PCCN

PCCN Unstable Angina

Unstable angina is a condition in which your heart doesn't get enough blood flow and oxygen. It may lead to a heart attack. Angina is a type of chest discomfort caused by poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). Angina, which may also be called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. Angina may be a new pain that needs evaluation by a doctor, or recurring pain that goes away with treatment. Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Signs and Symptoms

Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness

• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Sweating
• Dizziness

Causes

The main cause is CAD.

Risk Factors

• Tobacco Use
• DM, HTN
• Old Age
• High Cholesterol
• Heart Disease
• Old Age
• Stress, Obesity
• Lack of Exercise

Treatment

There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of a heart attack and death.  

PCCN Rhabdomyolysis

Rhabdomyolysis is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to serious complications such as renal (kidney) failure. This means the kidneys cannot remove waste and concentrated urine. In rare cases, rhabdomyolysis can even cause death.

Signs and Symptoms

• Dark, red, or cola-colored urine
• Decreased urine output
• General weakness
• Muscle stiffness or aching (myalgia)
• Muscle tenderness
• Weakness of the affected muscles
• Fatigue
• Joint pain
• Seizures
• Weight gain (unintentional)

Causes

When muscle is damaged, a protein called myoglobin is released into the bloodstream. It is then filtered out of the body by the kidneys. Myoglobin breaks down into substances that can damage kidney cells. Rhabdomyolysis may be caused by injury or any other condition that damages skeletal muscle. Problems that may lead to this disease include:

• Trauma or crush injuries
• Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP
• Genetic muscle diseases
• Extremes of body temperature
• Ischemia or death of muscle tissue
• Low phosphate levels
• Seizures or muscle tremors
• Severe exertion, such as marathon running or calisthenics
• Lengthy surgical procedures
• Severe dehydration

Treatment 

Treatment depends on the severity of the case, symptoms, and presence of additional health complications that may increase the risk of kidney damage. In severe cases, kidney damage can be irreversible without early treatment. One treatment method is intravenous fluid therapy. Large volumes of water are often administered to the veins for long time in order to rehydrate the body and flush out any myoglobin. Other treatment options for severe rhabdomyolysis include:

• urine alkalization
• dialysis
• filtration of the blood (in very severe cases)

 

PCCN Acute Coronary Syndrome

Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue. Even when acute coronary syndrome causes no cell death, the reduced blood flow changes how your heart works and is a sign of a high risk of heart attack. Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment include improving blood flow, treating complications and preventing future problems.

Signs and Symptoms

• Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning
• Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
• Nausea or vomiting
• Indigestion
• Shortness of breath (dyspnea)
• Sudden, heavy sweating (diaphoresis)
• Lightheadedness, dizziness or fainting
• Unusual or unexplained fatigue
• Feeling restless or apprehensive

Causes

Acute coronary syndrome usually results from the buildup of fatty deposits (plaques) in and on the walls of coronary arteries, the blood vessels delivering oxygen and nutrients to heart muscles. When a plaque deposit ruptures or splits, a blood clot forms. This clot blocks the flow of blood to heart muscles. When the supply of oxygen to cells is too low, cells of the heart muscles can die. The death of cells — resulting in damage to muscle tissues — is a heart attack (myocardial infarction). Even when there is no cell death, the decrease in oxygen still results in heart muscles that don't work the way they should. This change may be temporary or permanent. When acute coronary syndrome doesn't result in cell death, it is called unstable angina.

Risk Factors

• Aging
• High blood pressure
• High blood cholesterol
• Cigarette smoking
• Lack of physical activity
• Unhealthy diet
• Obesity or overweight
• Diabetes
• Family history of chest pain, heart disease or stroke
• History of high blood pressure, preeclampsia or diabetes during pregnancy

Treatment

The immediate goals of treatment for acute coronary syndrome are:

• Relieve pain and distress
• Improve blood flow
• Restore heart function as quickly and as best as possible

Long-term treatment goals are to improve overall heart function, manage risk factors and lower the risk of a heart attack. A combination of drugs and surgical procedures may be used to meet these goals.  

PCCN Chronic Renal Failure

Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. In the early stages of chronic kidney disease, you may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired.

Signs and Symptoms

Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Signs and symptoms of kidney disease may include:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in how much you urinate
• Decreased mental sharpness
• Muscle twitches and cramps
• Swelling of feet and ankles
• Persistent itching
• Chest pain, if fluid builds up around the lining of the heart
• Shortness of breath, if fluid builds up in the lungs
• High blood pressure (hypertension) that's difficult to control

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

Causes

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. Diseases and conditions that cause chronic kidney disease include:

• Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis, an inflammation of the kidney's filtering units (glomeruli)
• Interstitial nephritis, an inflammation of the kidney's tubules and surrounding structures
• Polycystic kidney disease
• Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
• Vesicoureteral reflux, a condition that causes urine to back up into your kidneys
• Recurrent kidney infection, also called pyelonephritis 

Risk Factors 

Factors that may increase your risk of chronic kidney disease include:

• Diabetes
• High blood pressure
• Heart and blood vessel (cardiovascular) disease
• Smoking
• Obesity
• Being African-American, Native American or Asian-American
• Family history of kidney disease
• Abnormal kidney structure
• Older age

Complications

Chronic kidney disease can affect almost every part of your body. Potential complications may include:

• Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
• A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening
• Heart and blood vessel (cardiovascular) disease
• Weak bones and an increased risk of bone fractures
• Anemia
• Decreased sex drive, erectile dysfunction or reduced fertility
• Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
• Decreased immune response, which makes you more vulnerable to infection
• Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium)
• Pregnancy complications that carry risks for the mother and the developing fetus
• Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

Treatment

Depending on the underlying cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure. Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you may need treatment for end-stage kidney disease.  

PCCN Ischemic Bowel Disease

Ischemic bowel disease results from inadequate flow of oxygenated blood to the intestines. The extent of ischemic bowel disease can range from mild to severe based on the amount of damage from lack of oxygenated blood. This is a potentially serious condition and immediate medical care. The sooner ischemic bowel disease is treated, the more favorable the outcome.

Signs and Symptoms

Ischemic bowel disease may cause:

• Cramping and abdominal pain
• Bloody stools
• Frequent urge to defecate
• Diarrhea
• Nausea or vomiting
• Abdominal distension

Causes

Ischemic bowel disease occurs when an artery that supplies blood becomes blocked or narrowed. There are several possible causes of ischemic bowel disease, including:

• Blockage in the arteries due to a tumor or blood clot
• Narrowing of the arteries supplying blood to the bowel from atherosclerosis
• Obstruction in the colon
• Low blood pressure
• Certain medications such as diuretics, chemotherapy drugs, or nonsteroidal anti-inflammatory drugs (NSAIDs)

Risk Factors

Ischemic bowel disease is more common in older adults. Other factors that may increase your chances of developing ischemic bowel disease include:

• Shock induced by conditions such as blood stream infection and blood loss
• Recent heart attack
• Sustained heart arrhythmias
• Heart failure
• Peripheral artery disease (PAD)
• Coronary artery bypass surgery (CABG) or other vascular surgeries
• Colon cancer
• Certain medications that cause arteries to narrow
• Diabetes
• Hemodialysis
• Sickle cell disease
• Dehydration
• Pregnancy

Treatment

Treatment options depend on the severity of the ischemia and include the following:

• Supportive Care
• Antibiotics
• Surgery

 

PCCN Myocardial Infarction

A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscle.

Signs and Symptoms

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
• Nausea, indigestion, heartburn or abdominal pain
• Shortness of breath
• Cold sweat
• Fatigue
• Lightheadedness or sudden dizziness

Causes

A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks.

Risk Factors

• Tobacco Use, HTN
• High Cholesterol
• DM, Obesity
• Family History
• Metabolic Syndrome
• Lack of Activity
• Stress, Drug Use

Treatment

• Aspirin
• Thrombolytics
• Anti-platelets
• Pain Relievers
• Nitroglyerin 
• Beta Blockers
• Statins, ACEI

 

PCCN Hyperthyroidism

Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated.

Signs and Symptoms

Hyperthyroidism can mimic other health problems, which can make it difficult for your doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

• Unintentional weight loss, even when your appetite and food intake stay the same or increase
• Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute
• Irregular heartbeat (arrhythmia)
• Pounding of your heart (palpitations)
• Increased appetite
• Nervousness, anxiety and irritability
• Tremor — usually a fine trembling in your hands and fingers
• Sweating
• Changes in menstrual patterns
• Increased sensitivity to heat
• Changes in bowel patterns, especially more frequent bowel movements
• An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
• Fatigue, muscle weakness
• Difficulty sleeping
• Skin thinning
• Fine, brittle hair

Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities.

Causes

Hyperthyroidism can be caused by a number of conditions, including Graves' disease, Plummer's disease and thyroiditis. Your thyroid is a small, butterfly-shaped gland at the base of your neck, just below your Adam's apple. The thyroid gland has an enormous impact on your health. Every aspect of your metabolism is regulated by thyroid hormones. Your thyroid gland produces two main hormones, thyroxine (T4) and triiodothyronine (T3), that influence every cell in your body. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of protein. Your thyroid also produces a hormone that helps regulate the amount of calcium in your blood (calcitonin).

Risk Factors

Risk factors for hyperthyroidism, include:

• A family history, particularly of Graves' disease
• Female sex
• A personal history of certain chronic illnesses, such as type 1 diabetes, pernicious anemia and primary adrenal insufficiency

Complications

• Heart Problems
• Brittle Bones
• Eye Problems
• Thyrotoxic Crisis
• Red, swollen skin

Treatment

Several treatments for hyperthyroidism exist. The best approach for you depends on your age, physical condition, the underlying cause of the hyperthyroidism, personal preference and the severity of your disorder. Possible treatments include:

• Radioactive Iodine
• Anti-thyroid Meds
• Beta-blockers
• Thyroidectomy 

 

PCCN Hypothyroidism

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Hypothyroidism may not cause noticeable symptoms in the early stages. Over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease.

Signs and Symptoms

Hypothyroidism signs and symptoms may include:

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory
• Enlarged thyroid gland (goiter)

Causes

When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body can be upset. There can be a number of causes, including autoimmune disease, hyperthyroidism treatments, radiation therapy, thyroid surgery and certain medications. Your thyroid is a small, butterfly-shaped gland situated at the base of the front of your neck, just below your Adam's apple. Hormones produced by the thyroid gland — triiodothyronine (T3) and thyroxine (T4) — have an enormous impact on your health, affecting all aspects of your metabolism. These hormones also influence the control of vital functions, such as body temperature and heart rate. Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including:

• Radiation Therapy
• Autoimmune Disease
• Thyroid Surgery

Risk Factors

• Are a woman
• Are older than 60
• Have a family history of thyroid disease
• Have an autoimmune disease, such as type 1 diabetes or celiac disease
• Have been treated with radioactive iodine or anti-thyroid medications
• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby within the past six months

Complications

• Goiter
• Heart Problems
• Mental Health Issues
• Myxedema
• Peripheral Neuropathy
• Birth Defects

Treatment

Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.  

PCCN Restrictive Cardiomyopathy

Restrictive cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. The pumping or systolic function of the ventricle may be normal but the diastolic function (the ability of the heart to fill with blood) is abnormal. Therefore, it is harder for the ventricles to fill with blood, and with time, the heart loses the ability to pump blood properly leading to heart failure.

Signs and Symptoms

Many people with restrictive cardiomyopathy have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress as heart function worsens. Symptoms occur at any age and may include:

• Shortness of breath (at first with exercise; but over time it occurs at rest)
• Fatigue (feeling overly tired)
• Inability to exercise
• Swelling of the legs and feet
• Weight gain
• Nausea, bloating, and poor appetite (related to fluid retention)
• Palpitations (fluttering in the chest due to abnormal heart rhythms)

Causes

Restrictive cardiomyopathy is not usually inherited and its cause is often unknown. Known causes include:

• Build-up of scar tissue (idiopathic is the most common cause)
• Build-up of abnormal proteins (amyloidosis) in the heart muscle
• Chemotherapy or chest exposure to radiation
• Excess iron (hemochromatosis) in the heart
• Other systemic diseases (sarcoidosis)

Treatment

The condition causing the cardiomyopathy is treated when it can be found.  Few treatments are known to work well for restrictive cardiomyopathy.  The main goal of treatment is to control symptoms and improve quality of life. The following treatments may be used to control symptoms or prevent problems:

• Blood thinning medicines
• Chemotherapy (in some situations)
• Diuretics to remove fluid and help improve breathing
• Medicines to prevent or control abnormal heart rhythms
• Steroids or chemotherapy for some causes
• A heart transplant may be considered if the heart function is very poor and symptoms are severe.

 

PCCN Endocarditis

Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves. Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. If it's not treated quickly, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in certain cases, surgery. Since there are many ways to develop endocarditis, your doctor might not be able to pinpoint the exact cause of your condition. However, people at greatest risk of endocarditis usually have damaged heart valves, artificial heart valves or other heart defects.

Signs and Symptoms

Endocarditis may develop slowly or suddenly, depending on what germs are causing the infection and whether you have any underlying heart problems. Endocarditis signs and symptoms can vary from person to person. Common signs and symptoms of endocarditis include:

• Flu-like symptoms, such as fever and chills
• A new or changed heart murmur, which is the heart sounds made by blood rushing through your heart
• Fatigue
• Aching joints and muscles
• Night sweats
• Shortness of breath
• Chest pain when you breathe
• Swelling in your feet, legs or abdomen
• Unexplained weight loss
• Blood in your urine, which you might be able to see or that your doctor might see when he or she views your urine under a microscope
• Tenderness in your spleen, which is an infection-fighting abdominal organ just below your rib cage on the left side of your body
• Osler's nodes, which are red, tender spots under the skin of your fingers or toes
• Petechiae which are tiny purple or red spots on the skin, whites of your eyes, or inside your mouth

Causes

Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Certain types of bacteria cause most cases, but fungi or other microorganisms also may be responsible. Usually, your immune system destroys harmful bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection. However, bacteria that live in your mouth, throat or other parts of your body, such as your skin or your gut, can sometimes cause serious infections like endocarditis under the right circumstances.

Risk Factors

If your heart is healthy, you could be less likely to develop endocarditis, although it is still possible. The germs that cause infection tend to stick to and multiply on damaged or surgically implanted heart valves, or on endocardium that has a rough surface. People at highest risk of endocarditis are those who have:

• Artificial or Congenital Heart Valves
• Damaged Heart Valves
• IV Drug Use

Complications

In endocarditis, clumps of bacteria and cell fragments form in your heart at the site of the infection. These clumps, called vegetations, can break loose and travel to your brain, lungs, abdominal organs, kidneys or limbs. As a result, endocarditis can cause several major complications, including:

• Heart problems, such as heart murmur, heart valve damage and heart failure
• Stroke, Seizure
• Loss of the ability to move part of all of your body (paralysis)
• Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other organs
• Pulmonary embolism — an infected vegetation that travels to the lungs and blocks a lung artery
• Kidney damage or Enlarged spleen

Treatment

Many cases of endocarditis are successfully treated with antibiotics. Sometimes, surgery may be required to fix damaged heart valves and clean up any remaining signs of the infection.