Anemia Part-3

What are other causes of anemia?

Some of the most common causes include:

• Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons.
• Strict vegetarians are at risk if they do not take adequate vitamin supplements.
• Long-term alcoholics.
• People who have abnormal structure or function of the stomach or intestines leading to impaired B12 absorption despite adequate intake.

This typically causes macrocytic (large blood cell volume) anemia. Vitamin B12, along with folate, is involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia as well. This may also be caused by inadequate absorption, under-consumption of green, leafy vegetables, and also long-term heavy alcohol use.

• There can be rupture or destruction of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells. Examples of hemolytic anemia include hemolytic disease of the newborn, medication induced hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic anemia.
• A wide assortment of bone marrow diseases can cause anemia.
• For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
• Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
• Certain infections may involve the bone marrow and result in bone marrow impairment and anemia.
• Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow.
• Chronic alcohol consumption may lead to anemia via different pathways and thus, anemia is commonly seen in alcoholics.
• Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with longstanding chronic diseases.

Anemia Part-2

Can inadequate iron cause anemia?

Absolutely! As a matter of fact, iron deficiency is a very common cause of anemia. This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body's iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia.
Young women are likely to have low grade iron deficiency anemia because of the loss of blood each month through normal menstruation. This is generally without any major symptoms as the blood loss is relatively small and temporary.
Another common reason for iron deficiency anemia can be due to recurring or small ongoing bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding may be induced by medications, even very common over-the-counter drugs such as aspirin and ibuprofen (Advil, Motrin). Slow and chronic oozing from these ulcers can lead to loss of iron. Gradually, this could result in anemia. In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. Dizziness, lightheadedness, fatigue, confusion, shortness of breath, and even loss of consciousness can occur with severe, sudden blood loss anemia.

Heart Disease Part-7

Heart Disease Part-7

Heart Disease Part-7

Angioplasty and stenting

If the coronary angiogram (coronary=heart + angio=artery + gram=record) shows significant blockage in an artery, the cardiologist may attempt an angioplasty, in which a balloon is placed via a catheter (as with angiography) at the area of narrowing and when quickly inflated, compresses the offending plaque into the wall of the artery. Often a stent, or a metal cage, is placed at the site of angioplasty to keep the blood vessel from narrowing again. Should a stent be placed, patients are usually started on antiplatelet medication to prevent clot formation. Clopidogrel (Plavix) and prasugrel (Effient) are the two most common medications prescribed.

Surgery

For those patients with multiple coronary artery blockages, coronary artery bypass grafting may be a consideration.

Heart Disease Part-5

Heart Disease Part-5

 

Heart Disease Part-5

Heart catheterization or coronary angiography

This test is the gold standard for the diagnosis of coronary artery disease. A cardiologist inserts and then threads a small tube through the groin or arm into the coronary arteries, where dye is injected to directly visualize the arteries on an x-ray. This test defines the anatomy of the coronary arteries. At the time of the catheterization, if blockages are found, they may be potentially treated with angioplasty in which a balloon is inflated to squash the plaque into the blood vessel wall and the insertion of a stent (wire cage that prevents the blood vessel from narrowing again).
CT coronary angiogram may be used test to diagnose coronary artery disease. During this procedure, intravenous dye containing iodine is injected into the patient and CT scanning is performed to image the coronary arteries.
Prior to the angiogram, a calcium score may be obtained. The calcium CT scan can measure the amount of calcium within heart blood vessels. If the score is 0, meaning that there is no calcium present, the risk of having heart disease is zero. The higher the score, the increased risk of narrowed coronary arteries.

What is the treatment for heart disease?

Coronary artery disease is usually treated in a multi-step approach depending upon a patient's symptoms. The patient and healthcare provider need to work together to return the patient to a normal lifestyle.

Prevention of heart disease

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The key to the treatment is prevention. A healthy lifestyle includes exercise, proper nutrition, and smoking cessation. Moreover, controlling diabetes and high blood pressure to minimize contribution risk for heart disease is a major aspect of prevention.
An aspirin a day is recommended to decrease the risk for heart disease and should be started with the recommendation of a health care practitioner.
A little alcohol (one drink per day for women or two drinks per day for men) decreases the risk of heart disease compared to nondrinkers. However, it is not recommended that nondrinkers begin drinking.

Heart Disease Part-4

Heart Disease Part-4

 

Heart Disease Part-4

Echocardiography

Used with or without exercise, echocardiography can assess how the heart works. Using sound waves to generate an image, a cardiologist can evaluate many aspects of the heart. Echocardiograms can examine the structure of the heart including the heart valves, the thickness of the heart muscle, the septum (the tissues that separate the four heart chambers from each other) and the pericardial sac (the outside lining of the heart).
The test can indirectly assess blood flow to parts of the heart muscle. If there is decreased blood flow, then segments of the heart wall may not beat as strongly as adjacent heart muscle. These wall motion abnormalities signal the potential for coronary artery disease.
The echocardiogram can also assess the efficiency of the heart by measuring ejection fraction. Normally when the heart beats, it pushes more than 60% of the blood in the ventricle out to the body. Many diseases of the heart, including coronary artery disease, can decrease this percentage (the ejection fraction).

Perfusion studies

Radioactive chemicals like thallium or technetium can be injected into a vein and their uptake measured in heart muscle cells. Abnormally decreased uptake can signify decreased blood flow to parts of the heart because of coronary artery narrowing. This test may be used when the patient's baseline EKG is not normal and is less reliable when used to monitor a stress test.

Computerized tomography

The latest generation of CT scanners can take detailed images of blood vessels and may be used as an adjunct to determine whether coronary artery disease is present. In some institutions, the heart CT is used as a negative predictor. That means that the test is done to prove that the coronary arteries are normal rather than to prove that the disease is present.

Cholesterol Drugs May Boost Your Gums' Health, Too

Cholesterol Drugs May Boost Your Gums' Health, Too

 

The statin medications you take for your heart may have an unexpected side benefit: They help reduce inflammation of the gums, according to new research.

Using advanced imaging techniques, researchers were able to see that when people with gum disease took higher doses of the commonly prescribed cholesterol-lowering drugs, their gum inflammation decreased.
During the 12-week study, the researchers also looked for evidence of inflammation or hardening of the blood vessels (atherosclerotic disease) in the study volunteers, and they found that reduced gum inflammation was correlated with improved blood vessel health.
"There is a building, growing body of literature that draws a line between gum disease and atherosclerotic disease. In our study, benefits in the gums correlated with benefits in the arteries," said the study's senior author, Dr. Ahmed Tawakol, co-director of the Cardiac Imaging Trials Program at Massachusetts General Hospital and Harvard Medical School in Boston. "People with [gum disease] and atherosclerotic disease should likely be that much more vigilant in treating their gum disease."
The study was published online Oct. 2 in the Journal of the American College of Cardiology. Funding was provided by drug manufacturer Merck and Co., which does not produce the statin used in this study.
Currently, statins are prescribed to lower high levels of "bad" cholesterol, also known as LDL cholesterol. When there's too much LDL cholesterol, it can start to build up on blood vessel walls, leading to hardening of the arteries.
In the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.
According to editorial author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, a "consistent stream of data" shows that statins have benefits beyond their cholesterol-lowering properties.
"There are three big categories of how statins likely exert their effects: lowering LDL, reducing inflammation, and by modulating plaque," said Blaha.
The current study lends support to the idea that statins can reduce inflammation. It included 83 adults who had risk factors for, or already had, atherosclerosis. They were randomly assigned to take either 10 or 80 milligrams of a statin called atorvastatin (brand name Lipitor) for three months.
Everyone underwent imaging at the start of the study, again after four weeks and then at 12 weeks.
At the end of the study, the investigators had complete data on 59 people. They found a significant reduction in gum inflammation for the people taking 80 mg of atorvastatin compared to those on the 10-mg dose. Changes began as early as four weeks after people started taking the higher-dose drug.
There was a more significant reduction in gum inflammation for people who had more serious gum disease at the start of the study and took a higher dose of the statin. The researchers also found that a reduction in gum inflammation correlated with reduced blood vessel inflammation.
"It was really those on the higher-dose statins that had the benefit," noted Tawakol. But, "I would not recommend the use of statins outside the current guidelines," he added. "We see this trial more as a proof-of-principle trial. Our findings need to be confirmed in a larger clinical trial."
Still, he said, there's little harm in telling people to take care of gum disease. "Patients with known heart disease and known gum disease should have their gum disease evaluated and treated," Tawakol said.

Daily Walk May Cut Your Breast Cancer Risk

Daily Walk May Cut Your Breast Cancer Risk

FRIDAY, Oct. 4 (HealthDay News) -- Older women who walk every day may reduce their risk of developing breast cancer. And those who exercise vigorously may get even more protection, according to new research.
The study of more than 73,000 postmenopausal women found that walking at a moderate pace for an hour a day was associated with a 14 percent reduced breast cancer risk, compared to leading a sedentary lifestyle. An hour or more of daily strenuous physical activity was associated with a 25 percent reduced risk, the study found.
This is welcome news for women who aren't very athletic.
"The nice message here is, you don't have to go out and run a marathon to lower your breast cancer risk," said study researcher Alpa Patel, senior epidemiologist at the American Cancer Society, which funded the study.
"Go for a nice, leisurely walk an hour a day to lower risk," Patel advised.
Breast cancer is the leading cancer among women. In the United States, about one in eight women will develop the disease in her lifetime.

When they enrolled in 1992, the average age was nearly 63. The women completed a questionnaire about medical, environmental and demographic factors at the start and repeated the reports every two years between 1997 and 2009. The study participants also reported on their physical activity and time spent sitting, including watching television and reading, and reported any diagnosis of breast cancer.
During the follow-up, which was roughly 14 years, 4,760 women developed breast cancer.
The researchers compared the exercise habits of women who developed breast cancer and those who did not. About 9 percent never participated in physical activity, while about half reported walking as their sole activity.
Those who walked seven hours or more a week, even without engaging in other recreational physical activity, reaped protective benefits compared to those who walked three hours or less a week.
The message is encouraging, Patel said.
However, the study only found an association between moderate exercise and reduced breast cancer risk, not a direct cause-and-effect relationship.
While other studies have found that exercise lowered risk of breast cancer more for women with a lower body mass index (BMI) -- a calculation of body fat based on height and weight -- this study found the effect held regardless of BMI, weight gain in adulthood or use of postmenopausal hormone therapy.
Other studies have found a link between time spent sitting and breast cancer risk, but Patel's group did not find this link.
This is "a good news study for women," said another cancer expert, Dr. Laura Kruper, who was not involved with the research.
The findings add to the accumulating evidence about exercise lowering breast cancer risk, and present a goal that is reachable for most women, said Kruper, co-director of the breast cancer program at the City of Hope Cancer Center in Duarte, Calif.
"This is something nearly every woman can do," Kruper said of exercising moderately for an hour daily.
"This is not running a marathon," she said.
Her advice to sedentary women who want to reduce their breast cancer risk: "If you get off the couch and walk around, it would help."

Heart Disease Part-3

Heart Disease Part-3

 Heart Disease Part-3

How is heart disease diagnosed?

The diagnosis of heart disease begins with obtaining a history that the potential for coronary artery disease exists. Risk factors need to be assessed and risk stratification occurs. The type of testing that is recommended, if any, depends upon the potential that the patient's symptoms actually represent angina and are coming from the heart.
Heart disease tests
Not every patient with chest pain needs heart catheterization (the most invasive test). Instead, the healthcare provider will try to choose the testing modality that will best provide the diagnosis, and if coronary artery disease is present, decide what impairment, if any, is present.

Electrocardiogram (ECG or EKG)

The heart is an electrical pump, and the electrical impulses it generates can be detected on the surface of the skin. Normal muscle conducts electricity in a reproducible fashion. Muscle that has decreased blood supply conducts electricity poorly. Muscle that has lost its blood supply and has been replaced with scar tissue cannot conduct electricity. The electrocardiogram (EKG) is a noninvasive test used to reflect underlying heart conditions by measuring the electrical activity of the heart.
Some people have "abnormal" EKGs at baseline but this may be normal for them. It is important that an electrocardiogram be compared to previous tracings if one is available. If a patient has a baseline abnormal EKG, they should consider carrying a copy with them for reference should they ever need another EKG.

Stress testing

If the baseline EKG is relatively normal, then monitoring the EKG tracing while the patient exercises may uncover electrical changes that may indicate the presence of coronary artery disease. There are a variety of testing protocols used to determine whether the exercise intensity is high enough to prove that the heart is normal.
Some patients are unable to exercise on a treadmill, but they can still undergo cardiac stress testing by using intravenous medication that causes the heart to work harder.
Stress testing is done under the supervision of medical personnel because of the potential of provoking angina, shortness of breath, abnormal heart rhythms, and heart attack.

Heart Disease- Part-2

Heart Disease- Part-2

Heart Disease- Part-2

What are the symptoms of heart disease?

The typical symptoms of coronary artery disease are chest pain associated with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of signs and symptoms, and there may not even be specific chest pain. Other locations of pain and other symptoms may include shoulder or back ache, upper abdominal pain, nausea, and indigestion.
Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue and generalized weakness and the inability to complete routine physical tasks such as walking or climbing stairs.
Health care practitioners and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain. Health care practitioners may misinterpret these symptoms when patient answers "no" to the question whether "pain is present," even though the patient is experiencing other types of discomfort.
People with coronary artery disease usually have gradual progression of their symptoms. As an artery narrows over time, the symptoms of decreased blood flow to part of the heart muscle may increase in frequency and/or severity. Health care practitioners may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?), and whether there has been an acute change in the symptoms.
Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care.