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Answer this question truthfully ### Question: What Procedure to Choose? ### Response: Although many indications are the same for performing either PCI or CABG, these two procedures have inherently different mechanisms. While PCI mitigates an obstruction, it can not prevent plaque progression or rupture in other involved segments of the artery. On the contrary, CABG is able to prevent future ischemic insults caused by plaque progression or rupture in other involved segments of the artery. Most studies report the same outcome with PCI and CABG, but there are some reports that favor CABG over PCI: The SYNTAX trial with 705 patients demonstrated a significantly higher rate of major adverse cardiovascular events and mortality rate among those who received PCI than the CABG cohort. Two Studies reported that CABG is more effective in prevention of late spontaneous MI when compared to PCI. ACA 2021 revascularization guideline recommends to consider the following factors to decide whether to chose PCI or CABG: SYNTAX Score SYNTAX score derived from a clinical trial with the same name which predicts the grade of the anatomic complexity and can be used as a decision-making tool. This score is a guide for selection of a revascularization procedure in patients with multivessel coronary artery disease. All cause mortality rate among patients with a coronary artery disease -associated SYNTAX score equal or greater than 33 were significantly lower when undergone CABG than PCI For patients with SYNTAX score lower than 33, no differences have been report in mortality rate of CABG and PCI Compliance to medications Preferences of patient Individual factors, such as anatomic complexity, which is discussed in the following table: PCI would help patients with STEMI and ischemic symptoms for less than 12 hours. Rescue PCI is recommended for STEMI patients who failed re-perfusion after fibrinolytic therapy to improve the survival. PCI has been related to improved survival rate when done in STEMI patients who are stable and presented 12 to 24 hours after symptom onset. Regardless of time from MI, PCI can increase survival in STEMI patients who developed complications such as ongoing ischemia, acute sever heart failure, or life-threatening cardiac arrhythmia. Performing the PCI is not beneficial in stable and asymptomatic STEMI patients who have a totally occluded infarct artery >24 hours after symptom onset with no evidence for sever ischemia. The role of PCI in asymptomatic STEMI patients who are presenting after 12 to 24 hours after symptom onset is not well studied. However, based on a small trial named BRAVE-2 a reduction in left ventricular infarct size has been reported among asymptomatic STEMI patients who were treated with an invasive strategy of coronary stent within 12 to 48 hours after symptom onset, compared to conservative therapies. Both PCI and CABG are indicated in patients with STEMI, cardiogenic shock, and hemodynamic instability. CABG is recommended for patients with STEMI who have mechanical complications such as ventricular septal rupture, mitral regurgitation because of papillary muscle infarction or rupture, or free wall rupture. Emergent or urgent CABG is recommended in STEMI patients whose PCI is not feasible with a large area of myocardial involvement. On the other hand, emergent or urgent CABG should be avoided in these patients in the absence of ischemia or large myocardial involvement. Furthermore, CABG is usually avoided if patients' distal targets are poor. The following algorithm demonstrates the proper revascularization in STEMI patients. The sole condition that fibrinolytic therapies are superior to PCI is when the duration from hospital presentation to PCI is anticipated to be more than 120 minutes. An early revascularization strategy could increase the survival rate in patients with STEMI complicated by cardiogenic shock. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are commonly used to assess the lesion significant. Fractional flow reserve (FFR) compares the maximal blood flow distal to the lesion to the normal maximal blood flow. On the other hand iFR compares the instantaneous wave-free ratio of the coronary pressure distal to the lesion during the diastole with the aortic pressure. Reported in numbers of trials which used FFR, FFR -guided PCI was successful in lowering the revascularization rate, procedure-related chest pain in patients with stable coronary artery disease and functionally significant stenosis. In one of these trials patients with abnormal FFR significantly benefited from PCI over medical therapy with lower rate of ischemia -driven revascularization and shorter procedural time. FFR -guided revascularization with CABG was more off-pump with fewer anastomosis and simpler procedure compared to CABG with angiogram -guided revascularization in one of the clinical trials. Although other studies reported similar outcomes in both. iFR measure does not require the administration of adenosine has been also studied in clinical trials. Results supported that this measure is not inferior to FFR and also showed less adverse outcome related to the procedure. Lower rate of long-term major adverse cardiac events has been reported when PCI was deferred with FFR greater than 0.80 or iFR that is >0.89. One of the trials named DEFER (Deferral of Percutaneous Intervention) reported that the rate of adverse outcome cardiac outcomes is similar in both group of patients whose PCI has been deferred either with a FFR greater than 0.75 or intermediate angiographic measures.
Answer this question truthfully ### Question: How a coronary risk profile performed? ### Response: Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood. Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding. The blood is sent to a laboratory, where the following are measured: Low density lipoprotein (LDL or "bad" cholesterol) High density lipoprotein (HDL or "good" cholesterol) Total cholesterol Triglycerides Very low density lipoprotein (VLDL cholesterol, though this is often calculated from the triglyceride level) Other blood tests, such as C-reactive protein (CRP), may be added to the profile in some laboratories.
Answer this question truthfully ### Question: How to prepare for a coronary risk profile? ### Response: You should not eat or drink anything except water for 9 - 12 hours before having your blood drawn.
Answer this question truthfully ### Question: How will a coronary risk profile feel? ### Response: When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Answer this question truthfully ### Question: Why is a coronary risk profile performed? ### Response: A coronary risk profile may be done: To screen adults and children for high blood cholesterol and triglycerides To follow people who have had high cholesterol levels and are being treated Screening for adults: The first screening test is performed between ages 20 - 35 in men, and ages 20 - 45 in women. (Note: Different national medical organizations recommend different starting ages.) Follow-up screening should be done every 5 years Screening is done for anyone who develops diabetes, high blood pressure, heart disease, or another illness caused by atherosclerosis. Follow-up testing is done to determine how well diet and medications are controlling high cholesterol. Screening for children is less agreed upon: Some experts recommend only screening children with risk factors, such as a family history of high cholesterol or early heart disease (a history of heart attacks before age 55 in men, and before age 65 in women). Some experts recommend screening all children, but according to the U.S. Preventive Services Task Force, there is not enough evidence to recommend for or against cholesterol screening in children.
Answer this question truthfully ### Question: What are normal results? ### Response: The ideal values are different for people without coronary artery disease or other risk factors than for those with known coronary artery disease, diabetes, or high blood pressure. The desired values in adults are: LDL: 70 - 130 mg/dL (lower numbers are desired) HDL: greater than 40 - 60 mg/dL (higher numbers are desired) Total cholesterol: less than 200 mg/dL (lower numbers are desired) Triglycerides: 10 - 150 mg/dL (lower numbers are desired) VLDL: 2 - 38 mg/dL Talk to your health care provider about the ideal levels in children. (Note: mg/dL = milligrams per deciliter) (Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.)
Answer this question truthfully ### Question: What do abnormal results mean? ### Response: Abnormal values may be a sign that you are at increased risk for atherosclerosis and related disorders, including: Heart disease Kidney disease Poor blood supply to the legs Stroke
Answer this question truthfully ### Question: What are the risks? ### Response: Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight but may include: Excessive bleeding Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken)
Answer this question truthfully ### Question: When could I drive after i underwent Coronary stent discharge instructions ? ### Response: You should not drive for 48 hours after the procedure.
Answer this question truthfully ### Question: What medications should I take after Coronary stent discharge instructions ? ### Response: Aspirin every day - usually for the rest of your life. Ask your doctor about the dose you should take. Plavix (clopidogrel) and Effient (prasugrel) may be used in addition to Aspirin to decrease the risk of a blood clot forming in the heart artery. You will be given a list of all medicines you should take once you are at home. Ask your doctor whether you should go back to taking the medications you were on before the procedure. Be sure your doctor knows about everything you are taking.
Answer this question truthfully ### Question: Should I take any OTC pain medications? ### Response: You may take acetaminophen (Tylenol) every six hours as needed for pain in the area where the catheter was placed. Please be sure you are not taking more than one product containing acetaminophen, and do not take more Tylenol than what is recommended on the label.
Answer this question truthfully ### Question: When may I resume my regular activities? ### Response: You may resume your regular activities one week after the procedure. Avoid lifting, pushing, or pulling anything heavier than 10 pounds in the first week after the procedure. Also avoid any exercise that causes you to hold your breath and bear down with your abdominal muscles. Begin your exercise program one week after the procedure at half your usual routine, then gradually work back to your full routine. Please ask your doctor about your exercise instructions.
Answer this question truthfully ### Question: When could I bathe or swim? ### Response: Usually after one week, when the puncture site is healed. This usually takes about a week. You may shower on the day after the procedure after removing the Band-Aid over your puncture site.
Answer this question truthfully ### Question: When can I go back to work after Coronary stent discharge instructions ? ### Response: It depends on the type of your work. You can ask your doctor when you can go back to work.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Coronary stent discharge instructions ? ### Response: Call your doctor if: There is bleeding at the catheter insertion site that does not stop when you apply pressure. There is swelling at the catheter site. Your leg or arm below where the catheter was inserted changes color, becomes cool to touch, or is numb. The small incision for your catheter becomes red or painful, or yellow or green discharge is draining from it. You have chest pain or shortness of breath that does not go away with rest. Your pulse feels irregular -- very slow (fewer than 60 beats), or very fast (over 100 to 120 beats) a minute. You have dizziness, fainting, or you are very tired. You are coughing up blood or yellow or green mucus. You have problems taking any of your heart medicines. You have chills or a fever over 101 °F.
Answer this question truthfully ### Question: What are the symptoms of Coronary vasospasm? ### Response: Coronary vasospasm may be silent (without symptoms) or it may result in chest pain or angina. If the spasm lasts long enough, it may even cause a heart attack. The main symptom is a type of chest pain called angina, which can be felt under the chest bone and is described as: Constricting Crushing Pressure Squeezing Tightness The pain: Often occurs at rest May occur at the same time each day, usually between midnight and 8:00 AM Lasts from 5 to 30 minutes It is usually severe. The pain may spread to the neck, jaw, shoulder, or arm. The person may lose consciousness. Unlike angina that is caused by hardening of the coronary arteries, chest pain and shortness of breath are often not present when you walk or exercise.
Answer this question truthfully ### Question: What causes Coronary vasospasm? ### Response: The spasm often occurs in coronary arteries that have not become hardened due to plaque buildup (atherosclerosis). However, it also can occur in arteries with plaque buildup. A contraction (squeezing) of muscles in the artery wall causes these spasms in the arteries. The contraction occurs in just one area of the artery. The coronary artery may appear normal during angiography, but it does not function normally.
Answer this question truthfully ### Question: Who is at highest risk for Coronary vasospasm ? ### Response: Coronary vasospasm affects approximately 4 out of 100,000 people. About 2% of patients with angina have coronary vasospasm. Coronary vasospasm occurs most commonly in people who smoke or who have high cholesterol or high blood pressure. In many people, coronary vasospasm may occur without any other heart risk factors and it may be triggered by: Alcohol withdrawal, Emotional stress, Exposure to cold, Medications that cause narrowing of the blood vessels (vasoconstriction), Stimulant drugs such as amphetamines and cocaine.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Coronary vasospasm ? ### Response: Immediately call- 911 or go to the hospital emergency room if you have a history of angina and the crushing or squeezing chest pain is not relieved by nitroglycerin. The pain may be due to a heart attack. Rest and nitroglycerin do not completely relieve the pain of a heart attack. A heart attack is a medical emergency. If you have symptoms of a heart attack, seek immediate medical help.
Answer this question truthfully ### Question: What are the symptoms of Deep vein thrombosis? ### Response: Changes in skin color (redness) in one leg Increased warmth in one leg Leg pain in one leg Leg tenderness in one leg Skin that feels warm to the touch Swelling (edema) of one leg
Answer this question truthfully ### Question: What causes Deep vein thrombosis? ### Response: Deep venous thrombosis (DVT) mainly affects the large veins in the lower leg and thigh. The clot can block blood flow and cause swelling and pain. When a clot breaks off and moves through the bloodstream, this is called an embolism. An embolism can get stuck in the brain, lungs, heart or another other area that can lead to severe damage. Blood clots may form when something causes the flow of blood in the veins to slow or change. {{#ev:youtube\|CETfozL0cQg}}
Answer this question truthfully ### Question: Who is at highest risk for Deep vein thrombosis ? ### Response: DVTs are most common in adults over age 60, but can occur at any age. Sitting for long periods when traveling can increase the risk of DVTs. This is most likely when one or more of the risk factors listed below are also present. Risk factors include: After a pacemaker catheter has been passed through the vein in the groin Bedrest Cigarette smoking Family history of blood clots Fractures in the pelvis or legs Giving birth within the last 6 months Heart failure Obesity Recent surgery (especially hip, knee, or female pelvic surgery) Too many blood cells being made by the bone marrow (polycythemia vera), causing the blood to be thicker and slower than normal You're also more likely to develop DVT if you have any of the following conditions: Blood that is more likely to clot (hypercoagulability) Cancer Taking estrogens or birth control pills. This risk is even higher if you smoke.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Deep vein thrombosis ? ### Response: Call your health care provider if you have symptoms of DVT. Go to the emergency room or call the local emergency number (such as 911) if you have DVT and you develop chest pain, difficulty breathing, coughing blood, fainting, loss of consciousness, or other severe symptoms.
Answer this question truthfully ### Question: What to expect if I have Deep vein thrombosis (Outlook/Prognosis)? ### Response: Many DVTs disappear without a problem, but they can return. Some people may have long-term pain and swelling in the leg known as post-phlebitic syndrome. Wearing tight (compression) stockings during and after the DVT may help prevent this problem. Blood clots in the thigh are more likely to break off and cause pulmonary embolism (PE) than blood clots in the lower leg or other parts of the body.
Answer this question truthfully ### Question: What are the symptoms of Dengue fever? ### Response: Dengue fever begins with a sudden high fever, often as high as 104–105 degrees Fahrenheit. A flat, red rash may appear over most of the body 2–5 days after the fever starts. A second rash, which looks like the measles, appears later in the disease. Infected people may have increased skin sensitivity and are very uncomfortable. Other symptoms include: Headache (especially behind the eyes) Fatigue Joint aches Muscle aches Nausea Swollen lymph nodes Vomiting
Answer this question truthfully ### Question: What causes Dengue fever? ### Response: Dengue fever is caused by one of four different but related viruses. It is spread by the bite of mosquitoes, most commonly the mosquito Aedes aegypti, which is found in tropic and subtropic regions. This includes parts of: Indonesian archipelago into northeastern Australia South and Central America Southeast Asia Sub-Saharan Africa Dengue fever is being seen more in world travelers. Dengue fever should not be confused with dengue hemorrhagic fever, which is a separate disease that is caused by the same type of virus but has much more severe symptoms.
Answer this question truthfully ### Question: Who is at highest risk for Dengue fever ? ### Response: Living or traveling to a region of the world where the infection is endemic is a risk factor for the disease. These regions include: Indonesian archipelago into northeastern Australia South and Central America Southeast Asia Sub-Saharan Africa The presence of water-holding containers in and around the home needed for the mosquito's to complete their development sustains the reservoir for disease and is a risk factor. Risk factors for severe disease include being a neonate or young child, female sex, high body mass index, a high viral load, genetic polymorphisms and previous infection with DENV-1 if the patient contracts the DENV-2 or DENV-3 strain. Diabetes and asthma are risk factors for fatal disease.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Dengue fever ? ### Response: Call your health care provider if you have traveled in an area where dengue fever is known to occur and have developed symptoms of the disease.
Answer this question truthfully ### Question: What to expect if I have Dengue fever (Outlook/Prognosis)? ### Response: The condition generally lasts a week or more. Although uncomfortable, dengue fever in most cases is not deadly. People with the condition should fully recover. Some people develop a more severe form of the disease which requires hospitalization.
Answer this question truthfully ### Question: What are the symptoms of Dextrocardia? ### Response: There are no symptoms of dextrocardia if the heart is normal. Conditions that may include dextrocardia may cause the following symptoms: Bluish skin Difficulty breathing Failure to grow and gain weight Fatigue Jaundice (yellow skin and eyes) Pale skin (pallor) Repeated sinus or lung infections
Answer this question truthfully ### Question: What causes Dextrocardia? ### Response: During the early weeks of pregnancy, the baby's heart develops. Sometimes, for reasons that are unclear, the heart develops and turns so that it points to the right side of the chest instead of the left side. There are several types of dextrocardia. Most involve other defects of the heart and abdomen area. The simplest type of dextrocardia is one in which the heart is a mirror image of the normal heart, and no other problems exist. This condition is rare. Usually in this case, the organs of the abdomen and the lungs will also be arranged in a mirror image of their normal position. For example, the liver will be on the left side instead of the right. Some people with mirror-image dextrocardia have a problem with the fine hairs (cilia) that filter the air going into their nose and air passages. This condition is called Kartagener syndrome. In the more common types of dextrocardia, heart defects are present in addition to the abnormal location of the heart. The most common heart defects seen with dextrocardia include: Double outlet right ventricle Endocardial cushion defect Pulmonary stenosis or atresia Single ventricle Transposition of the great vessels Ventricular septal defect The abdominal and chest organs in babies with dextrocardia may be abnormal and may not work correctly. A very serious syndrome that appears with dextrocardia is called heterotaxy. Heterotaxy means the organs (atria of the heart and abdominal organs) are not in their usual places. In heterotaxy, the spleen may be completely missing. Because the spleen is an extremely important part of the immune system, babies born without a spleen are in danger of severe bacterial infections and death. In another form of heterotaxy several small spleens exist, but may not work correctly. Heterotaxy may also include: Abnormal gallbladder system Problems with the lungs Problems with the structure of the intestines Severe heart defects Possible risk factors for dextrocardia include: Family history of the condition Mother with diabetes (may play a role in some forms of dextrocardia)
Answer this question truthfully ### Question: Who is at highest risk for Dextrocardia ? ### Response: Like most congenital heart defects, it is unclear exactly why certain babies are born with dextocardia. There is evidence to suggest that families with a history of genetic problems and other congenital heart disease may be at an increased risk for carrying and expressing the trait. Genetic testing may be performed to assist you in estimating the likelihood that any future children may be born with dextrocardia. Expectant mothers who consume alcohol and illicit drugs during pregnancy are putting their fetus at an increased risk for a congenital heart disease, such as dextrocardia.
Answer this question truthfully ### Question: What to expect if I have Dextrocardia (Outlook/Prognosis)? ### Response: Babies with simple dextrocardia have a normal life expectancy and should have no problems related to the location of the heart. When dextrocardia appears with other defects in the heart and elsewhere in the body, how well the baby does depends on the severity of the problems. The death rate in babies and children without a spleen may be high due to infections. This is at least partially preventable with daily antibiotics.
Answer this question truthfully ### Question: What are the symptoms of Diffuse esophageal spasm? ### Response: Difficulty swallowing or pain with swallowing Pain in the chest or upper abdomen It can be hard to tell a spasm from angina pectoris, a symptom of heart disease. The pain may spread to the neck, jaw, arms, or back
Answer this question truthfully ### Question: What causes Diffuse esophageal spasm? ### Response: The cause of diffuse esophageal spasm is unknown. Very hot or very cold foods may trigger an episode in some people.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Diffuse esophageal spasm ? ### Response: Call for an appointment with your health care provider if you have symptoms of diffuse esophageal spasm that don't go away.
Answer this question truthfully ### Question: What to expect if I have Diffuse esophageal spasm (Outlook/Prognosis)? ### Response: A diffuse esophageal spasm may come and go (intermittent) or last for a long time (chronic). Medicine can help relieve symptoms.
Answer this question truthfully ### Question: What are the symptoms of Dilated Cardiomyopathy? ### Response: Symptoms of heart failure are most common. Usually, they develop slowly over time. However, sometimes symptoms start very suddenly and are severe. Common symptoms are: Chest pain or pressure (more likely when you exercise) Cough Fatigue, weakness, faintness Irregular or rapid pulse Loss of appetite Shortness of breath with activity or after lying down (or being asleep) for a while Swelling of feet and ankles (in adults)
Answer this question truthfully ### Question: What causes Dilated Cardiomyopathy? ### Response: Heart disease (which is caused by a narrowing of the arteries) and poorly controlled high blood pressure are the most common causes of dilated cardiomyopathy. These problems lead to a weakened and enlarged heart muscle. There are many other causes of dilated cardiomyopathy, including: Alcohol or cocaine abuse, or medicines that can be toxic to the heart (such as drugs used to treat cancer) Abnormal heart rhythms in which the heart beats very fast for a long period of time Autoimmune illnesses, when the immune system attacks and destroys healthy body tissue by mistake Conditions that run in families Infections that involve the heart muscle Heart valves that are either too narrow or too leaky (regurgitant) Trace elements, such as lead, arsenic, or mercury This condition can affect anyone at any age. However, it is most common in adult men.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Dilated cardiomyopathy ? ### Response: Call your health care provider if you have symptoms of cardiomyopathy. If chest pain, palpitations, or faintness develop seek emergency medical treatment immediately.
Answer this question truthfully ### Question: What to expect if I have Dilated cardiomyopathy (Outlook/Prognosis)? ### Response: Heart failure is most often a chronic illness, which may get worse over time. Some people develop severe heart failure, in which medicines, other treatments, and surgery no longer help. Many people are at risk for deadly heart rhythms, and may need medicines or a defibrillator.
Answer this question truthfully ### Question: What are the symptoms of Disseminated intravascular coagulation ? ### Response: Bleeding, possibly from multiple sites in the body Blood clots Bruising Drop in blood pressure
Answer this question truthfully ### Question: What are the causes of Disseminated intravascular coagulation ? ### Response: Normally when you are injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, in persons with DIC, these proteins become abnormally active. This often occurs due to inflammation, infection, or cancer. Small blood clots form in the blood vessels. Some of these clots can clog up the vessels and cut off blood supply to various organs such as the liver, brain, or kidney. These organs will then be damaged and may stop functioning. Over time, the clotting proteins are consumed or used up. When this happens, the person is then at risk for serious bleeding, even from a minor injury or without injury. This process may also break up healthy red blood cells.
Answer this question truthfully ### Question: Who is at highest risk for Disseminated intravascular coagulation ? ### Response: Risk factors for DIC include: Blood transfusion reaction Cancer, especially certain types of leukemia Infection in the blood by bacteria or fungus Liver disease Pregnancy complications (such as placenta that is left behind after delivery) Recent surgery or anesthesia Sepsis (a serious infection) Severe tissue injury (as in burns and head injury)
Answer this question truthfully ### Question: When to seek urgent medical care when I have Disseminated intravascular coagulation ? ### Response: Go to the emergency room or call 911 if you have bleeding that won't stop.
Answer this question truthfully ### Question: What to expect if I have Disseminated intravascular coagulation (Outlook/Prognosis)? ### Response: The outcome depends on what is causing the disorder, but DIC can be life-threatening.
Answer this question truthfully ### Question: What are the symptoms of Dressler's syndrome? ### Response: Anxiety Chest pain May come and go (recur) Pain may be sharp and stabbing (pleuritic) or tight and crushing (ischemic) Pain may get worse when breathing and may go away when you stand or sit up Pain moves to the neck, shoulder, back, or abdomen Difficulty breathing Dry cough Fast heart rate (tachycardia) Fatigue Fever (more common with the second type of pericarditis) Malaise (general ill feeling) Splinting of ribs (bending over or holding the chest) with deep breathing
Answer this question truthfully ### Question: What causes Dressler's syndrome? ### Response: Two types of pericarditis can occur after a heart attack. The first type of pericarditis most often occurs within 2 to 5 days after a heart attack. When the body tries to clean up the diseased heart tissue, swelling and inflammation occur. The second type of pericarditis is also called Dressler's syndrome (or post-cardiac injury syndrome or postcardiotomy pericarditis). It occurs several weeks or months after a heart attack, heart surgery, or other trauma to the heart. Dressler's syndrome is believed to be caused by the immune system attacking the area. Pain occurs when the pericardium becomes inflamed (swollen) and rubs on the heart.
Answer this question truthfully ### Question: Who is at highest risk for Dressler%27s syndrome ? ### Response: You have a higher risk of pericarditis if you have had a previous heart attack, open heart surgery, or chest trauma, or if your heat attack affected the thickness of your heart muscle.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Dressler%27s syndrome ? ### Response: Call your health care provider if: You develop symptoms of pericarditis after a heart attack You have been diagnosed with pericarditis and symptoms continue or come back, despite treatment
Answer this question truthfully ### Question: What to expect if I have Dressler%27s syndrome (Outlook/Prognosis)? ### Response: The condition may come back, even in people who receive treatment. In some cases, untreated pericarditis can be life threatening.
Answer this question truthfully ### Question: What causes Dyspnea? ### Response: Shortness of breath has many different causes: A blockage of the air passages in your nose, mouth, or throat may lead to difficulty breathing. Heart disease can cause breathlessness if your heart is unable to pump enough blood to supply oxygen to your body. If your brain, muscles, or other body organs do not receive enough oxygen, a sense of breathlessness may occur. Lung disease can cause breathlessness. Sometimes emotional distress, such as anxiety, can lead to difficulty breathing. The following problems may cause breathing difficulty: Problems with the lungs: Blood clot in the arteries of the lungs (pulmonary embolism) Bronchiolitis Chronic obstructive pulmonary disease (COPD), asthma, and other chronic lung problems Pneumonia Pulmonary hypertension Problems with the airways leading to the lungs: Choking on something stuck in the airways Croup Epiglottitis Problems with the heart: Heart attack or angina Heart defects from birth (congenital heart disease) Heart failure Heart rhythm disturbances (arrhythmias) Other problems: Allergies (such as to mold, dander, or pollen) Climbing to high altitudes where there is less oxygen in the air Compression of the chest wall Dust in the environment Hiatal hernia Obesity Panic attacks
Answer this question truthfully ### Question: What are the symptoms of Ebstein's anomaly of the tricuspid valve? ### Response: Symptoms of Ebstein's anomaly develop after birth and include bluish-colored lips and nails due to low blood oxygen levels. Symptoms range from mild to severe. In severe cases, the baby appears very sick and has trouble breathing. However in older children symptoms are mild, and include: Cough Failure to grow Fatigue Rapid breathing Shortness of breath Very fast heartbeat
Answer this question truthfully ### Question: What are the causes of Ebstein's anomaly of the tricuspid valve? ### Response: The exact cause of Ebstein's anomaly is unknown, however the use of certain drugs (such as lithium or benzodiazepines) during pregnancy may play a role. Ebstein's anomaly occurs as a baby develops in the womb. This condition is rare but it is more common among Caucasians. The tricuspid valve is made up of three parts, called leaflets or flaps. These leaflets or flaps allow blood to flow from the right atrium (top chamber) to the right ventricle (bottom chamber) while the heart relaxes. The leaflets close to prevent blood from flowing from the right ventricle to the right atrium while the heart pumps.The leaflets are unusually deep in the right ventricle and are often larger than normal in cases of Ebstein's anomaly. Due to the defect, blood may go the wrong way back into the right atrium, when it should be flowing to the right ventricle. When the blood gets backed up it can lead to heart swelling and fluid buildup in the lungs or liver. Sometimes, blood can't get out of the heart into the lungs and the person may appear blue. However in most cases of Ebstein's anomaly, patients have a hole in the wall which separates the heart's two upper chambers and the blood may flow across the hole. This may cause oxygen -poor blood to go to the rest of the body. There may also be narrowing of the valve that leads to the lungs (pulmonary valve).
Answer this question truthfully ### Question: Who is at highest risk for Ebsteins anomaly of the tricuspid valve ? ### Response: Since the exact cause of Ebstein's anomaly is unknown, it is difficult to distinguish who is at risk. However, the use of certain drugs (such as lithium or benzodiazepines) during pregnancy may play a role. Even though this condition is very rare, it is more common among Caucasians.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Ebsteins anomaly of the tricuspid valve ? ### Response: Call your health care provider if your child develops symptoms of this condition. Seek immediate medical attention if breathing problems occur.
Answer this question truthfully ### Question: What are the symptoms of Eisenmenger's syndrome? ### Response: Abnormal heart rhythm (arrhythmia) Bluish lips, fingers, toes, and skin (cyanosis) Chest pain Coughing up blood Dizziness Fainting Feeling tired Shortness of breath Stroke Swelling in the joints caused by too much uric acid (gout)
Answer this question truthfully ### Question: What causes Eisenmenger's syndrome? ### Response: Eisenmenger syndrome is caused by a defect in the heart. Most often, babies with this condition are born with a hole between the two pumping chambers -- the left and right ventricles -- of the heart (ventricular septal defect). The hole allows blood that has already picked up oxygen from the lungs to flow back into the lungs, instead of going out to the rest of the body. Other heart defects that can lead to Eisenmenger syndrome include: Atrioventricular canal defect Atrial septal defect Cyanotic heart disease Patent ductus arteriosus Truncus arteriosus Over time, increased blood flow can damage the small blood vessels in the lungs. This causes high blood pressure in the lungs. As a result, the blood backs up and does not go to the lungs to pick up oxygen. Instead, the blood goes from the right side to the left side of the heart, allowing oxygen-poor blood to travel to the rest of the body. Eisenmenger syndrome usually develops before a child reaches puberty. However, it also can develop in young adulthood.
Answer this question truthfully ### Question: Who is at highest risk for Eisenmenger%27s syndrome ? ### Response: Like most congenital heart defects, it is unclear exactly why certain babies are born with Eisenmenger's syndrome. There is evidence to suggest that families with a history of genetic problems and other congenital heart disease may be at an increased risk for carrying and expressing the trait. Genetic testing may be performed to assist you in estimating the likelihood that any future children may be born with Eisenmenger's syndrome. During pregnancy, expectant mothers exposed to rubella may have an increased risk in having a baby with a heart defect. Drug and alcohol exposure during pregnancy can also harm the fetus during development and result in potential birth defects.
Answer this question truthfully ### Question: What to expect if I have Eisenmenger%27s syndrome (Outlook/Prognosis)? ### Response: How well the infant or child does depends on whether another medical condition is present, and the age at which high blood pressure develops in the lungs. Patients with this condition can live 20 to 50 years.
Answer this question truthfully ### Question: How do I begin to read an ECG? ### Response: A short ECG recording of normal heart rhythm (sinus rhythm) An example of a normal ECG. Click on the Image for an enlargement
Answer this question truthfully ### Question: Where do you start when interpreting an ECG? ### Response: on the top left are the patient's information, name, sex and date of birth at the right of that are below each other the Frequency, the conduction times (PQ,QRS,QT/QTc), and the heart axis (P-top axis, QRS axis and T-top axis) further to the right is the interpretation of the ECG written (this often misses in a'fresh' ECG, but later the interpretation of the cardiologist or computer will be added) down left is the'paper speed' (25 mm/s on the horizontal axis), the sensitivity (10mm/mV) and the filter's frequency (40Hz, filters noise from eg. lights) finally there is a calibration on the ECG, on the beginning of every lead is a vertical block that shows with what amplitude a 1 mV signal is drawn. So the height and depth of these signals are a measurement for the voltage. If this is not the set at 10 mm, there is something wrong with the machine setting. further we have the ECG leads themselves of course, these will be discussed below. Note that the lay-out is different for every machine, but most machines will show the information above somewhere.
Answer this question truthfully ### Question: What does the ECG register? ### Response: The ECG is a registration of the heart's electric activity. Just like skeletal muscles, the heart is electrically stimulated to contract. This stimulation is also called activation or excitation. Cardiac muscles are electrically charged at rest. The inside of the cell is negatively charged relative to the outside (resting potential). If the cardiac muscle cells are electrically stimulated they depolarize (the resting potential changes from negative to positive) and contract. As the impulse spreads through the heart, the electric field changes continually in size and direction. The ECG is a graphical visualization of these electric signals in the heart. Normal sinus rhythm
Answer this question truthfully ### Question: When could I drive after i underwent Electrophysiology study and ablation discharge instructions ? ### Response: You should not drive after the procedure without asking your doctor when you could do that. This is different for everyone.
Answer this question truthfully ### Question: What medications should I take after Electrophysiology study and ablation discharge instructions ? ### Response: Ask your doctor whether you should go back to taking the medications you were on before the procedure. Be sure your doctor knows about everything you are taking.
Answer this question truthfully ### Question: Should I take any OTC pain medications? ### Response: You may take acetaminophen (Tylenol) every six hours as needed for pain in the area where the catheter was placed. Please be sure you are not taking more than one product containing acetaminophen, and do not take more Tylenol than what is recommended on the label.
Answer this question truthfully ### Question: When may I resume my regular activities? ### Response: You may resume your regular activities one week after the procedure. Avoid lifting, pushing, or pulling anything heavier than 10 pounds in the first week after the procedure. Also avoid any exercise that causes you to hold your breath and bear down with your abdominal muscles. Begin your exercise program one week after the procedure at half your usual routine, then gradually work back to your full routine. Please ask your doctor about your exercise instructions.
Answer this question truthfully ### Question: When can I go back to work after Electrophysiology study and ablation discharge instructions ? ### Response: It depends on the type of your work. You can ask your doctor when you can go back to work.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Electrophysiology study and ablation discharge instructions ? ### Response: Call your doctor if: Your wound looks infected (redness, increased drainage, swelling, painful). You feel dizzy or short of breath. You have chest pain. You have hiccups that do not go away. You were unconscious for a moment.
Answer this question truthfully ### Question: What are the symptoms of Endocarditis ? ### Response: Symptoms of endocarditis may develop slowly (subacute) or suddenly (acute). Fever is the classic symptom and may persist for days before any other symptoms appear. Other symptoms may include: Abnormal urine color Blood in the urine Chills Excessive sweating Fatigue Joint pain Muscle aches and pains Nail abnormalities (splinter hemorrhages under the nails) Night sweats (may be severe) Paleness Red, painless skin spots on the palms and soles (Janeway lesions) Red, painful nodes in the pads of the fingers and toes (Osler's nodes) Shortness of breath with activity Swelling of the feet, legs, abdomen Weakness Weight loss
Answer this question truthfully ### Question: What are the causes of Endocarditis ? ### Response: Endocarditis is usually a result of a blood infection. Bacteria or other infectious substance can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves. The bacteria can grow and may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen. Most people who develop infectious endocarditis have underlying heart disease or valve problems. However, an organism commonly found in the mouth, Streptococcus viridans, is responsible for about 50% of all bacterial endocarditis cases. This is why dental procedures increase your chances for developing this condition. Such procedures are especially risky for children with congenital heart conditions. As a result, it is common practice for children with some forms of congenital heart disease and adults with certain heart-valve conditions to take antibiotics before any dental work. Other common culprits include Staphylococcus aureus and enterococcus. Staphylococcus aureus can infect normal heart valves, and is the most common cause of infectious endocarditis in intravenous drug users. Less common causes of infectious endocarditis include pseudomonas, serratia, and candida.
Answer this question truthfully ### Question: Who is at highest risk for Endocarditis ? ### Response: The following increase your chances for developing endocarditis: Artificial heart valves Congenital heart disease (atrial septal defect, patent ductus arteriosus, and others) Heart valve problems (such as mitral insufficiency) History of rheumatic heart disease Intravenous drug users are also at risk for this condition, because unsterile needles can cause bacteria to enter the bloodstream.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Endocarditis ? ### Response: Call your health care provider if you note the following symptoms during or after treatment: Weight loss without change in diet Blood in urine Chest pain Weakness Numbness or weakness of muscles Fever
Answer this question truthfully ### Question: What to expect if I have Endocarditis (Outlook/Prognosis)? ### Response: Early treatment of bacterial endocarditis generally has a good outcome. Heart valves may be damaged if diagnosis and treatment are delayed.
Answer this question truthfully ### Question: What are the costs of dabigatran and warfarin? ### Response: The annual cost of therapy with Dabigatran are estimated to be $2,884 per patient. The cost of Warfarin is approximately $0.30 per day, $109.5 per year. (http://www.pharmacychecker.com/Pricing.asp?DrugName=Warfarin&DrugId=19462&DrugStrengthId=31721) There is a cost associated with INR monitoring of Warfarin of $2,134 per year in the first year (http://www.biomedcentral.com/1471-2296/8/6/) which drops to $1,170 in the second year once the patient is at a more stable level of anticoagulation. Let’s assume an average cost of $1,652 per year. The cost of Warfarin and its monitoring is therefore $1,761 per year. Thus, the incremental drug acquisition and monitoring costs of DabigatranDabigatran over Warfarin would be $2,884 - $1,761 per year or $1,123 per year.
Answer this question truthfully ### Question: How many patients would you need to treat to save a life? ### Response: Given the 0.5% mortality reduction (which was of borderline statistical significance for the 150 mg dose), you would need to treat 200 patients for one year to save one life.
Answer this question truthfully ### Question: How much would it cost to save that life? ### Response: That one year of therapy in 200 patients would cost an additional 200 X $1,123 or $224,600.
Answer this question truthfully ### Question: How long does someone with atrial fibrillation live after you save their life? ### Response: The average age of patients in RE-LYwas 71.4 years. The average years of life a female can expect to live beyond 71 years is 14 years and a male is 13 years: (http://www.census.gov/compendia/statab/cats/births_deaths_marriages_divorces/life_expectancy.html). Patients who have atrial fibrillation may live less than the usual 13.5 years for a 71 year old. The survival of an atrial fibrillation patient may depend upon co-morbidities. Although post CABG atrial fibrillation may have a limited impact on survival, some conditions such as systolic heart failure that are associated with atrial fibrillation are associated with a 1.9 fold higher risk of dying. Given that the risk of dying is doubled in these patients, let’s assume that the survival of a 71-year old atrial fibrillation patient is cut in half to 6.75 years. Using this number will yield a conservative estimate of cost effectiveness.
Answer this question truthfully ### Question: What is the cost per year of life saved with dabigatran? ### Response: Therefore, $224,600 in societal costs divided by those 6.75 years the person whose life was saved goes on to live equates to $33,274 per year of life saved. This is well within the acceptable limits for cost per year of life saved in the United States and similar to the cost per year of life saved for a defibrillator.
Answer this question truthfully ### Question: What if you factor in the reduction in costly strokes and the reduction in costs due to a reduction in bleeding? ### Response: If complications of pharmacotherapy are included in the cost effectiveness analysis, the cost effectiveness of dabigatran may be even more favorable. The lifetime cost of all cause stroke is estimated by the CDC to be $100,000. The rate of stroke per year was 1.57% for Warfarin and 1.01% for 150 mg of dabigatran. Therefore, there is a 0.56% lower rate of stroke per year. In our population of 200 patients, there would be expected to be 1.12 fewer strokes. If each stroke costs $100,000 over the lifetime of the patient then preventing 1.12 fewer cases with dabigatran would save $112,000. In addition to the small but statistically significant reduction in mortality associated with Dabigatran therapy, there were also numerically (but not statistically significantly) fewer major bleeds (3.4% vs 3.1% per year). The cost of a major bleed is estimated to be $8000 (personal communication, Dr. David Cohen). The cost of treating 200 patients with dabigatran would be reduced slightly by 0.6 bleeds or $4,800 dollars. There was an increased risk of MI of 0.21% (p=0.048) for dabigatran vs Warfarin (0.74% - 0.53%/year). The cost of a significant q wave MI is $7000 (Source: Dr. David Cohen). Treatment of the 200 patients with dabigatran would yield 0.4 of an MI at an increased cost of $2800. Treating 200 patients with dabigatran for a year costs an additional $224,600 over Warfarin. Among 200 treated patients, there is a cost reduction of $112,000 due to 1.12 fewer stroke cases with dabigatran. Among these 200 treated patients, there is a cost reduction of $4,800 due to 0.6 fewer major bleeds. There is also a cost increase of $2,800 among these 200 treated patients due to 0.4 MI cases. The total additional cost of dabigatran treatment inclusive of complications in 200 patients is $110,600. The cost per year of life saved assuming 6.75 years of survival could therefore be as low as $16,385. If society views $50,000 / year of life saved as cost effective, and' if it costs society $110,600 to save that life when the costs of complications are factored in, then' the survival of atrial fibrillation patients must only exceed 2.2 years for the therapy to be cost effective. (Spending $110,600 to save a life of someone who lives 2.2. years equates to $50,000 per year of life saved.) Most 71 year old atrial fibrillation patients survive more than 2.2 years.
Answer this question truthfully ### Question: What does it cost to prevent a stroke? ### Response: There was a reduction in all cause stroke from 1.57% / year for Warfarin to 1.01% / year for dabigatran, a 0.56% / year reduction. You would need to treat 179 patients with dabigatran to prevent one stroke. This would incur an incremental cost of 179 x $1,123, or $200,535. On the other hand, the lifetime cost of all cause stroke is estimated by the CDC to be $100,000. The net total cost would therefore be $100,535. Patients with stroke have a 2.3 fold higher mortality, so survival was estimated to be 13.5 / 2.3 = 5.8 years. That’s $17,333 per year of stroke-free life saved.
Answer this question truthfully ### Question: What are the limitations of a cost-effectiveness analysis like this? ### Response: These estimates are driven by “point estimates” A 0.5% improvement in mortality is small, and this point estimate may be unstable (p=0.051). Patients with atrial fibrillation may live longer than the 6.75 years assumed here. A longer survival time would reduce the cost per year of life saved. No quality adjusted life expectancy data is presented. These data mix present cost with future costs. Some cost estimates are old. There may be heterogeneity in costs of stroke, bleeding and MI throughout the world.
Answer this question truthfully ### Question: How do these costs fit in with what we spend on other things in society? ### Response: Last year, in TIME magazine, Sir Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence stated the following (http://www.time.com/time/health/article/0,8599,1888006,00.html#ixzz13Z0tUMuG): “ Our Department of Transport, for instance, has a cost-per-life-saved threshold for new road schemes of about 1.5 million GBP per life, or around 30,000 GBP per life year gained. The judgment of our health economists is that somewhere in the region of 20,000-30,000 GBP per quality-adjusted life year is the threshold, but it's not a strict limit. “ This would convert to 1.58 X 20,000 GBP = $31,600 USD to $47,400 USD. Thus, $16,000 to $33,000per year of life saved would fall within or even below this range. While estimates of what governments are willing to pay for are generally about $50,000 per year of life saved, hemodialysis costs approximately $129,000 per year of life saved. (http://www.time.com/time/health/article/0,8599,1808049,00.html)
Answer this question truthfully ### Question: What causes Fatigue? ### Response: There are many possible causes of fatigue, including: Anemia (including iron deficiency anemia) Depression or grief Medications such as sedatives or antidepressants Persistent pain Sleep disorders such as insomnia, obstructive sleep apnea, or narcolepsy Thyroid gland that is underactive or overactive Use of alcohol or drugs such as cocaine or narcotics, especially with regular use Fatigue can also occur with the following illnesses: Addison's disease Anorexia or other eating disorders Arthritis, including juvenile rheumatoid arthritis Autoimmune diseases such as systemic lupus erythematosis Cancer Congestive heart failure Diabetes Fibromyalgia Infection, especially one that takes a long time to recover from or treat, such as bacterial endocarditis (infection of the heart muscle or valves), parasitic infections, AIDS, tuberculosis, and mononucleosis Kidney disease Liver disease Malnutrition Certain medications may also cause drowsiness or fatigue, including antihistamines for allergies, blood pressure medicines, sleeping pills, steroids, and diuretics. Chronic fatigue syndrome (CFS) is a condition that starts with flu-like symptoms and lasts for 6 months or more. It is diagnosed after all other possible causes of fatigue are ruled out. Most people with CFS do not get much relief from rest.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Fatigue ? ### Response: Call your doctor right away if: You are confused or dizzy You have blurred vision You have little to no urine, or recent swelling and weight gain Call your doctor if: You have unexplained weakness or fatigue, especially if you also have a fever or unintentional weight loss You have constipation, dry skin, weight gain, or you cannot tolerate cold You wake up and fall back to sleep many times during the night You have headaches You are taking any medications, prescription or non-prescription, or using drugs that may cause fatigue or drowsiness You feel sad or depressed You have insomnia
Answer this question truthfully ### Question: What are the symptoms of Fibromuscular dysplasia? ### Response: Some patients experience no symptoms of the disease while others may have High blood pressure Dizziness or vertigo Chronic headache Intracranial aneurysm Ringing in the ears Weakness or numbness in the face Neck pain Changes in vision
Answer this question truthfully ### Question: What causes Fibromuscular dysplasia? ### Response: While the cause of fibromuscular dysplasia is unknown, it's believed that several factors may play a role. Genetics. Genetics may play a role in the development of fibromuscular dysplasia. But, if another family member has fibromuscular dysplasia, you or a relative may never get fibromuscular dysplasia, or you might get the condition in a different artery or have a milder case or a more severe case than your family member's fibromuscular dysplasia. In addition, not everyone who has fibromuscular dysplasia has a relative with the disease. Hormones. premenopausal women have this disease more often than men do. Abnormally formed arteries
Answer this question truthfully ### Question: Who is at highest risk for Fibromuscular dysplasia ? ### Response: These factors increases the risk for the patients Sex. Women have a much greater risk than men. Age. more common in people from 25 to 50 years old. Smoking appear to have an increased risk of developing fibromuscular dysplasia. For those already diagnosed with the disease, smoking increases further risk.
Answer this question truthfully ### Question: When to seek urgent medical care when I have Fibromuscular dysplasia ? ### Response: If you are young female and develop any of the above mentioned symptoms then you should call or visit a health care professional.
Answer this question truthfully ### Question: What to expect if I have Fibromuscular dysplasia (Outlook/Prognosis)? ### Response: After the diagnosis have been made, a repeat Doppler ultrasound exam or a CT angiogram is done every six to 12 months to see the prognosis.
Answer this question truthfully ### Question: What are the symptoms of Gonorrhea? ### Response: Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the disease, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person. Symptoms in men include: Burning and pain while urinating Increased urinary frequency or urgency Discharge from the penis (white, yellow, or green in color) Red or swollen opening of penis (urethra) Tender or swollen testicles Sore throat (gonococcal pharyngitis) Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include: Vaginal discharge Burning and pain while urinating Increased urination Sore throat Painful sexual intercourse Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area) Fever (if the infection spreads to the fallopian tubes and stomach area) If the infection spreads to the bloodstream, fever, rash, and arthritis -like symptoms may occur.
Answer this question truthfully ### Question: What causes Gonorrhea? ### Response: Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. Anyone who has any type of sex can catch gonorrhea. The infection can be spread by contact with the mouth, vagina, penis, or anus. The bacteria grow in warm, moist areas of the body, including the tube that carries urine out of the body (urethra). In women, the bacteria may be found in the reproductive tract (which includes the fallopian tubes, uterus, and cervix). The bacteria can even grow in the eyes. Health care providers in every state in the U.S. are required by law to tell their State Board of Health about anyone diagnosed with gonorrhea. The goal of this law is to make sure the patient gets proper follow-up care and that their sexual partners are found and tested. More than 700,000 persons in the United States get gonorrhea every year, according to the Centers for Disease Control and Prevention (CDC). Gonorrhea is more common in large cities, inner-city areas, populations with lower overall levels of education and people with lower socioeconomic status.
Answer this question truthfully ### Question: Who is at highest risk for Gonorrhea ? ### Response: You are more likely to develop this infection if you: Have multiple sexual partners Have a partner with a past history of any sexually transmitted disease Do not use a condom during sex Are a man who has sexual contact with another man Have a drug addiction
Answer this question truthfully ### Question: When to seek urgent medical care when I have Gonorrhea ? ### Response: If you have symptoms suggestive of gonorrhea, you should call your health care provider immediately. Most state-sponsored clinics will diagnose and treat STDs without charge.
Answer this question truthfully ### Question: What to expect if I have Gonorrhea (Outlook/Prognosis)? ### Response: A gonorrhea infection that has not spread to the bloodstream or other areas almost always can be cured with antibiotics. Gonorrhea that has spread is a more serious infection but almost always gets better with treatment.
Answer this question truthfully ### Question: Which coronary artery is the culprit one? ### Response: Click on the ECG for magnification. Click on answer for the results of the coronary angiography. Check the chapter on myocardial infarction if you would like to review related EKG and angiographic characteristics of the different culprit lesions in detail. Ami0001.jpg Answer example 1 Ami0002.jpg Answer example 2 Ami0003.jpg Answer example 3 Ami0004.jpg Answer example 4 Ami0005.jpg Answer example 5 Ami0006.jpg Answer example 6 Ami0007.jpg Answer example 7 Ami0008.jpg Answer example 8 Ami0009.jpg Answer example 9 Ami0010.jpg Answer example 10 Image courtesy of C. Michael Gibson MS. MD. and copylefted Answer Ami0013.jpg Answer example 12
Answer this question truthfully ### Question: Is the Disease Fatal? ### Response: Yes. HPS can be fatal. It has a mortality rate of 38%.
Answer this question truthfully ### Question: Are there any complications? ### Response: Previous observations of patients that develop HPS from New World Hantaviruses recover completely. No chronic infection has been detected in humans. Some patients have experienced longer than expected recovery times, but the virus has not been shown to leave lasting effects on the patient.
Answer this question truthfully ### Question: What are the symptoms of a Heart attack? ### Response: It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include: Chest discomfort - pressure, squeezing, or pain. The most common symptom of heart attack is chest pain or discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can be mild or severe. Heart attack pain can sometimes feel like indigestion or heartburn. Shortness of breath - Shortness of breath may often occur with or before chest discomfort. Discomfort in the upper body. Upper body discomfort in one or both arms, the back, neck, jaw, or stomach. Nausea, vomiting, dizziness, lightheadedness, sweating Not all heart attacks begin with a sudden, crushing pain that is often shown on TV or in the movies. The warning signs and symptoms of a heart attack aren’t the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don’t have symptoms at all (this is called a silent heart attack).
Answer this question truthfully ### Question: What causes Heart attack? ### Response: Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen -rich blood to the part of the heart muscle fed by the artery.