Infographic: Acute Heart Failure (Nature Reviews)

Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome.

Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities.

As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.

Arthritic Conditions: The Signs & Symptoms Of Gout

#Gout is a common & complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in joints, most often in the big toe.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the bedsheet on it may seem intolerable.

Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares.

Symptoms

Gout in the big toe

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

  • Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. As gout progresses, you may not be able to move your joints normally.

Read about the ways to manage symptoms & prevent flares. https://mayocl.in/3P29WFA

Skin Cancers: ABCDE’s Of Melanoma (Mayo Clinic)

Moles are a common skin growth, and most are harmless. But changes in moles and other pigmented patches may be the sign of skin cancer, particularly melanoma.

When it comes to early detection, just remember the ABCDEs.

“A” is for asymmetry.

“You want moles to be perfectly symmetrical, such that you could put a mirror right down the middle of it and the image would look the same,” says Dr. Catherine Degesys, a Mayo Clinic dermatologist.

“B” stands for border.

“You want a nice crisp edge to these pigmented lesions and no scalloped edges or indistinct edges,” says Dr. Degesys.

“C” is for color.

“In general, you want moles to be a homogenous color and not have multiple different pigmented areas,” Dr. Degesys adds.

“D” represents the mole’s diameter. Pigmented lesions being greater than 6 millimeters potentially need further evaluation.

“E” is probably the most important, and that corresponds with evolution, says Dr. Degesys.

“Any pigmented lesion or any moles that are changing are something that really needs to be evaluated by a dermatologist.”

Women’s Health: What Is An Oophorectomy?

An oophorectomy is a surgical procedure where one or both of the ovaries are removed. This procedure can be done through a laparoscopic approach, a vaginal approach, or a laparotomy. Removing both ovaries will cause menopause to begin immediately.

There are many reasons why you may need an oophorectomy. This video provides a brief look at what the procedure is, how it’s done and important things to know.

Chapters: 0:00 What are ovaries? 0:17 What is an oophorectomy? 0:45 Why would you need an oophorectomy. 1:10 How is an oophorectomy performed? 2:13 Can you still get pregnant after an oophorectomy? 2:46 What is the recovery process after an oophorectomy? 3:38 Speak with your healthcare provider openly to discuss all of your options.

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Stroke Care: Deep Brain Stimulation ‘Pacemaker’ Restores Hand Movement

Deep brain stimulation for patients who experience a stroke.

Deep brain stimulation is a surgical procedure that involves implanting electrodes in the brain, which deliver electrical impulses that block or change the abnormal activity that cause symptoms. (Courtesy: Cleveland Clinic)

“He had limited use of his hand. It really wasn’t functioning,” explains Andre Machado, MD, PhD, who is Chairman of the Cleveland Clinic Neurological Institute. “He couldn’t do as much manual work, with both hands, and that was a limitation for his quality of life.”

For the study, Joe first underwent two surgical procedures — one to insert the DBS device under the skin of his chest, just below the collarbone, and the other, to implant the DBS electrode in a part of the cerebellum called the dentate nucleus. Once activated, the device, called an implantable pulse generator, serves as a specially-calibrated pacemaker for the brain, stimulating it to try and enhance motor rehabilitation.

COMMENTARY:

Many times in science, application precedes understanding. Deep brain stimulation, either by electrical or magnetic pulses is a good example.

It is not at all understood how the brain really works, much less how electrical and magnetic stimulation in the brain works. It may stimulate or slow down neural impulses, or interrupt the incoming signals or the outgoing messages. Are there any other possibilities?

At least it does work, Apparently.

One thing for certain is that deep brain stimulation is preferable to previous treatments, which produced small, destructive, irreversible lesions in the brain. At least these stimulations can be stopped if they don’t work.

I enjoyed this posting, since it reignited my interest in the cerebellum. This amazing Organ has more neurons than the rest of the brain combined, represented by innumerable small granule cells. I wasn’t even aware of the dentate nucleus, which is an island of cerebral cortex-like neurons in the white matter of the cerebellum. Apparently the action of the cerebellum is orchestrated through this and a couple of other islands of neurons. All of the coordination, movement, and thought processing accomplished in the cerebellum takes place through these nuclei.

It was also fascinating to learn of a patient who has complete lack of a cerebellum, and suffers only some mild incoordination and speech problems. Apparently, absent the cerebellum, the rest of the brain is largely capable of taking over the function of the missing cerebellum. Once the brain is formed, However, and dependent upon the cerebellum, damage to this organ causes a great deal of coordination, movement, and balance problems.

I’ll put another plug-in for sleep, diet and exercise, as well as being careful with your body. Prevention is far better than treatment.

—Dr. C.

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Potassium-Rich Diets Prevent Kidney Stones

Anyone who has ever had a kidney stone never wants a repeat of the blinding pain that comes when it passes. Now, a new study maps out a diet that can help guard against that.

The cornerstones of that diet include eating plenty of foods that contain potassium, as well as a few servings of low-fat dairy daily, to get enough calcium. High-potassium fruits and veggies that could help include bananas, oranges, grapefruits, apricots, mushrooms, peas, cucumbers, zucchini, and melons such as cantaloupe and honeydew.

To arrive at those recommendations, researchers from the Mayo Clinic used data from questionnaires completed by kidney stone patients between 2009 and 2018. The team compared the diets of 411 people who had already had their first kidney stone and a control group of 384 individuals.

“We had this information and then we, number one, could look at things that … differed between controls and kidney stone formers, but then we’ve also been following these people forward in time,” said study author Dr. John Lieske, director of the O’Brien Urology Research Center at the Mayo Clinic in Rochester, Minn.

During a median of just over four years of follow-up, 73 patients in the study had recurrent kidney stones.

Lower levels of calcium and potassium predicted that recurrence. After adjustments for non-dietary factors, lower calcium continued to be a predictor. So did lower potassium, but only among those who weren’t already taking certain types of diuretics and calcium supplements.

Read more at Health Day

COVID-19: HEART DISEASE RISKS RISE AFTER INFECTION

In December 2020, a week before cardiologist Stuart Katz was scheduled to receive his first COVID-19 vaccine, he came down with a fever. He spent the next two weeks wracked with a cough, body aches and chills. After months of helping others to weather the pandemic, Katz, who works at New York University, was having his own first-hand experience of COVID-19.

On Christmas Day, Katz’s acute illness finally subsided. But many symptoms lingered, including some related to the organ he’s built his career around: the heart. Walking up two flights of stairs would leave him breathless, with his heart racing at 120 beats per minute. Over the next several months, he began to feel better, and he’s now back to his normal routine of walking and cycling. But reports about COVID-19’s effects on the cardiovascular system have made him concerned about his long-term health. “I say to myself, ‘Well, is it really over?’” Katz says.

In one study1 this year, researchers used records from the US Department of Veterans Affairs (VA) to estimate how often COVID-19 leads to cardiovascular problems. They found that people who had had the disease faced substantially increased risks for 20 cardiovascular conditions — including potentially catastrophic problems such as heart attacks and strokes — in the year after infection with the coronavirus SARS-CoV-2. Researchers say that these complications can happen even in people who seem to have completely recovered from a mild infection.

Some smaller studies have mirrored these findings, but others find lower rates of complications. With millions or perhaps even billions of people having been infected with SARS-CoV-2, clinicians are wondering whether the pandemic will be followed by a cardiovascular aftershock. Meanwhile, researchers are trying to understand who is most at risk of these heart-related problems, how long the risk persists and what causes these symptoms.

COMMENTARY:

 The heart and Covid are connected from a variety of angles.

Obese people with high blood fats, diabetes, the metabolic syndrome tend to have atherosclerosis and heart problems, making them more susceptible to severe Covid and long Covid. Covid loves to involve the lining of blood vessels and the heart, the endothelium, where the number of ACE receptors are high.

The respiratory tract and lung are a particular target for Covid, and reduced oxygen from lung involvement can compromise the hard-working heart.

 Heart cells, cardio myocytes, can be directly infected with the virus. Even Covid vaccines can rarely produce myocarditis, raising the possibility that there is some antigenic similarity between the virus and heart cells, similar to the beta hemolytic streptococcus and the heart which sets up rheumatic fever. 

If this similarity is real, the tendency of Covid to compromise the immune system and produce a cytokine storm in severe cases could therefore specifically involve the heart.

The nature article indicates several different varieties of heart problems and is a recommended read. From my personal standpoint, arrhythmias were mentioned, and I already have trouble with a couple of different types, AF and NSVT.

To make definite statements about the likelihood of heart involvement in Covid is problematic. The patients reported on were infected with an earlier strain of Covid, and the present one, BA.5, seems to be milder, and  may not be as hard on the heart as previous strains. Many more people are now immunized, and the most susceptible patients may have passed away. There are medications to take, such as remdesivir, and even select immune globulins, such as an immuno-suppressed friend of mine was given when he contracted Covid recently.

The bottom line for me is that I am 90 years old and have no desire to let Covid have a crack at me, so I avoid big gatherings, and wear a mask whenever I am exposed.

—Dr. C.

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Diagnosis: Hypertensive Eye Disease (Infographic)

Hypertensive eye disease is diagnosed on the basis of a clinical history of #Hypertension and the presence of relevant pathological changes in the eye that are observed via fundoscopy or imaging. https://go.nature.com/3t0PahO

Commentary:

Control of hypertension is one of the triumphs of modern medicine, and there are many effective medications. One of the main problems that I hear about has  to do with taking too much of the medication, and having dizziness, especially on standing, which could cause a fall and injuries.

Abnormalities of the eye with hypertension are common. the doctor can look directly at the bare blood vessels as they course along the back of the eye. A hypertensive artery passing over a vein in the eye compresses it, producing a “nick” that doctors look for. other findings are shown in the info graphic.

These findings help doctors make a diagnosis, but only the rare complications of hypertensive optic atrophy and Choroidopathy actually endanger the vision.

The main organ that seems to suffer the most from hypertension is the heart, which has to work against a heavy load to pump the blood effectively at high pressure. This thickens the walls of the heart, especially the left side, making it less effective. Enlargement of the heart, heart attacks, and heart failure are not uncommon.

The brain is at risk with hypertensive arterial disease, and strokes can be a problem.

Kidney failure is also a real worry.

When you see your doctor for a blood pressure reading, make sure to take off coats and long sleeves. so that the bare arm can be tested. The left arm In right-handed people is preferable, because it has less musculature to shield the artery from compression by the blood pressure cuff.

Be sure you take your medication, if prescribed. The main emergency room visits occasioned by high blood pressure, such as 180/110, is when the patient skips the medication.

—Dr. C.

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