diseases_conditions.id,diseases_conditions.ts,diseases_conditions.title,diseases_conditions.diseases_conditions_detail,diseases_conditions.last_update,diseases_conditions.category_1_x_diseases_conditions_id
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.","{
""12"": {
""category_1_x_diseases_conditions.id"": 12,
""category_1.id"": 1,
""category_1.ts"": ""2018-02-02 04:25:06"",
""category_1.title"": ""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.","{
""13"": {
""category_1_x_diseases_conditions.id"": 13,
""category_1.id"": 1,
""category_1.ts"": ""2018-02-02 04:25:06"",
""category_1.title"": ""a""
}
}"
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.","{
""14"": {
""category_1_x_diseases_conditions.id"": 14,
""category_1.id"": 2,
""category_1.ts"": ""2018-02-02 04:25:06"",
""category_1.title"": ""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