condition and ways to protect yourself. For example, masks or personal respirators may help protect you from antigens in the air. (A personal respirator is a device that helps filter the air you breathe in.)
Some people who have HP may need to move to a different home or change jobs to avoid antigens. After hurricanes, for example, some people have to move from their homes to avoid molds that could harm their lungs. However, moving and changing jobs sometimes isn't possible.
Medicines and Other Treatments
If you have chronic HP, your doctor may prescribe medicines called corticosteroids. These medicines reduce lung inflammation. Prednisone is an example of a corticosteroid.
Long-term use of prednisone, especially at high doses, can cause serious side effects. Thus, if your doctor prescribes this medicine, he or she may reduce the dose over time.
Examples of side effects from corticosteroids are increased risk of infections, high blood pressure, high blood sugar, and osteoporosis (thinning of the skin and bones).
People who develop pulmonary fibrosis may need medicines, oxygen therapy, and/or pulmonary rehab. Pulmonary fibrosis is a condition in which tissue deep in your lungs becomes scarred over time.
If you smoke, try to quit. Smoking can make HP symptoms worse and lead to other lung diseases. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
Living With Hypersensitivity Pneumonitis
If you've had hypersensitivity pneumonitis (HP), avoiding the antigen that caused it is important. (An antigen is a substance that your body reacts against, such as molds, dusts, and chemicals.)
If HP is caught early, your symptoms will likely go away if you avoid contact with the antigen. Continued contact with the antigen can make your symptoms worse and may lead to long-term lung damage.
To avoid the antigen, you may need to find other hobbies, change jobs, move, or use protective gear (like a mask) at work.
If you smoke, try to quit. Smoking can make HP symptoms worse and lead to other lung diseases. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. Ask family members, friends, and coworkers not to smoke in front of you or in your home, car, or workplace.
If you've developed pulmonary fibrosis from the HP, you'll need further ongoing care. Pulmonary fibrosis is a condition in which tissue deep in your lungs becomes scarred over time.
If you have this condition, you may need medicines, oxygen therapy, and/or pulmonary rehabilitation. Follow your treatment plan as your doctor advises.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to hypersensitivity pneumonitis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
","June 11, 2014."
48,7,"2018-02-02 04:25:06",h,48,"2018-02-02 05:16:30",Hypotension,"
What Is Hypotension?
Hypotension (HI-po-TEN-shun) is abnormally low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.
Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. ""Systolic"" refers to blood pressure when the heart beats while pumping blood. ""Diastolic"" refers to blood pressure when the heart is at rest between beats.
You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
Normal blood pressure in adults is lower than 120/80 mmHg. Hypotension is blood pressure that's lower than 90/60 mmHg.
Overview
Blood pressure doesn't stay the same all the time. It lowers as you sleep and rises when you wake up. Blood pressure also rises when you're excited, nervous, or active.
Your body is very sensitive to changes in blood pressure. For example, if you stand up quickly, your blood pressure may drop for a short time. Your body adjusts your blood pressure to make sure enough blood and oxygen are flowing to your brain, kidneys, and other vital organs.
Most forms of hypotension happen because your body can't bring blood pressure back to normal or can't do it fast enough.
Some people have low blood pressure all the time. They have no signs or symptoms, and their low blood pressure is normal for them.
In other people, certain conditions or factors cause abnormally low blood pressure. As a result, less blood and oxygen flow to the body's organs.
For the most part, hypotension is a medical concern only if it causes signs or symptoms or is linked to a serious condition, such as heart disease. Signs and symptoms of hypotension may include dizziness, fainting, cold and sweaty skin, fatigue (tiredness), blurred vision, or nausea (feeling sick to your stomach).
In extreme cases, hypotension can lead to shock.
Outlook
In a healthy person, low blood pressure without signs or symptoms usually isn't a problem and needs no treatment. If it causes signs or symptoms, your doctor will try to find and treat the condition that's causing it.
Hypotension can be dangerous. It can make you fall because of dizziness or fainting. Shock, a severe form of hypotension, is a condition that's often fatal if not treated right away. With prompt and proper treatment, shock can be successfully treated.
Types of Hypotension
There are several types of hypotension. People who always have low blood pressure have chronic asymptomatic hypotension. They usually have no signs or symptoms and need no treatment. Their low blood pressure is normal for them.
Other types of hypotension occur if blood pressure suddenly drops too low. The signs and symptoms range from mild to severe.
The three main types of this kind of hypotension are orthostatic (OR-tho-STAT-ik) hypotension, neurally mediated hypotension, and severe hypotension linked to shock.
Orthostatic Hypotension
This type of hypotension occurs when standing up from a sitting or lying down position. You may feel dizzy or light-headed, or you may even faint.
Orthostatic hypotension occurs if your body isn't able to adjust blood pressure and blood flow fast enough for the change in position. The drop in blood pressure usually lasts only for a few seconds or minutes after you stand up. You may need to sit or lie down for a short time while your blood pressure returns to normal.
Orthostatic hypotension can occur in all age groups. However, it's more common in older adults, especially those who are frail or in poor health. This type of hypotension can be a symptom of another medical condition. Thus, treatment often focuses on treating underlying conditions.
Some people have orthostatic hypotension, but also have high blood pressure when lying down.
A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal. This type of hypotension mostly affects older adults. People who have high blood pressure or a central nervous system disorder, such as Parkinson's disease, also are at increased risk for postprandial hypotension.
Neurally Mediated Hypotension
With neurally mediated hypotension (NMH), blood pressure drops after you've been standing for a long time. You may feel dizzy, faint, or sick to the stomach as a result. NMH also can occur as the result of an unpleasant, upsetting, or scary situation.
NMH affects children and young adults more often than people in other age groups. Children often outgrow NMH.
Severe Hypotension Linked to Shock
Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work well. Blood pressure drops much lower in shock than in other types of hypotension.
Many factors can cause shock. Examples include major blood loss, certain severe infections, severe burns and allergic reactions, and poisoning. Shock can be fatal if it's not treated right away.
Other Names for Hypotension
What Causes Hypotension?
Conditions or factors that disrupt the body's ability to control blood pressure cause hypotension. The different types of hypotension have different causes.
Orthostatic Hypotension
Orthostatic hypotension has many causes. Sometimes two or more factors combine to cause this type of low blood pressure.
Dehydration (de-hi-DRA-shun) is the most common cause of orthostatic hypotension. Dehydration occurs if the body loses more water than it takes in.
You may become dehydrated if you don't drink enough fluids or if you sweat a lot during physical activity. Fever, vomiting, and severe diarrhea also can cause dehydration.
Orthostatic hypotension also may occur during pregnancy, but it usually goes away after birth.
Because an older body doesn't manage changes in blood pressure as well as a younger body, getting older also can lead to this type of hypotension.
Postprandial hypotension (a type of orthostatic hypotension) mostly affects older adults. Postprandial hypotension is a sudden drop in blood pressure after a meal.
Certain medical conditions can raise your risk of orthostatic hypotension, including:
Some medicines for high blood pressure and heart disease can raise your risk of orthostatic hypotension. These medicines include:
Medicines for conditions such as anxiety, depression, erectile dysfunction, and central nervous system disorders also can increase your risk of orthostatic hypotension.
Other substances, when taken with high blood pressure medicines, also can lead to orthostatic hypotension. These substances include alcohol, barbiturates, and some prescription and over-the-counter medicines.
Finally, other factors or conditions that can trigger orthostatic hypotension include being out in the heat or being immobile for a long time. ""Immobile"" means you can't move around very much.
Neurally Mediated Hypotension
Neurally mediated hypotension (NMH) occurs when the brain and heart don't communicate with each other properly.
For example, when you stand for a long time, blood begins to pool in your legs. This causes your blood pressure to drop. In NMH, the body mistakenly tells the brain that blood pressure is high. In response, the brain slows the heart rate. This makes blood pressure drop even more, causing dizziness and other symptoms.
Severe Hypotension Linked to Shock
Many factors and conditions can cause severe hypotension linked to shock. Some of these factors also can cause orthostatic hypotension. In shock, though, blood pressure drops very low and doesn't return to normal on its own.
Shock is an emergency and must be treated right away. If a person has signs or symptoms of shock, call 9–1–1.
Some severe infections can cause shock. This is known as septic shock. It can occur if bacteria enter the bloodstream. The bacteria release a toxin (poison) that leads to a dangerous drop in blood pressure.
A severe loss of blood or fluids from the body also can cause shock. This is known as hypovolemic (HI-po-vo-LE-mik) shock. Hypovolemic shock can happen as a result of:
Major external
bleeding (for example, from a severe cut or injury)
Major loss of body fluids from severe
burns
A major decrease in the heart's ability to pump blood also can cause shock. This is known as cardiogenic (KAR-de-o-JEN-ik) shock.
A heart attack, pulmonary embolism, or an ongoing arrhythmia (ah-RITH-me-ah) that disrupts heart function can cause this type of shock.
A sudden and extreme relaxation of the arteries linked to a drop in blood pressure also can cause shock. This is known as vasodilatory (VA-so-DI-la-tory) shock. It can occur due to:
Who Is At Risk for Hypotension?
Hypotension can affect people of all ages. However, people in certain age groups are more likely to have certain types of hypotension.
Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have neurally mediated hypotension.
People who take certain medicines—such as diuretics (""water pills"") or other high blood pressure medicines—are at increased risk for hypotension. Certain conditions also increase the risk for hypotension. Examples include central nervous system disorders (such as Parkinson's disease) and some heart conditions.
Other risk factors for hypotension include being immobile (not being able to move around very much) for long periods, being out in the heat for a long time, and pregnancy. Hypotension during pregnancy is normal and usually goes away after birth.
What Are the Signs and Symptoms of Hypotension?
Orthostatic Hypotension and Neurally Mediated Hypotension
The signs and symptoms of orthostatic hypotension and neurally mediated hypotension (NMH) are similar. They include:
Blurry vision
Confusion
Weakness
Orthostatic hypotension may happen within a few seconds or minutes of standing up after you've been sitting or lying down.
You may feel that you're going to faint, or you may actually faint. These signs and symptoms go away if you sit or lie down for a few minutes until your blood pressure adjusts to normal.
The signs and symptoms of NMH occur after standing for a long time or in response to an unpleasant, upsetting, or scary situation. The drop in blood pressure with NMH doesn't last long and often goes away after sitting down.
Severe Hypotension Linked to Shock
In shock, not enough blood and oxygen flow to the body's major organs, including the brain. The early signs and symptoms of reduced blood flow to the brain include light-headedness, sleepiness, and confusion.
In the earliest stages of shock, it may be hard to detect any signs or symptoms. In older people, the first symptom may only be confusion.
Over time, as shock worsens, a person won't be able to sit up without passing out. If the shock continues, the person will lose consciousness. Shock often is fatal if not treated right away.
Other signs and symptoms of shock vary, depending on what's causing the shock. When low blood volume (from major blood loss, for example) or poor pumping action in the heart (from heart failure, for example) causes shock:
When extreme relaxation of blood vessels causes shock (such as in vasodilatory shock), a person feels warm and flushed at first. Later, the skin becomes cold and sweaty, and the person feels very sleepy.
Shock is an emergency and must be treated right away. If a person has signs or symptoms of shock, call 9–1–1.
How Is Hypotension Diagnosed?
Hypotension is diagnosed based on your medical history, a physical exam, and test results. Your doctor will want to know:
Whether an underlying condition is causing the
hypotension
Diagnostic Tests
Shock is a life-threatening condition that requires emergency treatment. For other types of hypotension, your doctor may recommend tests to find out how your blood pressure responds in certain situations.
The test results will help your doctor understand why you're fainting or having other symptoms.
EKG (Electrocardiogram)
An EKG is a simple test that detects and records your heart's electrical activity. It shows how fast your heart is beating and whether its rhythm is steady or irregular. An EKG also shows the strength and timing of electrical signals as they pass through each part of your heart.
Holter and Event Monitors
Holter and event monitors are medical devices that record your heart's electrical activity. These monitors are similar to an EKG. However, a standard EKG only records your heartbeat for a few seconds. It won't detect heart rhythm problems that don't occur during the test.
Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart for longer periods than a standard EKG.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.
These tests may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.
Valsalva Maneuver
This is a simple test for the part of your nervous system that controls functions such as your heartbeat and the narrowing and widening of your blood vessels. If something goes wrong with this part of the nervous system, blood pressure problems may occur.
During this test, you take a deep breath and then force the air out through your lips. You will do this several times. Your heart rate and blood pressure will be checked during the test.
Tilt Table Test
This test is used if you have fainting spells for no known reason. For the test, you lie on a table that moves from a lying down to an upright position. Your doctor checks your reaction to the change in position.
Doctors use a tilt table test to diagnose orthostatic hypotension and neurally mediated hypotension (NMH). People who have NMH usually faint during this test. The test can help your doctor find any underlying brain or nerve condition.
How Is Hypotension Treated?
Treatment depends on the type of hypotension you have and the severity of your signs and symptoms. The goal of treatment is to bring blood pressure back to normal to relieve signs and symptoms. Another goal is to manage any underlying condition causing the hypotension.
Your response to treatment depends on your age, overall health, and strength. It also depends on how easily you can stop, start, or change medicines.
In a healthy person, low blood pressure without signs or symptoms usually isn't a problem and needs no treatment.
If you have signs or symptoms of hypotension, you should sit or lie down right away. Put your feet above the level of your heart. If your signs or symptoms don't go away quickly, you should seek medical care.
Orthostatic Hypotension
Many treatments are available for orthostatic hypotension. If you have this condition, your doctor may advise making lifestyle changes, such as:
Drinking plenty of fluids, such as water or sports drinks that contain
nutrients like sodium and
potassium.
Drinking little or no alcohol.
Standing up slowly.
Not crossing your legs while sitting.
Slowly increasing the amount of time you sit up if you've been immobile for a long time because of a medical condition. The term ""immobile"" refers to not being able to move around very much.
Talk with your doctor about using compression stockings. These stockings apply pressure to your lower legs. The pressure helps move blood throughout your body.
If medicine is causing your low blood pressure, your doctor may change the medicine or adjust the dose you take.
Several medicines are used to treat orthostatic hypotension. These medicines, which raise blood pressure, include fludrocortisone and midodrine.
Neurally Mediated Hypotension
If you have neurally mediated hypotension (NMH), you may need to make lifestyle changes. These may include:
If medicine is causing your hypotension, your doctor may change the medicine or adjust the dose you take. He or she also may prescribe medicine to treat NMH.
Children who have NHM often outgrow it.
Severe Hypotension Linked to Shock
Shock is a life-threatening emergency. People who have shock need prompt treatment from medical personnel. If a person has signs or symptoms of shock, call 9–1–1 right away.
The goals of treating shock are to:
Blood or special fluids are put into the bloodstream to restore blood flow to the organs. Medicines can help raise blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments—such as antibiotics or surgery—may be needed.
Living With Hypotension
Doctors can successfully treat hypotension. Many people who had the condition and were successfully treated live normal, healthy lives.
If you have hypotension, you can take steps to prevent or limit symptoms, such as dizzy spells and fainting.
If you have orthostatic hypotension, get up slowly after sitting or lying down, or move your legs before changing your position. Eat small, low-carbohydrate meals if you have postprandial hypotension (a form of orthostatic hypotension).
If you have neurally mediated hypotension, try not to stand for long periods. If you do have to stand for a long time, move around and wear compression stockings. These stockings apply pressure to your lower legs. The pressure helps move blood throughout your body.
Drink plenty of fluids, such as water or sports drinks that contain nutrients like sodium and potassium. Also, try to avoid unpleasant, upsetting, or scary situations. Learn to recognize symptoms and take action to raise your blood pressure. Children who have NMH often outgrow it.
Other lifestyle changes also can help you control hypotension. For more information, talk with your doctor and go to ""How Is Hypotension Treated?""
Ask your doctor about learning how to measure your own blood pressure. This will help you find out what a normal blood pressure reading is for you. Keeping a record of blood pressure readings done by health providers also can help you learn more about your blood pressure.
Severe hypotension linked to shock is an emergency. Shock can lead to death if it's not treated right away. If you see someone having signs or symptoms of shock, call 9–1–1.
Signs and symptoms of shock include light-headedness, sleepiness, and confusion. Over time, as shock worsens, a person won't be able to sit up without passing out. If the shock continues, the person can lose consciousness.
Other signs and symptoms of shock ","June 11, 2014."
49,8,"2018-02-02 04:25:06",i,49,"2018-02-02 05:16:48","Idiopathic Pulmonary Fibrosis","
What Is Idiopathic Pulmonary Fibrosis?
Pulmonary fibrosis (PULL-mun-ary fi-BRO-sis) is a disease in which tissue deep in your lungs becomes thick and stiff, or scarred, over time. The formation of scar tissue is called fibrosis.
As the lung tissue thickens, your lungs can't properly move oxygen into your bloodstream. As a result, your brain and other organs don't get the oxygen they need. (For more information, go to the ""How the Lungs Work"" section of this article.)
Sometimes doctors can find out what's causing fibrosis. But in most cases, they can't find a cause. They call these cases idiopathic (id-ee-o-PATH-ick) pulmonary fibrosis (IPF).
IPF is a serious disease that usually affects middle-aged and older adults. IPF varies from person to person. In some people, fibrosis happens quickly. In others, the process is much slower. In some people, the disease stays the same for years.
IPF has no cure yet. Many people live only about 3 to 5 years after diagnosis. The most common cause of death related to IPF is respiratory failure. Other causes of death include pulmonary hypertension (HI-per-TEN-shun), heart failure, pulmonary embolism (EM-bo-lizm), pneumonia (nu-MO-ne-ah), and lung cancer.
Genetics may play a role in causing IPF. If more than one member of your family has IPF, the disease is called familial IPF.
Research has helped doctors learn more about IPF. As a result, they can more quickly diagnose the disease now than in the past. Also, researchers are studying several medicines that may slow the progress of IPF. These efforts may improve the lifespan and quality of life for people who have the disease.
How the Lungs Work
To understand idiopathic pulmonary fibrosis (IPF), it helps to understand how the lungs work. The air that you breathe in through your nose or mouth travels down through your trachea (windpipe) into two tubes in your lungs called bronchial (BRONG-ke-al) tubes or airways.
The airways are shaped like an upside-down tree with many branches. The windpipe is the trunk. It splits into two bronchial tubes, or bronchi. Thinner tubes called bronchioles branch out from the bronchi.
The bronchioles end in tiny air sacs called alveoli (al-VEE-uhl-eye). These air sacs have very thin walls, and small blood vessels called capillaries run through them. There are about 300 million alveoli in a normal lung.
When the air that you've just breathed in reaches these air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide (a waste gas) moves from the capillaries into the air sacs. This process is called gas exchange.
The oxygen-rich blood in the capillaries then flows into larger veins, which carry it to the heart. Your heart pumps the oxygen-rich blood to all your body's organs. These organs can't function without an ongoing supply of oxygen.
The animation below shows how the lungs work. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how the lungs inhale oxygen and transfer it to the blood. It also shows how carbon dioxide (a waste product) is removed from the blood and exhaled.
In IPF, scarring begins in the air sac walls and the spaces around them. The scarring makes the walls of the air sacs thicker. This makes it harder for oxygen to pass through the air sac walls into the bloodstream.
![]()
Idiopathic Pulmonary Fibrosis. Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed view of the lung's airways and air sacs in cross-section. Figure B shows fibrosis (scarring) in the lungs. The inset image (more...)
For more information about lung function, go to the Health Topics How the Lungs Work article.
Other Names for Idiopathic Pulmonary Fibrosis
What Causes Idiopathic Pulmonary Fibrosis?
Sometimes doctors can find out what is causing pulmonary fibrosis (lung scarring). For example, exposure to environmental pollutants and certain medicines can cause the disease.
Environmental pollutants include inorganic dust (silica and hard metal dusts) and organic dust (bacteria and animal proteins).
Medicines that are known to cause pulmonary fibrosis in some people include nitrofurantoin (an antibiotic), amiodarone (a heart medicine), methotrexate and bleomycin (both chemotherapy medicines), and many other medicines.
In most cases, however, the cause of lung scarring isn’t known. These cases are called idiopathic pulmonary fibrosis (IPF). With IPF, doctors think that something inside or outside of the lungs attacks them again and again over time.
These attacks injure the lungs and scar the tissue inside and between the air sacs. This makes it harder for oxygen to pass through the air sac walls into the bloodstream.
The following factors may increase your risk of IPF:
Genetics also may play a role in causing IPF. Some families have at least two members who have IPF.
Researchers have found that 9 out of 10 people who have IPF also have gastroesophageal reflux disease (GERD). GERD is a condition in which acid from your stomach backs up into your throat.
Some people who have GERD may regularly breathe in tiny drops of acid from their stomachs. The acid can injure their lungs and lead to IPF. More research is needed to confirm this theory.
What Are the Signs and Symptoms of Idiopathic Pulmonary Fibrosis?
The signs and symptoms of idiopathic pulmonary fibrosis (IPF) develop over time. They may not even begin to appear until the disease has done serious damage to your lungs. Once they occur, they're likely to get worse over time.
The most common signs and symptoms are:
Shortness of breath. This usually is the main symptom of IPF. At first, you may be short of breath only during
exercise. Over time, you'll likely feel breathless even at rest.
A dry, hacking
cough that doesn't get better. Over time, you may have repeated bouts of
coughing that you can't control.
Other signs and symptoms that you may develop over time include:
![]()
Clubbing. The illustration shows clubbing of the fingertips associated with idiopathic pulmonary fibrosis.
IPF may lead to other medical problems, including a collapsed lung, lung infections, blood clots in the lungs, and lung cancer.
As the disease worsens, you may develop other potentially life-threatening conditions, including respiratory failure, pulmonary hypertension, and heart failure.
How Is Idiopathic Pulmonary Fibrosis Diagnosed?
Idiopathic pulmonary fibrosis (IPF) causes the same kind of scarring and symptoms as some other lung diseases. This makes it hard to diagnose.
Seeking medical help as soon as you have symptoms is important. If possible, seek care from a pulmonologist. This is a doctor who specializes in diagnosing and treating lung problems.
Your doctor will diagnose IPF based on your medical history, a physical exam, and test results. Tests can help rule out other causes of your symptoms and show how badly your lungs are damaged.
Medical History
Your doctor may ask about:
Your age
Your history of smoking
Things in the air at your job or elsewhere that could irritate your
lungsYour hobbies
Your history of legal and illegal drug use
Other medical conditions that you have
How long you've had symptoms
Diagnostic Tests
No single test can diagnose IPF. Your doctor may recommend several of the following tests.
Chest X Ray
A chest x ray is a painless test that creates a picture of the structures in your chest, such as your heart and lungs. This test can show shadows that suggest scar tissue. However, many people who have IPF have normal chest x rays at the time they're diagnosed.
High-Resolution Computed Tomography
A high-resolution computed tomography scan, or HRCT scan, is an x ray that provides sharper and more detailed pictures than a standard chest x ray.
HRCT can show scar tissue and how much lung damage you have. This test can help your doctor spot IPF at an early stage or rule it out. HRCT also can help your doctor decide how likely you are to respond to treatment.
Lung Function Tests
Your doctor may suggest a breathing test called spirometry (spi-ROM-eh-tree) to find out how much lung damage you have. This test measures how much air you can blow out of your lungs after taking a deep breath. Spirometry also measures how fast you can breathe the air out.
If you have a lot of lung scarring, you won't be able to breathe out a normal amount of air.
Pulse Oximetry
For this test, your doctor attaches a small sensor to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood.
Arterial Blood Gas Test
For this test, your doctor takes a blood sample from an artery, usually in your wrist. The sample is sent to a laboratory, where its oxygen and carbon dioxide levels are measured.
This test is more accurate than pulse oximetry. The blood sample also can be tested to see whether an infection is causing your symptoms.
Skin Test for Tuberculosis
For this test, your doctor injects a substance under the top layer of skin on one of your arms. This substance reacts to tuberculosis (TB). If you have a positive reaction, a small hard lump will develop at the injection site 48 to 72 hours after the test. This test is done to rule out TB.
Lung Biopsy
For a lung biopsy, your doctor will take samples of lung tissue from several places in your lungs. The samples are examined under a microscope. A lung biopsy is the best way for your doctor to diagnose IPF.
This procedure can help your doctor rule out other conditions, such as sarcoidosis (sar-koy-DO-sis), cancer, or infection. Lung biopsy also can show your doctor how far your disease has advanced.
Doctors use several procedures to get lung tissue samples.
Video-assisted thoracoscopy (thor-ah-KOS-ko-pee). This is the most common procedure used to get lung tissue samples. Your doctor inserts a small tube with an attached light and camera into your chest through small cuts between your ribs. The tube is called an endoscope.
The endoscope provides a video image of the lungs and allows your doctor to collect tissue samples. This procedure must be done in a hospital. You'll be given medicine to make you sleep during the procedure.
Bronchoscopy (bron-KOS-ko-pee). For a bronchoscopy, your doctor passes a thin, flexible tube through your nose or mouth, down your throat, and into your airways. At the tube's tip are a light and mini-camera. They allow your doctor to see your windpipe and airways.
Your doctor then inserts a forceps through the tube to collect tissue samples. You'll be given medicine to help you relax during the procedure.
Bronchoalveolar lavage (BRONG-ko-al-VE-o-lar lah-VAHZH). During bronchoscopy, your doctor may inject a small amount of salt water (saline) through the tube into your lungs. This fluid washes the lungs and helps bring up cells from the area around the air sacs. These cells are examined under a microscope.
Thoracotomy (thor-ah-KOT-o-me). For this procedure, your doctor removes a few small pieces of lung tissue through a cut in the chest wall between your ribs. Thoracotomy is done in a hospital. You'll be given medicine to make you sleep during the procedure.
How Is Idiopathic Pulmonary Fibrosis Treated?
Doctors may prescribe medicines, oxygen therapy, pulmonary rehabilitation (PR), and lung transplant to treat idiopathic pulmonary fibrosis (IPF).
Medicines
Currently, no medicines are proven to slow the progression of IPF.
Prednisone, azathioprine (A-zah-THI-o-preen), and N-acetylcysteine (a-SEH-til-SIS-tee-in) have been used to treat IPF, either alone or in combination. However, experts have not found enough evidence to support their use.
Prednisone
Prednisone is an anti-inflammatory medicine. You usually take it by mouth every day. However, your doctor may give it to you through a needle or tube inserted into a vein in your arm for several days. After that, you usually take it by mouth.
Because prednisone can cause serious side effects, your doctor may prescribe it for 3 to 6 months or less at first. Then, if it works for you, your doctor may reduce the dose over time and keep you on it longer.
Azathioprine
Azathioprine suppresses your immune system. You usually take it by mouth every day. Because it can cause serious side effects, your doctor may prescribe it with prednisone for only 3 to 6 months.
If you don't have serious side effects and the medicines seem to help you, your doctor may keep you on them longer.
N-acetylcysteine
N-acetylcysteine is an antioxidant that may help prevent lung damage. You usually take it by mouth several times a day.
A common treatment for IPF is a combination of prednisone, azathioprine, and N-acetylcysteine. However, this treatment was recently found harmful in a study funded by the National Heart, Lung, and Blood Institute (NHLBI).
If you have IPF and take this combination of medicines, talk with your doctor. Do not stop taking the medicines on your own.
The NHLBI currently supports research to compare N-acetylcysteine treatment with placebo treatment (sugar pills) in patients who have IPF.
New Medicines Being Studied
Researchers, like those in the Idiopathic Pulmonary Fibrosis Network, are studying new treatments for IPF. With the support and guidance of the NHLBI, these researchers continue to look for new IPF treatments and therapies.
Some of these researchers are studying medicines that may reduce inflammation and prevent or reduce scarring caused by IPF.
If you're interested in joining a research study, talk with your doctor. For more information about ongoing research, go to the ""Clinical Trials"" section of this article.
Other Treatments
Other treatments that may help people who have IPF include the following:
Flu and
pneumonia vaccines may help prevent infections and keep you healthy.
Oxygen Therapy
If the amount of oxygen in your blood gets low, you may need oxygen therapy. Oxygen therapy can help reduce shortness of breath and allow you to be more active.
Oxygen usually is given through nasal prongs or a mask. At first, you may need it only during exercise and sleep. As your disease worsens, you may need it all the time.
For more information, go to the Health Topics Oxygen Therapy article.
Pulmonary Rehabilitation
PR is now a standard treatment for people who have chronic (ongoing) lung disease. PR is a broad program that helps improve the well-being of people who have breathing problems.
The program usually involves treatment by a team of specialists in a special clinic. The goal is to teach you how to manage your condition and function at your best.
PR doesn't replace medical therapy. Instead, it's used with medical therapy and may include:
For more information, go to the Health Topics Pulmonary Rehabilitation article.
Lung Transplant
Your doctor may recommend a lung transplant if your condition is quickly worsening or very severe. A lung transplant can improve your quality of life and help you live longer.
Some medical centers will consider patients older than 65 for lung transplants if they have no other serious medical problems.
The major complications of a lung transplant are rejection and infection. (""Rejection"" refers to your body creating proteins that attack the new organ.) You will have to take medicines for the rest of your life to reduce the risk of rejection.
Because the supply of donor lungs is limited, talk with your doctor about a lung transplant as soon as possible.
For more information, go to the Health Topics Lung Transplant article.
Living With Idiopathic Pulmonary Fibrosis
No cure is available for idiopathic pulmonary fibrosis (IPF) yet. Your symptoms may get worse over time. As your symptoms worsen, you may not be able to do many of the things that you did before you had IPF.
However, lifestyle changes and ongoing care can help you manage the disease.
Lifestyle Changes
If you're still smoking, the most important thing you can do is quit. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. Ask family members and friends not to smoke in front of you or in your home, car, or workplace.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general tips on how to quit smoking.
Staying active can help with both your physical and mental health. Physical activity can help you maintain your strength and lung function and reduce stress. Try moderate exercise, such as walking or riding a stationary bike. Ask your doctor about using oxygen while exercising.
As your condition advances, use a wheelchair or motorized scooter, or stay busy with activities that aren't physical in nature.
You also should follow a healthy diet. A healthy diet includes a variety of fruits and vegetables. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
Eating smaller, more frequent meals may relieve stomach fullness, which can make it hard to breathe. If you need help with your diet, ask your doctor to arrange for a dietitian to work with you.
For more information about following a healthy diet, go to the NHLBI's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Getting plenty of rest can increase your energy and help you deal with the stress of living with a serious condition like IPF.
Try to maintain a positive attitude; relaxation techniques may help you do this. These techniques also may help you avoid excessive oxygen intake caused by tension or overworked muscles.
Avoid situations that can make your symptoms worse. For example, avoid traveling by air or living at or traveling to high altitudes where the air is thin and the amount of oxygen in the air is low.
Ongoing Care
If you have IPF, you will need ongoing medical care. If possible, seek treatment from a doctor who specializes in IPF. These specialists often are located at major medical centers.
Treatment may relieve your symptoms and even slow or stop the fibrosis (scarring). Follow your treatment plan as your doctor advises. For example:
As your condition worsens, you may need oxygen therapy full time. Some people who have IPF carry portable oxygen when they go out.
Emotional Issues and Support
Living with IPF may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with IPF. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent and treat these diseases.
Many more questions remain about lung diseases, including idiopathic pulmonary fibrosis (IPF). The NHLBI continues to support research aimed at learning more about these diseases. For example, NHLBI-supported research on IPF includes studies that explore:
What Is Immune Thrombocytopenia?
Immune thrombocytopenia (THROM-bo-si-toe-PE-ne-ah), or ITP, is a bleeding disorder. In ITP, the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets (PLATE-lets) or thrombocytes (THROM-bo-sites).
Platelets are made in your bone marrow along with other kinds of blood cells. They stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding.
Overview
Without enough platelets, bleeding can occur inside the body (internal bleeding) or underneath or from the skin (external bleeding).
People who have ITP often have purple bruises called purpura (PURR-purr-ah). These bruises appear on the skin or mucous membranes (for example, in the mouth). Bleeding from small blood vessels under the skin causes purpura.
People who have ITP also may have bleeding that causes tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae (peh-TEE-kee-ay). Petechiae may look like a rash.
![]()
Purpura and Petechiae. The photograph shows purpura (bruises) and petechiae (red and purple dots) on the skin. Bleeding under the skin causes the purple, brown, and red color of the purpura and petechiae.
People who have ITP also may have nosebleeds, bleeding from the gums during dental work, or other bleeding that's hard to stop. Women who have ITP may have menstrual bleeding that's heavier than normal.
A lot of bleeding can cause hematomas (he-mah-TO-mas). A hematoma is a collection of clotted or partially clotted blood under the skin. It looks or feels like a lump.
Bleeding in the brain as a result of ITP is very rare, but can be life threatening if it occurs.
In most cases, an autoimmune response is thought to cause ITP. Normally, your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens isn't known.
ITP can't be passed from one person to another.
Types of Immune Thrombocytopenia
The two types of ITP are acute (temporary or short-term) and chronic (long-lasting).
Acute ITP generally lasts less than 6 months. It mainly occurs in children—both boys and girls—and is the most common type of ITP. Acute ITP often occurs after a viral infection.
Chronic ITP lasts 6 months or longer and mostly affects adults. However, some teenagers and children do get this type of ITP. Chronic ITP affects women two to three times more often than men.
Treatment depends on the severity of bleeding and the platelet count. In mild cases, treatment may not be needed.
Outlook
For most children and adults, ITP isn't a serious or life-threatening condition.
Acute ITP in children often goes away on its own within a few weeks or months and doesn't return. In 80 percent of children who have ITP, the platelet count returns to normal within 6 to 12 months. Treatment may not be needed.
For a small number of children, ITP doesn't go away on its own and may require further medical or surgical treatment.
Chronic ITP varies from person to person and can last for many years. Even people who have severe forms of chronic ITP can live for decades. Most people who have chronic ITP can stop treatment at some point and maintain a safe platelet count.
Other Names for Immune Thrombocytopenia
What Causes Immune Thrombocytopenia?
In most cases, an autoimmune response is thought to cause immune thrombocytopenia (ITP).
Normally, your immune system helps your body fight off infections and diseases. In ITP, however, your immune system attacks and destroys your body's platelets by mistake. Why this happens isn't known.
In some people, ITP may be linked to viral or bacterial infections, such as HIV, hepatitis C, or H. pylori.
Children who have acute (short-term) ITP often have had recent viral infections. These infections may ""trigger"" or set off the immune reaction that leads to ITP.
Who Is at Risk for Immune Thrombocytopenia?
Immune thrombocytopenia (ITP) is a fairly common blood disorder. Both children and adults can develop ITP.
Children usually have the acute (short-term) type of ITP. Acute ITP often develops after a viral infection.
Adults tend to have the chronic (long-lasting) type of ITP. Women are two to three times more likely than men to develop chronic ITP.
The number of cases of ITP is rising because routine blood tests that can detect a low platelet count are being done more often.
ITP can't be passed from one person to another.
What Are the Signs and Symptoms of Immune Thrombocytopenia?
Immune thrombocytopenia (ITP) may not cause any signs or symptoms. However, ITP can cause bleeding inside the body (internal bleeding) or underneath or from the skin (external bleeding). Signs of bleeding may include:
Pinpoint red spots on the
skin called
petechiae. These spots often are found in groups and may look like a
rash.
Bleeding under the skin causes petechiae.
A collection of clotted or partially clotted
blood under the
skin that looks or feels like a lump. This is called a hematoma.
Nosebleeds or
bleeding from the
gums (for example, during dental work).
Any kind of bleeding that's hard to stop could be a sign of ITP. This includes menstrual bleeding that's heavier than normal. Bleeding in the brain is rare, and its symptoms may vary.
A low platelet count doesn't directly cause pain, problems concentrating, or other symptoms. However, a low platelet count might be associated with fatigue (tiredness).
How Is Immune Thrombocytopenia Diagnosed?
Your doctor will diagnose immune thrombocytopenia (ITP) based on your medical history, a physical exam, and test results.
Your doctor will want to make sure that your low platelet count isn't due to another condition (such as an infection) or medicines you're taking (such as chemotherapy medicines or aspirin).
Medical History
Your doctor may ask about:
Your signs and symptoms of
bleeding and any other signs or symptoms you're having
Whether you have illnesses that could lower your
platelet count or cause
bleedingMedicines or any over-the-counter supplements or remedies you take that could cause
bleeding or lower your
platelet count
Physical Exam
During a physical exam, your doctor will look for signs of bleeding and infection. For example, your doctor may look for purplish areas on the skin or mucous membranes and pinpoint red spots on the skin. These are signs of bleeding under the skin.
How Is Immune Thrombocytopenia Treated?
Treatment for immune thrombocytopenia (ITP) is based on how much and how often you're bleeding and your platelet count.
Adults who have mild ITP may not need any treatment, other than watching their symptoms and platelet counts. Adults who have ITP with very low platelet counts or bleeding problems often are treated.
The acute (short-term) type of ITP that occurs in children often goes away within a few weeks or months. Children who have bleeding symptoms, other than merely bruising (purpura), usually are treated.
Children who have mild ITP may not need treatment other than monitoring and followup to make sure their platelet counts return to normal.
Medicines
Medicines often are used as the first course of treatment for both children and adults.
Corticosteroids (cor-ti-co-STEER-roids), such as prednisone, are commonly used to treat ITP. These medicines, called steroids for short, help increase your platelet count. However, steroids have many side effects. Some people relapse (get worse) when treatment ends.
The steroids used to treat ITP are different from the illegal steroids that some athletes take to enhance performance. Corticosteroids aren't habit-forming, even if you take them for many years.
Other medicines also are used to raise the platelet count. Some are given through a needle inserted into a vein. These medicines include rituximab, immune globulin, and anti-Rh (D) immunoglobulin.
Medicines also may be used with a procedure to remove the spleen called splenectomy (splee-NECK-tuh-mee).
If medicines or splenectomy don't help, two newer medicines—eltrombopag and romiplostim—can be used to treat ITP.
Removal of the Spleen (Splenectomy)
If needed, doctors can surgically remove the spleen. This organ is located in the upper left abdomen. The spleen is about the size of a golf ball in children and a baseball in adults.
The spleen makes antibodies (proteins) that help fight infections. In ITP, these antibodies destroy platelets by mistake.
If ITP hasn't responded to medicines, removing the spleen will reduce the destruction of platelets. However, it also may raise your risk for infections. Before you have the surgery, your doctor may give you vaccines to help prevent infections.
If your spleen is removed, your doctor will explain what steps you can take to help avoid infections and what symptoms to watch for.
Other Treatments
Treating Infections
Some infections can briefly lower your platelet count. Treating the infection may help increase your platelet count and reduce bleeding problems.
Stopping Medicines
Some medicines can lower your platelet count or cause bleeding. Stopping the medicine can sometimes help raise your platelet count or prevent bleeding.
For example, aspirin and ibuprofen are common medicines that increase the risk of bleeding. If you have ITP, your doctor may suggest that you avoid these medicines.
How Can Immune Thrombocytopenia Be Prevented?
You can't prevent immune thrombocytopenia (ITP), but you can prevent its complications.
Talk with your doctor about which medicines are safe for you. Your doctor may advise you to avoid medicines that can affect your
platelets and increase your risk of
bleeding. Examples of such medicines include
aspirin and
ibuprofen.
Protect yourself from injuries that can cause bruising or
bleeding.
Seek
treatment right away if you develop any infections. Report any symptoms of
infection, such as a
fever, to your doctor. This is very important for people who have ITP and have had their
spleens removed.
Living With Immune Thrombocytopenia
If you have immune thrombocytopenia (ITP), you can take steps to prevent complications. Lifestyle changes and ongoing care can help you manage the condition.
Lifestyle Changes
Try to avoid injuries, especially head injuries, that can cause bleeding in the brain. For example, don't take part in contact sports, such as boxing, football, or karate. Other sports, such as skiing or horseback riding, also put you at risk for injuries that can cause bleeding.
Some safe activities are swimming, biking (with a helmet), and walking. Ask your doctor about physical activities that are safe for you.
Take precautions such as regular use of seatbelts and wearing gloves while working with knives and other tools.
If your child has ITP, ask his or her doctor whether you need to restrict your child's activities.
Ongoing Care
You may want to find a doctor who is familiar with treating people who have ITP. For example, hematologists are doctors who specialize in diagnosing and treating blood disorders. Discuss with your doctor how to manage ITP and when to seek medical care.
Talk with your doctor before taking prescription medicines or over-the-counter medicines, supplements, vitamins, or herbal remedies. Some medicines and supplements can affect platelets and increase your chance of bleeding. Common examples are aspirin or ibuprofen. Your doctor may advise you to avoid these medicines.
Watch for symptoms of infection, such as a fever, and report them to your doctor promptly. If you've had your spleen removed, you may be more likely to become ill from certain infections.
Immune Thrombocytopenia in Pregnancy
In women who are pregnant and have ITP, the ITP usually doesn't affect the baby. However, some babies may be born with or develop low platelet counts soon after birth.
The babies' platelet counts almost always return to normal without any treatment. Treatment can speed up recovery in the babies whose platelet counts are very low.
Treatment for ITP during pregnancy depends on a woman's platelet count. If treatment is needed, the doctor will take a close look at the possible effects of the treatment on the unborn baby.
Women who have mild cases of ITP usually can go through pregnancy without treatment. Pregnant women who have very low platelet counts or a lot of bleeding are more likely to have heavy bleeding during delivery or afterward. To prevent heavy bleeding, these women usually are treated.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to immune thrombocytopenia, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Insomnia?
Insomnia (in-SOM-ne-ah) is a common sleep disorder. People who have insomnia have trouble falling asleep, staying asleep, or both. As a result, they may get too little sleep or have poor-quality sleep. They may not feel refreshed when they wake up.
Overview
Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common and often is brought on by situations such as stress at work, family pressures, or a traumatic event. Acute insomnia lasts for days or weeks.
Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary, which means they are the symptom or side effect of some other problem. Certain medical conditions, medicines, sleep disorders, and substances can cause secondary insomnia.
In contrast, primary insomnia isn't due to medical problems, medicines, or other substances. It is its own distinct disorder, and its cause isn’t well understood. Many life changes can trigger primary insomnia, including long-lasting stress and emotional upset.
Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. These problems can prevent you from doing your best at work or school.
Insomnia also can cause other serious problems. For example, you may feel drowsy while driving, which could lead to an accident.
Outlook
Treating the underlying cause of secondary insomnia may resolve or improve the sleep problem, especially if you can correct the problem soon after it starts. For example, if caffeine is causing your insomnia, stopping or limiting your intake of the substance might make the insomnia go away.
Lifestyle changes, including better sleep habits, often help relieve acute insomnia. For chronic insomnia, your doctor may recommend medicines or cognitive-behavioral therapy.
What Causes Insomnia?
Secondary Insomnia
Secondary insomnia is the symptom or side effect of another problem. This type of insomnia often is a symptom of an emotional, neurological, or other medical or sleep disorder.
Emotional disorders that can cause insomnia include depression, anxiety, and posttraumatic stress disorder. Alzheimer's disease and Parkinson's disease are examples of neurological disorders that can cause insomnia.
Many other disorders or factors also can cause insomnia, such as:
Gastrointestinal disorders, such as
heartburn
Secondary insomnia also can be a side effect of some medicines. For example, certain asthma medicines, such as theophylline, and some allergy and cold medicines can cause insomnia. Beta blockers also can cause the condition. These medicines are used to treat heart conditions.
Commonly used substances also can cause insomnia. Examples include caffeine and other stimulants, tobacco and other nicotine products, and alcohol and other sedatives.
Primary Insomnia
Primary insomnia isn't a symptom or side effect of another medical condition. It is its own distinct disorder, and its cause isn’t well understood. Primary insomnia usually lasts for at least 1 month.
Many life changes can trigger primary insomnia. It may be due to major or long-lasting stress or emotional upset. Travel or other factors, such as work schedules that disrupt your sleep routine, also may trigger primary insomnia.
Even if these issues are resolved, the insomnia may not go away. Trouble sleeping can persist because of habits formed to deal with the lack of sleep. These habits might include taking naps, worrying about sleep, and going to bed early.
Researchers continue to try to find out whether some people are born with an increased risk for primary insomnia.
Who Is at Risk for Insomnia?
Insomnia is a common disorder. It affects women more often than men. The disorder can occur at any age. However, older adults are more likely to have insomnia than younger people.
People who might be at increased risk for insomnia include those who:
Are
depressed or have other emotional distress, such as divorce or death of a spouse.
Have lower incomes.
Work at night or have frequent major shifts in their work hours.
Travel long distances with time changes.
Have an inactive lifestyle.
Young and middle-aged African Americans also might be at increased risk for insomnia. Research shows that, compared with Caucasian Americans, it takes African Americans longer to fall asleep. They also have lighter sleep, don't sleep as well, and take more naps. Sleep-related breathing problems also are more common among African Americans.
What Are the Signs and Symptoms of Insomnia?
The main symptom of insomnia is trouble falling or staying asleep, which leads to lack of sleep. If you have insomnia, you may:
The lack of sleep can cause other symptoms. You may wake up feeling tired or not well-rested, and you may feel tired during the day. You also may have trouble focusing on tasks. Insomnia can cause you to feel anxious, depressed, or irritable.
Insomnia also can affect your daily activities and cause serious problems. For example, you may feel drowsy while driving. Driver sleepiness (not related to alcohol) is responsible for almost 20 percent of all serious car crash injuries. Research also shows that insomnia raises older women’s risk of falling.
If insomnia is affecting your daily activities, talk with your doctor. Treatment may help you avoid symptoms and problems related to the disorder. Also, poor sleep may be a sign of other health problems. Finding and treating those problems could improve your overall health and sleep.
How Is Insomnia Diagnosed?
Your doctor will likely diagnose insomnia based on your medical and sleep histories and a physical exam. He or she also may recommend a sleep study. For example, you may have a sleep study if the cause of your insomnia is unclear.
Medical History
To find out what's causing your insomnia, your doctor may ask whether you:
Have any new or ongoing health problems
Have painful injuries or health conditions, such as
arthritisTake any medicines, either over-the-counter or prescription
Are coping with highly stressful life events, such as divorce or death
Your doctor also may ask questions about your work and leisure habits. For example, he or she may ask about your work and exercise routines; your use of caffeine, tobacco, and alcohol; and your long-distance travel history. Your answers can give clues about what's causing your insomnia.
Your doctor also may ask whether you have any new or ongoing work or personal problems or other stresses in your life. Also, he or she may ask whether you have other family members who have sleep problems.
Sleep History
To get a better sense of your sleep problem, your doctor will ask you for details about your sleep habits. Before your visit, think about how to describe your problems, including:
How often you have trouble sleeping and how long you've had the problem
When you go to bed and get up on workdays and days off
How long it takes you to
fall asleep, how often you wake up at night, and how long it takes to fall back asleep
Whether you snore loudly and often or wake up gasping or feeling out of breath
How refreshed you feel when you wake up, and how tired you feel during the day
How often you doze off or have trouble staying awake during routine tasks, especially driving
To find out what's causing or worsening your insomnia, your doctor also may ask you:
Whether you worry about
falling asleep, staying asleep, or getting enough
sleepWhat you eat or drink, and whether you take medicines before going to bed
What routine you follow before going to bed
What the noise level, lighting, and temperature are like where you
sleepWhat distractions, such as a TV or computer, are in your bedroom
To help your doctor, consider keeping a sleep diary for 1 or 2 weeks. Write down when you go to sleep, wake up, and take naps. (For example, you might note: Went to bed at 10 a.m.; woke up at 3 a.m. and couldn't fall back asleep; napped after work for 2 hours.)
Also write down how much you sleep each night, as well as how sleepy you feel throughout the day.
You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Physical Exam
Your doctor will do a physical exam to rule out other medical problems that might cause insomnia. You also may need blood tests to check for thyroid problems or other conditions that can cause sleep problems.
How Is Insomnia Treated?
Lifestyle changes often can help relieve acute (short-term) insomnia. These changes might make it easier to fall asleep and stay asleep.
A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia.
Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it's important to treat the underlying cause (if possible).
Lifestyle Changes
If you have insomnia, avoid substances that make it worse, such as:
Caffeine,
tobacco, and other stimulants. The effects of these substances can last as long as 8 hours.
Certain over-the-counter and prescription medicines that can disrupt
sleep (for example, some cold and
allergy medicines). Talk with your doctor about which medicines won't disrupt your sleep.
Alcohol. An alcoholic drink before bedtime might make it easier for you to
fall asleep. However, alcohol triggers
sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
Try to adopt bedtime habits that make it easier to fall asleep and stay asleep. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath.
Try to schedule your daily exercise at least 5 to 6 hours before going to bed. Don't eat heavy meals or drink a lot before bedtime.
Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure the temperature of your bedroom is cool and comfortable. Your bedroom also should be dark and quiet.
Go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.
Cognitive-Behavioral Therapy
CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.
For example, relaxation techniques and biofeedback are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
CBT also aims to replace sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you're unable to fall asleep within a reasonable time.
CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.
CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you're usually asleep.
This schedule might make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.
For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone.
For people who have insomnia and major depressive disorder, CBT combined with antidepression medicines has shown promise in relieving both conditions.
Medicines
Prescription Medicines
Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use.
Talk to your doctor about the benefits and side effects of insomnia medicines. For example, insomnia medicines can help you fall asleep, but you may feel groggy in the morning after taking them.
Rare side effects of these medicines include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn't work well, tell your doctor. He or she might prescribe a different medicine.
Some insomnia medicines can be habit forming. Ask your doctor about the benefits and risks of insomnia medicines.
Over-the-Counter Products
Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.
The Food and Drug Administration doesn't regulate “natural” products and some food supplements. Thus, the dose and purity of these substances can vary. How well these products work and how safe they are isn't well understood.
Some OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your doctor before taking them.
Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products will benefit you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of sleep disorders and ways to diagnose and treat these conditions.
The NHLBI continues to support research aimed at learning more about sleep disorders, including insomnia. For example, the NHLBI currently is involved in research comparing two nondrug, self-help treatments for insomnia.
The NHLBI also supports research that explores the factors that affect sleep, how a lack of sleep increases certain health risks, and new ways to diagnose and treat sleep disorders.
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to insomnia, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.
What Is Iron-Deficiency Anemia?
Iron-deficiency anemia is a common, easily treated condition that occurs if you don't have enough iron in your body. Low iron levels usually are due to blood loss, poor diet, or an inability to absorb enough iron from food.
Overview
Iron-deficiency anemia is a common type of anemia. The term ""anemia"" usually refers to a condition in which your blood has a lower than normal number of red blood cells. Red blood cells carry oxygen and remove carbon dioxide (a waste product) from your body.
Anemia also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that carries oxygen from the lungs to the rest of the body.
Iron-deficiency anemia usually develops over time if your body doesn't have enough iron to build healthy red blood cells. Without enough iron, your body starts using the iron it has stored. Soon, the stored iron gets used up.
After the stored iron is gone, your body makes fewer red blood cells. The red blood cells it does make have less hemoglobin than normal.
Iron-deficiency anemia can cause fatigue (tiredness), shortness of breath, chest pain, and other symptoms. Severe iron-deficiency anemia can lead to heart problems, infections, problems with growth and development in children, and other complications.
Infants and young children and women are the two groups at highest risk for iron-deficiency anemia.
What Causes Iron-Deficiency Anemia?
Not having enough iron in your body causes iron-deficiency anemia. Lack of iron usually is due to blood loss, poor diet, or an inability to absorb enough iron from food.
Blood Loss
When you lose blood, you lose iron. If you don't have enough iron stored in your body to make up for the lost iron, you'll develop iron-deficiency anemia.
In women, long or heavy menstrual periods or bleeding fibroids in the uterus may cause low iron levels. Blood loss that occurs during childbirth is another cause of low iron levels in women.
Internal bleeding (bleeding inside the body) also may lead to iron-deficiency anemia. This type of blood loss isn't always obvious, and it may occur slowly. Some causes of internal bleeding are:
Regular use of
aspirin or other pain medicines, such as nonsteroidal anti-inflammatory drugs (for example,
ibuprofen and
naproxen)
Blood loss from severe injuries, surgery, or frequent blood drawings also can cause iron-deficiency anemia.
Poor Diet
The best sources of iron are meat, poultry, fish, and iron-fortified foods (foods that have iron added). If you don't eat these foods regularly, or if you don't take an iron supplement, you're more likely to develop iron-deficiency anemia.
Vegetarian diets can provide enough iron if you eat the right foods. For example, good nonmeat sources of iron include iron-fortified breads and cereals, beans, tofu, dried fruits, and spinach and other dark green leafy vegetables.
During some stages of life, such as pregnancy and childhood, it may be hard to get enough iron in your diet. This is because your need for iron increases during these times of growth and development.
Inability To Absorb Enough Iron
Even if you have enough iron in your diet, your body may not be able to absorb it. This can happen if you have intestinal surgery (such as gastric bypass) or a disease of the intestine (such as Crohn's disease or celiac disease).
Prescription medicines that reduce acid in the stomach also can interfere with iron absorption.
Who Is at Risk for Iron-Deficiency Anemia?
Infants and Young Children
Infants and young children need a lot of iron to grow and develop. The iron that full-term infants have stored in their bodies is used up in the first 4 to 6 months of life.
Premature and low-birth-weight babies (weighing less than 5.5 pounds) are at even greater risk for iron-deficiency anemia. These babies don't have as much iron stored in their bodies as larger, full-term infants.
Iron-fortified baby food or iron supplements, when used properly, can help prevent iron-deficiency anemia in infants and young children. Talk with your child's doctor about your child's diet.
Young children who drink a lot of cow's milk may be at risk for iron-deficiency anemia. Milk is low in iron, and too much milk may take the place of iron-rich foods in the diet. Too much milk also may prevent children's bodies from absorbing iron from other foods.
Children who have lead in their blood also may be at risk for iron-deficiency anemia. Lead can interfere with the body's ability to make hemoglobin. Lead may get into the body from breathing in lead dust, eating lead in paint or soil, or drinking water that contains lead.
Teens
Teens are at risk for iron-deficiency anemia if they're underweight or have chronic (ongoing) illnesses. Teenage girls who have heavy periods also are at increased risk for the condition.
Women
Women of childbearing age are at higher risk for iron-deficiency anemia because of blood loss during their monthly periods. About 1 in 5 women of childbearing age has iron-deficiency anemia.
Pregnant women also are at higher risk for the condition because they need twice as much iron as usual. The extra iron is needed for increased blood volume and for the fetus' growth.
About half of all pregnant women develop iron-deficiency anemia. The condition can increase a pregnant woman's risk for a premature or low-birth-weight baby.
Adults Who Have Internal Bleeding
Adults who have internal bleeding, such as intestinal bleeding, can develop iron-deficiency anemia due to blood loss. Certain conditions, such as colon cancer and bleeding ulcers, can cause blood loss. Some medicines, such as aspirin, also can cause internal bleeding.
What Are the Signs and Symptoms of Iron-Deficiency Anemia?
The signs and symptoms of iron-deficiency anemia depend on its severity. Mild to moderate iron-deficiency anemia may have no signs or symptoms.
When signs and symptoms do occur, they can range from mild to severe. Many of the signs and symptoms of iron-deficiency anemia apply to all types of anemia.
Signs and Symptoms of Anemia
The most common symptom of all types of anemia is fatigue (tiredness). Fatigue occurs because your body doesn't have enough red blood cells to carry oxygen to its many parts.
Also, the red blood cells your body makes have less hemoglobin than normal. Hemoglobin is an iron-rich protein in red blood cells. It helps red blood cells carry oxygen from the lungs to the rest of the body.
Anemia also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, chest pain, weakness, and fatigue (tiredness).
If you don't have enough hemoglobin-carrying red blood cells, your heart has to work harder to move oxygen-rich blood through your body. This can lead to irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart murmur, an enlarged heart, or even heart failure.
In infants and young children, signs of anemia include poor appetite, slowed growth and development, and behavioral problems.
Signs and Symptoms of Iron Deficiency
Signs and symptoms of iron deficiency may include brittle nails, swelling or soreness of the tongue, cracks in the sides of the mouth, an enlarged spleen, and frequent infections.
People who have iron-deficiency anemia may have an unusual craving for nonfood items, such as ice, dirt, paint, or starch. This craving is called pica (PI-ka or PE-ka).
Some people who have iron-deficiency anemia develop restless legs syndrome (RLS). RLS is a disorder that causes a strong urge to move the legs. This urge to move often occurs with strange and unpleasant feelings in the legs. People who have RLS often have a hard time sleeping.
Iron-deficiency anemia can put children at greater risk for lead poisoning and infections.
Some signs and symptoms of iron-deficiency anemia are related to the condition's causes. For example, a sign of intestinal bleeding is bright red blood in the stools or black, tarry-looking stools.
Very heavy menstrual bleeding, long periods, or other vaginal bleeding may suggest that a woman is at risk for iron-deficiency anemia.
How Is Iron-Deficiency Anemia Diagnosed?
Your doctor will diagnose iron-deficiency anemia based on your medical history, a physical exam, and the results from tests and procedures.
Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan for you.
Mild to moderate iron-deficiency anemia may have no signs or symptoms. Thus, you may not know you have it unless your doctor discovers it from a screening test or while checking for other problems.
Specialists Involved
Primary care doctors often diagnose and treat iron-deficiency anemia. These doctors include pediatricians, family doctors, gynecologists/obstetricians, and internal medicine specialists.
A hematologist (a blood disease specialist), a gastroenterologist (a digestive system specialist), and other specialists also may help treat iron-deficiency anemia.
Medical History
Your doctor will ask about your signs and symptoms and any past problems you've had with anemia or low iron. He or she also may ask about your diet and whether you're taking any medicines.
If you're a woman, your doctor may ask whether you might be pregnant.
Physical Exam
Your doctor will do a physical exam to look for signs of iron-deficiency anemia. He or she may:
Look at your
skin,
gums, and
nail beds to see whether they're pale
Listen to your
lungs for rapid or uneven breathing
Do a pelvic and rectal exam to check for internal
bleeding
Diagnostic Tests and Procedures
Many tests and procedures are used to diagnose iron-deficiency anemia. They can help confirm a diagnosis, look for a cause, and find out how severe the condition is.
Complete Blood Count
Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood.
This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels varies in certain racial and ethnic populations. Your doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of infection, a blood disorder, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. The results may be a clue as to the cause of your anemia. In iron-deficiency anemia, for example, red blood cells usually are smaller than normal.
Other Blood Tests
If the CBC results confirm you have anemia, you may need other blood tests to find out what's causing the condition, how severe it is, and the best way to treat it.
Reticulocyte count. This test measures the number of reticulocytes (re-TIK-u-lo-sites) in your blood. Reticulocytes are young, immature red blood cells. Over time, reticulocytes become mature red blood cells that carry oxygen throughout your body.
A reticulocyte count shows whether your bone marrow is making red blood cells at the correct rate.
Peripheral smear. For this test, a sample of your blood is examined under a microscope. If you have iron-deficiency anemia, your red blood cells will look smaller and paler than normal.
Tests to measure iron levels. These tests can show how much iron has been used from your body's stored iron. Tests to measure iron levels include:
Serum
iron. This test measures the amount of iron in your
blood. The level of iron in your blood may be normal even if the total amount of iron in your body is low. For this reason, other iron tests also are done.
Serum ferritin. Ferritin is a
protein that helps store
iron in your body. A measure of this protein helps your doctor find out how much of your body's stored iron has been used.
Transferrin level, or total
iron-binding capacity. Transferrin is a
protein that carries iron in your
blood. Total iron-binding capacity measures how much of the transferrin in your blood isn't carrying iron. If you have iron-deficiency
anemia, you'll have a high level of transferrin that has no iron.
Other tests. Your doctor also may recommend tests to check your hormone levels, especially your thyroid hormone. You also may have a blood test for a chemical called erythrocyte protoporphyrin. This chemical is a building block for hemoglobin.
Children also may be tested for the level of lead in their blood. Lead can make it hard for the body to produce hemoglobin.
Tests and Procedures for Gastrointestinal Blood Loss
To check whether internal bleeding is causing your iron-deficiency anemia, your doctor may suggest a fecal occult blood test. This test looks for blood in the stools and can detect bleeding in the intestines.
If the test finds blood, you may have other tests and procedures to find the exact spot of the bleeding. These tests and procedures may look for bleeding in the stomach, upper intestines, colon, or pelvic organs.
How Is Iron-Deficiency Anemia Treated?
Treatment for iron-deficiency anemia will depend on its cause and severity. Treatments may include dietary changes and supplements, medicines, and surgery.
Severe iron-deficiency anemia may require a blood transfusion, iron injections, or intravenous (IV) iron therapy. Treatment may need to be done in a hospital.
The goals of treating iron-deficiency anemia are to treat its underlying cause and restore normal levels of red blood cells, hemoglobin, and iron.
Dietary Changes and Supplements
Iron
You may need iron supplements to build up your iron levels as quickly as possible. Iron supplements can correct low iron levels within months. Supplements come in pill form or in drops for children.
Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes. Keep iron supplements out of reach from children. This will prevent them from taking an overdose of iron.
Iron supplements can cause side effects, such as dark stools, stomach irritation, and heartburn. Iron also can cause constipation, so your doctor may suggest that you use a stool softener.
Your doctor may advise you to eat more foods that are rich in iron. The best source of iron is red meat, especially beef and liver. Chicken, turkey, pork, fish, and shellfish also are good sources of iron.
The body tends to absorb iron from meat better than iron from nonmeat foods. However, some nonmeat foods also can help you raise your iron levels. Examples of nonmeat foods that are good sources of iron include:
Iron-fortified breads and cereals
Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
Tofu
Dried fruits, such as prunes, raisins, and apricots
Spinach and other dark green leafy vegetables
Prune juice
The Nutrition Facts labels on packaged foods will show how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.
Vitamin C
Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.
If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. Grapefruit can affect the strength of a few medicines and how well they work.
Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.
Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.
Treatment To Stop Bleeding
If blood loss is causing iron-deficiency anemia, treatment will depend on the cause of the bleeding. For example, if you have a bleeding ulcer, your doctor may prescribe antibiotics and other medicines to treat the ulcer.
If a polyp or cancerous tumor in your intestine is causing bleeding, you may need surgery to remove the growth.
If you have heavy menstrual flow, your doctor may prescribe birth control pills to help reduce your monthly blood flow. In some cases, surgery may be advised.
Treatments for Severe Iron-Deficiency Anemia
Iron Therapy
If you have severe anemia, your doctor may recommend iron therapy. For this treatment, iron is injected into a muscle or an IV line in one of your blood vessels.
IV iron therapy presents some safety concerns. It must be done in a hospital or clinic by experienced staff. Iron therapy usually is given to people who need iron long-term but can't take iron supplements by mouth. This therapy also is given to people who need immediate treatment for iron-deficiency anemia.
How Can Iron-Deficiency Anemia Be Prevented?
Eating a well-balanced diet that includes iron-rich foods may help you prevent iron-deficiency anemia.
Taking iron supplements also may lower your risk for the condition if you're not able to get enough iron from food. Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.
For more information about diet and supplements, go to ""How Is Iron-Deficiency Anemia Treated?""
Infants and young children and women are the two groups at highest risk for iron-deficiency anemia. Special measures can help prevent the condition in these groups.
Infants and Young Children
A baby's diet can affect his or her risk for iron-deficiency anemia. For example, cow's milk is low in iron. For this and other reasons, cow's milk isn't recommended for babies in their first year. After the first year, you may need to limit the amount of cow's milk your baby drinks.
Also, babies need more iron as they grow and begin to eat solid foods. Talk with your child's doctor about a healthy diet and food choices that will help your child get enough iron.
Your child's doctor may recommend Go to:
What Is Kawasaki Disease?
Kawasaki (KAH-wah-SAH-ke) disease is a rare childhood disease. It's a form of a condition called vasculitis (vas-kyu-LI-tis). This condition involves inflammation of the blood vessels.
In Kawasaki disease, the walls of the blood vessels throughout the body become inflamed. The disease can affect any type of blood vessel in the body, including the arteries, veins, and capillaries.
Sometimes Kawasaki disease affects the coronary arteries, which carry oxygen-rich blood to the heart. As a result, some children who have Kawasaki disease may develop serious heart problems.
Overview
The cause of Kawasaki disease isn't known. The body's response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn't known.
The disease can't be passed from one child to another. Your child won't get it from close contact with a child who has the disease. Also, if your child has the disease, he or she can't pass it to another child.
Kawasaki disease affects children of all races and ages and both genders. It occurs most often in children of Asian and Pacific Island descent. The disease is more likely to affect boys than girls. Most cases occur in children younger than 5 years old.
One of the main symptoms of Kawasaki disease is a fever that lasts longer than 5 days. The fever remains high even after treatment with standard childhood fever medicines.
Children who have the disease also may have red eyes, red lips, and redness on the palms of their hands and soles of their feet. These are all signs of inflamed blood vessels.
Early treatment helps reduce the risk of Kawasaki disease affecting the coronary arteries and causing serious problems.
Outlook
Kawasaki disease can't be prevented. However, most children who have the disease usually recover within weeks of getting symptoms. Further problems are rare.
The disease affects some children's coronary arteries, which can cause serious problems. These children need long-term care and treatment.
Researchers continue to look for the cause of Kawasaki disease and better ways to diagnose and treat it. They also hope to learn more about long-term health risks, if any, for people who have had the disease.
Other Names for Kawasaki Disease
What Causes Kawasaki Disease?
The cause of Kawasaki disease isn't known. The body's response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn't known.
Kawasaki disease can't be passed from one child to another. Your child won't get it from close contact with a child who has the disease. Also, if your child has the disease, he or she can't pass it to another child.
Who Is at Risk for Kawasaki Disease?
Kawasaki disease affects children of all races and ages and both genders. It occurs most often in children of Asian and Pacific Island descent.
The disease is more likely to affect boys than girls. Most cases occur in children younger than 5 years old. Kawasaki disease is rare in children older than 8.
What Are the Signs and Symptoms of Kawasaki Disease?
Major Signs and Symptoms
One of the main symptoms during the early part of Kawasaki disease, called the acute phase, is fever. The fever lasts longer than 5 days. It remains high even after treatment with standard childhood fever medicines.
Other classic signs of the disease are:
A
rash on the mid-section of the body and in the genital area
Red, swollen
palms of the
hands and soles of the feet
Other Signs and Symptoms
During the acute phase, your child also may be irritable and have a sore throat, joint pain, diarrhea, vomiting, and stomach pain.
Within 2 to 3 weeks of the start of symptoms, the skin on your child's fingers and toes may peel, sometimes in large sheets.
How Is Kawasaki Disease Diagnosed?
Kawasaki disease is diagnosed based on your child's signs and symptoms and the results from tests and procedures.
Specialists Involved
Pediatricians often are the first to suspect a child has Kawasaki disease. Pediatricians are doctors who specialize in treating children.
If the disease has affected your child's coronary (heart) arteries, a pediatric cardiologist will confirm the diagnosis and give ongoing treatment. Pediatric cardiologists treat children who have heart problems.
Other specialists also may be involved in treating children who have Kawasaki disease.
Signs and Symptoms
The doctor will check your child for the classic signs and symptoms of Kawasaki disease.
The doctor will rule out other diseases that cause similar symptoms. These diseases include Rocky Mountain spotted fever, scarlet fever, and juvenile rheumatoid arthritis.
Generally, your child will be diagnosed with Kawasaki disease if he or she has a fever that lasts longer than 5 days plus four other classic signs or symptoms of the disease.
However, not all children have classic signs and symptoms of Kawasaki disease. Tests and procedures can help confirm whether a child has the disease.
Tests and Procedures
Echocardiography
If the doctor thinks that your child has Kawasaki disease, he or she will likely recommend echocardiography (EK-o-kar-de-OG-ra-fee), or echo. This painless test uses sound waves to create pictures of the heart and coronary arteries.
Echo also can help show the disease's effects over time, if any, on your child's coronary arteries. Often, the disease's effects on the coronary arteries don't show up until the second or third week after the first symptoms appear. Thus, this test is done regularly after the diagnosis.
Some children who have Kawasaki disease don't have the classic signs and symptoms of the acute phase. Doctors may not diagnose these children until 2 to 3 weeks after the onset of the disease. This is when another common sign of Kawasaki disease occurs—peeling of the skin on the fingers and toes.
If your child is diagnosed at this point, he or she will likely need echo right away to see whether the disease has affected the coronary arteries.
Other Diagnostic Tests
Doctors also use other tests to help diagnose Kawasaki disease, such as:
How Is Kawasaki Disease Treated?
Medicines are the main treatment for Kawasaki disease. Rarely, children whose coronary (heart) arteries are affected may need medical procedures or surgery.
The goals of treatment include:
Initial Treatment
Kawasaki disease can cause serious health problems. Thus, your child will likely be treated in a hospital, at least for the early part of treatment.
The standard treatment during the disease's acute phase is high-dose aspirin and immune globulin. Immune globulin is a medicine that's injected into a vein.
Most children who receive these treatments improve greatly within 24 hours. For a small number of children, fever remains. These children may need a second round of immune globulin.
At the start of treatment, your child will receive high doses of aspirin. As soon as his or her fever goes away, a low dose of aspirin is given. The low dose helps prevent blood clots, which can form in the inflamed small arteries.
Most children treated for Kawasaki disease fully recover from the acute phase and don't need any further treatment. They should, however, follow a healthy diet and adopt healthy lifestyle habits. Taking these steps can help lower the risk of future heart disease. (Following a healthy lifestyle is advised for all children, not just those who have Kawasaki disease.)
Children who have had immune globulin should wait 11 months before having the measles and chicken pox vaccines. Immune globulin can prevent those vaccines from working well.
Long-Term Care and Treatment
If Kawasaki disease has affected your child's coronary arteries, he or she will need ongoing care and treatment.
It's best if a pediatric cardiologist provides this care to reduce the risk of severe heart problems. A pediatric cardiologist is a doctor who specializes in treating children who have heart problems.
Medicines and Tests
When Kawasaki disease affects the coronary arteries, they may expand and twist. If this happens, your child's doctor may prescribe blood-thinning medicines (for example, warfarin). These medicines help prevent blood clots from forming in the affected coronary arteries.
Blood-thinning medicines usually are stopped after the coronary arteries heal. Healing may occur about 18 months after the acute phase of the disease.
In a small number of children, the coronary arteries don't heal. These children likely will need routine tests, such as:
Medical Procedures and Surgery
Rarely, a child who has Kawasaki disease may need cardiac catheterization (KATH-eh-ter-ih-ZA-shun). Doctors use this procedure to diagnose and treat some heart conditions.
A flexible tube called a catheter is put into a blood vessel in the arm, groin (upper thigh), or neck and threaded to the heart. Through the catheter, doctors can perform tests and treatments on the heart.
Very rarely, a child may need to have other procedures or surgery if inflammation narrows his or her coronary arteries and blocks blood flow to the heart. Coronary angioplasty (AN-jee-oh-plas-tee), stent placement, or coronary artery bypass grafting (CABG) may be used.
Coronary angioplasty restores blood flow through narrowed or blocked coronary arteries. A thin tube with a balloon on the end is inserted into a blood vessel in the arm or groin. The tube is threaded to the narrowed or blocked coronary artery. Then, the balloon is inflated to widen the artery and restore blood flow.
A stent (small mesh tube) may be placed in the coronary artery during angioplasty. This device helps support the narrowed or weakened artery. A stent can improve blood flow and prevent the artery from bursting.
Rarely, a child may need to have CABG. This surgery is used to treat blocked coronary arteries. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery.
The grafted artery or vein bypasses (that is, goes around) the blocked part of the coronary artery. This improves blood flow to the heart.
How Can Kawasaki Disease Be Prevented?
Kawasaki disease can't be prevented. However, most children who have the disease recover—usually within weeks of getting signs and symptoms. Further problems are rare.
Living With Kawasaki Disease
Most children who have Kawasaki disease recover—usually within weeks of getting symptoms. Further problems are rare. Early treatment reduces the risk of serious problems.
Researchers continue to look for the cause of Kawasaki disease and better ways to diagnose and treat it. They also hope to learn more about long-term health risks, if any, for people who have had the disease.
What To Expect After Treatment
Most children who are treated for Kawasaki disease fully recover from the acute phase. They don't need further treatment.
They should, however, follow a healthy diet and adopt healthy lifestyle habits. Taking these steps can help lower their risk of future heart disease. (Following a healthy lifestyle is advised for all children, not just those who have Kawasaki disease).
Children treated with immune globulin should wait 11 months before having measles and chicken pox vaccines. Immune globulin can prevent these vaccines from working well.
Ongoing Health Care Needs
If Kawasaki disease has affected your child's coronary arteries, he or she will need ongoing care and treatment. It's best if a pediatric cardiologist provides this care to reduce the risk of severe heart problems. A pediatric cardiologist is a doctor who specializes in treating children who have heart problems.
Support Groups
Joining a support group may help you adjust to caring for a child who has Kawasaki disease. You can see how other parents have coped with the disease. Ask your child's doctor about local support groups or check with an area medical center.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.
When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.
If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to Kawasaki disease, talk with your child's doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is LAM?
LAM, or lymphangioleiomyomatosis (lim-FAN-je-o-LI-o-MI-o-ma-TO-sis), is a rare lung disease that mostly affects women of childbearing age.
In LAM, abnormal, muscle-like cells begin to grow out of control in certain organs or tissues, especially the lungs, lymph nodes, and kidneys.
Over time, these LAM cells can destroy the normal lung tissue. As a result, air can’t move freely in and out of the lungs. In some cases, this means the lungs can’t supply the body’s other organs with enough oxygen.
Overview
There are two forms of LAM. Sporadic LAM occurs for unknown reasons. LAM also can occur in women who have a rare disease called tuberous sclerosis complex (TSC). Women who have TSC often have a milder form of LAM.
About 50 percent of women who have LAM develop pneumothorax (noo-mo-THOR-aks), or collapsed lung. In this condition, air leaks out of the lung and into the space between the lung and chest wall (the pleural space).
A collapsed lung can cause pain and shortness of breath. Sometimes one lung will collapse over and over again. Pneumothorax is a serious condition. It usually requires treatment and might be life threatening.
Many women who have LAM get tumors called angiomyolipomas (AN-je-o-my-o-li-PO-mas), or AMLs, in their kidneys. Women who have LAM also may develop:
Outlook
LAM has no cure, and the disease tends to worsen over time. How quickly the disease worsens varies from woman to woman. LAM may lead to death from respiratory failure. Lung transplant is a treatment option for women whose lungs have been damaged by LAM.
Not long ago, doctors thought women who had LAM wouldn't live more than 8–10 years following diagnosis. They now know that some women may survive longer (as long as 20 years following diagnosis, although this is rare).
Doctors have learned a lot about LAM in recent years. They're now able to diagnose the condition earlier. Support services also are now available to help improve the quality of life for women who have LAM.
Researchers continue to explore and test new treatments for LAM.
What Causes LAM?
The cause of LAM and why it mainly affects women isn’t known. Recent studies show that sporadic LAM has some of the same traits as another rare disease called tuberous sclerosis complex (TSC). This information has provided some valuable clues about what causes LAM.
The common features of sporadic LAM and TSC are:
Kidney growths. People who have TSC get growths in their
kidneys. These growths are the same as the
angiomyolipomas that many women who have LAM get in their kidneys.
Lung
cysts. Some women who have TSC get cysts in their
lungs. These cysts are the same as the ones that women who have sporadic LAM get in their lungs. When a woman who has TSC gets cysts in her lungs, the
lung disease is called TSC-associated LAM or TSC–LAM.
TSC is a genetic disease. A defect in one of two genes causes the disease. These genes are called TSC1 and TSC2. They normally make proteins that control cell growth and movement in the body. In people who have TSC, the genes are faulty. The proteins that the genes make can’t control cell growth and movement.
Women who have LAM also have abnormal TSC1 and TSC2 genes. Researchers have found that these genes play a role in causing LAM. This finding is leading to new treatments for LAM.
Because LAM affects women, the hormone estrogen also may play a role in causing the disease.
Who Is at Risk for LAM?
LAM is a rare disease that mostly affects women of childbearing age. Many women who develop LAM are between the ages of 20 and 40 when they begin to have symptoms. LAM can occur in older women as well, although this is less common.
Some women might have LAM and not know it. Many of LAM’s signs and symptoms are the same as those of other diseases, such as asthma, emphysema (em-fih-SE-ma), and bronchitis (brong-KI-tis).
LAM affects about 3 out of every 10 women who have tuberous sclerosis complex (TSC). Some of these women may have mild cases of LAM that don’t cause symptoms. Not everyone who has TSC and LAM has lung symptoms.
In rare cases, LAM has been reported in men.
What Are the Signs and Symptoms of LAM?
The uncontrolled growth of LAM cells and their effect on nearby body tissues causes the signs and symptoms of LAM. The most common signs and symptoms are:
Shortness of breath, especially during activity. At first, shortness of breath may occur only during high-energy activities. Over time, you may have trouble breathing during simple activities, such as dressing and showering.
Chest pain or aches. This pain might be worse when you breathe in.
Frequent
cough. This may occur with bloody
phlegm (a sticky fluid).
Wheezing (a whistling sound when you breathe).
Other signs and symptoms of LAM include:
Other diseases also can cause many of these signs and symptoms. If you’re having any of these problems, see your doctor. He or she can help find the cause of your symptoms.
How Is LAM Diagnosed?
Methods for diagnosing LAM have improved. It's now possible for doctors to diagnose the disease at an early stage.
LAM is diagnosed based on your signs and symptoms and the results from tests and procedures. If you have LAM, you may need to see a pulmonologist. This is a doctor who specializes in lung diseases and conditions.
Signs and Symptoms
Your doctor will ask about your signs and symptoms related to LAM. He or she may ask how long you’ve had symptoms, and whether they’ve become worse over time.
Many of LAM’s signs and symptoms are the same as those of other diseases, such as asthma, emphysema, and bronchitis. Your doctor will want to rule out those conditions before making a final diagnosis.
Diagnostic Tests and Procedures
Your doctor may recommend tests to show how well your lungs are working and what your lung tissue looks like.
These tests can show whether your lungs are delivering enough oxygen to your blood. You also may have tests to check for complications of LAM.
Tests for Lung Function
Lung function tests. For lung function tests, you breathe through a mouthpiece into a machine called a spirometer (spi-ROM-eh-ter). The spirometer measures the amount of air you breathe in and out.
Other lung function tests can show about how much air your lungs can hold and how well your lungs deliver oxygen to your blood.
Blood tests. Your doctor may take a blood sample from a vein in your arm to look at your blood cells and blood chemistry.
Pulse oximetry. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood.
Tests To Check for Complications or Detect LAM Cells
Chest x ray. A chest x ray creates a picture of the structures in your chest, such as your heart and lungs. The test can show a collapsed lung or fluid in your chest. In the early stages of LAM, your chest x rays may look normal. As the disease gets worse, the x rays may show cysts in your lungs.
High-resolution CT (HRCT) scan. The most useful imaging test for diagnosing LAM is an HRCT scan. This test creates a computer-generated picture of your lungs. The picture shows more detail than the pictures from a chest x ray.
An HRCT scan can show cysts, shadows of cell clusters, excess fluid, a collapsed lung, and enlarged lymph nodes. The test also can show how much normal lung tissue has been replaced by the LAM cysts.
HRCT scans of your abdomen and pelvis can show whether you have growths in your kidneys, other abdominal organs, or lymph nodes.
Procedures To Look for LAM Cells
The results from the above tests—along with information about your signs, symptoms, and medical history—might be enough for your doctor to diagnose LAM.
However, if your doctor needs more information, the most useful method involves looking at samples of your lung tissue for LAM cells.
You may want to see a doctor who specializes in LAM for this test. Several procedures can be used to get a sample of lung tissue.
Video-assisted thoracoscopy (tho-rah-KOS-ko-pe). In this procedure, also called VAT, your doctor inserts a small, lighted tube into little cuts made in your chest wall. This lets him or her look inside your chest and snip out a few small pieces of lung tissue.
VAT is done in a hospital. The procedure isn’t major surgery, but it does require general anesthesia (that is, you’re given medicine to make you sleep during the procedure).
Open lung biopsy. In this procedure, your doctor removes a few small pieces of lung tissue through a cut made in your chest wall between your ribs. An open lung biopsy is done in a hospital. You’ll be given medicine to make you sleep during the procedure.
Open lung biopsies are rarely done anymore because the recovery time is much longer than the recovery time from VAT.
Transbronchial biopsy. In this procedure, your doctor inserts a long, narrow, flexible, lighted tube down your windpipe and into your lungs. He or she then snips out bits of lung tissue using a tiny device.
This procedure usually is done in a hospital. Your mouth and throat are numbed to prevent pain.
The amount of tissue that your doctor removes is very small, so this test doesn’t always provide enough information.
Other biopsies. Your doctor also can diagnose LAM using the results from other tissue biopsies, such as biopsies of lymph nodes or lymphatic tumors called lymphangiomyomas.
Other Tests
If you’re diagnosed with sporadic LAM, your doctor may advise you to have a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your head. These tests can help screen for underlying tuberous sclerosis complex (TSC).
CT and MRI scans will reveal TSC in only a small number of people who are initially diagnosed with sporadic LAM.
Researchers are exploring other tests that may help diagnose LAM. These tests include blood tests for the LAM cells or a blood vessel growth factor called VEGF-D.
How Is LAM Treated?
Currently, no treatment is available to stop the growth of the cysts and cell clusters that occur in LAM. Most treatments for LAM are aimed at easing symptoms and preventing complications.
The main treatments are:
Medicines to improve air flow in the
lungs and reduce wheezing
Procedures to remove fluid from the
chest or
abdomen and stop it from building up again
Medicines
Medicines That Help You Breathe Better
If you’re having trouble breathing, your doctor may prescribe bronchodilators. These medicines relax the muscles around the airways. This helps the airways open up, making it easier for you to breathe.
Lung function tests can sometimes show whether these medicines are likely to help you.
Medicines That Prevent Bone Loss
Women who have LAM are at risk for a bone-weakening condition called osteoporosis (OS-te-o-po-RO-sis). This is in part because many LAM therapies block the estrogen action needed to keep bones strong.
To prevent osteoporosis, your doctor may measure your bone density. If you have lost bone density, your doctor may prescribe medicines to prevent bone loss. He or she also may prescribe calcium and vitamin D supplements.
Rapamycin (Sirolimus)
Sirolimus was originally developed to prevent the immune system from rejecting kidney transplants. However, studies have shown that the medicine helps regulate the abnormal growth and movement of LAM cells.
Research suggests that sirolimus may shrink tumors in the kidneys of women who have LAM.
A recent study funded in part by the National Institutes of Health showed that sirolimus also helps stabilize lung function, reduce symptoms, and improve quality of life for people who have LAM.
Sirolimus does have side effects, some of which can be serious. If you have LAM, talk with your doctor about the benefits and risks of this medicine, and whether it’s an option for you.
Oxygen Therapy
If the level of oxygen in your blood is low, your doctor may suggest oxygen therapy. Oxygen usually is given through nasal prongs or a mask. At first, you may need oxygen only while exercising. It also may help to use it while sleeping. Over time, you may need full-time oxygen therapy.
A standard exercise stress test or a 6-minute walk test can show whether you need oxygen while exercising. A 6-minute walk test measures the distance you can walk in 6 minutes. An exercise stress test measures how well your lungs and heart work while you walk on a treadmill or pedal a stationary bike.
You also may need a blood test to show your blood oxygen level and how much oxygen you need.
For more information, go to the Health Topics Oxygen Therapy article.
Procedures To Remove Air or Fluid From the Chest or Abdomen
Several procedures can remove excess air or fluid from your chest and abdomen. These procedures also help prevent air or fluid from building up again.
Removing fluid from your chest or abdomen may help relieve discomfort and shortness of breath. The procedure to remove fluid from the chest is called thoracentesis (THOR-ah-sen-TE-sis). The procedure to remove fluid from the abdomen is called paracentesis (PAR-ah-sen-TE-sis).
Your doctor often can remove the fluid with a needle and syringe. If large amounts of fluid build up in your chest, your doctor may have to insert a tube into your chest to remove the fluid.
Removing air from your chest may relieve shortness of breath and chest pain caused by a collapsed lung. Your doctor usually can remove the air with a tube. The tube is inserted into your chest between your side ribs. Often, the tube is attached to a suction device. If this procedure doesn't work, or if your lungs collapse often, you may need surgery.
If fluid and air often leak into your chest, your doctor may inject a chemical at the site of the leakage. The chemical fuses your lung and chest wall together. This removes the space for leakage.
Your doctor may do this procedure at your bedside in the hospital. You will be given medicine to prevent pain. The procedure also can be done in an operating room using video-assisted thoracoscopy. In this case, you will be given medicine to make you sleep during the procedure.
Procedures To Remove or Shrink Angiomyolipomas
AMLs often don't cause symptoms, but sometimes they can cause ongoing pain or bleeding. If this happens, you may need surgery to remove some of the tumors.
If bleeding isn't too severe, a radiologist often can block the blood vessels feeding the AMLs. This may cause them to shrink.
Lung Transplant
Lung transplants can improve lung function and quality of life in patients who have advanced LAM.
However, lung transplants have a high risk of complications, including infections and rejection of the transplanted lung by the body.
Studies suggest that more than three-quarters of women with LAM who receive a lung transplant survive for at least 3 years.
In a few cases, doctors have found LAM cells in the newly transplanted lungs and other parts of the body. However, the LAM cells don't seem to stop the transplanted lung from working.
For more information, go to the Health Topics Lung Transplant article.
Hormone Therapy
Estrogen is thought to play a role in causing LAM. Thus, your doctor may want to treat you with hormone therapy that limits the effects of estrogen on your body. Hormone therapy is given in pill form or as injections.
Some doctors also suggest surgery to remove the ovaries. This causes menopause and greatly reduces estrogen levels in the body.
Unfortunately, at this time, no clear evidence shows that this type of treatment works for women who have LAM.
Living With LAM
In the early stages of LAM, you usually can do your normal daily activities. These may include attending school, going to work, and doing common physical activities such as walking up stairs.
In the later stages of LAM, you may find it harder to be active. You also may need oxygen therapy full time.
Ongoing Care
Getting ongoing medical care is important. You may need to see a pulmonologist. This is a doctor who specializes in treating lung diseases and conditions.
Take steps to care for your lungs. For example, talk with your doctor about getting a yearly flu shot and pneumonia vaccine.
Lifestyle Changes
If you have LAM, taking good care of your health is important. Follow a healthy eating plan, be as physically active as you can, and get plenty of rest.
If you smoke, quit. Talk to your doctor about programs and products that can help you quit smoking.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI’s) ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include basic information about how to quit smoking.
Also, check with your doctor before traveling by air or traveling to areas where medical attention isn't readily available. Also, talk to your doctor before traveling to places where the amount of oxygen in the air is low.
Pregnancy and Birth Control
If your lung function is normal, pregnancy might be an option. However, hormones during pregnancy can worsen LAM. Thus, you should discuss a possible pregnancy with both a pulmonologist who specializes in LAM and your obstetrician.
Most doctors don't recommend birth control pills containing estrogen to women who have LAM. Talk to your doctor about birth control options.
Emotional Issues and Support
Living with LAM may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with LAM. Information about patient support groups is available from the NHLBI Health Information Center at 301–592–8573 or the National Institutes of Health/NHLBI Pulmonary Vascular Medicine Branch at 1–877–NIH–LUNG (1–877–644–5864), extension 3.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent and treat these diseases.
Many more questions remain about chronic lung diseases, including LAM. The NHLBI continues to support research aimed at learning more about these diseases. For example, NHLBI-supported research on LAM includes studies that explore:
The disease processes involved in LAM, and how to develop better
treatments based on these processes
Much of the NHLBI’s research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you may gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to LAM, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Long QT Syndrome?
Long QT syndrome (LQTS) is a disorder of the heart's electrical activity. It can cause sudden, uncontrollable, dangerous arrhythmias (ah-RITH-me-ahs) in response to exercise or stress. Arrhythmias are problems with the rate or rhythm of the heartbeat.
People who have LQTS also can have arrhythmias for no known reason. However, not everyone who has LQTS has dangerous heart rhythms. When they do occur, though, they can be fatal.
What Does ""Long QT"" Mean?
The term ""long QT"" refers to an abnormal pattern seen on an EKG (electrocardiogram). An EKG is a test that detects and records the heart's electrical activity.
With each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As it travels, the signal causes the heart to contract and pump blood. An EKG records electrical signals as they move through your heart.
Data from the EKG are mapped on a graph so your doctor can study your heart's electrical activity. Each heartbeat is mapped as five distinct electrical waves: P, Q, R, S, and T.
![]()
EKG. The picture shows the standard setup for an EKG. Figure A shows the data from the EKG, which are mapped on a graph. In figure B, a patient lies in bed with EKG electrodes attached to his chest, upper arms, and legs. A nurse oversees the painless procedure. (more...)
The electrical activity that occurs between the Q and T waves is called the QT interval. This interval shows electrical activity in the heart's lower chambers, the ventricles (VEN-trih-kuls).
The timing of the heart's electrical activity is complex, and the body carefully controls it. Normally the QT interval is about a third of each heartbeat cycle. However, in people who have LQTS, the QT interval lasts longer than normal.
A long QT interval can upset the careful timing of the heartbeat and trigger dangerous heart rhythms.
For more information about the heart's electrical system, go to the Health Topics How the Heart Works article.
Overview
On the surface of each heart muscle cell are tiny pores called ion channels. Ion channels open and close to let electrically charged sodium, calcium, and potassium atoms (ions) flow into and out of each cell. This generates the heart's electrical activity.
In people who have LQTS, the ion channels may not work well, or there may be too few of them. This may disrupt electrical activity in the heart's ventricles and cause dangerous arrhythmias.
LQTS often is inherited, which means you're born with the condition and have it your whole life. There are seven known types of inherited LQTS. The most common ones are LQTS 1, 2, and 3.
In LQTS 1, emotional stress or exercise (especially swimming) can trigger arrhythmias. In LQTS 2, extreme emotions, such as surprise, can trigger arrhythmias. In LQTS 3, a slow heart rate during sleep can trigger arrhythmias.
You also can acquire LQTS. This means you aren't born with the disorder, but you develop it during your lifetime. Some medicines and conditions can cause acquired LQTS. (For more information, go to ""What Causes Long QT Syndrome?"")
Outlook
More than half of the people who have untreated, inherited types of LQTS die within 10 years. However, lifestyle changes and medicines can help people who have LQTS prevent complications and live longer.
Some of these lifestyle changes and treatments include:
If you have LQTS, talk with your doctor about which lifestyle changes and treatments are best for you.
Other Names for Long QT Syndrome
What Causes Long QT Syndrome?
Long QT syndrome (LQTS) can be inherited or acquired. ""Inherited"" means you're born with the condition and have it your whole life. Inherited conditions are passed from parents to children through genes. ""Acquired"" means you aren't born with the condition, but you develop it during your lifetime.
Inherited Long QT Syndrome
Faulty genes cause inherited LQTS. These genes control the production of certain types of ion channels in your heart. Faulty genes may cause the body to make too few ion channels, ion channels that don't work well, or both.
There are seven known types of inherited LQTS (types 1 though 7). The most common types are LQTS 1, 2, and 3.
Some types of LQTS involve faulty or lacking potassium ion or sodium ion channels.
If you have LQTS 1 or LQTS 2, the flow of potassium ions through the ion channels in your heart cells isn't normal. This may cause problems when you exercise or when you have strong emotions.
You may develop a rapid, uncontrollable heart rhythm that prevents your heart from pumping blood. This type of heart rhythm can be fatal if it's not quickly brought under control.
If you have LQTS 3, the flow of sodium ions through ion channels in your heart cells isn't normal. This can trigger a rapid, uncontrollable heart rhythm that can be fatal. In LQTS 3, problems usually occur when your heart beats slower than normal, such as during sleep.
Acquired Long QT Syndrome
Some medicines and conditions can cause acquired LQTS.
Medication-Induced Long QT Syndrome
More than 50 medicines have been found to cause LQTS. Some common medicines that may cause the disorder include:
Some people who have medication-induced LQTS also may have an inherited form of the disorder. They may not have symptoms unless they take medicines that lengthen the QT interval or lower potassium levels in the blood. When LQTS doesn't cause symptoms, it's called silent LQTS.
Who Is at Risk for Long QT Syndrome?
Long QT syndrome (LQTS) is a rare disorder. Experts think that about 1 in 7,000 people has LQTS. But no one knows for sure, because LQTS often goes undiagnosed.
LQTS causes about 3,000 to 4,000 sudden deaths in children and young adults each year in the United States. Unexplained sudden deaths in children are rare. When they do occur, LQTS often is the cause.
Inherited LQTS usually is first detected during childhood or young adulthood. Half of all people who have LQTS have their first abnormal heart rhythm by the time they're 12 years old, and 90 percent by the time they're 40 years old. The condition rarely is diagnosed after age 40.
In boys who have LQTS, the QT interval (which can be seen on an EKG test) often returns toward normal after puberty. If this happens, the risk of LQTS symptoms and complications goes down.
LQTS is more common in women than men. Women who have LQTS are more likely to faint or die suddenly from the disorder during menstruation and shortly after giving birth.
Children who are born deaf also are at increased risk for LQTS. This is because the same genetic problem that affects hearing also affects the function of ion channels in the heart.
Major Risk Factors
You're at risk of having LQTS if anyone in your family has ever had it. Unexplained fainting or seizures, drowning or near drowning, and unexplained sudden death are all possible signs of LQTS.
You're also at risk for LQTS if you take medicines that make the QT interval longer. Your doctor can tell you whether your prescription or over-the-counter medicines might do this.
You also may develop LQTS if you have excessive vomiting or diarrhea or other conditions that cause low blood levels of potassium or sodium. These conditions include the eating disorders anorexia nervosa and bulimia, as well as some thyroid disorders.
What Are the Signs and Symptoms of Long QT Syndrome?
Major Signs and Symptoms
If you have long QT syndrome (LQTS), you can have sudden and dangerous arrhythmias (abnormal heart rhythms). Signs and symptoms of LQTS-related arrhythmias often first occur during childhood and include:
Unexplained
fainting. This happens because the
heart isn't pumping enough
blood to the
brain. Fainting may occur during physical or emotional
stress. Fluttering feelings in the
chest may occur before fainting.
Unexplained drowning or near drowning. This may be due to
fainting while swimming.
Unexplained
sudden cardiac arrest (SCA) or death. SCA is a condition in which the
heart suddenly stops beating for no obvious reason. People who have SCA die within minutes unless they receive
treatment. In about 1 out of 10 people who have LQTS, SCA or sudden death is the first sign of the disorder.
Other Signs and Symptoms
Often, people who have LQTS 3 develop an abnormal heart rhythm during sleep. This may cause noisy gasping while sleeping.
Silent Long QT Syndrome
Sometimes long QT syndrome doesn't cause any signs or symptoms. This is called silent LQTS. For this reason, doctors often advise family members of people who have LQTS to be tested for the disorder, even if they have no symptoms.
Medical and genetic tests may reveal whether these family members have LQTS and what type of the condition they have.
How Is Long QT Syndrome Diagnosed?
Cardiologists diagnose and treat long QT syndrome (LQTS). Cardiologists are doctors who specialize in diagnosing and treating heart diseases and conditions. To diagnose LQTS, your cardiologist will consider your:
EKG (Electrocardiogram)
An EKG is a simple test that detects and records the heart's electrical activity. This test may show a long QT interval and other signs that suggest LQTS. Often, doctors first discover a long QT interval when an EKG is done for another suspected heart problem.
Not all people who have LQTS will always have a long QT interval on an EKG. The QT interval may change from time to time; it may be long sometimes and normal at other times. Thus, your doctor may want you to have several EKG tests over a period of days or weeks. Or, your doctor may have you wear a device called a Holter monitor.
A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period. It can detect heart problems that occur for only a few minutes out of the day.
You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. You can clip the recorder to a belt, keep it in a pocket, or hang it around your neck.
While you wear the monitor, you do your usual daily activities. You also keep a notebook, noting any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.
Some people have a long QT interval only while they exercise. For this reason, your doctor may recommend that you have a stress test.
During a stress test, you exercise to make your heart work hard and beat fast. An EKG is done while you exercise. If you can't exercise, you may be given medicine to increase your heart rate.
Medical History and Physical Exam
Your doctor will ask whether you've had any symptoms of an abnormal heart rhythm. Symptoms may include:
A fluttering feeling in your
chest, which is the result of your
heart beating too fast
Loud gasping during
sleep
Your doctor may ask what over-the-counter, prescription, or other drugs you take. He or she also may want to know whether anyone in your family has been diagnosed with or has had signs of LQTS. Signs of LQTS include unexplained fainting, drowning, sudden cardiac arrest, or sudden death.
Your doctor will check you for signs of conditions that may lower blood levels of potassium or sodium. These conditions include the eating disorders anorexia nervosa and bulimia, excessive vomiting or diarrhea, and certain thyroid disorders.
Genetic Tests
Genetic blood tests can detect some forms of inherited LQTS. If your doctor thinks that you have LQTS, he or she may suggest genetic testing. Genetic blood tests usually are suggested for family members of people who have LQTS as well.
However, genetic tests don't always detect LQTS. So, even if you have the disorder, the tests may not show it.
Also, some people who test positive for LQTS don't have any signs or symptoms of the disorder. These people may have silent LQTS. Less than 10 percent of these people will faint or suddenly die from an abnormal heart rhythm.
Even if you have silent LQTS, you may be at increased risk of having an abnormal heart rhythm while taking medicines that affect potassium ion channels or blood levels of potassium.
Types of Inherited Long QT Syndrome
If you have inherited LQTS, it may be helpful to know which type you have. This will help you and your doctor plan your treatment and decide which lifestyle changes you should make.
To find out what type of LQTS you have, your doctor will consider:
How Is Long QT Syndrome Treated?
The goal of treating long QT syndrome (LQTS) is to prevent life-threatening, abnormal heart rhythms and fainting spells.
Treatment isn't a cure for the disorder and may not restore a normal QT interval on an EKG (electrocardiogram). However, treatment greatly improves the chances of survival.
Specific Types of Treatment
Your doctor will recommend the best treatment for you based on:
People who have LQTS without symptoms may be advised to:
Make lifestyle changes that reduce the risk of
fainting or SCA. Lifestyle changes may include avoiding certain sports and strenuous
exercise, such as swimming, which can cause abnormal
heart rhythms.
Take medicines such as beta-
blockers, which reduce the risk of symptoms by slowing the
heart rate.
The type of medicine you take will depend on the type of LQTS you have. For example, doctors usually will prescribe sodium channel blocker medicines only for people who have LQTS 3.
If your doctor thinks you're at increased risk for LQTS complications, he or she may suggest more aggressive treatments (in addition to medicines and lifestyle changes). These treatments may include:
People at increased risk are those who have fainted or who have had dangerous heart rhythms from their LQTS.
Lifestyle Changes
If possible, try to avoid things that can trigger abnormal heart rhythms. For example, people who have LQTS should avoid medicines that lengthen the QT interval or lower potassium blood levels. (For more information, go to ""What Causes Long QT Syndrome?"")
Many people who have LQTS also benefit from adding more potassium to their diets. Check with your doctor about eating more potassium-rich foods (such as bananas) or taking potassium supplements daily.
Medicines
Beta blockers are medicines that prevent the heart from beating faster in response to physical or emotional stress. Most people who have LQTS are treated with beta blockers.
Doctors may suggest that people who have LQTS 3 take sodium channel blockers, such as mexiletine. These medicines make sodium ion channels less active.
Medical Devices
Pacemakers and ICDs are small devices that help control abnormal heart rhythms. Both devices use electrical currents to prompt the heart to beat normally. Surgeons implant pacemakers and ICDs in the chest or belly with a minor procedure.
The use of these devices is similar in children and adults. However, because children are still growing, other issues may arise. For example, as children grow, they may need to have their devices replaced.
Surgery
People who are at high risk of death from LQTS sometimes are treated with surgery. During surgery, the nerves that prompt the heart to beat faster in response to physical or emotional stress are cut.
This type of surgery keeps the heart beating at a steady pace and lowers the risk of dangerous heart rhythms in response to stress or exercise.
Living With Long QT Syndrome
Long QT syndrome (LQTS) usually is a lifelong condition. The risk of having an abnormal heart rhythm that leads to fainting or sudden cardiac arrest may lessen as you age. However, the risk never completely goes away.
You'll need to take certain steps for the rest of your life to prevent abnormal heart rhythms. You can:
Avoid things that trigger abnormal
heart rhythms
Let others know you might
faint or your
heart might stop beating, and tell them what steps they can take
Have a plan in place for how to handle abnormal
heart rhythms
If an abnormal heart rhythm does occur, you'll need to seek treatment right away.
Avoid Triggers
If exercise triggers an abnormal heart rhythm, your doctor may tell you to avoid any strenuous exercise, especially swimming. Ask your doctor what types and amounts of exercise are safe for you.
If you have a pacemaker or implantable cardioverter defibrillator, avoid contact sports that may dislodge these devices. You may want to exercise in public or with a friend who can help you if you faint.
Avoid medicines that can trigger an abnormal heart rhythm. This includes some medicines used to treat allergies, infections, high blood pressure, high blood cholesterol, depression, and arrhythmias. Talk with your doctor before taking any prescription, over-the-counter, or other medicines or drugs.
Seek medical care right away for conditions that lower the sodium or potassium level in your blood. These conditions include the eating disorders anorexia nervosa and bulimia, excessive vomiting or diarrhea, and certain thyroid disorders.
If you have LQTS 2, try to avoid unexpected noises, such as loud or jarring alarm clock buzzers and telephone ringers.
Inform Others
You may want to wear a medical ID necklace or bracelet that states that you have LQTS. This will help alert medical personnel and others about your condition if you have an emergency.
Let your roommates, coworkers, or other people with whom you have regular contact know that you have a condition that might cause you to faint or go into cardiac arrest. Tell them to call 9–1–1 right away if you faint.
Consider asking a family member and/or coworker to learn cardiopulmonary resuscitation (CPR) in case your heart stops beating.
You also may want to keep an automated external defibrillator (AED) with you at home or at work. This device uses electric shocks to restore a normal heart rhythm.
Someone at your home and/or workplace should be trained on how to use the AED, just in case your heart stops beating. If a trained person isn't available, an untrained person also can use the AED to help save your life.
If you have LQTS 3 and you sleep alone, you may want to have an intercom in your bedroom that's connected to someone else's bedroom. This will let others detect the noisy gasping that often occurs if you have an abnormal heart rhythm while lying down.
Ongoing Health Care Needs
You should see your cardiologist (heart specialist) regularly. He or she will adjust your treatment as needed. For example, if you still faint often while using less aggressive treatments, your doctor may suggest other treatment options.
Emotional Issues and Support
Living with LQTS may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with LQTS. You can see how other people have coped with the condition. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Some people learn they have LQTS because they're tested after a family member dies suddenly from LQTS. Grief counseling may help you cope if this has happened to you. Talk with your doctor about finding a grief counselor.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to long QT syndrome, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Lymphocytopenia?
Lymphocytopenia (LIM-fo-si-to-PE-ne-ah) is a disorder in which your blood doesn’t have enough white blood cells called lymphocytes (LIM-fo-sites).
These cells are made in the bone marrow along with other kinds of blood cells. Lymphocytes help protect your body from infection. Low numbers of lymphocytes can raise your risk of infection.
Lymphocytopenia also is called lymphopenia.
Overview
About 20 to 40 percent of all white blood cells are lymphocytes. A normal lymphocyte count for adults usually is between 1,000 and 4,800 lymphocytes per microliter of blood. For children, a normal lymphocyte count usually is between 3,000 and 9,500 lymphocytes per microliter of blood.
The term ""lymphocytopenia"" refers to a count of less than 1,000 lymphocytes per microliter of blood in adults, or less than 3,000 lymphocytes per microliter of blood in children.
The three types of lymphocytes are B lymphocytes, T lymphocytes, and natural killer cells. All of these cells help protect the body from infection. Most people who have lymphocytopenia have low numbers of T lymphocytes. Sometimes they also have low numbers of the other types of lymphocytes.
Certain factors can cause a low lymphocyte count, such as:
Many diseases, conditions, and factors can cause the above problems that lead to lymphocytopenia. These causes can be acquired or inherited.
""Acquired"" means you aren't born with the condition, but you develop it. One of the most common acquired causes of lymphocytopenia is AIDS.
""Inherited"" means your parents passed the gene for the condition on to you. Inherited causes include DiGeorge anomaly, Wiskott-Aldrich syndrome, severe combined immunodeficiency syndrome, and ataxia-telangiectasia. These inherited conditions are rare.
Outlook
Lymphocytopenia can range from mild to severe. The condition alone may not cause any signs, symptoms, or serious problems.
How long lymphocytopenia lasts depends on its cause. The treatment for this condition depends on its cause and severity. Mild lymphocytopenia may not require treatment. If an underlying condition is successfully treated, lymphocytopenia will likely improve.
If lymphocytopenia causes serious infections, you may need medicines or other treatments.
What Causes Lymphocytopenia?
In general, lymphocytopenia (a low lymphocyte count) occurs because:
The body makes enough
lymphocytes, but they’re destroyed.
A combination of these factors also may cause a low lymphocyte count.
Many diseases, conditions, and factors can lead to a low lymphocyte count. These conditions can be acquired or inherited. ""Acquired"" means you aren't born with the condition, but you develop it. ""Inherited"" means your parents passed the gene for the condition on to you.
Exactly how each disease, condition, or factor affects your lymphocyte count isn't known. Some people have low lymphocyte counts with no underlying cause.
Acquired Causes
Many acquired diseases, conditions, and factors can cause lymphocytopenia. Examples include:
Inherited Causes
Certain inherited diseases and conditions can lead to lymphocytopenia. Examples include DiGeorge anomaly, Wiskott-Aldrich syndrome, severe combined immunodeficiency syndrome, and ataxia-telangiectasia. These inherited conditions are rare.
What Are the Signs and Symptoms of Lymphocytopenia?
A low lymphocyte count alone may not cause any signs or symptoms. The condition usually is found when a person is tested for other diseases or conditions, such as AIDS.
If you have unusual infections, repeat infections, and/or infections that won't go away, your doctor may suspect that you have lymphocytopenia. Fever is the most common symptom of infection.
How Is Lymphocytopenia Diagnosed?
Your doctor will diagnose lymphocytopenia based on your medical history, a physical exam, and test results.
A low lymphocyte count alone may not cause any signs or symptoms. Thus, the condition often is diagnosed during testing for other diseases or conditions.
Specialists Involved
Your primary care doctor may notice that you have unusual infections, repeat infections, and/or infections that won't go away. These infections may be signs of lymphocytopenia. Your primary care doctor may refer you to an infectious disease specialist to find out what's causing the infections.
You also may see a hematologist (blood disease specialist) or an immunologist (immune disorders specialist). Blood diseases and immune disorders can cause lymphocytopenia.
Medical History
To assess your risk for a low lymphocyte count, your doctor may ask:
About your risk for AIDS, including questions about
blood transfusions, sexual partners,
intravenous (IV) drug use, and exposure to infectious
blood or bodily fluids at work
Whether you've ever been diagnosed with a
blood disease or immune disorder, or whether you have a
family history of such illnesses
Physical Exam
Your doctor will do a physical exam to look for signs of infection, such as fever. He or she may check your abdomen for signs of an enlarged spleen and your neck for signs of enlarged lymph nodes.
Your doctor also will look for signs and symptoms of diseases and conditions that can affect your lymphocyte count, such as AIDS and blood cancers.
Diagnostic Tests
Your doctor may recommend one or more of the following tests to help diagnose a low lymphocyte count.
Tests for Underlying Conditions
Many diseases and conditions can cause lymphocytopenia. Your doctor will want to find the cause of the disorder. You may be tested for HIV/AIDS, tuberculosis, blood diseases, and immune disorders.
Tests for these underlying conditions might include blood tests, bone marrow tests, and lymph node tests.
Lymph nodes are part of the immune system. They're found in many places in your body. During a physical exam, your doctor may find that certain lymph nodes are swollen. In lymphocytopenia, the lymph nodes may hold on to too many lymphocytes instead of releasing them into the bloodstream.
To test a lymph node, you may need to have it removed. Removing a lymph node involves minor surgery.
How Is Lymphocytopenia Treated?
If you have mild lymphocytopenia with no underlying cause, you may not need treatment. The disorder may improve on its own.
If you have unusual infections, repeat infections, and/or infections that won't go away due to lymphocytopenia, you'll need treatment for the infections.
If you have a disease or condition that's causing lymphocytopenia, your doctor will prescribe treatment for that illness. Treating the underlying problem will help treat the lymphocytopenia.
Treatment for Underlying Diseases or Conditions
Many diseases and conditions can cause lymphocytopenia. Examples include infectious diseases, such as AIDS; blood diseases, such as aplastic anemia; and inherited diseases, such as Wiskott-Aldrich syndrome.
Your treatment will depend on your underlying disease or condition.
Emerging Treatments
Researchers are looking at ways to increase lymphocyte production in people who have lymphocytopenia with serious underlying conditions.
For example, some studies are looking into blood and marrow stem cell transplants. This procedure may help treat or cure some of the conditions that can cause a low lymphocyte count.
Other studies are looking at medicines and other substances that can help the body make more lymphocytes.
How Can Lymphocytopenia Be Prevented?
You can't prevent lymphocytopenia that's caused by an inherited condition. However, you can take steps to control lymphocytopenia. Follow your treatment plan and take all medicines as your doctor advises.
Early diagnosis also can help control lymphocytopenia. In the United States, newborns are routinely screened for an immune condition that can lead to lymphocytopenia. This allows doctors to diagnose the disorder before serious problems develop.
You may be able to lower your risk for acquired conditions that cause lymphocytopenia. For more information about acquired causes of the disorder, go to ""What Causes Lymphocytopenia?""
Living With Lymphocytopenia
If you have mild lymphocytopenia with no underlying cause, you may not need treatment. The disorder may improve on its own.
If an underlying condition is causing your lymphocytopenia, you'll need treatment for that condition. You'll also need treatment for infections if your body is unable to fight them because of lymphocytopenia.
Treating and Preventing Infections
The main risk of lymphocytopenia is getting unusual infections, repeat infections, and/or infections that won't go away. If you have the disorder, you may get treatments to prevent infections or to treat infections you already have.
You also can take other steps to prevent infections. For example:
Know the signs of an infection, such as a fever. Call your doctor right away if you think you have an infection.
Physical Activity
Talk with your doctor about what types and amounts of physical activity are safe for you. You may want to avoid activities that could result in injuries or increase your risk of infections.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to lymphocytopenia, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.
What Is Marfan Syndrome?
Marfan syndrome is a condition in which your body's connective tissue is abnormal. Connective tissue helps support all parts of your body. It also helps control how your body grows and develops.
Marfan syndrome most often affects the connective tissue of the heart and blood vessels, eyes, bones, lungs, and covering of the spinal cord. Because the condition affects many parts of the body, it can cause many complications. Sometimes the complications are life threatening.
Overview
Marfan syndrome is a genetic disorder. A mutation, or change, in the gene that controls how the body makes fibrillin causes Marfan syndrome. Fibrillin is a protein that plays a major role in your body's connective tissue.
Most people who have Marfan syndrome inherit it from their parents. If you have Marfan syndrome, you have a 50 percent chance of passing the altered gene to each of your children.
In about 1 in 4 cases, the mutation that causes Marfan syndrome is not inherited. Thus, the affected person is the first in his or her family to have the condition.
Marfan syndrome often affects the long bones of the body. This can lead to signs, or traits, such as:
A tall, thin build.
A
spine that curves to one side. This condition is called
scoliosis (sko-le-O-sis).
A
chest that sinks in or sticks out. These conditions are called pectus excavatum (eks-ka-VA-tum) and pectus carinatum (ka-ri-NA-tum), respectively.
Teeth that are too crowded.
Flat feet.
Marfan syndrome traits vary from person to person, even in the same family. Some people who have the condition have many traits, while others have few.
The most serious complications of Marfan syndrome involve the heart and blood vessels. Marfan syndrome can affect the aorta, the main blood vessel that supplies oxygen-rich blood to the body. In Marfan syndrome, the aorta can stretch and grow weak. This condition is called aortic dilation (di-LA-shun) or aortic aneurysm (AN-u-rism).
If the aorta stretches and grows weak, it may tear or burst and leak blood. This condition is called aortic dissection. It's very serious and can lead to severe heart problems or even death.
Marfan syndrome has no cure, but treatments can help delay or prevent complications. Treatments include medicines, surgery, and other therapies. Limiting certain activities, or changing how you do them, may help reduce the risks to the aorta, eyes, and joints.
The type of treatment you receive depends on how the condition is affecting your body.
Outlook
About 1 out of every 5,000 people in the United States has Marfan syndrome. Men, women, children, and people of all races can have the condition.
Advances have been made in the early diagnosis and treatment of Marfan syndrome. It's now possible for people who have the condition to live longer and enjoy a good quality of life. Many people who have Marfan syndrome and are properly diagnosed and treated may live an average lifespan.
Researchers continue to study the condition and look for better treatments.
What Causes Marfan Syndrome?
Marfan syndrome is a genetic disorder. A mutation, or change, in the gene that controls how the body makes fibrillin causes Marfan syndrome. Fibrillin is a protein that plays a major role in your body's connective tissue.
Most people who have Marfan syndrome inherit it from their parents. If you have the condition, you have a 50 percent chance of passing the altered gene to each of your children.
Sometimes Marfan syndrome isn't inherited. The mutation in the fibrillin gene occurs in the egg or sperm cells. If a child is conceived, the altered gene may be passed on to the child. The risk of that child's brothers or sisters having Marfan syndrome is low.
Who Is at Risk for Marfan Syndrome?
People at highest risk for Marfan syndrome are those who have a family history of the condition. If you have Marfan syndrome, you have a 50 percent chance of passing the altered gene to each of your children.
Marfan syndrome affects about 1 out of every 5,000 people in the United States. Men, women, and children, and people of all races, can have the condition.
What Are the Signs and Symptoms of Marfan Syndrome?
Marfan syndrome can affect many parts of the body. As a result, the signs and symptoms of the disorder vary from person to person, even in the same family.
Marfan complications also vary, depending on how the condition affects your body. Marfan syndrome most often affects the connective tissue of the heart, eyes, bones, lungs, and covering of the spinal cord. This can cause many complications, some of which are life threatening.
Marfan Traits
Marfan syndrome often affects the long bones of the body. This can lead to signs, or traits, such as:
A tall, thin build.
A
chest that sinks in or sticks out. These conditions are called pectus excavatum and pectus carinatum, respectively.
Teeth that are too crowded.
Flat feet.
Stretch marks on the skin also are a common trait in people who have Marfan syndrome. Stretch marks usually appear on the lower back, buttocks, shoulders, breasts, thighs, and abdomen.
Not everyone who has these traits has Marfan syndrome. Some of these traits also are signs of other connective tissue disorders.
Complications of Marfan Syndrome
Heart and Blood Vessel Complications
The most serious complications of Marfan syndrome involve the heart and blood vessels.
Marfan syndrome can affect the aorta, the main blood vessel that supplies oxygen-rich blood to the body. In Marfan syndrome, the aorta can stretch and grow weak. This condition is called aortic dilation or aortic aneurysm.
If the aorta stretches and grows weak, it may tear and leak blood. This condition, called aortic dissection, can lead to severe heart problems or even death.
Aortic dissection can cause severe pain in either the front or back of the chest or abdomen. The pain can travel upward or downward. If you have symptoms of aortic dissection, call 9–1–1.
Marfan syndrome also can cause problems with the heart's mitral (MI-trul) valve. This valve controls blood flow between the upper and lower chambers on the left side of the heart. Marfan syndrome can lead to mitral valve prolapse (MVP).
MVP is a condition in which the flaps of the mitral valve are floppy and don't close tightly. MVP can cause shortness of breath, palpitations (pal-pi-TA-shuns), chest pain, and other symptoms.
If you have MVP, your doctor may hear a heart murmur if he or she listens to your heart with a stethoscope. A heart murmur is an extra or unusual sound heard during the heartbeat.
Eye Complications
Marfan syndrome can cause many eye problems. A common problem in Marfan syndrome is a dislocated lens in one or both of the eyes. In this condition, the lens (the part of the eye that helps focus light) shifts up, down, or to the side. This can affect your eyesight. A dislocated lens often is the first sign that someone has Marfan syndrome.
Other eye complications of Marfan syndrome include nearsightedness, early glaucoma (high pressure in the fluid in the eyes), and early cataracts (clouding of an eye's lens). A detached retina also can occur.
Lung Complications
Marfan syndrome can cause sudden pneumothorax (noo-mo-THOR-aks), or collapsed lung. In this condition, air or gas builds up in the space between the lungs and chest wall. If enough air or gas builds up, a lung can collapse.
The most common symptoms of a collapsed lung are sudden pain in one side of the lung and shortness of breath.
Conditions such as scoliosis (a curved spine) and pectus excavatum (a chest that sinks in) can prevent the lungs from expanding fully. This can cause breathing problems. Marfan syndrome also can cause changes in the lung tissue, and it can lead to early emphysema (em-fi-SE-ma).
Marfan syndrome also has been linked to sleep apnea. In people who have Marfan syndrome, the shape of the face, oral cavity, or teeth may increase the risk of sleep apnea. Sleep apnea causes one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
How Is Marfan Syndrome Diagnosed?
Your doctor will diagnose Marfan syndrome based on your medical and family histories, a physical exam, and test results. He or she also will consult a set of guidelines called Ghent criteria, which are used to diagnose Marfan syndrome.
Marfan syndrome can be hard to diagnose. This is because its signs, or traits, are the same as or similar to the signs of other connective tissue disorders.
If you're diagnosed with Marfan syndrome, all of your first-degree relatives (for example, parents, siblings, and children) also should be checked for the disorder. This is because, even in families, the outward traits of Marfan syndrome may vary quite a bit.
Specialists Involved
Your family doctor or another type of doctor, such as an orthopedist (bone specialist), may notice certain traits that suggest Marfan syndrome.
If so, your doctor will likely refer you to a geneticist or cardiologist. A geneticist is hereditary disease expert. A cardiologist is a heart specialist. These two types of specialists often have the most experience working with people who have Marfan syndrome.
A geneticist will ask for medical information about you and your family. He or she will examine you and perhaps other members of your family. The geneticist also will coordinate your visits with other doctors, including a cardiologist, an ophthalmologist (eye specialist), and an orthopedist.
After reviewing the medical findings, the geneticist will determine whether you have Marfan syndrome.
Medical and Family Histories
Your doctor will ask about your medical history and your family's medical history. For example, your doctor may ask whether:
Any of your family members have
Marfan syndrome, have died from
heart problems, or have died suddenly.
Physical Exam
During the physical exam, your doctor will look for Marfan syndrome traits. For example, he or she may check the curve of your spine and the shape of your feet. Your doctor also will listen to your heart and lungs with a stethoscope.
Diagnostic Tests
Your doctor may recommend one or more of the following tests to help diagnose Marfan syndrome.
Ghent Criteria
Because no single test can diagnose Marfan syndrome, doctors use a set of guidelines called Ghent criteria to help diagnose the condition. The Ghent criteria are divided into major criteria and minor criteria. Sometimes genetic testing is part of this evaluation.
Major criteria include traits that are common in people who have Marfan syndrome. Minor criteria include traits that are common in many people. Doctors use a scoring system based on the number and type of Ghent criteria present to diagnose Marfan syndrome.
Talk with your doctor about which traits you have and your likelihood of having Marfan syndrome.
How Is Marfan Syndrome Treated?
Marfan syndrome has no cure. However, treatments can help delay or prevent complications, especially when started early.
Marfan syndrome can affect many parts of your body, including your heart, bones and joints, eyes, nervous system, and lungs. The type of treatment you receive will depend on your signs and symptoms.
Heart Treatments
Aortic dilation, or aortic aneurysm, is the most common and serious heart problem linked to Marfan syndrome. In this condition, the aorta—the main artery that carries oxygen-rich blood to your body—stretches and grows weak.
Medicines are used to try to slow the rate of aortic dilation. Surgery is used to replace the dilated segment of aorta before it tears.
If you have Marfan syndrome, you'll need routine care and tests to check your heart valves and aorta.
Surgery
If your aorta stretches, it's more likely to tear (a condition called aortic dissection). To prevent this, your doctor may recommend surgery to repair or replace part of your aorta.
Surgery may involve:
A composite valve graft. For this
surgery, part of the
aorta and the
aortic valve are removed. The aorta is replaced with a man-made tube called a graft. A man-made valve replaces the original valve.
Aortic valve-sparing
surgery. If your aortic valve is working well, your doctor may recommend valve-sparing surgery. For this surgery, your doctor replaces the enlarged part of your
aorta with a graft. Your aortic valve is left in place.
After aortic surgery, you may need medicines or followup tests. For example, after a composite valve graft, your doctor will prescribe medicines called anticoagulants, or ""blood thinners.""
Blood thinners help prevent blood clots from forming on your man-made aortic valve. You'll need to take these medicines for the rest of your life. If you've had valve-sparing surgery, you'll only need to take blood thinners for a short time, as your doctor prescribes.
If you've had a composite valve graft, you're at increased risk for endocarditis (EN-do-kar-DI-tis). This is an infection of the inner lining of your heart chambers and valves. Your doctor may recommend that you take antibiotics before certain medical or dental procedures that increase your risk of endocarditis.
Your doctor also may advise you to continue taking beta blockers or other medicines after either type of aortic surgery.
After surgery, you may have routine cardiac magnetic resonance imaging (MRI) or cardiac computed tomography (CT) scans to check your aorta.
Cardiac MRI is a painless test that uses radio waves and magnets to created detailed pictures of your organs and tissues. Cardiac CT is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart.
Bone and Joint Treatments
If you have scoliosis (a curved spine), your doctor may suggest a brace or other device to prevent the condition from getting worse. Severe cases of scoliosis may require surgery.
Some people who have Marfan syndrome need surgery to repair a chest that sinks in or sticks out. This surgery is done to prevent the chest from pressing on the lungs and heart.
Nervous System Treatments
Marfan syndrome can lead to dural ectasia. In this condition, a substance called the dura (which covers the fluid around your brain and spinal cord) stretches and grows weak. This can cause the bones of the spine to wear away. Dural ectasia usually is treated with pain medicines.
Living With Marfan Syndrome
Advances have been made in the early diagnosis and treatment of Marfan syndrome. It's now possible for people who have Marfan syndrome to live longer and enjoy a good quality of life. Many people who have Marfan syndrome and are properly diagnosed and treated may live an average lifespan.
If you have Marfan syndrome, talk with your doctor about ongoing care and what types of physical activity are safe for you. If you're thinking about becoming pregnant, discuss the possible risks with your doctor.
Ongoing Care
If you have Marfan syndrome, you'll need regular checkups with the doctor who is coordinating your care and other medical experts, including:
Annual checkups with an orthopedist (
bone specialist) to look for changes in your
spine and
breastbone.
Regular
eye exams with an
ophthalmologist (eye specialist) to find and treat eye problems early.
Let your doctors and dentists know if you've had a composite valve graft. If you've had this type of surgery, you're at increased risk for endocarditis. This is an infection of the inner lining of your heart chambers and valves.
Your health care providers, including dentists, may give you antibiotics before certain medical or dental procedures that could raise your risk of endocarditis.
Take all of your medicines as your doctor prescribes.
Emergencies
If you have Marfan syndrome, you're at risk for aortic dissection. This is a condition in which the aorta tears and leaks blood. Aortic dissection is a life-threatening condition.
The main symptom of aortic dissection is severe pain in either the front or back of your Go to:
What Is Metabolic Syndrome?
Metabolic (met-ah-BOL-ik) syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
The term ""metabolic"" refers to the biochemical processes involved in the body's normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.
In this article, ""heart disease"" refers to coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary (heart) arteries.
Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead to chest pain, a heart attack, heart damage, or even death.
Metabolic Risk Factors
The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.
A large waistline. This also is called abdominal
obesity or ""having an apple shape."" Excess
fat in the
stomach area is a greater risk factor for
heart disease than excess fat in other parts of the body, such as on the hips.
A low
HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called ""good"" cholesterol. This is because it helps remove cholesterol from your
arteries. A low HDL cholesterol level raises your risk for
heart disease.
Outlook
Metabolic syndrome is becoming more common due to a rise in obesity rates among adults. In the future, metabolic syndrome may overtake smoking as the leading risk factor for heart disease.
It is possible to prevent or delay metabolic syndrome, mainly with lifestyle changes. A healthy lifestyle is a lifelong commitment. Successfully controlling metabolic syndrome requires long-term effort and teamwork with your health care providers.
Other Names for Metabolic Syndrome
Who Is at Risk for Metabolic Syndrome?
People at greatest risk for metabolic syndrome have these underlying causes:
Abdominal
obesity (a large waistline)
An inactive lifestyle
Some people are at risk for metabolic syndrome because they take medicines that cause weight gain or changes in blood pressure, blood cholesterol, and blood sugar levels.
These medicines most often are used to treat inflammation, allergies, HIV, and depression and other types of mental illness.
Populations Affected
Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups. The condition affects White women and men about equally.
Some racial and ethnic groups in the United States are at higher risk for metabolic syndrome than others. Mexican Americans have the highest rate of metabolic syndrome, followed by Whites and African Americans.
Worldwide, certain ethnic groups, such as South Asians, are at increased risk for metabolic syndrome.
Other groups at increased risk for metabolic syndrome include:
People who have a sibling or parent who has
diabetesPeople who have a personal history of
diabetes
Heart Disease Risk
Metabolic syndrome increases your risk for heart disease. Heart disease risk can be divided into short-term risk and long-term risk.
""Short-term risk"" refers to the risk of having a heart attack or dying from heart disease in the next 10 years. ""Long-term risk"" refers to the risk of developing heart disease over your lifetime.
Other risk factors, besides metabolic syndrome, also increase your risk for heart disease. For example, a high LDL cholesterol level and smoking are major risk factors for heart disease. For details about all of the risk factors for heart disease, go to the Health Topics Coronary Heart Disease Risk Factors article.
Even if you don't have metabolic syndrome, you should find out your short-term risk for heart disease. The National Cholesterol Education Program (NCEP) divides short-term heart disease risk into four categories, as shown below. Your risk category depends on which risk factors you have and how many you have.
Your risk factors are used to calculate your 10-year risk of developing heart disease. The NCEP has an online calculator that you can use to determine your 10-year heart disease risk score.
High risk: You're in this category if you already have
heart disease or
diabetes, or if your 10-year risk score is more than 20 percent.
Moderately high risk: You're in this category if you have two or more risk factors and your 10-year risk score is 10–20 percent.
Moderate risk: You're in this category if you have two or more risk factors and your 10-year risk score is less than 10 percent.
Lower risk: You're in this category if you have zero or one risk factor.
Even if your 10-year risk score isn't high, metabolic syndrome will increase your risk for heart disease over time. Thus, metabolic syndrome should be treated (mainly with lifestyle changes).
What Are the Signs and Symptoms of Metabolic Syndrome?
Metabolic syndrome is a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. These risk factors can increase your risk for health problems even if they're only moderately raised (borderline-high risk factors).
Most of the metabolic risk factors have no signs or symptoms, although a large waistline is a visible sign.
Some people may have symptoms of high blood sugar if diabetes—especially type 2 diabetes—is present. Symptoms of high blood sugar often include increased thirst; increased urination, especially at night; fatigue (tiredness); and blurred vision.
High blood pressure usually has no signs or symptoms. However, some people in the early stages of high blood pressure may have dull headaches, dizzy spells, or more nosebleeds than usual.
How Is Metabolic Syndrome Diagnosed?
Your doctor will diagnose metabolic syndrome based on the results of a physical exam and blood tests. You must have at least three of the five metabolic risk factors to be diagnosed with metabolic syndrome.
Metabolic Risk Factors
A Large Waistline
Having a large waistline means that you carry excess weight around your waist (abdominal obesity). This is also called having an ""apple-shaped"" figure. Your doctor will measure your waist to find out whether you have a large waistline.
A waist measurement of 35 inches or more for women or 40 inches or more for men is a metabolic risk factor. A large waistline means you're at increased risk for heart disease and other health problems.
A High Triglyceride Level
Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or higher (or being on medicine to treat high triglycerides) is a metabolic risk factor. (The mg/dL is milligrams per deciliter—the units used to measure triglycerides, cholesterol, and blood sugar.)
A Low HDL Cholesterol Level
HDL cholesterol sometimes is called ""good"" cholesterol. This is because it helps remove cholesterol from your arteries.
An HDL cholesterol level of less than 50 mg/dL for women and less than 40 mg/dL for men (or being on medicine to treat low HDL cholesterol) is a metabolic risk factor.
High Fasting Blood Sugar
A normal fasting blood sugar level is less than 100 mg/dL. A fasting blood sugar level between 100–125 mg/dL is considered prediabetes. A fasting blood sugar level of 126 mg/dL or higher is considered diabetes.
A fasting blood sugar level of 100 mg/dL or higher (or being on medicine to treat high blood sugar) is a metabolic risk factor.
About 85 percent of people who have type 2 diabetes—the most common type of diabetes—also have metabolic syndrome. These people have a much higher risk for heart disease than the 15 percent of people who have type 2 diabetes without metabolic syndrome.
How Is Metabolic Syndrome Treated?
Healthy lifestyle changes are the first line of treatment for metabolic syndrome. Lifestyle changes include losing weight, being physically active, following a heart healthy diet, and quitting smoking.
If lifestyle changes aren't enough, your doctor may prescribe medicines. Medicines are used to treat and control risk factors such as high blood pressure, high triglycerides, low HDL cholesterol, and high blood sugar.
Blood-thinning medicines, such as aspirin, also may be used to reduce the risk of blood clots. Excessive blood clotting is a condition that often occurs with metabolic syndrome.
Lifestyle Changes
Losing Weight
If you have metabolic syndrome and are overweight or obese, your doctor will likely recommend weight loss. He or she can help you create a weight-loss plan and goals.
The long-range target is to lower your body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat.
A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for prevention and treatment of metabolic syndrome.
You can calculate your BMI using the National Heart, Lung, and Blood Institute's (NHLBI's) online calculator, or your health care provider can calculate your BMI.
For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article.
Following a Heart Healthy Diet
A heart healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to fill half of your plate with vegetables and fruits.
A healthy diet also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.
Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of sugary drinks, such as soda.
Also, try to limit the amount of solid fats and refined grains that you eat. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
If you drink alcohol, do so in moderation. Too much alcohol can raise your blood pressure and triglyceride level. Alcohol also adds extra calories, which can cause weight gain.
Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in from food and drinks with the calories you use while doing physical activity.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Being Physically Active
Physical activity can help keep your heart and lungs healthy. Many Americans are not active enough. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you'll benefit.
Before starting any kind of exercise program or new physical activity, talk with your doctor about the types and amounts of physical activity that are safe for you.
The four main types of physical activity are aerobic, muscle-strengthening, bone strengthening, and stretching.
You can do physical activity with light, moderate, or vigorous intensity. The level of intensity depends on how hard you have to work to do the activity. People who have metabolic syndrome usually are urged to keep up a moderate level of activity.
For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Smoking
If you smoke, quit. Smoking can raise your risk for heart disease and heart attack and worsen other heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart.""
How Can Metabolic Syndrome Be Prevented?
Making healthy lifestyle choices is the best way to prevent metabolic syndrome. One important lifestyle choice is to maintain a healthy weight. Other than weighing yourself on a scale, you can find out if you're at a healthy weight using your waist measurement and body mass index (BMI).
A waist measurement indicates your abdominal fat, which is linked to your risk for heart disease and other diseases. To measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. Make sure the tape is snug but doesn't squeeze the flesh.
A waist measurement of less than 35 inches for women and less than 40 inches for men is the goal for preventing metabolic syndrome; it's also the goal when treating metabolic syndrome.
BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing metabolic syndrome; it's also the goal when treating metabolic syndrome.
You can figure out your BMI using the National Heart, Lung, and Blood Institute's (NHLBI's) online calculator, or your doctor can help you.
To maintain a healthy weight, follow a heart healthy diet and try not to overeat. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the NHLBI's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Being physically active also can help you maintain a healthy weight. Before starting any kind of exercise program or new physical activity, talk with your doctor about the types and amounts of physical activity that are safe for you.
For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Make sure to schedule routine doctor visits to keep track of your cholesterol, blood pressure, and blood sugar levels. A blood test called a lipoprotein panel will show your levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
Living With Metabolic Syndrome
Metabolic syndrome is a lifelong condition. However, lifestyle changes can help you control your risk factors and reduce your risk for heart disease and diabetes.
If you already have heart disease and/or diabetes, lifestyle changes can help you prevent or delay related problems. Examples of these problems include heart attack, stroke, and diabetes-related complications (for example, damage to your eyes, nerves, kidneys, feet, and legs).
Lifestyle changes may include losing weight, following a heart healthy diet, being physically active, and quitting smoking.
If lifestyle changes aren't enough, your doctor may recommend medicines. Take all of your medicines as your doctor prescribes. For more information about lifestyle changes and medicines, go to ""How Is Metabolic Syndrome Treated?""
Make realistic short- and long-term goals for yourself when you begin to make healthy lifestyle changes. Work closely with your doctor and seek regular medical care.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of various diseases and conditions, as well as ways to prevent or treat them.
The NHLBI continues to support research aimed at learning more about various diseases and conditions, including metabolic syndrome. For example, NHLBI-supported research includes studies that explore:
The effects of two diets on the
treatment of adolescents who have
heart disease risk factors
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to metabolic syndrome, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Mitral Valve Prolapse?
Mitral (MI-tral) valve prolapse (MVP) is a condition in which the heart's mitral valve doesn't work well. The flaps of the valve are ""floppy"" and don't close tightly. These flaps normally help seal or open the valve.
Much of the time, MVP doesn't cause any problems. Rarely, blood can leak the wrong way through the floppy valve. This can lead to palpitations, shortness of breath, chest pain, and other symptoms. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)
Normal Mitral Valve
The mitral valve controls blood flow between the upper and lower chambers of the left side of the heart. The upper chamber is called the left atrium (AY-tree-um). The lower chamber is called the left ventricle (VEN-trih-kul).
The mitral valve allows blood to flow from the left atrium into the left ventricle, but not back the other way. The heart also has a right atrium and ventricle, separated by the tricuspid (tri-CUSS-pid) valve.
With each heartbeat, the atria contract and push blood into the ventricles. The flaps of the mitral and tricuspid valves open to let blood through. Then, the ventricles contract to pump the blood out of the heart.
When the ventricles contract, the flaps of the mitral and tricuspid valves close. They form a tight seal that prevents blood from flowing back into the atria.
For more information, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.
Mitral Valve Prolapse
In MVP, when the left ventricle contracts, one or both flaps of the mitral valve flop or bulge back (prolapse) into the left atrium. This can prevent the valve from forming a tight seal.
As a result, blood may leak from the ventricle back into the atrium. The backflow of blood is called regurgitation (re-GUR-jih-TA-shun).
MVP doesn't always cause backflow. In fact, most people who have MVP don't have backflow and never have any related symptoms or problems. Their mitral valves still can form a tight seal.
When backflow does occur, it can cause shortness of breath, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), or chest pain.
![]()
Mitral Valve Prolapse. Figure A shows a normal mitral valve. The valve separates the left atrium from the left ventricle. Figure B shows a heart with mitral valve prolapse. Figure C shows a closeup view of mitral valve prolapse. Figure D shows a mitral (more...)
Backflow can get worse over time. It can change the heart's size and raise pressure in the left atrium and lungs. Backflow also raises the risk of heart valve infections.
Medicines can treat troublesome MVP symptoms and help prevent complications. Some people will need surgery to repair or replace their mitral valves.
MVP once was thought to affect as much as 5 to 15 percent of the population. Researchers now believe that many people who were diagnosed with MVP in the past didn't actually have a faulty mitral valve.
They may have had a slight bulging of the valve flaps due to other conditions, such as dehydration (lack of fluid in the body) or a small heart. However, their valves were normal, and little or no backflow of blood occurred.
Diagnosing MVP is more precise now because of a test called echocardiography (EK-o-kar-de-OG-ra-fee). This test allows doctors to easily see MVP and detect troublesome backflow.
As a result, researchers now think that less than 3 percent of the population actually has MVP. They believe an even smaller percentage has serious complications from the condition.
Outlook
Most people who have MVP have no symptoms or medical problems and don't need treatment. They're able to lead normal, active lives; they may not even know they have the condition.
A small number of people who have MVP may need medicine to relieve their symptoms. Very few people who have MVP need heart valve surgery to repair their mitral valves.
Rarely, MVP can cause problems such as arrhythmias (irregular heartbeats) or infective endocarditis (EN-do-kar-DI-tis). Endocarditis is an infection of the inner lining of the heart chambers and valves. Bacteria that enter the bloodstream can cause the infection.
Other Names for Mitral Valve Prolapse
Barlow's syndrome
Floppy valve syndrome
What Causes Mitral Valve Prolapse?
The exact cause of mitral valve prolapse (MVP) isn't known. Most people who have the condition are born with it. MVP tends to run in families. Also, it's more common in people who are born with connective tissue disorders, such as Marfan syndrome.
In people who have MVP, the mitral valve may be abnormal in the following ways:
These problems can keep the valve from making a tight seal. Some people's valves are abnormal in more than one way.
Who Is at Risk for Mitral Valve Prolapse?
Mitral valve prolapse (MVP) affects people of all ages and both sexes. MVP that causes complications or severe symptoms most often occurs in men older than 50.
Certain conditions increase the risk of MVP, including:
Scoliosis (SKO-le-O-sis) and other skeletal problems
What Are the Signs and Symptoms of Mitral Valve Prolapse?
Most people who have mitral valve prolapse (MVP) aren't affected by the condition. They don't have any symptoms or major mitral valve backflow.
When MVP does cause signs and symptoms, they may include:
Palpitations (feelings that your
heart is skipping a beat, fluttering, or beating too hard or too fast)
Shortness of breath
MVP symptoms can vary from one person to another. They tend to be mild but can worsen over time, mainly when complications occur.
Mitral Valve Prolapse Complications
MVP complications are rare. When present, they're most often caused by the backflow of blood through the mitral valve.
Mitral valve backflow is most common among men and people who have high blood pressure. People who have severe backflow may need valve surgery to prevent complications.
Mitral valve backflow causes blood to flow from the left ventricle back into the left atrium. Blood can even back up from the atrium into the lungs, causing shortness of breath.
The backflow of blood strains the muscles of both the atrium and the ventricle. Over time, the strain can lead to arrhythmias. Backflow also increases the risk of infective endocarditis (IE). IE is an infection of the inner lining of your heart chambers and valves.
Arrhythmias
Arrhythmias are problems with the rate or rhythm of the heartbeat. The most common types of arrhythmias are harmless. Other arrhythmias can be serious or even life threatening, such as ventricular arrhythmias.
If the heart rate is too slow, too fast, or irregular, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
One troublesome arrhythmia that MVP can cause is atrial fibrillation (AF). In AF, the walls of the atria quiver instead of beating normally. As a result, the atria aren't able to pump blood into the ventricles the way they should.
AF is bothersome but rarely life threatening, unless the atria contract very fast or blood clots form in the atria. Blood clots can occur because some blood ""pools"" in the atria instead of flowing into the ventricles. If a blood clot breaks off and travels through the bloodstream, it can reach the brain and cause a stroke.
How Is Mitral Valve Prolapse Diagnosed?
Mitral valve prolapse (MVP) most often is detected during a routine physical exam. During the exam, your doctor will listen to your heart with a stethoscope.
Stretched valve flaps can make a clicking sound as they shut. If the mitral valve is leaking blood back into the left atrium, your doctor may heart a heart murmur or whooshing sound.
However, these abnormal heart sounds may come and go. Your doctor may not hear them at the time of an exam, even if you have MVP. Thus, you also may have tests and procedures to diagnose MVP.
Diagnostic Tests and Procedures
Echocardiography
Echocardiography (echo) is the most useful test for diagnosing MVP. This painless test uses sound waves to create a moving picture of your heart.
Echo shows the size and shape of your heart and how well your heart chambers and valves are working. The test also can show areas of heart muscle that aren't contracting normally because of poor blood flow or injury to the heart muscle.
Echo can show prolapse of the mitral valve flaps and backflow of blood through the leaky valve.
There are several types of echo, including stress echo. Stress echo is done before and after a stress test. During a stress test, you exercise or take medicine (given by your doctor) to make your heart work hard and beat fast.
You may have stress echo to find out whether you have decreased blood flow to your heart (a sign of coronary heart disease).
Echo also can be done by placing a tiny probe in your esophagus to get a closer look at the mitral valve. The esophagus is the passage leading from your mouth to your stomach.
The probe uses sound waves to create pictures of your heart. This form of echo is called transesophageal (tranz-ih-sof-uh-JEE-ul) echocardiography, or TEE.
Doppler Ultrasound
A Doppler ultrasound is part of an echo test. A Doppler ultrasound shows the speed and direction of blood flow through the mitral valve.
Other Tests
Other tests that can help diagnose MVP include:
A
chest x ray. This test is used to look for fluid in your
lungs or to show whether your
heart is enlarged.
An
EKG (
electrocardiogram). An EKG is a simple test that records your
heart's electrical activity. An EKG can show how fast your heart is beating and whether its rhythm is steady or irregular. This test also records the strength and timing of electrical signals as they pass through your heart.
How Is Mitral Valve Prolapse Treated?
Most people who have mitral valve prolapse (MVP) don't need treatment because they don't have symptoms and complications.
Even people who do have symptoms may not need treatment. The presence of symptoms doesn't always mean that the backflow of blood through the valve is significant.
People who have MVP and troublesome mitral valve backflow usually need treatment. MVP is treated with medicines, surgery, or both.
The goals of treating MVP include:
Relieving symptoms
Correcting the underlying
mitral valve problem, if necessary
Medicines
Medicines called beta blockers may be used to treat palpitations and chest discomfort in people who have little or no mitral valve backflow.
If you have significant backflow and symptoms, your doctor may prescribe:
Digoxin to strengthen your heartbeat.
Surgery
Surgery is done only if the mitral valve is very abnormal and blood is flowing back into the atrium. The main goal of surgery is to improve symptoms and reduce the risk of heart failure.
The timing of the surgery is important. If it's done too early and your leaking valve is working fairly well, you may be put at needless risk from surgery. If it's done too late, you may have heart damage that can't be fixed.
Surgical Approaches
Traditionally, heart surgeons repair or replace a mitral valve by making an incision (cut) in the breastbone and exposing the heart.
A small but growing number of surgeons are using another approach that involves one or more small cuts through the side of the chest wall. This results in less cutting, reduced blood loss, and a shorter hospital stay. However, not all hospitals offer this method.
Valve Repair and Valve Replacement
In mitral valve surgery, the valve is repaired or replaced. Valve repair is preferred when possible. Repair is less likely than replacement to weaken the heart. Repair also lowers the risk of infection and decreases the need for lifelong use of blood-thinning medicines.
If repair isn't an option, the valve can be replaced. Mechanical and biological valves are used as replacement valves.
Mechanical valves are man-made and can last a lifetime. People who have mechanical valves must take blood-thinning medicines for the rest of their lives.
Biological valves are taken from cows or pigs or made from human tissue. Many people who have biological valves don't need to take blood-thinning medicines for the rest of their lives. The major drawback of biological valves is that they weaken over time and often last only about 10 years.
After surgery, you'll likely stay in the hospital's intensive care unit for 2 to 3 days. Overall, most people who have mitral valve surgery spend about 1 to 2 weeks in the hospital. Complete recovery takes a few weeks to several months, depending on your health before surgery.
If you've had valve repair or replacement, you may need antibiotics before dental work and surgery. These procedures can allow bacteria to enter your bloodstream. Antibiotics can help prevent IE, a serious heart valve infection. Discuss with your doctor whether you need to take antibiotics before such procedures.
Experimental Approaches
Researchers are testing whether they can repair leaky mitral valves using a catheter (tube) inserted through a large blood vessel.
This approach is less invasive and can prevent a patient from having open-heart surgery. However, only a few medical centers are doing this type of procedure. Large studies haven't yet shown that this new approach is better than traditional approaches.
How Can Mitral Valve Prolapse Be Prevented?
You can't prevent mitral valve prolapse (MVP). Most people who have the condition are born with it.
Complications from MVP, such as arrhythmias (irregular heartbeats) and infective endocarditis (IE), are rare. IE is an infection of the inner lining of your heart chambers and valves.
People at high risk for IE may be given antibiotics before some types of surgery and dental work. Antibiotics can help prevent IE. Your doctor will tell you whether you need this type of treatment.
People at high risk for IE may include those who've had valve repair or replacement or who have some types of underlying heart disease.
Living With Mitral Valve Prolapse
Most people who have mitral valve prolapse (MVP) have no symptoms or related problems, need no treatment, and are able to lead normal, active lives. If symptoms and complications do occur, you often can control them with medicine.
Some people may need heart valve surgery to relieve their symptoms and prevent complications. Rarely, MVP can cause arrhythmias (irregular heartbeats) and other problems.
Ongoing Care
If you have MVP, having ongoing care is important. Ask your doctor how often you should schedule followup visits. See your doctor if your symptoms worsen.
The backflow of blood that may occur with MVP increases your risk of infective endocarditis (IE). IE is an infection of the inner lining of your heart chambers and valves.
You can take steps to try to prevent IE. Tell your doctors and dentists that you have MVP. Floss and brush your teeth regularly. Gum infections and tooth decay can cause IE. Call your doctor if you have any signs of infection, such as sore throat, general body aches, or fever.
Take all of your medicines as your doctor prescribes, including blood-thinning and high blood pressure medicines.
Make healthy lifestyle choices. For example, avoid smoking and taking birth control pills; both can raise your risk for blood clots.
If you smoke, talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article.
Ask your doctor how much and what types of physical activity are safe for you. Also, ask your doctor whether you need to make any changes to your diet.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to mitral valve prolapse, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Narcolepsy?
Narcolepsy (NAR-ko-lep-se) is a disorder that causes periods of extreme daytime sleepiness. The disorder also may cause muscle weakness.
Most people who have narcolepsy have trouble sleeping at night. Some people who have the disorder fall asleep suddenly, even if they're in the middle of talking, eating, or another activity.
Narcolepsy also can cause:
Cataplexy (KAT-ah-plek-se). This condition causes a sudden loss of
muscle tone while you're awake. Muscle weakness can affect certain parts of your body or your whole body. For example, if cataplexy affects your
hand, you may drop what you're holding. Strong emotions often trigger this weakness. It may last seconds or minutes.
Sleep paralysis (pah-RAL-ih-sis). This condition prevents you from moving or speaking while waking up and sometimes while
falling asleep. Sleep paralysis usually goes away within a few minutes.
Overview
The two main phases of sleep are nonrapid eye movement (NREM) and rapid eye movement (REM). Most people are in the NREM phase when they first fall asleep. After about 90 minutes of sleep, most people go from NREM to REM sleep.
Dreaming occurs during the REM phase of sleep. During REM, your muscles normally become limp. This prevents you from acting out your dreams. (For more information about sleep cycles, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep."")
People who have narcolepsy often fall into REM sleep quickly and wake up directly from it. As a result, they may have vivid dreams while falling asleep and waking up.
Hypocretin (hi-po-KREET-in), a chemical in the brain, helps promote wakefulness. Most people who have narcolepsy have low levels of this chemical. What causes these low levels isn't well understood.
Researchers think that certain factors may work together to cause a lack of hypocretin. These factors may include heredity, infections, brain injuries, and autoimmune disorders. (Autoimmune disorders occur if the body's immune system mistakenly attacks the body's cells and tissues.)
Outlook
Narcolepsy symptoms usually begin during the teen or young adult years. People who have narcolepsy may find it hard to function at school, work, home, and in social situations because of extreme tiredness.
Narcolepsy has no cure, but medicines, lifestyle changes, and other therapies can improve symptoms. Research is ongoing on the causes of narcolepsy and new ways to treat it.
What Causes Narcolepsy?
Most people who have narcolepsy have low levels of hypocretin. This is a chemical in the brain that helps promote wakefulness. What causes low hypocretin levels isn't well understood.
Researchers think that certain factors may work together to cause a lack of hypocretin. These factors may include:
Heredity. Some people may inherit a
gene that affects hypocretin. Up to 10 percent of people who have
narcolepsy report having a relative who has the same symptoms.
Infections.
Low levels of
histamine, a substance in the
blood that promotes wakefulness.
Some research suggests that environmental toxins may play a role in triggering narcolepsy. Toxins may include heavy metals, pesticides and weed killers, and secondhand smoke.
Heredity alone doesn't cause narcolepsy. You also must have at least one other factor, such as one of those listed above, to develop narcolepsy.
Who Is At Risk for Narcolepsy?
Narcolepsy affects men and women. Symptoms usually begin during the teen or young adult years. The disorder also can develop later in life or in children, but it's rare before age 5.
Researchers think that certain factors may work together to cause narcolepsy. If these factors affect you, you may be at higher risk for the disorder. (For more information, go to ""What Causes Narcolepsy?"")
What Are the Signs and Symptoms of Narcolepsy?
The four major signs and symptoms of narcolepsy are extreme daytime sleepiness, cataplexy (muscle weakness) while awake, and hallucinations and sleep paralysis during sleep.
If you have narcolepsy, you may have one or more of these symptoms. They can range from mild to severe. Less than one-third of people who have narcolepsy have all four symptoms.
Extreme Daytime Sleepiness
All people who have narcolepsy have extreme daytime sleepiness. This often is the most obvious symptom of the disorder.
During the day, you may have few or many periods of sleepiness. Each period usually lasts 30 minutes or less. Strong emotions—such as anger, fear, laughter, or excitement—can trigger this sleepiness.
People who have daytime sleepiness often complain of:
Mental cloudiness or ""fog""
Memory problems or problems focusing
Lack of energy or extreme exhaustion
Some people who have narcolepsy have episodes in which they fall asleep suddenly. This is more likely to happen when they're not active—for example, while reading, watching TV, or sitting in a meeting.
However, sleep episodes also may occur in the middle of talking, eating, or another activity. Cataplexy also may occur at the same time.
Cataplexy
This condition causes loss of muscle tone while you're awake. Muscle weakness affects part or all of your body.
Cataplexy may make your head nod or make it hard for you to speak. Muscle weakness also may make your knees weak or cause you to drop things you're holding. Some people lose all muscle control and fall.
Strong emotions—such as anger, surprise, fear, or laughter—often trigger cataplexy. It usually lasts a few seconds or minutes. During this time, you're usually awake.
Cataplexy may occur weeks to years after you first start to have extreme daytime sleepiness.
Hallucinations
If you have narcolepsy, you may have vivid dreams while falling asleep, waking up, or dozing. These dreams can feel very real. You may feel like you can see, hear, smell, and taste things.
Sleep Paralysis
This condition prevents you from moving or speaking while falling asleep or waking up. However, you're fully conscious (aware) during this time. Sleep paralysis usually lasts just a few seconds or minutes, but it can be scary.
Other Symptoms
Most people who have narcolepsy don't sleep well at night. They may have trouble falling and staying asleep. Vivid, scary dreams may disturb sleep. Not sleeping well at night worsens daytime sleepiness.
Rarely, people who fall asleep in the middle of an activity, such as eating, may continue that activity for a few seconds or minutes. This is called automatic behavior.
During automatic behavior, you're not aware of your actions, so you don't do them well. For example, if you're writing before falling asleep, you may scribble rather than form words. If you're driving, you may get lost or have an accident. Most people who have this symptom don't remember what happened while it was going on.
Children who have narcolepsy often have trouble studying, focusing, and remembering things. Also, they may seem hyperactive. Some children who have narcolepsy speed up their activities rather than slow them down.
Children who have narcolepsy may have severe sleepiness. They may fall asleep while talking or eating, or during sporting events and social activities.
How Is Narcolepsy Diagnosed?
It can take as long as 10 to 15 years after the first symptoms appear before narcolepsy is recognized and diagnosed. This is because narcolepsy is fairly rare. Also, many narcolepsy symptoms are like symptoms of other illnesses, such as infections, depression, and sleep disorders.
Narcolepsy sometimes is mistaken for learning problems, seizure disorders, or laziness, especially in school-aged children and teens. When narcolepsy symptoms are mild, the disorder is even harder to diagnose.
Your doctor will diagnose narcolepsy based on your signs and symptoms, your medical and family histories, a physical exam, and test results.
Signs and Symptoms
Tell your doctor about any signs and symptoms of narcolepsy that you have. This is important because your doctor may not ask about them during a routine checkup.
Your doctor will want to know when you first had signs and symptoms and whether they bother your sleep or daily routine. He or she also will want to know about your sleep habits and how you feel and act during the day.
To help answer these questions, you may want to keep a sleep diary for a few weeks. Keep a daily record of how easy it is to fall and stay asleep, how much sleep you get at night, and how alert you feel during the day.
For a sample sleep diary, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Medical and Family Histories
Your doctor may ask whether:
You're affected by certain factors that can lead to
narcolepsy. Examples of these factors include infections,
brain injuries, and
autoimmune disorders. Some research suggests that environmental
toxins may play a role in triggering narcolepsy.
You take medicines and which ones you take. Some medicines can cause daytime sleepiness. Thus, your symptoms may be due to medicine, not
narcolepsy.
You have relatives who have
narcolepsy or who have signs or symptoms of the disorder.
Physical Exam
Your doctor will check you to see whether another condition is causing your symptoms. For example, infections, certain thyroid diseases, drug and alcohol use, and other medical or sleep disorders may cause symptoms similar to those of narcolepsy.
Diagnostic Tests
Sleep Studies
If your doctor thinks you have narcolepsy, he or she will likely suggest that you see a sleep specialist. This specialist may advise you to have sleep studies to find out more about your condition.
Sleep studies usually are done at a sleep center. Doctors use the results from two tests to diagnose narcolepsy. These tests are a polysomnogram (PSG) and a multiple sleep latency test (MSLT).
Polysomnogram. You usually stay overnight at a sleep center for a PSG. The test records brain activity, eye movements, heart rate, and blood pressure. A PSG can help find out whether you:
Multiple sleep latency test. This daytime sleep study measures how sleepy you are. It's often done the day after a PSG. During the test, you're asked to nap for 20 minutes every 2 hours throughout the day. (You will nap a total of four or five times.)
A technician checks your brain activity during this time. He or she notes how quickly you fall asleep and how long it takes you to reach various stages of sleep.
An MSLT finds out how quickly you fall asleep during the day (after a full night's sleep). It also shows whether you go into REM sleep soon after falling asleep.
Other Tests
Hypocretin test. This test measures the level of hypocretin in the fluid that surrounds your spinal cord. Most people who have narcolepsy have low levels of hypocretin. Hypocretin is a chemical that helps promote wakefulness.
To get a sample of spinal cord fluid, a spinal tap (also called a lumbar puncture) is done. For this procedure, your doctor inserts a needle into your lower back area and then withdraws a sample of your spinal fluid.
How Is Narcolepsy Treated?
Narcolepsy has no cure. However, medicines, lifestyle changes, and other therapies can relieve many of its symptoms. Treatment for narcolepsy is based on the type of symptoms you have and how severe they are.
Not all medicines and lifestyle changes work for everyone. It may take weeks to months for you and your doctor to find the best treatment.
Medicines
You may need one or more medicines to treat narcolepsy symptoms. These may include:
Some prescription and over-the-counter medicines can interfere with your sleep. Ask your doctor about these medicines and how to avoid them, if possible. For example, your doctor may advise you to avoid antihistamines. These medicines suppress the action of histamine, a substance in the blood that promotes wakefulness.
If you take regular naps when you feel sleepy, you may need less medicine to stay awake.
Lifestyle Changes
Lifestyle changes also may help relieve some narcolepsy symptoms. You can take steps to make it easier to fall asleep at night and stay asleep.
Certain activities, foods, and drinks before bedtime can keep you awake. Try to follow these guidelines:
For more tips on sleeping better, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Other Therapies
Light therapy may help you keep a regular sleep and wake schedule. For this type of therapy, you sit in front of a light box, which has special lights, for 10 to 30 minutes. This therapy can help you feel less sleepy in the morning.
Living With Narcolepsy
Living with narcolepsy can be hard. It can affect your ability to drive, work, go to school, and have relationships. Besides taking medicine, you can do many things to live a safe and fulfilling life.
Driving
Driving can be dangerous for people who have narcolepsy. Ask your doctor whether you can drive safely. To help make it safer for you to drive:
Take naps before driving. This helps some people who have
periods of extreme daytime sleepiness.
Stop often during long drives. Stretch and walk around during the stops.
Try to have family, friends, or coworkers in the car to keep you aware and engaged, or get rides from them.
Working
People who have narcolepsy can work in almost any type of job, but some jobs may be better than others.
For example, a job with a flexible work schedule can make it easier to take naps when needed. A job in which you interact with your coworkers can help keep you awake. Jobs that don't require you to drive or are closer to home also may better suit your needs.
Certain laws may apply to workers who have medical conditions, such as narcolepsy. These laws include the:
Americans with Disabilities Act (ADA). This law requires employers to reasonably accommodate the needs of their workers who have disabilities. This includes people who have
narcolepsy. For example, employers may allow workers to take short naps during the workday or adjust work schedules to avoid sleepy
periods.
Family and Medical Leave Act. This law requires employers who have 50 or more employees to provide unpaid leave to employees who have an illness, such as
narcolepsy. This law also gives leave to family members who need time to care for a close relative who has a serious illness.
Social Security Disability Insurance or Supplemental Security Income programs. These programs may offer financial help if you can't work because of your
narcolepsy.
Emotional Issues and Support
Living with narcolepsy may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with narcolepsy. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Narcolepsy in Special Groups
School-Aged Children
Children who have narcolepsy may have trouble studying, focusing, and remembering things. To help your child in school:
Talk with your child's teachers and school officials about your child's
narcolepsy and the best ways to meet his or her needs. For example, your child may need to take naps or walks during the day or tape the teacher's lessons.
Talk with the school nurse about your child's
narcolepsy and medicines. Together you can work out a place to keep the medicines and a schedule for taking them at school.
Pregnant Women
If you're pregnant or planning a pregnancy, ask your doctor whether you should continue taking your narcolepsy medicines. Certain medicines may interfere with your pregnancy.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to narcolepsy, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Obesity Hypoventilation Syndrome?
Obesity hypoventilation (HI-po-ven-tih-LA-shun) syndrome (OHS) is a breathing disorder that affects some obese people. In OHS, poor breathing results in too much carbon dioxide (hypoventilation) and too little oxygen in the blood (hypoxemia).
OHS sometimes is called Pickwickian syndrome.
Overview
To understand OHS, it helps to understand how the lungs work. When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries (KAP-ih-lare-ees) run through the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the air sacs. This process is called gas exchange.
In people who have OHS, poor breathing prevents proper gas exchange. As a result, the level of carbon dioxide in the blood rises. Also, the level of oxygen in the blood drops.
These changes can lead to serious health problems, such as leg edema (e-DE-mah), pulmonary hypertension (PULL-mun-ary HI-per-TEN-shun), cor pulmonale (pul-meh-NAL-e), and secondary erythrocytosis (eh-RITH-ro-si-TOE-sis). If left untreated, OHS can even be fatal.
The cause of OHS isn't fully known. Researchers think that several factors may work together to cause the disorder.
Many people who have OHS also have obstructive sleep apnea. Obstructive sleep apnea is a common disorder in which the airway collapses or is blocked during sleep. This causes pauses in breathing or shallow breaths while you sleep.
Obstructive sleep apnea disrupts your sleep and causes you to feel very tired during the day. (For more information, go to the Health Topics Sleep Apnea article.)
Outlook
Doctors treat OHS in a number of ways. One way is with positive airway pressure (PAP) machines, which are used during sleep.
PAP therapy uses mild air pressure to keep your airways open. Your doctor might recommend CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure).
If your doctor prescribes PAP therapy, you'll work with someone from a home equipment provider to select a CPAP or BiPAP machine. The home equipment provider will help you select a machine based on your prescription and the features that meet your needs.
Other treatments for OHS include ventilator (VEN-til-a-tor) support and medicines. (A ventilator is a machine that supports breathing.)
OHS occurs with obesity, so your doctor will likely recommend weight loss as part of your treatment plan. Successful weight loss often involves setting goals and making lifestyle changes, such as following a healthy diet and being physically active.
OHS can lead to other serious health problems, so following your treatment plan is important. Your health care team, home equipment provider, and family can help you manage your treatment.
What Causes Obesity Hypoventilation Syndrome?
Obesity hypoventilation syndrome (OHS) is a breathing disorder that affects some obese people. Why these people develop OHS isn't fully known. Researchers think that several factors may work together to cause OHS. These factors include:
A
respiratory (RES-pih-rah-tor-e) system that has to work harder than normal and perhaps differently because of excess body weight. (The
respiratory system is a group of
organs and
tissues, including the
lungs, that helps you breathe.)
Who Is at Risk for Obesity Hypoventilation Syndrome?
People who are obese are at risk for obesity hypoventilation syndrome (OHS). ""Obesity"" refers to having too much body fat. People who are obese have body weight that's greater than what is considered healthy for a certain height.
The most useful measure of obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 30 or more is considered obese.
You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.
If you are obese, you're at greater risk for OHS if your BMI is 40 or higher. You're also at greater risk if most of your excess weight is around your waist, rather than at your hips. This is referred to as ""abdominal obesity.""
OHS tends to occur more often in men than women. At the time of diagnosis, most people are 40 to 60 years old.
What Are the Signs and Symptoms of Obesity Hypoventilation Syndrome?
Many of the signs and symptoms of obesity hypoventilation syndrome (OHS) are the same as those of obstructive sleep apnea. This is because many people who have OHS also have obstructive sleep apnea.
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
Other symptoms include:
You also may have rapid, shallow breathing. During a physical exam, your doctor might hear abnormal heart sounds while listening to your heart with a stethoscope. He or she also might notice that the opening to your throat is small and your neck is larger than normal.
Complications of Obesity Hypoventilation Syndrome
When left untreated, OHS can cause serious problems, such as:
Leg
edema, which is swelling in the legs caused by fluid in the body's
tissues.
Cor pulmonale, which is failure of the right side of the
heart.
How Is Obesity Hypoventilation Syndrome Diagnosed?
Obesity hypoventilation syndrome (OHS) is diagnosed based on your medical history, signs and symptoms, and test results.
Specialists Involved
A critical care specialist, pulmonologist (lung specialist), and/or sleep specialist may diagnose and treat your condition.
A sleep specialist is a doctor who diagnoses and treats sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.
Your health care team also may include:
A registered dietitian or nutritionist to help you plan and follow a healthy diet. (Your primary care doctor also might oversee weight-loss
treatment and progress.)
An
exercise physiologist or trainer to assess your fitness level and help create a physical activity plan that's safe for you.
A bariatric surgeon if weight-loss
surgery is an option for you.
Medical History and Physical Exam
Your doctor will ask about your signs and symptoms, such as loud snoring or daytime sleepiness. He or she also may ask about your use of alcohol and certain medicines, such as sedatives and narcotics. These substances can worsen OHS.
During the physical exam, your doctor will listen to your heart with a stethoscope. He or she also will check to see whether another disease or condition could be the cause of your poor breathing.
Diagnostic Tests
In OHS, poor breathing leads to too much carbon dioxide and too little oxygen in the blood. An arterial blood gas test can measure the levels of these gases in your blood.
For this test, a blood sample is taken from an artery, usually in your wrist. The sample is then sent to a laboratory, where the oxygen and carbon dioxide levels are measured.
Other tests also can measure the carbon dioxide level or oxygen level in your blood. These tests include a serum bicarbonate test and pulse oximetry.
A serum bicarbonate test measures the amount of carbon dioxide in the liquid part of your blood, called the serum. For this test, a blood sample is taken from a vein, usually in your wrist or hand.
Pulse oximetry measures the level of oxygen in your blood. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood.
Other Tests
Your doctor may recommend other tests to help check for conditions and problems related to OHS.
Polysomnogram
A polysomnogram (PSG) is a type of sleep study. You usually have to stay overnight at a sleep center for a PSG. The test records brain activity, eye movements, heart rate, and blood pressure.
A PSG also records the amount of oxygen in your blood, how much air is moving through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe.
Your doctor might use the PSG results to help diagnose sleep-related breathing disorders, such as sleep apnea.
Lung Function Tests
Lung function tests, also called pulmonary function tests, measure how well your lungs work. For example, these tests show:
How much air you can take into your
lungs. This amount is compared with that of other people your age, height, and sex. This allows your doctor to see whether you're in the normal range.
How much air you can blow out of your
lungs and how fast you can do it.
The strength of your breathing
muscles.
Chest X Ray
A chest x ray is a test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can help rule out other conditions that might be causing your signs and symptoms.
EKG (Electrocardiogram)
An EKG is a test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
The results from an EKG might show whether OHS has affected your heart function.
Other Tests
A complete blood count (CBC) can show whether your body is making too many red blood cells as a result of OHS. A CBC measures many parts of your blood, including red blood cells.
A toxicology screen is a group of tests that shows which medicines and drugs you've taken and how much of them you've taken. A blood or urine sample usually is collected for a toxicology screen.
How Is Obesity Hypoventilation Syndrome Treated?
Treatments for obesity hypoventilation syndrome (OHS) include breathing support, weight loss, and medicines.
The goals of treating OHS may include:
Supporting and aiding your breathing
Achieving major weight loss
Treating underlying and related conditions
Breathing Support
Positive Airway Pressure
Treatment for OHS often involves a machine that provides positive airway pressure (PAP) while you sleep.
PAP therapy uses mild air pressure to keep your airways open. This treatment can help your body better maintain the carbon dioxide and oxygen levels in your blood. PAP therapy also can help relieve daytime sleepiness.
Your doctor might recommend CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure). CPAP provides continuous mild air pressure to keep your airways open. BiPAP works almost the same, but it changes the air pressure while you breathe in and out.
The machines have three main parts:
A mask or other device that
fits over your
nose or your nose and
mouth. Straps keep the mask in place while you're wearing it.
A tube that connects the mask to the machine's
motor.
A
motor that blows air into the tube.
Some machines have other features, such as heated humidifiers. The machines are small, lightweight, and fairly quiet. The noise they make is soft and rhythmic.
Some people who have OHS receive extra oxygen as part of their PAP treatment. However, oxygen therapy alone isn't recommended as a treatment for OHS.
PAP therapy also is used to treat obstructive sleep apnea. Many people who have OHS also have this common condition.
If your doctor prescribes PAP therapy, you'll work with someone from a home equipment provider to select a CPAP or BiPAP machine. The home equipment provider will help you pick a machine based on your prescription and the features that meet your needs.
Ventilator Support
If you have severe OHS that requires treatment in a hospital, you might be put on a ventilator. A ventilator is a machine that supports breathing. This machine:
A ventilator blows air, or air with extra oxygen, into the airways through a breathing tube. One end of the tube is inserted into your windpipe, and the other end is hooked to the ventilator.
Usually, the breathing tube is put into your nose or mouth and then moved down into your throat. A tube placed like this is called an endotracheal (en-do-TRA-ke-al) tube. Endotracheal tubes are used only in a hospital setting.
Sometimes the breathing tube is placed through a surgically made hole called a tracheostomy (TRA-ke-OS-toe-me). The hole goes through the front of your neck and into your windpipe.
The procedure to make a tracheostomy usually is done in an operating room. You'll be given medicine so you won't feel any pain. The tracheostomy allows you to be on a ventilator in the hospital, in a long-term care facility, or at home.
Talk with your doctor about how long you'll need ventilator support and whether you can receive treatment at home.
For more information about ventilator support, go to the Health Topics Ventilator/Ventilator Support article.
Weight Loss
Your doctor will likely recommend weight loss as part of your treatment plan. Successful weight loss often involves setting goals and making lifestyle changes. For example, eating fewer calories and being physically active can help you lose weight.
Medicines and weight-loss surgery might be an option if lifestyle changes aren't enough. Your doctor will advise you on the best weight-loss treatment for you.
For more information about weight loss, go to the treatment section of the Health Topics Overweight and Obesity article.
Medicines
Your doctor may prescribe medicines to treat OHS (although this treatment is less common than others).
Your doctor also may advise you to avoid certain substances and medicines that can worsen OHS. Examples include alcohol, sedatives, and narcotics. They can interfere with how well your body is able to maintain normal carbon dioxide and oxygen levels.
If you're having surgery, make sure you tell your surgeon and health care team that you have OHS. Some medicines routinely used for surgery can worsen your condition.
How Can Obesity Hypoventilation Syndrome Be Prevented?
You can prevent obesity hypoventilation syndrome (OHS) by maintaining a healthy weight. However, not everyone who is obese develops OHS. Researchers don't fully know why only some people who are obese develop the condition.
Adopting healthy habits can help you maintain a healthy weight. Many lifestyle habits begin during childhood. So, it's important to make following a healthy lifestyle a family goal.
A healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Lowering Your Blood Pressure With DASH"" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
To adopt other healthy lifestyle habits, follow these tips:
Focus on portion size. Watch the portion sizes in fast food and other restaurants. The portions served often are enough for two or three people. Children's portion sizes should be smaller than those for adults. Cutting back on portion sizes will help you manage your calorie intake.
Be
physically active. Make personal and family time as active as possible. Find activities that everyone will enjoy. For example, go for a brisk walk, bike or rollerblade, or train together for a walk or run.
Reduce screen time. Limit the use of TVs, computers, DVDs, and videogames; they cut back on the time for physical activity. Health experts recommend 2 hours or less a day of screen time that's not work- or homework-related.
Keep track of your weight and body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 30 or more is considered obese. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.
For more information, go to the prevention section of the Health Topics Overweight and Obesity article.
Even if you have OHS, you might be able to prevent the condition from worsening. For example, avoid alcohol, sedatives, and narcotics. These substances can interfere with how well your body is able to maintain normal carbon dioxide and oxygen levels.
Living With Obesity Hypoventilation Syndrome
Obesity hypoventilation syndrome (OHS) can be very serious. However, following your treatment plan can help improve your breathing. Treatment also can:
Ongoing Care
To make sure your treatment is working, see your doctor for ongoing care. Tell him or her if your treatment is causing any side effects or problems.
CPAP and BiPAP Treatment
If your doctor has prescribed CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure), use your machine as directed. You may find that it takes time to adjust to this treatment.
If you can't adjust to the CPAP or BiPAP machine, or if it doesn't seem to work well, talk with your doctor or home equipment provider. You may need to switch to a different device or mask. If you're having side effects from CPAP or BiPAP, your doctor may be able to treat them.
Weight-Loss Treatment
Weight loss will likely be part of your treatment plan. Your doctor will work with you to create a reasonable weight-loss plan. Your doctor and other members of your health care team can help you meet your weight-loss goals.
For more information about weight-loss treatments and for tips on losing weight, go to the Health Topics Overweight and Obesity article.
Other Treatment Concerns
OHS can cause daytime sleepiness. Until this symptom is fully treated, know the dangers of driving or using heavy machinery while sleepy.
If you're having surgery, tell your surgeon and health care team that you have OHS. Some medicines routinely used for surgery can worsen your condition.
Ask your doctor when you should contact him or her or seek emergency medical care. In an emergency, call 9–1–1. You may want to wear a medical ID bracelet or necklace to alert others to your medical needs.
Family Support
If you have a family member who has OHS, you can help him or her achieve success with treatment. Tell his or her doctor about any signs or symptoms you've noticed.
For example, many people who have OHS also have obstructive sleep apnea. Family members or bed partners usually are the first to notice symptoms, such as loud snoring and pauses in breathing. Telling the doctor about these symptoms can help him or her diagnose and treat your family member promptly.
Encourage your family member to seek medical help when needed and to follow up with his or her doctor regularly. You also can help your family member adopt healthy lifestyle habits, such as following a healthy diet and being physically active.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to obesity hypoventilation syndrome, talk with your doctor. You can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Are Overweight and Obesity?
The terms ""overweight"" and ""obesity"" refer to body weight that’s greater than what is considered healthy for a certain height.
The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. For more information about BMI, go to ""How Are Overweight and Obesity Diagnosed?""
Overview
Millions of Americans and people worldwide are overweight or obese. Being overweight or obese puts you at risk for many health problems. The more body fat that you have and the more you weigh, the more likely you are to develop:
Your weight is the result of many factors. These factors include environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy), behavior or habits, and more.
You can't change some factors, such as family history. However, you can change other factors, such as your lifestyle habits.
For example, follow a healthy eating plan and keep your calorie needs in mind. Be physically active and try to limit the amount of time that you're inactive.
Weight-loss medicines and surgery also are options for some people if lifestyle changes aren't enough.
Outlook
Reaching and staying at a healthy weight is a long-term challenge for people who are overweight or obese. But it also is a chance to lower your risk for other serious health problems. With the right treatment and motivation, it's possible to lose weight and lower your long-term disease risk.
What Causes Overweight and Obesity?
Lack of Energy Balance
A lack of energy balance most often causes overweight and obesity. Energy balance means that your energy IN equals your energy OUT.
Energy IN is the amount of energy or calories you get from food and drinks. Energy OUT is the amount of energy your body uses for things like breathing, digesting, and being physically active.
To maintain a healthy weight, your energy IN and OUT don't have to balance exactly every day. It's the balance over time that helps you maintain a healthy weight.
The same amount of energy IN and energy OUT over time = weight stays the same
More energy IN than energy OUT over time = weight gain
More energy OUT than energy IN over time = weight loss
Overweight and obesity happen over time when you take in more calories than you use.
Other Causes
An Inactive Lifestyle
Many Americans aren't very physically active. One reason for this is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked to overweight and obesity.
Other reasons for not being active include: relying on cars instead of walking, fewer physical demands at work or at home because of modern technology and conveniences, and lack of physical education classes in schools.
People who are inactive are more likely to gain weight because they don't burn the calories that they take in from food and drinks. An inactive lifestyle also raises your risk for coronary heart disease, high blood pressure, diabetes, colon cancer, and other health problems.
Environment
Our environment doesn't support healthy lifestyle habits; in fact, it encourages obesity. Some reasons include:
Lack of neighborhood sidewalks and safe places for recreation. Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active.
Work schedules. People often say that they don't have time to be physically active because of long work hours and time spent commuting.
Oversized food portions. Americans are exposed to huge food portions in restaurants, fast food places, gas stations, movie theaters, supermarkets, and even at home. Some of these meals and snacks can feed two or more people. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn't balanced with physical activity.
Lack of access to healthy foods. Some people don't live in neighborhoods that have supermarkets that sell healthy foods, such as fresh fruits and vegetables. Or, for some people, these healthy foods are too costly.
Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-
fat snacks and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods, and often they do.
Genes and Family History
Studies of identical twins who have been raised apart show that genes have a strong influence on a person's weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese.
Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat. Because families also share food and physical activity habits, a link exists between genes and the environment.
Children adopt the habits of their parents. A child who has overweight parents who eat high-calorie foods and are inactive will likely become overweight too. However, if the family adopts healthy food and physical activity habits, the child's chance of being overweight or obese is reduced.
Health Conditions
Some hormone problems may cause overweight and obesity, such as underactive thyroid (hypothyroidism), Cushing's syndrome, and polycystic ovarian syndrome (PCOS).
Underactive thyroid is a condition in which the thyroid gland doesn't make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You'll also feel tired and weak.
Cushing's syndrome is a condition in which the body's adrenal glands make too much of the hormone cortisol. Cushing's syndrome also can develop if a person takes high doses of certain medicines, such as prednisone, for long periods.
People who have Cushing's syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs.
PCOS is a condition that affects about 5–10 percent of women of childbearing age. Women who have PCOS often are obese, have excess hair growth, and have reproductive problems and other health issues. These problems are caused by high levels of hormones called androgens.
Medicines
Certain medicines may cause you to gain weight. These medicines include some corticosteroids, antidepressants, and seizure medicines.
These medicines can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold on to extra water. All of these factors can lead to weight gain.
Emotional Factors
Some people eat more than usual when they're bored, angry, or stressed. Over time, overeating will lead to weight gain and may cause overweight or obesity.
Smoking
Some people gain weight when they stop smoking. One reason is that food often tastes and smells better after quitting smoking.
Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. However, smoking is a serious health risk, and quitting is more important than possible weight gain.
Age
As you get older, you tend to lose muscle, especially if you're less active. Muscle loss can slow down the rate at which your body burns calories. If you don't reduce your calorie intake as you get older, you may gain weight.
Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain about 5 pounds during menopause and have more fat around the waist than they did before.
Pregnancy
During pregnancy, women gain weight to support their babies’ growth and development. After giving birth, some women find it hard to lose the weight. This may lead to overweight or obesity, especially after a few pregnancies.
Lack of Sleep
Research shows that lack of sleep increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Lack of sleep increases the risk of obesity in other age groups as well.
People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity.
Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested.
Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Lack of sleep results in a higher than normal blood sugar level, which may increase your risk for diabetes.
For more information, go to the Health Topics Sleep Deprivation and Deficiency article.
What Are the Health Risks of Overweight and Obesity?
Being overweight or obese isn't a cosmetic problem. These conditions greatly raise your risk for other health problems.
Overweight and Obesity-Related Health Problems in Adults
High Blood Pressure
Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.
Your chances of having high blood pressure are greater if you're overweight or obese.
Type 2 Diabetes
Diabetes is a disease in which the body's blood glucose, or blood sugar, level is too high. Normally, the body breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.
In type 2 diabetes, the body's cells don't use insulin properly. At first, the body reacts by making more insulin. Over time, however, the body can't make enough insulin to control its blood sugar level.
Diabetes is a leading cause of early death, CHD, stroke, kidney disease, and blindness. Most people who have type 2 diabetes are overweight.
Metabolic Syndrome
Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
You can develop any one of these risk factors by itself, but they tend to occur together. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors:
A large waistline. This is called abdominal
obesity or ""having an apple shape."" Having extra
fat in the waist area is a greater risk factor for CHD than having extra fat in other parts of the body, such as on the hips.
A lower than normal
HDL cholesterol level (or you're on medicine to treat low HDL cholesterol).
Osteoarthritis
Osteoarthritis is a common joint problem of the knees, hips, and lower back. The condition occurs if the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain.
Sleep Apnea
Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
A person who has sleep apnea may have more fat stored around the neck. This can narrow the airway, making it hard to breathe.
Obesity Hypoventilation Syndrome
Obesity hypoventilation syndrome (OHS) is a breathing disorder that affects some obese people. In OHS, poor breathing results in too much carbon dioxide (hypoventilation) and too little oxygen in the blood (hypoxemia).
OHS can lead to serious health problems and may even cause death.
Overweight and Obesity-Related Health Problems in Children and Teens
Overweight and obesity also increase the health risks for children and teens. Type 2 diabetes once was rare in American children, but an increasing number of children are developing the disease.
Also, overweight children are more likely to become overweight or obese as adults, with the same disease risks.
Who Is at Risk for Overweight and Obesity?
Overweight and obesity affect Americans of all ages, sexes, and racial/ethnic groups. This serious health problem has been growing over the last 30 years.
Adults
According to the National Health and Nutrition Examination Survey (NHANES) 2009–2010, almost 70 percent of Americans are overweight or obese. The survey also shows differences in overweight and obesity among racial/ethnic groups.
In women,
overweight and
obesity are highest among non-Hispanic Black women (about 82 percent), compared with about 76 percent for Hispanic women and 64 percent for non-Hispanic White women.
In men,
overweight and
obesity are highest among Hispanic men (about 82 percent), compared with about 74 percent for non-Hispanic White men and about 70 percent for non-Hispanic Black men.
Children and Teens
Children also have become heavier. In the past 30 years, obesity has tripled among school-aged children and teens.
According to NHANES 2009–2010, about 1 in 6 American children ages 2–19 are obese. The survey also suggests that overweight and obesity are having a greater effect on minority groups, including Blacks and Hispanics.
What Are the Signs and Symptoms of Overweight and Obesity?
Weight gain usually happens over time. Most people know when they've gained weight. Some of the signs of overweight and obesity include:
How Are Overweight and Obesity Diagnosed?
The most common way to find out whether you're overweight or obese is to figure out your body mass index (BMI). BMI is an estimate of body fat, and it's a good gauge of your risk for diseases that occur with more body fat.
BMI is calculated from your height and weight. You can use the chart below or the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI. Or, you health care provider can measure your BMI.
Body Mass Index for Adults
Use this table to learn your BMI. First, find your height on the far left column. Next, move across the row to find your weight. Weight is measured with underwear but no shoes.
Once you've found your weight, move to the very top of that column. This number is your BMI.
View in own window
| Height | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 |
|---|
| 4'10"" | 100 | 105 | 110 | 115 | 119 | 124 | 129 | 134 | 138 | 143 | 148 |
|---|
| 5'0"" | 107 | 112 | 118 | 123 | 128 | 133 | 138 | 143 | 148 | 153 | 158 |
|---|
| 5'1"" | 111 | 116 | 122 | 127 | 132 | 137 | 143 | 148 | 153 | 158 | 164 |
|---|
| 5'3"" | 118 | 124 | 130 | 135 | 141 | 146 | 152 | 158 | 163 | 169 | 175 |
|---|
| 5'5"" | 126 | 132 | 138 | 144 | 150 | 156 | 162 | 168 | 174 | 180 | 186 |
|---|
| 5'7"" | 134 | 140 | 146 | 153 | 159 | 166 | 172 | 178 | 185 | 191 | 198 |
|---|
| 5'9"" | 142 | 149 | 155 | 162 | 169 | 176 | 182 | 189 | 196 | 203 | 209 |
|---|
| 5'11"" | 150 | 157 | 165 | 172 | 179 | 186 | 193 | 200 | 208 | 215 | 222 |
|---|
| 6'1"" | 159 | 166 | 174 | 182 | 189 | 197 | 204 | 212 | 219 | 227 | 235 |
|---|
| 6'3"" | 168 | 176 | 184 | 192 | 200 | 208 | 216 | 224 | 232 | 240 | 248 |
|---|
This table offers a sample of BMI measurements. If you don't see your height and/or weight listed on this table, go the NHLBI's complete Body Mass Index Table.
What Does Body Mass Index Mean?
Although BMI can be used for most men and women, it does have some limits. It may overestimate body fat in athletes and others who have a muscular build. BMI also may underestimate body fat in older people and others who have lost muscle.
Body Mass Index for Children and Teens
Overweight are obesity are defined differently for children and teens than for adults. Children are still growing, and boys and girls mature at different rates.
BMIs for children and teens compare their heights and weights against growth charts that take age and sex into account. This is called BMI-for-age percentile. A child or teen's BMI-for-age percentile shows how his or her BMI compares with other boys and girls of the same age.
For more information about BMI-for-age and growth charts for children, go to the Centers for Disease Control and Prevention's BMI-for-age calculator.
What Does the BMI-for-Age Percentile Mean?
View in own window
| BMI-for-Age Percentile | |
|---|
| Less than 5th percentile | Underweight |
| 5th percentile to less than the 85th percentile | Healthy weight |
| 85th percentile to less than the 95th percentile | Overweight |
| 95th percentile or greater | Obese |
Waist Circumference
Health care professionals also may take your waist measurement. This helps screen for the possible health risks related to overweight and obesity in adults.
If you have abdominal obesity and most of your fat is around your waist rather than at your hips, you're at increased risk for coronary heart disease and type 2 diabetes. The risk goes up with a waist size that's greater than 35 inches for women or greater than 40 inches for men.
You also can measure your waist size. To do so correctly, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.
Specialists Involved
A primary care doctor (or pediatrician for children and teens) will assess your BMI, waist measurement, and overall health risk. If you're overweight or obese, or if you have a large waist size, your doctor should explain the health risks and find out whether you're interested and willing to lose weight.
If you are, you and your doctor can work together to create a treatment plan. The plan may include weight-loss goals and treatment options that are realistic for you.
Your doctor may send you to other health care specialists if you need expert care. These specialists may include:
What Is Patent Ductus Arteriosus?
Patent ductus arteriosus (PDA) is a heart problem that affects some babies soon after birth. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. These arteries are the aorta and the pulmonary (PULL-mun-ary) artery.
Before birth, these arteries are connected by a blood vessel called the ductus arteriosus. This blood vessel is a vital part of fetal blood circulation.
Within minutes or up to a few days after birth, the ductus arteriosus closes. This change is normal in newborns.
In some babies, however, the ductus arteriosus remains open (patent). The opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries.
![]()
Normal Heart and Heart With Patent Ductus Arteriosus. Figure A shows a cross-section of a normal heart. The arrows show the direction of blood flow through the heart. Figure B shows a heart with patent ductus arteriosus. The defect connects the aorta (more...)
Go to the ""How the Heart Works"" section of this article for more details about how a normal heart works compared with a heart that has PDA.
Overview
PDA is a type of congenital (kon-JEN-ih-tal) heart defect. A congenital heart defect is any type of heart problem that's present at birth.
If your baby has a PDA but an otherwise normal heart, the PDA may shrink and go away. However, some children need treatment to close their PDAs.
Some children who have PDAs are given medicine to keep the ductus arteriosus open. For example, this may be done if a child is born with another heart defect that decreases blood flow to the lungs or the rest of the body.
Keeping the PDA open helps maintain blood flow and oxygen levels until doctors can do surgery to correct the other heart defect.
Outlook
PDA is a fairly common congenital heart defect in the United States. Although the condition can affect full-term infants, it's more common in premature infants.
On average, PDA occurs in about 8 out of every 1,000 premature babies, compared with 2 out of every 1,000 full-term babies. Premature babies also are more vulnerable to the effects of PDA.
PDA is twice as common in girls as it is in boys.
Doctors treat the condition with medicines, catheter-based procedures, and surgery. Most children who have PDAs live healthy, normal lives after treatment.
How the Heart Works
To understand patent ductus arteriosus (PDA), it helps to know how a normal heart works. Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.
![]()
A Healthy Heart Cross-Section. Figure A shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to (more...)
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-
pid) valve is in the right side of the
heart, between the right atrium and the right
ventricle.
The mitral (MI-trul) valve is in the left side of the
heart, between the left atrium and the left
ventricle.
The aortic (ay-OR-tik) valve is in the left side of the
heart, between the left
ventricle and the entrance to the
aorta. This
artery carries
blood from the heart to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a ""lub-DUB"" sound that a doctor can hear using a stethoscope.
The first sound—the ""lub""—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the
ventricles contract, or squeeze, and pump
blood out of the
heart.
The second sound—the ""DUB""—is made by the aortic and
pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the
ventricles relax and fill with
blood pumped into them by the
atria.
Veins
The veins also are major blood vessels connected to your heart.
For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. The article contains animations that show how your heart pumps blood and how your heart's electrical system works.
The Heart With Patent Ductus Arteriosus
The ductus arteriosus is a blood vessel that connects the aorta and pulmonary artery in unborn babies. This vessel allows blood to be pumped from the right side of the heart into the aorta, without stopping at the lungs for oxygen.
While a baby is in the womb, only a small amount of his or her blood needs to go to the lungs. This is because the baby gets oxygen from the mother's bloodstream.
After birth, the baby no longer is connected to the mother's bloodstream. Thus, the baby's blood must travel to his or her own lungs to get oxygen. As the baby begins to breathe on his or her own, the pulmonary artery opens to allow blood into the lungs. Normally, the ductus arteriosus closes because the infant no longer needs it.
Once the ductus arteriosus closes, blood leaving the right side of the heart no longer goes into the aorta. Instead, the blood travels through the pulmonary artery to the lungs. There, the blood picks up oxygen. The oxygen-rich blood returns to the left side of the heart and is pumped to the rest of the body.
Sometimes the ductus arteriosus remains open (patent) after birth. A PDA allows blood to flow from the aorta into the pulmonary artery and to the lungs. The extra blood flowing into the lungs strains the heart. It also increases blood pressure in the lung's arteries.
Effects of Patent Ductus Arteriosus
Full-term infants. A small PDA might not cause any problems, but a large PDA likely will cause problems. The larger the PDA, the greater the amount of extra blood that passes through the lungs.
A large PDA that remains open for an extended time can cause the heart to enlarge, forcing it to work harder. Also, fluid can build up in the lungs.
A PDA can slightly increase the risk of infective endocarditis (IE). IE is an infection of the inner lining of the heart chambers and valves.
In PDA, increased blood flow can irritate the lining of the pulmonary artery, where the ductus arteriosus connects. This irritation makes it easier for bacteria in the bloodstream to collect and grow, which can lead to IE.
Premature infants. PDA can be more serious in premature infants than in full-term infants. Premature babies are more likely to have lung damage from the extra blood flowing from the PDA into the lungs. These infants may need to be put on ventilators. Ventilators are machines that support breathing.
Increased blood flow through the lungs also can reduce blood flow to the rest of the body. This can damage other organs, especially the intestines and kidneys.
What Causes Patent Ductus Arteriosus?
If your child has patent ductus arteriosus (PDA), you may think you did something wrong during your pregnancy to cause the problem. However, the cause of patent ductus arteriosus isn't known.
Genetics may play a role in causing the condition. A defect in one or more genes might prevent the ductus arteriosus from closing after birth.
Who Is at Risk for Patent Ductus Arteriosus?
Patent ductus arteriosus (PDA) is a fairly common congenital heart defect in the United States. Although the condition can affect full-term infants, it's more common in premature infants.
On average, PDA occurs in about 8 out of every 1,000 premature babies, compared with 2 out of every 1,000 full-term babies.
PDA also is more common in:
PDA is twice as common in girls as it is in boys.
What Are the Signs and Symptoms of Patent Ductus Arteriosus?
A heart murmur may be the only sign that a baby has patent ductus arteriosus (PDA). A heart murmur is an extra or unusual sound heard during the heartbeat. Heart murmurs also have other causes besides PDA, and most murmurs are harmless.
Some infants may have signs or symptoms of volume overload on the heart and excess blood flow in the lungs. These signs and symptoms may include:
How Is Patent Ductus Arteriosus Diagnosed?
In full-term infants, patent ductus arteriosus (PDA) usually is first suspected if a heart murmur is heard during a routine checkup.
A heart murmur is an extra or unusual sound heard during the heartbeat. Heart murmurs have other causes besides PDA, and most murmurs are harmless.
If a PDA is large, an infant also may have symptoms of volume overload and increased blood flow to the lungs. If a PDA is small, it may not be diagnosed until later in childhood.
If your child's doctor thinks your child has PDA, he or she may refer you to a pediatric cardiologist. This is a doctor who specializes in diagnosing and treating heart problems in children.
Premature babies who have PDA may not have the same signs and symptoms as full-term babies, such as heart murmurs. Doctors may suspect PDA in premature babies who have breathing problems soon after birth. Tests can help confirm a diagnosis.
Diagnostic Tests
Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of your baby's heart. The sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen.
The test allows the doctor to clearly see any problems with the way the heart is formed or the way it's working. Echo is an important test for both diagnosing a heart defect and following the problem over time.
Echo can show the size of a PDA and how the heart is responding to the defect. When medical treatments are used to try to close a PDA, echo can show how well the treatments are working.
EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart's electrical activity. For babies who have PDA, an EKG can show whether the heart is enlarged. The test also can show other subtle changes that may suggest the presence of a PDA.
How Is Patent Ductus Arteriosus Treated?
Patent ductus arteriosus (PDA) is treated with medicines, catheter-based procedures, and surgery. The goal of treatment is to close the PDA. Closure will help prevent complications and reverse the effects of increased blood volume.
Small PDAs often close without treatment. For full-term infants, treatment is needed if the PDA is large or causing health problems. For premature infants, treatment is needed if the PDA is causing breathing problems or heart problems.
Talk with your child's doctor about treatment options and how your family prefers to handle treatment decisions.
Medicines
Your child's doctor may prescribe medicines to help close your child's PDA.
Indomethacin (in-doh-METH-ah-sin) is a medicine that helps close PDAs in premature infants. This medicine triggers the PDA to constrict or tighten, which closes the opening. Indomethacin usually doesn't work in full-term infants.
Ibuprofen also is used to close PDAs in premature infants. This medicine is similar to indomethacin.
Catheter-Based Procedures
Catheters are thin, flexible tubes that doctors use as part of a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun). Catheter-based procedures often are used to close PDAs in infants or children who are large enough to have the procedure.
Your child's doctor may refer to the procedure as ""transcatheter device closure."" The procedure sometimes is used for small PDAs to prevent the risk of infective endocarditis (IE). IE is an infection of the inner lining of the heart chambers and valves.
Your child will be given medicine to help him or her relax or sleep during the procedure. The doctor will insert a catheter in a large blood vessel in the groin (upper thigh). He or she will then guide the catheter to your child's heart.
A small metal coil or other blocking device is passed through the catheter and placed in the PDA. This device blocks blood flow through the vessel.
Catheter-based procedures don't require the child's chest to be opened. They also allow the child to recover quickly.
These procedures often are done on an outpatient basis. You'll most likely be able to take your child home the same day the procedure is done.
Complications from catheter-based procedures are rare and short term. They can include bleeding, infection, and movement of the blocking device from where it was placed.
Surgery
Surgery to correct a PDA may be done if:
A premature or full-term infant has health problems due to a PDA and is too small to have a
catheter-based procedure
A
catheter-based procedure doesn't successfully close the PDA
Often, surgery isn't done until after 6 months of age in infants who don't have health problems from their PDAs. Doctors sometimes do surgery on small PDAs to prevent the risk of IE.
For the surgery, your child will be given medicine so that he or she will sleep and not feel any pain. The surgeon will make a small incision (cut) between your child's ribs to reach the PDA. He or she will close the PDA using stitches or clips.
Complications from surgery are rare and usually short term. They can include hoarseness, a paralyzed diaphragm (the muscle below the lungs), infection, bleeding, or fluid buildup around the lungs.
After Surgery
After surgery, your child will spend a few days in the hospital. He or she will be given medicine to reduce pain and anxiety. Most children go home 2 days after surgery. Premature infants usually have to stay in the hospital longer because of their other health issues.
The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk to you about:
Limits on activity for your child while he or she recovers
Followup appointments with your child's doctors
How to give your child medicines at home, if needed
When your child goes home after surgery, you can expect that he or she will feel fairly comfortable. However, you child may have some short-term pain.
Your child should begin to eat better and gain weight quickly. Within a few weeks, he or she should fully recover and be able to take part in normal activities.
Long-term complications from surgery are rare. However, they can include narrowing of the aorta, incomplete closure of the PDA, and reopening of the PDA.
Living With Patent Ductus Arteriosus
Most children who have PDAs live healthy, normal lives after treatment. Full-term infants will likely have normal activity levels, appetite, and growth after PDA treatment, unless they had other congenital heart defects.
For premature infants, the outlook after PDA treatment depends on other factors, such as:
Ongoing Care
Children who have PDAs are at slightly increased risk for infective endocarditis (IE). IE is an infection of the inner lining of the heart chambers and valves.
Your child's doctor will tell you whether your child needs antibiotics before certain medical procedures to help prevent IE. According to the most recent American Heart Association guidelines, most children who have PDAs don't need antibiotics.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat them.
Many more questions remain about heart diseases and conditions, including patent ductus arteriosus (PDA) and other congenital heart defects. The NHLBI continues to support research aimed at learning more about these conditions. For example, the NHLBI currently sponsors two research groups that study congenital heart disease.
The Pediatric Heart Network conducts clinical research to improve outcomes and quality of life for children who have congenital heart disease and other pediatric heart diseases.
The Pediatric Cardiac Genomic Consortium (part of the NHLBI's Bench to Bassinet Program) conducts clinical research to find the genetic causes of congenital heart disease. This group's research also aims to pinpoint the genetic factors that affect clinical outcomes in people who have congenital heart disease.
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.
When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.
If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to PDA, talk with your child's doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Pericarditis?
Pericarditis (PER-ih-kar-DI-tis) is a condition in which the membrane, or sac, around your heart is inflamed. This sac is called the pericardium (per-ih-KAR-de-um).
The pericardium holds the heart in place and helps it work properly. The sac is made of two thin layers of tissue that enclose your heart. Between the two layers is a small amount of fluid. This fluid keeps the layers from rubbing against each other and causing friction.
![]()
Pericardium. Figure A shows the location of the heart and a normal heart and pericardium (the sac surrounding the heart). The inset image is an enlarged cross-section of the pericardium that shows its two layers of tissue and the fluid between the layers. Figure (more...)
In pericarditis, the layers of tissue become inflamed and can rub against the heart. This causes chest pain, a common symptom of pericarditis.
The chest pain from pericarditis may feel like pain from a heart attack. More often, the pain may be sharp and get worse when you inhale, and improve when you are sitting up and leaning forward. If you have chest pain, you should call 9–1–1 right away, as you may be having a heart attack.
Overview
In many cases, the cause of pericarditis is unknown. Viral infections are likely a common cause of pericarditis, although the virus may never be found. Bacterial, fungal, and other infections also can cause pericarditis.
Other possible causes include heart attack or heart surgery, other medical conditions, injuries, and certain medicines.
Pericarditis can be acute or chronic. ""Acute"" means that it occurs suddenly and usually doesn't last long. ""Chronic"" means that it develops over time and may take longer to treat.
Both acute and chronic pericarditis can disrupt your heart's normal rhythm or function and possibly (although rarely) lead to death. However, most cases of pericarditis are mild; they clear up on their own or with rest and simple treatment.
Other times, more intense treatments are needed to prevent complications. Treatments may include medicines and, less often, procedures or surgery.
Outlook
It may take from a few days to weeks or even months to recover from pericarditis. With proper and prompt treatment, such as rest and ongoing care, most people fully recover from pericarditis. Proper treatment also can help reduce the chance of getting the condition again.
Other Names for Pericarditis
Chronic effusive
pericarditis and chronic constrictive pericarditis. These are forms of chronic pericarditis.
Who Is at Risk for Pericarditis?
Pericarditis occurs in people of all ages. However, men aged 20 to 50 are more likely to develop it than others.
People who are treated for acute pericarditis may get it again. This may happen in 15 to 30 percent of people who have the condition. A small number of these people go on to develop chronic pericarditis.
What Are the Signs and Symptoms of Pericarditis?
The most common sign of acute pericarditis is sharp, stabbing chest pain. The pain usually comes on quickly. It often is felt in the middle or left side of the chest or over the front of the chest. You also may feel pain in one or both shoulders, the neck, back, and abdomen.
The pain tends to ease when you sit up and lean forward. Lying down and deep breathing worsens it. For some people, the pain feels like a dull ache or pressure in the chest.
The chest pain also may feel like pain from a heart attack. If you have chest pain, you should call 9–1–1 right away, as you may be having a heart attack.
Some people with acute pericarditis develop a fever. Other symptoms are weakness, palpitations, trouble breathing, and coughing. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)
The most common symptom of chronic pericarditis is chest pain. Chronic pericarditis also often causes tiredness, coughing, and shortness of breath. Severe cases of chronic pericarditis can lead to swelling in the stomach and legs and hypotension (low blood pressure).
Complications of Pericarditis
Two serious complications of pericarditis are cardiac tamponade (tam-po-NAD) and chronic constrictive pericarditis.
Cardiac tamponade occurs if too much fluid collects in the pericardium (the sac around the heart). The extra fluid puts pressure on the heart. This prevents the heart from properly filling with blood. As a result, less blood leaves the heart, which causes a sharp drop in blood pressure. If left untreated, cardiac tamponade can be fatal.
Chronic constrictive pericarditis is a rare disease that develops over time. It leads to scar-like tissue forming throughout the pericardium. The sac becomes stiff and can't move properly. In time, the scarred tissue compresses the heart and prevents it from working well.
How Is Pericarditis Diagnosed?
Your doctor will diagnose pericarditis based on your medical history, a physical exam, and test results.
Specialists Involved
Primary care doctors—such as a family doctor, internist, or pediatrician—often diagnose and treat pericarditis. Other types of doctors also may be involved, such as a cardiologist, pediatric cardiologist, and an infectious disease specialist.
A cardiologist treats adults who have heart problems. A pediatric cardiologist treats children who have heart problems. An infectious disease specialist treats people who have infections.
Medical History
Your doctor may ask whether you:
Your doctor also may ask about your symptoms. If you have chest pain, he or she will ask you to describe how it feels, where it's located, and whether it's worse when you lie down, breathe, or cough.
Physical Exam
When the pericardium (the sac around your heart) is inflamed, the amount of fluid between its two layers of tissue increases. As part of the exam, your doctor will look for signs of excess fluid in your chest.
A common sign is the pericardial rub. This is the sound of the pericardium rubbing against the outer layer of your heart. Your doctor will place a stethoscope on your chest to listen for this sound.
Your doctor may hear other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion). These are more severe problems related to pericarditis.
Diagnostic Tests
Your doctor may recommend one or more tests to diagnose your condition and show how severe it is. The most common tests are:
Echocardiography. This painless test uses sound waves to create pictures of your
heart. The pictures show the size and shape of your heart and how well your heart is working. This test can show whether fluid has built up in the
pericardium.
Cardiac CT (computed tomography (to-MOG-rah-fee).
Cardiac CT is a type of x ray that takes a clear, detailed picture of your
heart and
pericardium. A cardiac CT helps rule out other causes of
chest pain.
Cardiac MRI (magnetic resonance imaging). This test uses powerful magnets and radio waves to create detailed pictures of your
organs and
tissues. A
cardiac MRI can show thickening or other changes in the
pericardium.
Your doctor also may recommend blood tests. These tests can help your doctor find out whether you've had a heart attack, the cause of your pericarditis, and how inflamed your pericardium is.
How Is Pericarditis Treated?
Most cases of pericarditis are mild; they clear up on their own or with rest and simple treatment. Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures or surgery.
The goals of treatment include:
Specific Types of Treatment
As a first step in your treatment, your doctor may advise you to rest until you feel better and have no fever. He or she may tell you to take over-the-counter, anti-inflammatory medicines to reduce pain and inflammation. Examples of these medicines include aspirin and ibuprofen.
You may need stronger medicine if your pain is severe. If your pain continues to be severe, your doctor may prescribe a medicine called colchicine and, possibly, prednisone (a steroid medicine).
If an infection is causing your pericarditis, your doctor will prescribe an antibiotic or other medicine to treat the infection.
You may need to stay in the hospital during treatment for pericarditis so your doctor can check you for complications.
The symptoms of acute pericarditis can last from a few days to a few weeks. Chronic pericarditis may last for several months.
Other Types of Treatment
You may need treatment for complications of pericarditis. Two serious complications are cardiac tamponade and chronic constrictive pericarditis.
Cardiac tamponade is treated with a procedure called pericardiocentesis (per-ih-KAR-de-o-sen-TE-sis). A needle or tube (called a catheter) is inserted into the chest wall to remove excess fluid in the pericardium. This procedure relieves pressure on the heart.
The only cure for chronic constrictive pericarditis is surgery to remove the pericardium. This is known as a pericardiectomy (PER-ih-kar-de-EK-to-me).
The treatments for these complications require staying in the hospital.
How Can Pericarditis Be Prevented?
You usually can't prevent acute pericarditis. You can take steps to reduce your chance of having another acute episode, having complications, or getting chronic pericarditis.
These steps include getting prompt treatment, following your treatment plan, and having ongoing medical care (as your doctor advises).
Living With Pericarditis
Many cases of pericarditis are mild and go away on their own. But other cases, if not treated, can lead to chronic pericarditis and serious problems that affect your heart. Some problems can be life threatening.
Sometimes it takes weeks or months to recover from pericarditis. Full recovery is likely with rest and ongoing care. These measures also can help reduce your risk of having the condition again.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to pericarditis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Peripheral Arterial Disease?
Peripheral arterial disease (P.A.D.) is a disease in which plaque (plak) builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.
When plaque builds up in the body's arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on P.A.D. that affects blood flow to the legs.
![]()
Normal Artery and Artery With Plaque Buildup. The illustration shows how P.A.D. can affect arteries in the legs. Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of the normal artery. Figure B shows an artery (more...)
Overview
Blocked blood flow to your legs can cause pain and numbness. It also can raise your risk of getting an infection in the affected limbs. Your body may have a hard time fighting the infection.
If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.
If you have leg pain when you walk or climb stairs, talk with your doctor. Sometimes older people think that leg pain is just a symptom of aging. However, the cause of the pain could be P.A.D. Tell your doctor if you're feeling pain in your legs and discuss whether you should be tested for P.A.D.
Smoking is the main risk factor for P.A.D. If you smoke or have a history of smoking, your risk of P.A.D. increases up to four times. Other factors, such as age and having certain diseases or conditions, also increase your risk of P.A.D.
Other Names for Peripheral Arterial Disease
Leg
cramps from poor circulation
Poor circulation
Vascular disease
What Causes Peripheral Arterial Disease?
The most common cause of peripheral arterial disease (P.A.D.) is atherosclerosis. Atherosclerosis is a disease in which plaque builds up in your arteries. The exact cause of atherosclerosis isn't known.
The disease may start if certain factors damage the inner layers of the arteries. These factors include:
When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.
Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site. The buildup of plaque or blood clots can severely narrow or block the arteries and limit the flow of oxygen-rich blood to your body.
Who Is at Risk for Peripheral Arterial Disease?
Peripheral arterial disease (P.A.D.) affects millions of people in the United States. The disease is more common in African Americans than any other racial or ethnic group.
The major risk factors for P.A.D. are smoking, older age, and having certain diseases or conditions.
Smoking
Smoking is the main risk factor for P.A.D. Your risk of P.A.D. increases four times if you smoke or have a history of smoking.
On average, people who smoke and develop P.A.D. have symptoms 10 years earlier than people who don't smoke and develop P.A.D.
Quitting smoking slows the progress of P.A.D. Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. People who smoke and people who have diabetes are at highest risk for P.A.D. complications, such as gangrene (tissue death) in the leg from decreased blood flow.
Older Age
Older age also is a risk factor for P.A.D. Plaque builds up in your arteries as you age. About 1 in every 20 Americans over the age of 60 has P.A.D. The risk continues to rise as you get older.
Older age combined with other risk factors, such as smoking or diabetes, also puts you at higher risk for P.A.D.
Diseases and Conditions
Many diseases and conditions can raise your risk of P.A.D., including:
Diabetes. About 1 in 3 people older than 50 who has diabetes also has P.A.D.
What Are the Signs and Symptoms of Peripheral Arterial Disease?
Many people who have peripheral arterial disease (P.A.D.) don't have any signs or symptoms. Others may have many signs and symptoms.
Even if you don't have signs or symptoms, ask your doctor whether you should get checked for P.A.D. if you're:
Intermittent Claudication
People who have P.A.D. may have symptoms when walking or climbing stairs. These symptoms may include pain, numbness, aching, or heaviness in the leg muscles.
Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet. Symptoms may ease after resting.
These symptoms are called intermittent claudication. During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won't get enough blood, which will lead to symptoms. When resting, the muscles need less blood flow, so the symptoms will go away.
About 10 percent of people who have P.A.D. have claudication. This symptom is more likely in people who also have atherosclerosis in other arteries.
Other Signs and Symptoms
Other signs and symptoms of P.A.D. include:
How Is Peripheral Arterial Disease Diagnosed?
Peripheral arterial disease (P.A.D.) is diagnosed based on your medical and family histories, a physical exam, and test results.
P.A.D. often is diagnosed after symptoms are reported. A correct diagnosis is important because people who have P.A.D. are at higher risk for coronary heart disease (CHD), heart attack, stroke, and transient ischemic attack (""mini-stroke""). If you have P.A.D., your doctor also may want to check for signs of these diseases and conditions.
Specialists Involved
Primary care doctors, such as internists and family doctors, may treat people who have mild P.A.D. For more advanced P.A.D., a vascular specialist may be involved. This is a doctor who specializes in treating blood vessel diseases and conditions.
A cardiologist also may be involved in treating people who have P.A.D. Cardiologists treat heart problems, such as CHD and heart attack, which often affect people who have P.A.D.
Medical and Family Histories
Your doctor may ask:
Whether you have any risk factors for P.A.D. For example, he or she may ask whether you
smoke or have
diabetes.
About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing.
About your diet.
About any medicines you take, including prescription and over-the-counter medicines.
Physical Exam
During the physical exam, your doctor will look for signs of P.A.D. He or she may check the blood flow in your legs or feet to see whether you have weak or absent pulses.
Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit (broo-E). He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked artery.
Your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb. He or she also may check for poor wound healing or any changes in your hair, skin, or nails that may be signs of P.A.D.
Diagnostic Tests
Ankle-Brachial Index
A simple test called an ankle-brachial index (ABI) often is used to diagnose P.A.D. The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs.
ABI can show whether P.A.D. is affecting your limbs, but it won't show which blood vessels are narrowed or blocked.
A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10 to 15 minutes to measure both arms and both ankles. This test may be done yearly to see whether P.A.D. is getting worse.
![]()
Ankle-Brachial Index. The illustration shows the ankle-brachial index test. The test compares blood pressure in the ankle to blood pressure in the arm. As the blood pressure cuff deflates, the blood pressure in the arteries is recorded.
Doppler Ultrasound
A Doppler ultrasound looks at blood flow in the major arteries and veins in the limbs. During this test, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of blood flow in the arteries and veins.
The results of this test can show whether a blood vessel is blocked. The results also can help show the severity of P.A.D.
Treadmill Test
A treadmill test can show the severity of symptoms and the level of exercise that brings them on. You'll walk on a treadmill for this test. This shows whether you have any problems during normal walking.
You may have an ABI test before and after the treadmill test. This will help compare blood flow in your arms and legs before and after exercise.
Magnetic Resonance Angiogram
A magnetic resonance angiogram (MRA) uses magnetic and radio wave energy to take pictures of your blood vessels. This test is a type of magnetic resonance imaging (MRI).
An MRA can show the location and severity of a blocked blood vessel. If you have a pacemaker, man-made joint, stent, surgical clips, mechanical heart valve, or other metallic devices in your body, you might not be able to have an MRA. Ask your doctor whether an MRA is an option for you.
Arteriogram
An arteriogram provides a ""road map"" of the arteries. Doctors use this test to find the exact location of a blocked artery.
For this test, dye is injected through a needle or catheter (tube) into one of your arteries. This may make you feel mildly flushed. After the dye is injected, an x ray is taken. The x ray can show the location, type, and extent of the blockage in the artery.
Some doctors use a newer method of arteriogram that uses tiny ultrasound cameras. These cameras take pictures of the insides of the blood vessels. This method is called intravascular ultrasound.
How Is Peripheral Arterial Disease Treated?
Treatments for peripheral arterial disease (P.A.D.) include lifestyle changes, medicines, and surgery or procedures.
The overall goals of treating P.A.D. include reducing symptoms, improving quality of life, and preventing complications. Treatment is based on your signs and symptoms, risk factors, and results from a physical exam and tests.
Treatment may slow or stop disease progress and reduce the risk of complications. Without treatment, P.A.D. can cause sores or gangrene (tissue death). In extreme cases, it may be necessary to remove part of the leg or foot (amputation).
Lifestyle Changes
Treatment often includes making long-lasting lifestyle changes, such as:
Quitting
smoking. Your risk of P.A.D. increases four times if you smoke. Smoking also raises your risk for other diseases, such as
coronary heart disease (CHD). Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid
secondhand smoke.
Being
physically active. Talk with your doctor about taking part in a supervised
exercise program. This type of program has been shown to reduce P.A.D. symptoms.
Follow a healthy eating plan that's low in total fat, saturated fat, trans fat, cholesterol, and sodium (salt). Include fruits, vegetables, and low-fat dairy products in your diet. If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan.
Two examples of healthy eating plans are Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH).
Medicines
Your doctor may prescribe medicines to:
Prevent
blood clots from forming due to low blood flow
Help ease
leg pain that occurs when you walk or climb stairs
Surgery or Procedures
Bypass Grafting
Your doctor may recommend bypass grafting surgery if blood flow in your limb is blocked or nearly blocked. For this surgery, your doctor uses a blood vessel from another part of your body or a man-made tube to make a graft.
This graft bypasses (that is, goes around) the blocked part of the artery. The bypass allows blood to flow around the blockage.
This surgery doesn't cure P.A.D., but it may increase blood flow to the affected limb.
Angioplasty and Stenting
Your doctor may recommend angioplasty (AN-jee-oh-plas-tee) to restore blood flow through a narrowed or blocked artery.
During this procedure, a catheter (thin tube) with a balloon at the tip is inserted into a blocked artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the artery and restores blood flow.
A stent (a small mesh tube) may be placed in the artery during angioplasty. A stent helps keep the artery open after angioplasty is done. Some stents are coated with medicine to help prevent blockages in the artery.
Atherectomy
Atherectomy (ath-eh-REK-to-me) is a procedure that removes plaque buildup from an artery. During the procedure, a catheter is used to insert a small cutting device into the blocked artery. The device is used to shave or cut off plaque.
The bits of plaque are removed from the body through the catheter or washed away in the bloodstream (if they're small enough).
Doctors also can do atherectomy using a special laser that dissolves the blockage.
How Can Peripheral Arterial Disease Be Prevented?
Taking action to control your risk factors can help prevent or delay peripheral arterial disease (P.A.D.) and its complications.
Know your family history of health problems related to P.A.D. If you or someone in your family has the disease, be sure to tell your doctor.
If you smoke, quit. Smoking is the main risk factor for P.A.D. Your risk of P.A.D. increases four times if you smoke or have a history of smoking. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
The Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart"" both include information about how to quit smoking.
Follow a healthy diet that includes a variety of fruits, vegetables, and whole grains. A healthy diet also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
The National Heart, Lung, and Blood Institute's (NHLBI's) Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) are two programs that promote healthy eating.
If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Also, try to be physically active. Physical activity can improve your fitness level and your health. Talk with your doctor about the types of activity that are safe for you.
The Health Topics Physical Activity and Your Heart article and the NHLBI's ""Your Guide to Physical Activity and Your Heart"" include information about physical activity. Although these resources focus on heart health, they also apply to general health and well-being.
The lifestyle changes described above can reduce your risk of P.A.D. These changes also can help prevent and control conditions that can lead to P.A.D., such as diabetes, high blood pressure, high blood cholesterol, coronary heart disease, and stroke.
Living With Peripheral Arterial Disease
If you have peripheral arterial disease (P.A.D.), you're more likely to also have coronary heart disease (CHD), heart attack, stroke, and transient ischemic attack (""mini-stroke""). However, you can take steps to treat and control P.A.D. and lower your risk for these other conditions.
Living With Peripheral Arterial Disease Symptoms
If you have P.A.D., you may feel pain in your calf or thigh muscles after walking. Try to take a break and allow the pain to ease before walking again. Over time, this may increase the distance that you can walk without pain.
Talk with your doctor about taking part in a supervised exercise program. This type of program has been shown to reduce P.A.D. symptoms.
Check your feet and toes regularly for sores or possible infections. Wear comfortable shoes that fit well. Maintain good foot hygiene and have professional medical treatment for corns, bunions, or calluses.
Ongoing Health Care Needs and Lifestyle Changes
See your doctor for checkups as he or she advises. If you have P.A.D. without symptoms, you should still see your doctor regularly. Take all medicines as your doctor prescribes.
Lifestyle changes can help prevent or delay P.A.D. and other related problems, such as CHD, heart attack, stroke, and transient ischemic attack. Lifestyle changes include quitting smoking, controlling risk factors, being physically active, and following a healthy diet.
For more information about lifestyle changes, go to ""How Can Peripheral Arterial Disease Be Treated?""
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of various diseases and conditions, as well as ways to prevent, diagnose, or treat them.
The NHLBI continues to support research aimed at learning more about various diseases and conditions, including peripheral arterial disease (P.A.D.). For example, NHLBI-supported research on P.A.D. includes studies that explore:
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to P.A.D., talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Pernicious Anemia?
Pernicious anemia (per-NISH-us uh-NEE-me-uh) is a condition in which the body can't make enough healthy red blood cells because it doesn't have enough vitamin B12.
Vitamin B12 is a nutrient found in some foods. The body needs this nutrient to make healthy red blood cells and to keep its nervous system working properly.
People who have pernicious anemia can't absorb enough vitamin B12 from food. This is because they lack intrinsic (in-TRIN-sik) factor, a protein made in the stomach. A lack of this protein leads to vitamin B12 deficiency.
Other conditions and factors also can cause vitamin B12 deficiency. Examples include infections, surgery, medicines, and diet. Technically, the term ""pernicious anemia"" refers to vitamin B12 deficiency due to a lack of intrinsic factor. Often though, vitamin B12 deficiency due to other causes also is called pernicious anemia.
This article discusses pernicious anemia due to a lack of intrinsic factor and other causes.
Outlook
The term “pernicious” means “deadly.” The condition is called pernicious anemia because it often was fatal in the past, before vitamin B12 treatments were available. Now, pernicious anemia usually is easy to treat with vitamin B12 pills or shots.
With ongoing care and proper treatment, most people who have pernicious anemia can recover, feel well, and live normal lives.
Without treatment, pernicious anemia can lead to serious problems with the heart, nerves, and other parts of the body. Some of these problems may be permanent.
What Causes Pernicious Anemia?
Pernicious anemia is caused by a lack of intrinsic factor or other causes, such as infections, surgery, medicines, or diet.
Other Causes
Pernicious anemia also has other causes, besides a lack of intrinsic factor. Malabsorption in the small intestine and a diet lacking vitamin B12 both can lead to pernicious anemia.
Diet Lacking Vitamin B12
Some people get pernicious anemia because they don't have enough vitamin B12 in their diets. This cause of pernicious anemia is less common than other causes.
Good food sources of vitamin B12 include:
Strict vegetarians who don't eat any animal or dairy products and don't take a vitamin B12 supplement are at risk for pernicious anemia.
Breastfed infants of strict vegetarian mothers also are at risk for pernicious anemia. These infants can develop anemia within months of being born. This is because they haven't had enough time to store vitamin B12 in their bodies. Doctors treat these infants with vitamin B12 supplements.
Other groups, such as the elderly and people who suffer from alcoholism, also may be at risk for pernicious anemia. These people may not get the proper nutrients in their diets.
Who Is at Risk for Pernicious Anemia?
Pernicious anemia is more common in people of Northern European and African descent than in other ethnic groups.
Older people also are at higher risk for the condition. This is mainly due to a lack of stomach acid and intrinsic factor, which prevents the small intestine from absorbing vitamin B12. As people grow older, they tend to make less stomach acid.
Pernicious anemia also can occur in younger people and other populations. You're at higher risk for pernicious anemia if you:
Have had part or all of your
stomach surgically removed. The stomach makes intrinsic factor. This
protein helps your body absorb
vitamin B12.
Have certain intestinal diseases or other disorders that may prevent your body from properly absorbing
vitamin B12. Examples include Crohn's disease, intestinal infections, and HIV.
Take medicines that prevent your body from properly absorbing
vitamin B12. Examples of such medicines include antibiotics and certain
seizure medicines.
Are a strict vegetarian who doesn't eat any animal or dairy products and doesn't take a
vitamin B12 supplement, or if you eat poorly overall.
What Are the Signs and Symptoms of Pernicious Anemia?
A lack of vitamin B12 (vitamin B12 deficiency) causes the signs and symptoms of pernicious anemia. Without enough vitamin B12, your body can't make enough healthy red blood cells, which causes anemia.
Some of the signs and symptoms of pernicious anemia apply to all types of anemia. Other signs and symptoms are specific to a lack of vitamin B12.
Signs and Symptoms of Vitamin B12 Deficiency
Vitamin B12 deficiency may lead to nerve damage. This can cause tingling and numbness in your hands and feet, muscle weakness, and loss of reflexes. You also may feel unsteady, lose your balance, and have trouble walking. Vitamin B12 deficiency can cause weakened bones and may lead to hip fractures.
Severe vitamin B12 deficiency can cause neurological problems, such as confusion, dementia, depression, and memory loss.
Other symptoms of vitamin B12 deficiency involve the digestive tract. These symptoms include nausea (feeling sick to your stomach) and vomiting, heartburn, abdominal bloating and gas, constipation or diarrhea, loss of appetite, and weight loss. An enlarged liver is another symptom.
A smooth, thick, red tongue also is a sign of vitamin B12 deficiency and pernicious anemia.
Infants who have vitamin B12 deficiency may have poor reflexes or unusual movements, such as face tremors. They may have trouble feeding due to tongue and throat problems. They also may be irritable. If vitamin B12 deficiency isn't treated, these infants may have permanent growth problems.
How Is Pernicious Anemia Diagnosed?
Your doctor will diagnose pernicious anemia based on your medical and family histories, a physical exam, and test results.
Your doctor will want to find out whether the condition is due to a lack of intrinsic factor or another cause. He or she also will want to find out the severity of the condition, so it can be properly treated.
Specialists Involved
Primary care doctors—such as family doctors, internists, and pediatricians (doctors who treat children)—often diagnose and treat pernicious anemia. Other kinds of doctors also may be involved, including:
A hematologist (
blood disease specialist)
Medical and Family Histories
Your doctor may ask about your signs and symptoms. He or she also may ask:
Physical Exam
During the physical exam, your doctor may check for pale or yellowish skin and an enlarged liver. He or she may listen to your heart for rapid or irregular heartbeats or a heart murmur.
Your doctor also may check for signs of nerve damage. He or she may want to see how well your muscles, eyes, senses, and reflexes work. Your doctor may ask questions or do tests to check your mental status, coordination, and ability to walk.
Diagnostic Tests and Procedures
Blood tests and procedures can help diagnose pernicious anemia and find out what's causing it.
Complete Blood Count
Often, the first test used to diagnose many types of anemia is a complete blood count (CBC). This test measures many parts of your blood. For this test, a small amount of blood is drawn from a vein (usually in your arm) using a needle.
A CBC checks your hemoglobin (HEE-muh-glow-bin) and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels may be lower in certain racial and ethnic populations. Your doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets (PLATE-lets) in your blood. Abnormal results may be a sign of anemia, another blood disorder, an infection, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. MCV can be a clue as to what's causing your anemia. In pernicious anemia, the red blood cells are larger than normal.
Other Blood Tests
If the CBC results confirm that you have anemia, you may need other blood tests to find out what type of anemia you have.
A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have pernicious anemia have low reticulocyte counts.
Serum folate, iron, and iron-binding capacity tests also can help show whether you have pernicious anemia or another type of anemia.
Your doctor may recommend other blood tests to check:
Your homocysteine and methylmalonic acid (MMA) levels. High levels of these substances in your body are a sign of
pernicious anemia.
How Is Pernicious Anemia Treated?
Doctors treat pernicious anemia by replacing the missing vitamin B12 in the body. People who have pernicious anemia may need lifelong treatment.
The goals of treating pernicious anemia include:
Preventing or treating the
anemia and its signs and symptoms
Preventing or managing complications, such as
heart and
nerve damage
Specific Types of Treatment
Pernicious anemia usually is easy to treat with vitamin B12 shots or pills.
If you have severe pernicious anemia, your doctor may recommend shots first. Shots usually are given in a muscle every day or every week until the level of vitamin B12 in your blood increases. After your vitamin B12 blood level returns to normal, you may get a shot only once a month.
For less severe pernicious anemia, your doctor may recommend large doses of vitamin B12 pills. A vitamin B12 nose gel and spray also are available. These products may be useful for people who have trouble swallowing pills, such as older people who have had strokes.
Your signs and symptoms may begin to improve within a few days after you start treatment. Your doctor may advise you to limit your physical activity until your condition improves.
If your pernicious anemia is caused by something other than a lack of intrinsic factor, you may get treatment for the cause (if a cause can be found). For example, your doctor may prescribe medicines to treat a condition that prevents your body from absorbing vitamin B12.
If medicines are the cause of your pernicious anemia, your doctor may change the type or dose of medicine you take. Infants of strict vegetarian mothers may be given vitamin B12 supplements from birth.
How Can Pernicious Anemia Be Prevented?
You can't prevent pernicious anemia caused by a lack of intrinsic factor. Without intrinsic factor, you won't be able to absorb vitamin B12 and will develop pernicious anemia.
Although uncommon, some people develop pernicious anemia because they don't get enough vitamin B12 in their diets. You can take steps to prevent pernicious anemia caused by dietary factors.
Eating foods high in vitamin B12 can help prevent low vitamin B12 levels. Good food sources of vitamin B12 include:
If you’re a strict vegetarian, talk with your doctor about having your vitamin B12 level checked regularly.
Vitamin B12 also is found in multivitamins and B-complex vitamin supplements. Doctors may recommend supplements for people at risk for vitamin B12 deficiency, such as strict vegetarians or people who have had stomach surgery.
Older adults may have trouble absorbing vitamin B12. Thus, doctors may recommend that older adults eat foods fortified with vitamin B12 or take vitamin B12 supplements.
Living With Pernicious Anemia
With proper treatment, people who have pernicious anemia can recover, feel well, and live normal lives. If you have complications of pernicious anemia, such as nerve damage, early treatment may help reverse the damage.
Ongoing Care
If you have pernicious anemia, you may need lifelong treatment. See your doctor regularly for checkups and ongoing care. Take vitamin B12 supplements as your doctor advises. This may help prevent symptoms and complications.
During your followup visits, your doctor may check for signs of vitamin B12 deficiency. He or she also may adjust your treatment as needed.
If you have pernicious anemia, you're at higher risk for stomach cancer. See your doctor regularly so he or she can check for this complication.
Also, tell your family members, especially your children and brothers and sisters, that you have pernicious anemia. Pernicious anemia can run in families, so they may have a higher risk for the condition.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to pernicious anemia and vitamin B12 deficiency, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Are Pleurisy and Other Pleural Disorders?
Pleurisy (PLUR-ih-se) is a condition in which the pleura is inflamed. The pleura is a membrane that consists of two large, thin layers of tissue. One layer wraps around the outside of your lungs. The other layer lines the inside of your chest cavity.
Between the layers of tissue is a very thin space called the pleural space. Normally this space is filled with a small amount of fluid—about 4 teaspoons full. The fluid helps the two layers of the pleura glide smoothly past each other as you breathe in and out.
Pleurisy occurs if the two layers of the pleura become irritated and inflamed. Instead of gliding smoothly past each other, they rub together every time you breathe in. The rubbing can cause sharp pain.
Many conditions can cause pleurisy, including viral infections.
Other Pleural Disorders
Pneumothorax
Air or gas can build up in the pleural space. When this happens, it's called a pneumothorax (noo-mo-THOR-aks). A lung disease or acute lung injury can cause a pneumothorax.
Some lung procedures also can cause a pneumothorax. Examples include lung surgery, drainage of fluid with a needle, bronchoscopy (bron-KOS-ko-pee), and mechanical ventilation.
Sometimes the cause of a pneumothorax isn't known.
The most common symptoms of a pneumothorax are sudden pain in one side of the lung and shortness of breath. The air or gas in the pleural space also can put pressure on the lung and cause it to collapse.
![]()
Pleurisy and Pneumothorax. Figure A shows the location of the lungs, airways, pleura, and diaphragm (a muscle that helps you breathe). The inset image shows a detailed view of the two pleural layers and pleural space. Figure B shows lungs with pleurisy (more...)
A small pneumothorax may go away without treatment. A large pneumothorax may require a procedure to remove air or gas from the pleural space.
A very large pneumothorax can interfere with blood flow through your chest and cause your blood pressure to drop. This is called a tension pneumothorax.
Outlook
Pleurisy and other pleural disorders can be serious, depending on their causes. If the condition that caused the pleurisy or other pleural disorder isn't too serious and is diagnosed and treated early, you usually can expect a full recovery.
Other Names for Pleurisy and Other Pleural Disorders
Pneumothorax also is called air around the lung and air outside the lung.
What Causes Pleurisy and Other Pleural Disorders?
What Are the Signs and Symptoms of Pleurisy and Other Pleural Disorders
Pleurisy
The main symptom of pleurisy is sharp or stabbing chest pain. The pain gets worse when you breathe in deeply, cough, or sneeze.
The pain may stay in one place or spread to your shoulders or back. Sometimes the pain becomes a fairly constant dull ache.
Depending on the cause of the pleurisy, you may have other symptoms such as:
Pleural Effusion
A pleural effusion often has no symptoms. However, the disorder may cause shortness of breath or chest discomfort.
Hemothorax
The symptoms of a hemothorax often are similar to those of a pneumothorax. They include:
Shortness of breath
Restlessness
How Are Pleurisy and Other Pleural Disorders Diagnosed?
Your doctor will diagnose pleurisy or another pleural disorder based on your medical history, a physical exam, and test results.
Your doctor will want to rule out other causes of your symptoms. He or she also will want to find the underlying cause of the pleurisy or other pleural disorder so it can be treated.
Medical History
Your doctor may ask detailed questions about your medical history. He or she likely will ask you to describe any pain, especially:
Your doctor also may ask whether you have other symptoms, such as shortness of breath, coughing, or palpitations. Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or fast.
Your doctor also may ask whether you've ever:
Smoked.
Traveled to places where you may have been exposed to
tuberculosis.
Had a job that exposed you to asbestos. Asbestos is a
mineral that, at one time, was widely used in many industries.
Your doctor also may ask about medicines you take or have taken. Reactions to some medicines can cause pleurisy or other pleural disorders.
Physical Exam
Your doctor will listen to your breathing with a stethoscope to find out whether your lungs are making any abnormal sounds.
If you have pleurisy, the inflamed layers of the pleura make a rough, scratchy sound as they rub against each other when you breathe. Doctors call this a pleural friction rub. If your doctor hears the friction rub, he or she will know that you have pleurisy.
If you have a pleural effusion, fluid buildup in the pleural space will prevent a friction rub. But if you have a lot of fluid, your doctor may hear a dull sound when he or she taps on your chest. Or, he or she may have trouble hearing any breathing sounds.
Muffled or dull breathing sounds also can be a sign of a pneumothorax (a buildup of air or gas in the pleural space).
Diagnostic Tests
Depending on the results of your physical exam, your doctor may recommend tests.
Chest CT Scan
A chest computed tomography (to-MOG-rah-fee) scan, or chest CT scan, is a painless test that creates precise pictures of the structures in your chest.
This test provides a computer-generated picture of your lungs that can show pockets of fluid. A chest CT scan also may show signs of pneumonia, a lung abscess, a tumor, or other possible causes of pleural disorders.
Ultrasound
This test uses sound waves to create pictures of your lungs. An ultrasound may show where fluid is located in your chest. The test also can show some tumors.
Chest MRI
A chest magnetic resonance imaging scan, or chest MRI, uses radio waves, magnets, and a computer to created detailed pictures of the structures in your chest. This test can show pleural effusions and tumors.
This test also is called a magnetic resonance (MR) scan or a nuclear magnetic resonance (NMR) scan.
Arterial Blood Gas Test
For this test, a blood sample is taken from an artery, usually in your wrist. The blood's oxygen and carbon dioxide levels are checked. This test shows how well your lungs are taking in oxygen.
Thoracentesis
Once your doctor knows whether fluid has built up in the pleural space and where it is, he or she can remove a sample for testing. This is done using a procedure called thoracentesis (THOR-ah-sen-TE-sis).
During the procedure, your doctor inserts a thin needle or plastic tube into the pleural space and draws out the excess fluid. After the fluid is removed from your chest, it's sent for testing.
The risks of thoracentesis—such as pain, bleeding, and infection—usually are minor. They get better on their own, or they're easily treated. Your doctor may do a chest x ray after the procedure to check for complications.
Fluid Analysis
The fluid removed during thoracentesis is examined under a microscope. It's checked for signs of infection, cancer, or other conditions that can cause fluid or blood to build up in the pleural space.
Biopsy
Your doctor may suspect that tuberculosis or cancer has caused fluid to build up in your pleural space. If so, he or she may want to look at a small piece of the pleura under a microscope.
To take a tissue sample, your doctor may do one of the following procedures:
Insert a needle into your
chest to remove a small sample of the
pleura's outer layer.
Insert a tube with a light on the end (
endoscope) into tiny cuts in your
chest wall so that he or she can see the
pleura. Your doctor can then snip out small pieces of
tissue. This procedure must be done in a hospital. You'll be given medicine to make you
sleep during the procedure.
Snip out a sample of the
pleura through a small cut in your
chest wall. This is called an open pleural
biopsy. It's usually done if the sample from the
needle biopsy is too small for an accurate diagnosis. This procedure must be done in a hospital. You'll be given medicine to make you
sleep during the procedure.
How Are Pleurisy and Other Pleural Disorders Treated?
Pleurisy and other pleural disorders are treated with procedures, medicines, and other methods. The goals of treatment include:
Removing Fluid, Air, or Blood From the Pleural Space
Your doctor may recommend removing fluid, air, or blood from your pleural space to prevent a lung collapse.
The procedures used to drain fluid, air, or blood from the pleural space are similar.
During
thoracentesis, your doctor will insert a thin needle or plastic tube into the
pleural space. An attached syringe will draw fluid out of your
chest. This procedure can remove more than 6 cups of fluid at a time.
If your doctor needs to remove a lot of fluid, he or she may use a
chest tube. Your doctor will inject a painkiller into the area of your
chest wall where the fluid is. He or she will then insert a plastic tube into your chest between two
ribs. The tube will be connected to a box that suctions out the fluid. Your doctor will use a
chest x ray to check the tube's position.
Your doctor also can use a
chest tube to drain
blood and air from the
pleural space. This process can take several days. The tube will be left in place, and you'll likely stay in the hospital during this time.
Sometimes the fluid in the pleural space contains thick pus or blood clots. It may form a hard skin or peel, which makes the fluid harder to drain. To help break up the pus or blood clots, your doctor may use a chest tube to deliver medicines called fibrinolytics to the pleural space. If the fluid still won't drain, you may need surgery.
If you have a small, persistent air leak into the pleural space, your doctor may attach a one-way valve to the chest tube. The valve allows air to exit the pleural space, but not reenter. Using this type of valve may allow you to continue your treatment from home.
Treat the Underlying Condition
The fluid sample that was removed during thoracentesis will be checked under a microscope. This can tell your doctor what's causing the fluid buildup, and he or she can decide the best way to treat it.
If the fluid is infected, treatment will involve antibiotics and drainage. If you have tuberculosis or a fungal infection, treatment will involve long-term use of antibiotics or antifungal medicines.
If tumors in the pleura are causing fluid buildup, the fluid may quickly build up again after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, your doctor may seal the pleural space. Sealing the pleural space is called pleurodesis (plur-OD-eh-sis).
For this procedure, your doctor will drain all of the fluid out of your chest through a chest tube. Then he or she will push a substance through the chest tube into the pleural space. The substance will irritate the surface of the pleura. This will cause the two layers of the pleura to stick together, preventing more fluid from building up.
Chemotherapy or radiation treatment also may be used to reduce the size of the tumors.
If heart failure is causing fluid buildup, treatment usually includes diuretics (medicines that help reduce fluid buildup) and other medicines.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to pleurisy and other pleural disorders, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Pneumonia?
Pneumonia (nu-MO-ne-ah) is an infection in one or both of the lungs. Many germs—such as bacteria, viruses, and fungi—can cause pneumonia.
The infection inflames your lungs' air sacs, which are called alveoli (al-VEE-uhl-eye). The air sacs may fill up with fluid or pus, causing symptoms such as a cough with phlegm (a slimy substance), fever, chills, and trouble breathing.
Overview
Pneumonia and its symptoms can vary from mild to severe. Many factors affect how serious pneumonia is, such as the type of germ causing the infection and your age and overall health.
Pneumonia tends to be more serious for:
Outlook
Pneumonia is common in the United States. Treatment for pneumonia depends on its cause, how severe your symptoms are, and your age and overall health. Many people can be treated at home, often with oral antibiotics.
Children usually start to feel better in 1 to 2 days. For adults, it usually takes 2 to 3 days. Anyone who has worsening symptoms should see a doctor.
People who have severe symptoms or underlying health problems may need treatment in a hospital. It may take 3 weeks or more before they can go back to their normal routines.
Fatigue (tiredness) from pneumonia can last for a month or more.
Types of Pneumonia
Pneumonia is named for the way in which a person gets the infection or for the germ that causes it.
Community-Acquired Pneumonia
Community-acquired pneumonia (CAP) occurs outside of hospitals and other health care settings. Most people get CAP by breathing in germs (especially while sleeping) that live in the mouth, nose, or throat.
CAP is the most common type of pneumonia. Most cases occur during the winter. About 4 million people get this form of pneumonia each year. About 1 out of every 5 people who has CAP needs to be treated in a hospital.
Hospital-Acquired Pneumonia
Some people catch pneumonia during a hospital stay for another illness. This is called hospital-acquired pneumonia (HAP). You're at higher risk of getting HAP if you're on a ventilator (a machine that helps you breathe).
HAP tends to be more serious than CAP because you're already sick. Also, hospitals tend to have more germs that are resistant to antibiotics (medicines used to treat pneumonia).
Health Care-Associated Pneumonia
Patients also may get pneumonia in other health care settings, such as nursing homes, dialysis centers, and outpatient clinics. This type of pneumonia is called health care-associated pneumonia.
Other Common Types of Pneumonia
Atypical Pneumonia
Several types of bacteria—Legionella pneumophila, mycoplasma pneumonia, and Chlamydophila pneumoniae—cause atypical pneumonia, a type of CAP. Atypical pneumonia is passed from person to person.
Other Names for Pneumonia
What Causes Pneumonia?
Many germs can cause pneumonia. Examples include different kinds of bacteria, viruses, and, less often, fungi.
Most of the time, the body filters germs out of the air that we breathe to protect the lungs from infection. Your immune system, the shape of your nose and throat, your ability to cough, and fine, hair-like structures called cilia (SIL-e-ah) help stop the germs from reaching your lungs. (For more information, go to the Health Topics How the Lungs Work article.)
Sometimes, though, germs manage to enter the lungs and cause infections. This is more likely to occur if:
Your body fails to filter
germs out of the air that you breathe
For example, if you can't cough because you've had a stroke or are sedated, germs may remain in your airways. (""Sedated"" means you're given medicine to make you sleepy.)
When germs reach your lungs, your immune system goes into action. It sends many kinds of cells to attack the germs. These cells cause the alveoli (air sacs) to become red and inflamed and to fill up with fluid and pus. This causes the symptoms of pneumonia.
Germs That Can Cause Pneumonia
Bacteria
Bacteria are the most common cause of pneumonia in adults. Some people, especially the elderly and those who are disabled, may get bacterial pneumonia after having the flu or even a common cold.
Many types of bacteria can cause pneumonia. Bacterial pneumonia can occur on its own or develop after you've had a cold or the flu. This type of pneumonia often affects one lobe, or area, of a lung. When this happens, the condition is called lobar pneumonia.
The most common cause of pneumonia in the United States is the bacterium Streptococcus (strep-to-KOK-us) pneumoniae, or pneumococcus (nu-mo-KOK-us).
![]()
Lobar Pneumonia. Figure A shows the location of the lungs and airways in the body. This figure also shows pneumonia affecting the lower lobe of the left lung. Figure B shows normal alveoli. Figure C shows infected alveoli.
Another type of bacterial pneumonia is called atypical pneumonia. Atypical pneumonia includes:
Legionella pneumophila. This type of
pneumonia sometimes is called Legionnaire's disease, and it has caused serious outbreaks. Outbreaks have been linked to exposure to cooling towers, whirlpool spas, and decorative fountains.
Mycoplasma
pneumonia. This is a common type of pneumonia that usually affects people younger than 40 years old. People who live or work in crowded places like schools, homeless shelters, and prisons are at higher risk for this type of pneumonia. It's usually mild and responds well to
treatment with antibiotics. However, mycoplasma pneumonia can be very serious. It may be associated with a
skin rash and
hemolysis (the breakdown of
red blood cells).
Chlamydophila pneumoniae. This type of
pneumonia can occur all year and often is mild. The
infection is most common in people 65 to 79 years old.
Fungi
Three types of fungi in the soil in some parts of the United States can cause pneumonia. These fungi are:
Histoplasmosis (HIS-to-plaz-MO-sis). This
fungus is found in the Ohio and Mississippi River Valleys.
Cryptococcus (krip-to-KOK-us). This
fungus is found throughout the United States in bird droppings and soil contaminated with bird droppings.
Most people exposed to these fungi don't get sick, but some do and require treatment.
Serious fungal infections are most common in people who have weak immune systems due to the long-term use of medicines to suppress their immune systems or having HIV/AIDS.
Pneumocystis jiroveci (nu-mo-SIS-tis ye-RO-VECH-e), formerly Pneumocystis carinii, sometimes is considered a fungal pneumonia. However, it's not treated with the usual antifungal medicines. This type of infection is most common in people who:
Other kinds of fungal infections also can lead to pneumonia.
Who Is at Risk for Pneumonia?
Pneumonia can affect people of all ages. However, two age groups are at greater risk of developing pneumonia:
Other conditions and factors also raise your risk for pneumonia. You're more likely to get pneumonia if you have a lung disease or other serious disease. Examples include cystic fibrosis, asthma, COPD (chronic obstructive pulmonary disease), bronchiectasis, diabetes, heart failure, and sickle cell anemia.
You're at greater risk for pneumonia if you're in a hospital intensive-care unit, especially if you're on a ventilator (a machine that helps you breathe).
Having a weak or suppressed immune system also raises your risk for pneumonia. A weak immune system may be the result of a disease such as HIV/AIDS. A suppressed immune system may be due to an organ transplant or blood and marrow stem cell transplant, chemotherapy (a treatment for cancer), or long-term steroid use.
Your risk for pneumonia also increases if you have trouble coughing because of a stroke or problems swallowing. You're also at higher risk if you can't move around much or are sedated (given medicine to make you relaxed or sleepy).
Smoking cigarettes, abusing alcohol, or being undernourished also raises your risk for pneumonia. Your risk also goes up if you've recently had a cold or the flu, or if you're exposed to certain chemicals, pollutants, or toxic fumes.
What Are the Signs and Symptoms of Pneumonia?
The signs and symptoms of pneumonia vary from mild to severe. Many factors affect how serious pneumonia is, including the type of germ causing the infection and your age and overall health. (For more information, go to ""Who Is at Risk for Pneumonia?"")
See your doctor promptly if you:
People who have pneumonia may have other symptoms, including nausea (feeling sick to the stomach), vomiting, and diarrhea.
Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy.
Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. If they already have a lung disease, it may get worse. Older adults who have pneumonia sometimes have sudden changes in mental awareness.
Complications of Pneumonia
Often, people who have pneumonia can be successfully treated and not have complications. But some people, especially those in high-risk groups, may have complications such as:
Bacteremia (bak-ter-E-me-ah). This serious complication occurs if the
infection moves into your bloodstream. From there, it can quickly spread to other
organs, including your
brain.
Lung
abscesses. An
abscess occurs if
pus forms in a
cavity in the lung. An abscess usually is treated with antibiotics. Sometimes
surgery or drainage with a needle is needed to remove the pus.
Pleural effusion.
Pneumonia may cause fluid to build up in the
pleural space. This is a very thin space between two layers of
tissue that line the
lungs and the
chest cavity. Pneumonia can cause the fluid to become infected—a condition called empyema (em-pi-E-ma). If this happens, you may need to have the fluid drained through a chest tube or removed with
surgery.
How Is Pneumonia Diagnosed?
Pneumonia can be hard to diagnose because it may seem like a cold or the flu. You may not realize it's more serious until it lasts longer than these other conditions.
Your doctor will diagnose pneumonia based on your medical history, a physical exam, and test results.
Medical History
Your doctor will ask about your signs and symptoms and how and when they began. To find out what type of germ is causing the pneumonia, he or she also may ask about:
Any recent traveling you've done
Your hobbies
Your exposure to animals
Your exposure to sick people at home, school, or work
Your past and current medical conditions, and whether any have gotten worse recently
Any medicines you take
Whether you smoke
Physical Exam
Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale. Your doctor also may hear wheezing.
Your doctor may find it hard to hear sounds of breathing in some areas of your chest.
Diagnostic Tests
If your doctor thinks you have pneumonia, he or she may recommend one or more of the following tests.
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.
A chest x ray is the best test for diagnosing pneumonia. However, this test won't tell your doctor what kind of germ is causing the pneumonia.
Blood Tests
Blood tests involve taking a sample of blood from a vein in your body. A complete blood count (CBC) measures many parts of your blood, including the number of white blood cells in the blood sample. The number of white blood cells can show whether you have a bacterial infection.
Your doctor also may recommend a blood culture to find out whether the infection has spread to your bloodstream. This test is used to detect germs in the bloodstream. A blood culture may show which germ caused the infection. If so, your doctor can decide how to treat the infection.
Other Tests
Your doctor may recommend other tests if you're in the hospital, have serious symptoms, are older, or have other health problems.
Sputum test. Your doctor may look at a sample of sputum (spit) collected from you after a deep cough. This may help your doctor find out what germ is causing your pneumonia. Then, he or she can plan treatment.
Chest computed tomography (CT) scan. A chest CT scan is a painless test that creates precise pictures of the structures in your chest, such as your lungs. A chest CT scan is a type of x ray, but its pictures show more detail than those of a standard chest x ray.
Pleural fluid culture. For this test, a fluid sample is taken from the pleural space (a thin space between two layers of tissue that line the lungs and chest cavity). Doctors use a procedure called thoracentesis (THOR-ah-sen-TE-sis) to collect the fluid sample. The fluid is studied for germs that may cause pneumonia.
Pulse oximetry. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood. Pneumonia can keep your lungs from moving enough oxygen into your bloodstream.
If you're very sick, your doctor may need to measure the level of oxygen in your blood using a blood sample. The sample is taken from an artery, usually in your wrist. This test is called an arterial blood gas test.
Bronchoscopy. Bronchoscopy (bron-KOS-ko-pee) is a procedure used to look inside the lungs' airways. If you're in the hospital and treatment with antibiotics isn't working well, your doctor may use this procedure.
Your doctor passes a thin, flexible tube through your nose or mouth, down your throat, and into the airways. The tube has a light and small camera that allow your doctor to see your windpipe and airways and take pictures.
Your doctor can see whether something is blocking your airways or whether another factor is contributing to your pneumonia.
How Is Pneumonia Treated?
Treatment for pneumonia depends on the type of pneumonia you have and how severe it is. Most people who have community-acquired pneumonia—the most common type of pneumonia—are treated at home.
The goals of treatment are to cure the infection and prevent complications.
General Treatment
If you have pneumonia, follow your treatment plan, take all medicines as prescribed, and get ongoing medical care. Ask your doctor when you should schedule followup care. Your doctor may want you to have a chest x ray to make sure the pneumonia is gone.
Although you may start feeling better after a few days or weeks, fatigue (tiredness) can persist for up to a month or more. People who are treated in the hospital may need at least 3 weeks before they can go back to their normal routines.
Bacterial Pneumonia
Bacterial pneumonia is treated with medicines called antibiotics. You should take antibiotics as your doctor prescribes. You may start to feel better before you finish the medicine, but you should continue taking it as prescribed. If you stop too soon, the pneumonia may come back.
Most people begin to improve after 1 to 3 days of antibiotic treatment. This means that they should feel better and have fewer symptoms, such as cough and fever.
Viral Pneumonia
Antibiotics don't work when the cause of pneumonia is a virus. If you have viral pneumonia, your doctor may prescribe an antiviral medicine to treat it.
Viral pneumonia usually improves in 1 to 3 weeks.
Treating Severe Symptoms
You may need to be treated in a hospital if:
If the level of oxygen in your bloodstream is low, you may receive oxygen therapy. If you have bacterial pneumonia, your doctor may give you antibiotics through an intravenous (IV) line inserted into a vein.
How Can Pneumonia Be Prevented?
Pneumonia can be very serious and even life threatening. When possible, take steps to prevent the infection, especially if you're in a high-risk group.
Vaccines
Vaccines are available to prevent pneumococcal pneumonia and the flu. Vaccines can't prevent all cases of infection. However, compared to people who don't get vaccinated, those who do and still get pneumonia tend to have:
Pneumococcal Pneumonia Vaccine
A vaccine is available to prevent pneumococcal pneumonia. In most adults, one shot is good for at least 5 years of protection. This vaccine often is recommended for:
For more information about the pneumococcal pneumonia vaccine, go to the Centers for Disease Control and Prevention's (CDC's) Vaccines and Preventable Diseases: Pneumococcal Vaccination Web page.
Influenza Vaccine
The vaccine that helps prevent the flu is good for 1 year. It's usually given in October or November, before peak flu season.
Because many people get pneumonia after having the flu, this vaccine also helps prevent pneumonia.
For more information about the influenza vaccine, go to the CDC's Vaccines and Preventable Diseases: Seasonal Influenza (Flu) Vaccination Web page.
Hib Vaccine
Haemophilus influenzae type b (Hib) is a type of bacteria that can cause pneumonia and meningitis (men-in-JI-tis). (Meningitis is an infection of the covering of the brain and spinal cord.) The Hib vaccine is given to children to help prevent these infections.
The vaccine is recommended for all children in the United States who are younger than 5 years old. The vaccine often is given to infants starting at 2 months of age.
For more information about the Hib vaccine, go to the CDC's Vaccines and Preventable Diseases: Hib Vaccination Web page.
Other Ways To Help Prevent Pneumonia
You also can take the following steps to help prevent pneumonia:
Wash your
hands with soap and water or alcohol-based rubs to kill
germs.
Don't smoke. Smoking damages your
lungs' ability to filter out and defend aga","June 11, 2014."
69,14,"2018-02-02 04:25:06",p,69,"2018-02-02 05:23:04","Polycythemia Vera","
What Is Polycythemia Vera?
Polycythemia vera (POL-e-si-THEE-me-ah VAY-rah or VE-rah), or PV, is a rare blood disease in which your body makes too many red blood cells.
The extra red blood cells make your blood thicker than normal. As a result, blood clots can form more easily. These clots can block blood flow through your arteries and veins, which can cause a heart attack or stroke.
Thicker blood also doesn't flow as quickly to your body as normal blood. Slowed blood flow prevents your organs from getting enough oxygen, which can cause serious problems, such as angina (an-JI-nuh or AN-juh-nuh) and heart failure. (Angina is chest pain or discomfort.)
Overview
Red blood cells carry oxygen to all parts of your body. They also remove carbon dioxide (a waste product) from your body's cells and carry it to the lungs to be exhaled.
Red blood cells are made in your bone marrow—a sponge-like tissue inside the bones. White blood cells and platelets (PLATE-lets) also are made in your bone marrow. White blood cells help fight infection. Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding.
If you have PV, your bone marrow makes too many red blood cells. It also can make too many white blood cells and platelets.
A mutation, or change, in the body's JAK2 gene is the major cause of PV. This gene makes a protein that helps the body produce blood cells. What causes the change in the JAK2 gene isn't known. PV generally isn't inherited—that is, passed from parents to children through genes.
PV develops slowly and may not cause symptoms for years. The disease often is found during routine blood tests done for other reasons.
When signs and symptoms are present, they're the result of the thick blood that occurs with PV. This thickness slows the flow of oxygen-rich blood to all parts of your body. Without enough oxygen, many parts of your body won't work normally.
For example, slower blood flow deprives your arms, legs, lungs, and eyes of the oxygen they need. This can cause headaches, dizziness, itching, and vision problems, such as blurred or double vision.
Outlook
PV is a serious, chronic (ongoing) disease that can be fatal if not diagnosed and treated. PV has no cure, but treatments can help control the disease and its complications.
PV is treated with procedures, medicines, and other methods. You may need one or more treatments to manage the disease.
Other Names for Polycythemia Vera
Cryptogenic (KRIP-to-JEN-ik) polycythemia
Erythrocytosis (eh-RITH-ro-si-TO-sis) megalosplenica (MEG-ah-lo-SPLE-ne-kah)
Myelopathic (MY-e-lo-PATH-ik) polycythemia
Myeloproliferative (MY-e-lo-pro-LIF-er-ah-tiv) disorder
Splenomegalic (SPLE-no-me-GA-lic) polycythemia
What Causes Polycythemia Vera?
Primary Polycythemia
Polycythemia vera (PV) also is known as primary polycythemia. A mutation, or change, in the body's JAK2 gene is the main cause of PV. The JAK2 gene makes a protein that helps the body produce blood cells.
What causes the change in the JAK2 gene isn't known. PV generally isn't inherited—that is, passed from parents to children through genes. However, in some families, the JAK2 gene may have a tendency to mutate. Other, unknown genetic factors also may play a role in causing PV.
Secondary Polycythemia
Another type of polycythemia, called secondary polycythemia, isn't related to the JAK2 gene. Long-term exposure to low oxygen levels causes secondary polycythemia.
A lack of oxygen over a long period can cause your body to make more of the hormone erythropoietin (EPO). High levels of EPO can prompt your body to make more red blood cells than normal. This leads to thicker blood, as seen in PV.
People who have severe heart or lung disease may develop secondary polycythemia. People who smoke, spend long hours at high altitudes, or are exposed to high levels of carbon monoxide where they work or live also are at risk.
For example, working in an underground parking garage or living in a home with a poorly vented fireplace or furnace can raise your risk for secondary polycythemia.
Rarely, tumors can make and release EPO, or certain blood problems can cause the body to make more EPO.
Sometimes doctors can cure secondary polycythemia—it depends on whether the underlying cause can be stopped, controlled, or cured.
Who Is at Risk for Polycythemia Vera?
Polycythemia vera (PV) is a rare blood disease. The disease affects people of all ages, but it's most common in adults who are older than 60. PV is rare in children and young adults. Men are at slightly higher risk for PV than women.
What Are the Signs and Symptoms of Polycythemia Vera?
Polycythemia vera (PV) develops slowly. The disease may not cause signs or symptoms for years.
When signs and symptoms are present, they're the result of the thick blood that occurs with PV. This thickness slows the flow of oxygen-rich blood to all parts of your body. Without enough oxygen, many parts of your body won't work normally.
The signs and symptoms of PV include:
In rare cases, people who have PV may have pain in their bones.
Polycythemia Vera Complications
If you have PV, the thickness of your blood and the slowed blood flow can cause serious health problems.
Blood clots are the most serious complication of PV. Blood clots can cause a heart attack or stroke. They also can cause your liver and spleen to enlarge. Blood clots in the liver and spleen can cause sudden, intense pain.
Slowed blood flow also prevents enough oxygen-rich blood from reaching your organs. This can lead to angina (chest pain or discomfort) and heart failure. The high levels of red blood cells that PV causes can lead to stomach ulcers, gout, or kidney stones.
Some people who have PV may develop myelofibrosis (MY-e-lo-fi-BRO-sis). This is a condition in which your bone marrow is replaced with scar tissue. Abnormal bone marrow cells may begin to grow out of control.
This abnormal growth can lead to acute myelogenous (my-eh-LOJ-eh-nus) leukemia (AML), a cancer of the blood and bone marrow. This disease can worsen very quickly.
How Is Polycythemia Vera Diagnosed?
Polycythemia vera (PV) may not cause signs or symptoms for years. The disease often is found during routine blood tests done for other reasons. If the results of your blood tests aren't normal, your doctor may want to do more tests.
Your doctor will diagnose PV based on your signs and symptoms, your age and overall health, your medical history, a physical exam, and test results.
During the physical exam, your doctor will look for signs of PV. He or she will check for an enlarged spleen, red skin on your face, and bleeding from your gums.
If your doctor confirms that you have polycythemia, the next step is to find out whether you have primary polycythemia (polycythemia vera) or secondary polycythemia.
Your medical history and physical exam may confirm which type of polycythemia you have. If not, you may have tests that check the level of the hormone erythropoietin (EPO) in your blood.
People who have PV have very low levels of EPO. People who have secondary polycythemia usually have normal or high levels of EPO.
Specialists Involved
If your primary care doctor thinks you have PV, he or she may refer you to a hematologist. A hematologist is a doctor who specializes in diagnosing and treating blood diseases and conditions.
Diagnostic Tests
You may have blood tests to diagnose PV. These tests include a complete blood count (CBC) and other tests, if necessary.
Complete Blood Count
Often, the first test used to diagnose PV is a CBC. The CBC measures many parts of your blood.
This test checks your hemoglobin (HEE-muh-glow-bin) and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A high level of hemoglobin or hematocrit may be a sign of PV.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of PV, a blood disorder, an infection, or another condition.
In addition to high red blood cell counts, people who have PV also may have high white blood cell and/or platelet counts.
Other Blood Tests
Blood smear. For this test, a small sample of blood is drawn from a vein, usually in your arm. The blood sample is examined under a microscope.
A blood smear can show whether you have a higher than normal number of red blood cells. The test also can show abnormal blood cells that are linked to myelofibrosis and other conditions related to PV.
Erythropoietin level. This blood test measures the level of EPO in your blood. EPO is a hormone that prompts your bone marrow to make new blood cells. People who have PV have very low levels of EPO. People who have secondary polycythemia usually have normal or high levels of EPO.
Bone Marrow Tests
Bone marrow tests can show whether your bone marrow is healthy. These tests also show whether your bone marrow is making normal amounts of blood cells.
The two bone marrow tests are aspiration (as-pi-RA-shun) and biopsy. For aspiration, your doctor removes a small amount of fluid bone marrow through a needle. For a biopsy, your doctor removes a small amount of bone marrow tissue through a larger needle. The samples are then examined under a microscope.
If the tests show that your bone marrow is making too many blood cells, it may be a sign that you have PV.
How Is Polycythemia Vera Treated?
Polycythemia vera (PV) doesn't have a cure. However, treatments can help control the disease and its complications. PV is treated with procedures, medicines, and other methods. You may need one or more treatments to manage the disease.
Goals of Treatment
The goals of treating PV are to control symptoms and reduce the risk of complications, especially heart attack and stroke. To do this, PV treatments reduce the number of red blood cells and the level of hemoglobin (an iron-rich protein) in the blood. This brings the thickness of your blood closer to normal.
Blood with normal thickness flows better through the blood vessels. This reduces the chance that blood clots will form and cause a heart attack or stroke.
Blood with normal thickness also ensures that your body gets enough oxygen. This can help reduce some of the signs and symptoms of PV, such as headaches, vision problems, and itching.
Studies show that treating PV greatly improves your chances of living longer.
The goal of treating secondary polycythemia is to control its underlying cause, if possible. For example, if the cause is carbon monoxide exposure, the goal is to find the source of the carbon monoxide and fix or remove it.
Treatments To Lower Red Blood Cell Levels
Phlebotomy
Phlebotomy (fle-BOT-o-me) is a procedure that removes some blood from your body. For this procedure, a needle is inserted into one of your veins. Blood from the vein flows through an airtight tube into a sterile container or bag. The process is similar to the process of donating blood.
Phlebotomy reduces your red blood cell count and starts to bring your blood thickness closer to normal.
Typically, a pint (1 unit) of blood is removed each week until your hematocrit level approaches normal. (Hematocrit is the measure of how much space red blood cells take up in your blood.)
You may need to have phlebotomy done every few months.
Medicines
Your doctor may prescribe medicines to keep your bone marrow from making too many red blood cells. Examples of these medicines include hydroxyurea and interferon-alpha.
Hydroxyurea is a medicine generally used to treat cancer. This medicine can reduce the number of red blood cells and platelets in your blood. As a result, this medicine helps improve your blood flow and bring the thickness of your blood closer to normal.
Interferon-alpha is a substance that your body normally makes. It also can be used to treat PV. Interferon-alpha can prompt your immune system to fight overactive bone marrow cells. This helps lower your red blood cell count and keep your blood flow and blood thickness closer to normal.
Treatments for Symptoms
Aspirin can relieve bone pain and burning feelings in your hands or feet that you may have as a result of PV. Aspirin also thins your blood, so it reduces the risk of blood clots.
Aspirin can have side effects, including bleeding in the stomach and intestines. For this reason, take aspirin only as your doctor recommends.
If your PV causes itching, your doctor may prescribe medicines to ease the discomfort. Your doctor also may prescribe ultraviolet light treatment to help relieve your itching.
Other ways to reduce itching include:
Avoiding hot baths. Cooler water can limit irritation to your
skin.
Gently patting yourself dry after bathing. Vigorous rubbing with a towel can irritate your
skin.
Taking
starch baths. Add half a box of starch to a tub of lukewarm water. This can help soothe your
skin.
Experimental Treatments
Researchers are studying other treatments for PV. An experimental treatment for itching involves taking low doses of selective serotonin reuptake inhibitors (SSRIs). This type of medicine is used to treat depression. In clinical trials, SSRIs reduced itching in people who had PV.
Imatinib mesylate is a medicine that's approved for treating leukemia. In clinical trials, this medicine helped reduce the need for phlebotomy in people who had PV. This medicine also helped reduce the size of enlarged spleens.
Researchers also are trying to find a treatment that can block or limit the effects of an abnormal JAK2 gene. (A mutation, or change, in the JAK2 gene is the major cause of PV.)
How Can Polycythemia Vera Be Prevented?
Primary polycythemia (polycythemia vera) can't be prevented. However, with proper treatment, you can prevent or delay symptoms and complications.
Sometimes you can prevent secondary polycythemia by avoiding things that deprive your body of oxygen for long periods. For example, you can avoid mountain climbing, living at a high altitude, or smoking.
People who have serious heart or lung diseases may develop secondary polycythemia. Treatment for the underlying disease may improve the secondary polycythemia. Following a healthy lifestyle to lower your risk of heart and lung diseases also will help you prevent secondary polycythemia.
Living With Polycythemia Vera
Polycythemia vera (PV) develops very slowly. It may not cause signs or symptoms for years. If you have PV, the sooner it's diagnosed, the sooner your doctor can begin treating you. With proper treatment, you can prevent or delay complications.
Preventing Complications
Moderate physical activities, such as walking, can safely increase your heart rate and improve blood flow to your body. Improving blood flow lowers your risk of blood clots. Leg and ankle stretching exercises also can help improve your blood flow.
PV may cause itching all over your body. It's important not to scratch and damage your skin. If bathing or showering causes you to have severe itching, try using cooler water and gentler soap. Carefully and gently dry your skin after baths, and use moisturizing lotion on your skin. Starch baths also may help ease itchy skin.
PV causes poor blood flow in your hands and feet. As a result, you may be more prone to injuries from cold, heat, and pressure. If you have PV, avoid long-term exposure to extremes in temperature or pressure. For example:
Getting Ongoing Care
If you have PV, you'll need lifelong medical care for the disease. Ask your doctor how often you should schedule followup visits.
Routine care will allow your doctor to detect any changes with your PV and treat them early, if needed. You may need periodic blood tests to show whether the disease is getting worse.
Follow your treatment plan and take all of your medicines exactly as your doctor prescribes.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to polycythemia vera, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Primary Ciliary Dyskinesia?
Primary ciliary (SIL-e-ar-e) dyskinesia (dis-kih-NE-ze-ah), or PCD, is a rare disease that affects tiny, hair-like structures that line the airways. These structures are called cilia (SIL-e-ah).
Cilia move together in wave-like motions. They carry mucus (a slimy substance) toward the mouth to be coughed or sneezed out of the body. The mucus contains inhaled dust, bacteria, and other small particles.
If the cilia don't work well, bacteria stay in your airways. This can cause breathing problems, infections, and other disorders. PCD mainly affects the sinuses, ears, and lungs. Some people who have PCD have breathing problems from the moment of birth.
Sperm cells have structures that are like cilia. In men who have PCD, these structures also may not work well. This can cause fertility problems. ""Fertility"" refers to the ability to have children.
Fertility problems also occur in some women who have PCD. These problems likely are due to faulty cilia in the fallopian tubes. (The fallopian tubes carry eggs from the ovaries to the uterus.)
Overview
PCD is an inherited disease. ""Inherited"" means the disease is passed from parents to children through genes. With PCD, this process is very complex. Researchers are still learning how the disease is inherited and which genes are involved.
Generally, a child must inherit faulty genes from both parents to have PCD. These genes affect how cilia grow and function. Faulty genes may cause the cilia to be the wrong size or shape or move in the wrong way. Sometimes the cilia are missing altogether.
No single faulty gene causes all cases of PCD. Rather, many genes are associated with the disease.
If a child inherits a faulty gene (or genes) from only one parent, he or she may be a ""PCD carrier."" Carriers usually have no symptoms of PCD. However, carriers can pass faulty PCD genes on to their children.
The symptoms and severity of PCD vary from person to person. If you or your child has the disease, you may have serious sinus, ear, and/or lung infections. If the disease is mild, it may not show up until the teen or adult years.
The symptoms and severity of PCD also vary over time. Sometimes you may have few symptoms. Other times, your symptoms may become more severe.
Some people who have PCD have a condition called situs inversus (SI-tus in-VER-sus). This is a condition in which the internal organs (for example, the heart, stomach, spleen, liver, and gallbladder) are in opposite positions from where they normally are.
A correct and early diagnosis of PCD is very important. It will allow you or your child to get the proper treatment to keep your airways and lungs as healthy as possible. An early diagnosis and proper treatment also can prevent or delay lung damage.
Outlook
Many people who have PCD have normal lifespans. However, about 25 percent of people who have the disease may develop respiratory failure, a life-threatening condition. A small number of people who have PCD need lung transplants.
Scientists continue to study the faulty genes that cause PCD. Further studies of the disease will likely lead to earlier diagnoses, better treatments, and improved outcomes.
Other Names for Primary Ciliary Dyskinesia
Acilia syndrome
Dyskinetic
cilia syndrome
What Causes Primary Ciliary Dyskinesia?
Primary ciliary dyskinesia (PCD) is a rare, inherited disease. ""Inherited"" means the disease is passed from parents to children through genes. With PCD, this process is very complex. Researchers are still learning how the disease is inherited and which genes are involved.
Generally, a child must inherit faulty genes from both parents to have PCD. These genes affect how cilia grow and function. Cilia are tiny, hair-like structures that line the airways.
The airways include your nose and linked air passages; mouth; larynx (LAR-ingks), or voice box; trachea (TRA-ke-ah), or windpipe; and tubes called bronchial tubes or bronchi, and their branches.
Cilia move mucus (a slimy substance) through your airways and toward your mouth to be coughed or sneezed out of your body. The mucus contains inhaled dust, bacteria, and other small particles.
Faulty genes may cause the cilia to be the wrong size or shape or move in the wrong way. Sometimes the cilia are missing altogether. If the cilia don't work well, bacteria stay in your airways. This can cause breathing problems, infections, and other disorders.
Figure A shows the organs that primary ciliary dyskinesia can affect. Figure B shows a cross-section of the trachea (windpipe). Figure C shows a closeup view of normal cilia lining the trachea. The cilia move together in wave-like motions to transport mucus toward the mouth. Figure D shows a closeup view of faulty cilia lining the trachea. The cilia are deformed and do not move together, causing a buildup of mucus.
No single faulty gene causes all cases of PCD. Rather, many genes are associated with the disease.
If a child inherits a faulty gene (or genes) from only one parent, he or she may be a ""PCD carrier."" Carriers usually have no symptoms of PCD. However, carriers can pass faulty PCD genes on to their children.
Who Is at Risk for Primary Ciliary Dyskinesia?
Primary ciliary dyskinesia (PCD) is a rare disease that affects both males and females. The disease also affects people from all racial and ethnic groups.
Some people who have PCD have breathing problems from the moment of birth. However, other people can go through all or most of their lives without knowing that they have the disease.
What Are the Signs and Symptoms of Primary Ciliary Dyskinesia?
Primary ciliary dyskinesia (PCD) mainly affects the sinuses, ears, and lungs. One sign that you might have PCD is if you have chronic (ongoing) infections in one or more of these areas. Common signs, symptoms, and complications linked to PCD include the following:
PCD also can cause fertility problems in men and women. ""Fertility"" refers to the ability to have children. In men, PCD can affect cilia-like structures that help sperm cells move. Because the sperm cells don't move well, men who have the disease usually are unable to father children.
Fertility problems also occur in some women who have PCD. These problems likely are due to faulty cilia in the fallopian tubes. (The fallopian tubes carry eggs from the ovaries to the uterus.)
About half of all people who have PCD have Kartagener's syndrome. This syndrome involves three disorders: chronic sinusitis (si-nu-SI-tis), bronchiectasis (brong-ke-EK-tah-sis), and situs inversus.
Chronic sinusitis is a condition in which the sinuses are infected or inflamed. The sinuses are hollow air spaces around the nasal passages.
Bronchiectasis is a condition in which damage to the airways causes them to widen and become flabby and scarred.
Situs inversus is a condition in which the internal organs (for example, the heart, stomach, spleen, liver, and gallbladder) are in opposite positions from where they normally are.
Situs inversus can occur without PCD. In fact, only 25 percent of people who have the condition also have PCD. By itself, situs inversus may not affect your health. However, in PCD, it's a sign of Kartagener's syndrome.
Some people who have PCD have abnormally placed organs and congenital heart defects.
When Do Symptoms Occur?
The symptoms and severity of PCD vary from person to person. If you or your child has the disease, you may have serious sinus, ear, and/or lung infections. If the disease is mild, it may not show up until the teen or adult years.
The symptoms and severity of PCD also vary over time. Sometimes, you may have few symptoms. Other times, your symptoms may become more severe.
Some people who have PCD have breathing problems when they're born and need extra oxygen for several days. Afterward, airway infections are common.
Diagnosing PCD in children can be hard. This is because some PCD symptoms—such as ear infections, chronic cough, and runny nose—are common in children, even if they don't have PCD. Also, the disease may be confused with another condition, such as cystic fibrosis.
A correct and early diagnosis of PCD is very important. It will allow you or your child to get the proper treatment to keep your airways and lungs as healthy as possible. An early diagnosis and proper treatment also can prevent or delay ongoing and long-term lung damage.
How Is Primary Ciliary Dyskinesia Diagnosed?
Your doctor or your child's doctor will diagnose primary ciliary dyskinesia (PCD) based on signs and symptoms and test results.
If your primary care doctor thinks that you may have PCD or another lung disorder, he or she may refer you to a pulmonologist. This is a doctor who specializes in diagnosing and treating lung diseases and conditions.
Signs and Symptoms
Your doctor will look for signs and symptoms that point to PCD, such as:
Situs inversus (internal
organs in positions opposite of what is normal)
For more information, go to ""What Are the Signs and Symptoms of Primary Ciliary Dyskinesia?""
Your doctor also may ask whether you have a family history of PCD. PCD is an inherited disease. ""Inherited"" means the disease is passed from parents to children through genes. A family history of PCD suggests an increased risk for the disease.
Diagnostic Tests
If the doctor thinks that you or your child might have PCD, he or she may recommend tests to confirm the diagnosis.
Genetic Testing
Researchers have found many gene defects associated with PCD. Genetic testing can show whether you have faulty genes linked to the disease.
Genetic testing is done using a blood sample. The sample is taken from a vein in your body using a needle. The blood sample is checked at a special genetic testing laboratory (lab).
Electron Microscopy
Doctors can use a special microscope, called an electron microscope, to look at samples of your airway cilia. This test can show whether your cilia are faulty.
An ear, nose, and throat (ENT) specialist or a pulmonologist (lung specialist) will take samples of your cilia. He or she will brush the inside of your nose or remove some cells from your airways.
The doctor will send the samples to a lab. There, a pathologist will look at them under an electron microscope. (A pathologist is a doctor who specializes in identifying diseases by studying cells and tissues under a microscope.)
Other Tests
Sometimes doctors use one or more of the following tests to help diagnose PCD. These tests are less complex than genetic testing and electron microscopy, and they can be done in a doctor's office.
However, these tests don't give a final diagnosis. Based on the test results, doctors may recommend the more complex tests.
Video microscopy. For this test, a pulmonologist brushes the inside of your nose to get a sample of cilia. Then, he or she looks at the cilia under a microscope to see how they move. Abnormal movement of the cilia may be a sign of PCD.
Radiolabeled particles. For this test, you breathe in tiny particles that have a small amount of radiation attached to them. When you breathe out, your doctor will test how well your cilia can move the particles.
If you breathe out a smaller than normal number of particles, your cilia may not be working well. This could be a sign of PCD.
Nasal nitric oxide. This test measures the level of nitric oxide (a gas) when you breathe out. In people who have PCD, the level of nitric oxide is very low compared with normal levels. Doctors don't know why people who have PCD breathe out such low levels of nitric oxide.
Semen analysis. This test is used for adult men. In men, PCD can affect cilia-like structures that help sperm cells move. As a result, men who have PCD may have fertility problems. (""Fertility"" refers to the ability to have children.)
For this test, a sample of semen is checked under a microscope. Abnormal sperm may be a sign of PCD.
Tests for other conditions. Your doctor also might want to do tests to rule out diseases and disorders that have symptoms similar to those of PCD. For example, you may have tests to rule out cystic fibrosis or immune disorders.
How Is Primary Ciliary Dyskinesia Treated?
Unfortunately, no treatment is available yet to fix faulty airway cilia. (Cilia are tiny, hair-like structures that line the airways.) Thus, treatment for primary ciliary dyskinesia (PCD) focuses on which symptoms and complications you have.
The main goals of treating PCD are to:
Specialists Involved
Many doctors may help care for someone who has PCD. For example, a neonatologist may suspect PCD or another lung disorder if a newborn has breathing problems at birth. A neonatologist is a doctor who specializes in treating newborns.
A pediatrician may suspect PCD if a child has chronic (ongoing) sinus, ear, and/or lung infections. A pediatrician is a doctor who specializes in treating children. This type of doctor provides children with ongoing care from an early age and treats conditions such as ear infections and breathing problems.
An otolaryngologist also may help diagnose and treat PCD. This type of doctor treats ear, nose, and throat disorders and also is called an ear, nose, and throat (ENT) specialist. If a child has chronic sinus or ear infections, an ENT specialist may be involved in the child's care.
A pulmonologist may help diagnose or treat lung problems related to PCD. This type of doctor specializes in diagnosing and treating lung diseases and conditions. Most people who have PCD have lung problems at some point in their lives.
A pathologist is a doctor who specializes in identifying diseases by studying cells and tissues under a microscope. This type of doctor may help diagnose PCD by looking at cilia under a microscope.
A pathologist also may look at mucus samples to see what types of bacteria are causing infections. This information can help your doctor decide which treatments to prescribe.
Treatments for Breathing and Lung Problems
Standard treatments for breathing and lung problems in people who have PCD are chest physical therapy (CPT), exercise, and medicines.
One of the main goals of these treatments is to get you to cough. Coughing clears mucus from the airways, which is important for people who have PCD. For this reason, your doctor also may advise you to avoid medicines that suppress coughing.
Chest Physical Therapy
CPT also is called chest clapping or percussion. It involves pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so that you can cough it up.
You might sit down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.
Some people find CPT hard or uncomfortable to do. Several devices have been made to help with CPT, such as:
An electric
chest clapper, known as a mechanical percussor.
An inflatable
therapy vest that uses high-frequency airwaves. The airwaves force the
mucus that's deep in your
lungs toward your upper airways so you can
cough it up.
A small
hand-held device that you breathe out through. The device causes vibrations that dislodge the
mucus.
A mask that creates vibrations to help break the
mucus loose from your airway walls.
Breathing techniques also may help dislodge mucus so you can cough it up. These techniques include forcing out a couple of short breaths or deeper breaths and then doing relaxed breathing. This may help loosen the mucus in your lungs and open your airways.
Exercise
Aerobic exercise that makes you breathe harder helps loosen the mucus in your airways so you can cough it up. Exercise also helps improve your overall physical condition.
Talk with your doctor about what types and amounts of exercise are safe for you or your child.
Medicines
If you have PCD, your doctor may prescribe antibiotics, bronchodilators, or anti-inflammatory medicines. These medicines help treat lung infections, open up the airways, and reduce swelling.
Antibiotics are the main treatment to prevent or treat lung infections. Your doctor may prescribe oral or intravenous (IV) antibiotics.
Oral antibiotics often are used to treat mild lung infections. For severe or hard-to-treat infections, you may be given IV antibiotics through a tube inserted into a vein.
To help decide which antibiotics you need, your doctor may send mucus samples to a pathologist. The pathologist will try to find out which bacteria are causing the infection.
Bronchodilators help open the airways by relaxing the muscles around them. You inhale these medicines. Often, they're taken just before CPT to help clear mucus from your lungs. You also may take bronchodilators before inhaling other medicines into your lungs.
Anti-inflammatory medicines can help reduce swelling in your airways that's caused by ongoing infections. These medicines may be inhaled or oral.
Treatments for Sinus and Ear Infections
To treat infections, your doctor may recommend saline nasal washes and anti-inflammatory nasal spray. If these treatments aren't enough, you may need medicines, such as antibiotics. If antibiotics don't work, surgery may be an option.
Tympanostomy (tim-pan-OS-toe-me) is a procedure in which small tubes are inserted into the eardrums to help drain mucus from the ears. This procedure may help children who have hearing problems caused by PCD.
Nasal or sinus surgery may help drain the sinuses and provide short-term relief of symptoms. However, the long-term benefits of this treatment are unclear.
Treatments for Advanced Lung Disease
People who have PCD may develop a serious lung condition called bronchiectasis. This condition often is treated with medicines, hydration (drinking plenty of fluids), and CPT.
If bronchiectasis severely affects part of your lung, surgery may be used to remove that area of lung.
In very rare cases, if other treatments haven't worked, lung transplant may be an option for severe lung disease. A lung transplant is surgery to remove a person's diseased lung and replace it with a healthy lung from a deceased donor.
Living With Primary Ciliary Dyskinesia
If you or your child has primary ciliary dyskinesia (PCD), try to learn as much as you can about the disease. Work closely with your doctors or your child's doctors to learn how to manage PCD.
Ongoing Care
You'll need ongoing care to check your lung function and your general health. Ask your doctor how often you should schedule followup visits.
Your doctor will likely recommend periodic chest x rays and lung function tests. He or she will use the test results and information about your symptoms to plan your treatment.
Make sure to report new or worsening symptoms, such as increased coughing, to your doctor right away. This will allow him or her to find out whether you have an infection and what's causing it. Your doctor can then prescribe medicine to prevent the infection from worsening.
Also, certain vaccines can lower your risk for some infections. Talk with your doctor about which vaccines may benefit you.
If your child has PCD, encourage him or her to learn about the disease and take an active role in his or her treatment.
Healthy Lifestyle
Between medical checkups, you can practice good self-care and follow a healthy lifestyle. An important part of a healthy lifestyle is following a healthy diet.
A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources include general information about healthy eating.
Another important part of a healthy lifestyle is to quit smoking or not start smoking. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
If you have a child who has PCD, avoid smoking anywhere your child spends time, including the home and car. Encourage your child to never start smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart."" Although these resources focus on heart health, they include general information about how to quit smoking.
Other steps you can take to follow a healthy lifestyle include:
Other Concerns
Adults who have PCD can expect to have normal sex lives. However, men and women who have the disease may have fertility problems. (""Fertility"" refers to the ability to have children.) Fertility treatments may help some people who have PCD.
If you have PCD and fertility concerns, talk with your doctor. He or she can advise you about available treatment options.
People who have PCD should still have protected sex to avoid sexually transmitted diseases.
Emotional Issues and Support
Living with PCD may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Genetic Counseling
You may want to consider genetic counseling if you have:
A genetic counselor can explain the risk (likelihood) of having children who have the disease. He or she also can help explain the choices that are available.
You can find information about genetic counseling from health departments, neighborhood health centers, and medical centers.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic (ongoing) lung diseases, as well as ways to prevent or treat these diseases.
Many more questions remain about chronic lung diseases, including primary ciliary dyskinesia (PCD). The NHLBI continues to support research aimed at learning more about these diseases. For example, the NHLBI currently is supporting a study to explore how PCD starts and changes over time and how it affects lung function.
Research often depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures)","June 11, 2014."
71,14,"2018-02-02 04:25:06",p,71,"2018-02-02 05:23:29","Pulmonary Embolism","
What Is Pulmonary Embolism?
Pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE, is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg.
A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus (EM-bo-lus).
PE is a serious condition that can:
Damage other
organs in your body because of a lack of
oxygen.
If a blood clot is large, or if there are many clots, PE can cause death.
Overview
PE most often is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the body—most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery.
Deep vein clots are not like clots in veins close to the skin's surface. Those clots remain in place and do not cause PE.
Outlook
The exact number of people affected by DVT and PE isn't known. Estimates suggest these conditions affect 300,000 to 600,000 people in the United States each year.
If left untreated, about 30 percent of patients who have PE will die. Most of those who die do so within the first few hours of the event.
The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE.
Other Names for Pulmonary Embolism
What Causes Pulmonary Embolism?
Major Causes
Pulmonary embolism (PE) usually begins as a blood clot in a deep vein of the leg. This condition is called deep vein thrombosis. The clot can break free, travel through the bloodstream to the lungs, and block an artery.
The animation below shows how a blood clot from a deep vein in the leg can travel to the lungs, causing pulmonary embolism. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how a blood clot in a deep vein of the leg can break off, travel to the lungs, and block blood flow.
Blood clots can form in the deep veins of the legs if blood flow is restricted and slows down. This can happen if you don't move around for long periods, such as:
Blood clots are more likely to develop in veins damaged from surgery or injured in other ways.
Other Causes
Rarely, an air bubble, part of a tumor, or other tissue travels to the lungs and causes PE. Also, if a large bone in the body (such as the thigh bone) breaks, fat from the bone marrow can travel through the blood. If the fat reaches the lungs, it can cause PE.
Who Is at Risk for Pulmonary Embolism?
Pulmonary embolism (PE) occurs equally in men and women. The risk increases with age. For every 10 years after age 60, the risk of having PE doubles.
Certain inherited conditions, such as factor V Leiden, increase the risk of blood clotting and PE.
Major Risk Factors
Your risk for PE is high if you have deep vein thrombosis (DVT) or a history of DVT. In DVT, blood clots form in the deep veins of the body—most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery.
Your risk for PE also is high if you've had the condition before.
Other Risk Factors
Other factors also can increase the risk for PE, such as:
People who have recently been treated for cancer or who have a central venous catheter are more likely to develop DVT, which increases their risk for PE. A central venous catheter is a tube placed in a vein to allow easy access to the bloodstream for medical treatment.
Other risk factors for DVT include sitting for long periods (such as during long car or airplane rides), pregnancy and the 6-week period after pregnancy, and being overweight or obese. Women who take hormone therapy pills or birth control pills also are at increased risk for DVT.
The risk of developing blood clots increases as your number of risk factors increases.
What Are the Signs and Symptoms of Pulmonary Embolism?
Major Signs and Symptoms
Signs and symptoms of pulmonary embolism (PE) include unexplained shortness of breath, problems breathing, chest pain, coughing, or coughing up blood. An arrhythmia (irregular heartbeat) also may suggest that you have PE.
Sometimes the only signs and symptoms are related to deep vein thrombosis (DVT). These include swelling of the leg or along a vein in the leg, pain or tenderness in the leg, a feeling of increased warmth in the area of the leg that's swollen or tender, and red or discolored skin on the affected leg.
See your doctor right away if you have any signs or symptoms of PE or DVT. It's also possible to have PE and not have any signs or symptoms.
Other Signs and Symptoms
Some people who have PE have feelings of anxiety or dread, light-headedness or fainting, rapid breathing, sweating, or an increased heart rate.
How Is Pulmonary Embolism Diagnosed?
Pulmonary embolism (PE) is diagnosed based on your medical history, a physical exam, and test results.
Doctors who treat patients in the emergency room often are the ones to diagnose PE with the help of a radiologist. A radiologist is a doctor who deals with x rays and other similar tests.
Medical History and Physical Exam
To diagnose PE, the doctor will ask about your medical history. He or she will want to:
Your doctor also will do a physical exam. During the exam, he or she will check your legs for signs of DVT. He or she also will check your blood pressure and your heart and lungs.
Diagnostic Tests
Many tests can help diagnose PE. Which tests you have will depend on how you feel when you get to the hospital, your risk factors, available testing options, and other conditions you could possibly have. You may have one or more of the following tests.
Ultrasound
Doctors can use ultrasound to look for blood clots in your legs. Ultrasound uses sound waves to check blood flow in your veins.
For this test, gel is put on the skin of your legs. A hand-held device called a transducer is moved back and forth over the affected areas. The transducer gives off ultrasound waves and detects their echoes as they bounce off the vein walls and blood cells.
A computer turns the echoes into a picture on a computer screen, allowing the doctor to see blood flow in your legs. If the doctor finds blood clots in the deep veins of your legs, he or she will recommend treatment.
DVT and PE both are treated with the same medicines.
Computed Tomography Scans
Doctors can use computed tomography (to-MOG-rah-fee) scans, or CT scans, to look for blood clots in the lungs and legs.
For this test, dye is injected into a vein in your arm. The dye makes the blood vessels in your lungs and legs show up on x-ray images. You'll lie on a table, and an x-ray tube will rotate around you. The tube will take pictures from many angles.
This test allows doctors to detect most cases of PE. The test only takes a few minutes. Results are available shortly after the scan is done.
Pulmonary Angiography
Pulmonary angiography (an-jee-OG-rah-fee) is another test used to diagnose PE. This test isn't available at all hospitals, and a trained specialist must do the test.
For this test, a flexible tube called a catheter is threaded through the groin (upper thigh) or arm to the blood vessels in the lungs. Dye is injected into the blood vessels through the catheter.
X-ray pictures are taken to show blood flowing through the blood vessels in the lungs. If a blood clot is found, your doctor may use the catheter to remove it or deliver medicine to dissolve it.
Blood Tests
Certain blood tests may help your doctor find out whether you're likely to have PE.
A D-dimer test measures a substance in the blood that's released when a blood clot breaks down. High levels of the substance may mean a clot is present. If your test is normal and you have few risk factors, PE isn't likely.
Other blood tests check for inherited disorders that cause blood clots. Blood tests also can measure the amount of oxygen and carbon dioxide in your blood. A clot in a blood vessel in your lungs may lower the level of oxygen in your blood.
Other Tests
To rule out other possible causes of your symptoms, your doctor may use one or more of the following tests.
Echocardiography (echo). This test uses sound waves to create a moving picture of your
heart. Doctors use echo to check heart function and detect
blood clots inside the heart.
Chest MRI (magnetic resonance imaging). This test uses radio waves and magnetic fields to create pictures of
organs and structures inside the body. MRI often can provide more information than an x ray.
How Is Pulmonary Embolism Treated?
Pulmonary embolism (PE) is treated with medicines, procedures, and other therapies. The main goals of treating PE are to stop the blood clot from getting bigger and keep new clots from forming.
Treatment may include medicines to thin the blood and slow its ability to clot. If your symptoms are life threatening, your doctor may give you medicine to quickly dissolve the clot. Rarely, your doctor may use surgery or another procedure to remove the clot.
Medicines
Anticoagulants (AN-te-ko-AG-u-lants), or blood thinners, decrease your blood's ability to clot. They're used to stop blood clots from getting larger and prevent clots from forming. Blood thinners don't break up blood clots that have already formed. (The body dissolves most clots with time.)
You can take blood thinners as either a pill, an injection, or through a needle or tube inserted into a vein (called intravenous, or IV, injection). Warfarin is given as a pill. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube.
Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once warfarin starts to work, heparin usually is stopped.
Pregnant women usually are treated with heparin only, because warfarin is dangerous for the pregnancy.
If you have deep vein thrombosis, treatment with blood thinners usually lasts for 3 to 6 months. If you've had blood clots before, you may need a longer period of treatment. If you're being treated for another illness, such as cancer, you may need to take blood thinners as long as PE risk factors are present.
The most common side effect of blood thinners is bleeding. This can happen if the medicine thins your blood too much. This side effect can be life threatening.
Sometimes the bleeding is internal, which is why people treated with blood thinners usually have routine blood tests. These tests, called PT and PTT tests, measure the blood's ability to clot. These tests also help your doctor make sure you're taking the right amount of medicine. Call your doctor right away if you're bruising or bleeding easily.
Thrombin inhibitors are a newer type of blood-thinning medicine. They're used to treat some types of blood clots in people who can't take heparin.
Emergency Treatment
When PE is life threatening, a doctor may use treatments that remove or break up the blood clot. These treatments are given in an emergency room or hospital.
Thrombolytics (THROM-bo-LIT-iks) are medicines that can quickly dissolve a blood clot. They're used to treat large clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.
Sometimes a doctor may use a catheter (a flexible tube) to reach the blood clot. The catheter is inserted into a vein in the groin (upper thigh) or arm and threaded to the clot in the lung. The doctor may use the catheter to remove the clot or deliver medicine to dissolve it.
Rarely, surgery may be needed to remove the blood clot.
Other Types of Treatment
If you can't take medicines to thin your blood, or if the medicines don't work, your doctor may suggest a vena cava filter. This device keeps blood clots from traveling to your lungs.
The filter is inserted inside a large vein called the inferior vena cava. (This vein carries blood from the body back to the heart). The filter catches clots before they travel to the lungs. This type of treatment can prevent PE, but it won't stop other blood clots from forming.
Graduated compression stockings can reduce the chronic (ongoing) swelling that a blood clot in the leg may cause.
Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the ankle and become looser as they go up the leg. This causes gentle compression (pressure) up the leg. The pressure keeps blood from pooling and clotting.
How Can Pulmonary Embolism Be Prevented?
Preventing pulmonary embolism (PE) begins with preventing deep vein thrombosis (DVT). Knowing whether you're at risk for DVT and taking steps to lower your risk are important.
If you've already had DVT or PE, you can take more steps to prevent new blood clots from forming. Visit your doctor for regular checkups. Also, use compression stockings to prevent chronic (ongoing) swelling in your legs from DVT (as your doctor advises).
Contact your doctor right away if you have any signs or symptoms of DVT or PE.
Living With Pulmonary Embolism
Pulmonary embolism (PE) usually is treated in a hospital. After leaving the hospital, you may need to take medicine at home for 6 months or longer. It's important to:
Medicines used to treat PE can thin your blood too much. This can cause bleeding in the digestive system or the brain. If you have signs or symptoms of bleeding in the digestive system or the brain, get treatment at once.
Signs and symptoms of bleeding in the digestive system include:
Bright red
vomit or vomit that looks like coffee grounds
Bright red
blood in your
stool or black, tarry stools
Signs and symptoms of bleeding in the brain include:
Excessive bleeding from a fall or injury also may mean that your PE medicines have thinned your blood too much. Excessive bleeding is bleeding that won't stop after you apply pressure to a wound for 10 minutes. If you have excessive bleeding from a fall or injury, get treatment at once.
Once you've had PE (with or without deep vein thrombosis (DVT)), you're at higher risk of having the condition again. During treatment and after, continue to take steps to prevent DVT.
Check your legs for any signs or symptoms of DVT, such as swollen areas, pain or tenderness, increased warmth in swollen or painful areas, or red or discolored skin.
If you think that you have DVT or are having symptoms of PE, contact your doctor right away.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to pulmonary embolism, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Pulmonary Hypertension?
Pulmonary hypertension (PULL-mun-ary HI-per-TEN-shun), or PH, is increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen.
PH causes symptoms such as shortness of breath during routine activity (for example, climbing two flights of stairs), tiredness, chest pain, and a racing heartbeat. As the condition worsens, its symptoms may limit all physical activity.
Overview
To understand PH, it helps to understand how your heart and lungs work. Your heart has two sides, separated by an inner wall called the septum.
Each side of your heart has an upper and lower chamber. The lower right chamber of your heart, the right ventricle (VEN-trih-kul), pumps blood to your pulmonary arteries. The blood then travels to your lungs, where it picks up oxygen.
The upper left chamber of your heart, the left atrium (AY-tree-um), receives the oxygen-rich blood from your lungs. The blood is then pumped into the lower left chamber of your heart, the left ventricle. From the left ventricle, the blood is pumped to the rest of your body through an artery called the aorta.
For more information about the heart and lungs, go to the Health Topics How the Heart Works and How the Lungs Work articles.
PH begins with inflammation and changes in the cells that line your pulmonary arteries. Other factors also can affect the pulmonary arteries and cause PH. For example, the condition may develop if:
The walls of the
arteries are stiff at birth or become stiff from an overgrowth of
cells.
These changes make it hard for your heart to push blood through your pulmonary arteries and into your lungs. As a result, the pressure in your arteries rises. Also, because your heart is working harder than normal, your right ventricle becomes strained and weak.
Your heart may become so weak that it can't pump enough blood to your lungs. This causes heart failure. Heart failure is the most common cause of death in people who have PH.
PH is divided into five groups based on its causes and treatment options. In all groups, the average pressure in the pulmonary arteries is 25 mmHg or higher. The pressure in normal pulmonary arteries is 8–20 mmHg at rest. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
Other diseases or conditions, such as heart and lung diseases or blood clots, usually cause PH. Some people inherit the condition (that is, their parents pass the genes for PH on to them). In some cases, the cause isn't known.
Outlook
PH has no cure. However, research for new treatments is ongoing. The earlier PH is treated, the easier it is to control.
Treatments include medicines, procedures, and other therapies. These treatments can relieve PH symptoms and slow the progress of the disease. Lifestyle changes also can help control symptoms.
Types of Pulmonary Hypertension
The World Health Organization divides pulmonary hypertension (PH) into five groups. These groups are organized based on the cause of the condition and treatment options.
In all groups, the average pressure in the pulmonary arteries is 25 mmHg or higher. The pressure in normal pulmonary arteries is 8–20 mmHg at rest.
(Note that group 1 is called pulmonary arterial hypertension (PAH) and groups 2 through 5 are called pulmonary hypertension. However, together all groups are called pulmonary hypertension.)
Group 1 Pulmonary Arterial Hypertension
Group 1 PAH includes:
Group 2 Pulmonary Hypertension
Group 2 includes PH with left heart disease. Conditions that affect the left side of the heart, such as mitral valve disease or long-term high blood pressure, can cause left heart disease and PH. Left heart disease is likely the most common cause of PH.
Group 5 Pulmonary Hypertension
Group 5 includes PH caused by various other diseases or conditions. Examples include:
Systemic disorders, such as
sarcoidosis (sar-koy-DO-sis) and
vasculitis (vas-kyu-LI-tis). Systemic disorders involve many of the body's
organs.
Other Names for Pulmonary Hypertension
Group 1 pulmonary arterial hypertension (PAH) that occurs without a known cause often is called primary PAH or idiopathic (id-ee-o-PATH-ick) PAH.
Group 1 PAH that occurs with a known cause often is called associated PAH. For example, PAH that occurs in a person who has scleroderma might be called ""PAH occurring in association with scleroderma,"" or simply ""scleroderma-associated PAH.""
Groups 2–5 pulmonary hypertension (PH) sometimes are called secondary PH.
What Causes Pulmonary Hypertension?
Pulmonary hypertension (PH) begins with inflammation and changes in the cells that line your pulmonary arteries. Other factors also can affect the pulmonary arteries and cause PH. For example, the condition may develop if:
The walls of the
arteries are stiff at birth or become stiff from an overgrowth of
cells.
These changes make it hard for your heart to push blood through your pulmonary arteries and into your lungs. Thus, the pressure in the arteries rises, causing PH.
Many factors can contribute to the process that leads to the different types of PH.
Group 1 pulmonary arterial hypertension (PAH) may have no known cause, or the condition may be inherited. (""Inherited"" means the condition is passed from parents to children through genes.)
Some diseases and conditions also can cause group 1 PAH. Examples include HIV infection, congenital heart disease, and sickle cell disease. Also, the use of street drugs (such as cocaine) and certain diet medicines can lead to PAH.
Many diseases and conditions can cause groups 2 through 5 PH (often called secondary PH), including:
For more information about the types of PH and the diseases, conditions, and factors that can cause them, go to ""Types of Pulmonary Hypertension.""
Who Is at Risk for Pulmonary Hypertension?
The exact number of people who have pulmonary hypertension (PH) isn't known.
Group 1 pulmonary arterial hypertension (PAH) without a known cause is rare. Experts think that there are about 15 cases per 1 million adults. (Similar estimates have not been made for the other PH groups.) Group 1 PAH affects women more often than men. People who have group 1 PAH tend to be overweight.
PH that occurs with another disease or condition is more common.
PH usually develops between the ages of 20 and 60, but it can occur at any age. People who are at increased risk for PH include:
What Are the Signs and Symptoms of Pulmonary Hypertension?
Signs and symptoms of pulmonary hypertension (PH) may include:
As PH worsens, you may find it hard to do any physical activities. At this point, other signs and symptoms may include:
How Is Pulmonary Hypertension Diagnosed?
Your doctor will diagnose pulmonary hypertension (PH) based on your medical and family histories, a physical exam, and the results from tests and procedures.
PH can develop slowly. In fact, you may have it for years and not know it. This is because the condition has no early signs or symptoms.
When symptoms do occur, they're often like those of other heart and lung conditions, such as asthma. This makes PH hard to diagnose.
Medical and Family Histories
Your doctor may ask about your signs and symptoms and how and when they began. He or she also may ask whether you have other medical conditions that can cause PH.
Your doctor will want to know whether you have any family members who have or have had PH. People who have a family history of PH are at higher risk for the condition.
Physical Exam
During the physical exam, your doctor will listen to your heart and lungs with a stethoscope. He or she also will check your ankles and legs for swelling and your lips and skin for a bluish color. These are signs of PH.
Diagnostic Tests and Procedures
Your doctor may recommend tests and procedures to confirm a diagnosis of PH and to look for its underlying cause. Your doctor also will use test results to find out the severity of your PH.
Tests To Look for the Underlying Cause of Pulmonary Hypertension
PH has many causes, so many tests may need to be done to find its underlying cause.
Chest CT scan. A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. These pictures can show signs of PH or a condition that may be causing PH.
Chest MRI. Chest magnetic resonance imaging, or chest MRI, shows how your right ventricle is working. The test also shows blood flow in your lungs. Chest MRI also can help detect signs of PH or an underlying condition causing PH.
Lung function tests. Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. These tests can help detect a lung disease that may be causing PH.
Polysomnogram (PSG). This test records brain activity, eye movements, heart rate, and blood pressure while you sleep. A PSG also measures the level of oxygen in your blood. A low oxygen level during sleep is common in PH, and it can make the condition worse.
A PSG usually is done while you stay overnight at a sleep center. For more information about this test, go to the Health Topics Sleep Studies article.
Lung ventilation/perfusion (VQ) scan. A lung VQ scan measures air and blood flow in your lungs. This test can help detect blood clots in your lung's blood vessels.
Blood tests. Blood tests are used to rule out other diseases, such as HIV, liver disease, and autoimmune diseases (such as rheumatoid arthritis).
Finding Out the Severity of Pulmonary Hypertension
Exercise testing is used to find out the severity of PH. This testing consists of either a 6-minute walk test or a cardiopulmonary exercise test.
A 6-minute walk test measures the distance you can quickly walk in 6 minutes. A cardiopulmonary exercise test measures how well your lungs and heart work while you exercise on a treadmill or bicycle.
During exercise testing, your doctor will rate your activity level. Your level is linked to the severity of your PH. The rating system ranges from class 1 to class 4.
Class 1 has no limits. You can do regular physical activities, such as walking or climbing stairs. These activities don't cause PH symptoms, such as
tiredness, shortness of breath, or
chest pain.
Class 2 has slight or mild limits. You're comfortable while resting, but regular physical activity causes PH symptoms.
Class 3 has marked or noticeable limits. You're comfortable while resting. However, walking even one or two blocks or climbing one flight of stairs can cause PH symptoms.
Class 4 has severe limits. You're not able to do any physical activity without discomfort. You also may have PH symptoms while at rest.
Over time, you may need more exercise tests to find out how well your treatments are working. Each time testing is done, your doctor will compare your activity level with the previous one.
How Is Pulmonary Hypertension Treated?
Pulmonary hypertension (PH) has no cure. However, treatment may help relieve symptoms and slow the progress of the disease.
PH is treated with medicines, procedures, and other therapies. Treatment will depend on what type of PH you have and its severity. (For more information, go to ""Types of Pulmonary Hypertension."")
Group 1 Pulmonary Arterial Hypertension
Group 1 pulmonary arterial hypertension (PAH) includes PH that's inherited, that has no known cause, or that's caused by certain drugs or conditions. Treatments for group 1 PAH include medicines and medical procedures.
Medicines
Your doctor may prescribe medicines to relax the blood vessels in your lungs and reduce excess cell growth in the blood vessels. As the blood vessels relax, more blood can flow through them.
Your doctor may prescribe medicines that are taken by mouth, inhaled, or injected.
Examples of medicines for group 1 PAH include:
Your doctor may prescribe one or more of these medicines. To find out which of these medicines works best, you'll likely have an acute vasoreactivity test. This test shows how the pressure in your pulmonary arteries reacts to certain medicines. The test is done during right heart catheterization.
Medical and Surgical Procedures
If you have group 1 PAH, your doctor may recommend one or more of the following procedures.
Atrial septostomy (sep-TOS-toe-me). For this procedure, a thin, flexible tube called a catheter is put into a blood vessel in your leg and threaded to your heart. The tube is then put through the wall that separates your right and left atria (the upper chambers of your heart). This wall is called the septum.
A tiny balloon on the tip of the tube is inflated. This creates an opening between the atria. This procedure relieves the pressure in the right atria and increases blood flow. Atrial septostomy is rarely done in the United States.
Lung transplant. A lung transplant is surgery to replace a person's diseased lung with a healthy lung from a deceased donor. This procedure may be used for people who have severe lung disease that's causing PAH.
Heart–lung transplant. A heart–lung transplant is surgery in which both the heart and lung are replaced with healthy organs from a deceased donor.
Group 2 Pulmonary Hypertension
Conditions that affect the left side of the heart, such as mitral valve disease, can cause group 2 PH. Treating the underlying condition will help treat PH. Treatments may include lifestyle changes, medicines, and surgery.
Group 4 Pulmonary Hypertension
Blood clots in the lungs or blood clotting disorders can cause group 4 PH. If you have this type of PH, your doctor will likely prescribe blood-thinning medicines. These medicines prevent clots from forming or getting larger.
Sometimes doctors use surgery to remove scarring in the pulmonary arteries due to old blood clots.
Group 5 Pulmonary Hypertension
Various diseases and conditions, such as thyroid disease and sarcoidosis, can cause group 5 PH. An object, such as a tumor, pressing on the pulmonary arteries also can cause group 5 PH.
Group 5 PH is treated by treating its cause.
All Types of Pulmonary Hypertension
Several treatments may be used for all types of PH. These treatments include:
Research is ongoing for better PH treatments. These treatments offer hope for the future.
Living With Pulmonary Hypertension
Pulmonary hypertension (PH) has no cure. However, you can work with your doctor to manage your symptoms and slow the progress of the disease.
Ongoing Care
Follow your treatment plan as your doctor advises. Call your doctor if your PH symptoms worsen or change. The earlier symptoms are addressed, the easier it is to treat them.
Some symptoms, such as chest pain, may require emergency treatment. Ask your doctor when you should call him or her or seek emergency care.
Also, talk with your doctor before taking any over-the-counter medicines. Some medicines can make your PH worse or interfere with the medicines you're taking for PH. Ask your doctor whether you should get a pneumonia vaccine and a yearly flu shot.
You may have a complex schedule for taking medicines. Call your doctor or nurse if you're having problems with this schedule. Knowing the names of your medicines and how they work is helpful. Keep a list of your medicines with you. Don't stop or change medicines unless you talk with your doctor first.
Pay careful attention to your weight. You may want to keep a daily record of your weight. You should weigh yourself at the same time each day. If you notice a rapid weight gain (2 or more pounds in 1 day or 5 or more pounds in 1 week), call your doctor. This may be a sign that your PH is worsening.
Pregnancy is risky for women who have PH. Consider using birth control if there is a chance you may become pregnant. Ask your doctor which birth control methods are safe for you.
Lifestyle Changes
Making lifestyle changes can help you manage your symptoms. These changes will depend on the type of PH you have. Talk with your doctor about which lifestyle changes can help you.
Quit Smoking
If you smoke, quit. Smoking makes PH symptoms worse. Ask your doctor about programs and products that can help you quit. Also, avoid exposure to secondhand smoke.
For more information about how to quit smoking, go ","June 11, 2014."
73,15,"2018-02-02 04:25:06",r,73,"2018-02-02 05:24:08",Raynaud's,"
What Is Raynaud's?
Raynaud's is a rare disorder that affects the arteries. Arteries are blood vessels that carry blood from your heart to different parts of your body.
Raynaud's sometimes is called a disease, syndrome, or phenomenon. The disorder is marked by brief episodes of vasospasm (VA-so-spazm), which is a narrowing of the blood vessels.
Vasospasm of the arteries reduces blood flow to the fingers and toes. In people who have Raynaud's, the disorder usually affects the fingers. In about 40 percent of people who have Raynaud's, it affects the toes. Rarely, the disorder affects the nose, ears, nipples, and lips.
Overview
There are two main types of Raynaud’s—primary and secondary.
In primary Raynaud’s (also called Raynaud’s disease), the cause isn't known. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's.
Secondary Raynaud’s is caused by an underlying disease, condition, or other factor. This type of Raynaud's is often called Raynaud's phenomenon.
If you have primary or secondary Raynaud's, cold temperatures or stress can trigger ""Raynaud's attacks."" During an attack, little or no blood flows to affected body parts.
As a result, the skin may turn white and then blue for a short time. As blood flow returns, the affected areas may turn red and throb, tingle, burn, or feel numb.
In both types of Raynaud's, even mild or brief changes in temperature can cause Raynaud's attacks. For example, taking something out of the freezer or being exposed to temperatures below 60 degrees Fahrenheit can cause your fingers to turn blue.
![]()
Raynaud's. Figure A shows arteries in the fingers (digital arteries) with normal blood flow. The inset image shows a cross-section of a digital artery. Figure B shows fingertips that have turned white due to blocked blood flow. Figure C shows narrowed (more...)
Most people who have Raynaud's have no long-term tissue damage or disability. However, people who have severe Raynaud's can develop skin sores or gangrene from prolonged or repeated Raynaud's attacks. ""Gangrene"" refers to the death or decay of body tissues.
Outlook
About 5 percent of the U.S. population has Raynaud's. For most people who have primary Raynaud's, the disorder is more of a bother than a serious illness. They usually can manage the condition with minor lifestyle changes.
Secondary Raynaud's may be harder to manage. However, several treatments are available to help prevent or relieve symptoms. With secondary Raynaud's, it's important to treat the underlying disease or condition that's causing it.
Researchers continue to look for better ways to diagnose and treat Raynaud's.
What Causes Raynaud's?
There are two main types of Raynaud’s—primary and secondary.
In primary Raynaud’s (also called Raynaud’s disease), the cause isn't known. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's.
Secondary Raynaud’s is caused by an underlying disease, condition, or other factor. This type of Raynaud's is often called Raynaud's phenomenon.
Causes of Secondary Raynaud's
Many things can cause secondary Raynaud's. Examples include:
Diseases and Conditions
Secondary Raynaud's is linked to diseases and conditions that directly damage the arteries. The disorder also is linked to diseases and conditions that damage the nerves that control the arteries in the hands and feet.
For example, Raynaud’s occurs in most people who have scleroderma (skler-o-DER-ma). It also is a common problem for people with lupus.
Other examples of diseases and conditions that can cause Raynaud's include:
Blood disorders such as cryoglobulinemia (KRI-o-GLOB-yu-li-NE-me-ah) and polycythemia (POL-e-si-THE-me-ah)
Thyroid problems and pulmonary hypertension also may cause Raynaud's.
Repetitive Actions
Repetitive actions that damage the arteries or the nerves that control the arteries in the hands and feet may lead to Raynaud's.
Typing, playing the piano, or doing other similar movements repeatedly over long periods may lead to secondary Raynaud's. Using vibrating tools, such as jackhammers and drills, also may raise your risk of developing Raynaud's.
Chemicals
Exposure to certain workplace chemicals can cause a scleroderma-like illness that's linked to Raynaud's. An example of this type of chemical is vinyl chloride, which is used in the plastics industry.
The nicotine in cigarettes also can raise your risk of developing Raynaud's.
Medicines
Certain medicines can cause secondary Raynaud's, including:
Some over-the-counter cold and
allergy medicines and diet aids. Some of these medicines can narrow your
arteries.
Birth control pills. These medicines can affect
blood flow.
Who Is at Risk for Raynaud's?
The risk factors for primary Raynaud's (Raynaud's disease) and secondary Raynaud's (Raynaud's phenomenon) are different.
The risk factors for primary Raynaud's include:
Gender. Women are more likely to have primary
Raynaud's than men.
Age. Primary
Raynaud's usually develops before the age of 30.
Living in a cold climate. Cold temperatures can trigger
Raynaud's attacks.
The risk factors for secondary Raynaud's include:
Age. Secondary
Raynaud's usually develops after the age of 30.
Injuries to the
hands or feet.
Exposure to certain workplace chemicals, such as vinyl chloride (used in the plastics industry).
Repetitive actions with the
hands, such as typing or using vibrating tools.
Smoking.
Living in a cold climate.
What Are the Signs and Symptoms of Raynaud's?
People who have primary Raynaud's (Raynaud's disease) or secondary Raynaud's (Raynaud's phenomenon) can have attacks in response to cold temperatures or emotional stress.
Raynaud's attacks usually affect the fingers and toes. Rarely, the attacks affect the nose, ears, nipples, or lips.
During a Raynaud's attack, the arteries become very narrow for a brief period. As a result, little or no blood flows to affected body parts. This may cause these areas to:
Turn pale or white and then blue
Feel numb, cold, or painful
Turn red, throb, tingle, burn, or feel numb as
blood flow returns to the affected areas
Raynaud's attacks can last less than a minute or as long as several hours. Attacks can occur daily or weekly.
Attacks often begin in one finger or toe and move to other fingers or toes. Sometimes only one or two fingers or toes are affected. Different areas may be affected at different times.
Severe secondary Raynaud's can cause skin sores or gangrene. ""Gangrene"" refers to the death or decay of body tissues. Fortunately, severe Raynaud's is rare.
How Is Raynaud's Diagnosed?
Your doctor will diagnose primary Raynaud's (Raynaud's disease) or secondary Raynaud's (Raynaud's phenomenon) based on your medical history, a physical exam, and test results.
Medical History
Your doctor may ask about your risk factors for Raynaud's. He or she also may ask about your signs and symptoms when you're exposed to cold temperatures or stress.
For example, your doctor may ask whether your fingers or toes:
Feel numb or painful when they're exposed to cold temperatures
Turn white or blue, or both, when they're exposed to cold temperatures
Physical Exam
Your doctor will look at your fingers and toes to check the health of your skin and nails and to check blood flow to these areas.
Your doctor also may do a more complete physical exam to check for signs of diseases and conditions that are linked to secondary Raynaud's.
Diagnostic Tests and Procedures
Your doctor may recommend the following tests to check for Raynaud's and related conditions.
Cold Stimulation Test
A cold stimulation test can be used to trigger Raynaud's symptoms. For this test, a small device that measures temperature is taped to your fingers. Your hands are then exposed to cold—they're usually briefly put into ice water.
Your hands are then removed from the cold, and the device measures how quickly your fingers return to their normal temperature. If you have Raynaud's, it may take more than 20 minutes for your fingers to return to their normal temperature.
Because results of this type of test are not always consistent, your doctor may do other tests to check for Raynaud’s.
Nailfold Capillaroscopy
You may have a test called nailfold capillaroscopy (KAP-ih-lar-OS-ko-pe). For this test, your doctor puts a drop of oil at the base of your fingernail. He or she then looks at your fingernail under a microscope.
If your doctor sees abnormal arteries, it may mean you have a disease linked to Raynaud's, such as scleroderma.
Other Tests
Your doctor may order blood tests to look for conditions that are linked to secondary Raynaud's. Examples include antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR or ""sed rate""), and C-reactive protein (CRP) blood tests.
How Is Raynaud's Treated?
Primary Raynaud's (Raynaud's disease) and secondary Raynaud's (Raynaud's phenomenon) have no cure. However, treatments can reduce the number and severity of Raynaud's attacks. Treatments include lifestyle changes, medicines, and, rarely, surgery.
Most people who have primary Raynaud's can manage the condition with lifestyle changes. People who have secondary Raynaud's may need medicines in addition to lifestyle changes. Rarely, they may need surgery or shots.
If you have Raynaud's and develop sores on your fingers, toes, or other parts of your body, see your doctor right away. Timely treatment can help prevent permanent damage to these areas.
Lifestyle Changes
Lifestyle changes can help you avoid things that may trigger a Raynaud's attack. Examples of such triggers include cold temperatures, emotional stress, workplace or recreational factors, and contact with certain chemicals or medicines.
Protect Yourself From Cold Temperatures
To protect yourself from cold temperatures:
Wear a hat, mittens (rather than gloves), scarf, coat with snug cuffs, and warm socks and shoes during cold weather. Layer your clothing for extra warmth.
Put
hand and foot warmers in your mittens, boots, socks, or pockets. Some warmers are small heat packs, and others are battery-operated. These warmers often are available at sporting goods stores.
Turn down air conditioning or dress warmly while in an air-conditioned space.
Warm up your car before driving in cold weather.
Wear gloves or mittens when taking food out of the refrigerator or freezer (if cold temperatures severely affect you).
Avoid Other Triggers
Try to avoid things that make you upset or stressed. Learn ways to handle stress that you can't avoid. Physical activity helps some people cope with stress. Other people listen to music or focus on something calm or peaceful to reduce stress. Some people learn yoga, tai chi, or meditation.
Try to avoid workplace and recreational triggers. For example, limit the use of vibrating tools, such as drills. Wear proper protective gear if you work with industrial chemicals. Also, try to limit repetitive hand actions, such as typing or playing the piano.
Some medicines can trigger Raynaud's attacks. Examples include:
Over-the-counter cold or
allergy medicines or diet aids. Some of these medicines can narrow your
arteries.
Birth control pills. These medicines can affect
blood flow.
Talk with your doctor about whether your medicines are safe for you.
Other Lifestyle Changes
Other lifestyle changes also can help you avoid Raynaud's attacks. For example, include physical activity as part of your healthy lifestyle. Physical activity can increase your blood flow and help keep you warm.
Limit your use of caffeine and alcohol. These substances can trigger Raynaud's attacks. If you smoke, quit. Smoking makes Raynaud's worse. Ask your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
You also can take steps to help stop Raynaud's attacks when they occur. For example:
Move to a warmer spot, such as indoors, during cold weather.
Warm your
hands or feet. Place your hands under your armpits. Soak your feet or hands in warm water.
Move your
arms in circles or shake your arms or feet.
Get out of stressful situations and try relaxation techniques.
If you have Raynaud's, be sure to take care of your hands and feet. Protect them from cuts, bruises, and other injuries. For example, wear properly fitted shoes and don't walk barefoot. Use lotion to prevent your skin from drying and cracking. Also, avoid tight wristbands and rings.
Medicines and Surgery
If lifestyle changes don't control Raynaud's, you may need medicines or surgery. Medicines are used to improve blood flow to the fingers and toes.
Examples of medicines used to treat Raynaud's include calcium channel blockers, alpha blockers, prescription skin creams, and ACE inhibitors (used less often).
Rarely, people who have severe Raynaud's may develop skin sores or gangrene. ""Gangrene"" refers to the death or decay of body tissues. If this happens, antibiotics or surgery to cut out the damaged tissue may be needed. In very serious cases, the affected toe or finger may need to be removed.
Another treatment for severe Raynaud's is to block the nerves in the hands or feet that control the arteries. This can help prevent Raynaud's attacks. This treatment is done using surgery or shots.
The surgery often relieves symptoms, but sometimes for only a few years. Shots may need to be repeated if symptoms persist or come back.
Living With Raynaud's
Primary Raynaud's (Raynaud's disease) and secondary Raynaud's (Raynaud's phenomenon) can be lifelong conditions. However, you can take steps to help control Raynaud's. Lifestyle changes and ongoing care can help you manage the disorder.
Most people who have primary Raynaud's can manage the disorder with lifestyle changes. People who have secondary Raynaud's may need medicines in addition to lifestyle changes. Rarely, they may need surgery or shots.
Lifestyle Changes
You can take steps to avoid things that trigger Raynaud's attacks. If you have Raynaud's:
You also can take steps to stop a Raynaud's attack once it starts. Warm up your hands, feet, or other affected areas right away. For example, place your hands under your armpits, run warm water over your fingers and toes, or massage your hands and feet.
If you have Raynaud's, be sure to take care of your hands and feet. Protect them from cuts, bruises, and other injuries. For example, wear properly fitted shoes and don't walk barefoot. Use lotion to prevent your skin from drying and cracking. Also, avoid tight wristbands and rings.
For more information about lifestyle changes, go to ""How Is Raynaud's Treated?""
Ongoing Care
If you have Raynaud's, it's important to get ongoing care. Talk with your doctor about how often to schedule followup visits. Take all medicines as your doctor prescribes.
See your doctor right away if your Raynaud's symptoms get worse or if you develop sores on your fingers, toes, or other parts of your body. Timely treatment can help prevent permanent damage to these areas.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to primary or secondary Raynaud's, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Respiratory Distress Syndrome?
Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely occurs in full-term infants. The disorder is more common in premature infants born about 6 weeks or more before their due dates.
RDS is more common in premature infants because their lungs aren't able to make enough surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so that infants can breathe in air once they're born.
Without enough surfactant, the lungs collapse and the infant has to work hard to breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. The lack of oxygen can damage the baby's brain and other organs if proper treatment isn't given.
Most babies who develop RDS show signs of breathing problems and a lack of oxygen at birth or within the first few hours that follow.
Overview
RDS is a common lung disorder in premature infants. In fact, nearly all infants born before 28 weeks of pregnancy develop RDS.
RDS might be an early phase of bronchopulmonary dysplasia (brong-ko-PUL-mo-nar-e dis-PLA-ze-ah), or BPD. This is another breathing disorder that affects premature babies.
RDS usually develops in the first 24 hours after birth. If premature infants still have breathing problems by the time they reach their original due dates, they may be diagnosed with BPD. Some of the life-saving treatments used for RDS may cause BPD.
Some infants who have RDS recover and never get BPD. Infants who do get BPD have lungs that are less developed or more damaged than the infants who recover.
Infants who develop BPD usually have fewer healthy air sacs and tiny blood vessels in their lungs. Both the air sacs and the tiny blood vessels that support them are needed to breathe well.
Outlook
Due to improved treatments and medical advances, most infants who have RDS survive. However, these babies may need extra medical care after going home.
Some babies have complications from RDS or its treatments. Serious complications include chronic (ongoing) breathing problems, such as asthma and BPD; blindness; and brain damage.
Other Names for Respiratory Distress Syndrome
Hyaline membrane disease
Surfactant deficiency
What Causes Respiratory Distress Syndrome?
The main cause of respiratory distress syndrome (RDS) is a lack of surfactant in the lungs. Surfactant is a liquid that coats the inside of the lungs.
A fetus's lungs start making surfactant during the third trimester of pregnancy (weeks 26 through labor and delivery). The substance coats the insides of the air sacs in the lungs. This helps keep the lungs open so breathing can occur after birth.
Without enough surfactant, the lungs will likely collapse when the infant exhales (breathes out). The infant then has to work harder to breathe. He or she might not be able to get enough oxygen to support the body's organs.
Some full-term infants develop RDS because they have faulty genes that affect how their bodies make surfactant.
Who Is at Risk for Respiratory Distress Syndrome?
Certain factors may increase the risk that your infant will have respiratory distress syndrome (RDS). These factors include:
Premature delivery. The earlier your baby is born, the greater his or her risk for RDS. Most cases of RDS occur in babies born before 28 weeks of
pregnancy.
Stress during your baby's delivery, especially if you lose a lot of
blood.
Your baby also is at greater risk for RDS if you require an emergency cesarean delivery (C-section) before your baby is full term. You may need an emergency C-section because of a condition, such as a detached placenta, that puts you or your infant at risk.
Planned C-sections that occur before a baby's lungs have fully matured also can increase the risk of RDS. Your doctor can do tests before delivery that show whether it's likely that your baby's lungs are fully developed. These tests assess the age of the fetus or lung maturity.
What Are the Signs and Symptoms of Respiratory Distress Syndrome?
Signs and symptoms of respiratory distress syndrome (RDS) usually occur at birth or within the first few hours that follow. They include:
Rapid, shallow breathing
Sharp pulling in of the
chest below and between the
ribs with each breath
Grunting sounds
The infant also may have pauses in breathing that last for a few seconds. This condition is called apnea (AP-ne-ah).
Respiratory Distress Syndrome Complications
Depending on the severity of an infant's RDS, he or she may develop other medical problems.
Blood and Blood Vessel Complications
Infants who have RDS may develop sepsis, an infection of the bloodstream. This infection can be life threatening.
Lack of oxygen may prevent a fetal blood vessel called the ductus arteriosus from closing after birth as it should. This condition is called patent ductus arteriosus, or PDA.
The ductus arteriosus connects a lung artery to a heart artery. If it remains open, it can strain the heart and increase blood pressure in the lung arteries.
Other Complications
Complications of RDS also may include blindness and other eye problems and a bowel disease called necrotizing enterocolitis (EN-ter-o-ko-LI-tis). Infants who have severe RDS can develop kidney failure.
Some infants who have RDS develop bleeding in the brain. This bleeding can delay mental development. It also can cause mental retardation or cerebral palsy.
How Is Respiratory Distress Syndrome Diagnosed?
Respiratory distress syndrome (RDS) is common in premature infants. Thus, doctors usually recognize and begin treating the disorder as soon as babies are born.
Doctors also do several tests to rule out other conditions that could be causing an infant's breathing problems. The tests also can confirm that the doctors have diagnosed the condition correctly.
The tests include:
Chest x ray. A
chest x ray creates a picture of the structures inside the chest, such as the
heart and
lungs. This test can show whether your infant has signs of RDS. A chest x ray also can detect problems, such as a
collapsed lung, that may require urgent
treatment.
Blood tests.
Blood tests are used to see whether an infant has enough
oxygen in his or her blood. Blood tests also can help find out whether an
infection is causing the infant's breathing problems.
Echocardiography (echo). This test uses sound waves to create a moving picture of the
heart. Echo is used to rule out heart defects as the cause of an infant's breathing problems.
How Is Respiratory Distress Syndrome Treated?
Treatment for respiratory distress syndrome (RDS) usually begins as soon as an infant is born, sometimes in the delivery room.
Most infants who show signs of RDS are quickly moved to a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from health care professionals who specialize in treating premature infants.
The most important treatments for RDS are:
Breathing support from a
ventilator or nasal continuous positive airway pressure (NCPAP) machine. These machines help premature infants breathe better.
Surfactant Replacement Therapy
Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so that an infant can breathe in air once he or she is born.
Babies who have RDS are given surfactant until their lungs are able to start making the substance on their own. Surfactant usually is given through a breathing tube. The tube allows the surfactant to go directly into the baby's lungs.
Once the surfactant is given, the breathing tube is connected to a ventilator, or the baby may get breathing support from NCPAP.
Surfactant often is given right after birth in the delivery room to try to prevent or treat RDS. It also may be given several times in the days that follow, until the baby is able to breathe better.
Some women are given medicines called corticosteroids during pregnancy. These medicines can speed up surfactant production and lung development in a fetus. Even if you had these medicines, your infant may still need surfactant replacement therapy after birth.
Breathing Support
Infants who have RDS often need breathing support until their lungs start making enough surfactant. Until recently, a mechanical ventilator usually was used. The ventilator was connected to a breathing tube that ran through the infant's mouth or nose into the windpipe.
Today, more and more infants are receiving breathing support from NCPAP. NCPAP gently pushes air into the baby's lungs through prongs placed in the infant's nostrils.
Oxygen Therapy
Infants who have breathing problems may get oxygen therapy. Oxygen is given through a ventilator or NCPAP machine, or through a tube in the nose. This treatment ensures that the infants' organs get enough oxygen to work well.
For more information, go to the Health Topics Oxygen Therapy article.
Other Treatments
Other treatments for RDS include medicines, supportive therapy, and treatment for patent ductus arteriosus (PDA). PDA is a condition that affects some premature infants.
Medicines
Doctors often give antibiotics to infants who have RDS to control infections (if the doctors suspect that an infant has an infection).
Supportive Therapy
Treatment in the NICU helps limit stress on babies and meet their basic needs of warmth, nutrition, and protection. Such treatment may include:
Using a radiant warmer or incubator to keep infants warm and reduce the risk of
infection.
Ongoing monitoring of
blood pressure,
heart rate, breathing, and temperature through sensors taped to the babies' bodies.
Giving fluids and
nutrients through needles or tubes inserted into the infants'
veins. This helps prevent
malnutrition and promotes growth. Nutrition is critical to the growth and development of the
lungs. Later, babies may be given
breast milk or infant formula through feeding tubes that are passed through their
noses or
mouths and into their
throats.
Checking fluid intake to make sure that fluid doesn't build up in the babies'
lungs.
Treatment for Patent Ductus Arteriosus
PDA is a possible complication of RDS. In this condition, a fetal blood vessel called the ductus arteriosus doesn't close after birth as it should.
The ductus arteriosus connects a lung artery to a heart artery. If it remains open, it can strain the heart and increase blood pressure in the lung arteries.
PDA is treated with medicines, catheter procedures, and surgery. For more information, go to the Health Topics Patent Ductus Arteriosus article.
How Can Respiratory Distress Syndrome Be Prevented?
Taking steps to ensure a healthy pregnancy might prevent your infant from being born before his or her lungs have fully developed. These steps include:
If you're having a planned cesarean delivery (C-section), your doctor can do tests before delivery to show whether it's likely that your baby's lungs are fully developed. These tests assess the age of the fetus or lung maturity.
Your doctor may give you injections of a corticosteroid medicine if he or she thinks you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in your baby.
Treatment with corticosteroids can reduce your baby's risk of respiratory distress syndrome (RDS). If the baby does develop RDS, it will probably be fairly mild.
Corticosteroid treatment also can reduce the chances that your baby will have bleeding in the brain.
Living With Respiratory Distress Syndrome
Caring for a premature infant can be challenging. You may experience:
Take Steps to Manage Your Situation
You can take steps to help yourself during this difficult time. For example, take care of your health so that you have enough energy to deal with the situation.
Learn as much as you can about what goes on in the NICU. You can help your baby during his or her stay there and begin to bond with the baby before he or she comes home.
Learn as much as you can about your infant's condition and what's involved in daily care. This will allow you to ask questions and feel more confident about your ability to care for your baby at home.
Seek out support from family, friends, and hospital staff. Ask the case manager or social worker at the hospital about what you'll need after your baby leaves the hospital. The doctors and nurses can assist with questions about your infant's care. Also, you may want to ask whether your community has a support group for parents of premature infants.
Parents are encouraged to visit their baby in the NICU as much as possible. Spend time talking to your baby and holding and touching him or her (when allowed).
Ongoing Care for Your Infant
Your baby may need special care after leaving the NICU, including:
Talk to your child's doctor about ongoing care for your infant and any other medical concerns you have.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. However, many questions remain about various diseases and conditions, including respiratory distress syndrome (RDS).
The NHLBI continues to support research aimed at learning more about RDS. For example, NHLBI-supported research includes studies that explore:
Whether corticosteroid
treatment given to pregnant women 12–24 hours before delivery can decrease late preterm infants' need for
oxygen support. (Late preterm infants are babies born between 34 and 36 weeks of
pregnancy.)
The role that
genes play in surfactant deficiency and new ways to treat this problem in newborns.
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, your child may gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.
When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.
If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to RDS, talk with your doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Respiratory Failure?
Respiratory (RES-pih-rah-tor-e) failure is a condition in which not enough oxygen passes from your lungs into your blood. Your body's organs, such as your heart and brain, need oxygen-rich blood to work well.
Respiratory failure also can occur if your lungs can't properly remove carbon dioxide (a waste gas) from your blood. Too much carbon dioxide in your blood can harm your body's organs.
Both of these problems—a low oxygen level and a high carbon dioxide level in the blood—can occur at the same time.
Diseases and conditions that affect your breathing can cause respiratory failure. Examples include COPD (chronic obstructive pulmonary disease) and spinal cord injuries. COPD prevents enough air from flowing in and out of the airways. Spinal cord injuries can damage the nerves that control breathing.
Overview
To understand respiratory failure, it helps to understand how the lungs work. When you breathe, air passes through your nose and mouth into your windpipe. The air then travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries run through the walls of the air sacs. When air reaches the air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the air sacs. This process is called gas exchange.
In respiratory failure, gas exchange is impaired.
Respiratory failure can be acute (short term) or chronic (ongoing). Acute respiratory failure can develop quickly and may require emergency treatment. Chronic respiratory failure develops more slowly and lasts longer.
Signs and symptoms of respiratory failure may include shortness of breath, rapid breathing, and air hunger (feeling like you can't breathe in enough air). In severe cases, signs and symptoms may include a bluish color on your skin, lips, and fingernails; confusion; and sleepiness.
One of the main goals of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition.
Acute respiratory failure usually is treated in an intensive care unit. Chronic respiratory failure can be treated at home or at a long-term care center.
Outlook
The outlook for respiratory failure depends on the severity of its underlying cause, how quickly treatment begins, and your overall health.
People who have severe lung diseases may need long-term or ongoing breathing support, such as oxygen therapy or the help of a ventilator (VEN-til-a-tor). A ventilator is a machine that supports breathing. It blows air—or air with increased amounts of oxygen—into your airways and then your lungs.
Other Names for Respiratory Failure
What Causes Respiratory Failure?
Diseases and conditions that impair breathing can cause respiratory failure. These disorders may affect the muscles, nerves, bones, or tissues that support breathing, or they may affect the lungs directly.
When breathing is impaired, your lungs can't easily move oxygen into your blood and remove carbon dioxide from your blood (gas exchange). This can cause a low oxygen level or high carbon dioxide level, or both, in your blood.
Respiratory failure can occur as a result of:
Problems with the
spine, such as
scoliosis (a curve in the spine). This condition can affect the
bones and
muscles used for breathing.
Drug or alcohol overdose. An overdose affects the area of the
brain that controls breathing. During an overdose, breathing becomes slow and shallow.
![]()
Normal Lungs and Conditions Causing Respiratory Failure. Figure A shows the location of the lungs, airways, diaphragm, rib cage, pulmonary arteries, brain, and spinal cord in the body. Figure B shows the major conditions that cause respiratory failure. (more...)
What Are the Signs and Symptoms of Respiratory Failure?
The signs and symptoms of respiratory failure depend on its underlying cause and the levels of oxygen and carbon dioxide in the blood.
A low oxygen level in the blood can cause shortness of breath and air hunger (feeling like you can't breathe in enough air). If the level of oxygen is very low, it also can cause a bluish color on the skin, lips, and fingernails. A high carbon dioxide level can cause rapid breathing and confusion.
Some people who have respiratory failure may become very sleepy or lose consciousness. They also may develop arrhythmias (ah-RITH-me-ahs), or irregular heartbeats. These symptoms can occur if the brain and heart are not getting enough oxygen.
How Is Respiratory Failure Diagnosed?
Your doctor will diagnose respiratory failure based on your medical history, a physical exam, and test results. Once respiratory failure is diagnosed, your doctor will look for its underlying cause.
Physical Exam
During the physical exam, your doctor will look for signs of respiratory failure and its underlying cause.
Respiratory failure can cause shortness of breath, rapid breathing, and air hunger (feeling like you can't breathe in enough air). Using a stethoscope, your doctor can listen to your lungs for abnormal sounds, such as crackling.
Your doctor also may listen to your heart for signs of an arrhythmia (irregular heartbeat). An arrhythmia can occur if your heart doesn't get enough oxygen.
Your doctor might look for a bluish color on your skin, lips, and fingernails. A bluish color means your blood has a low oxygen level.
Respiratory failure also can cause extreme sleepiness and confusion, so your doctor might check how alert you are.
Diagnostic Tests
To check the oxygen and carbon dioxide levels in your blood, you may have:
Pulse oximetry. For this test, a small sensor is attached to your finger or
ear. The sensor uses light to estimate how much
oxygen is in your
blood.
Arterial
blood gas test. This test measures the
oxygen and
carbon dioxide levels in your blood. A blood sample is taken from an
artery, usually in your
wrist. The sample is then sent to a laboratory, where its oxygen and carbon dioxide levels are measured.
A low level of oxygen or a high level of carbon dioxide in the blood (or both) is a possible sign of respiratory failure.
Your doctor may recommend other tests, such as a chest x ray, to help find the underlying cause of respiratory failure. A chest x ray is a painless test that takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.
If your doctor thinks that you have an arrhythmia as a result of respiratory failure, he or she may recommend an EKG (electrocardiogram). An EKG is a simple, painless test that detects and records the heart's electrical activity.
How Is Respiratory Failure Treated?
Treatment for respiratory failure depends on whether the condition is acute (short-term) or chronic (ongoing) and its severity. Treatment also depends on the condition's underlying cause.
Acute respiratory failure can be a medical emergency. It often is treated in an intensive care unit at a hospital. Chronic respiratory failure often can be treated at home. If chronic respiratory failure is severe, your doctor may recommend treatment in a long-term care center.
One of the main goals of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition.
Oxygen Therapy and Ventilator Support
If you have respiratory failure, you may receive oxygen therapy. Extra oxygen is given through a nasal cannula (two small plastic tubes, or prongs, that are placed in both nostrils) or through a mask that fits over your nose and mouth.
![]()
Oxygen Therapy. The image shows how a nasal cannula and portable oxygen container are attached to a patient.
Oxygen also can be given through a tracheostomy (TRA-ke-OS-to-me). This is a surgically made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy or trach tube, is placed in the hole to help you breathe.
![]()
Oxygen Therapy Tracheostomy. Figure A shows a side view of the neck and the correct placement of a tracheostomy tube in the trachea, or windpipe. Figure B shows an external view of a patient who has a tracheostomy.
If the oxygen level in your blood doesn't increase, or if you're still having trouble breathing, your doctor may recommend a ventilator. A ventilator is a machine that supports breathing. It blows air—or air with increased amounts of oxygen—into your airways and then your lungs.
![]()
Oxygen Therapy Tracheostomy Ventilator. The illustration shows a standard setup for a ventilator in a hospital room. The ventilator pushes warm, moist air (or air with increased oxygen) to the patient. Exhaled air flows away from the patient.
Your doctor will adjust the ventilator as needed. This will help your lungs get the right amount of oxygen. It also can prevent the machine's pressure from injuring your lungs. You'll use the ventilator until you can breathe on your own.
Other Treatments To Help You Breathe
Noninvasive positive pressure ventilation (NPPV) and a rocking bed are two methods that can help you breathe better while you sleep. These methods are very useful for people who have chronic respiratory failure.
NPPV is a treatment that uses mild air pressure to keep your airways open while you sleep. You wear a mask or other device that fits over your nose or your nose and mouth. A tube connects the mask to a machine, which blows air into the tube.
CPAP (continuous positive airway pressure) is one type of NPPV. For more information, go to the Health Topics CPAP article. Although the article focuses on CPAP treatment for sleep apnea, it explains how CPAP works.
A rocking bed consists of a mattress on a motorized platform. The mattress gently rocks back and forth. When your head rocks down, the organs in your abdomen and your diaphragm (the main muscle used for breathing) slide up, helping you exhale. When your head rocks up, the organs in your abdomen and your diaphragm slide down, helping you inhale.
Fluids
You may be given fluids to improve blood flow throughout your body and to provide nutrition. Your doctor will make sure you get the right amount of fluids.
Too much fluid can fill the lungs and make it hard for you to get the oxygen you need. Not enough fluid can limit the flow of oxygen-rich blood to the body's organs.
Fluids usually are given through an intravenous (IV) line inserted in one of your blood vessels.
Medicines
Your doctor may prescribe medicines to relieve discomfort.
Treatments for the Underlying Cause of Respiratory Failure
Once your doctor figures out what's causing your respiratory failure, he or she will plan how to treat that disease or condition. Treatments may include medicines, procedures, and other therapies.
Living With Respiratory Failure
One of the main goals of treating respiratory failure is to treat the underlying cause of the condition. However, sometimes it's hard to cure or control the underlying cause. Thus, respiratory failure may last for weeks or even years. This is called chronic respiratory failure.
Oxygen therapy and other treatments can help you breathe easier. However, your oxygen and carbon dioxide levels still may not be normal. Thus, you may have one or more of the following symptoms:
Shortness of breath
Rapid breathing
These symptoms may go away within a few weeks or last longer. Talk with your doctor about how to deal with these symptoms, and read the tips below.
Ongoing Care
If you have respiratory failure, see your doctor for ongoing medical care. Your doctor may refer you to pulmonary rehabilitation (rehab).
Rehab can involve exercise training, education, and counseling. Your rehab team might include doctors, nurses, and other specialists. They'll work with you to create a program that meets your needs.
If you smoke, quit. Talk to your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
If you're on oxygen therapy, don't smoke. Oxygen isn't explosive, but it can worsen a fire. In the presence of oxygen, a small fire can quickly get out of control. Also, the cylinder that compressed oxygen gas comes in can explode when exposed to heat.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article. Although this resource focuses on heart health, it includes basic information about how to quit smoking.
Emotional Issues and Support
Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with respiratory failure. You can see how other people who have the same symptoms have coped with them. Talk to your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Prepare for Emergencies
If you have chronic respiratory failure, knowing when and where to seek help for your symptoms is important. You should seek emergency care if you have severe symptoms, such as trouble catching your breath or talking.
Call your doctor if you notice that your symptoms are worsening or if you have new signs and symptoms. Your doctor may change or adjust your treatments to relieve and treat symptoms.
Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you're taking.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to respiratory failure, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Restless Legs Syndrome?
Restless legs syndrome (RLS) is a disorder that causes a strong urge to move your legs. This urge to move often occurs with strange and unpleasant feelings in your legs. Moving your legs relieves the urge and the unpleasant feelings.
People who have RLS describe the unpleasant feelings as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, these feelings also occur in the arms.
The urge to move and unpleasant feelings happen when you're resting and inactive. Thus, they tend to be worse in the evening and at night.
Overview
RLS can make it hard to fall asleep and stay asleep. It may make you feel tired and sleepy during the day. This can make it hard to learn, work, and do other daily activities. Not getting enough sleep also can cause depression, mood swings, or other health problems.
RLS can range from mild to severe based on:
One type of RLS usually starts early in life (before 45 years of age) and tends to run in families. It may even start in childhood. Once this type of RLS starts, it usually lasts for the rest of your life. Over time, symptoms slowly get worse and occur more often. If you have a mild case, you may have long periods with no symptoms.
Another type of RLS usually starts later in life (after 45 years of age). It generally doesn't run in families. This type of RLS tends to have a more abrupt onset. The symptoms usually don't get worse over time.
Some diseases, conditions, and medicines may trigger RLS. For example, the disorder has been linked to kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a disease, condition, or medicine causes RLS, the symptoms usually start suddenly.
Medical conditions or medicines often cause or worsen the type of RLS that starts later in life.
Outlook
RLS symptoms often get worse over time. However, some people's symptoms go away for weeks to months.
If a medical condition or medicine triggers RLS, the disorder may go away if the trigger is relieved or stopped. For example, RLS that occurs due to pregnancy tends to go away after giving birth. Kidney transplants (but not dialysis) relieve RLS linked to kidney failure.
Treatments for RLS include lifestyle changes and medicines. Some simple lifestyle changes often help relieve mild cases of RLS. Medicines often can relieve or prevent the symptoms of more severe RLS.
Research is ongoing to better understand the causes of RLS and to find better treatments.
What Causes Restless Legs Syndrome?
Faulty Use of Iron or Lack of Iron
Research suggests that the main cause of restless legs syndrome (RLS) is a faulty use of iron or a lack of iron in the brain. The brain uses iron to make the chemical dopamine (DO-pah-meen) and to control other brain activities. Dopamine works in the parts of the brain that control movement.
Many conditions can affect how much iron is in the brain or how it's used. These conditions include kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. All of these conditions increase your risk of RLS.
People whose family members have RLS also are more likely to develop the disorder. This suggests that genetics may contribute to the faulty use of iron or lack of iron in the brain that triggers RLS.
Nerve Damage
Nerve damage in the legs or feet and sometimes in the arms or hands may cause or worsen RLS. Several conditions can cause this type of nerve damage, including diabetes.
Medicines and Substances
Certain medicines may trigger RLS. These include some:
RLS symptoms usually get better or may even go away if the medicine is stopped.
Certain substances, such as alcohol and tobacco, also can trigger or worsen RLS symptoms. Symptoms may get better or go away if the substances are stopped.
Who Is at Risk for Restless Legs Syndrome?
Restless legs syndrome (RLS) affects about 5–15 percent of Americans. Many people who have RLS have family members with the disorder.
RLS can affect people of any racial or ethnic group, but the disorder is more common in people of Northern European descent. RLS affects both genders, but women are more likely to have it than men.
The number of cases of RLS rises with age. Many people who have RLS are diagnosed in middle age. People who develop RLS early in life tend to have a family history of the disorder.
People who have certain diseases or conditions or who take certain medicines are more likely to develop RLS. (For more information, go to ""What Causes Restless Legs Syndrome?"")
For example, pregnancy is a risk factor for RLS. It usually occurs during the last 3 months of pregnancy. The disorder usually improves or goes away after giving birth. Some women may continue to have symptoms after giving birth. Other women may develop RLS again later in life.
What Are the Signs and Symptoms of Restless Legs Syndrome?
The four key signs of restless legs syndrome (RLS) are:
A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your
arms.
Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
Symptoms that start or get worse in the evening or at night.
You must have all four of these signs to be diagnosed with RLS.
The Urge To Move
RLS gets its name from the urge to move the legs when sitting or lying down. This movement relieves the unpleasant feelings that RLS sometimes causes. Typical movements are:
Pacing and walking
Jiggling the legs
Stretching and flexing
Tossing and turning
Rubbing the legs
Unpleasant Feelings
People who have RLS describe the unpleasant feelings in their limbs as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Severe RLS may cause painful feelings. However, the pain usually is more of an ache than a sharp, stabbing pain.
Children may describe RLS symptoms differently than adults. In children, the condition may occur with hyperactivity. However, it's not fully known how the disorders are related.
The unpleasant feelings from RLS often occur in the lower legs (calves). But the feelings can occur at any place in the legs or feet. They also can occur in the arms.
The feelings seem to come from deep within the limbs, rather than from the surface. You usually will have the feelings in both legs. However, the feelings can occur in one leg, move from one leg to the other, or affect one leg more than the other.
People who have mild symptoms may notice them only when they're still or awake for a long time, such as on a long airplane trip or while watching TV. If they fall asleep quickly, they may not have symptoms when lying down at night.
The unpleasant feelings from RLS aren't the same as the leg cramps many people get at night. Leg cramps often are limited to certain muscle groups in the leg, which you can feel tightening. Leg cramps cause more severe pain and require stretching the affected muscle for relief.
Sometimes arthritis or peripheral arterial disease (P.A.D.) can cause pain or discomfort in the legs. Moving the limbs usually worsens the discomfort instead of relieving it.
Periodic Limb Movement in Sleep
Many people who have RLS also have a condition called periodic limb movement in sleep (PLMS). PLMS causes your legs or arms to twitch or jerk about every 10 to 60 seconds during sleep. These movements cause you to wake up often and get less sleep.
PLMS usually affects the legs, but it also can affect the arms. Not everyone who has PLMS also has RLS.
Related Sleep Problems
RLS can make it hard to fall or stay asleep. If RLS disturbs your sleep, you may feel very tired during the day.
Lack of sleep may make it hard for you to concentrate at school or work. Not enough sleep also can cause depression, mood swings, and other health problems such as diabetes or high blood pressure.
How Is Restless Legs Syndrome Diagnosed?
Your doctor will diagnose restless legs syndrome (RLS) based on your signs and symptoms, your medical and family histories, a physical exam, and test results.
Your doctor will use this information to rule out other conditions that have symptoms similar to those of RLS.
Specialists Involved
Your primary care doctor usually can diagnose and treat RLS. However, he or she also may suggest that you see a sleep specialist or neurologist.
Signs and Symptoms
You must have the four key signs of RLS to be diagnosed with the disorder.
Your doctor will want to know how your symptoms are affecting your sleep and how alert you are during the day.
To help your doctor, you may want to keep a sleep diary. Use the diary to keep a daily record of how easy it is to fall and stay asleep, how much sleep you get at night, and how alert you feel during the day.
For a sample sleep diary, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Medical and Family Histories
Your doctor may ask whether you have any of the diseases or conditions that can trigger RLS. These include kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency.
Your doctor also may want to know what medicines you take. Some medicines can trigger or worsen RLS.
The most common type of RLS tends to run in families. Thus, your doctor may ask whether any of your relatives have RLS.
Physical Exam
Your doctor will do a physical exam to check for underlying conditions that may trigger RLS. He or she also will check for other conditions that have symptoms similar to those of RLS.
Diagnostic Tests
Currently, no test can diagnose RLS. Still, your doctor may recommend blood tests to measure your iron levels. He or she also may suggest muscle or nerve tests. These tests can show whether you have a condition that can worsen RLS or that has symptoms similar to those of RLS.
Rarely, sleep studies are used to help diagnose RLS. A sleep study measures how much and how well you sleep. Although RLS can cause a lack of sleep, this sign isn't specific enough to diagnose the condition.
Researchers continue to study new ways to diagnose RLS.
Drug Therapy Trial
If your doctor thinks you have RLS, he or she may prescribe certain medicines to relieve your symptoms. These medicines, which are used to treat people who have Parkinson's disease, also can relieve RLS symptoms. If the medicines relieve your symptoms, your doctor can confirm that you have RLS.
How Is Restless Legs Syndrome Treated?
Restless legs syndrome (RLS) has no cure. If a condition or medicine triggers RLS, it may go away or get better if the trigger is relieved or stopped.
RLS can be treated. The goals of treatment are to:
Mild cases of RLS often are treated with lifestyle changes and sometimes with periodic use of medicines. More severe RLS usually is treated with daily medicines.
Lifestyle Changes
Lifestyle changes can prevent or relieve the symptoms of RLS. For mild RLS, lifestyle changes may be the only treatment needed.
Preventing Symptoms
Many common substances, such as alcohol and tobacco, can trigger RLS symptoms. Avoiding these substances can limit or prevent symptoms.
Some prescription and over-the-counter medicines can cause or worsen RLS symptoms. Tell your doctor about all of the medicines you're taking. He or she can tell you whether you should stop or change certain medicines.
Adopting good sleep habits can help you fall asleep and stay asleep—a problem for many people who have RLS. Good sleep habits include:
Doing a challenging activity before bedtime, such as solving a crossword puzzle, may ease your RLS symptoms. This distraction may make it easier for you to fall asleep. Focusing on your breathing and using other relaxation techniques also may help you fall asleep.
Regular, moderate physical activity also can help limit or prevent RLS symptoms. Often, people who have RLS find that if they increase their activity during the day, they have fewer symptoms.
Relieving Symptoms
Certain activities can relieve RLS symptoms. These include:
Choose an aisle seat at the movies or on airplanes and trains so you can move around, if necessary.
Medicines
You may need medicines to treat RLS if lifestyle changes can't control symptoms. Many medicines can relieve or prevent RLS symptoms.
No single medicine works for all people who have RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.
Some of the medicines used to treat RLS also are used to treat Parkinson's disease. These medicines make dopamine or mimic it in the parts of the brain that control movement. (Dopamine is a chemical that helps you move properly.)
If medicines for Parkinson's disease don't prevent or relieve your symptoms, your doctor may prescribe other medicines. You may have to take more than one medicine to treat your RLS.
Always talk with your doctor before taking any medicines. He or she can tell you the side effects of each RLS medicine. Side effects may include nausea (feeling sick to your stomach), headache, and daytime sleepiness.
In some cases, RLS medicines may worsen problems with excessive gambling, shopping, or sexual activity. Sometimes, continued use of RLS medicines may make your RLS symptoms worse.
Contact your doctor if you have any of these problems. He or she can adjust your medicines to prevent these side effects.
Living With Restless Legs Syndrome
Restless legs syndrome (RLS) often is a lifelong condition. Symptoms may come and go often or go away for long periods. Symptoms often get worse over time.
If a condition or medicine triggers RLS, the disorder may go away if the trigger is relieved or stopped. For example, RLS that occurs due to pregnancy tends to go away after giving birth.
Although RLS has no cure, treatments can relieve or prevent RLS symptoms. Mild cases of RLS often are treated with lifestyle changes and sometimes with periodic use of medicines. More severe RLS usually is treated with daily medicines. (For more information, go to ""How Is Restless Legs Syndrome Treated?"")
Ongoing Medical Care
If you have RLS, see your doctor regularly so he or she can watch for changes in your symptoms. This will show whether your treatment is working and whether it will continue to work over time.
Call your doctor if you notice your treatment is no longer working or if you have new symptoms.
Other Considerations
Try to plan long car trips and other long periods of inactivity at the times of day when your symptoms are least severe. Give yourself time to stretch or take walking breaks.
Choose an aisle seat at the movies or on airplanes and trains so you can move around if needed.
Consider finding a work setting where you can stand or walk around.
Emotional Issues and Support
Living with RLS may cause anxiety and stress. It's important to talk about how you feel with your health care team.
Joining a patient support group may help you adjust to living with RLS. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to restless legs syndrome, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Rh Incompatibility?
Rh incompatibility is a condition that occurs during pregnancy if a woman has Rh-negative blood and her baby has Rh-positive blood.
""Rh-negative"" and ""Rh-positive"" refer to whether your blood has Rh factor. Rh factor is a protein on red blood cells. If you have Rh factor, you're Rh-positive. If you don't have it, you're Rh-negative. Rh factor is inherited (passed from parents to children through the genes). Most people are Rh-positive.
Whether you have Rh factor doesn't affect your general health. However, it can cause problems during pregnancy.
Overview
When you're pregnant, blood from your baby can cross into your bloodstream, especially during delivery. If you're Rh-negative and your baby is Rh-positive, your body will react to the baby's blood as a foreign substance.
Your body will create antibodies (proteins) against the baby's Rh-positive blood. These antibodies usually don't cause problems during a first pregnancy. This is because the baby often is born before many of the antibodies develop.
However, the antibodies stay in your body once they have formed. Thus, Rh incompatibility is more likely to cause problems in second or later pregnancies (if the baby is Rh-positive).
The Rh antibodies can cross the placenta and attack the baby's red blood cells. This can lead to hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) in the baby.
Hemolytic anemia is a condition in which red blood cells are destroyed faster than the body can replace them. Red blood cells carry oxygen to all parts of the body.
Without enough red blood cells, your baby won't get enough oxygen. This can lead to serious problems. Severe hemolytic anemia may even be fatal to the child.
Outlook
With prompt and proper prenatal care and screening, you can prevent the problems of Rh incompatibility. Screening tests allow your doctor to find out early in your pregnancy whether you're at risk for the condition.
If you're at risk, your doctor will carefully check on you and your baby throughout your pregnancy and prescribe treatment as needed.
Injections of a medicine called Rh immune globulin can keep your body from making Rh antibodies. This medicine helps prevent the problems of Rh incompatibility. If you're Rh-negative, you'll need this medicine every time you have a baby with Rh-positive blood.
Other events also can expose you to Rh-positive blood, which could affect a pregnancy. Examples include a miscarriage or blood transfusion. If you're treated with Rh immune globulin right after these events, you may be able to avoid Rh incompatibility during your next pregnancy.
Other Names for Rh Incompatibility
What Causes Rh Incompatibility?
A difference in blood type between a pregnant woman and her baby causes Rh incompatibility. The condition occurs if a woman is Rh-negative and her baby is Rh-positive.
When you're pregnant, blood from your baby can cross into your bloodstream, especially during delivery. If you're Rh-negative and your baby is Rh-positive, your body will react to the baby's blood as a foreign substance.
Your body will create antibodies (proteins) against the baby's Rh-positive blood. These antibodies can cross the placenta and attack the baby's red blood cells. This can lead to hemolytic anemia in the baby.
Rh incompatibility usually doesn't cause problems during a first pregnancy. The baby often is born before many of the antibodies develop.
However, once you've formed Rh antibodies, they remain in your body. Thus, the condition is more likely to cause problems in second or later pregnancies (if the baby is Rh-positive).
With each pregnancy, your body continues to make Rh antibodies. As a result, each Rh-positive baby you conceive becomes more at risk for serious problems, such as severe hemolytic anemia.
Who Is at Risk for Rh Incompatibility?
An Rh-negative woman who conceives a child with an Rh-positive man is at risk for Rh incompatibility.
Rh factor is inherited (passed from parents to children through the genes). If you're Rh-negative and the father of your baby is Rh-positive, the baby has a 50 percent or more chance of having Rh-positive blood.
Simple blood tests can show whether you and the father of your baby are Rh-positive or Rh-negative.
If you're Rh-negative, your risk of problems from Rh incompatibility is higher if you were exposed to Rh-positive blood before the pregnancy. This may have happened during:
An earlier
pregnancy (usually during delivery). You also may have been exposed to Rh-positive
blood if you had
bleeding or abdominal trauma (for example, from a car accident) during the pregnancy.
An
injection or puncture with a needle or other object containing Rh-positive
blood.
Certain tests also can expose you to Rh-positive blood. Examples include amniocentesis (AM-ne-o-sen-TE-sis) and chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS).
Amniocentesis is a test that you may have during pregnancy. Your doctor uses a needle to remove a small amount of fluid from the sac around your baby. The fluid is then tested for various reasons.
CVS also may be done during pregnancy. For this test, your doctor threads a thin tube through the vagina and cervix to the placenta. He or she removes a tissue sample from the placenta using gentle suction. The tissue sample is tested for various reasons.
Unless you were treated with the medicine that prevents Rh antibodies (Rh immune globulin) after each of these events, you're at risk for Rh incompatibility during current and future pregnancies.
How Is Rh Incompatibility Diagnosed?
Rh incompatibility is diagnosed with blood tests. To find out whether a baby is developing hemolytic anemia and how serious it is, doctors may use more advanced tests, such as ultrasound.
Specialists Involved
An obstetrician will screen for Rh incompatibility. This is a doctor who specializes in treating pregnant women. The obstetrician also will monitor the pregnancy and the baby for problems related to hemolytic anemia. He or she also will oversee treatment to prevent problems with future pregnancies.
A pediatrician or hematologist treats newborns who have hemolytic anemia and related problems. A pediatrician is a doctor who specializes in treating children. A hematologist is a doctor who specializes in treating people who have blood diseases and disorders.
Diagnostic Tests
If you're pregnant, your doctor will order a simple blood test at your first prenatal visit to learn whether you're Rh-positive or Rh-negative.
If you're Rh-negative, you also may have another blood test called an antibody screen. This test shows whether you have Rh antibodies in your blood. If you do, it means that you were exposed to Rh-positive blood before and you're at risk for Rh incompatibility.
If you're Rh-negative and you don't have Rh antibodies, your baby's father also will be tested to find out his Rh type. If he's Rh-negative too, the baby has no chance of having Rh-positive blood. Thus, there's no risk of Rh incompatibility.
However, if the baby's father is Rh-positive, the baby has a 50 percent or more chance of having Rh-positive blood. As a result, you're at high risk of developing Rh incompatibility.
If your baby's father is Rh-positive, or if it's not possible to find out his Rh status, your doctor may do a test called amniocentesis.
For this test, your doctor inserts a hollow needle through your abdominal wall into your uterus. He or she removes a small amount of fluid from the sac around the baby. The fluid is tested to learn whether the baby is Rh-positive. (Rarely, an amniocentesis can expose you to Rh-positive blood).
Your doctor also may use this test to measure bilirubin levels in your baby. Bilirubin builds up as a result of red blood cells dying too quickly. The higher the level of bilirubin is, the greater the chance that the baby has hemolytic anemia.
If Rh incompatibility is known or suspected, you'll be tested for Rh antibodies one or more times during your pregnancy. This test often is done at least once at your sixth or seventh month of pregnancy.
The results from this test also can suggest how severe the baby's hemolytic anemia has become. Higher levels of antibodies suggest more severe hemolytic anemia.
To check your baby for hemolytic anemia, your doctor also may use a test called Doppler ultrasound. He or she will use this test to measure how fast blood is flowing through an artery in the baby's head.
Doppler ultrasound uses sound waves to measure how fast blood is moving. The faster the blood flow is, the greater the risk of hemolytic anemia. This is because the anemia will cause the baby's heart to pump more blood.
How Is Rh Incompatibility Treated?
Rh incompatibility is treated with a medicine called Rh immune globulin. Treatment for a baby who has hemolytic anemia will vary based on the severity of the condition.
Goals of Treatment
The goals of treating Rh incompatibility are to ensure that your baby is healthy and to lower your risk for the condition in future pregnancies.
Treatment for Rh Incompatibility
If Rh incompatibility is diagnosed during your pregnancy, you'll receive Rh immune globulin in your seventh month of pregnancy and again within 72 hours of delivery.
You also may receive Rh immune globulin if the risk of blood transfer between you and the baby is high (for example, if you've had a miscarriage, ectopic pregnancy, or bleeding during pregnancy).
Rh immune globulin contains Rh antibodies that attach to the Rh-positive blood cells in your blood. When this happens, your body doesn't react to the baby's Rh-positive cells as a foreign substance. As a result, your body doesn't make Rh antibodies. Rh immune globulin must be given at the correct times to work properly.
Once you have formed Rh antibodies, the medicine will no longer help. That's why a woman who has Rh-negative blood must be treated with the medicine with each pregnancy or any other event that allows her blood to mix with Rh-positive blood.
Rh immune globulin is injected into the muscle of your arm or buttock. Side effects may include soreness at the injection site and a slight fever. The medicine also may be injected into a vein.
Treatment for Hemolytic Anemia
Several options are available for treating hemolytic anemia in a baby. In mild cases, no treatment may be needed. If treatment is needed, the baby may be given a medicine called erythropoietin and iron supplements. These treatments can prompt the body to make red blood cells.
If the hemolytic anemia is severe, the baby may get a blood transfusion through the umbilical cord. If the hemolytic anemia is severe and the baby is almost full-term, your doctor may induce labor early. This allows the baby's doctor to begin treatment right away.
A newborn who has severe anemia may be treated with a blood exchange transfusion. The procedure involves slowly removing the newborn's blood and replacing it with fresh blood or plasma from a donor.
Newborns also may be treated with special lights to reduce the amount of bilirubin in their blood. These babies may have jaundice (a yellowish color of the skin and whites of the eyes). High levels of bilirubin cause jaundice.
Reducing the blood's bilirubin level is important because high levels of this compound can cause brain damage. High levels of bilirubin often are seen in babies who have hemolytic anemia. This is because the compound forms when red blood cells break down.
How Can Rh Incompatibility Be Prevented?
Rh incompatibility can be prevented with Rh immune globulin, as long as the medicine is given at the correct times. Once you have formed Rh antibodies, the medicine will no longer help.
Thus, a woman who has Rh-negative blood must be treated with Rh immune globulin during and after each pregnancy or after any other event that allows her blood to mix with Rh-positive blood.
Early prenatal care also can help prevent some of the problems linked to Rh incompatibility. For example, your doctor can find out early whether you're at risk for the condition.
If you're at risk, your doctor can closely monitor your pregnancy. He or she will watch for signs of hemolytic anemia in your baby and provided treatment as needed.
Living With Rh Incompatibility
If you have Rh-negative blood, injections of Rh immune globulin can reduce your risk of Rh incompatibility in future pregnancies. It's important to get this medicine every time you give birth to an Rh-positive baby or come in contact with Rh-positive blood.
If you're Rh-negative, your risk of problems from Rh incompatibility is higher if you were exposed to Rh-positive blood before your current pregnancy. This may have happened during:
An earlier
pregnancy (usually during delivery). You also may have been exposed to Rh-positive
blood if you had
bleeding or abdominal trauma (for example, from a car accident) during the pregnancy.
An
injection or puncture with a needle or other object containing Rh-positive
blood.
You also can be exposed to Rh-positive blood during certain tests, such as amniocentesis and chorionic villus sampling. (For more information, go to ""Who Is At Risk for Rh Incompatibility?"")
Unless you were treated with Rh immune globulin after each of these events, you're at risk for Rh incompatibility during current and future pregnancies.
Let your doctor know about your risk early in your pregnancy. This allows him or her to carefully monitor your pregnancy and promptly treat any problems that arise.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Sarcoidosis?
Sarcoidosis (sar-koy-DO-sis) is a disease of unknown cause that leads to inflammation. This disease affects your body’s organs.
Normally, your immune system defends your body against foreign or harmful substances. For example, it sends special cells to protect organs that are in danger.
These cells release chemicals that recruit other cells to isolate and destroy the harmful substance. Inflammation occurs during this process. Once the harmful substance is gone, the cells and the inflammation go away.
In people who have sarcoidosis, the inflammation doesn't go away. Instead, some of the immune system cells cluster to form lumps called granulomas (gran-yu-LO-mas) in various organs in your body.
Overview
Sarcoidosis can affect any organ in your body. However, it's more likely to affect some organs than others. The disease usually starts in the lungs, skin, and/or lymph nodes (especially the lymph nodes in your chest).
Also, the disease often affects the eyes and liver. Although less common, sarcoidosis can affect the heart and brain, leading to serious complications.
If many granulomas form in an organ, they can affect how the organ works. This can cause signs and symptoms. Signs and symptoms vary depending on which organs are affected. Many people who have sarcoidosis have no signs or symptoms or mild ones.
Lofgren's syndrome is a classic set of signs and symptoms that is typical in some people who have sarcoidosis. Lofgren's syndrome may cause fever, enlarged lymph nodes, arthritis (usually in the ankles), and/or erythema nodosum (er-ih-THE-ma no-DO-sum).
Erythema nodosum is a rash of red or reddish-purple bumps on your ankles and shins. The rash may be warm and tender to the touch.
Treatment for sarcoidosis varies depending on which organs are affected. Your doctor may prescribe topical treatments and/or medicines to treat the disease. Not everyone who has sarcoidosis needs treatment.
Outlook
The outlook for sarcoidosis varies. Many people recover from the disease with few or no long-term problems.
More than half of the people who have sarcoidosis have remission within 3 years of diagnosis. “Remission” means the disease isn't active, but it can return.
Two-thirds of people who have the disease have remission within 10 years of diagnosis. People who have Lofgren's syndrome usually have remission. Relapse (return of the disease) 1 or more years after remission occurs in less than 5 percent of patients.
Sarcoidosis leads to organ damage in about one-third of the people diagnosed with the disease. Damage may occur over many years and involve more than one organ. Rarely, sarcoidosis can be fatal. Death usually is the result of problems with the lungs, heart, or brain.
Poor outcomes are more likely in people who have advanced disease and show little improvement from treatment.
Certain people are at higher risk for poor outcomes from chronic (long-term) sarcoidosis. This includes people who have lung scarring, heart or brain complications, or lupus pernio (LU-pus PUR-ne-o). Lupus pernio is a serious skin condition that sarcoidosis may cause.
Research is ongoing for new and better treatments for sarcoidosis.
What Causes Sarcoidosis?
The cause of sarcoidosis isn't known. More than one factor may play a role in causing the disease.
Some researchers think that sarcoidosis develops if your immune system responds to a trigger, such as bacteria, viruses, dust, or chemicals.
Normally, your immune system defends your body against foreign or harmful substances. For example, it sends special cells to protect organs that are in danger.
These cells release chemicals that recruit other cells to isolate and destroy the harmful substance. Inflammation occurs during this process. Once the harmful substance is gone, the cells and the inflammation go away.
In people who have sarcoidosis, the inflammation doesn't go away. Instead, some of the immune system cells cluster to form lumps called granulomas in various organs in your body.
Genetics also may play a role in sarcoidosis. Researchers believe that sarcoidosis occurs if:
You have a certain
gene or
genes that raise your risk for the disease
—And—
Triggers may vary depending on your genetic makeup. Certain genes may influence which organs are affected and the severity of your symptoms.
Researchers continue to try to pinpoint the genes that are linked to sarcoidosis.
Who Is at Risk for Sarcoidosis?
Sarcoidosis affects people of all ages and races. However, it's more common among African Americans and Northern Europeans. In the United States, the disease affects African Americans somewhat more often and more severely than Whites.
Studies have shown that sarcoidosis tends to vary amongst ethnic groups. For example, eye problems related to the disease are more common in Japanese people.
Lofgren's syndrome, a type of sarcoidosis, is more common in people of European descent. Lofgren's syndrome may involve fever, enlarged lymph nodes, arthritis (usually in the ankles), and/or erythema nodosum. Erythema nodosum is a rash of red or reddish-purple bumps on your ankles and shins. The rash may be warm and tender to the touch.
Sarcoidosis is somewhat more common in women than in men. The disease usually develops between the ages of 20 and 50. People who have a family history of sarcoidosis also are at higher risk for the disease.
Researchers have looked for a link between sarcoidosis and exposure to workplace and environmental factors. However, no clear link has been found.
What Are the Signs and Symptoms of Sarcoidosis?
Many people who have sarcoidosis have no signs or symptoms or mild ones. Often, the disease is found when a chest x ray is done for another reason (for example, to diagnose pneumonia).
The signs and symptoms of sarcoidosis vary depending on which organs are affected. Signs and symptoms also may vary depending on your gender, age, and ethnic background. (For more information, go to ""Who Is at Risk for Sarcoidosis?"")
Common Signs and Symptoms
In both adults and children, sarcoidosis most often affects the lungs. If granulomas (inflamed lumps) form in your lungs, you may wheeze, cough, feel short of breath, or have chest pain. Or, you may have no symptoms at all.
Some people who have sarcoidosis feel very tired, uneasy, or depressed. Night sweats and weight loss are common symptoms of the disease.
Common signs and symptoms in children are fatigue (tiredness), loss of appetite, weight loss, bone and joint pain, and anemia.
Children who are younger than 4 years old may have a distinct form of sarcoidosis. It may cause enlarged lymph nodes in the chest (which can be seen on chest x-ray pictures), skin lesions, and eye swelling or redness.
Other Signs and Symptoms
Sarcoidosis may affect your lymph nodes. The disease can cause enlarged lymph nodes that feel tender. Sarcoidosis usually affects the lymph nodes in your neck and chest. However, the disease also may affect the lymph nodes under your chin, in your armpits, or in your groin.
Sarcoidosis can cause lumps, ulcers (sores), or areas of discolored skin. These areas may itch, but they don't hurt. These signs tend to appear on your back, arms, legs, and scalp. Sometimes they appear near your nose or eyes. These signs usually last a long time.
Sarcoidosis may cause a more serious skin condition called lupus pernio. Disfiguring skin sores may affect your nose, nasal passages, cheeks, ears, eyelids, and fingers. These sores tend to be ongoing. They can return after treatment is over.
Sarcoidosis also can cause eye problems. If you have sarcoidosis, having an annual eye exam is important. If you have changes in your vision and can't see as clearly or can't see color, call 9–1–1 or have someone drive you to the emergency room.
You should call your doctor if you have any new eye symptoms, such as burning, itching, tearing, pain, or sensitivity to light.
Signs and symptoms of sarcoidosis also may include an enlarged liver, spleen, or salivary glands.
Although less common, sarcoidosis can affect the heart and brain. This can cause many symptoms, such as abnormal heartbeats, shortness of breath, headaches, and vision problems. If sarcoidosis affects the heart or brain, serious complications can occur.
Lofgren's Syndrome
Lofgren's syndrome is a classic set of signs and symptoms that occur in some people when they first have sarcoidosis. Signs and symptoms may include:
Fever. This symptom only occurs in some people.
Arthritis, usually in the
ankles. This symptom is more common in men than women.
Erythema nodosum. This is a
rash of red or reddish-purple bumps on your
ankles and
shins. The rash may be warm and tender to the
touch. This symptom is more common in women than men.
![]()
Sarcoidosis Signs and Symptoms. The illustration shows the major signs and symptoms of sarcoidosis and the organs involved.
How Is Sarcoidosis Diagnosed?
Your doctor will diagnose sarcoidosis based on your medical history, a physical exam, and test results. He or she will look for granulomas (inflamed lumps) in your organs. Your doctor also will try to rule out other possible causes of your symptoms.
Medical History
Your doctor may ask you detailed questions about your medical history. For example, he or she may ask whether you:
Have had any jobs that may have raised your risk for the disease.
Have ever been exposed to inhaled beryllium metal. (This type of metal is used to make aircrafts and weapons.)
Have had contact with organic dust from birds or hay.
Exposure to beryllium metal and organic dust can cause inflamed lumps in your lungs that look like the granulomas from sarcoidosis. However, these lumps are signs of other conditions.
Physical Exam
Your doctor will check you for signs and symptoms of sarcoidosis. Signs and symptoms may include red bumps on your skin; swollen lymph nodes; an enlarged liver, spleen, or salivary glands; or redness in your eyes. Your doctor also will check for other causes of your symptoms.
Your doctor may listen to your lungs and heart. Abnormal breathing or heartbeat sounds could be a sign that sarcoidosis is affecting your lungs or heart.
Diagnostic Tests
You may have tests to confirm a diagnosis and to find out how sarcoidosis is affecting you. Tests include a chest x ray, lung function tests, biopsy, and other tests to assess organ damage.
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart and lungs. The test may show granulomas or enlarged lymph nodes in your chest. About 95 percent of people who have sarcoidosis have abnormal chest x rays.
Lung Function Tests
Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. These tests can show whether sarcoidosis is affecting your lungs.
Biopsy
Your doctor may do a biopsy to confirm a diagnosis or rule out other causes of your symptoms. A biopsy involves taking a small sample of tissue from one of your affected organs.
Usually, doctors try to biopsy the organs that are easiest to access. Examples include the skin, tear glands, or the lymph nodes that are just under the skin.
If this isn't possible, your doctor may use a positron emission tomography (PET) scan to pinpoint areas for biopsy. For this test, a small amount of radioactive substance is injected into a vein, usually in your arm.
The substance, which releases energy, travels through the blood and collects in organs or tissues. Special cameras detect the energy and convert it into three-dimensional (3D) pictures.
If lung function tests or a chest x ray shows signs of sarcoidosis in your lungs, your doctor may do a bronchoscopy (bron-KOS-ko-pee) to get a small sample of lung tissue.
During this procedure, a thin, flexible tube is passed through your nose (or sometimes your mouth), down your throat, and into the airways to reach your lung tissue. (For more information, go to the Health Topics Bronchoscopy article.)
Other Tests To Assess Organ Damage
You also may have other tests to assess organ damage and find out whether you need treatment. For example, your doctor may recommend blood tests and/or an EKG (electrocardiogram).
If you’re diagnosed with sarcoidosis, you should see an ophthalmologist (eye specialist), even if you don’t have eye symptoms. In sarcoidosis, eye damage can occur without symptoms.
How Is Sarcoidosis Treated?
Not everyone who has sarcoidosis needs treatment. Sometimes the disease goes away on its own. Whether you need treatment and what type of treatment you need depend on your signs and symptoms, which organs are affected, and whether those organs are working well.
If the disease affects certain organs—such as your eyes, heart, or brain—you'll need treatment even if you don't have any symptoms.
In either case, whether you have symptoms or not, you should see your doctor for ongoing care. He or she will want to check to make sure that the disease isn't damaging your organs. For example, you may need routine lung function tests to make sure that your lungs are working well.
If the disease isn't worsening, your doctor may watch you closely to see whether the disease goes away on its own. If the disease does start to get worse, your doctor can prescribe treatment.
The goals of treatment include:
Your doctor may prescribe topical treatments and/or medicines to treat the disease.
Medicines
Prednisone
Prednisone, a type of steroid, is the main treatment for sarcoidosis. This medicine reduces inflammation. In most people, prednisone relieves symptoms within a couple of months.
Although most people need to take prednisone for 12 months or longer, your doctor may lower the dose within a few months after you start the medicine.
Long-term use of prednisone, especially at high doses, can cause serious side effects. Work with your doctor to decide whether the benefits of this medicine outweigh the risks. If your doctor prescribes this treatment, he or she will find the lowest dose that controls your disease.
When you stop taking prednisone, you should cut back slowly (as your doctor advises). This will help prevent flareups of sarcoidosis. Cutting back slowly also allows your body to adjust to not having the medicine.
If a relapse or flareup occurs after you stop taking prednisone, you may need a second round of treatment. If you remain stable for more than 1 year after stopping this treatment, the risk of relapse is low.
Other Medicines
Other medicines, besides prednisone, also are used to treat sarcoidosis. Examples include:
Your doctor may prescribe these medicines if your sarcoidosis worsens while you're taking prednisone or if you can't handle prednisone's side effects.
If you have Lofgren's syndrome with pain or fever, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
If you're wheezing and coughing, you may need inhaled medicine to help open your airways. You take inhaled medicine using an inhaler. This device allows the medicine to go straight to your lungs.
Anti-tumor necrosis factor drugs, originally developed to treat arthritis, are being studied to treat sarcoidosis.
Ongoing Research
Researchers continue to look for new and better treatments for sarcoidosis. They're currently studying treatments aimed at the immune system. Researchers also are studying antibiotics as a possible treatment for sarcoidosis that affects the skin.
For more information about ongoing research, go to the “Clinical Trials” section of this article.
Living With Sarcoidosis
Sarcoidosis has no cure, but you can take steps to manage the disease. Get ongoing care and follow a healthy lifestyle. Talk with your doctor if you’re pregnant or planning a pregnancy.
Ongoing Care
Ongoing care is important, even if you don't take medicine for your sarcoidosis. New symptoms can occur at any time. Also, the disease can slowly worsen without your noticing.
How often you need to see your doctor will depend on the severity of your symptoms, which organs are affected, which treatments you're using, and whether you have any side effects from treatment. Even if you don’t have symptoms, you should see your doctor for ongoing care.
Your doctor may recommend routine tests, such as lung function tests and eye exams. He or she will want to check to make sure that the disease isn’t damaging your organs.
Discuss with your doctor how often you need to have followup visits. You may have some followup visits with your primary care doctor and others with one or more specialists.
Make sure to take all of your medicines as your doctor prescribes.
Lifestyle Changes
Making lifestyle changes can help you manage your health. For example, follow a healthy diet and be as physically active as you can. A healthy diet includes a variety of fruits, vegetables, and whole grains.
It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI’s) Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources include general information about healthy eating.
If you smoke, quit. Talk with your doctor about programs and products that can help you quit. Also, try to avoid other lung irritants, such as dust, chemicals, and secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI’s “Your Guide to a Healthy Heart” booklet. Although these resources focus on heart health, both include general information about how to quit smoking.
Emotional Issues
Living with sarcoidosis may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with sarcoidosis. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Pregnancy
Many women who have sarcoidosis give birth to healthy babies. Women who have severe sarcoidosis, especially if they’re older, may have trouble becoming pregnant. Sometimes sarcoidosis may get worse after the baby is delivered.
If you have sarcoidosis and are pregnant or planning a pregnancy, talk with your doctor about the risks involved. Also, if you become pregnant, it’s important to get good prenatal care and regular sarcoidosis checkups during and after pregnancy.
Some sarcoidosis medicines are considered safe to use during pregnancy; others are not recommended.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent or treat these diseases.
The NHLBI continues to support research aimed at learning more about Go to:
What Is Sickle Cell Anemia?
Sickle cell anemia (uh-NEE-me-uh) is the most common form of sickle cell disease (SCD). SCD is a serious disorder in which the body makes sickle-shaped red blood cells. “Sickle-shaped” means that the red blood cells are shaped like a crescent.
Normal red blood cells are disc-shaped and look like doughnuts without holes in the center. They move easily through your blood vessels. Red blood cells contain an iron-rich protein called hemoglobin (HEE-muh-glow-bin). This protein carries oxygen from the lungs to the rest of the body.
Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S. Sickle hemoglobin causes the cells to develop a sickle, or crescent, shape.
Sickle cells are stiff and sticky. They tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow can cause pain and organ damage. It can also raise the risk for infection.
![]()
Normal Red Blood Cells and Sickle Cells. Figure A shows normal red blood cells flowing freely in a blood vessel. The inset image shows a cross-section of a normal red blood cell with normal hemoglobin. Figure B shows abnormal, sickled red blood cells (more...)
Outlook
Sickle cell anemia has no widely available cure. However, treatments to improve the anemia and lower complications can help with the symptoms and complications of the disease in both children and adults. Blood and marrow stem cell transplants may offer a cure for a small number of people.
Over the past 100 years, doctors have learned a great deal about sickle cell anemia. They know its causes, how it affects the body, and how to treat many of its complications.
Sickle cell anemia varies from person to person. Some people who have the disease have chronic (long-term) pain or fatigue (tiredness). However, with proper care and treatment, many people who have the disease can have improved quality of life and reasonable health much of the time.
Because of improved treatments and care, people who have sickle cell anemia are now living into their forties or fifties, or longer.
Other Names for Sickle Cell Anemia
What Causes Sickle Cell Anemia?
Sickle cell anemia is an inherited disease. People who have the disease inherit two genes for sickle hemoglobin—one from each parent.
Sickle hemoglobin causes red blood cells to develop a sickle, or crescent, shape. Sickle cells are stiff and sticky. They tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow can cause pain and organ damage. It can also raise the risk for infection.
Sickle Cell Trait
People who inherit a sickle hemoglobin gene from one parent and a normal gene from the other parent have sickle cell trait. Their bodies make both sickle hemoglobin and normal hemoglobin.
People who have sickle cell trait usually have few, if any, symptoms and lead normal lives. However, some people may have medical complications.
People who have sickle cell trait can pass the sickle hemoglobin gene to their children. The following image shows an example of an inheritance pattern for sickle cell trait.
![]()
Example of an Inheritance Pattern for Sickle Cell Trait. The image shows how sickle hemoglobin genes are inherited. A person inherits two hemoglobin genes—one from each parent. A normal gene will make normal hemoglobin (A). A sickle hemoglobin (more...)
When both parents have a normal gene and an abnormal gene, each child has a 25 percent chance of inheriting two normal genes; a 50 percent chance of inheriting one normal gene and one abnormal gene; and a 25 percent chance of inheriting two abnormal genes.
Who Is at Risk for Sickle Cell Anemia?
Sickle cell anemia is most common in people whose families come from Africa, South or Central America (especially Panama), Caribbean islands, Mediterranean countries (such as Turkey, Greece, and Italy), India, and Saudi Arabia.
In the United States, it's estimated that sickle cell anemia affects 70,000–100,000 people, mainly African Americans. The disease occurs in about 1 out of every 500 African American births. Sickle cell anemia also affects Hispanic Americans. The disease occurs in more than 1 out of every 36,000 Hispanic American births.
More than 2 million Americans have sickle cell trait. The condition occurs in about 1 in 12 African Americans.
What Are the Signs and Symptoms of Sickle Cell Anemia?
The signs and symptoms of sickle cell anemia vary. Some people have mild symptoms. Others have very severe symptoms and often are hospitalized for treatment.
Sickle cell anemia is present at birth, but many infants don't show any signs until after 4 months of age.
The most common signs and symptoms are linked to anemia and pain. Other signs and symptoms are linked to the disease's complications.
Signs and Symptoms Related to Anemia
The most common symptom of anemia is fatigue (feeling tired or weak). Other signs and symptoms of anemia include:
Shortness of breath
Coldness in the
hands and feet
Signs and Symptoms Related to Pain
Sudden pain throughout the body is a common symptom of sickle cell anemia. This pain is called a sickle cell crisis. Sickle cell crises often affect the bones, lungs, abdomen, and joints.
These crises occur when sickled red blood cells block blood flow to the limbs and organs. This can cause pain and organ damage.
The pain from sickle cell anemia can be acute or chronic, but acute pain is more common. Acute pain is sudden and can range from mild to very severe. The pain usually lasts from hours to as long as a week or more.
Many people who have sickle cell anemia also have chronic pain, especially in their bones. Chronic pain often lasts for weeks or months and can be hard to bear and mentally draining. Chronic pain may limit your daily activities.
Almost all people who have sickle cell anemia have painful crises at some point in their lives. Some have these crises less than once a year. Others may have crises once a month or more. Repeated crises can damage the bones, kidneys, lungs, eyes, heart, and liver. This type of damage happens more often in adults than in children.
Many factors can play a role in sickle cell crises. Often, more than one factor is involved and the exact cause isn't known.
You can control some factors. For example, the risk of a sickle cell crisis increases if you're dehydrated (your body doesn't have enough fluids). Drinking plenty of fluids can lower the risk of a painful crisis.
You can't control other factors, such as infections.
Painful crises are the leading cause of emergency room visits and hospital stays for people who have sickle cell anemia.
Complications of Sickle Cell Anemia
Sickle cell crises can affect many parts of the body and cause many complications.
Hand-Foot Syndrome
Sickle cells can block the small blood vessels in the hands and feet in children (usually those younger than 4 years of age). This condition is called hand-foot syndrome. It can lead to pain, swelling, and fever.
Swelling often occurs on the back of the hands and feet and moves into the fingers and toes. One or both hands and/or feet might be affected at the same time.
Splenic Crisis
The spleen is an organ in the abdomen. Normally, it filters out abnormal red blood cells and helps fight infections. Sometimes the spleen may trap red blood cells that should be in the bloodstream. This causes the spleen to grow large and leads to anemia.
If the spleen traps too many red blood cells, you may need blood transfusions until your body can make more cells and recover.
Infections
Both children and adults who have sickle cell anemia may get infections easily and have a hard time fighting them. This is because sickle cell anemia can damage the spleen, an organ that helps fight infections.
Infants and young children who have damaged spleens are more likely to get serious infections that can kill them within hours or days. Bloodstream infections are the most common cause of death in young children who have sickle cell anemia.
Medicines and vaccines can help prevent severe illness and death. For example, vaccines are available for infections such as meningitis, influenza, and hepatitis.
Getting treatment right away for high fevers (which can be a sign of a severe infection) also helps prevent death in infants and children who have sickle cell anemia.
It's also important to get treatment right away for a cough, problems breathing, bone pain, and headaches.
Pulmonary Hypertension
Damage to the small blood vessels in the lungs makes it hard for the heart to pump blood through the lungs. This causes blood pressure in the lungs to rise.
Increased blood pressure in the lungs is called pulmonary hypertension (PH). Shortness of breath and fatigue are the main symptoms of PH.
Delayed Growth and Puberty in Children
Children who have sickle cell anemia often grow more slowly than other children. They may reach puberty later. A shortage of red blood cells causes the slow growth rate. Adults who have sickle cell anemia often are slender or smaller in size than other adults.
Stroke
Two forms of stroke can occur in people who have sickle cell anemia. One form occurs if a blood vessel in the brain is damaged and blocked. This type of stroke occurs more often in children than adults. The other form of stroke occurs if a blood vessel in the brain bursts.
Either type of stroke can cause learning problems and lasting brain damage, long-term disability, paralysis (an inability to move), or death.
Eye Problems
Sickle cells also can affect the small blood vessels that deliver oxygen-rich blood to the eyes. Sickle cells can block these vessels or cause them to break open and bleed. This can damage the retinas—thin layers of tissue at the back of the eyes. The retinas take the images you see and send them to your brain.
This damage can cause serious problems, including blindness.
Priapism
Males who have sickle cell anemia may have painful, unwanted erections. This condition is called priapism (PRI-a-pizm). It happens because the sickle cells block blood flow out of an erect penis. Over time, priapism can damage the penis and lead to impotence.
Gallstones
When red blood cells die, they release their hemoglobin. The body breaks down this protein into a compound called bilirubin. Too much bilirubin in the body can cause stones to form in the gallbladder, called gallstones.
Gallstones may cause steady pain that lasts for 30 minutes or more in the upper right side of the belly, under the right shoulder, or between the shoulder blades. The pain may happen after eating fatty meals.
People who have gallstones may have nausea (feeling sick to the stomach), vomiting, fever, sweating, chills, clay-colored stools, or jaundice.
Ulcers on the Legs
Sickle cell ulcers (sores) usually begin as small, raised, crusted sores on the lower third of the leg. Leg sores may occur more often in males than in females. These sores usually develop in people who are aged 10 years or older.
The cause of sickle cell ulcers isn't clear. The number of ulcers can vary from one to many. Some heal quickly, but others persist for years or come back after healing.
Multiple Organ Failure
Multiple organ failure is rare, but serious. It happens if you have a sickle cell crisis that causes two out of three major organs (lungs, liver, or kidneys) to fail. Often, multiple organ failure occurs during an unusually severe pain crisis.
Symptoms of this complication are fever, rapid heartbeat, problems breathing, and changes in mental status (such as sudden tiredness or confusion).
How Is Sickle Cell Anemia Diagnosed?
A simple blood test, done at any time during a person's lifespan, can detect whether he or she has sickle hemoglobin. However, early diagnosis is very important.
In the United States, all States mandate testing for sickle cell anemia as part of their newborn screening programs. The test uses blood from the same blood samples used for other routine newborn screening tests. The test can show whether a newborn infant has sickle hemoglobin.
Test results are sent to the doctor who ordered the test and to the baby's primary care doctor. It's important to give the correct contact information to the hospital. This allows the baby's doctor to get the test results as quickly as possible.
Health providers from a newborn screening followup program may contact you directly to make sure you're aware of the test results.
If the test shows some sickle hemoglobin, a second blood test is done to confirm the diagnosis. The second test should be done as soon as possible and within the first few months of life.
The primary care doctor may send you to a hematologist for a second blood test. A hematologist is a doctor who specializes in blood diseases and disorders. This doctor also can provide treatment for sickle cell disease if needed.
Doctors also can diagnose sickle cell disease before birth. This is done using a sample of amniotic fluid or tissue taken from the placenta. (Amniotic fluid is the fluid in the sac surrounding a growing embryo. The placenta is the organ that attaches the umbilical cord to the mother's womb.)
Testing before birth can be done as early as 10 weeks into the pregnancy. This testing looks for the sickle hemoglobin gene, rather than the abnormal hemoglobin that the gene makes.
How Is Sickle Cell Anemia Treated?
Sickle cell anemia has no widely available cure. However, treatments can help relieve symptoms and treat complications. The goals of treating sickle cell anemia are to relieve pain; prevent infections, organ damage, and strokes; and control complications (if they occur).
Blood and marrow stem cell transplants may offer a cure for a small number of people who have sickle cell anemia. Researchers continue to look for new treatments for the disease.
Infants who have been diagnosed with sickle cell anemia through newborn screening are treated with antibiotics to prevent infections and receive needed vaccinations. Their parents are educated about the disease and how to manage it. These initial treatment steps have greatly improved the outcome for children who have sickle cell anemia.
Specialists Involved
People who have sickle cell anemia need regular medical care. Some doctors and clinics specialize in treating people who have the disease. Hematologists specialize in treating adults and children who have blood diseases or disorders.
Treating Pain
Medicines and Fluids
Mild pain often is treated at home with over-the-counter pain medicines, heating pads, rest, and plenty of fluids. More severe pain may need to be treated in a day clinic, emergency room, or hospital.
The usual treatments for acute (rapid-onset) pain are fluids, medicines, and oxygen therapy (if the oxygen level is low). Fluids help prevent dehydration, a condition in which your body doesn't have enough fluids. Fluids are given either by mouth or through a vein. Your doctor may prescribe antibiotics if you have an infection.
Treatment for mild-to-moderate pain usually begins with acetaminophen (Tylenol®) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
If pain continues or becomes severe, stronger medicines called opioids might be needed. Talk with your doctor about the possible benefits and risks of taking strong pain medicine, especially if the medicine will be used for a long period.
Hydroxyurea
Severe sickle cell anemia can be treated with a medicine called hydroxyurea (hi-DROK-se-yu-RE-ah). This medicine prompts your body to make fetal hemoglobin. Fetal hemoglobin, or hemoglobin F, is the type of hemoglobin that newborns have.
In people who have sickle cell anemia, fetal hemoglobin helps prevent red blood cells from sickling and improves anemia.
Taken daily by mouth, hydroxyurea reduces how often painful sickle cell crises and acute chest syndrome occur. Many people taking hydroxyurea also need fewer blood transfusions and have fewer hospital visits.
Doctors are studying the long-term effects of hydroxyurea on people who have sickle cell anemia. Studies in very young children have shown that hydroxyurea can be given safely and that it improves anemia and hemoglobin F levels while reducing complications of sickle cell anemia. Long-term followup studies of adults treated with hydroxyurea suggest that those treated with the drug survive longer than those not treated with the drug.
Hydroxyurea can reduce the number of white blood cells in your blood, which can raise your risk for infections.
People who take hydroxyurea must have careful medical followup, including blood tests. The dose of this medicine might need to be adjusted to reduce the risk of side effects.
A doctor who has knowledge about hydroxyurea can tell you about the risks and benefits of taking this medicine.
Preventing Complications
Blood transfusions are commonly used to treat worsening anemia and sickle cell complications. A sudden worsening of anemia due to an infection or enlarged spleen is a common reason for a blood transfusion.
Some, but not all, people who have sickle cell anemia need regular blood transfusions to prevent life-threatening problems, such as stroke, spleen problems, or acute chest syndrome.
Having routine blood transfusions can cause side effects. Examples include allergic reactions and a dangerous buildup of iron in the body (which must be treated). In general, the blood supply is fairly safe from infections such as hepatitis and HIV.
For more information, go to the Health Topics Blood Transfusion article.
Infections
Infections can be a major complication of sickle cell anemia throughout life, but especially during childhood. Often, infections can be prevented or treated.
To prevent infections in babies and young children, treatments include:
Daily doses of antibiotics.
Treatment may begin as early as 2 months of age and continue until the child is at least 5 years old.
If your child has sickle cell anemia and shows early signs of an infection, such as a fever, you should seek treatment right away.
Adults who have sickle cell anemia also should have flu shots every year and get vaccinated against pneumonia.
What Is Sleep Apnea?
Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.
As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.
Overview
Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, no blood test can help diagnose the condition.
Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea.
The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses.
When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea.
The animation below shows how obstructive sleep apnea occurs. Click the ""start"" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
![]()
The animation shows how the airway can collapse and block air flow to the lungs, causing sleep apnea.
Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of your brain that controls your breathing doesn't send the correct signals to your breathing muscles. As a result, you'll make no effort to breathe for brief periods.
Central sleep apnea can affect anyone. However, it's more common in people who have certain medical conditions or use certain medicines.
Central sleep apnea can occur with obstructive sleep apnea or alone. Snoring typically doesn't happen with central sleep apnea.
This article mainly focuses on obstructive sleep apnea.
Outlook
Untreated sleep apnea can:
Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, surgery, and breathing devices can successfully treat sleep apnea in many people.
Other Names for Sleep Apnea
Sleep-disordered breathing
What Causes Sleep Apnea?
When you're awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles relax, which narrows your throat.
Normally, this narrowing doesn’t prevent air from flowing into and out of your lungs. But if you have sleep apnea, your airway can become partially or fully blocked because:
You're
overweight. The extra soft
fat tissue can thicken the wall of the
windpipe. This narrows the inside of the windpipe, which makes it harder to keep open.
The shape of your head and
neck (bony structure) may cause a smaller airway size in the
mouth and
throat area.
The aging process limits your
brain signals' ability to keep your
throat muscles stiff during
sleep. Thus, your airway is more likely to narrow or collapse.
Not enough air flows into your lungs if your airway is partially or fully blocked during sleep. As a result, loud snoring and a drop in your blood oxygen level can occur.
If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breathing then starts again, often with a loud snort or choking sound.
Frequent drops in your blood oxygen level and reduced sleep quality can trigger the release of stress hormones. These hormones raise your heart rate and increase your risk for high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats). The hormones also can raise your risk for, or worsen, heart failure.
Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obesity and diabetes.
Who Is at Risk for Sleep Apnea?
Obstructive sleep apnea is a common condition. About half of the people who have this condition are overweight.
Men are more likely than women to have sleep apnea. Although the condition can occur at any age, the risk increases as you get older. A family history of sleep apnea also increases your risk for the condition.
People who have small airways in their noses, throats, or mouths are more likely to have sleep apnea. Small airways might be due to the shape of these structures or allergies or other conditions that cause congestion.
Small children might have enlarged tonsil tissues in their throats. Enlarged tonsil tissues raise a child’s risk for sleep apnea. Overweight children also might be at increased risk for sleep apnea.
About half of the people who have sleep apnea also have high blood pressure. Sleep apnea also is linked to smoking, metabolic syndrome, diabetes, and risk factors for stroke and heart failure.
Race and ethnicity might play a role in the risk of developing sleep apnea. However, more research is needed.
What Are the Signs and Symptoms of Sleep Apnea?
Major Signs and Symptoms
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder.
You're asleep when the snoring or gasping happens. You likely won't know that you're having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will notice these problems before you do.
Not everyone who snores has sleep apnea.
Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active. Even if you don't have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.
Other Signs and Symptoms
Others signs and symptoms of sleep apnea include:
In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day.
How Is Sleep Apnea Diagnosed?
Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Your primary care doctor may evaluate your symptoms first. He or she will then decide whether you need to see a sleep specialist.
Sleep specialists are doctors who diagnose and treat people who have sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.
Medical and Family Histories
If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment.
Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder.
You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
At your appointment, your doctor will ask you questions about how you sleep and how you function during the day.
Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them.
Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.
Many people aren't aware of their symptoms and aren't diagnosed.
If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.
Physical Exam
Your doctor will check your mouth, nose, and throat for extra or large tissues. Children who have sleep apnea might have enlarged tonsils. Doctors may need only a physical exam and medical history to diagnose sleep apnea in children.
Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.
Sleep Studies
Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea.
There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (poly-SOM-no-gram; also called a PSG) or a home-based portable monitor.
Polysomnogram
A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure.
A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe.
PSGs often are done at sleep centers or sleep labs. The test is painless. You'll go to sleep as usual, except you'll have sensors attached to your scalp, face, chest, limbs, and a finger. The staff at the sleep center will use the sensors to check on you throughout the night.
A sleep specialist will review the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment.
Your doctor also may use a PSG to find the best setting for you on a CPAP (continuous positive airway pressure) machine. CPAP is the most common treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your airway open while you sleep.
If your doctor thinks that you have sleep apnea, he or she may schedule a split-night sleep study. During the first half of the night, your sleep will be checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is.
If the PSG shows that you have sleep apnea, you’ll use a CPAP machine during the second half of the split-night study. The staff at the sleep center will adjust the flow of air from the CPAP machine to find the setting that works best for you.
Home-Based Portable Monitor
Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG. For example, it may record:
Air movement through your
nose while you breathe
Chest movements that show whether you're making an effort to breathe
A sleep specialist may use the results from a home-based sleep test to help diagnose sleep apnea. He or she also may use the results to decide whether you need a full PSG study in a sleep center.
How Is Sleep Apnea Treated?
Sleep apnea is treated with lifestyle changes, mouthpieces, breathing devices, and surgery. Medicines typically aren't used to treat the condition.
The goals of treating sleep apnea are to:
Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.
If you have sleep apnea, talk with your doctor or sleep specialist about the treatment options that will work best for you.
Lifestyle changes and/or mouthpieces may relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.
If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you're getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and teens need more. For more information, go to the Health Topics Sleep Deprivation and Deficiency article.)
If treatment and enough sleep don't relieve your daytime sleepiness, your doctor will consider other treatment options.
Lifestyle Changes
If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.
Mouthpieces
A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.
A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.
If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.
Breathing Devices
CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose.
The machine gently blows air into your throat. The pressure from the air helps keep your airway open while you sleep.
Treating sleep apnea may help you stop snoring. But not snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Your sleep apnea will return if you stop using your CPAP machine or don’t use it correctly.
Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's prescription. After the initial setup, you may need to have the CPAP adjusted from time to time for the best results.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn't adjusted properly, you may get stomach bloating and discomfort while wearing the mask.
If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce the side effects.
For example, the CPAP settings or size/fit of the mask might need to be adjusted. Adding moisture to the air as it flows through the mask or using nasal spray can help relieve a dry, stuffy, or runny nose.
There are many types of CPAP machines and masks. Tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different type that might work better for you.
People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
Surgery
Some people who have sleep apnea might benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.
Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
Surgery to shrink or stiffen excess tissue is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. You may need a series of treatments to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a piece of stiff plastic.
Surgery to remove excess tissue is done in a hospital. You're given medicine to help you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.
Surgery to remove the tonsils, if they're blocking the airway, might be helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.
Living With Sleep Apnea
Sleep apnea can be very serious. However, following an effective treatment plan often can improve your quality of life quite a bit.
Treatment can improve your sleep and relieve daytime sleepiness. Treatment also might lower your risk for high blood pressure, heart disease, and other health problems linked to sleep apnea.
Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).
Ongoing Health Care Needs
Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing bothersome side effects.
Ongoing care is important if you're getting CPAP (continuous positive airway pressure) treatment. It may take a while before you adjust to using CPAP.
If you aren't comfortable with your CPAP device, or if it doesn't seem to be working, let your doctor know. You may need to switch to a different device or mask. Or, you may need treatment to relieve CPAP side effects.
Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea.
Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.
If you're having any type of surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery.
If you're using a mouthpiece to treat your sleep apnea, you may need to have routine checkups with your dentist.
How Can Family Members Help?
Often, people who have sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea.
Family members can do many things to help a loved one who has sleep apnea.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of various sleep disorders and ways to diagnose and treat them.
The NHLBI continues to support research to learn more about sleep and sleep disorders. For example, the NHLBI’s Sleep Heart Health Study showed that moderate to severe sleep apnea is associated with an increased risk of stroke and death in middle-aged adults, especially men. Current NHLBI studies are exploring:
New behavioral programs and methods to help patients adhere to CPAP
treatment
In November 2011, the National Institutes of Health (NIH) released its ""2011 NIH Sleep Disorders Research Plan."" The plan expands upon previous and current research programs and identifies new research opportunities.
The NHLBI's National Center on Sleep Disorders Research coordinates this research across the NIH and other Federal agencies. The research focuses on sleep and the body's natural 24-hour cycle, the role of genes and the environment on sleep health, and ways to improve the prevention, diagnosis, and treatment of sleep disorders.
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases, conditions, and health problems.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to sleep apnea, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Are Sleep Deprivation and Deficiency?
Sleep deprivation (DEP-rih-VA-shun) is a condition that occurs if you don't get enough sleep. Sleep deficiency is a broader concept. It occurs if you have one or more of the following:
You
sleep at the wrong time of day (that is, you're out of sync with your body's natural clock)
You don't
sleep well or get all of the different types of sleep that your body needs
You have a
sleep disorder that prevents you from getting enough sleep or causes poor quality sleep
This article focuses on sleep deficiency, unless otherwise noted.
Sleeping is a basic human need, like eating, drinking, and breathing. Like these other needs, sleeping is a vital part of the foundation for good health and well-being throughout your lifetime.
Sleep deficiency can lead to physical and mental health problems, injuries, loss of productivity, and even a greater risk of death.
Overview
To understand sleep deficiency, it helps to understand how sleep works and why it's important. The two basic types of sleep are rapid eye movement (REM) and non-REM.
Non-REM sleep includes what is commonly known as deep sleep or slow wave sleep. Dreaming typically occurs during REM sleep. Generally, non-REM and REM sleep occur in a regular pattern of 3–5 cycles each night.
Your ability to function and feel well while you're awake depends on whether you're getting enough total sleep and enough of each type of sleep. It also depends on whether you're sleeping at a time when your body is prepared and ready to sleep.
You have an internal ""body clock"" that controls when you're awake and when your body is ready for sleep. This clock typically follows a 24-hour repeating rhythm (called the circadian rhythm). The rhythm affects every cell, tissue, and organ in your body and how they work. (For more information, go to ""What Makes You Sleep?"")
If you aren't getting enough sleep, are sleeping at the wrong times, or have poor quality sleep, you'll likely feel very tired during the day. You may not feel refreshed and alert when you wake up.
Sleep deficiency can interfere with work, school, driving, and social functioning. You might have trouble learning, focusing, and reacting. Also, you might find it hard to judge other people's emotions and reactions. Sleep deficiency also can make you feel frustrated, cranky, or worried in social situations.
The signs and symptoms of sleep deficiency may differ between children and adults. Children who are sleep deficient might be overly active and have problems paying attention. They also might misbehave, and their school performance can suffer.
Outlook
Sleep deficiency is a common public health problem in the United States. People in all age groups report not getting enough sleep.
As part of a health survey for the Centers for Disease Control and Prevention, about 7–19 percent of adults in the United States reported not getting enough rest or sleep every day.
Nearly 40 percent of adults report falling asleep during the day without meaning to at least once a month. Also, an estimated 50 to 70 million Americans have chronic (ongoing) sleep disorders.
Sleep deficiency is linked to many chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, and depression.
Sleep deficiency also is associated with an increased risk of injury in adults, teens, and children. For example, driver sleepiness (not related to alcohol) is responsible for serious car crash injuries and death. In the elderly, sleep deficiency might be linked to an increased risk of falls and broken bones.
In addition, sleep deficiency has played a role in human errors linked to tragic accidents, such as nuclear reactor meltdowns, grounding of large ships, and aviation accidents.
A common myth is that people can learn to get by on little sleep with no negative effects. However, research shows that getting enough quality sleep at the right times is vital for mental health, physical health, quality of life, and safety.
What Makes You Sleep?
Many factors play a role in preparing your body to fall asleep and wake up. You have an internal ""body clock"" that controls when you're awake and when your body is ready for sleep.
The body clock typically has a 24-hour repeating rhythm (called the circadian rhythm). Two processes interact to control this rhythm. The first is a pressure to sleep that builds with every hour that you're awake. This drive for sleep reaches a peak in the evening, when most people fall asleep.
A compound called adenosine (ah-DEN-o-seen) seems to be one factor linked to this drive for sleep. While you're awake, the level of adenosine in your brain continues to rise. The increasing level of this compound signals a shift toward sleep. While you sleep, your body breaks down adenosine.
A second process involves your internal body clock. This clock is in sync with certain cues in the environment. Light, darkness, and other cues help determine when you feel awake and when you feel drowsy.
For example, light signals received through your eyes tell a special area in your brain that it is daytime. This area of your brain helps align your body clock with periods of the day and night.
Your body releases chemicals in a daily rhythm, which your body clock controls. When it gets dark, your body releases a hormone called melatonin (mel-ah-TONE-in). Melatonin signals your body that it's time to prepare for sleep, and it helps you feel drowsy.
The amount of melatonin in your bloodstream peaks as the evening wears on. Researchers believe this peak is an important part of preparing your body for sleep.
Exposure to bright artificial light in the late evening can disrupt this process, making it hard to fall asleep. Examples of bright artificial light include the light from a TV screen, computer screen, or a very bright alarm clock.
As the sun rises, your body releases cortisol (KOR-tih-sol). This hormone naturally prepares your body to wake up.
The rhythm and timing of the body clock change with age. Teens fall asleep later at night than younger children and adults. One reason for this is because melatonin is released and peaks later in the 24-hour cycle for teens. As a result, it's natural for many teens to prefer later bedtimes at night and sleep later in the morning than adults.
People also need more sleep early in life, when they're growing and developing. For example, newborns may sleep more than 16 hours a day, and preschool-aged children need to take naps.
Young children tend to sleep more in the early evening. Teens tend to sleep more in the morning. Also, older adults tend to go to bed earlier and wake up earlier.
The patterns and types of sleep also change as people mature. For example, newborn infants spend more time in REM sleep. The amount of slow-wave sleep (a stage of non-REM sleep) peaks in early childhood and then drops sharply after puberty. It continues to decline as people age.
For more information about what makes you sleep, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Why Is Sleep Important?
Sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety.
The way you feel while you're awake depends in part on what happens while you're sleeping. During sleep, your body is working to support healthy brain function and maintain your physical health. In children and teens, sleep also helps support growth and development.
The damage from sleep deficiency can occur in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk for some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others.
Healthy Brain Function and Emotional Well-Being
Sleep helps your brain work properly. While you're sleeping, your brain is preparing for the next day. It's forming new pathways to help you learn and remember information.
Studies show that a good night's sleep improves learning. Whether you're learning math, how to play the piano, how to perfect your golf swing, or how to drive a car, sleep helps enhance your learning and problem-solving skills. Sleep also helps you pay attention, make decisions, and be creative.
Studies also show that sleep deficiency alters activity in some parts of the brain. If you're sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Sleep deficiency also has been linked to depression, suicide, and risk-taking behavior.
Children and teens who are sleep deficient may have problems getting along with others. They may feel angry and impulsive, have mood swings, feel sad or depressed, or lack motivation. They also may have problems paying attention, and they may get lower grades and feel stressed.
Physical Health
Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke.
Sleep deficiency also increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Sleep deficiency increases the risk of obesity in other age groups as well.
Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested.
Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Sleep deficiency results in a higher than normal blood sugar level, which may increase your risk for diabetes.
Sleep also supports healthy growth and development. Deep sleep triggers the body to release the hormone that promotes normal growth in children and teens. This hormone also boosts muscle mass and helps repair cells and tissues in children, teens, and adults. Sleep also plays a role in puberty and fertility.
Your immune system relies on sleep to stay healthy. This system defends your body against foreign or harmful substances. Ongoing sleep deficiency can change the way in which your immune system responds. For example, if you're sleep deficient, you may have trouble fighting common infections.
Daytime Performance and Safety
Getting enough quality sleep at the right times helps you function well throughout the day. People who are sleep deficient are less productive at work and school. They take longer to finish tasks, have a slower reaction time, and make more mistakes.
After several nights of losing sleep—even a loss of just 1–2 hours per night—your ability to function suffers as if you haven't slept at all for a day or two.
Lack of sleep also may lead to microsleep. Microsleep refers to brief moments of sleep that occur when you're normally awake.
You can't control microsleep, and you might not be aware of it. For example, have you ever driven somewhere and then not remembered part of the trip? If so, you may have experienced microsleep.
Even if you're not driving, microsleep can affect how you function. If you're listening to a lecture, for example, you might miss some of the information or feel like you don't understand the point. In reality, though, you may have slept through part of the lecture and not been aware of it.
Some people aren't aware of the risks of sleep deficiency. In fact, they may not even realize that they're sleep deficient. Even with limited or poor-quality sleep, they may still think that they can function well.
For example, drowsy drivers may feel capable of driving. Yet, studies show that sleep deficiency harms your driving ability as much as, or more than, being drunk. It's estimated that driver sleepiness is a factor in about 100,000 car accidents each year, resulting in about 1,500 deaths.
Drivers aren't the only ones affected by sleep deficiency. It can affect people in all lines of work, including health care workers, pilots, students, lawyers, mechanics, and assembly line workers.
As a result, sleep deficiency is not only harmful on a personal level, but it also can cause large-scale damage. For example, sleep deficiency has played a role in human errors linked to tragic accidents, such as nuclear reactor meltdowns, grounding of large ships, and aviation accidents.
How Much Sleep Is Enough?
The amount of sleep you need each day will change over the course of your life. Although sleep needs vary from person to person, the chart below shows general recommendations for different age groups.
View in own window
| Age | Recommended Amount of Sleep |
|---|
| Newborns | 16–18 hours a day |
| Preschool-aged children | 11–12 hours a day |
| School-aged children | At least 10 hours a day |
| Teens | 9–10 hours a day |
| Adults (including the elderly) | 7–8 hours a day |
If you routinely lose sleep or choose to sleep less than needed, the sleep loss adds up. The total sleep lost is called your sleep debt. For example, if you lose 2 hours of sleep each night, you'll have a sleep debt of 14 hours after a week.
Some people nap as a way to deal with sleepiness. Naps may provide a short-term boost in alertness and performance. However, napping doesn't provide all of the other benefits of night-time sleep. Thus, you can't really make up for lost sleep.
Some people sleep more on their days off than on work days. They also may go to bed later and get up later on days off.
Sleeping more on days off might be a sign that you aren't getting enough sleep. Although extra sleep on days off might help you feel better, it can upset your body's sleep–wake rhythm.
Bad sleep habits and long-term sleep loss will affect your health. If you're worried about whether you're getting enough sleep, try using a sleep diary for a couple of weeks.
Write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel during the day. Show the results to your doctor and talk about how you can improve your sleep. You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Sleeping when your body is ready to sleep also is very important. Sleep deficiency can affect people even when they sleep the total number of hours recommended for their age group.
For example, people whose sleep is out of sync with their body clocks (such as shift workers) or routinely interrupted (such as caregivers or emergency responders) might need to pay special attention to their sleep needs.
If your job or daily routine limits your ability to get enough sleep or sleep at the right times, talk with your doctor. You also should talk with your doctor if you sleep more than 8 hours a night, but don't feel well rested. You may have a sleep disorder or other health problem.
Who Is at Risk for Sleep Deprivation and Deficiency?
Sleep deficiency, which includes sleep deprivation, affects people of all ages, races, and ethnicities. Certain groups of people may be more likely to be sleep deficient. Examples include people who:
Have limited time available for
sleep, such as caregivers or people working long hours or more than one job
Have schedules that conflict with their internal body clocks, such as shift workers, first responders, teens who have early school schedules, or people who must travel for work
Make lifestyle choices that prevent them from getting enough
sleep, such as taking medicine to stay awake, abusing alcohol or drugs, or not leaving enough time for sleep
Have medical conditions or take medicines that interfere with
sleep
Certain medical conditions have been linked to sleep disorders. These conditions include heart failure, heart disease, obesity, diabetes, high blood pressure, stroke or transient ischemic attack (mini-stroke), depression, and attention-deficit hyperactivity disorder (ADHD).
If you have or have had one of these conditions, ask your doctor whether you might benefit from a sleep study.
A sleep study allows your doctor to measure how much and how well you sleep. It also helps show whether you have sleep problems and how severe they are. For more information, go to the Health Topics Sleep Studies article.
If you have a child who is overweight, talk with the doctor about your child's sleep habits.
What Are the Signs and Symptoms of Problem Sleepiness?
Sleep deficiency can cause you to feel very tired during the day. You may not feel refreshed and alert when you wake up. Sleep deficiency also can interfere with work, school, driving, and social functioning.
How sleepy you feel during the day can help you figure out whether you're having symptoms of problem sleepiness. You might be sleep deficient if you often feel like you could doze off while:
Sitting and reading or watching TV
Sitting still in a public place, such as a movie theater, meeting, or classroom
Riding in a car for an hour without stopping
Sitting and talking to someone
Sitting quietly after lunch
Sitting in traffic for a few minutes
Sleep deficiency can cause problems with learning, focusing, and reacting. You may have trouble making decisions, solving problems, remembering things, controlling your emotions and behavior, and coping with change. You may take longer to finish tasks, have a slower reaction time, and make more mistakes.
The signs and symptoms of sleep deficiency may differ between children and adults. Children who are sleep deficient might be overly active and have problems paying attention. They also might misbehave, and their school performance can suffer.
Sleep-deficient children may feel angry and impulsive, have mood swings, feel sad or depressed, or lack motivation.
You may not notice how sleep deficiency affects your daily routine. A common myth is that people can learn to get by on little sleep with no negative effects. However, research shows that getting enough quality sleep at the right times is vital for mental health, physical health, quality of life, and safety.
To find out whether you're sleep deficient, try keeping a sleep diary for a couple of weeks. Write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel during the day.
Compare the amount of time you sleep each day with the average amount of sleep recommended for your age group, as shown in the chart in ""How Much Sleep Is Enough?"" If you often feel very sleepy, and efforts to increase your sleep don't help, talk with your doctor.
You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Strategies for Getting Enough Sleep
You can take steps to improve your sleep habits. First, make sure that you allow yourself enough time to sleep. With enough sleep each night, you may find that you're happier and more productive during the day.
Sleep often is the first thing that busy people squeeze out of their schedules. Making time to sleep will help you protect your health and well-being now and in the future.
To improve your sleep habits, it also may help to:
Go to bed and wake up at the same time every day. For children, have a set bedtime and a bedtime routine. Don't use the child's bedroom for timeouts or punishment.
Try to keep the same
sleep schedule on weeknights and weekends. Limit the difference to no more than about an hour. Staying up late and sleeping in late on weekends can disrupt your body clock's sleep–wake rhythm.
Use the hour before bed for quiet time. Avoid strenuous
exercise and bright artificial light, such as from a TV or computer screen. The light may signal the
brain that it's time to be awake.
Avoid heavy and/or large meals within a couple hours of bedtime. (Having a light snack is okay.) Also, avoid alcoholic drinks before bed.
Avoid
nicotine (for example, cigarettes) and
caffeine (including caffeinated soda, coffee, tea, and chocolate). Nicotine and caffeine are stimulants, and both substances can interfere with
sleep. The effects of caffeine can last as long as 8 hours. So, a cup of coffee in the late afternoon can make it hard for you to
fall asleep at night.
Spend time outside every day (when possible) and be physically active.
Keep your bedroom quiet, cool, and dark (a dim night light is fine, if needed).
Take a hot bath or use relaxation techniques before bed.
Napping during the day may provide a boost in alertness and performance. However, if you have trouble falling asleep at night, limit naps or take them earlier in the afternoon. Adults should nap for no more than 20 minutes.
Napping in preschool-aged children is normal and promotes healthy growth and development.
For more information about healthy sleep habits, go to the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Strategies for Special Groups
Some people have schedules that conflict with their internal body clocks. For example, shift workers and teens who have early school schedules may have trouble getting enough sleep. This can affect how they feel mentally, physically, and emotionally.
If you're a shift worker, you may find it helpful to:
If you're still not able to fall asleep during the day or have problems adapting to a shift-work schedule, talk with your doctor about other options to help you sleep.
When possible, employers and schools might find it helpful to consider options to address issues related to sleep deficiency.
How To Discuss Sleep With Your Doctor
Doctors might not detect sleep problems during routine office visits because patients are awake. Thus, you should let your doctor know if you think you might have a sleep problem.
For example, talk with your doctor if you often feel sleepy during the day, don't wake up feeling refreshed and alert, or are having trouble adapting to shift work.
To get a better sense of your sleep problem, your doctor will ask you about your sleep habits. Before you see the doctor, think about how to describe your problems, including:
How often you have trouble sleeping and how long you've had the problem
When you go to bed and get up on workdays and days off
How long it takes you to
fall asleep, how often you wake up at night, and how long it takes you to fall back asleep
Whether you snore loudly and often or wake up gasping or feeling out of breath
How refreshed you feel when you wake up, and how tired you feel during the day
How often you doze off or have trouble staying awake during routine tasks, especially driving
Your doctor also may ask questions about your personal routine and habits. For example, he or she may ask about your work and exercise routines. Your doctor also may ask whether you use caffeine, tobacco, alcohol, or any medicines (including over-the-counter medicines).
To help your doctor, consider keeping a sleep diary for a couple of weeks. Write down when you go to sleep, wake up, and take naps. (For example, you might note: Went to bed at 10 a.m.; woke up at 3 a.m. and couldn't fall back asleep; napped after work for 2 hours.)
Also write down how much you sleep each night, how alert and rested you feel in the morning, as well as how sleepy you feel at various times during the day. Share the information in your sleep diary with your doctor. You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's ""Your Guide to Healthy Sleep.""
Doctors can diagnose some sleep disorders by asking questions about sleep schedules and habits and by getting information from sleep partners or parents. To diagnose other sleep disorders, doctors also use the results from sleep studies and other medical tests.
Sleep studies allow your doctor to measure how much and how well you sleep. They also help show whether you have sleep problems and how severe they are. For more information, go to the Health Topics Sleep Studies article.
Your doctor will do a physical exam to rule out other medical problems that might interfere with sleep. You may need blood tests to check for thyroid problems or other conditions that can cause sleep problems.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of various sleep disorders and ways to diagnose and treat these disorders.
The NHLBI continues to support research aimed at learning more about sleep and sleep disorders. For example, the NHLBI currently supports studies that explore:
How well light and nonlight
therapies regulate
sleep cycles and improve sleep quality.
The biological factors that determine how much
sleep people need.
Ways to improve
sleep habits and reduce the risk of poor sleep in children from minority or disadvantaged populations.
In November of 2011, the National Institutes of Health (NIH) released its ""2011 NIH Sleep Disorders Research Plan."" The plan expands upon previous and current research programs and identifies new research opportunities.
The NHLBI's National Center on Sleep Disorders Research will coordinate this research across the NIH and other Federal agencies. The research will focus on sleep and the body's natural 24-hour cycle, the role of genes and the environment on sleep health, and ways to improve the prevention, diagnosis, and treatment of sleep disorders.
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases, conditions, and health problems.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to sleep deficiency, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is a Stroke?
A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells.
If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing.
A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death.
If you think you or someone else is having a stroke, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Overview
The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke.
An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.)
Another condition that’s similar to a stroke is a transient ischemic attack, also called a TIA or “mini-stroke.” A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isn’t permanent (lasting).
Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, it’s important for your doctor to find the cause so you can take steps to prevent a stroke.
Both strokes and TIAs require emergency care.
Outlook
Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke.
If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke.
Researchers continue to study the causes and risk factors for stroke. They’re also finding new and better treatments and new ways to help the brain repair itself after a stroke.
Types of Stroke
Ischemic Stroke
An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
The two types of ischemic stroke are thrombotic (throm-BOT-ik) and embolic (em-BOL-ik). In a thrombotic stroke, a blood clot (thrombus) forms in an artery that supplies blood to the brain.
In an embolic stroke, a blood clot or other substance (such as plaque, a fatty material) travels through the bloodstream to an artery in the brain. (A blood clot or piece of plaque that travels through the bloodstream is called an embolus.)
With both types of ischemic stroke, the blood clot or plaque blocks the flow of oxygen-rich blood to a portion of the brain.
![]()
Ischemic Stroke. The illustration shows how an ischemic stroke can occur in the brain. If a blood clot breaks away from plaque buildup in a carotid (neck) artery, it can travel to and lodge in an artery in the brain. The clot can block blood flow to part (more...)
Hemorrhagic Stroke
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells.
The two types of hemorrhagic stroke are intracerebral (in-trah-SER-e-bral) and subarachnoid (sub-ah-RAK-noyd). In an intracerebral hemorrhage, a blood vessel inside the brain leaks blood or ruptures.
In a subarachnoid hemorrhage, a blood vessel on the surface of the brain leaks blood or ruptures. When this happens, bleeding occurs between the inner and middle layers of the membranes that cover the brain.
In both types of hemorrhagic stroke, the leaked blood causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage cells and tissues in the brain.
![]()
Ischemic Stroke Hemorrhagic Stroke. The illustration shows how a hemorrhagic stroke can occur in the brain. An aneurysm in a cerebral artery breaks open, which causes bleeding in the brain. The pressure of the blood causes brain tissue death.
Other Names for a Stroke
Ischemic
stroke (includes thrombotic stroke and embolic stroke)
A transient ischemic attack sometimes is called a TIA or mini-stroke. A TIA has the same symptoms as a stroke, and it increases your risk of having a stroke.
What Causes a Stroke?
Ischemic Stroke and Transient Ischemic Attack
An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA.
For example, atherosclerosis (ath-er-o-skler-O-sis) is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque hardens and narrows the arteries, which limits the flow of blood to tissues and organs (such as the heart and brain).
Plaque in an artery can crack or rupture (break open). Blood platelets (PLATE-lets), which are disc-shaped cell fragments, stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery.
Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck. The two main arteries on each side of the neck are called the carotid (ka-ROT-id) arteries. These arteries supply oxygen-rich blood to the brain, face, scalp, and neck.
When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States.
An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brain’s arteries. This stops blood flow through the artery and damages brain cells.
Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is a common cause of embolic stroke.
In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers.
An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain.
Who Is at Risk for a Stroke?
Certain traits, conditions, and habits can raise your risk of having a stroke or transient ischemic attack (TIA). These traits, conditions, and habits are known as risk factors.
The more risk factors you have, the more likely you are to have a stroke. You can treat or control some risk factors, such as high blood pressure and smoking. Other risk factors, such as age and gender, you can’t control.
The major risk factors for stroke include:
Diabetes. Diabetes is a disease in which the
blood sugar level is high because the body doesn't make enough
insulin or doesn't use its insulin properly. Insulin is a
hormone that helps move blood sugar into
cells where it’s used for energy.
Age and gender. Your risk of
stroke increases as you get older. At younger ages, men are more likely than women to have
strokes. However, women are more likely to die from strokes. Women who take birth control pills also are at slightly higher risk of stroke.
Race and ethnicity.
Strokes occur more often in African American, Alaska Native, and American Indian adults than in Caucasian, Hispanic, or Asian American adults.
Personal or
family history of
stroke or TIA. If you’ve had a stroke, you’re at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke, as does having a family history of stroke.
Other risk factors for stroke, many of which of you can control, include:
Following a healthy lifestyle can lower the risk of stroke. Some people also may need to take medicines to lower their risk.
Sometimes strokes can occur in people who don’t have any known risk factors.
What Are the Signs and Symptoms of a Stroke?
The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days.
The type of symptoms depends on the type of stroke and the area of the brain that’s affected. How long symptoms last and how severe they are vary among different people.
Signs and symptoms of a stroke may include:
A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 1–2 hours (although they may last up to 24 hours). A TIA may occur only once in a person’s lifetime or more often.
At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care.
If you think you or someone else is having a TIA or stroke, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Stroke Complications
After you’ve had a stroke, you may develop other complications, such as:
Blood clots and
muscle weakness. Being immobile (unable to move around) for a long time can raise your risk of developing blood clots in the deep
veins of the legs. Being immobile also can lead to muscle weakness and decreased muscle flexibility.
How Is a Stroke Diagnosed?
Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results.
Your doctor will want to find out the type of stroke you’ve had, its cause, the part of the brain that's affected, and whether you have bleeding in the brain.
If your doctor thinks you’ve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke.
Medical History and Physical Exam
Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began.
During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly.
Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit (broo-E) may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries.
Diagnostic Tests and Procedures
Your doctor may recommend one or more of the following tests to diagnose a stroke or TIA.
Brain Computed Tomography
A brain computed tomography (to-MOG-rah-fee) scan, or brain CT scan, is a painless test that uses x rays to take clear, detailed pictures of your brain. This test often is done right after a stroke is suspected.
A brain CT scan can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing your symptoms.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test can detect changes in brain tissue and damage to brain cells from a stroke.
An MRI may be used instead of, or in addition to, a CT scan to diagnose a stroke.
Computed Tomography Arteriogram and Magnetic Resonance Arteriogram
A CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) can show the large blood vessels in the brain. These tests may give your doctor more information about the site of a blood clot and the flow of blood through your brain.
Carotid Angiography
Carotid angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your carotid arteries.
For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved up into one of your carotid arteries.
Your doctor will inject a substance (called contrast dye) into the carotid artery. The dye helps make the artery visible on x-ray pictures.
Heart Tests
EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
An EKG can help detect heart problems that may have led to a stroke. For example, the test can help diagnose atrial fibrillation or a previous heart attack.
Echocardiography
Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart.
The test gives information about the size and shape of your heart and how well your heart's chambers and valves are working.
Echo can detect possible blood clots inside the heart and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to all parts of your body.
Blood Tests
Your doctor also may use blood tests to help diagnose a stroke.
A blood glucose test measures the amount of glucose (sugar) in your blood. Low blood glucose levels may cause symptoms similar to those of a stroke.
A platelet count measures the number of platelets in your blood. Blood platelets are cell fragments that help your blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting).
Your doctor also may recommend blood tests to measure how long it takes for your blood to clot. Two tests that may be used are called PT and PTT tests. These tests show whether your blood is clotting normally.
How Is a Stroke Treated?
Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions.
Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Once you receive initial treatment, your doctor will try to treat your stroke risk factors and prevent complications.
Treating Ischemic Stroke and Transient Ischemic Attack
An ischemic stroke or TIA occurs if an artery that supplies oxygen-","June 11, 2014."
83,16,"2018-02-02 04:25:06",s,83,"2018-02-02 05:27:02","Sudden Cardiac Arrest","
What Is Sudden Cardiac Arrest?
Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs.
SCA usually causes death if it's not treated within minutes.
Overview
To understand SCA, it helps to understand how the heart works. The heart has an electrical system that controls the rate and rhythm of the heartbeat. Problems with the heart's electrical system can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs).
There are many types of arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood to the body—these arrhythmias cause SCA.
SCA is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart muscle is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. SCA, however, may happen after or during recovery from a heart attack.
People who have heart disease are at higher risk for SCA. However, SCA can happen in people who appear healthy and have no known heart disease or other risk factors for SCA.
Outlook
Most people who have SCA die from it—often within minutes. Rapid treatment of SCA with a defibrillator can be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm.
Automated external defibrillators (AEDs) can be used by bystanders to save the lives of people who are having SCA. These portable devices often are found in public places, such as shopping malls, golf courses, businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools.
What Causes Sudden Cardiac Arrest?
Ventricular fibrillation (v-fib) causes most sudden cardiac arrests (SCAs). V-fib is a type of arrhythmia.
During v-fib, the ventricles (the heart's lower chambers) don't beat normally. Instead, they quiver very rapidly and irregularly. When this happens, the heart pumps little or no blood to the body. V-fib is fatal if not treated within a few minutes.
Other problems with the heart's electrical system also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals.
Certain diseases and conditions can cause the electrical problems that lead to SCA. Examples include coronary heart disease (CHD), also called coronary artery disease; severe physical stress; certain inherited disorders; and structural changes in the heart.
Several research studies are under way to try to find the exact causes of SCA and how to prevent them.
Coronary Heart Disease
CHD is a disease in which a waxy substance called plaque (plak) builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
Plaque narrows the arteries and reduces blood flow to your heart muscle. Eventually, an area of plaque can rupture (break open). This may cause a blood clot to form on the plaque's surface.
A blood clot can partly or fully block the flow of oxygen-rich blood to the portion of heart muscle fed by the artery. This causes a heart attack.
During a heart attack, some heart muscle cells die and are replaced with scar tissue. The scar tissue damages the heart's electrical system. As a result, electrical signals may spread abnormally throughout the heart. These changes to the heart increase the risk of dangerous arrhythmias and SCA.
CHD seems to cause most cases of SCA in adults. Many of these adults, however, have no signs or symptoms of CHD before having SCA.
Physical Stress
Certain types of physical stress can cause your heart's electrical system to fail. Examples include:
Intense physical activity. The
hormone adrenaline is released during intense physical activity. This hormone can trigger SCA in people who have
heart problems.
Inherited Disorders
A tendency to have arrhythmias runs in some families. This tendency is inherited, which means it's passed from parents to children through the genes. Members of these families may be at higher risk for SCA.
An example of an inherited disorder that makes you more likely to have arrhythmias is long QT syndrome (LQTS). LQTS is a disorder of the heart's electrical activity. Problems with tiny pores on the surface of heart muscle cells cause the disorder. LQTS can cause sudden, uncontrollable, dangerous heart rhythms.
People who inherit structural heart problems also may be at higher risk for SCA. These types of problems often are the cause of SCA in children.
Structural Changes in the Heart
Changes in the heart's normal size or structure may affect its electrical system. Examples of such changes include an enlarged heart due to high blood pressure or advanced heart disease. Heart infections also may cause structural changes in the heart.
Who Is at Risk for Sudden Cardiac Arrest?
The risk of sudden cardiac arrest (SCA) increases with age. The risk also is higher if you have underlying heart disease. Men are two to three times more likely to have SCA than women.
SCA rarely occurs in children unless they have inherited problems that make them likely to have SCA. Only a very small number of children have SCA each year.
Major Risk Factors
The major risk factor for SCA is coronary heart disease (CHD). Most people who have SCA have some degree of CHD. However, these people may not know that they have CHD until SCA occurs.
Their CHD is ""silent""—that is, it has no signs or symptoms. Because of this, doctors and nurses have not detected it. Many SCAs happen in people who have silent CHD and no known heart disease prior to SCA.
Many people who have SCA also have silent, or undiagnosed, heart attacks before SCA happens. These people have no clear signs of heart attack, and they don't even realize that they've had one. The chances of having SCA are higher during the first 6 months after a heart attack.
For more information about CHD risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article.
Other Risk Factors
Other risk factors for SCA include:
What Are the Signs and Symptoms of Sudden Cardiac Arrest?
Usually, the first sign of sudden cardiac arrest (SCA) is loss of consciousness (fainting). At the same time, no heartbeat (or pulse) can be felt.
Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. Within an hour before SCA, some people have chest pain, shortness of breath, nausea (feeling sick to the stomach), or vomiting.
How Is Sudden Cardiac Arrest Diagnosed?
Sudden cardiac arrest (SCA) happens without warning and requires emergency treatment. Doctors rarely diagnose SCA with medical tests as it's happening. Instead, SCA often is diagnosed after it happens. Doctors do this by ruling out other causes of a person's sudden collapse.
Specialists Involved
If you're at high risk for SCA, your doctor may refer you to a cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. Your cardiologist will work with you to decide whether you need treatment to prevent SCA.
Some cardiologists specialize in problems with the heart's electrical system. These specialists are called cardiac electrophysiologists.
Diagnostic Tests and Procedures
Doctors use several tests to help detect the factors that put people at risk for SCA.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
An EKG can show evidence of heart damage due to coronary heart disease (CHD). The test also can show signs of a previous or current heart attack.
Echocardiography
Echocardiography, or echo, is a painless test that uses sound waves to create pictures of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several types of echo, including stress echo. This test is done both before and after a cardiac stress test. During this test, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast.
Stress echo shows whether you have decreased blood flow to your heart (a sign of CHD).
MUGA Test or Cardiac MRI
A MUGA (multiple gated acquisition) test shows how well your heart is pumping blood. For this test, a small amount of radioactive substance is injected into a vein and travels to your heart.
The substance releases energy, which special cameras outside of your body can detect. The cameras use the energy to create pictures of many parts of your heart.
Cardiac MRI (magnetic resonance imaging) is a safe procedure that uses radio waves and magnets to create detailed pictures of your heart. The test creates still and moving pictures of your heart and major blood vessels.
Doctors use cardiac MRI to get pictures of the beating heart and to look at the structure and function of the heart.
Cardiac Catheterization
Cardiac catheterization is a procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, your doctor can do diagnostic tests and treatments on your heart.
Sometimes dye is put into the catheter. The dye will flow through your bloodstream to your heart. The dye makes your coronary (heart) arteries visible on x-ray pictures. The dye can show whether plaque has narrowed or blocked any of your coronary arteries.
Electrophysiology Study
For an electrophysiology study, doctors use cardiac catheterization to record how your heart's electrical system responds to certain medicines and electrical stimulation. This helps your doctor find where the heart's electrical system is damaged.
Blood Tests
Your doctor may recommend blood tests to check the levels of potassium, magnesium, and other chemicals in your blood. These chemicals play an important role in your heart's electrical signaling.
How Is Sudden Cardiac Arrest Treated?
Emergency Treatment
Sudden cardiac arrest (SCA) is an emergency. A person having SCA needs to be treated with a defibrillator right away. This device sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating.
To work well, defibrillation must be done within minutes of SCA. With every minute that passes, the chances of surviving SCA drop rapidly.
Police, emergency medical technicians, and other first responders usually are trained and equipped to use a defibrillator. Call 9–1–1 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin.
Automated External Defibrillators
Automated external defibrillators (AEDs) are special defibrillators that untrained bystanders can use. These portable devices often are found in public places, such as shopping malls, golf courses, businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools.
AEDs are programmed to give an electric shock if they detect a dangerous arrhythmia, such as ventricular fibrillation. This prevents giving a shock to someone who may have fainted but isn't having SCA.
You should give cardiopulmonary resuscitation (CPR) to a person having SCA until defibrillation can be done.
People who are at risk for SCA may want to consider having an AED at home. Currently, one AED, the Phillips HeartStart Home Defibrillator, is sold over-the-counter for home use.
A 2008 study by the National Heart, Lung, and Blood Institute and the National Institutes of Health found that AEDs in the home are safe and effective. However, the benefits of home-use AEDs are still debated.
Some people feel that placing these devices in homes will save many lives because many SCAs occur at home.
Others note that no evidence supports the idea that home-use AEDs save more lives. These people fear that people who have AEDs in their homes will delay calling for help during an emergency. They're also concerned that people who have home-use AEDs will not properly maintain the devices or forget where they are.
When considering a home-use AED, talk with your doctor. He or she can help you decide whether having an AED in your home will benefit you.
How Can Death Due to Sudden Cardiac Arrest Be Prevented?
Ways to prevent death due to sudden cardiac arrest (SCA) differ depending on whether:
For People Who Have Survived Sudden Cardiac Arrest
If you've already had SCA, you're at high risk of having it again. Research shows that an implantable cardioverter defibrillator (ICD) reduces the chances of dying from a second SCA.
An ICD is surgically placed under the skin in your chest or abdomen. The device has wires with electrodes on the ends that connect to your heart's chambers. The ICD monitors your heartbeat.
If the ICD detects a dangerous heart rhythm, it gives an electric shock to restore the heart's normal rhythm. Your doctor may give you medicine to limit irregular heartbeats that can trigger the ICD.
![]()
Implantable Cardioverter Defibrillator. The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted into the heart through a vein.
An ICD isn't the same as a pacemaker. The devices are similar, but they have some differences. Pacemakers give off low-energy electrical pulses. They're often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of the heart. Most new ICDs work as both pacemakers and ICDs.
For People Who Have No Known Risk Factors for Sudden Cardiac Arrest
CHD seems to be the cause of most SCAs in adults. CHD also is a major risk factor for angina (chest pain or discomfort) and heart attack, and it contributes to other heart problems.
Following a healthy lifestyle can help you lower your risk for CHD, SCA, and other heart problems.
Healthy Diet and Physical Activity
A healthy diet is an important part of a healthy lifestyle. Choose a variety of fruits, vegetables, and grains; half of your grains should come from whole-grain products.
Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat milk and milk products.
Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.
Choose foods and beverages that are low in added sugar. If you drink alcoholic beverages, do so in moderation.
Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in with the calories you use for physical activity. Be as physically active as you can.
Some people should get medical advice before starting or increasing physical activity. For example, talk with your doctor if you have a chronic (ongoing) health problem, are on medicine, or have symptoms such as chest pain, shortness of breath, or dizziness. Your doctor can suggest types and amounts of physical activity that are safe for you.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" and ""Your Guide to Lowering Your Blood Pressure With DASH."" All of these resources provide general information about healthy eating.
For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's ""Your Guide to Physical Activity and Your Heart.""
Other Lifestyle Changes
Other lifestyle changes also can help lower your risk for SCA. Examples include:
Quitting
smoking. Talk to your doctor about programs and products that can help you quit. Also, try to avoid
secondhand smoke.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to sudden cardiac arrest, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Tetralogy of Fallot?
Tetralogy (teh-TRAL-o-je) of Fallot (fah-LO) is a congenital heart defect. This is a problem with the heart's structure that's present at birth. Congenital heart defects change the normal flow of blood through the heart.
Tetralogy of Fallot is a rare, complex heart defect. It occurs in about 5 out of every 10,000 babies. The defect affects boys and girls equally.
To understand tetralogy of Fallot, it helps to know how a healthy heart works. The Health Topics How the Heart Works article describes the structure and function of a healthy heart. The article also has animations that show how your heart pumps blood and how your heart's electrical system works.
Overview
Tetralogy of Fallot involves four heart defects:
Ventricular Septal Defect
The heart has an inner wall that separates the two chambers on its left side from the two chambers on its right side. This wall is called a septum. The septum prevents blood from mixing between the two sides of the heart.
A VSD is a hole in the septum between the heart's two lower chambers, the ventricles. The hole allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood from the right ventricle.
Right Ventricular Hypertrophy
With this defect, the muscle of the right ventricle is thicker than usual. This occurs because the heart has to work harder than normal to move blood through the narrowed pulmonary valve.
Overriding Aorta
This defect occurs in the aorta, the main artery that carries oxygen-rich blood from the heart to the body. In a healthy heart, the aorta is attached to the left ventricle. This allows only oxygen-rich blood to flow to the body.
In tetralogy of Fallot, the aorta is located between the left and right ventricles, directly over the VSD. As a result, oxygen-poor blood from the right ventricle flows directly into the aorta instead of into the pulmonary artery.
Outlook
With tetralogy of Fallot, not enough blood is able to reach the lungs to get oxygen, and oxygen-poor blood flows to the body.
![]()
Cross-Section of a Normal Heart and a Heart With Tetralogy of Fallot. Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with the four defects of tetralogy of Fallot.
Babies and children who have tetralogy of Fallot have episodes of cyanosis (si-ah-NO-sis). Cyanosis is a bluish tint to the skin, lips, and fingernails. It occurs because the oxygen level in the blood leaving the heart is below normal.
Tetralogy of Fallot is repaired with open-heart surgery, either soon after birth or later in infancy. The timing of the surgery will depend on how narrow the pulmonary artery is.
Over the past few decades, the diagnosis and treatment of tetralogy of Fallot have greatly improved. Most children who have this heart defect survive to adulthood. However, they'll need lifelong medical care from specialists to help them stay as healthy as possible.
Other Names for Tetralogy of Fallot
What Causes Tetralogy of Fallot?
Doctors often don't know what causes tetralogy of Fallot and other congenital heart defects.
Some conditions or factors that occur during pregnancy may raise your risk of having a child who has tetralogy of Fallot. These conditions and factors include:
Heredity may play a role in causing tetralogy of Fallot. An adult who has tetralogy of Fallot may be more likely than other people to have a baby with the condition.
Children who have certain genetic disorders, such as Down syndrome and DiGeorge syndrome, often have congenital heart defects, including tetralogy of Fallot.
Researchers continue to search for the causes of tetralogy of Fallot and other congenital heart defects.
What Are the Signs and Symptoms of Tetralogy of Fallot?
Cyanosis is an important sign of tetralogy of Fallot. Cyanosis is a bluish tint to the skin, lips, and fingernails. Low oxygen levels in the blood cause cyanosis.
Babies who have unrepaired tetralogy of Fallot sometimes have ""tet spells."" These spells happen in response to an activity like crying or having a bowel movement.
A tet spell occurs when the oxygen level in the blood suddenly drops. This causes the baby to become very blue. The baby also may:
In years past, when tetralogy of Fallot wasn't treated in infancy, children would get very tired during exercise and could faint. Now, doctors repair tetralogy of Fallot in infancy to prevent these symptoms.
Another common sign of tetralogy of Fallot is a heart murmur. A heart murmur is an extra or unusual sound that doctors might hear while listening to the heart.
The sound occurs because the heart defect causes abnormal blood flow through the heart. However, not all heart murmurs are signs of congenital heart defects. Many healthy children have heart murmurs.
Babies who have tetralogy of Fallot may tire easily while feeding. Thus, they may not gain weight or grow as quickly as children who have healthy hearts. Also, normal growth depends on a normal workload for the heart and normal flow of oxygen-rich blood to all parts of the body.
Children who have tetralogy of Fallot also may have clubbing. Clubbing is the widening or rounding of the skin or bone around the tips of the fingers.
How Is Tetralogy of Fallot Diagnosed?
Doctors diagnose tetralogy of Fallot based on a baby's signs and symptoms, a physical exam, and the results from tests and procedures.
Signs and symptoms of the heart defect usually occur during the first weeks of life. Your infant's doctor may notice signs or symptoms during a routine checkup. Some parents also notice cyanosis or poor feeding and bring the baby to the doctor. (Cyanosis is a bluish tint to the skin, lips, and fingernails.)
Specialists Involved
If your child has tetralogy of Fallot, a pediatric cardiologist and pediatric cardiac surgeon may be involved in his or her care.
A pediatric cardiologist is a doctor who specializes in diagnosing and treating heart problems in children. Pediatric cardiac surgeons repair children's heart defects using surgery.
Physical Exam
During a physical exam, the doctor may:
Look for signs of a
heart defect, such as a bluish tint to the
skin,
lips, or fingernails and rapid breathing.
Look at your baby's general appearance. Some children who have tetralogy of Fallot also have DiGeorge syndrome. This syndrome causes characteristic facial traits, such as wide-set
eyes.
Diagnostic Tests and Procedures
Your child's doctor may recommend several tests to diagnose tetralogy of Fallot. These tests can provide information about the four heart defects that occur in tetralogy of Fallot and how serious they are.
Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen.
Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.
Echo is an important test for diagnosing tetralogy of Fallot because it shows the four heart defects and how the heart is responding to them. This test helps the cardiologist decide when to repair the defects and what type of surgery to use.
Echo also is used to check a child's condition over time, after the defects have been repaired.
EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
This test can help the doctor find out whether your child's right ventricle is enlarged (ventricular hypertrophy).
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged or whether the lungs have extra blood flow or extra fluid, a sign of heart failure.
Pulse Oximetry
For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood.
How Is Tetralogy of Fallot Treated?
Tetralogy of Fallot is repaired with open-heart surgery, either soon after birth or later in infancy. The goal of surgery is to repair the four defects of tetralogy of Fallot so the heart can work as normally as possible. Repairing the defects can greatly improve a child's health and quality of life.
The pediatric cardiologist and cardiac surgeon will decide the best time to do the surgery. They will base their decision on your baby's health and weight and the severity of the defects and symptoms.
Some teenagers or adults who had tetralogy of Fallot repaired in childhood need additional surgery to correct heart problems that develop over time. For more information, go to ""Living With Tetralogy of Fallot.""
Types of Surgery
Complete Intracardiac Repair
Surgery to repair tetralogy of Fallot improves blood flow to the lungs. Surgery also ensures that oxygen-rich and oxygen-poor blood flow to the right places.
The surgeon will:
Fixing these two defects resolves problems caused by the other two defects. When the right ventricle no longer has to work so hard to pump blood to the lungs, it will return to a normal thickness. Fixing the VSD means that only oxygen-rich blood will flow out of the left ventricle into the aorta.
The incision (cut) that the surgeon makes to reach the heart usually heals in about 6 weeks. The surgeon or a hospital staff member will explain when it's okay to give your baby a bath, pick him or her up under the arms, and take your baby for regular shots (immunizations).
Temporary or Palliative Surgery
It was common in the past to do temporary surgery during infancy for tetralogy of Fallot. This surgery improved blood flow to the lungs. A complete repair of the four defects was done later in childhood.
Now, tetralogy of Fallot usually is fully repaired in infancy. However, some babies are too weak or too small to have the full repair. They must have temporary surgery first. This surgery improves oxygen levels in the blood. The surgery also gives the baby time to grow and get strong enough for the full repair.
For temporary surgery, the surgeon places a tube between a large artery branching off the aorta and the pulmonary artery. The tube is called a shunt. One end of the shunt is sewn to the artery branching off the aorta. The other end is sewn to the pulmonary artery.
The shunt creates an additional pathway for blood to travel to the lungs to get oxygen. The surgeon removes the shunt when the baby's heart defects are fixed during the full repair.
After temporary surgery, your baby may need medicines to keep the shunt open while waiting for the full repair. These medicines are stopped after the surgeon removes the shunt.
Living With Tetralogy of Fallot
The outlook for a child born with tetralogy of Fallot is much better today than in the past. Advances in testing and treatment mean that most children who have this congenital heart defect survive to adulthood. However, they need long-term care from specialists to stay as healthy as possible.
Caring for Your Child at Home
Feeding and Nutrition
Babies who have tetralogy of Fallot can tire while nursing or feeding. Small, frequent meals may be easier for your baby to handle.
Your child also may need extra nutrition. A supplement or an extra feeding can give the baby more calories, vitamins, or iron. Your child's doctors will work with you to decide whether your baby needs extra nutrition.
Tet Spells
""Tet spells"" can occur in babies whose tetralogy of Fallot hasn't yet been repaired. Lowering your baby's anxiety or stress can help prevent tet spells and save the baby's energy. For example, slowly picking up your baby and speaking in a soothing voice can avoid startling him or her, which may prevent or reduce crying.
Ask your doctor how you can manage your child's tet spells. Your doctor may suggest that you:
Activity Restrictions
If your child was born with tetralogy of Fallot, he or she may have some physical activity limits. The limits vary with each child. Ask your child's doctor whether:
Ongoing Medical Care
Children who have tetralogy of Fallot should have ongoing medical care. This includes making sure your child:
Children who have severe heart defects, like tetralogy of Fallot, may be at slightly increased risk for infective endocarditis (IE). IE is a serious infection of the inner lining of the heart chambers and valves.
Your child's doctor or dentist may give your child antibiotics before some medical or dental procedures (such as surgery or dental cleanings) that can allow bacteria into the bloodstream. Your child's doctor will tell you whether your child needs to take antibiotics before such procedures.
To reduce the risk of IE, gently brush your young child's teeth every day as soon as they begin to come in. As your child gets older, make sure he or she brushes every day and sees a dentist regularly. Talk with your child's doctor and dentist about how to keep your child's mouth and teeth healthy.
Consider having your child wear a medical ID bracelet or necklace. This alerts anyone caring for your child that the child has a heart defect.
Special Needs for Teenagers and Adults
As children who have heart defects grow up and become teens, they should learn how their hearts differ from normal hearts. They also should know what kind of defects they have, how they were treated, and what type of care is still needed. They should be able to recognize signs and symptoms and know how to respond.
Work with your child's health care providers to compile a packet of medical records and information that covers all aspects of your child's heart defect, including:
Review your current health insurance plan so you understand your coverage. Keeping your health insurance current is important. If you plan to change jobs, find out whether your new health insurance will cover care for your child's congenital heart defect.
Transition of Care
The move from pediatric care to adult care is an important step in treatment. Talk with your teen's health care team about creating a plan to help your teen transition to adult care. Start planning as soon as your teen is able and willing to fully take part in this process.
Following a transition plan has many benefits. It will help your teen:
Get used to talking with health care providers
Learn about the adult health care system
Understand the importance of having health insurance and learn what his or her insurance covers
Take responsibility for his or her medical care
A transition plan also can help your teen think about other important issues, such as future education and employment, birth control and pregnancy planning, and making healthy choices about nutrition, physical activity, and other lifestyle habits.
Additional Surgery and Other Complications
Some teenagers or young adults need additional surgery. For example, the pulmonary valve can narrow again over time, reducing blood flow. A surgeon may need to widen or replace the valve. The cardiologist will discuss with you and your teenager the need for any additional heart surgeries.
Over time, people who have had surgery to repair tetralogy of Fallot also may face other heart problems.
Leaking heart valves. The heart has four valves that open and close with each heartbeat. These valves ensure that blood flows only in one direction.
If a valve doesn't seal tightly, blood can leak back into the chamber it came from. This is called backflow or regurgitation (re-GUR-jih-TA-shun), and it can lead to symptoms and complications.
The most frequent problem that occurs after tetralogy of Fallot repair is pulmonary backflow, or leaking from the pulmonary valve. Backflow from the tricuspid valve and aortic valve also can occur.
Surgery is used to repair or replace the leaking valve. In some cases, catheter-based procedures may be used to replace leaking valves.
Arrhythmias. Arrhythmias (ah-RITH-me-ahs) are another complication that may occur. Arrhythmias are problems with the rate or rhythm of the heartbeat.
Arrhythmias associated with tetralogy of Fallot include ventricular tachycardia, atrial fibrillation, and atrial flutter. For more information, go to the Health Topics Arrhythmia article.
Doctors use medicines to control these arrhythmias. They also may recommend medical procedures or surgery to treat arrhythmias.
Pulmonary artery branch stenosis. Over time, the pulmonary valve can narrow again. This will reduce blood flow to the lungs, making the heart work harder than it should. Several surgical techniques can be used to fix this problem.
Right ventricular aneurysms. The patch used to fix a ventricular septal defect (VSD) can cause areas of the ventricle to weaken. These areas, called aneurysms (AN-u-risms), can bulge or ""balloon"" out. Aneurysms make it hard for the heart to work as well as it should. Aneurysms are repaired with surgery.
Residual ventricular septal defects. Some VSDs still leak, even after they've been repaired. VSDs are repaired again if they're large or are causing problems with the function of the right ventricle.
Coronary heart disease. As people who have repaired tetralogy of Fallot approach middle age, they can develop coronary heart disease (CHD). (Adults who don't have congenital heart defects also can develop CHD.)
CHD is a condition in which a waxy substance called plaque (plak) builds up in the coronary (heart) arteries. CHD can lead to chest pain, shortness of breath, and heart attack.
For people who have repaired tetralogy of Fallot, preventing CHD is important. The procedures used to treat CHD, such as coronary artery bypass grafting, can cause problems for these people.
Other Considerations
Many women with repaired tetralogy of Fallot who become pregnant are able to have successful, full-term pregnancies. Others may have difficult pregnancies.
Women with tetralogy of Fallot who want to become pregnant (or who are pregnant) should talk with their doctors about:
If possible, these women should consult specialists who take care of pregnant women who have heart conditions, such as congenital heart defects.
Adults who were born with tetralogy of Fallot should consider job changes carefully, because health benefits may change. Some health plans have waiting periods or clauses to exclude some types of coverage. Before making any job changes, find out whether the change will affect your health insurance.
Several laws protect the employment rights of people who have health conditions, such as congenital heart defects. The Americans with Disabilities Act and the Work Incentives Improvement Act try to ensure fairness in hiring for all people, including those who have health conditions.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat them.
Many more questions remain about heart diseases and conditions, including tetralogy of Fallot. The NHLBI continues to support research aimed at learning more about tetralogy of Fallot and other congenital heart defects. For example, the NHLBI currently sponsors two research groups that study congenital heart disease.
The Pediatric Heart Network conducts clinical research to improve outcomes and quality of life for children who have congenital heart disease and other pediatric heart diseases.
The Pediatric Cardiac Genomic Consortium (part of the NHLBI's Bench to Bassinet Program) conducts clinical research to find the genetic causes of congenital heart disease. This group's research also aims to pinpoint the genetic factors that affect clinical outcomes in people who have congenital heart disease.
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.
When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.
If you agree to have your child ","June 11, 2014."
85,17,"2018-02-02 04:25:06",t,85,"2018-02-02 05:27:35",Thalassemias,"
What Are Thalassemias?
Thalassemias (thal-a-SE-me-ahs) are inherited blood disorders. ""Inherited"" means that the disorder is passed from parents to children through genes.
Thalassemias cause the body to make fewer healthy red blood cells and less hemoglobin (HEE-muh-glow-bin) than normal. Hemoglobin is an iron-rich protein in red blood cells. It carries oxygen to all parts of the body. Hemoglobin also carries carbon dioxide (a waste gas) from the body to the lungs, where it's exhaled.
People who have thalassemias can have mild or severe anemia (uh-NEE-me-uh). Anemia is caused by a lower than normal number of red blood cells or not enough hemoglobin in the red blood cells.
Overview
Normal hemoglobin, also called hemoglobin A, has four protein chains—two alpha globin and two beta globin. The two major types of thalassemia, alpha and beta, are named after defects in these protein chains.
Four genes (two from each parent) are needed to make enough alpha globin protein chains. Alpha thalassemia trait occurs if one or two of the four genes are missing. If more than two genes are missing, moderate to severe anemia occurs.
The most severe form of alpha thalassemia is called alpha thalassemia major or hydrops fetalis. Babies who have this disorder usually die before or shortly after birth.
Two genes (one from each parent) are needed to make enough beta globin protein chains. Beta thalassemia occurs if one or both genes are altered.
The severity of beta thalassemia depends on how much one or both genes are affected. If both genes are affected, the result is moderate to severe anemia. The severe form of beta thalassemia is known as thalassemia major or Cooley's anemia.
Thalassemias affect males and females. The disorders occur most often among people of Italian, Greek, Middle Eastern, Southern Asian, and African descent. Severe forms usually are diagnosed in early childhood and are lifelong conditions.
Doctors diagnose thalassemias using blood tests. The disorders are treated with blood transfusions, medicines, and other procedures.
Outlook
Treatments for thalassemias have improved over the years. People who have moderate or severe thalassemias are now living longer and have better quality of life.
However, complications from thalassemias and their treatments are frequent. People who have moderate or severe thalassemias must closely follow their treatment plans. They need to take care of themselves to remain as healthy as possible.
Other Names for Thalassemias
The various types of thalassemia have specific names related to the severity of the disorder. (For more information about the types of thalassemia, go to ""What Causes Thalassemias?"")
Alpha Thalassemias
Alpha
thalassemia minor, also called alpha thalassemia trait
Beta Thalassemias
Beta
thalassemia minor, also called beta thalassemia trait
What Causes Thalassemias?
Your body makes three types of blood cells: red blood cells, white blood cells, and platelets (PLATE-lets). Red blood cells contain hemoglobin, an iron-rich protein that carries oxygen from your lungs to all parts of your body. Hemoglobin also carries carbon dioxide (a waste gas) from your body to your lungs, where it's exhaled.
Hemoglobin has two kinds of protein chains: alpha globin and beta globin. If your body doesn't make enough of these protein chains or they're abnormal, red blood cells won't form correctly or carry enough oxygen. Your body won't work well if your red blood cells don't make enough healthy hemoglobin.
Genes control how the body makes hemoglobin protein chains. When these genes are missing or altered, thalassemias occur.
Thalassemias are inherited disorders—that is, they're passed from parents to children through genes. People who inherit faulty hemoglobin genes from one parent but normal genes from the other are called carriers. Carriers often have no signs of illness other than mild anemia. However, they can pass the faulty genes on to their children.
People who have moderate to severe forms of thalassemia have inherited faulty genes from both parents.
Alpha Thalassemias
You need four genes (two from each parent) to make enough alpha globin protein chains. If one or more of the genes is missing, you'll have alpha thalassemia trait or disease. This means that your body doesn't make enough alpha globin protein.
If you're only missing one
gene, you're a ""silent"" carrier. This means you won't have any signs of illness.
If you're missing two
genes, you have alpha
thalassemia trait (also called alpha thalassemia minor). You may have mild
anemia.
Very rarely, a baby is missing all four genes. This condition is called alpha thalassemia major or hydrops fetalis. Babies who have hydrops fetalis usually die before or shortly after birth.
![]()
Example of an Inheritance Pattern for Alpha Thalassemia. The picture shows one example of how alpha thalassemia is inherited. The alpha globin genes are located on chromosome 16. A child inherits four alpha globin genes (two from each parent). In this (more...)
Beta Thalassemias
You need two genes (one from each parent) to make enough beta globin protein chains. If one or both of these genes are altered, you'll have beta thalassemia. This means that your body won’t make enough beta globin protein.
If you have one altered
gene, you're a carrier. This condition is called beta
thalassemia trait or beta thalassemia minor. It causes mild
anemia.
If both
genes are altered, you'll have beta
thalassemia intermedia or beta thalassemia major (also called Cooley's
anemia). The intermedia form of the disorder causes moderate anemia. The major form causes severe anemia.
![]()
Example of an Inheritance Pattern for Alpha Thalassemia Example of an Inheritance Pattern for Beta Thalassemia. The picture shows one example of how beta thalassemia is inherited. The beta globin gene is located on chromosome 11. A child inherits two (more...)
Who Is at Risk for Thalassemias?
Family history and ancestry are the two risk factors for thalassemias.
Family History
Thalassemias are inherited—that is, the genes for the disorders are passed from parents to their children. If your parents have missing or altered hemoglobin-making genes, you may have thalassemia.
Ancestry
Thalassemias occur most often among people of Italian, Greek, Middle Eastern, Southern Asian, and African descent.
What Are the Signs and Symptoms of Thalassemias?
A lack of oxygen in the bloodstream causes the signs and symptoms of thalassemias. The lack of oxygen occurs because the body doesn't make enough healthy red blood cells and hemoglobin. The severity of symptoms depends on the severity of the disorder.
No Symptoms
Alpha thalassemia silent carriers generally have no signs or symptoms of the disorder. The lack of alpha globin protein is so minor that the body's hemoglobin works normally.
Mild Anemia
People who have alpha or beta thalassemia trait can have mild anemia. However, many people who have these types of thalassemia have no signs or symptoms.
Mild anemia can make you feel tired. Mild anemia caused by alpha thalassemia trait might be mistaken for iron-deficiency anemia.
Mild to Moderate Anemia and Other Signs and Symptoms
People who have beta thalassemia intermedia have mild to moderate anemia. They also may have other health problems, such as:
Slowed growth and delayed puberty.
Anemia can slow down a child's growth and development.
Bone problems.
Thalassemia may cause
bone marrow to expand. Bone marrow is the spongy substance inside
bones that makes
blood cells. When bone marrow expands, the bones become wider than normal. They may become brittle and break easily.
An enlarged
spleen. The spleen is an
organ that helps your body fight
infection and remove unwanted material. When a person has
thalassemia, the spleen has to work very hard. As a result, the spleen becomes larger than normal. This makes
anemia worse. If the spleen becomes too large, it must be removed.
Severe Anemia and Other Signs and Symptoms
People who have hemoglobin H disease or beta thalassemia major (also called Cooley's anemia) have severe thalassemia. Signs and symptoms usually occur within the first 2 years of life. They may include severe anemia and other health problems, such as:
Complications of Thalassemias
Better treatments now allow people who have moderate and severe thalassemias to live much longer. As a result, these people must cope with complications of these disorders that occur over time.
Infection
Among people who have thalassemias, infections are a key cause of illness and the second most common cause of death. People who have had their spleens removed are at even higher risk because they no longer have this infection-fighting organ.
Osteoporosis
Many people who have thalassemias have bone problems, including osteoporosis (OS-te-o-po-RO-sis). This is a condition in which bones are weak and brittle and break easily.
How Are Thalassemias Diagnosed?
Doctors diagnose thalassemias using blood tests, including a complete blood count (CBC) and special hemoglobin tests.
A CBC measures the amount of
hemoglobin and the different kinds of
blood cells, such as
red blood cells, in a sample of blood. People who have
thalassemias have fewer healthy red blood cells and less hemoglobin than normal in their blood. People who have alpha or beta
thalassemia trait may have red blood cells that are smaller than normal.
Hemoglobin tests measure the types of hemoglobin in a
blood sample. People who have
thalassemias have problems with the alpha or beta globin
protein chains of hemoglobin.
Moderate and severe thalassemias usually are diagnosed in early childhood. This is because signs and symptoms, including severe anemia, often occur within the first 2 years of life.
People who have milder forms of thalassemia might be diagnosed after a routine blood test shows they have anemia. Doctors might suspect thalassemia if a person has anemia and is a member of an ethnic group that's at increased risk for thalassemias. (For more information, go to ""Who Is at Risk for Thalassemias?"")
Doctors also test the amount of iron in the blood to find out whether the anemia is due to iron deficiency or thalassemia. Iron-deficiency anemia occurs if the body doesn't have enough iron to make hemoglobin. The anemia in thalassemia occurs because of a problem with either the alpha globin or beta globin chains of hemoglobin, not because of a lack of iron.
Because thalassemias are passed from parents to children through genes, family genetic studies also can help diagnose the disorder. These studies involve taking a family medical history and doing blood tests on family members. The tests will show whether any family members have missing or altered hemoglobin genes.
If you know of family members who have thalassemias and you're thinking of having children, consider talking with your doctor and a genetic counselor. They can help determine your risk for passing the disorder to your children.
If you're expecting a baby and you and your partner are thalassemia carriers, you may want to consider prenatal testing.
Prenatal testing involves taking a sample of amniotic fluid or tissue from the placenta. (Amniotic fluid is the fluid in the sac surrounding a growing embryo. The placenta is the organ that attaches the umbilical cord to the mother's womb.) Tests done on the fluid or tissue can show whether your baby has thalassemia and how severe it might be.
How Are Thalassemias Treated?
Treatments for thalassemias depend on the type and severity of the disorder. People who are carriers or who have alpha or beta thalassemia trait have mild or no symptoms. They’ll likely need little or no treatment.
Doctors use three standard treatments for moderate and severe forms of thalassemia. These treatments include blood transfusions, iron chelation (ke-LAY-shun) therapy, and folic acid supplements. Other treatments have been developed or are being tested, but they're used much less often.
Standard Treatments
Blood Transfusions
Transfusions of red blood cells are the main treatment for people who have moderate or severe thalassemias. This treatment gives you healthy red blood cells with normal hemoglobin.
During a blood transfusion, a needle is used to insert an intravenous (IV) line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours.
Red blood cells live only for about 120 days. So, you may need repeated transfusions to maintain a healthy supply of red blood cells.
If you have hemoglobin H disease or beta thalassemia intermedia, you may need blood transfusions on occasion. For example, you may have transfusions when you have an infection or other illness, or when your anemia is severe enough to cause tiredness.
If you have beta thalassemia major (Cooley's anemia), you’ll likely need regular blood transfusions (often every 2 to 4 weeks). These transfusions will help you maintain normal hemoglobin and red blood cell levels.
Blood transfusions allow you to feel better, enjoy normal activities, and live into adulthood. This treatment is lifesaving, but it's expensive and carries a risk of transmitting infections and viruses (for example, hepatitis). However, the risk is very low in the United States because of careful blood screening.
For more information, go to the Health Topics Blood Transfusion article.
Iron Chelation Therapy
The hemoglobin in red blood cells is an iron-rich protein. Thus, regular blood transfusions can lead to a buildup of iron in the blood. This condition is called iron overload. It damages the liver, heart, and other parts of the body.
To prevent this damage, doctors use iron chelation therapy to remove excess iron from the body. Two medicines are used for iron chelation therapy.
Deferoxamine is a liquid medicine that's given slowly under the
skin, usually with a small portable pump used overnight. This
therapy takes time and can be mildly painful. Side effects include problems with vision and
hearing.
Other Treatments
Other treatments for thalassemias have been developed or are being tested, but they're used much less often.
Possible Future Treatments
Researchers are working to find new treatments for thalassemias. For example, it might be possible someday to insert a normal hemoglobin gene into stem cells in bone marrow. This will allow people who have thalassemias to make their own healthy red blood cells and hemoglobin.
Researchers also are studying ways to trigger a person's ability to make fetal hemoglobin after birth. This type of hemoglobin is found in fetuses and newborns. After birth, the body switches to making adult hemoglobin. Making more fetal hemoglobin might make up for the lack of healthy adult hemoglobin.
Treating Complications
Better treatments now allow people who have moderate and severe thalassemias to live longer. As a result, these people must cope with complications that occur over time.
An important part of managing thalassemias is treating complications. Treatment might be needed for heart or liver diseases, infections, osteoporosis, and other health problems.
How Can Thalassemias Be Prevented?
You can’t prevent thalassemias because they’re inherited (passed from parents to children through genes). However, prenatal tests can detect these blood disorders before birth.
Family genetic studies may help find out whether people have missing or altered hemoglobin genes that cause thalassemias. (For more information, go to ""How Are Thalassemias Diagnosed?"")
If you know of family members who have thalassemias and you're thinking of having children, consider talking with your doctor and a genetic counselor. They can help determine your risk for passing the disorder to your children.
Living With Thalassemias
Survival and quality of life have improved for people who have moderate or severe thalassemias. This is because:
Iron chelation
treatments are available that are easier for some people to take.
Living with thalassemia can be challenging, but several approaches can help you cope.
Follow Your Treatment Plan
Following the treatment plan your doctor gives you is important. For example, get blood transfusions as your doctor recommends, and take your iron chelation medicine as prescribed.
Iron chelation treatment can take time and be mildly painful. However, don't stop taking your medicine. The leading cause of death among people who have thalassemias is heart disease caused by iron overload. Iron buildup can damage your heart, liver, and other organs.
Several chelation treatments are now available, including injections and pills. Your doctor will talk with you about which treatment is best for you.
Take folic acid supplements if your doctor prescribes them. Folic acid is a B vitamin that helps build healthy red blood cells. Also, talk with your doctor about whether you need other vitamin or mineral supplements, such as vitamins A, C, or D","June 11, 2014."
86,17,"2018-02-02 04:25:06",t,86,"2018-02-02 05:27:46","Thrombocythemia and Thrombocytosis","
What Are Thrombocythemia and Thrombocytosis?
Thrombocythemia (THROM-bo-si-THE-me-ah) and thrombocytosis (THROM-bo-si-TO-sis) are conditions in which your blood has a higher than normal number of platelets (PLATE-lets).
Platelets are blood cell fragments. They're made in your bone marrow along with other kinds of blood cells.
Platelets travel through your blood vessels and stick together (clot). Clotting helps stop any bleeding that may occur if a blood vessel is damaged. Platelets also are called thrombocytes (THROM-bo-sites) because a blood clot also is called a thrombus.
A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.
Overview
The term ""thrombocythemia"" is preferred when the cause of a high platelet count isn't known. The condition sometimes is called primary or essential thrombocythemia.
This condition occurs if faulty cells in the bone marrow make too many platelets. Bone marrow is the sponge-like tissue inside the bones. It contains stem cells that develop into red blood cells, white blood cells, and platelets. What causes the bone marrow to make too many platelets often isn't known.
With primary thrombocythemia, a high platelet count may occur alone or with other blood cell disorders. This condition isn't common.
When another disease or condition causes a high platelet count, the term ""thrombocytosis"" is preferred. This condition often is called secondary or reactive thrombocytosis. Secondary thrombocytosis is more common than primary thrombocythemia.
Often, a high platelet count doesn't cause signs or symptoms. Rarely, serious or life-threatening symptoms can develop, such as blood clots and bleeding. These symptoms are more likely to occur in people who have primary thrombocythemia.
Outlook
People who have primary thrombocythemia with no signs or symptoms don't need treatment, as long as the condition remains stable.
Other people who have this condition may need medicines or procedures to treat it. Most people who have primary thrombocythemia will live a normal lifespan.
Treatment and outlook for secondary thrombocytosis depend on its underlying cause.
Other Names for Thrombocythemia and Thrombocytosis
Primary thrombocythemia also is called:
Thrombocytosis also is known as:
What Causes Thrombocythemia and Thrombocytosis?
Primary Thrombocythemia
In this condition, faulty stem cells in the bone marrow make too many platelets. What causes this to happen usually isn't known. When this process occurs without other blood cell disorders, it's called essential thrombocythemia.
A rare form of thrombocythemia is inherited. (""Inherited"" means the condition is passed from parents to children through the genes.) In some cases, a genetic mutation may cause the condition.
In addition to the bone marrow making too many platelets, the platelets also are abnormal in primary thrombocythemia. They may form blood clots or, surprisingly, cause bleeding when they don't work well.
Bleeding also can occur because of a condition that develops called von Willebrand disease. This condition affects the blood clotting process.
After many years, scarring of the bone marrow can occur.
Secondary Thrombocytosis
This condition occurs if another disease, condition, or outside factor causes the platelet count to rise. For example, 35 percent of people who have high platelet counts also have cancer—mostly lung, gastrointestinal, breast, ovarian, and lymphoma. Sometimes a high platelet count is the first sign of cancer.
Other conditions or factors that can cause a high platelet count are:
Some conditions can lead to a high platelet count that lasts for only a short time. Examples of such conditions include:
Although the platelet count is high in secondary thrombocytosis, the platelets are normal (unlike in primary thrombocythemia). Thus, people who have secondary thrombocytosis have a lower risk of blood clots and bleeding.
Who Is at Risk for Thrombocythemia or Thrombocytosis?
Primary Thrombocythemia
Thrombocythemia isn't common. The exact number of people who have the condition isn't known. Some estimates suggest that 24 out of every 100,000 people have primary thrombocythemia.
Primary thrombocythemia is more common in people aged 50 to 70, but it can occur at any age. For unknown reasons, more women around the age of 30 have primary thrombocythemia than men of the same age.
Secondary Thrombocytosis
You might be at risk for secondary thrombocytosis if you have a disease, condition, or factor that can cause it. (For more information, go to ""What Causes Thrombocythemia and Thrombocytosis?"")
Secondary thrombocytosis is more common than primary thrombocythemia. Studies have shown that most people who have platelet counts over 500,000 have secondary thrombocytosis.
What Are the Signs and Symptoms of Thrombocythemia and Thrombocytosis?
People who have thrombocythemia or thrombocytosis may not have signs or symptoms. These conditions might be discovered only after routine blood tests.
However, people who have primary thrombocythemia are more likely than those who have secondary thrombocytosis to have serious signs and symptoms.
The signs and symptoms of a high platelet count are linked to blood clots and bleeding. They include weakness, bleeding, headache, dizziness, chest pain, and tingling in the hands and feet.
Blood Clots
In primary thrombocythemia, blood clots most often develop in the brain, hands, and feet. But they can develop anywhere in the body, including in the heart and intestines.
Blood clots in the brain may cause symptoms such as chronic (ongoing) headache and dizziness. In extreme cases, stroke may occur.
Blood clots in the tiny blood vessels of the hands and feet leave them numb and red. This may lead to an intense burning and throbbing pain felt mainly on the palms of the hands and the soles of the feet.
Other signs and symptoms of blood clots may include:
Changes in speech or awareness, ranging from confusion to
passing out
In pregnant women, blood clots in the placenta can cause miscarriage or problems with fetal growth and development.
Women who have primary thrombocythemia or secondary thrombocytosis and take birth control pills are at increased risk for blood clots.
Blood clots are related to other conditions and factors as well. Older age, prior blood clots, diabetes, high blood pressure, and smoking also increase your risk for blood clots.
Bleeding
If bleeding occurs, it most often affects people who have platelet counts higher than 1 million platelets per microliter of blood. Signs of bleeding include nosebleeds, bruising, bleeding from the mouth or gums, or blood in the stools.
Although bleeding usually is associated with a low platelet count, it also can occur in people who have high platelet counts. Blood clots that develop in thrombocythemia or thrombocytosis may use up your body's platelets. This means that not enough platelets are left in your bloodstream to seal off cuts or breaks on the blood vessel walls.
Another cause of bleeding in people who have very high platelets counts is a condition called von Willebrand Disease. This condition affects the blood clotting process.
In rare cases of primary thrombocythemia, the faulty bone marrow cells will cause a form of leukemia (lu-KE-me-ah). Leukemia is a cancer of the blood cells.
How Are Thrombocythemia and Thrombocytosis Diagnosed?
Your doctor will diagnose thrombocythemia or thrombocytosis based on your medical history, a physical exam, and test results. A hematologist also may be involved in your care. This is a doctor who specializes in blood diseases and conditions.
Medical History
Your doctor may ask you about factors that can affect your platelets, such as:
Any recent infections or vaccines you've had
The medicines you take, including over-the-counter medicines
Your general eating habits, including the amount of alcohol you normally drink
Physical Exam
Your doctor will do a physical exam to look for signs and symptoms of blood clots and bleeding. He or she also will check for signs of conditions that can cause secondary thrombocytosis, such as an infection.
Primary thrombocythemia is diagnosed only after all possible causes of a high platelet count are ruled out. For example, your doctor may recommend tests to check for early, undiagnosed cancer. If another disease, condition, or factor is causing a high platelet count, the diagnosis is secondary thrombocytosis.
Diagnostic Tests
Your doctor may recommend one or more of the following tests to help diagnose a high platelet count.
Blood Smear
A blood smear is used to check the condition of your platelets. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm. Some of your blood is put on a glass slide. A microscope is then used to look at your platelets.
Bone Marrow Tests
Bone marrow tests check whether your bone marrow is healthy. Blood cells, including platelets, are made in the bone marrow. The two bone marrow tests are aspiration (as-pih-RA-shun) and biopsy.
Bone marrow aspiration might be done to find out whether your bone marrow is making too many platelets. For this test, your doctor removes a sample of fluid bone marrow through a needle. He or she examines the sample under a microscope to check for faulty cells.
A bone marrow biopsy often is done right after an aspiration. For this test, your doctor removes a small amount of bone marrow tissue through a needle. He or she examines the tissue to check the number and types of cells in the bone marrow.
With thrombocythemia and thrombocytosis, the bone marrow has a higher than normal number of the very large cells that make platelets.
How Are Thrombocythemia and Thrombocytosis Treated?
Primary Thrombocythemia
This condition is considered less harmful today than in the past, and its outlook often is good. People who have no signs or symptoms don't need treatment, as long as the condition remains stable.
Taking aspirin may help people who are at risk for blood clots (aspirin thins the blood). However, talk with your doctor about using aspirin because it can cause bleeding.
Doctors prescribe aspirin to most pregnant women who have primary thrombocythemia. This is because it doesn't have a high risk of side effects for the fetus.
Some people who have primary thrombocythemia may need medicines or medical procedures to lower their platelet counts.
Medicines To Lower Platelet Counts
You may need medicines to lower your platelet count if you:
You'll need to take these medicines throughout your life.
Hydroxyurea. This platelet-lowering medicine is used to treat cancers and other life-threatening diseases. Hydroxyurea most often is given under the care of doctors who specialize in cancer or blood diseases. Patients on hydroxyurea are closely monitored.
Currently, hydroxyurea plus aspirin is the standard treatment for people who have primary thrombocythemia and are at high risk for blood clots.
Anagrelide. This medicine also has been used to lower platelet counts in people who have thrombocythemia. However, research shows that when compared with hydroxyurea, anagrelide has worse outcomes. Anagrelide also has side effects, such as fluid retention, palpitations (pal-pih-TA-shuns), arrhythmias (ah-RITH-me-ahs), heart failure, and headaches.
Interferon alfa. This medicine lowers platelet counts, but 20 percent of patients can't handle its side effects. Side effects include a flu-like feeling, decreased appetite, nausea (feeling sick to the stomach), diarrhea, seizures, irritability, and sleepiness.
Doctors may prescribe this medicine to pregnant women who have primary thrombocythemia because it's safer for a fetus than hydroxyurea and anagrelide.
Plateletpheresis
Plateletpheresis (PLATE-let-fe-REH-sis) is a procedure used to rapidly lower your platelet count. This procedure is used only for emergencies. For example, if you're having a stroke due to primary thrombocythemia, you may need plateletpheresis.
An intravenous (IV) needle that's connected to a tube is placed in one of your blood vessels to remove blood. The blood goes through a machine that removes platelets from the blood. The remaining blood is then put back into you through an IV line in one of your blood vessels.
One or two procedures might be enough to reduce your platelet count to a safe level.
Secondary Thrombocytosis
Secondary thrombocytosis is treated by addressing the condition that's causing it.
People who have secondary thrombocytosis usually don't need platelet-lowering medicines or procedures. This is because their platelets usually are normal (unlike in primary thrombocythemia).
Also, secondary thrombocytosis is less likely than primary thrombocythemia to cause serious problems related to blood clots and bleeding.
How Can Thrombocythemia and Thrombocytosis Be Prevented?
You can't prevent primary thrombocythemia. However, you can take steps to reduce your risk for complications. For example, you can control many of the risk factors for blood clots, such as high blood cholesterol, high blood pressure, diabetes, and smoking.
To reduce your risk, quit smoking, adopt healthy lifestyle habits, and work with your doctor to manage your risk factors.
It's not always possible to prevent conditions that lead to secondary thrombocytosis. But, if you have routine medical care, your doctor may detect these conditions before you develop a high platelet count.
Living With Thrombocythemia or Thrombocytosis
If you have thrombocythemia or thrombocytosis:
If you're taking medicines to lower your platelet count, tell your doctor or dentist about them before any surgical or dental procedures. These medicines thin your blood and may increase bleeding during these procedures.
Medicines that thin the blood also may cause internal bleeding. Signs of internal bleeding include bruises, bloody or tarry-looking stools, pink or bloody urine, increased menstrual bleeding, bleeding gums, and nosebleeds. Contact your doctor right away if you have any of these signs.
Avoid over-the-counter pain medicines such as ibuprofen (except Tylenol®). These medicines may raise your risk of bleeding in the stomach or intestines and may limit the effect of aspirin. Be aware that cold and pain medicines and other over-the-counter products may contain ibuprofen.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to thrombocythemia or thrombocytosis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
What Is Thrombocytopenia?
Thrombocytopenia (THROM-bo-si-to-PE-ne-ah) is a condition in which your blood has a lower than normal number of blood cell fragments called platelets (PLATE-lets).
Platelets are made in your bone marrow along with other kinds of blood cells. They travel through your blood vessels and stick together (clot) to stop any bleeding that may happen if a blood vessel is damaged. Platelets also are called thrombocytes (THROM-bo-sites) because a clot also is called a thrombus.
Overview
When your blood has too few platelets, mild to serious bleeding can occur. Bleeding can occur inside your body (internal bleeding) or underneath your skin or from the surface of your skin (external bleeding).
A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood. A platelet count of less than 150,000 platelets per microliter is lower than normal. If your blood platelet count falls below normal, you have thrombocytopenia.
However, the risk for serious bleeding doesn't occur until the count becomes very low—less than 10,000 or 20,000 platelets per microliter. Mild bleeding sometimes occurs when the count is less than 50,000 platelets per microliter.
Many factors can cause a low platelet count, such as:
How long thrombocytopenia lasts depends on its cause. It can last from days to years.
The treatment for this condition also depends on its cause and severity. Mild thrombocytopenia often doesn't require treatment. If the condition causes or puts you at risk for serious bleeding, you may need medicines or blood or platelet transfusions. Rarely, the spleen may need to be removed.
Outlook
Thrombocytopenia can be fatal, especially if the bleeding is severe or occurs in the brain. However, the overall outlook for people who have the condition is good, especially if the cause of the low platelet count is found and treated.
What Causes Thrombocytopenia?
Many factors can cause thrombocytopenia (a low platelet count). The condition can be inherited or acquired. ""Inherited"" means your parents pass the gene for the condition to you. ""Acquired"" means you aren't born with the condition, but you develop it. Sometimes the cause of thrombocytopenia isn't known.
In general, a low platelet count occurs because:
A combination of the above factors also may cause a low platelet count.
The Bone Marrow Doesn't Make Enough Platelets
Bone marrow is the sponge-like tissue inside the bones. It contains stem cells that develop into red blood cells, white blood cells, and platelets. When stem cells are damaged, they don't grow into healthy blood cells.
Many conditions and factors can damage stem cells.
Toxic Chemicals
Exposure to toxic chemicals—such as pesticides, arsenic, and benzene—can slow the production of platelets.
Alcohol
Alcohol also slows the production of platelets. A temporary drop in the platelet count is common among heavy drinkers, especially if they're eating foods that are low in iron, vitamin B12, or folate.
Genetic Conditions
Some genetic conditions can cause low numbers of platelets in the blood. Examples include Wiskott-Aldrich and May-Hegglin syndromes.
The Body Destroys Its Own Platelets
A low platelet count can occur even if the bone marrow makes enough platelets. The body may destroy its own platelets due to autoimmune diseases, certain medicines, infections, surgery, pregnancy, and some conditions that cause too much blood clotting.
Medicines
A reaction to medicine can confuse your body and cause it to destroy its platelets. Examples of medicines that may cause this to happen include quinine; antibiotics that contain sulfa; and some medicines for seizures, such as Dilantin,® vancomycin, and rifampin. (Quinine is a substance often found in tonic water and nutritional health products.)
Heparin is a medicine commonly used to prevent blood clots. But an immune reaction may trigger the medicine to cause blood clots and thrombocytopenia. This condition is called heparin-induced thrombocytopenia (HIT). HIT rarely occurs outside of a hospital.
In HIT, the body's immune system attacks a substance formed by heparin and a protein on the surface of the platelets. This attack activates the platelets and they start to form blood clots.
Blood clots can form deep in the legs (deep vein thrombosis), or they can break loose and travel to the lungs (pulmonary embolism).
Pregnancy
About 5 percent of pregnant women develop mild thrombocytopenia when they're close to delivery. The exact cause isn't known for sure.
The Spleen Holds On to Too Many Platelets
Usually, one-third of the body's platelets are held in the spleen. If the spleen is enlarged, it will hold on to too many platelets. This means that not enough platelets will circulate in the blood.
An enlarged spleen often is due to cancer or severe liver disease, such as cirrhosis (sir-RO-sis). Cirrhosis is a disease in which the liver is scarred. This prevents it from working well.
An enlarged spleen also might be due to a bone marrow condition, such as myelofibrosis (MI-eh-lo-fi-BRO-sis). With this condition, the bone marrow is scarred and isn't able to make blood cells.
Who Is at Risk for Thrombocytopenia?
People who are at highest risk for thrombocytopenia are those affected by one of the conditions or factors discussed in ""What Causes Thrombocytopenia?"" This includes people who:
People at highest risk also include heavy alcohol drinkers and pregnant women.
What Are the Signs and Symptoms of Thrombocytopenia?
Mild to serious bleeding causes the main signs and symptoms of thrombocytopenia. Bleeding can occur inside your body (internal bleeding) or underneath your skin or from the surface of your skin (external bleeding).
Signs and symptoms can appear suddenly or over time. Mild thrombocytopenia often has no signs or symptoms. Many times, it's found during a routine blood test.
Check with your doctor if you have any signs of bleeding. Severe thrombocytopenia can cause bleeding in almost any part of the body. Bleeding can lead to a medical emergency and should be treated right away.
External bleeding usually is the first sign of a low platelet count. External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.
![]()
Purpura and Petechiae. The photograph shows purpura (bruises) and petechiae (dots) on the skin. Bleeding under the skin causes the purple, brown, and red colors of the purpura and petechiae.
Other signs of external bleeding include:
Prolonged
bleeding, even from minor cuts
Abnormal vaginal
bleeding (especially heavy menstrual flow)
A lot of bleeding after surgery or dental work also might suggest a bleeding problem.
Heavy bleeding into the intestines or the brain (internal bleeding) is serious and can be fatal. Signs and symptoms include:
Blood in the
urine or
stool or
bleeding from the
rectum. Blood in the stool can appear as red blood or as a dark, tarry color. (Taking
iron supplements also can cause dark, tarry stools.)
Headaches and other
neurological symptoms. These problems are very rare, but you should discuss them with your doctor.
How Is Thrombocytopenia Diagnosed?
Your doctor will diagnose thrombocytopenia based on your medical history, a physical exam, and test results. A hematologist also may be involved in your care. This is a doctor who specializes in diagnosing and treating blood diseases and conditions.
Once thrombocytopenia is diagnosed, your doctor will begin looking for its cause.
Medical History
Your doctor may ask about factors that can affect your platelets, such as:
Physical Exam
Your doctor will do a physical exam to look for signs and symptoms of bleeding, such as bruises or spots on the skin. He or she will check your abdomen for signs of an enlarged spleen or liver. You also will be checked for signs of infection, such as a fever.
Diagnostic Tests
Your doctor may recommend one or more of the following tests to help diagnose a low platelet count. For more information about blood tests, go to the Health Topics Blood Tests article.
Blood Smear
A blood smear is used to check the appearance of your platelets under a microscope. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm.
Bone Marrow Tests
Bone marrow tests check whether your bone marrow is healthy. Blood cells, including platelets, are made in your bone marrow. The two bone marrow tests are aspiration (as-pih-RA-shun) and biopsy.
Bone marrow aspiration might be done to find out why your bone marrow isn't making enough blood cells. For this test, your doctor removes a sample of fluid bone marrow through a needle. He or she examines the sample under a microscope to check for faulty cells.
A bone marrow biopsy often is done right after an aspiration. For this test, your doctor removes a sample of bone marrow tissue through a needle. He or she examines the tissue to check the number and types of cells in the bone marrow.
Other Tests
If a bleeding problem is suspected, you may need other blood tests as well. For example, your doctor may recommend PT and PTT tests to see whether your blood is clotting properly.
Your doctor also may suggest an ultrasound to check your spleen. An ultrasound uses sound waves to create pictures of your spleen. This will allow your doctor to see whether your spleen is enlarged.
How Is Thrombocytopenia Treated?
Treatment for thrombocytopenia depends on its cause and severity. The main goal of treatment is to prevent death and disability caused by bleeding.
If your condition is mild, you may not need treatment. A fully normal platelet count isn't necessary to prevent bleeding, even with severe cuts or accidents.
Thrombocytopenia often improves when its underlying cause is treated. People who inherit the condition usually don't need treatment.
If a reaction to a medicine is causing a low platelet count, your doctor may prescribe another medicine. Most people recover after the initial medicine has been stopped. For heparin-induced thrombocytopenia (HIT), stopping the heparin isn't enough. Often, you'll need another medicine to prevent blood clotting.
If your immune system is causing a low platelet count, your doctor may prescribe medicines to suppress the immune system.
How Can Thrombocytopenia Be Prevented?
Whether you can prevent thrombocytopenia depends on its specific cause. Usually the condition can't be prevented. However, you can take steps to prevent health problems associated with thrombocytopenia. For example:
Avoid heavy drinking. Alcohol slows the production of
platelets.
Try to avoid contact with toxic chemicals. Chemicals such as pesticides, arsenic, and benzene can slow the production of
platelets.
Avoid medicines that you know have decreased your
platelet count in the past.
Talk with your doctor about getting vaccinated for
viruses that can affect your
platelets. You may need vaccines for
mumps,
measles,
rubella, and
chickenpox. You may want to have your child vaccinated for these viruses as well. Talk with your child's doctor about these vaccines.
Living With Thrombocytopenia
If you have thrombocytopenia, watch for any signs and symptoms of bleeding. Report these signs and symptoms to your doctor right away.
Symptoms can appear suddenly or over time. Severe thrombocytopenia can cause bleeding in almost any part of the body. Bleeding can lead to a medical emergency and should be treated right away.
You can take steps to avoid health problems associated with thrombocytopenia. Be aware of the medicines you’re taking, avoid injuries, and contact your doctor if you have a fever or other signs or symptoms of an infection.
Medicines
Avoid medicines that may affect your platelets and raise your risk of bleeding. Two examples of such medicines are aspirin and ibuprofen. These medicines may thin your blood too much. Be careful when using over-the-counter medicines—many contain aspirin or ibuprofen.
Tell your doctor about all of the medicines you take, including over-the-counter medicines, vitamins, supplements, and herbal remedies.
Injuries
Avoid injuries that can cause bruising and bleeding. Don't take part in contact sports such as boxing, football, or karate. These sports are likely to lead to injuries that can cause bleeding.
Other sports, such as skiing or horseback riding, also put you at risk for injuries that can cause bleeding. Ask your doctor about physical activities that are safe for you.
Take safety precautions, such as using a seatbelt while riding in a car and wearing gloves when working with knives and other tools.
If your child has thrombocytopenia, try to protect him or her from injuries, especially head injuries that can cause bleeding in the brain. Ask your child's doctor whether you need to restrict your child's activities.
Infection
If you've had your spleen removed, you may be more likely to become ill from certain types of infection. Watch for fever or other signs of infection and report them to your doctor promptly. People who have had their spleens removed may need vaccines to prevent certain infections.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, Go to:
What Is Thrombotic Thrombocytopenic Purpura?
Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder. In TTP, blood clots form in small blood vessels throughout the body.
The clots can limit or block the flow of oxygen-rich blood to the body's organs, such as the brain, kidneys, and heart. As a result, serious health problems can develop.
The increased clotting that occurs in TTP also uses up platelets (PLATE-lets) in the blood. Platelets are blood cell fragments that help form blood clots. These cell fragments stick together to seal small cuts and breaks on blood vessel walls and stop bleeding.
With fewer platelets available in the blood, bleeding problems can occur. People who have TTP may bleed inside their bodies, underneath the skin, or from the surface of the skin. When cut or injured, they also may bleed longer than normal.
""Thrombotic"" (throm-BOT-ik) refers to the blood clots that form. ""Thrombocytopenic"" (throm-bo-cy-toe-PEE-nick) means the blood has a lower than normal number of platelets. ""Purpura"" (PURR-purr-ah) refers to purple bruises caused by bleeding under the skin.
Bleeding under the skin also can cause tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae (peh-TEE-kee-ay). Petechiae may look like a rash.
![]()
Purpura and Petechiae. The photograph shows purpura (bruises) and petechiae (dots) on the skin. Bleeding under the skin causes the purple, brown, and red colors of the purpura and petechiae.
TTP also can cause red blood cells to break apart faster than the body can replace them. This leads to hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh)—a rare form of anemia. Anemia is a condition in which the body has a lower than normal number of red blood cells.
A lack of activity in the ADAMTS13 enzyme (a type of protein in the blood) causes TTP. The ADAMTS13 gene controls the enzyme, which is involved in blood clotting. The enzyme breaks up a large protein called von Willebrand factor that clumps together with platelets to form blood clots.
Types of Thrombotic Thrombocytopenic Purpura
The two main types of TTP are inherited and acquired. ""Inherited"" means the condition is passed from parents to children through genes. This type of TTP mainly affects newborns and children.
In inherited TTP, the ADAMTS13 gene is faulty and doesn't prompt the body to make a normal ADAMTS13 enzyme. As a result, enzyme activity is lacking or changed.
Acquired TTP is the more common type of the disorder. ""Acquired"" means you aren't born with the disorder, but you develop it. This type of TTP mostly occurs in adults, but it can affect children.
In acquired TTP, the ADAMTS13 gene isn't faulty. Instead, the body makes antibodies (proteins) that block the activity of the ADAMTS13 enzyme.
It's not clear what triggers inherited and acquired TTP, but some factors may play a role. These factors may include:
Quinine, which is a substance often found in tonic water and nutritional health products
If you have TTP, you may sometimes hear it referred to as TTP–HUS. HUS, or hemolytic-uremic syndrome, is a disorder that resembles TTP, but is more common in children. Kidney problems also tend to be worse in HUS. Although some researchers think TTP and HUS are two forms of a single syndrome, recent evidence suggests that each has different causes.
Outlook
TTP is a rare disorder. It can be fatal or cause lasting damage, such as brain damage or a stroke, if it's not treated right away.
TTP usually occurs suddenly and lasts for days or weeks, but it can continue for months. Relapses (or flareups) can occur in up to 60 percent of people who have the acquired type of TTP. Many people who have inherited TTP have frequent flareups that need to be treated.
Treatments for TTP include infusions of fresh frozen plasma and plasma exchange, also called plasmapheresis (PLAZ-ma-feh-RE-sis). These treatments have greatly improved the outlook of the disorder.
Other Names for Thrombotic Thrombocytopenic Purpura
Inherited Thrombotic Thrombocytopenic Purpura
Acquired Thrombotic Thrombocytopenic Purpura
If you have TTP, you may sometimes hear it referred to as TTP–HUS. HUS, or hemolytic-uremic syndrome, is a disorder that resembles TTP, but is more common in children. Kidney problems also tend to be worse in HUS. Although some researchers think TTP and HUS are two forms of a single syndrome, recent evidence suggests that each has different causes.
What Causes Thrombotic Thrombocytopenic Purpura?
A lack of activity in the ADAMTS13 enzyme (a type of protein in the blood) causes thrombotic thrombocytopenic purpura (TTP). The ADAMTS13 gene controls the enzyme, which is involved in blood clotting.
Not having enough enzyme activity causes overactive blood clotting. In TTP, blood clots form in small blood vessels throughout the body. These clots can limit or block the flow of oxygen-rich blood to the body's organs, such as the brain, kidneys, and heart. As a result, serious health problems can develop.
The increased clotting that occurs in TTP also uses up many of the blood's platelets. With fewer platelets available in the blood, bleeding problems can occur.
People who have TTP may bleed inside their bodies, underneath the skin, or from the surface of the skin. When cut or injured, they also may bleed longer than normal.
TTP also can cause red blood cells to break apart faster than the body can replace them. This leads to hemolytic anemia.
Inherited Thrombotic Thrombocytopenic Purpura
In inherited TTP, the ADAMTS13 gene is faulty. It doesn't prompt the body to make a normal ADAMTS13 enzyme. As a result, enzyme activity is lacking or changed.
""Inherited"" means that the condition is passed from parents to children through genes. A person who inherits TTP is born with two copies of the faulty gene—one from each parent.
Most often, the parents each have one copy of the faulty gene, but have no signs or symptoms TTP.
Acquired Thrombotic Thrombocytopenic Purpura
In acquired TTP, the ADAMTS13 gene isn't faulty. Instead, the body makes antibodies (proteins) that block the activity of the ADAMTS13 enzyme.
""Acquired"" means you aren't born with the condition, but you develop it sometime after birth.
Triggers for Thrombotic Thrombocytopenic Purpura
It's unclear what triggers inherited and acquired TTP, but some factors may play a role. These factors may include:
Quinine, which is a substance often found in tonic water and nutritional health products
Who Is at Risk for Thrombotic Thrombocytopenic Purpura?
Thrombotic thrombocytopenic purpura (TTP) is a rare disorder. Most cases of TTP are acquired. Acquired TTP mostly occurs in adults, but it can affect children. The condition occurs more often in women and in Black people than in other groups.
Inherited TTP mainly affects newborns and children. Most people who have inherited TTP begin to have symptoms soon after birth. Some, however, don't have symptoms until they're adults.
It isn't clear what triggers inherited and acquired TTP, but some factors may play a role. These factors may include:
Quinine, which is a substance often found in tonic water and nutritional health products
What Are the Signs and Symptoms of Thrombotic Thrombocytopenic Purpura?
Blood clots, a low platelet count, and damaged red blood cells cause the signs and symptoms of thrombotic thrombocytopenic purpura (TTP).
The signs and symptoms include:
Pinpoint-sized red or purple dots on the
skin. These dots, called
petechiae, often are found in groups and may look like a
rash.
Bleeding under the skin causes petechiae.
Fatigue (feeling very tired and weak).
If you've had TTP and have any of these signs or symptoms, you may be having a relapse (flareup). Ask your doctor when to call him or her or seek emergency care.
How Is Thrombotic Thrombocytopenic Purpura Diagnosed?
Your doctor will diagnosis thrombotic thrombocytopenic purpura (TTP) based on your medical history, a physical exam, and test results.
If TTP is suspected or diagnosed, a hematologist will be involved in your care. A hematologist is a doctor who specializes in diagnosing and treating blood disorders.
Medical History
Your doctor will ask about factors that may affect TTP. For example, he or she may ask whether you:
Have certain diseases or conditions, such as
cancer, HIV,
lupus, or infections (or whether you're pregnant).
Have used any products that contain
quinine. Quinine is a substance often found in tonic water and nutritional health products.
Physical Exam
As part of the medical history and physical exam, your doctor will ask about any signs or symptoms you've had. He or she will look for signs such as:
Speech changes or changes in awareness that can range from confusion to
passing out
Diagnostic Tests
Your doctor also may recommend tests to help find out whether you have TTP.
Blood Smear
For this test, a sample of blood is drawn from a vein, usually in your arm. Some of your blood is put on a glass slide. A microscope is then used to look at your red blood cells. In TTP, the red blood cells are torn and broken.
Platelet Count
This test counts the number of platelets in a blood smear. People who have TTP have a lower than normal number of platelets in their blood. This test is used with the blood smear to help diagnose TTP.
Bilirubin Test
When red blood cells die, they release a protein called hemoglobin (HEE-muh-glow-bin) into the bloodstream. The body breaks down hemoglobin into a compound called bilirubin. High levels of bilirubin in the bloodstream cause jaundice.
For this blood test, a sample of blood is drawn from a vein, usually in your arm. The level of bilirubin in the sample is checked. If you have TTP, your bilirubin level may be high because your body is breaking down red blood cells faster than normal.
Kidney Function Tests and Urine Tests
These tests show whether your kidneys are working well. If you have TTP, your urine may contain protein or blood cells. Also, your blood creatinine (kre-AT-ih-neen) level may be high. Creatinine is a blood product that's normally removed by the kidneys.
Lactate Dehydrogenase Test
This blood test measures a protein called lactate dehydrogenase (LDH). For this test, a sample of blood is drawn from a vein, usually in your arm.
Hemolytic anemia causes red blood cells to break down and release LDH into the blood. LDH also is released from tissues that are injured by blood clots as a result of TTP.
ADAMTS13 Assay
A lack of activity in the ADAMTS13 enzyme causes TTP. For this test, a sample of blood is drawn from a vein, usually in your arm. The blood is sent to a special lab to test for the enzyme's activity.
How Is Thrombotic Thrombocytopenic Purpura Treated?
Thrombotic thrombocytopenic purpura (TTP) can be fatal or cause lasting damage, such as brain damage or a stroke, if it's not treated right away.
In most cases, TTP occurs suddenly and lasts for days or weeks, but it can go on for months. Relapses (flareups) can occur in up to 60 percent of people who have acquired TTP. Flareups also occur in most people who have inherited TTP.
Plasma treatments are the most common way to treat TTP. Other treatments include medicines and surgery. Treatments are done in a hospital.
Plasma Therapy
Plasma is the liquid part of your blood. It carries blood cells, hormones, enzymes, and nutrients to your body.
TTP is treated with plasma therapy. This includes:
Fresh frozen
plasma for people who have inherited TTP
Plasma therapy is started in the hospital as soon as TTP is diagnosed or suspected.
For inherited TTP, fresh frozen plasma is given through an intravenous (IV) line inserted into a vein. This is done to replace the missing or changed ADAMTS13 enzyme.
Plasma exchange (also called plasmapheresis) is used to treat acquired TTP. This is a lifesaving procedure. It removes antibodies (proteins) from the blood that damage your ADAMTS13 enzyme. Plasma exchange also replaces the ADAMTS13 enzyme.
If plasma exchange isn't available, you may be given fresh frozen plasma until it is available.
During plasma exchange, an IV needle or tube is placed in a vein in your arm to remove blood. The blood goes through a cell separator, which removes plasma from the blood. The nonplasma part of the blood is saved, and donated plasma is added to it.
Then, the blood is put back into you through an IV line inserted into one of your blood vessels. The time required to complete the procedure varies, but it often takes about 2 hours.
Treatments of fresh frozen plasma or plasma exchange usually continue until your blood tests results and signs and symptoms improve. This can take days or weeks, depending on your condition. You'll stay in the hospital while you recover.
Some people who recover from TTP have flareups. This can happen in the hospital or after you go home. If you have a flareup, your doctor will restart plasma therapy.
Living With Thrombotic Thrombocytopenic Purpura
Some people fully recover from thrombotic thrombocytopenic purpura (TTP). However, relapses (flareups) can occur in many people who have acquired and inherited TTP.
If you've had TTP, call your doctor right away if you have signs or symptoms of a relapse. These signs and symptoms include:
Pinpoint-sized red or purple dots on the
skin. These dots, called
petechiae, often are found in groups and may look like a
rash.
Bleeding under the skin causes petechiae.
Fatigue (feeling very tired and weak).
If you've been treated for TTP, ask your doctor about medicines that may raise your risk of bleeding during a relapse, such as aspirin and ibuprofen.
Also, tell your doctor about all over-the-counter medicines you take, including vitamins, supplements, and herbal remedies.
Your doctor may ask whether you're using any products that contain quinine. Quinine is a substance often found in tonic water and nutritional health products. Quinine may trigger TTP or a flareup of the disorder.
If your child has inherited TTP, ask the doctor whether you need to restrict your child's activities.
Report any symptoms of infection, such as a fever, to your doctor. This is very important for people who have had their spleens removed.
Talk with your doctor about changing medicines that may raise your risk of TTP, such as ticlopidine and clopidogrel.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a Go to:
What Are Varicose Veins?
Varicose (VAR-i-kos) veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body.
Varicose veins are a common condition. They usually cause few signs and symptoms. Sometimes varicose veins cause mild to moderate pain, blood clots, skin ulcers (sores), or other problems.
Overview
Veins are blood vessels that carry blood from your body's tissues to your heart. Your heart pumps the blood to your lungs to pick up oxygen. The oxygen-rich blood then is pumped to your body through blood vessels called arteries.
From your arteries, the blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body's tissues. Your blood then returns to your heart through your veins to pick up more oxygen. For more information about blood flow, go to the Health Topics How the Heart Works article.
Veins have one-way valves that help keep blood flowing toward your heart. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins.
Many factors can raise your risk for varicose veins. Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity, lack of movement, and leg trauma.
Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.
Outlook
Varicose veins usually don't cause medical problems. If they do, your doctor may simply suggest making lifestyle changes.
Sometimes varicose veins cause pain, blood clots, skin ulcers, or other problems. If this happens, your doctor may recommend one or more medical procedures. Some people choose to have these procedures to improve the way their veins look or to relieve pain.
Many treatments for varicose veins are quick and easy and don't require a long recovery.
Vein Problems Related to Varicose Veins
Many vein problems are related to varicose veins, such as telangiectasias (tel-AN-juh-ek-TA-ze-uhs), spider veins, varicoceles (VAR-i-ko-seals), and other vein problems.
Telangiectasias
Telangiectasias are small clusters of blood vessels. They're usually found on the upper body, including the face.
These blood vessels appear red. They may form during pregnancy, and often they develop in people who have certain genetic disorders, viral infections, or other conditions, such as liver disease.
Because telangiectasias can be a sign of a more serious condition, see your doctor if you think you have them.
Spider Veins
Spider veins are a smaller version of varicose veins and a less serious type of telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body.
Spider veins often appear on the legs and face. They're red or blue and usually look like a spider web or tree branch. These veins usually aren't a medical concern.
Other Related Vein Problems
Other types of varicose veins include venous lakes, reticular veins, and hemorrhoids. Venous lakes are varicose veins that appear on the face and neck. Reticular veins are flat blue veins often seen behind the knees. Hemorrhoids are varicose veins in and around the anus.
What Causes Varicose Veins?
Weak or damaged valves in the veins can cause varicose veins. After your arteries and capillaries deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your legs must work against gravity to do this.
One-way valves inside the veins open to let blood flow through, and then they shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell.
Weak vein walls may cause weak valves. Normally, the walls of the veins are elastic (stretchy). If these walls become weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider, and it causes the flaps of the valves to separate.
When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often twist as they try to squeeze into their normal space. These are varicose veins.
![]()
Normal Vein and Varicose Vein. Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might (more...)
Older age or a family history of varicose veins may raise your risk for weak vein walls. You also may be at higher risk if you have increased pressure in your veins due to overweight or obesity or pregnancy.
Who Is at Risk for Varicose Veins?
Many factors may raise your risk for varicose veins, including family history, older age, gender, pregnancy, overweight or obesity, lack of movement, and leg trauma.
Family History
Having family members who have varicose veins may raise your risk for the condition. About half of all people who have varicose veins have a family history of them.
Older Age
Getting older may raise your risk for varicose veins. The normal wear and tear of aging may cause the valves in your veins to weaken and not work well.
Gender
Women tend to get varicose veins more often than men. Hormonal changes that occur during puberty, pregnancy, and menopause (or with the use of birth control pills) may raise a woman's risk for varicose veins.
Pregnancy
During pregnancy, the growing fetus puts pressure on the veins in the mother's legs. Varicose veins that occur during pregnancy usually get better within 3 to 12 months of delivery.
Lack of Movement
Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for varicose veins. This is because staying in one position for a long time may force your veins to work harder to pump blood to your heart.
Leg Trauma
Previous blood clots or traumatic damage to the valves in your veins can weaken their ability to move blood back to the heart, increasing the risk for varicose veins.
What Are the Signs and Symptoms of Varicose Veins?
The signs and symptoms of varicose veins include:
Signs of telangiectasias are clusters of red veins that you can see just under the surface of your skin. These clusters usually are found on the upper body, including the face. Signs of spider veins are red or blue veins in a web or tree branch pattern. Often, these veins appear on the legs and face.
See your doctor if you have these signs and symptoms. They also may be signs of other, more serious conditions.
Complications of Varicose Veins
Varicose veins can lead to dermatitis (der-ma-TI-tis), an itchy rash. If you have varicose veins in your legs, dermatitis may affect your lower leg or ankle. Dermatitis can cause bleeding or skin ulcers (sores) if the skin is scratched or irritated.
Varicose veins also can lead to a condition called superficial thrombophlebitis (THROM-bo-fleh-BI-tis). Thrombophlebitis is a blood clot in a vein. Superficial thrombophlebitis means that the blood clot occurs in a vein close to the surface of the skin. This type of blood clot may cause pain and other problems in the affected area.
How Are Varicose Veins Diagnosed?
Doctors often diagnose varicose veins based on a physical exam alone. Sometimes tests or procedures are used to find out the extent of the problem or to rule out other conditions.
Specialists Involved
If you have varicose veins, you may see a vascular medicine specialist or vascular surgeon. These doctors specialize in blood vessel conditions. You also may see a dermatologist. This type of doctor specializes in skin conditions.
Physical Exam
To check for varicose veins in your legs, your doctor will look at your legs while you're standing or sitting with your legs dangling. He or she may ask you about your signs and symptoms, including any pain you're having.
Diagnostic Tests and Procedures
Duplex Ultrasound
Your doctor may recommend duplex ultrasound to check blood flow in your veins and to look for blood clots. Duplex ultrasound combines traditional with Doppler ultrasound. Traditional ultrasound uses sound waves to create a picture of the structures in your body, in this case the blood vessels and anything that may be blocking the flow of blood. Doppler ultrasound uses sound waves to create pictures of the flow or movement of the blood through the veins. The two types of ultrasound together paint a picture that helps your doctor diagnose your condition.
During this test, a handheld device will be placed on your body and passed back and forth over the affected area. The device sends and receives sound waves. A computer will convert the sound waves into a picture of the blood flow in your arteries and veins.
Angiogram
Although it is not very common, your doctor may recommend an angiogram to get a more detailed look at the blood flow through your veins.
For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray images.
An angiogram can help your doctor confirm whether you have varicose veins or another condition.
How Are Varicose Veins Treated?
Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.
If varicose veins cause few symptoms, your doctor may simply suggest making lifestyle changes. If your symptoms are more severe, your doctor may recommend one or more medical procedures. For example, you may need a medical procedure if you have a lot of pain, blood clots, or skin disorders caused by your varicose veins.
Some people who have varicose veins choose to have procedures to improve how their veins look.
Although treatment can help existing varicose veins, it can't keep new varicose veins from forming.
Lifestyle Changes
Lifestyle changes often are the first treatment for varicose veins. These changes can prevent varicose veins from getting worse, reduce pain, and delay other varicose veins from forming. Lifestyle changes include the following:
Avoid standing or sitting for long
periods without taking a break. When sitting, avoid crossing your legs. Keep your legs raised when sitting, resting, or sleeping. When you can, raise your legs above the level of your
heart.
Do physical activities to get your legs moving and improve
muscle tone. This helps
blood move through your
veins.
Avoid wearing tight clothes, especially those that are tight around your waist,
groin (upper thighs), and legs. Tight clothes can make
varicose veins worse.
Your doctor may recommend compression stockings. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling and decreases swelling in the legs.
There are three types of compression stockings. One type is support pantyhose. These offer the least amount of pressure. A second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.
Prescription-strength compression hose are the third type of compression stockings. These stockings offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies. However, you need to be fitted for them in the store by a specially trained person.
Medical Procedures
Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins.
You may be treated with one or more of the procedures described below. Common side effects right after most of these procedures include bruising, swelling, skin discoloration, and slight pain.
The side effects are most severe with vein stripping and ligation (li-GA-shun). Rarely, this procedure can cause severe pain, infections, blood clots, and scarring.
Sclerotherapy
Sclerotherapy (SKLER-o-ther-ah-pe) uses a liquid chemical to close off a varicose vein. The chemical is injected into the vein to cause irritation and scarring inside the vein. The irritation and scarring cause the vein to close off, and it fades away.
This procedure often is used to treat smaller varicose veins and spider veins. It can be done in your doctor's office, while you stand. You may need several treatments to completely close off a vein.
Treatments typically are done every 4 to 6 weeks. Following treatments, your legs will be wrapped in elastic bandaging to help with healing and decrease swelling.
Microsclerotherapy
Microsclerotherapy (MI-kro-SKLER-o-ther-ah-pe) is used to treat spider veins and other very small varicose veins.
A small amount of liquid chemical is injected into a vein using a very fine needle. The chemical scars the inner lining of the vein, causing it to close off.
Endovenous Ablation Therapy
Endovenous ablation (ab-LA-shun) therapy uses lasers or radiowaves to create heat to close off a varicose vein.
Your doctor makes a tiny cut in your skin near the varicose vein. He or she then inserts a small tube called a catheter into the vein. A device at the tip of the tube heats up the inside of the vein and closes it off.
You'll be awake during this procedure, but your doctor will numb the area around the vein. You usually can go home the same day as the procedure.
Endoscopic Vein Surgery
For endoscopic (en-do-SKOP-ik) vein surgery, your doctor will make a small cut in your skin near a varicose vein. He or she then uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein.
Endoscopic vein surgery usually is used only in severe cases when varicose veins are causing skin ulcers (sores). After the procedure, you usually can return to your normal activities within a few weeks.
Ambulatory Phlebectomy
For ambulatory phlebectomy (fle-BEK-to-me), your doctor will make small cuts in your skin to remove small varicose veins. This procedure usually is done to remove the varicose veins closest to the surface of your skin.
You'll be awake during the procedure, but your doctor will numb the area around the vein. Usually, you can go home the same day that the procedure is done.
Vein Stripping and Ligation
Vein stripping and ligation typically is done only for severe cases of varicose veins. The procedure involves tying shut and removing the veins through small cuts in your skin.
You'll be given medicine to temporarily put you to sleep so you don't feel any pain during the procedure.
Vein stripping and ligation usually is done as an outpatient procedure. The recovery time from the procedure is about 1 to 4 weeks.
How Can Varicose Veins Be Prevented?
You can't prevent varicose veins from forming. However, you can prevent the ones you have from getting worse. You also can take steps to delay other varicose veins from forming.
Avoid standing or sitting for long periods without taking a break. When sitting, avoid crossing your legs. Keep your legs raised when sitting, resting, or sleeping. When you can, raise your legs above the level of your heart.
Do physical activities to get your legs moving and improve muscle tone. This helps blood move through your veins.
If you're overweight or obese, try to lose weight. This will improve blood flow and ease the pressure on your veins.
Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs. Tight clothes can make varicose veins worse.
Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.
Wear compression stockings if your doctor recommends them. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling in the veins and decreases swelling in the legs.
Living With Varicose Veins
Varicose veins are a common condition. They often cause few signs and symptoms. If your signs and symptoms are minor, your doctor may simply suggest making lifestyle changes.
If your condition is more severe—for example, if you have pain, blood clots, or skin ulcers (sores)—your doctor may recommend one or more medical procedures. Many treatments for varicose veins are quick and easy and don't require a long recovery.
For more information about lifestyle changes and medical procedures, go to ""How Are Varicose Veins Treated?""
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to varicose veins, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
What Is Vasculitis?
Vasculitis (vas-kyu-LI-tis) is a condition that involves inflammation in the blood vessels. The condition occurs if your immune system attacks your blood vessels by mistake. This may happen as the result of an infection, a medicine, or another disease or condition.
“Inflammation” refers to the body’s response to injury, including injury to the blood vessels. Inflammation may involve pain, redness, warmth, swelling, and loss of function in the affected tissues.
In vasculitis, inflammation can lead to serious problems. Complications depend on which blood vessels, organs, or other body systems are affected.
Overview
Vasculitis can affect any of the body's blood vessels. These include arteries, veins, and capillaries. Arteries carry blood from your heart to your body's organs. Veins carry blood from your organs and limbs back to your heart. Capillaries connect the small arteries and veins.
If a blood vessel is inflamed, it can narrow or close off. This limits or prevents blood flow through the vessel. Rarely, the blood vessel will stretch and weaken, causing it to bulge. This bulge is known as an aneurysm (AN-u-rism).
![]()
Vasculitis. Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of the normal artery. Figure B shows an inflamed, narrowed artery with decreased blood flow. The inset image shows a cross-section of the inflamed (more...)
The disruption in blood flow caused by inflammation can damage the body's organs. Signs and symptoms depend on which organs have been damaged and the extent of the damage.
Typical symptoms of inflammation, such as fever and general aches and pains, are common among people who have vasculitis.
Outlook
There are many types of vasculitis, but overall the condition is rare. If you have vasculitis, the outlook depends on:
Treatment often works well if it’s started early. In some cases, vasculitis may go into remission. ""Remission"" means the condition isn't active, but it can come back, or ""flare,"" at any time.
Sometimes vasculitis is chronic (ongoing) and never goes into remission. Long-term treatment with medicines often can control the signs and symptoms of chronic vasculitis.
Rarely, vasculitis doesn't respond well to treatment. This can lead to disability and even death.
Much is still unknown about vasculitis. However, researchers continue to learn more about the condition and its various types, causes, and treatments.
Types of Vasculitis
There are many types of vasculitis. Each type involves inflamed blood vessels. However, most types differ in whom they affect and the organs that are involved.
The types of vasculitis often are grouped based on the size of the blood vessels they affect.
Mostly Large Vessel Vasculitis
These types of vasculitis usually, but not always, affect the body’s larger blood vessels.
Behçet's Disease
Behçet's (beh-CHET'S) disease can cause recurrent, painful ulcers (sores) in the mouth, ulcers on the genitals, acne-like skin lesions, and eye inflammation called uveitis (u-ve-I-tis).
The disease occurs most often in people aged 20 to 40. Men are more likely to get it, but it also can affect women. Behçet's disease is more common in people of Mediterranean, Middle Eastern, and Far Eastern descent, although it rarely affects Blacks.
Researchers believe that a gene called the HLA-B51 gene may play a role in Behçet's disease. However, not everyone who has the gene gets the disease.
Giant Cell Arteritis
Giant cell arteritis (ar-ter-I-tis) usually affects the temporal artery, an artery on the side of your head. This condition also is called temporal arteritis. Symptoms of this condition can include headaches, scalp tenderness, jaw pain, blurred vision, double vision, and acute (sudden) vision loss.
Giant cell arteritis is the most common form of vasculitis in adults older than 50. It's more likely to occur in people of Scandinavian origin, but it can affect people of any race.
Polymyalgia Rheumatica
Polymyalgia rheumatica (POL-e-my-AL-jah RU-ma-ti-kuh), or PMR, commonly affects the large joints in the body, such as the shoulders and hips. PMR typically causes stiffness and pain in the muscles of the neck, shoulders, lower back, hips, and thighs.
PMR usually occurs by itself, but 10–20 percent of people who have PMR also develop giant cell arteritis. Also, about half of the people who have giant cell arteritis may develop PMR.
Takayasu's Arteritis
Takayasu's (tock-e-AH-sues) arteritis affects medium- and large-sized arteries, particularly the aorta and its branches. The condition sometimes is called aortic arch syndrome.
Though rare, Takayasu's arteritis mainly affects teenage girls and young women. The condition is most common in Asians, but it can affect people of all races.
Takayasu's arteritis is a systemic disease. A systemic disease is one that affects you in a general or overall way.
Symptoms of Takayasu's arteritis may include tiredness and a sense of feeling unwell, fever, night sweats, sore joints, loss of appetite, and weight loss. These symptoms usually occur before other signs develop that point to arteritis.
Mostly Medium Vessel Vasculitis
These types of vasculitis usually, but not always, affect the body’s medium-sized blood vessels.
Buerger's Disease
Buerger's disease, also known as thromboangiitis (THROM-bo-an-jee-I-tis) obliterans, typically affects blood flow to the hands and feet. In this disease, the blood vessels in the hands and feet tighten or become blocked. As a result, less blood flows to the affected tissues, which can lead to pain and tissue damage.
Rarely, Buerger's disease also can affect blood vessels in the brain, abdomen, and heart. The disease usually affects men aged 20 to 40 of Asian or Eastern European descent. The disease is strongly linked to cigarette smoking.
Symptoms of Buerger's disease include pain in the calves or feet when walking or pain in the forearms and hands with activity. Other symptoms include blood clots in the surface veins of the limbs and Raynaud's phenomenon.
In severe cases, ulcers may develop on the fingers and toes, leading to gangrene. The term ""gangrene"" refers to the death or decay of body tissues.
Surgical bypass of the blood vessels may help restore blood flow to some areas. Medicines generally don’t work well to treat Buerger’s disease. The best treatment is to stop using tobacco of any kind.
Central Nervous System Vasculitis
Central nervous system (CNS) vasculitis usually occurs as a result of a systemic vasculitis. A systemic vasculitis is one that affects you in a general or overall way.
Very rarely, vasculitis affects only the brain and/or spinal cord. When it does, the condition is called isolated vasculitis of the central nervous system or primary angiitis (an-jee-I-tis) of the central nervous system.
Symptoms of CNS vasculitis include headaches, problems thinking clearly, changes in mental function, or stroke-like symptoms, such as muscle weakness and paralysis (an inability to move).
Polyarteritis Nodosa
Polyarteritis nodosa (POL-e-ar-ter-I-tis no-DO-suh) can affect many parts of the body. This disorder often affects the kidneys, the digestive tract, the nerves, and the skin.
Symptoms often include fever, a general feeling of being unwell, weight loss, and muscle and joint aches, including pain in the calf muscles that develops over weeks or months.
Other signs and symptoms include anemia (a low red blood cell count), a lace- or web-like rash, bumps under the skin, and stomach pain after eating.
Researchers believe that this type of vasculitis is very rare, although the symptoms can be similar to those of other types of vasculitis. Some cases of polyarteritis nodosa seem to be linked to hepatitis B or C infections.
Mostly Small Vessel Vasculitis
These types of vasculitis usually, but not always, affect the body’s small blood vessels.
Essential Mixed Cryoglobulinemia
Essential mixed cryoglobulinemia (KRI-o-GLOB-u-luh-NE-me-uh) can occur alone or with a systemic vasculitis. A systemic vasculitis is one that affects the body in a general or overall way.
“Cryoglobulinemia” refers to abnormal proteins in the blood. These proteins form a gel when a blood sample is exposed to temperatures lower than normal body temperature.
Symptoms often include joint aches; weakness; nerve changes, such as numbness, tingling, and pain in the limbs; kidney inflammation; and a raised, bumpy, reddish-purple skin rash known as palpable purpura (PURR-purr-ah).
Although essential mixed cryoglobulinemia can occur with other conditions, most often it’s linked to chronic hepatitis C infection.
Henoch-Schönlein Purpura
Henoch-Schönlein purpura (HSP) is a type of vasculitis that affects the smallest blood vessels in the skin, joints, intestines, and kidneys. These blood vessels are called capillaries.
Symptoms often include stomach pain, aching and swollen joints, and signs of kidney damage, such as blood in the urine. Another symptom is a bruise-like rash that mostly shows up as reddish-purple blotches on the lower legs and buttocks (although it can appear anywhere on the body).
HSP is most common in children, but it also can affect teens and adults. In children, about half of all cases follow a viral or bacterial upper respiratory infection. Most people get better in a few weeks and have no lasting problems.
Hypersensitivity Vasculitis
Hypersensitivity vasculitis affects the skin. This condition also is known as allergic vasculitis, cutaneous (ku-TA-ne-us) vasculitis, or leukocytoclastic (LU-ko-si-TOE-klas-tic) vasculitis.
A common symptom is red spots on the skin, usually on the lower legs. For people who are bedridden, the rash appears on the lower back.
An allergic reaction to a medicine or infection often causes this type of vasculitis. Stopping the medicine or treating the infection usually clears up the vasculitis. However, some people may need to take anti-inflammatory medicines, such as corticosteroids, for a short time. These medicines help reduce inflammation.
Microscopic Polyangiitis
Microscopic polyangiitis (POL-e-an-jee-I-tis) affects small blood vessels, particularly those in the kidneys and lungs. The disease mainly occurs in middle-aged people; it affects men slightly more often than women.
The symptoms often aren't specific, and they can begin gradually with fever, weight loss, and muscle aches. Sometimes the symptoms come on suddenly and progress quickly, leading to kidney failure.
If the lungs are affected, coughing up blood may be the first symptom. Sometimes microscopic polyangiitis occurs with a vasculitis that affects the intestinal tract, the skin, and the nervous system.
The signs and symptoms of microscopic polyangiitis are similar to those of Wegener's granulomatosis (another type of vasculitis). However, microscopic polyangiitis usually doesn't affect the nose and sinuses or cause abnormal tissue formations in the lungs and kidneys.
The results of certain blood tests can suggest inflammation. These results include a higher than normal erythrocyte sedimentation rate (ESR); lower than normal hemoglobin (HEE-muh-glow-bin) and hematocrit (hee-MAT-oh-crit) levels (which suggest anemia); and higher than normal white blood cell and platelet (PLATE-let) counts.
Also, more than half of the people who have microscopic polyangiitis have certain antibodies (proteins) in their blood. These antibodies are called antineutrophil cytoplasmic autoantibodies (ANCA). ANCA also occur in people who have Wegener's granulomatosis.
Testing for ANCA can't be used to diagnose either of these two types of vasculitis. However, testing can help evaluate people who have vasculitis-like symptoms.
Wegener's Granulomatosis
Wegener's granulomatosis is a rare type of vasculitis. It affects men and women equally, but it occurs more often in Whites than in African Americans. This type of vasculitis can occur at any age, but it’s more common in middle-aged people.
Wegener's granulomatosis typically affects the sinuses, nose, and throat; the lungs; and the kidneys. The condition also can affect other organs.
In addition to inflamed blood vessels, the affected tissues also develop abnormal lumps called granulomas. If granulomas develop in the lungs, they can destroy the lung tissue. The damage can be mistaken for pneumonia or even lung cancer.
Symptoms of Wegener's granulomatosis often aren’t specific. They can begin slowly with fever, weight loss, and muscle aches. Sometimes the symptoms come on suddenly and progress rapidly, leading to kidney failure. If the lungs are affected, coughing up blood may be the first symptom.
The results of certain blood tests can suggest inflammation. These results include a higher than normal ESR; lower than normal hemoglobin and hematocrit levels (which suggest anemia); and higher than normal white blood cell and platelet counts.
Another test looks for antiproteinase-3 (an antineutrophil cytoplasmic autoantibody (ANCA)) in the blood. Most people who have active Wegener's granulomatosis will have this antibody. A small portion may have another ANCA known as antimyeloperoxidase-specific ANCA.
Having either ANCA antibody isn't enough on its own to make a diagnosis of Wegener's granulomatosis. However, testing for the antibodies can help support the diagnosis in patients who have other signs and symptoms of the condition.
A biopsy of an affected organ is the best way for your doctor to make a firm diagnosis. A biopsy is a procedure in which your doctor takes a small sample of your body tissue to examine under a microscope.
Other Names for Vasculitis
Who Is at Risk for Vasculitis?
Vasculitis can affect people of all ages and races and both sexes. Some types of vasculitis seem to occur more often in people who:
For more information, go to ""Types of Vasculitis.""
What Are the Signs and Symptoms of Vasculitis?
The signs and symptoms of vasculitis vary. They depend on the type of vasculitis you have, the organs involved, and the severity of the condition. Some people may have few signs and symptoms. Other people may become very sick.
Sometimes the signs and symptoms develop slowly, over months. Other times, the signs and symptoms develop quickly, over days or weeks.
Systemic Signs and Symptoms
Systemic signs and symptoms are those that affect you in a general or overall way. Common systemic signs and symptoms of vasculitis are:
Weight loss
General aches and pains
Organ- or Body System-Specific Signs and Symptoms
Vasculitis can affect specific organs and body systems, causing a range of signs and symptoms.
Skin
If vasculitis affects your skin, you may notice skin changes. For example, you may have purple or red spots or bumps, clusters of small dots, splotches, bruises, or hives. Your skin also may itch.
Eyes
If vasculitis affects your eyes, you may develop red, itchy, burning eyes. Your eyes also may become sensitive to light, and your vision may blur. Rarely, certain types of vasculitis may cause blindness.
Brain
If vasculitis affects your brain, symptoms may include headaches, problems thinking clearly, changes in mental function, or stroke-like symptoms, such as muscle weakness and paralysis (an inability to move).
Nerves
If vasculitis affects your nerves, you may have numbness, tingling, and weakness in various parts of your body. You also may have a loss of feeling or strength in your hands and fee","June 11, 2014."
91,18,"2018-02-02 04:25:06",v,91,"2018-02-02 05:29:14","von Willebrand Disease","
What Is von Willebrand Disease?
Von Willebrand disease (VWD) is a bleeding disorder. It affects your blood's ability to clot. If your blood doesn't clot, you can have heavy, hard-to-stop bleeding after an injury. The bleeding can damage your internal organs. Rarely, the bleeding may even cause death.
In VWD, you either have low levels of a certain protein in your blood or the protein doesn't work well. The protein is called von Willebrand factor, and it helps your blood clot.
Normally, when one of your blood vessels is injured, you start to bleed. Small blood cell fragments called platelets (PLATE-lets) clump together to plug the hole in the blood vessel and stop the bleeding. Von Willebrand factor acts like glue to help the platelets stick together and form a blood clot.
Von Willebrand factor also carries clotting factor VIII (8), another important protein that helps your blood clot. Factor VIII is the protein that's missing or doesn't work well in people who have hemophilia, another bleeding disorder.
VWD is more common and usually milder than hemophilia. In fact, VWD is the most common inherited bleeding disorder. It occurs in about 1 out of every 100 to 1,000 people. VWD affects both males and females, while hemophilia mainly affects males.
Types of von Willebrand Disease
The three major types of VWD are called type 1, type 2, and type 3.
Type 1
People who have type 1 VWD have low levels of von Willebrand factor and may have low levels of factor VIII. Type 1 is the mildest and most common form of VWD. About 3 out of 4 people who have VWD have type 1.
Type 2
In type 2 VWD, the von Willebrand factor doesn't work well. Type 2 is divided into subtypes: 2A, 2B, 2M, and 2N. Different gene mutations (changes) cause each type, and each is treated differently. Thus, it's important to know the exact type of VWD that you have.
Type 3
People who have type 3 VWD usually have no von Willebrand factor and low levels of factor VIII. Type 3 is the most serious form of VWD, but it's very rare.
Overview
Most people who have VWD have type 1, a mild form. This type usually doesn't cause life-threatening bleeding. You may need treatment only if you have surgery, tooth extraction, or trauma. Treatment includes medicines and medical therapies.
Some people who have severe forms of VWD need emergency treatment to stop bleeding before it becomes life threatening.
Early diagnosis is important. With the proper treatment plan, even people who have type 3 VWD can live normal, active lives.
What Causes von Willebrand Disease?
Von Willebrand disease (VWD) is almost always inherited. ""Inherited"" means that the disorder is passed from parents to children though genes.
You can inherit type 1 or type 2 VWD if only one of your parents passes the gene on to you. You usually inherit type 3 VWD only if both of your parents pass the gene on to you. Your symptoms may be different from your parents' symptoms.
Some people have the genes for the disorder but don't have symptoms. However, they still can pass the genes on to their children.
Some people get VWD later in life as a result of other medical conditions. This type of VWD is called acquired von Willebrand syndrome.
What Are the Signs and Symptoms of von Willebrand Disease?
The signs and symptoms of von Willebrand disease (VWD) depend on which type of the disorder you have. They also depend on how serious the disorder is. Many people have such mild symptoms that they don't know they have VWD.
If you have type 1 or type 2 VWD, you may have the following mild-to-moderate bleeding symptoms:
People who have type 3 VWD may have all of the symptoms listed above and severe bleeding episodes for no reason. These bleeding episodes can be fatal if not treated right away. People who have type 3 VWD also may have bleeding into soft tissues or joints, causing severe pain and swelling.
Heavy menstrual bleeding often is the main symptom of VWD in women. Doctors call this menorrhagia (men-o-RA-je-ah). They define it as:
However, just because a woman has heavy menstrual bleeding doesn't mean she has VWD.
How Is von Willebrand Disease Diagnosed?
Early diagnosis of von Willebrand disease (VWD) is important to make sure that you're treated and can live a normal, active life.
Sometimes VWD is hard to diagnose. People who have type 1 or type 2 VWD may not have major bleeding problems. Thus, they may not be diagnosed unless they have heavy bleeding after surgery or some other trauma.
On the other hand, type 3 VWD can cause major bleeding problems during infancy and childhood. So, children who have type 3 VWD usually are diagnosed during their first year of life.
To find out whether you have VWD, your doctor will review your medical history and the results from a physical exam and tests.
Medical History
Your doctor will likely ask questions about your medical history and your family's medical history. He or she may ask about:
Physical Exam
Your doctor will do a physical exam to look for unusual bruising or other signs of recent bleeding. He or she also will look for signs of liver disease or anemia (a low red blood cell count).
Diagnostic Tests
No single test can diagnose VWD. Your doctor may recommend one or more blood tests to diagnose the disorder. These tests may include:
Von Willebrand factor
antigen. This test measures the amount of von Willebrand factor in your
blood.
Von Willebrand factor ristocetin (ris-to-SEE-tin) cofactor activity. This test shows how well your von Willebrand factor works.
Factor VIII clotting activity. This test checks the clotting activity of factor VIII. Some people who have VWD have low levels of factor VIII activity, while others have normal levels.
Von Willebrand factor multimers. This test is done if one or more of the first three tests are abnormal. It shows the structure of your von Willebrand factor. The test helps your doctor diagnose what type of VWD you have.
You may have these tests more than once to confirm a diagnosis. Your doctor also may refer you to a hematologist to confirm the diagnosis and for followup care. A hematologist is a doctor who specializes in diagnosing and treating blood disorders.
How Is von Willebrand Disease Treated?
Treatment for von Willebrand disease (VWD) is based on the type of VWD you have and how severe it is. Most cases of VWD are mild, and you may need treatment only if you have surgery, tooth extraction, or an accident.
Medicines are used to:
Specific Treatments
One treatment for VWD is a man-made hormone called desmopressin. You usually take this hormone by injection or nasal spray. It makes your body release more von Willebrand factor and factor VIII into your bloodstream. Desmopressin works for most people who have type 1 VWD and for some people who have type 2 VWD.
Another type of treatment is von Willebrand factor replacement therapy. This involves an infusion of concentrated von Willebrand factor and factor VIII into a vein in your arm. This treatment may be used if you:
Antifibrinolytic (AN-te-fi-BRIN-o-LIT-ik) medicines also are used to treat VWD. These medicines help prevent the breakdown of blood clots. They're mostly used to stop bleeding after minor surgery, tooth extraction, or an injury. These medicines may be used alone or with desmopressin and replacement therapy.
Fibrin glue is medicine that's placed directly on a wound to stop bleeding.
Treatments for Women
Treatments for women who have VWD with heavy menstrual bleeding include:
Birth control pills. The
hormones in these pills can increase the amount of von Willebrand factor and factor VIII in your
blood. The hormones also can reduce menstrual blood loss. Birth control pills are the most recommended birth control method for women who have VWD.
For some women who are done having children or don't want children, endometrial ablation (EN-do-ME-tre-al ab-LA-shun) is done. This procedure destroys the lining of the uterus. It has been shown to reduce menstrual blood loss in women who have VWD.
If you need a hysterectomy (HIS-ter-EK-to-me; surgical removal of the uterus) for another reason, this procedure will stop menstrual bleeding and possibly improve your quality of life. However, hysterectomy has its own risk of bleeding complications.
Living With von Willebrand Disease
If you have von Willebrand disease (VWD), you can take steps to prevent bleeding and stay healthy.
For example, avoid over-the-counter medicines that can affect blood clotting, such as aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs). Always check with your doctor before taking any medicines.
Tell your doctor, dentist, and pharmacist that you have VWD. Your dentist can ask your doctor whether you need medicine before dental work to reduce bleeding.
You also may want to tell other people about your condition, like your employee health nurse, gym trainer, and sports coach. Making them aware will allow them to act quickly if you have an injury.
Consider wearing a medical ID bracelet or necklace if you have a serious form of VWD (for example, type 3). In case of a serious accident or injury, the health care team treating you will know that you have VWD.
Be physically active and maintain a healthy weight. Physical activity helps keep muscles flexible. It also helps prevent damage to muscles and joints. Always stretch before exercising.
Some safe physical activities are swimming, biking, and walking. Football, hockey, wrestling, and lifting heavy weights are not safe activities if you have bleeding problems. Always check with your doctor before starting any exercise program.
Your parents, brothers and sisters, and children also may have VWD. Talk with them about your diagnosis and suggest that they get tested too.
Pregnancy and von Willebrand Disease
Pregnancy can be a challenge for women who have VWD. Blood levels of von Willebrand factor and factor VIII tend to increase during pregnancy. However, women who have VWD can have bleeding problems during delivery. They also are likely to have heavy bleeding for an extended time after delivery.
You can take steps to lower the risk of complications during pregnancy. If possible, talk with a hematologist and an obstetrician who specializes in high-risk pregnancies before you become pregnant.
A hematologist is a doctor who specializes in diagnosing and treating blood disorders. An obstetrician is a doctor who provides treatment and care for pregnant women.
Consider using a medical center that specializes in high-risk obstetrics and has a hematologist on staff for prenatal care and delivery.
Before you have any invasive procedure, such as amniocentesis (AM-ne-o-sen-TE-sis), discuss with your doctor whether you need to take steps to prevent serious blood loss.
During your third trimester, you should have blood tests to measure von Willebrand factor and factor VIII to help plan for delivery.
You also should meet with an anesthesiologist to review your choices for anesthesia (AN-es-THE-ze-ah) and to discuss taking medicine to reduce your bleeding risk. The term ""anesthesia"" refers to a loss of feeling and awareness. Some types of anesthesia temporarily put you to sleep, while others only numb certain areas of your body.
With these steps for safety, most women who have VWD can have successful pregnancies.
Children and von Willebrand Disease
If your child has VWD that's severe enough to cause bleeding, anyone who cares for him or her should be told about the condition.
For example, the school nurse, teacher, daycare provider, coach, or any leader of afterschool activities should know, especially if your child has severe VWD. This information will help them handle the situation if your child has an injury.
Clinical Trials
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to von Willebrand disease, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.