Mitral valve prolapse (MVP) is a condition in which the heart’s mitral valve doesn’t work well.

Definition

Mitral valve prolapse (MVP) is a condition in which the heart’s mitral valve doesn’t work well. The flaps of the valve are “floppy” and may not close tightly. These flaps normally help seal or open the valve. Much of the time, MVP doesn’t cause any problems. Rarely, blood can leak the wrong way through the floppy valve. This can lead to palpitations, shortness of breath, chest pain, and other symptoms. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)

The mitral valve is located between the left atrium and the left ventricle and has 2 flaps. Normally the flaps are tightly closed by small tendon or “cords” that connect the flaps to the muscles of the heart. This closure prevents blood from flowing backward. In MVP, the flaps enlarge and stretch inward toward the left atrium, sometimes “snapping” during heart contraction. This may allow some backflow or regurgitation of blood into the left atrium. MVP usually does not need to be treated because it is rarely a serious condition, and it doesn’t damage the heart. However, regular check-ups with a doctor are advised.

Epidemiology

The prevalence of this entity is 1% to 2.5% of the population. It is the most common cardiac valvular anomaly in developed countries. Myxomatous degeneration is the main etiology of prolapsing valvar leaflets, explaining the fact that MVP is uncommon before adolescence. Indeed, the prevalence of MVP was 0.7% in a population of healthy teenagers.

Types

There are 2 forms of MVP: primary and secondary.

Primary MVP

Primary MVP means the mitral valve is abnormal because of one or more of these changes:

One or both of the flaps are too large and thick

The flap surfaces are scarred

The tendon cords are thinner or longer than they should be

There are fibrin deposits on the flaps

Primary MVP is most often an isolated disease. But is can be linked to other valve or skeletal problems. Some rare instances of MVP are hereditary.

Secondary MVP

In secondary MVP, another disease is linked to MVP. Often the valve flaps are not thickened. Prolapse occurs for other reasons. The prolapse may be from:

Damage caused by decreased blood flow from coronary artery disease to the muscles attached to the tendon cords

Functional changes in the heart muscle

Damage to valve structures caused by heart attack, rheumatic heart disease, valve infection, or hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is when the left ventricle of the heart is larger than normal.

Damage caused by a connective tissue disorder such as Marfan syndrome

Mitral Valve Prolapse Risk factors

Factors that may increase your chance of getting mitral valve prolapse include:

Family histories of mitral valve prolapse

Female gender

Age: 14 to 30

Scoliosis

Thin chest diameter

Low body weight

Low blood pressure

Chest wall deformities

Marfan syndrome

Grave’s disease

Ehlers-Danlos syndrome

Ebstein’s anomaly

Causes

Common causes of mitral valve prolapse include:

Connective tissue disease

Coronary artery disease

Hypertrophic obstructive cardiomyopathy: A condition in which the ventricular walls have gotten excessively thick, making it difficult for the heart to pump blood

Myxomatous proliferation, a tumor near the valve

Rheumatic heart disease: Damaged heart valves and heart failure in patients with a history of rheumatic fever

Symptoms of Mitral Valve Prolapse

MVP may not cause any symptoms. Symptoms may vary depending on the degree of prolapse present. The presence of symptoms doesn’t necessarily match the severity of MVP.

These are the most common symptoms of MVP:

Fast or irregular heartbeats (palpitations): This may be the result of irregular heartbeats or just the sensation of the valve closing when the heart rhythm is normal.

Chest pain: Chest pain linked to MVP is different from chest pain associated with coronary artery disease. Usually, the chest pain is not like classic angina, such as pain with exertion, but it can happen often, can be very uncomfortable, and can affect your quality of life.

Anxiety

Hyperventilation

Exercise intolerance

Dizziness

Depending on the severity of the mitral regurgitation or leak, the left atrium or left ventricle may become enlarged, leading to symptoms of heart failure. These symptoms include weakness, tiredness, dizziness, and shortness of breath. The symptoms of mitral valve prolapse may look like other medical conditions or problems. Always see a healthcare provider for a diagnosis.

Mitral Valve Prolapse Complications           

Palpitations are sensations of fast or irregular heartbeats. In most patients with mitral valve prolapse, palpitations are harmless. In very rare cases, potentially serious heart rhythm abnormalities (for example, atrial fibrillation) may underlie palpitations and require further evaluation and treatment. Moreover, pulmonary hypertension may develop and lead to heart failure.

Sharp chest pains are reported in some patients with mitral valve prolapse, which can be prolonged. Unlike angina, chest pain with mitral valve prolapse rarely occurs during or after exercise, and may not respond to nitroglycerin.

Anxiety, panic attacks, and depression may be associated with mitral valve prolapse. Like fatigue, these symptoms are believed to be related to imbalances of the autonomic nervous system.

Migraine headaches have been occasionally linked to mitral valve prolapse. They are probably related to abnormal nervous system control of the tension in the blood vessels in the brain.

Mitral valve prolapse may be rarely associated with strokes occurring in young people. These patients appear to have increased blood clotting tendencies due to abnormally sticky blood-clotting elements, called platelets.

Often the severity of symptoms in patients with mitral prolapse is inversely correlated to the degree of anatomic abnormality. Many patients with severe symptoms have barely detectable prolapse, and the small minority with severe prolapse and valve dysfunction have no symptoms.

Diagnosis and test

People with MVP often have no symptoms and detection of a click or murmur may be discovered during a routine examination.

MVP may be detected by listening with a stethoscope, revealing a “click” (created by the stretched flaps snapping against each other during contraction) and/or a murmur. The murmur is caused by some of the blood leaking back into the left atrium. The click or murmur may be the only clinical sign.

In addition to a complete medical history and physical examination, diagnostic procedures for MVP may include any, or a combination, of the following:

Electrocardiogram (ECG or EKG): A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.

Echocardiogram (also called echo): A non-invasive test that uses sound waves to evaluate the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Echocardiography is the most useful diagnostic test for MVP.

In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:

Stress test (also called treadmill or exercise ECG): A test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.

Cardiac catheterization: With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate any narrowing, occlusions, or other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed.

Cardiac MRI: This is a non-invasive test that produces comprehensive images of the heart. It may be used as a complement to echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery.

Treatment and medications

Most people who have mitral valve prolapse (MVP) don’t need treatment because they don’t have symptoms and complications.

Even people who do have symptoms may not need treatment. The presence of symptoms doesn’t always mean that the backflow of blood through the valve is significant.

People who have MVP and troublesome mitral valve backflow may be treated with medicines, surgery, or both.

The goals of treating MVP include:

Correcting the underlying mitral valve problem, if necessary

Preventing infective endocarditis, arrhythmias, and other complications

Relieving symptoms

Medicines

Medicines called beta-blockers may be used to treat palpitations and chest discomfort in people who have little or no mitral valve backflow.

If you have significant backflow and symptoms, your doctor may prescribe:

Blood-thinning medicines to reduce the risk of blood clots forming if you have atrial fibrillation.

Digoxin to strengthen your heartbeat.

Diuretics (fluid pills) to remove excess sodium and fluid in your body and lungs.

Medicines such as flecainide and procainamide to regulate your heart rhythms.

Vasodilators to widen your blood vessels and reduce your heart’s workload. Examples of vasodilators are isosorbide dinitrate and hydralazine.

Surgery

Surgery is done only if the mitral valve is very abnormal and blood is flowing back into the atrium. The main goal of surgery is to improve symptoms and reduce the risk of heart failure.

Depending on the severity of the mitral valve defect, mitral valve repair or mitral valve replacement may be needed. At Cardiac Partners, expert heart surgeons perform mitral valve repair and replacement using minimally invasive techniques.

  • Mitral valve repair is surgery to repair the valve that controls blood flow through the left side of the heart. This procedure leaves a person with their own functioning tissue and doesn’t require blood-thinning medication over the long term.

Mitral valve replacement uses either a mechanical or a biological valve to replace the malfunctioning valve. Mechanical valves are man-made and can last a lifetime, but patients must take blood-thinning medicines for the rest of their lives. Biological valves don’t require taking blood-thinning medicines, but these valves weaken over time and often last only about 10 years.

Transcatheter valve therapy is performed by interventional cardiologists who repair leaky mitral valves by implanting a device using a catheter (tube) inserted through a large blood vessel. Cardiac Partners is on the program in South Jersey to offer transcatheter mitral valve repair (TMVr) with MitraClip™ therapy as a treatment option for patients who suffer from mitral regurgitation.

Prevention of Mitral Valve Prolapse

There are no current guidelines for preventing MVP of unknown or genetic origin. However, you may be able to prevent symptoms through certain lifestyle changes:

Avoid excess caffeine and alcohol, and any drugs that speed up your heart rate.

Exercise regularly and eat a heart-healthy diet.

Vertigo is a type of dizziness that can last just for a short period of time.

Definition

Vertigo is a type of dizziness that can last just for a short period of time (minutes) or that can last for hours or even days. People who have vertigo have a false feeling of their surroundings moving or spinning. This is usually accompanied by a feeling of sickness (nausea) and a loss of balance. The condition can also cause someone with the condition to be sick (vomit). Vertigo is a symptom and not a condition in itself. In most cases, there is a medical condition that causes vertigo. However, sometimes the cause is unknown.

Types of Vertigo

The two main types of vertigo are:

Peripheral Vertigo

It is caused by a problem in areas of the inner ear or the vestibular nerve, which connects the inner ear and the brain. This is the most common type of vertigo.

Central Vertigo

It happens when there’s a glitch in the brain, particularly in an area of the brain called the cerebellum.

RSV-HSN: A New Type of Vertigo

Researchers recently discovered a new kind of vertigo. Scientists called it “recurrent spontaneous vertigo with head-shaking nystagmus” (RSV-HSN).

To diagnose this condition, participants sat in a dark room while an examiner moved their heads forward and then side-to-side for about 15 seconds. Next, researchers video-recorded the participants’ eye motions. Results showed those with RSV-HSN had eye movements, known as “nystagmus,” that lasted longer than it does in others with vertigo.

The scientists say that, compared to other types of vertigo, RSV-HSN involves more severe bouts of motion sickness. In the study, people with RSV-HSN had attacks that included nausea, vomiting, headaches, and intolerance of head motions. They experienced symptoms anywhere from a few times a week to once a year. At this point, the cause of RSV-HSN isn’t known, but the condition does seem to respond well to medication.

Pathophysiology

The neurochemistry of vertigo includes six primary neurotransmitters that have been identified between the three-neuron arc that drives the vestibulo-ocular reflex (VOR). Glutamate maintains the resting discharge of the central vestibular neurons and may modulate synaptic transmission in all three neurons of the VOR arc.

Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. Gamma-Aminobutyric acid (GABA) is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells, and the lateral vestibular nucleus, and the vertical VOR.

Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear.

Dopamine, histamine, serotonin, and acetylcholine are neurotransmitters thought to produce vomiting. It is known that centrally acting antihistamines modulate the symptoms of acute symptomatic vertigo.

Vertigo risk factors

Factors that increase your risk of VAD include:

Cardiovascular diseases, especially in older adults

Recent ear infection, which causes an imbalance in the inner ear

History of head trauma

Medications, such as antidepressants and antipsychotics

Causes of Vertigo

Vertigo is often the result of an inner ear problem.

The most common cause is benign paroxysmal positional vertigo (BPPV). BPPV occurs when tiny calcium particles clump together in the part of the inner ear that helps control our balance, affecting the messages sent from your inner ear to your brain.

Other inner ear problems that can cause vertigo are Meniere’s disease, where there is associated tinnitus and hearing loss, and 2 conditions that involved swelling or infection of the inner ear, vestibular neuronitis and labyrinthitis.

Other causes of vertigo include head injuries, circulation problems, and infections.

Rarely, vertigo is caused by serious problems such as a brain tumor or a stroke.

Symptoms

If you have vertigo, you may feel as though you are spinning, falling or tumbling in space, or standing still while your surroundings are moving.

It often begins suddenly and may vary in intensity. It may be constant or it may come and go.

Vertigo or giddiness is often mistaken for light-headedness or dizziness. Light-headedness is a feeling that you are going to lose consciousness or faint (pass out). This feeling isn’t caused by an inner ear problem but is due to a lack of oxygen flowing to the brain.

If you have vertigo it’s normal to feel out of control and frightened – but in most cases, the causes of vertigo aren’t a serious health threat.

You may also have these symptoms:

Nausea and vomiting

Tinnitus or ringing in your ears

Decreased hearing

Ear pain

Complications of Vertigo

Complications can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

Adverse effects of treatment

Anxiety

Brain damage

Depression

Difficulty performing daily tasks

Diminished overall quality of life

Impaired balance and coordination

Nerve problems that cause pain, numbness or tingling

Paralysis

Permanent hearing loss

Permanent loss of sensation

Spread of cancer

Spread of infection

Traumatic injuries from falls

Unconsciousness and coma

Diagnosis and test

To assess what’s causing your vertigo, doctors will give you a number of subtests that examine the effectiveness and interaction of the vestibular system, or inner ear, the somatosensory system, or flex and pressure sensors in your feet, and the vision system — as well as how these systems contribute to your overall stability and balance. The assessment helps determine which system or systems may be contributing to your symptoms and gives direction for treatment.

The assessment includes a videonystagmography (VNG) or electronystagmography (ENG) test. The VNG or ENG evaluation is separated into three subtests.

Oculomotor

This assesses the oculomotor system, the visual system for balance. In this part of the test, we measure voluntary eye movements by having you complete a series of exercises while visually following a dot on a light bar.

Positional or Positioning

This part of the test focuses on the vestibular system, which is the balanced structure of the inner ear. We will ask you to move your head, or head and body, to monitor how the vestibular system reacts to these movements and to changes in gravity.

Calorics

This measurement determines how well the vestibular system responds by applying warm and cool air into each ear canal separately. Comparisons are then made of the vestibular system’s performance from one side to the other, and whether there’s a possible weakness or hyperresponse in the inner ear. During the caloric test, it isn’t unusual to experience a sensation of movement, which goes away immediately when the test is complete.

Treatment

You may experience dizziness and moderate to severe false spinning sensations that can cause loss of balance, disorientation (which may cause falls), vomiting, sweating and severe nausea. It’s important to identify the cause of your vertigo symptoms to be certain it’s not a symptom of a more serious underlying disorder in the ear or nervous system, as well as to determine the best course of treatment.

It varies depending on the underlying cause of vertigo. Some cases of vertigo will resolve on their own since the brain is able to adapt to changes in the inner ear. However, for moderate to severe vertigo there are three common treatments:

Physical therapy/repositioning maneuvers: Some physical therapists are trained in vestibular rehabilitation, which helps strengthen the vestibular system to improve vertigo. They can also teach you ways to move around safely despite vertigo.  There are also head movements helpful to those with BPPV, which helps clear calcium the ear canal.

Medication: A doctor may switch your current medications if they are the cause of vertigo. Medications to help vertigo, will either treat the underlying cause of vertigo or help suppress the symptoms of vertigo caused by a recurring condition. For causes like Meniere’s disease, vestibular suppressants are used. These medications may include benzodiazepines, which work by suppressing the nervous system. It associated with migraines is often treated with benzodiazepines, antiemetics and antihistamines. It can be prevented with either antidepressants or calcium channel antagonists, which prevent constriction in the arteries.

Surgery: Rare causes of vertigo, such as those caused by tumor or brainstem injury, may require surgery.

Other types of treatment

Your doctor will recommend an individualized treatment plan, which may include:

Medications, including muscle relaxants or anti-anxiety drugs

Balance retraining, utilizing both static and dynamic balance exercises

Sensory organization training

Gaze stabilization exercises

Habituation exercises

Compensatory strategies (behavioral strategies to achieve rehabilitation goals)

Aerobic conditioning

Canalith repositioning treatment (CRT), also known as the Epley maneuver (used to treat the most common type of vertigo, called benign paroxysmal positional vertigo, which is caused by calcium carbonate crystals (ear rocks) falling or being dislodged in the inner ear)

Medications to treat vertigo

There are a variety of drugs that may be prescribed to treat vertigo. These medications include:

Antihistamines, such as Antivert (meclizine) or Phenergan (promethazine), may be prescribed to treat nausea and vomiting associated with vertigo. These decrease the feelings of motion sickness associated with vertigo. Antihistamines can sometimes cause drowsiness.

Benzodiazepines, such as Valium (diazepam) or Ativan (lorazepam), often relieve vertigo caused by inner ear disorders such as Meniere’s disease, labyrinthitis, migraine-associated vertigo, or vestibular neuronitis. These drugs relieve vertigo by suppressing the vestibular system. These drugs are typically given in small doses to avoid addiction to the medication. These drugs also have a side effect of drowsiness.

Diuretics, or water pills—such as Dyazide (triamterene/HCTZ), Lasix (furosemide), or acetazolamide—are often prescribed to those with Meniere’s disease. Diuretics help remove inner ear fluid that can cause vertigo. Side effects of diuretics can include dehydration and frequent urination.

Corticosteroids, such as Decadron (dexamethasone) or oral prednisone, have been found to decrease the length and frequency of vertigo in those with Meniere’s disease. These drugs should be used for a short time; otherwise, you can become steroid-dependent and develop adrenal insufficiency.

Prevention

It can affect your balance and may make you feel unsteady, you are at risk of falls or accidents. To reduce your risk of a fall or accident:

Get out of a bed or chair slowly

Wear low-heeled shoes that fit properly

Use handrails on stairs

Install grab bars in the bathroom. Don’t use towel racks for balance

Use a shower stool. Also, apply adhesive strips to the shower or tub floor

Use a walking aid if needed

If you become dizzy or disoriented while driving, you could hurt yourself and others. It is best to avoid driving until symptoms subside

At work, let your employer know about your symptoms, especially if your job involves operating machinery or climbing ladders

Emphysema is a lung condition that causes shortness of breath.

What is emphysema?

Emphysema is a lung condition that causes shortness of breath. In people with this condition, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

When you exhale, the damaged alveoli don’t work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough. Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can’t reverse the damage.

Types of Emphysema

Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.

These are:

paraseptal emphysema

centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke

panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs

During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.

Pathophysiology

Emphysema is a pathologic diagnosis defined by permanent enlargement of airspaces distal to the terminal bronchioles. This leads to a dramatic decline in the alveolar surface area available for gas exchange. Furthermore, loss of alveoli leads to airflow limitation by 2 mechanisms. First, loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation. Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.

It has 3 morphologic patterns:

Centriacinar

Panacinar

Distal acinar, or paraseptal

Centriacinar emphysema is characterized by focal destruction limited to the respiratory bronchioles and the central portions of the acini. This form of emphysema is associated with cigarette smoking and is typically most severe in the upper lobes.

Panacinar emphysema involves the entire alveolus distal to the terminal bronchiole. The panacinar type is typically most severe in the lower lung zones and generally develops in patients with homozygous alpha1-antitrypsin (AAT) deficiency.

Distal acinar emphysema, or paraseptal emphysema, is the least common form and involves distal airway structures, alveolar ducts, and sacs. This form of emphysema is localized to fibrous septa or to the pleura and leads to formation of bullae (as seen in the images below). The apical bullae may cause pneumothorax. Paraseptal emphysema is not associated with airflow obstruction.

The gradual destruction of alveolar septae (shown in the image below) and of the pulmonary capillary bed in emphysema leads to a decreased ability to oxygenate blood. The body compensates with lowered cardiac output and hyperventilation. This V/Q mismatch results in relatively limited blood flow through a fairly well oxygenated lung with normal blood gases and pressures in the lung, in contrast to the situation in chronic bronchitis. Because of low cardiac output, the rest of the body also suffers from tissue hypoxia and pulmonary cachexia. Eventually, these patients develop muscle wasting and weight loss and are identified as “pink puffers.”

Causes

The main cause is exposure to airborne irritants, which include tobacco smoke, marijuana smoke, air pollutants, and manufacturing smoke.

Very rarely, emphysema is caused by heredity, wherein a person has a shortage of a protein that guards the elastic structure in the lungs, known as alpha-1 antitrypsin deficiency.

Close relatives of people with emphysema are more likely to develop the disease themselves. This is probably because the tissue sensitivity or response to smoke and other irritants may be inherited. The role of genetics in the development of emphysema, however, remains unclear.

Abnormal airway reactivity, such as bronchial asthma, has been shown to be a risk factor for the development of emphysema.

Who is at risk for emphysema?

The risk factors include

This the main risk factor. Up to 75 percent of people who have emphysema smoke or used to smoke.

Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace.

Most people who have emphysema are at least 40 years old when their symptoms begin.

This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get emphysema are more likely to get it if they have a family history of COPD.

Symptoms of emphysema

The symptoms include:

Breathlessness with exertion, and eventually breathlessness most of the time in advanced disease

Susceptibility to chest infections

Cough with phlegm production

Fatigue

Barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)

Cyanosis (a blue tinge to the skin) due to lack of oxygen.

Complications of Emphysema

People who have emphysema are also more likely to develop:

Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (bullae). Some people with emphysema develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

How do doctors diagnose Emphysema?

Your chest feels tight, you’re out of breath much of the time, and you have a cough that won’t go away. Do you have emphysema? You can’t go on symptoms alone. See your doctor. They’ll do the following tests to find out for sure:

Medical History

Your doctor will talk to you about your health and any recent changes you might have noticed. If you have emphysema, you’ll probably have had shortness of breath, often over a period of months or years. You may also experience wheezing. You might have a cough that won’t go away, too.

Physical Exam

Your doctor will check your weight and blood pressure. They’ll listen to your heartbeat and keep an eye out for anything that seems strange or unusual.

If you have advanced emphysema, your doctor may notice that you have any of the following:

You have a “barrel chest” caused by larger-than-normal lungs.

You’re wheezing, having a hard time getting air out of your lungs.

Your fingertips are rounded. Doctors call this “clubbing.”

You purse your lips when you breathe, like you’re blowing a kiss.

The oxygen levels in your blood are low (hypoxemia).

The carbon dioxide levels in your blood are high (hypercarbia), because emphysema makes it hard to exhale properly.

Your lips have a blue tinge (cyanosis), another sign of low oxygen in your blood.

Malnutrition causes muscles to slowly waste away in advanced emphysema.

Pulmonary Function Tests (PFTs)

For this exam, you may sit inside an enclosed booth and breathe into a tube. This will allow your doctor to measure:

How much air your lungs can hold

How fast you can blow air out of your lungs

How much air stays trapped in your lungs after you exhale

Whether you’re able to breathe better after using medicines you inhale, such as albuterol

If you have normal lungs, you’ll likely be able to empty most of the air from them in 1 second. If you have emphysema, it’ll probably take longer.

Chest X-ray and CT scan

If you have advanced emphysema, your lungs will appear to be much larger than they should be. In early stages of the disease, your chest X-ray may look normal. Your doctor can’t diagnose emphysema with an X-ray alone.

A CT scan of your chest will show if the air sacs (alveoli) in your lungs have been destroyed. These make it hard for you to breathe out like normal.

Arterial blood gas

This test measures the amount of oxygen and carbon dioxide in blood from an artery. It is a test often used as emphysema worsens. It is especially helpful in determining if a patient needs extra oxygen.

Pulse oximetry

This test is also known as an oxygen saturation test. Pulse oximetry is used to measure the oxygen content of the blood. This is done by attaching the monitor to a person’s finger, forehead, or earlobe.

Electrocardiogram (ECG)

ECGs check heart function and are used to rule out heart disease as a cause of shortness of breath.

How is emphysema treated?

There is no cure for emphysema. Treatment aims to reduce symptoms and slow the progression of the disease with medications, therapies, or surgeries.

If you are a smoker, the first step in treating this condition is to quit smoking, either with medications or cold turkey.

Medications

Bronchodilator Medications

Inhaled as aerosol sprays or taken orally, bronchodilator medications may help to relieve symptoms of emphysema by relaxing and opening the air passages in the lungs.

Steroids

Inhaled as an aerosol spray, steroids can help relieve symptoms of emphysema associated with asthma and bronchitis. Over time, however, inhaled steroids can cause side effects, such as weakened bones, high blood pressure, diabetes and cataracts. It is important to discuss these side effects with your doctor before using steroids.

Antibiotics

Antibiotics may be used to help fight respiratory infections common in people with emphysema, such as acute bronchitis, pneumonia and the flu.

Vaccines

Patients with emphysema should receive a flu shot annually and pneumonia shot every five to seven years to prevent infections.

Oxygen Therapy

As a patient’s disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen. Oxygen comes in various forms and may be delivered with different devices, including those you can use at home.

Surgery or Lung Transplant

Lung transplantation may be an option for some patients with emphysema. For others, lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended.

Protein Therapy

Patients with emphysema caused by an alpha-1 antitrypsin (AAT) deficiency may be given infusions of AAT to help slow the progression of lung damage.

Pulmonary Rehabilitation

An important part of emphysema treatment is pulmonary rehabilitation, which includes education, nutrition counseling, learning special breathing techniques, help with quitting smoking and starting an exercise regimen. Because people with it are often physically limited, they may avoid any kind of physical activity. However, regular physical activity can actually improve a patient’s health and wellbeing.

Lifestyle changes

Quitting smoking if you are a smoker. This is the most important step you can take to treat this condition.

Avoiding secondhand smoke and places where you might breathe in other lung irritants

Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

Prevention of Emphysema

To prevent emphysema:

If you smoke, talk to your doctor about how to quit

Avoid exposure to secondhand smoke

Avoid exposure to air pollution or irritants

Wear protective gear if you are around irritants or toxins on the job

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation.

Overview

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction. It can occur in all age groups, including newborns. However, it usually affects men in two different age groups: between the ages of 5 and 10, and 20 and 50.

Types

There are two main types:

Low-flow or ischemic priapism: This type happens when blood gets trapped in the erection chambers. Most of the time, there’s no clear cause, but it may affect men with sickle-cell disease, leukemia (cancer of the blood), or malaria. If you don’t get treatment right away, it can lead to scarring and permanent erectile dysfunction (ED).

High-flow or non-ischemic priapism: This type is more rare than low-flow and is usually less painful. It often happens when an injury to the penis or the area between the scrotum and anus, called the perineum, ruptures an artery, which prevents blood in the penis from moving normally.

Pathophysiology

The penis has 3 corporeal bodies: 2 corpora cavernosa and 1 corpus spongiosum. Erection is the result of smooth-muscle relaxation and increased arterial flow into the corpora cavernosa, causing engorgement and rigidity (see image below). In priapism, the corpus spongiosum and glans penis are typically not engorged.

Engorgement of the corpora cavernosa compresses the venous outflow tracts (ie, subtunical venules), trapping blood within the corpora cavernosa. The major neurotransmitter that controls erection is nitric oxide, which is secreted by the endothelium that lines the corpora cavernosa (see image below). These events occur in both normal and pathologic erections.

Pathophysiologically, priapism can be of either a low-flow (ischemic) or a high-flow (nonischemic) type. Low-flow priapism, which is by far the most common type, results from failure of venous outflow, whereas high-flow priapism results from uncontrolled arterial inflow. Clinically, differentiation of low-flow from high-flow priapism is critical, because treatment for each is different.

Low-flow priapism may be due to any of the following:

An excessive release of neurotransmitters

Blockage of draining venules (eg, mechanical interference in sickle cell crisis, leukemia, or excessive use of intravenous parenteral lipids)

Paralysis of the intrinsic detumescence mechanism

Prolonged relaxation of the intracavernous smooth muscles (most often caused by the use of exogenous smooth-muscle relaxants such as injectable intracavernosal prostaglandin E1)

Prolonged low-flow priapism leads to a painful ischemic state, which can cause fibrosis of the corporeal smooth muscle and cavernosal artery thrombosis. The degree of ischemia is a function of the number of emissary veins involved and the duration of occlusion. Light-microscopy studies conducted early on demonstrated that corporeal tissue becomes thickened, edematous, and fibrotic after days of priapism.

What are the causes and risk factors of priapism?

A normal erection occurs in response to sexual stimulation. It occurs in several conditions that interfere with the blood flow to the penis or blood drainage from the penis. This condition is unrelated to sexual stimulation and can last for several hours. Below are some of the causes of it.

Medical conditions that can cause priapism:

Sickle cell disease (most common reason for priapism)

Leukemia

History of malignancy (cancer)

Trauma as a cause of priapism:

  • Direct trauma to the penis, pelvis, or perineum
  • Spinal cord injuries

Medications (several drugs have priapism as a side effect):

Antidepressants

Antipsychotics

Blood thinners (warfarin [Coumadin] and heparin)

Medications to help with erectile dysfunction (Viagra, Cialis, Levitra, Caverject)

Illegal drugs (cocaine, ecstasy, methamphetamine, crystal meth, cannabis)

Symptoms

Symptoms vary depending on the type of priapism. The two main types of priapism are ischemic and nonischemic priapism.

Ischemic priapism

It’s the more common type. Signs and symptoms include:

Unwanted erection lasting a lot more than four hours

Unwanted erection on / off for several hours (stuttering priapism)

Rigorous penile shaft, but typically soft tip of male member (glans)

Usually painful or tender penis

Nonischemic priapism

Nonischemic priapism is usually less painful than ischemic priapism. Signs and symptoms include:

Erection lasting more than four hours or unrelated to sexual interest or stimulation

Erect but not fully rigid penile shaft

Complications

Ischemic priapism can cause serious complications.

Due to the lack of oxygen, there can be significant damage if it lasts for more than four hours.

When an erection lasts for too long, this oxygen-poor blood can begin to damage or destroy tissues in the penis.

The complications include erectile dysfunction as well as disfigurement of the penis.

How can a doctor diagnose priapism?

Even though both types of priapism have similar symptoms, your doctor has to run diagnostic tests to determine whether you have low-flow or high-flow priapism. The treatment options differ depending on the exact type of the condition.

Sometimes, doctors can diagnose it based on symptoms and a physical examination of the genital area. Tests used to determine the type of priapism may include:

Blood gas measurement

This procedure involves inserting a needle into your penis and collecting a blood sample. If the sample reveals that blood in your penis is deprived of oxygen, you have low-flow priapism. But if the sample reveals bright red blood, you have high-flow priapism.

Blood tests

Since it can be caused by other diseases and blood disorders, your doctor may also collect a blood sample to check your level of red blood cells and platelets. This can help your doctor diagnose blood disorders, cancers, and sickle cell anemia.

Toxicology test

It is also associated with drug abuse, so your doctor may collect a urine sample to look for drugs in your system.

Ultrasound

Doctors use an ultrasound to measure blood flow in the penis. This test also helps your doctor determine whether trauma or injury is the underlying cause of this disorder.

How is priapism treated?

The goal of all treatment is to make the erection go away and preserve the ability to have erections in the future. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may decrease blood flow to the penis, may be very helpful. Other treatment options include:

Ice packs: Ice applied to the penis and perineum may reduce swelling.

Surgical ligation: Used in some cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing it in order to restore normal blood flow.

Intracavernous injection: This treatment is used for low-flow priapism. Drugs known as alpha-agonists are injected into the penis. They cause the arteries to narrow, reducing blood flow to the penis and causing the swelling to decrease.

Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.

Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you think that you are experiencing it, you should not attempt to treat it yourself. Instead, get emergency help as soon as possible.

What are the home remedies for priapism?

The home remedies are-

Urination – in a priapism attack, you should go to urination when you feel desire. Do not wait till you are full as urination can relax the erection to some extent.

Drinking Water – in such a situation, you should drink as much as water as you can it should be more than what you intake. Drinking lots of water can assist in oxygen-rich blood supply to the penis.

Warm Showers – you should take warm showers when your penis is stuck in erection, it helps a lot to control priapism.

Urination Before Sleep – morning erections is a normal phenomenon and it is closely related to a full bladder. You should evacuate your bladder at night before sleep. It has been reported that early morning erections can lead to a priapism attack.

Exercises – exercising during an attack can resolve an erection. You can perform squats, jogging, cycling, running up and down a stair, gentle walk or running on the spot for this condition.

Sexual Activities – scientific studies state that having sex or masturbation during a priapism has no effect on the erection. On the other hand, it can lengthen the erection.

Stress – stress can be more dangerous for priapism as it can worsen a priapism attack. You should opt for counseling and other support groups for stress relieving.

Medicines – you may take painkillers to relieve your pain. But you should not take other medicines such as antidepressants, antipsychotics, etc. without the consent of your physician.

What are the ways to prevent priapism?

Depending on the cause, certain steps can be taken to prevent it from occurring. These steps are:

Prompt treatment of the disease that may cause this condition

If medication is found to be the cause of Priapism then changing the medication

Abstaining from alcohol and drugs

Injection of phenylephrine in order to stop sustained erections

Chilblains (CHILL-blayns) are the painful inflammation of small blood vessels in your skin.

Overview – Chilblains

Chilblains (CHILL-blayns) are the painful inflammation of small blood vessels in your skin that occur in response to repeated exposure to cold but not freezing air. Also known as pernio, chilblains can cause itching, red patches, swelling and blistering on your hands and feet.

Chilblains usually clear up within one to three weeks, especially if the weather gets warmer. You may have recurrences seasonally for years. Treatment involves protecting yourself from the cold and using lotions to ease the symptoms. Chilblains don’t usually result in permanent injury. But the condition can lead to infection, which may cause severe damage if left untreated. The best approach to chilblains is to avoid developing them by limiting your exposure to cold, dressing warmly and covering exposed skin.

Pathophysiology

The pathophysiology and pathogenesis of pernio remain still largely unknown due to the rarity of the condition. However, the thinking is that there is some association with vasospasm as the primary pathophysiologic finding, particularly when the patient becomes exposed to cold, damp conditions for a prolonged period. In a small study by the Mayo Clinic, researchers exposed five patients with known pernio to ice-water immersions and analyzed the patients’ vascular response. They found that all of the patients demonstrated vasospasm when exposed to the ice water bath, potentially discovering a target for pharmacologic therapy in patients with pernio.

What causes chilblains?

Chilblains are the result of an abnormal reaction to the cold. They’re common in the UK because damp, cold weather is usually in the winter.

Some people develop chilblains that last for several months every winter.

When the skin is cold, blood vessels near its surface get narrower. If the skin is then exposed to heat, the blood vessels become wider.

If this happens too quickly, blood vessels near the surface of the skin can’t always handle the increased blood flow.

This can cause blood to leak into the surrounding tissue, which may cause the swelling and itchiness associated with chilblains.

Risk factors of Chilblains

Some people are more at risk of chilblains than others.

This includes people with:

Poor circulation

A family history of chilblains

Regular exposure to cold, damp or draughty conditions

A poor diet or low body weight

Lupus – a long-term condition that causes swelling in the body’s tissues

Raynaud’s phenomenon – a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes

People who smoke are more at risk of chilblains as nicotine constricts blood vessels.

Chilblains can also occur on areas of the feet exposed to pressure, such as a bunion or a toe that’s squeezed by tight shoes.

What are the symptoms of chilblains?

Chilblains occur several hours after being exposed to the cold. You may get just one chilblain but often several develop. They may join together to form a larger swollen, red area of skin.

Chilblains are very itchy. A burning sensation is also typical. They are usually red at first but may become purple. Pain and tenderness over the chilblains often develop.

Common places for chilblains to develop are:

Fingers

Toes

Ear lobes

Nose

Cheeks

Heels

Shins

Thighs

Hips

Typically, each chilblain lasts for about seven days and then, gradually, goes away over a week or so. Some people have repeated bouts of chilblains each winter.

Complications of chilblains

If you have severe or recurring chilblains, there’s a small risk of further problems developing, such as:

Infection from blistered or scratched skin

Ulcers forming on the skin

Permanent discolouration of the skin

Scarring of the skin

It’s often possible to avoid these complications by:

Not scratching or rubbing the affected areas of skin

Not directly overheating the chilblains (by using hot water, for example)

You can also help reduce your risk of infection by cleaning any breaks in your skin with antiseptic and covering the area with an antiseptic dressing. The dressing should be changed every other day until the skin heals.

If the skin does become infected, antibiotics may be prescribed to treat the infection.

Differential Diagnosis

The primary disorder that merits consideration when diagnosing pernio is chilblain lupus erythematosus (CHLE). CHLE is a rare dermatology condition often confused with other forms of pernio or vasculitic processes. Due to the implications of familial genetic inheritance and the possible association with systemic lupus erythematosus, a specific diagnosis of chilblains lupus becomes a priority when a patient presents with pernio-like symptoms. CHLE is largely idiopathic, but familial variants are associated with several different genetic mutations, including TREX1, SAMHD1, and STING.

Treatment is often symptomatic with steroids, but literature has shown the possibility for systemic medications such as JAK inhibitors as effective treatments.  While the progression to systemic lupus erythematosus (SLE) is low in CHLE, further workup is the recommended course due to the implications of long-term undiagnosed SLE.

Other conditions, particularly vasospastic conditions, that the clinician should consider in the differential include:

Raynaud phenomenon

Acrocyanosis

Cryoglobulinemia

Cold panniculitis

Treatment and medication

The first line of treatment for chilblains generally includes measures to keep hands and feet warm and dry, such as keeping your indoor environment warm and dry, using gloves and socks, and changing damp gloves and socks when needed.

If your chilblains don’t clear up with these home remedies, your doctor may recommend medication, including:

Nifedipine (Procardia). This type of blood pressure medication treats chilblains by helping to open up blood vessels and improve circulation. Side effects may include flushing, nausea, dizziness and swelling in the hands or feet.

A topical corticosteroid. Applying a corticosteroid cream to chilblains may help the lesions go away.

Lifestyle and home remedies

Chilblains usually clear up in one to three weeks after cold exposure. In the meantime, you can take steps to ease your signs and symptoms, including:

Rewarming affected skin gently, without massaging, rubbing or applying direct heat

Avoiding cold exposure whenever possible

Keeping your affected skin dry and warm, but away from sources of heat

Applying lotion to alleviate itching

Making sure the affected skin is cleaned with an antiseptic and gently bandaged to prevent infection

Avoiding scratching

Quitting smoking, as smoking can constrict your blood vessels and slow wound healing

Preventing chilblains

The following advice may help prevent chilblains:

Stop smoking. Nicotine causes the blood vessels to constrict (get narrower), which can make chilblains worse.

Avoid medicines that may constrict blood vessels, such as caffeine and decongestants.

Keep active. This helps improve your circulation.

Wear warm clothes and insulate your hands, feet, and legs. Wearing long johns, long boots, tights, leg warmers or long socks will help. If you get cold feet in bed, wear a pair of clean socks.

Avoid tight shoes and boots as these can restrict the circulation to toes and feet.

Moisturize your feet regularly. This stops them from drying out and the skin cracking.

In cold weather, eat at least one hot meal during the day. This will help warm your whole body.

Warm your shoes on the radiator before you put them on. Make sure damp shoes are dry before wearing them.

Warm your hands before going outdoors by soaking them in warm water for several minutes and drying them thoroughly. Wear cotton-lined waterproof gloves if necessary.

Turn up the central heating. Try to keep one room in the house warm and avoid drafts.

If you are diabetic, give yourself regular foot checks (or ask someone else to do this). Diabetics may not be able to feel their feet and could have septic chilblains without realising.

Russia labeled terrorist state by Lithuania Government.

Lithuania’s parliament has voted to label Vladimir Putin’s invasion of Ukraine as genocide and has described Russia as a terrorist state.

The Lithuanian Seimas revealed on social media they had voted unanimously on the motion.

The Seimas recognises the full-scale armed aggression war against Ukraine by the armed forces of the Russian Federation and its political and military leadership as genocide against the Ukrainian people, the Seimas resolution read.

“The Russian Federation, whose military forces deliberately and systematically target civilian targets, is a state that supports and perpetrates terrorism.

The Lithuanian motion also described what it believes to be Russia’s intentions in Ukraine and why they are perpetrators of genocide.

“The intent is to wholly or partially destroy the Ukrainian nation and break its spirit by killing entire families, including children, abducting and raping people, and mocking them and the bodies of the murdered,” the motion reads.

Lithuanian lawmakers specifically referred to the atrocities in Bucha, Irpin, Mariupol, Borodyanka, and Hostomel, where mass graves of bodies have been found, as well as evidence of other cruel acts carried out against Ukrainian civilians.

The European Union nation stressed that Russia must be held accountable by the international community by establishing a special tribunal to investigate Russia’s crimes in Ukraine.

The resolution had been proposed by a number of Lithuanian parliamentarians, including Deputy Speaker Paulius Saudargas.

Since the time of the Tsars, Russia has been a basically autocratic state, and Putin is continuing the work of Stalin, Saudargas told lawmakers, according to EuroNews.

The genocide began even then, and Putin’s Russia is simply the reincarnation of Stalinist Russia the Soviet Union.

Their move received praise from the Stratcom Centre, Ukraine’s body for strategic communications and information security.

Stratcom said Lithuania’s bold move makes the it the first country to label Russia as a terror state.

They are not the first nation to accuse Putin’s army of genocide, with Canada adopting a similar motion last month, according to an NPR report.

In the months following Russia’s invasion of neighbouring Ukraine, the European Union member state has taken steps to distance itself from Russia.

In April, AP reported it became the first EU nation to stop Russian gas imports.

Homepage

11 feard dead in a plane crash in Central Cameroon.

A plane conveying 11 persons crashed in a forest in central Cameroon on Wednesday, POLITICS NIGERIA reports.

Shortly after takeoff, air traffic controllers lost radio contact with the aircraft which was later located in the forest near Nanga Eboko, around 150 kilometres northeast of the capital Yaounde, the country’s Ministry of Transport said in a statement.

The radio signal was lost during the storm that hit the capital city late in the afternoon.

The plane was chartered by a private firm, the Cameroon Oil Transportation Company (COTCO). The company maintains a hydrocarbon pipeline that runs between Cameroon and Chad. The ill-fated plane was flying from Yaounde-Nsimalen airport to Belabo, in the east of Cameroon.

Air and ground search teams have been put on duty.

Local media, Cameroon24, reported that the accident left no survivors; however, there has been no official confirmation from authorities.

It is the first major air catastrophe reported in Cameroon since 2007, when a Kenya Airways plane transporting 114 people crashed after take-off from Douala Airport. There were no survivors in that accident.

Homepage

Panic as APC supporters lynched on one of them who tried to run away with money given to them.

Supporter of APC presidential aspirant, Bola Tinubu on Wednesday in Abuja engaged in a free-for-all at the International Conference Centre (ICC) following a disagreement that ensued over the sharing formula for the money given to them.

The supporters threw caution to the wind as they engaged one another in a brawl, leading to pandemonium in the area Sahara reports.

Trouble started shortly after the former Secretary to the Government of Federation, Babachir Lawal, who was there to submit nomination and expression of interest forms on behalf of Tinubu, left the venue.

The group of supporters, who had positioned themselves at strategic locations at the centre, were given a bail of money which triggered the fight.

One of the supporters was sighted running away with the money as others went after him. He was eventually caught and mercilessly beaten.

Homepage