AtoZ Diseases

What do doctors call these conditions?

Hypochloremia, hyperchloremia

What are these conditions?

Chloride imbalance refers to too little or too much chloride in the blood. Too little chloride is called hypochloremia; too much, hyperchloremia.

Chloride is secreted by the stomach lining as hydrochloric acid to help with digestion and to activate needed enzymes. Chloride also helps the body maintain its chemical (acid-base) balance and body water balance and plays a role in the exchange of oxygen and carbon dioxide in red blood cells. It also helps activate chemicals in the saliva, which in turn starts the digestive process.

What causes chloride deficiency?

Too little chloride may be caused by:

• poorly absorbed or insufficient sodium in the person’s diet, potassium deficiency, or metabolic alkalosis (an imbalance caused by too little acid)

•  prolonged use of certain diuretics

• intravenous administration of dextrose without electrolytes (chlorides or other dissolved salts)

• excessive chloride loss, which is caused by prolonged diarrhea or sweating

• loss of chloride in stomach acid through vomiting, gastric suctioning, or gastric surgery.

What causes chloride excess?

Too much chloride may be caused by:

• eating or absorbing too much ammonium chloride, or the bowel’s reabsorbing too much chloride

• dehydration, which raises the proportion of chloride to other fluids in the blood

• the body’s compensating for other metabolic abnormalities.

What are the symptoms of chloride deficiency?

The person with a chloride deficit usually has muscle weakness and twitching, which is also characteristic of sodium imbalance. However, if the deficit results from loss of stomach acids (and sodium imbalance isn’t part of the problem), typical symptoms are muscle tension or spasm and shallow, depressed breathing.

What are the symptoms of chloride excess?

Too much chloride usually causes agitation, fluid volume excess, rapid heartbeat, high blood pressure, swelling, and difficulty breathing. If excessive chloride comes from metabolic acidosis, the symptoms are deep, rapid breathing; weakness; confusion; and, ultimately, coma.

How chloride imbalances are diagnosed?

The doctor may check chloride levels through blood tests to confirm chloride imbalances.

How is chloride deficiency treated?

In chloride deficit, the doctor will try to correct the cause and give an oral chloride replacement, such as salty broth. If the person can’t drink or eat or if the imbalance causes an emergency, the doctor may prescribe normal saline solution intravenously. The doctor may also prescribe chloride-containing drugs, such as ammonium chloride to increase blood chloride levels and potassium chloride to treat metabolic alkalosis.

How is chloride excess treated?

For severe hyperchloremic acidosis, the doctor will prescribe intravenous sodium bicarbonate to aid chloride excretion. In either kind of chloride imbalance, treatment must correct the underlying disorder.

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What do Doctors call this Condition - Thromboangiitis obliterans

What is this Condition?

Buerger’s disease - an inflammatory, occlusive condition - causes segmental lesions and subsequent blood clot (thrombus) formation in the small and medium arteries (and sometimes the veins), thereby reducing blood flow to the feet and legs. This disorder may produce ulceration and, eventually, gangrene.

What Causes it?

Although the cause of Buerger’s disease is unknown, it has been linked to smoking, suggesting a hypersensitivity reaction to nicotine. Incidence is highest among men of Jewish ancestry between the ages of 20 and 40 who smoke heavily.

What are its Symptoms?

Buerger’s disease typically causes intermittent claudication (cramplike pains) of the instep, which is aggravated by exercise and relieved by rest. During exposure to low temperature, the feet initially become cold, pale, and numb; later, they redden, become hot, and tingle.

Occasionally, Buerger’s disease also affects the hands, possibly resulting in painful fingertip ulcers.

How is it Diagnosed?

The person’s history and physical exam strongly suggest Buerger’s disease. Supportive diagnostic tests include arteriography (X-ray of the artery) and an ultrasound scan.

How is it Treated?

The primary goals of treatment are to relieve symptoms and prevent complications. Such therapy may include an exercise program that uses gravity to fill and drain the blood vessels or, in severe disease, a surgical procedure called a lumbar sympathectomy (interruption of the sympathetic nervous system pathway) to increase blood supply to the skin. Amputation may be necessary for nonhealing ulcers, intractable pain, or gangrene.

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What do Doctors call this Condition - Myocardial infarction

What is this Condition?

In a heart attack, one of the heart’s arteries fails to deliver enough blood to the part of the heart muscle it serves. The reduced blood flow causes destruction of localized areas of heart tissue.

If treatment is delayed, the person may die; almost half of sudden deaths from heart attack occur before the victims reach the hospital, within 1 hour after symptoms arise. (Typically, death stems from severe tissue damage or from complications.) The prognosis is better if vigorous treatment begins immediately.

What Causes it?

Arteriosclerosis (hardening of the heart’s arteries), which reduces the artery’s blood flow, is usually the underlying cause of a heart attack. Risk factors include:

• a family history of heart disease

• high blood pressure

• smoking

• high cholesterol and triglyceride levels

• diabetes

• obesity or a diet high in saturated fats, carbohydrates, or salt

• a sedentary lifestyle

• aging

• drug use, especially cocaine

• stress or Type A personality.

Men are more susceptible to heart attacks than women, although the heart attack rate is rising in women - especially those who smoke or take oral contraceptives.

What are its Symptoms?

The chief symptom of a heart attack is persistent, crushing chest pain that may spread to the left arm, jaw, neck, or shoulder blades and may last 12 hours or longer. Typically, heart attack victims describe the pain as heavy, squeezing, or crushing. Bur some - particularly elderly people and those with diabetes - don’t experience pain. Others have mild pain that they, or their doctor, may mistake for indigestion. In people with hardening of the arteries, chest pain that grows more and more frequent, severe, or longer-lasting may signal an impending heart attack - especially if the pain isn’t triggered by exertion, a heavy meal, or cold and wind.

Some heart attack victims also have a feeling of impending doom, fatigue, nausea, vomiting, shortness of breath, coolness in the arms and legs, perspiration, anxiety, and restlessness. And some people have a “silent” heart attack, which causes no symptoms at all.

Complications

The most common complications of a heart attack are recurrent or persistent chest pain; irregular heart rhythms; failure of the heart’s main chamber (left ventricle), causing heart failure or massive fluid buildup in the lungs; and failure of the heart to pump enough blood, causing shock.

Soon after a heart attack, a few people have potentially fatal complications - a blood clot in a vein, heart valve malfunction, rupture of the partition between the heart’s chambers, and rupture of the heart muscle.

Up to several months after a heart attack, some people experience Dressler’s syndrome - inflammation of the sac around the heart, accompanied by chest pain, fever, and possibly lung inflammation.

How is it Diagnosed?

To confirm a heart attack, the doctor checks for persistent chest pain, characteristic electrocardiogram findings, and blood tests showing elevated levels of cardiac enzymes over a 72-hour period. A physical exam may reveal abnormal heart sounds.

When symptoms and physical exam results aren’t clear-cut, the doctor assumes that the person has had a heart attack - to be on the safe side - until tests rule it out. To investigate further, these tests may be ordered:

• 12-lead electrocardiogram - may reveal characteristic abnormalities during the first few hours after a heart attack

• echocardiography- (a study of the heart’s structure and motion) ­may show abnormal motion of the ventricular wall in a heart attack that involves the entire wall of the heart.

• technetium scans - can identify badly damaged heart muscle by detecting emissions from the radioactive marker, an isotope of technetium, which looks like a “hot spot” on film. These scans help to pinpoint a recent heart attack.

How is it Treated?

The goals of treatment are to relieve chest pain, stabilize the heart rhythm, ease the heart’s workload, restore blood to the heart’s arteries, and preserve heart muscle tissue. Irregular heart rhythms - the main problem during the first 48 hours after a heart attack - may require drugs and possibly a pacemaker. Rarely, a person requires car- dioversion, in which an electrical current is delivered to the heart in an attempt to restore a normal rhythm.

To preserve heart muscle tissue, the doctor may administer thrombolytics (drugs that break up clots in the arteries) within 6 hours after heart attack symptoms arise. These drugs include streptokinase, alteplase, and urokinase.

Percutaneous transluminal coronary angioplasty may be another option. In this procedure, the doctor threads a thin, balloon-tipped catheter into the narrowed heart artery (if narrowing has caused the heart attack). After injecting contrast dye through the catheter to pinpoint the narrowed site, the doctor inflates the balloon catheter to expand and reopen the artery. If this procedure is done soon after symptoms begin, a thrombolytic drug may be injected directly into the artery.

Other Treatments

After a heart attack, some people also receive:

• lidocaine, a drug used to control certain irregular heart rhythms

• other drugs, such as Pronestyl, Cardioquin, Bretylol, or Norpace

• the drug atropine or a temporary pacemaker if the heart rate is abnormally slow

• nitroglycerin, calcium channel blockers, or other drugs that relieve pain, redistribute blood to blood-starved areas of the heart, help the heart to pump more blood, and reduce the heart’s workload

• heparin to prevent clotting

• morphine for pain relief and sedation

• drugs that improve heart contractions or raise blood pressure

• beta blockers, such as Inderal or Blocadren, after an acute heart attack to help prevent another heart attack

• aspirin to prevent clot formation (should be started within 24 hours after symptoms arise)

• bed rest with a bedside commode to rest the heart

• oxygen administration for 24 to 48 hours

• pulmonary artery catheterization to detect failure of the heart’s left or right ventricle and to monitor the person’s response to treatment. In this procedure, the doctor threads a thin, hollow tube through the heart and into the pulmonary artery to measure various pressures.

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