#Migraine is a common, chronic disorder that is typically characterized by recurrent disabling attacks of headache and accompanying symptoms, including aura.
B-type natriuretic peptide (BNP) belongs to a family of protein hormones called natriuretic peptides. These natriuretic peptides have an important role in regulating the circulation. They act on blood vessels, causing them to dilate, or widen. They also work on the kidneys, causing them to excrete more salt and water. In addition, the natriuretic peptides reduce the production of various hormones that narrow blood vessels, boost the heart rate, or affect fluid retention; examples include adrenaline, angiotensin, and aldosterone.
Can you prevent varicose veins?
Even if you have a family history of varicose veins, they aren’t always inevitable, says Dr. Sherry Scovell, a vascular and endovascular surgeon at Harvard-affiliated Massachusetts General Hospital. Three simple strategies can help to prevent them.
1. Get moving. “Leading an active lifestyle is probably the most important thing that you can do for prevention,” says Dr. Scovell. Exercise, particularly walking, induces calf muscle contractions that keep blood flowing efficiently. “The calf muscles act like a heart for the veins,” she says. People sometimes believe that if they stand more and sit less, they can prevent vein problems. But that’s not true if you’re mostly standing still. “It’s better to move as much as possible,” says Dr. Scovell. Exercise also helps you maintain a healthy weight, which can keep varicose veins at bay.
2. Put your feet up. Give your legs a break by elevating your feet at the end of the day, and even during the middle of the day if you’ve got some spare time. This can relieve pressure on the veins to help keep them healthy.
3. Pull on compression stockings. These garments fit snugly on your legs, squeezing them slightly to help keep blood moving. People sometimes think they’re unfashionable and are reluctant to wear them. But today’s stockings don’t resemble old-fashioned versions, says Dr. Scovell. Compression stockings come in numerous styles, including calf-high tube socks, dress socks, and tall stockings that look like tights. “They make them in so many cool colors and patterns,” says Dr. Scovell. “They can be fashionable and still help your veins at the same time.” You can purchase over-the-counter compression stockings at a drugstore or get medical-grade options through your primary care doctor or a specialist.
Varicose veins entered my vocabulary when I noticed that my feet were different in their coloration; my left foot was darker than my right, and had a bruise-like discoloration at the heel. Some enlargement and irregular “snaking” of my veins was also apparant at that time.
I went to see a vascular surgeon who performed an ultrasound on my veins, and informed me that my popliteal valve, the one in the vein behind my knee, wasn’t working. This caused a constant column of blood, unchecked by a valve, to enlarge my veins.
I have been wearing compression stockings ever since, to slow down the enlargement of those veins.
My right leg has done better than my left, but still has a few varicose veins.
The compression stockings are hard for me to put on my legs, especially since I have arthritis in my hands. However, by learning a few tricks, this is not an intolerable burden.
First, you have to select your stockings. Jobst was the brand first suggested to me, and I used them for years. Recently, my big toe has been starting to cross over the second toe, a condition called “scissor toe”. The jobst stockings had toes in them, like most stockings, and I thought the compression acting on the toes was partially responsible for the scissor toe. Jobst has no open toe option that I can find. After going through several different brands, I settled on Sigvaris open toe. The label states the number of millimeters compression that is provided. More than 30 mm would be best, but 20-30mm. Is the tightest that my fingers will allow. More commonly I use 15 to 20, because after I swim the skin is wet, and wet skin simply gives too much friction to allow my painful hands to get the stockings on.
In the Harvard article, walking is also suggested, since the calf muscles act like a pumping mechanism on the deep veins to get the blood back to the heart. I learned from the article that the deep veins return 80% of the blood, and the superficial varicose veins only 20%, making them expendable. There are a number of different options for getting rid of the varicose veins, “sclerosing” them, including thermal and chemical treatments.
I walk a lot, going along with another suggestion from the article, although I don’t usually prop my legs up; I’m too busy running around to make propping a viable option.
Preventative treatment, such as I’ve been discussing, certainly beats having edematous legs with ulcers, such as I see in many older people.
Coronary artery bypass graft (CABG) was supported as superior to fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for three-vessel coronary artery disease (CAD). PCI failed to meet noninferiority criteria at 1-year follow-up in a study comparing outcomes between FFR-guided PCI using contemporary stents and CABG. This adds to existing evidence showing superior outcomes with CABG in patients with the most-complex CAD.
The sodium–glucose transporter-2 (SGLT-2) inhibitor empagliflozin was found to be beneficial in heart failure with preserved ejection fraction. Empagliflozin is the first medication shown to improve outcomes in this population. It’s unknown if this is a class effect of all SGLT-2 inhibitors, but this could be a game changer.
Poor-quality carbohydrates were linked to cardiovascular mortality, around the world. Consumption of higher-glycemic-index carbohydrates was associated with higher rates of cardiovascular disease and mortality in countries all around the world. These data are particularly important because lower-income countries often have diets high in refined carbohydrates, which may worsen cardiovascular disparities.
New guidelines for managing valvular heart disease were released. These new guidelines add or elevate several recommendations for transcatheter therapy, and they lower thresholds for intervention in some conditions.
The editors of Circulation: Cardiovascular Quality and Outcomes addressed racial-ethnic disparities. The editors affirmed that structural racism is a public health crisis and that the scientific publishing community can play a role in addressing it.
Tricuspid annuloplasty for moderate regurgitation during mitral-valve surgery was of unclear benefit. Annuloplasty was associated with less progression of moderate tricuspid regurgitation but more pacemakers at 2 years. Unfortunately, this mixed outcome does not clearly inform the decision on performing annuloplasty at the time of surgery, and longer-term follow-up is needed.
Immediate angiography was not beneficial in out-of-hospital cardiac arrest without ST elevation. Patients with out-of-hospital cardiac arrest who did not have ST elevation on their initial ECG did not benefit from immediate angiography. Although a potential coronary culprit was identified in about 40% of patients, neurologic injury was by far the most frequent cause of death, negating any benefit from coronary revascularization.
Many statin side effects are related to the “nocebo” effect. A creative study enrolled 60 people with statin intolerance and gave them 12 randomly ordered 1-month treatment periods: 4 periods of no medication, 4 of placebo, and 4 of statin. Symptom intensity did not differ between placebo and statin periods and, interestingly, some even had more symptoms on placebo. This demonstrates that some cases of “statin intolerance” may be related to the “nocebo” effect.
Shorter duration of dual antiplatelet therapy following PCI/stent placement was found to be acceptable in patients with high bleeding risk. A large, randomized trial found that 1 month of dual antiplatelet therapy provided similar clinical outcomes and a lower bleeding risk than 3-to-6-month regimens for this challenging patient subset.
“De-escalation” of dual antiplatelet therapy for patients undergoing PCI for acute myocardial infarction (MI). This industry-funded study evaluated patients who had received 1 month of aspirin plus ticagrelor after acute MI and stent placement and “de-escalated” half to aspirin plus clopidogrel. At 1 year, there was significantly less bleeding in the de-escalation group and a nonsignificant trend toward fewer ischemic events as well.
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