>Acute Myocardial Infarction (MI)

Acute Myocardial Infarction

Of all the different types of heart diseases in this cardiovascular diseases list, acute myocardial infarction, which is commonly known as a heart attack, is one of the most common medical emergency conditions, which comes with a high mortality rate. A large number of myocardial infarction cases occur at rest, during sleep or sometimes after heavy exertion.

Causes:

• Coronary artery blockage is by far the most common cause of acute myocardial infarction. Partial or complete blockage of one or more coronary arteries leads to an attack of myocardial infarction which may even culminate in sudden cardiac arrest and death.
• Other factors that may lead to an acute myocardial infarction attack include unstable angina, variant angina and hypoglycemia.

Warning sign of MI

Warning Sign of MI:

Most heart attacks are also asymptomatic in nature and are known as silent heart attacks. Such attacks are common in patients suffering from diabetes mellitus.

The most common warning signs of a heart attack are related to chest discomfort. This discomfort if accompanied with or without breathing difficulty, demands emergency medical attention. This may include crushing pain due to extreme force on and squeezing of the chest. The person may have a feeling of fullness in his chest and this is accompanied by a chest pain or heart burn.

Before a heart attack, certain kinds of discomforts arise in the upper part of the body. The person may feel the pain extending into the jaw and to the left arm or shoulder. There will be pain in the back and feeling of uneasiness in one or both the arms and also in the neck area and stomach.

Severe heart attack warning signs include loss of consciousness and absence of pulse. The pupils of the person may get dilated; and cyanosis ( a bluish discoloration of the skin and mucous membranes. It a sign that oxygen in the blood is critically diminished ) or pallor (Unnatural lack of color in the skin) may also occur. These symptoms are usually 'not-to-be-avoided' alerts for a full cardiac arrest.

Symptoms:

• Chest pain, which is severe, constricting and resembles an angina attack. Also, the patient may seem restless, profusely sweating and be in a state of panic. These also sometimes manifest as heart attack warning signs.
• There maybe symptoms of left heart failure, cardiac arrhythmias, ventricular tachycardia, fibrillation or supraventricular tachycardia.
• Weak peripheral pulse, with cold and sweating extremities and visible pallor, accompanied by hypotension. The heart sound maybe muffled.

Treatment:

• The first line of action in heart attack treatment is pain relief. A subcutaneous injection of pain reliever is given. If that fails to act, then a slow intravenous or subcutaneous injection of morphine is given.
• Oxygen is given via a mask. Continuous oxygen administration provides relief by improving myocardial oxygen supply.
• Certain drugs are used for the cure and treatment of heart attack.This includes low dose aspirin, certain sedative drugs, and even anti-anxiety drugs.
• Fibrinolytic therapy is given to patients so as reduce the infarct size. These agents reduce the infarct size and the ventricular damage. They help restore coronary blood flow, thus, salvaging the myocardium. Streptokinase is the most commonly used fibrinolytic agent.
• Complete bed rest is enforced for the first 48 hours after an attack. Also, the patient should be preferably on a low fat diet, which should be a liquid diet for the first few days, and then should be slowly shifted to a semi-solid diet.
• If all these measures fail, then the only option left for a patient of myocardial infarction is surgery. The various surgery options include angioplasty and coronary artery bypass surgery.

>New Anti-cancer Therapy

Anti-cancer Therapy

Chemotherapy

Presently, there are three primary ways of treating cancer at present, and these have undergone very little fundamental change in 30 years. In the case of solid tumors, surgery is used to cut out the cancerous tissue, while radiation therapy can kill the malignant cells, and chemotherapy stops them dividing. An enzyme called Topoisomerase IB that plays a key role in some of the molecular motors involved in the processes of DNA and RNA copying during cell division targets cancer cells much more specifically than traditional chemotherapy, can cut off the genetic information flow that tumors need to grow.

Chemotherapy

... molecular copying machinery, constructed mostly out of proteins, in effect walks along the DNA double helix reading the genetic code so that it can be copied accurately into new DNA during division. Other components of the machinery are responsible for slicing and assembling the DNA itself. All of these are potential targets for anti-cancer therapy, providing it is possible to single out the tumor cells. Most existing chemotherapy targets all dividing cells, and the aim to find more sensitive techniques.

>Congestive Heart Failure(CCF)

Congestive Heart Failure

Congestive heart failure is one of the most common conditions affecting the heart, thus, cementing its place in one of the top slots of cardiovascular diseases list. It is the failure of the heart to meet the body demands of adequate circulation for its metabolizing tissues. The different types of congestive heart failure are acute or chronic heart failure, high output or low output heart failure and left sided or right sided biventricular failure. There can also be compensated or decompensated heart failure.

Causes:

• Myocardial causes, where there is myocardial dysfunction leading to reduced contractile force of the heart. The causes of this include viral infections like viral pneumonia, rheumatic fever, beri-beri, coronary heart disease, hypertension, diphtheria, amyloidosis, and degenerative diseases involving the heart.
• Mechanical lesions of the heart where there is a volume overload, as seen in valvular heart disease (aortic and mitral disease), syphilitic heart disease, as seen in the third stage of syphilis.
• Diseases interfering with diastolic filling of the heart, like constrictive pericarditis, pericardial effusion restrictive cardiomyopathy.
• Rhythm disturbances, especially in a compromised heart, since they reduce the end diastolic volume due to reduction in diastolic interval. These include atrial tachycardias, atrial flutter, atrial fibrillation and heart block.
• Conditions where there is an increased pressure on the heart to pump out more blood, like high fever, pregnancy or thyrotoxicosis.

Signs of Congestive Heart Failure:

One of the earliest signs of congestive heart failure is fatigue, accompanied by the affected person’s diminished capacity to exercise. In fact, most people don’t even realize this reduction, with them usually compensating subconsciously by reducing their activities in order to adapt to this limitation.

With the body becoming congested with fluid, and the lungs becoming affected, resulting in shortness of breath, which impairs the ability to exercise and also when lying down flat. Sometimes, the affected person may wake up at night gasping for breath. Some even have to sleep sitting in an upright position. The excessive fluid in the body also results in an increase in urination, especially at night. When the fluids accumulate in the intestines and liver, it may result in a decrease in the appetite, pain in the abdomen, and nausea.

Symptoms:

Left Heart Failure Symptoms

• Progressive breathlessness, that is more marked on exertion.
• Paroxysmal nocturnal dyspnea attacks.
• Weakness, fatigue, palpitation and pain in the chest.
• Acute left heart failure is characterized by basal crepitations, tachycardia, cold extremities, facial pallor, hypertension and a galloping rhythm.

Right Heart Failure Symptoms

• Generalized fatigue and weakness including cough, breathlessness, anorexia, abdominal distension, pain and dragging sensation in the right hypochondrium.
• Headache, restlessness, insomnia, weight gain, swelling of legs and feet, oliguria and nocturia.
• Physical signs include cyanosis, warm extremities, engorged neck veins, elevated jugular venous pressure, enlarged liver and edema over legs and feet.
• The size of the heart is generally within normal limits. Pulmonary diastolic murmur is seen due to pulmonary hypertension. Signs of pleural effusion maybe present.

Treatment:

• Take adequate rest but maintain a certain minimum level of physical activity.
• A nutritious diet that is well balanced and is low in calories and salt is very important. Frequent but small meals should be consumed. Evening meals should be light and adequate time interval should be maintained between the evening meals and the time of sleep.
• Often after being diagnosed with congestive heart failure, the patient is confined to bed and the diet is either light and semi-solid or liquid. So a daily movement of bowels is desirable. Straining at stools must be avoided.
• In most cases there is need to take to drug therapy. They are mostly inotropic drugs that have a direct effect on the myocardium, by increasing the systolic contraction of the heart and thus increasing the cardiac output. Other drugs that are also used include diuretics and vasodilators.

>Chlamydia

Introduction of Chlamydia

Chlamydia, often misspelt Clamidia, is one of the most commonly reported bacterial sexually transmitted diseases (STDs). Global chlamydia statistics show that an estimated 92 million new chlamydia infections occur each year, affecting more women (50 million) than men (42 million).
Chlamydia is caused by the bacterium chlamydia trachomatis. This bacteria can infect the cervix in women and the urethra and rectum in both men and women. Occasionally chlamydia can also affect other parts of the body, including the throat and eyes.
Chlamydia often has no symptoms, especially among women. If left untreated, chlamydia can cause serious problems later in life.

Chlamydia symptoms and signs:

Chlamydia symptoms usually appear between 1 and 3 weeks after exposure but may not emerge until much later. Chlamydia is known as the ‘silent’ disease as in many people it produces no symptoms. It is estimated that 70-75% of women infected with chlamydia are asymptomatic (have no symptoms) and a significant proportion of men also have no symptoms. Those who do have symptoms of chlamydia may experience:


       In Women

• An increase in vaginal discharge caused by an inflamed cervix;
• the need to urinate more frequently, or pain whilst passing urine;
• pain during sexual intercourse or bleeding after sex;
• lower abdominal pains;
• irregular menstrual bleeding.

      In Men

• A white/cloudy and watery discharge from the penis that may stain underwear;
• a burning sensation and/or pain when passing urine;
• pain and swelling in the testicles.
• Men are more likely to notice chlamydia symptoms than women, though they too may be asymptomatic.

In both men and women a chlamydia infection in the rectum will rarely cause symptoms.

Transmission of chlamydia:

Chlamydia can be transmitted:

• By having unprotected vaginal, anal or oral sex with someone who is infected;
• from a mother to her baby during vaginal childbirth;
• by transferring the infection on fingers from the genitals to the eyes, although it is rare for this to happen.

"I think I may have chlamydia..."

If you have any symptoms or are worried you may have been infected with chlamydia, there are a number of places you can go for help.

• You can visit your doctor, who may be able to test you for chlamydia. If they do not have the facilities to do this, they will probably be able to refer you to a place where you can get tested.
• Some countries also have specific sexual health clinics that can help you directly. Have a look at our help and advice page or your local telephone directory to see if you have a clinic near you.
• In some countries, local pharmacies and chemists may offer chlamydia testing kits that allow a person to take a sample themselves for analysis by the pharmacy.

Chlamydia testing:

Chlamydia testing is the only way to find out for certain whether a person is infected.
A woman can provide a urine sample, which is sent to a laboratory for testing. Alternatively a swab can be taken from the vagina (either by a doctor or nurse, or by the woman herself) that is sent to a laboratory. Results for the chlamydia test are usually available within one week, though this may vary depending on location.
For men, either a urine sample is taken, or a swab is taken from the opening of the urethra at the tip of the penis. Many testing sites now just take a urine sample. This is an easier and less painful procedure, but is slightly less reliable than a swab.
A modern 'rapid' urine test for men has also been developed, which provides the results within the hour and eliminates the need for laboratory testing.

Treatment of chlamydia:

The treatment of chlamydia is simple and effective once the infection has been diagnosed. It consists of a short course of antibiotic tablets, which if taken correctly, can be more than 95 percent effective.
If a patient is allergic to any antibiotics, or if there is a possibility they may be pregnant, it is important that the doctor is informed as this may affect which antibiotics are prescribed. Treatment must not be interrupted once a course of antibiotics has been started, otherwise it may be necessary to start again from the beginning.
The doctor or health advisor will discuss the chlamydia infection and answer any questions. They will also ask about any partners the patient has had sexual contact with in the past six months, as they may also have chlamydia and will need to get tested.

It is important that the patient returns for a check-up once the treatment has been completed to make sure they have no recurring infection. The patient should not have penetrative sex until they have received a negative test result following the check-up.

Complications of chlamydia:

If chlamydia is left undiagnosed and untreated it can cause serious health problems. Early diagnosis and treatment means that chlamydial infection can be easily cleared up, but if left unchecked it can lead to:


      In Women

• Pelvic inflammatory disease (PID) - an infection of the uterus, ovaries and fallopian tubes. PID increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth. If the fallopian tubes are scarred, it can also lead to problems with fertility.
• Cervicitis - an inflammation of the cervix. Symptoms include a yellowish vaginal discharge and pain during sex. In long-term cervicitis the cervix becomes very inflammed and cysts can develop and become infected. This can lead to deep pelvic pain and backache.

    In Men

• Epididymitis - painful inflammation of the tube system that is part of the testicles, which can lead to infertility.
• Urethritis - inflammation of the urine tube (urethra), causing a yellow or clear pus-like discharge to collect at the tip of the penis. Left untreated it can lead to a narrowing of the urethra, which can affect the ability to urinate easily and can potentially cause kidney problems.
• Reactive arthritis - symptoms include inflammation of the joints, urethra and eyes. 
• Complications of chlamydia are less common in men than women.

If a pregnant woman has untreated chlamydia, the infection can potentially be passed on to a baby during pregnancy, giving it an eye or lung infection. Chlamydia can be safely treated during pregnancy provided the correct antibiotics are prescribed.

Chlamydia prevention:

Using condoms greatly reduces the risk of chlamydia being passed on during sex. Getting tested for STDs at a sexual health clinic, and encouraging new partners to get tested before having sexual intercourse, also helps to prevent transmission.
If you think you may have any of the symptoms listed above then having a chlamydia test is highly recommended. Visit the nearest GUM (genitourinary medicine) clinic, sexual health clinic or doctor as soon as possible to avoid complications. In countries such as the USA and UK, all pregnant women are offered a test for STDs such as chlamydia, and it is recommended that all sexually active women under the age of 25 get screened for STDs at least once a year.

>Genital warts: HPV, symptoms and treatment

Introduction

Structure of HPV

Genital warts, caused by some types of HPV (human papilloma virus), can appear on the skin anywhere in the genital area as white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps (see genital warts pictures). There are more than 100 different subtypes of HPV, and around 30 of them specifically affect the genitals. Other HPV subtypes cause warts to grow on different parts of the body, such as the hands.

Life cycle of HPV

Not everyone infected with HPV will develop genital warts. Some people will be infected with a strain that does not produce warts, or they will remain asymptomatic (i.e. no warts will appear), even though the virus is present in the skin or mucous membranes around the genital area, or on the cervix in women. Those who do go on to develop genital warts will usually notice them 1 to 3 months after initial infection.

Symptoms of genital warts

If symptoms do appear then the infected person may notice pinkish/white small lumps or larger cauliflower-shaped lumps on the genital area. Genital warts can appear on or around the penis, the scrotum, the thighs or the anus. In women genital warts can develop around the vulva or inside the vagina and on the cervix. If a woman has warts on her cervix, this may cause slight bleeding or, very rarely, an unusual coloured vaginal discharge. Warts may occur singly or in groups. The warts may itch, but they are usually painless. Sometimes genital warts can be difficult to spot. In severe cases, it is possible for genital warts to spread from the genitals to the area around the anus, even if anal intercourse has not occurred.
Occasionally, people can confuse skin problems caused by other STDs (such as genital herpes, syphilis or molluscum) with genital warts. Other people may become very worried because they mistake perfectly normal and non-infectious lumps and bumps for genital warts. Conditions that may be confused with genital warts include:

• Pearly penile papules - small white or skin-coloured bumps that, when numerous, appear in a ring around the edge of the head of the penis. More rarely, similar papules may be found on the vulva.
• Angiokeratomas - bright red or purple spots that look a little like blood blisters.
• Sebaceous glands (also known as 'Fordyce spots') - hard white, yellowish or skin-coloured little bumps that may be found all over the skin of the penis and scrotum in men, and the vulva in women. Sebaceous glands produce a substance called sebum, which keeps the skin healthy.
• Pimples or spots - caused by blocked sebaceous glands. Pimples and spots can form just as easily around the genital area as they do on the face, and may become sore and inflamed in a similar way.

All of the above are common, non-infectious skin manifestations that are not sexually transmitted.
Any doubt about lumps and bumps on the genitals can usually be resolved by a visit to a doctor or sexual health clinic.

How is HPV passed on?

Genital HPV is transmitted by genital skin-to-skin contact, or through the transfer of infected genital fluids. This is usually during vaginal or anal sex, but it is also possible to pass it on through non-penetrative sexual activity.
In rare circumstances, a woman can pass HPV on to her baby during vaginal child birth.

"I think I may have genital warts"

If you have any symptoms or are worried you may have been infected with an STD, there are a number of places you can go for help.

• You can visit your doctor, who may be able to tell whether you have genital warts just by looking closely at the affected area. If you would prefer, they will probably be able to refer you to a specialist clinic to get tested.
• Some countries also have specific sexual health clinics that can test for a range of STDs. Have a look at our help and advice page or your local telephone directory to see if you have a clinic near you.

If genital warts are suspected but are not obvious, the doctor or nurse may apply a weak vinegar-like solution to the genital area; this turns any warts white and makes them more visible. To check for hidden genital warts, the doctor may carry out an internal examination of the vagina, cervix and/or anus.
If a person suspects they have been exposed to HPV, but does not yet have symptoms, their doctor may be able to take a swab to test for high-risk strains of the virus (this isn't available in all countries). In women, this may be performed alongside a cervical Pap smear test (see below).
Not everyone diagnosed with HPV will develop warts, and patients may be asked to come back for another examination at a later date if nothing is yet visible.

Treatment for genital warts

There is no treatment that can completely eliminate genital warts once a person has been infected. Often outbreaks of genital warts will become less frequent over time, until the body naturally clears the virus and the warts disappear of their own accord. However, in some people the infection may linger.
A doctor can give patients various treatments to clear genital warts, but they may reappear even after treatment. Genital warts are caused by a virus, not a bacterium, so antibiotics will not get rid of them. Common treatments include:

• Podophyllin resin – a brown liquid that removes genital warts by stopping cell growth. Podophyllin resin and podofilox lotion is painted on to the wart(s) by a doctor or nurse and must be washed off 4 hours later (or sooner, if the area is irritated). It has to be applied by a medical professional to avoid damaging the healthy tissue around the wart and may have to be applied several times to work effectively.
• Podopfilox lotion/gel – can be applied to the wart(s) by the patient at home. The usual schedule is twice a day for 3 days, followed by 4 days without any lotion. This cycle is repeated for 4 weeks. It has few side effects and is well-suited for treatment at home.
• Cryocautery (also called cryotherapy) – uses liquid nitrogen to freeze more persistent warts every 1 to 3 weeks for a short period.
• Laser treatments – this approach, which uses an intense beam of light, can be expensive and is usually reserved for very extensive and tough-to-treat warts.
• Electrocautery – an electrical current is used to super-heat a needle which burns the wart cells and cauterises the blood vessels. A local anesthetic is used to prevent any pain and the procedure is usually carried out at a doctor's surgery. Electrocautery is used only after other treatments have failed.
• Surgical excision – the doctor will perform minor surgery to remove the wart under local anesthetic.

The doctor or nurse should give the patient advice about having sex whilst receiving treatment.
There are some non-prescription treatments available for genital HPV, but it is advisable to always seek medical advice. Never try to treat genital warts by yourself.
It is important that a woman who is pregnant, or trying to become pregnant, informs her doctor. Podophyllin treatment could harm the developing baby and an alternative treatment should be used.

Follow-up

It is important to return regularly for treatment until all of the genital warts have gone so the doctor or nurse can check progress and make any necessary changes in your treatment. Sometimes treatment can take a long time.
The majority of people whose genital warts initially disappear will get a recurrence.
In the majority of cases, the immune system keeps the virus under control and eventually destroys it a few years after the initial infection.

Taking care of yourself and your partner

If you have genital warts, following these suggestions will make an outbreak easier to deal with, and will help protect your partner.

• Use condoms when having sex. But remember that condoms will only prevent the transmission of genital warts if they cover the affected areas. Talk to your doctor or nurse for more advice on safer sex.
• Make sure that your partner has a check-up too, as they may have warts that they haven't noticed.
• Keep your genitals clean and dry.
• Don't use scented soaps and bath oils or vaginal deodorants, as these may irritate the warts.

HPV and cervical Pap smear tests

Some types of the human papilloma virus (notably types 16 and 18) have been linked to changes in cervical cells that can lead to cancer. This is why it is important that all sexually active women have a regular cervical Pap smear test.
A smear test is performed by opening the vagina using a speculum (a metal instrument that gently stretches the entrance and the walls of the vagina) and taking a small sample of cells from the cervix with a special swab. The cells will then be looked at under a microscope. If any changes to the cells are noted, the woman may be asked to repeat the test or will be referred for treatment that can prevent the cells from developing into cervical cancer. It is important to note that cell changes (also called cervical dysplasia) DO NOT indicate that a woman already has cancer. Most of these changes will go away on their own, or with treatment. However, it is very important to monitor the cell changes closely, as there is a risk that they may turn precancerous if they do not clear.
A woman who has received an abnormal Pap smear result may sometimes be given a colposcopy to look at cells on the cervix. A colposcope is a kind of small microscope with a light which is used to view the cervix. The scope magnifies the cervix so the doctor can see any changes or problems. The doctor may take a small sample of cells (called a biopsy), which will be looked at in a laboratory. The colposcopy may feel slightly uncomfortable. If the patient has a biopsy taken then they may have a dull ache like a mild period cramp, with slight bleeding.
Treatment to remove abnormal cells on the cervix will usually consist of cryocautery (freezing the cells using a special cold probe), electrocautery (heating the cells with electricity) or using laser treatment to 'zap' the cells. None of these procedures should be painful, but they may lead to dull aching (like period pains) and watery vaginal discharge that may last several weeks.
A woman who has had visible genital warts in the past is not necessarily at any greater risk of cervical cancer, as genital warts tend to be linked to non-cancer causing subtypes of HPV.

Pap smear tests of the anus and rectum

The subtypes of HPV that can lead to cervical cancer may also pose a risk for men and women who have regular anal sex. Though few countries offer regular screening for anal and rectal cancer, many doctors recommend that people who have frequent anal sex (such as gay or bisexual men) should still receive a regular Pap smear test of the rectum and anus. As with cervical cell changes, early detection and treatment can help to prevent cancer from developing.

Is there a vaccine against genital warts?

Two vaccines are currently used to prevent cervical, vulvar and vaginal cancers, and genital warts caused by some of the major subtypes of HPV.
Gardasil®, marketed by Merck, was first approved by the Food and Drug Administration (FDA) for use in the United States of America in June 2006.¹ The vaccine is now approved in over 100 countries. Gardasil® has also been found to provide protection for men against anal disease caused by some types of HPV.²
The other FDA approved vaccine, Cervarix® (marketed by GlaxoSmithKline), is used in the UK's HPV vaccination programme for girls run by the National Health Service.
The vaccines are not recommended for pregnant women and a very small number of people may not be able to have the vaccine due to specific medical reasons. The vaccines may also be less effective in women who are already sexually active, as they may have already been infected with HPV.
HPV vaccines do not protect against all cervical cancers, so it is important for women to continue attending cervical Pap smear tests.