What is exertional dyspnea?

Exertional dyspnea basics

When we hear talking about   exertional dyspnea or in other words “shortness of breath” one must think to the difficulty of breathing when is doing an exercise or easier said, lack of comfort in breathing. But isn’t it normal to experience some kind of dyspnea when we are exercising? Apparently not! In the next article I’m going to explain what is exertional dyspnea, when it appears, when we say this condition is pathological or not and what causes it.
The word “dypnea” is originally composed from two greek words: “dysp” which means hard, heavy, difficult and “pnoia” that means breathing. If we combine these two words we have “hard breathing”also said dyspnea. Dyspnea is a breathing disorder characterized by changing the pace and intensity of respiratory movements.
Exertional dyspnea is frequently overlooked because it can occur to healthy people and is frequent confused with fatigue. It isn’t always a pathological symptom. You can experience exertional dyspnea when you are exercising more than your body is used to, if you have a weight problem (you weigh to much or you are obese), if you are an active smoker, or if the air around you is polluted.
Exertional dyspnea becomes pathological and that means that we should worry and go see a doctor when even if we make the same exercise as we did before we feel like our lungs aren’t getting enough air.

 But how does exertional dyspnea appear ?

Dyspnea due to illness can occur when there is an imbalance between tissue oxygen demand, and the amount of oxygen that the body can provide. Many diseases can give exertional dyspnea , the most common being:

• anemia (lack of blood) - Shortness of breath is accompanied by pale skin

• disease with increased energy consumption (as in cancers with different locations, hyperthyroidism, and uncompensated diabetes
• lung disease (dyspnea by lack of oxygen) of various causes, dyspnea is accompanied by coughing and / or wheezing and  sputum
• heart disease – exertional dyspnea occurs first and then it can occur during  rest or lying down, the patient can also feel palpitations and chest pains
• serious liver disease (cirrhosis) - liver as “laboratory” of the body, shortness of breath occurs in cirrhosis by multiple mechanisms
• severe kidney disease - shortness of breath occurs with changes in fluid and electrolyte balance or anemia (erythropoietin synthesized by  kidney, substance that stimulates the bone marrow to manufacture red blood cells that are the cells that  transport oxygen around the body)
• hypertension – exertional dyspnea  occurs by forcing the heart and the  blood vessel
• obesity (fat in the chest and abdomen pressed, preventing the movement of breath, plus a larger amount of tissue needs a greater amount of oxygen).

As you can see there are many conditions that can  manifest as exertional dyspnea, some of them  really serious diseases and that’s why is very important to go see a doctor whenever you notice changes in your breathing rhythm or you experience respiratory problems.

Fibrillation of the heart

Fibrillation of the heart

In the next part of the article we will discuss about fibrillation of the heart, one type of irregular heart rate and what are the consequences for our body. Our heart is an organ that has a so called „automatism”, an intrinsic property of the cardiac tissue to create its own electric impulse, a signal that allows changes in cell metabolism in order to generate cardiac muscle contraction and therefore pumping blood into the arteries. This electric signal is generated in the sinus node (a structure capable of generating electric signal, located in right atrium) and then conducted through special structures until it reaches the ventricles (heart chambers that pump blood into the arteries). If these structures called pacemakers, can’t function normally, irregular heart rate occurs and one of them is fibrillation of the heart.

 What is fibrillation of the heart ?

What is fibrillation of the heart? And how many types of fibrillation of the heart exist? There are two types of fibrillation of the heart: one is called atrial fibrillation and another ventricular fibrillation. The difference between these types of fibrillation of the heart is not just in name, but also in origin and prognostic. The first type of fibrillation of the heart-the atrial fibrillation-is an irregular heart rate generated in multiple atrial cells (but not in the sinus node which is the „natural” heart pacemaker).
Patients with atrial fibrillation may experience palpitations, shortness of breath, chest pain, dizziness, drowsiness, fainting, but there are some patients that don’t complain of any symptom and they are diagnosed with the occasion of a routine medical check or when the complications occur. Usually, atrial fibrillation allows blood clots to form and they can flow in the arteries and block them, causing a condition known as ischemia: the tissues won’t receive enough blood and oxygen and cells start to die. In this situation, strokes, pulmonary embolism (clots in the pulmonary arteries that can lead to death), limbs ischemia (if untreated it can lead to amputation) can occur and can lead to patient’s death, if immediate  measures aren’t taken. On the electrocardiogram, in atrial fibrillation there is an irregular heart rate, without „P” waves (which are a mark of  heart rate generated by the sinus node) and the frequency of the heart beats can vary: low, average or rapid.
If this arrhythmia was discovered at its beginning, a conversion to the normal heart rate called sinus rhythm can be tried (either using medication or with electric shocks). After this procedure succeeded, other medication is needed in order to maintain the normal heart rate, to control the normal frequency of the heart beats and prevent blood clotting. In some patients, when the beginning of this arrhythmia is unknown, doctors will use only drugs to control the heart rate (beta blockers like metoprolole, atenolol; digoxin-a drug that increases heart contractility and also has antuarrthymic properties, very often used in the treatment of atrial fibrillation, calcium channel blockers like amlodipine, verapamil, diltiazem) and prevent blood clotting. Atrial fibrillation associated with rapid heart rate can be a severe medical condition affecting the level of consciousness and the only way to save patient life is the electrical conversion to the sinus rhythm using electric shocks.
The other type of fibrillation of the heart-ventricular fibrillation is an irregular heart rate generated in the ventricular cells and is not compatible with life, meaning that is one of the heart rate that generates cardiac arrest. Heart stops from beating and emergency measures of resuscitation are needed-cardiac massage alternating with artificial oxygenation of lungs, using facial masks with balloons or orotracheal intubation (which is preferred if it is possible to perform), electric shocks, specific medication like adrenaline, vasopressin, amiodarone. If in 30-45 minutes all these maneuvers are unsuccessfully, then the patient is declared dead.

As we saw above, fibrillation of the heart is a major heart disorder, that requires  special attention, knowledge, maneuvers and skills, since ventricular fibrillation is the most frequent cause of cardiac arrest in adults.

Hyperlipidemia symptoms

What are the hyperlipidemia symptoms ?

Hyperlipidemia represents increasing levels of lipid or lipoproteins in the blood and hyperlipidemia symptoms can be varied from patient to patient. Hyperlipidemia is a metabolic disease and may include changes in cholesterol (blood fat levels), triglycerides (a type of blood fat) or lipoproteins. There are two main types of hyperlipidemia: hypercholesterolemia (which occurs most frequently) and hypertriglyceridemia.  Hyperlipidemia may be a risk factor for atherosclerosis, cardiovascular diseases (coronary artery diseases and peripheral vascular diseases), but can affect other organs such as pancreas.

Hyperlipidemia symptoms

Hyperlipidemia symptoms are usually absent from most of the patients, if this is the only change to the analysis of blood. This can be found at a routine exam that the patient makes. It can remain undiagnosed for many years.
Hyperlipidemia symptoms can include first deposits of cholesterol (known as xanthomas) that form under the skin (especially around the eyes). They may be the only symptom that indicate an increase in blood lipids. They can also form the Achilles tendon and the extensor tendons of the hands. Xanthomas may have varied sizes, from very small to several centimeters. The diagnose of xanthoma can be done by physical examinations and by determining blood cholesterol levels.
Chest pain may be another symptom for hyperlipidemia. This pain can be felt by the patient as chest discomfort located anywhere. Patients go to the doctor for the fear of a heart attack. Hyperlipidemia is a risk factor for atherosclerosis (deposition of fat in the arteries of large and medium) that causes coronary artery diseases manifested primarily through chest pain. Any organ in the thorax may be the source of pain (heart, lungs, esophagus, muscles or nerves).
Another symptom which may be included in the category of hyperlipidemia symptoms is hepatomegaly (increased liver beyond normal size, 12 inches). This may or may not be associated with increased spleen size.
One of the last hyperlipidemia symptoms is abdominal pain. This may occur in the right hypochondrium where it is located the liver or anywhere in the abdomen. Hyperlipidemia occurs in the liver as fatty liver disease caused by the deposition of fat in liver cells. Pain in the abdomen can originate from many organs (stomach, small and large intestines, appendix, spleen, liver or pancreas). Pain may be generalized or may be located in a single point. In many cases patients don’t go to a doctor and expect that the pain to go by itself.
Treatment of hyperlipidemia symptoms

Treatment of hyperlipidemia symptoms can be done with drugs or by dietary changes, weight reduction and exercise. If cholesterol and triglycerides are not very high and patients have no important hyperlipidemia symptoms, doctors advice patients dietary changes by reducing dietary fat, weight loss and moderate exercise daily.
If  lipids values may be lower without drugs then doctors recommend the use statins (drugs used to lower cholesterol) and fibrates (drugs used to lower triglycerides).
Conclusion
In conclusion there are no specific hyperlipidemia symptoms, but if discovered at a routine exam is better to be treated because it can have serious complications.

Marfan syndrome life expectancy

When we talk about Marfan syndrome should really talk about Marfan syndrome life expectancy because it is a disease that undiagnosed, timely can lead to the death of the patients.
Marfan syndrome is a genetic disorder (autosomal dominant) characterized by connective tissue damage. This syndrome includes multiple malformations of organs (bones, eyes, skin, intestines, heart and lungs).

Marfan syndrome symptoms

Most of the visible signs or symptoms occur in the skeletal system. The patients  suffering from Marfan syndrome are taller than patients without the disease and arachnodactyly ( very thin and long fingers). Another anomaly in the skeletal system is pectus excavatus (deformity of the anterior wall of the chest which penetrates inside sternum) and scoliosis (abnormality of the spine that consists of spine deformity in the form of the letter S). Other signs include abnormal joint flexibility and sometimes pain in joint.
The most important signs and symptoms  associated with Marfan syndrome are the cardiovascular symptoms. This are mitral or aortic valve prolapse (the most common heart valve abnormality) and aneurysm of the aorta.  Many patients with Marfan syndrom have some type of vision problems of which the most important are myopia (a visual anomaly in which distant objects appear blurred), glaucoma and cataracts. This can severely influence Marfan syndrome life expectancy.

Marfan syndrome life expectancy

Marfan syndrome life expectancy may be different from patient to patient. There is no treatment for the Marfan syndrome, but life expectancy may be influenced by monitoring and treatment of complications that can occur. Marfan syndrome life expectancy increased lately because of the advancement in medical techniques and appearance of new treatments.
Best way to expend Marfan syndrome life expectancy is tracking the aneurysm of the aorta and mitral valve prolapse. This is done by a cardiologist annual control for monitoring the health of the heart valves and the aorta. This is done by performing an ECG or another radiological method for the visualization of the anomaly (such as CT or MRI image). The goal of treatment in Marfan syndrome is to slow the progression of the aortic dilatation and to prevent the dissection of the aorta. Another goal of the treatment is to eliminate arrythmias and diminuate the heart rate.
The skeletal manifestations of this syndrome are also important for Marfan syndrome life expectancy. They can be serious and can affect patients life. To solve these problems are used different kinds of pain medication or muscle relaxants.
Because some of the Marfan symptoms of the spine may be asymptomatic, but serious if are not treated, they can be solved by surgery and thus increase the Marfan syndrome life expectancy.
Lung damage involves spontaneous pneumothorax and Marfan syndrome life expectancy depends on the volume of air in the pleural space.  It may resolve by itself or can be made by chest drainage.
Conclusion

Today patients with this syndrome needs to know is not the end of life and Marfan syndrome life expectancy can be good if patients are addressed in time to the doctor.