Lung Diseases:

Acute bronchitis is an inflammation of the bronchial tubes, the major airways into the lungs. It may be
caused by a variety of bacteria and viruses. Acute bronchitis can last from a few days to 10 days. But the cough that comes with acute bronchitis may last for several weeks after the infection has gone.

How Serious is Acute Bronchitis? Acute bronchitis can last from a few days to 10 days. But the cough that comes with acute bronchitis may last for several weeks after the infection has gone. What Causes Acute Bronchitis? Acute bronchitis may develop on its own, or as a result of an upper respiratory infection, pertussis (whooping cough) or other infection. What are the Symptoms of Acute Bronchitis? The symptoms of acute bronchitis may include:
y y y y y

Cough, which may produce clear, yellow or green mucus Wheezing Low fever Chest tightness or pain Shortness of breath (in severe cases)

How is Acute Bronchitis Detected? Your healthcare provider will ask questions about your medical history and your symptoms, such as whether you've recently had a cold or the flu. He or she may also ask whether you smoke or are exposed to smoke or other lung irritants such as air pollution, dust or fumes. Your healthcare provider will listen to your lungs with a stethoscope to detect abnormal breathing sounds such as wheezing. Other possible tests include:
y y y y y

Examination of mucus to see if you have a bacterial infection Test for blood oxygen levels using a sensor attached to your finger or toe Chest x-ray Lung function tests Blood tests

How is Acute Bronchitis Treated? Your healthcare provider may recommend rest, lots of fluids, and fever-reducing medication such as acetaminophen. If your he or she thinks you have a bacterial infection, you may be given antibiotics. But antibiotics don't work against viruses, which are the most common cause of acute bronchitis. Other treatments may include:

y y y

A humidifier or steam to ease breathing and help loosen mucus Inhaled medicine to open airways if you are wheezing Cough medicine

Preventing Acute Bronchitis Avoiding lung irritants is important for preventing acute bronchitis as well as treating it. If you smoke, quit. To help protect your lungs, wear a mask over your mouth and nose when using lung irritants such as paint, paint remover or varnish. Other ways to help prevent acute bronchitis include:
y y y

Wash your hands often to reduce your exposure to viruses and bacteria Get a flu shot every year Ask your doctor if you should get a pneumonia shot, especially if you're 60 or older

y Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is the sudden failure of the respiratory (breathing) system. It can develop in anyone over the age of 1 who is critically ill. A person with ARDS has rapid breathing, difficulty getting enough air into the lungs and low blood oxygen levels. ARDS usually develops in people who are already very ill with another disease or who have major injuries. They are usually already in the hospital when they develop the ARDS. ARDS can be life-threatening because your body's organs need oxygen-rich blood to function well. The good news is that because of improved treatment in recent years, more people are surviving ARDS. If you have ARDS your lung function is likely to return to normal or near normal within several months. But some people with ARDS have lasting damage to their lungs or to areas outside the lungs. How Serious is ARDS? Approximately 190,000 Americans are affected by ARDS annually. ARDS can be life-threatening because your body's organs need oxygen-rich blood to function well. Up to 30% of ARDS cases can be fatal. That is a significant improvement from the 50%-70% death rate just 20 years ago. Patients who develop ARDS due to trauma or a lung infection usually do better than those who develop the condition due to sepsis (infection of the blood). If you have ARDS your lung function is likely to return to normal or near normal within several months. But some people with ARDS have lasting damage to their lungs or to areas outside the lungs. What Causes ARDS? Causes of ARDS include:
y y

Sepsis (bacterial infection of the blood) Trauma

y y y y y y y y y

Pneumonia or other lung infection Multiple blood transfusions Breathing in salt water Breathing in harmful smoke or fumes Breathing vomit into the lungs Narcotics Sedatives Overdoses of tricyclic antidepressants Shock

What are the Symptoms of ARDS? Signs and symptoms of ARDS may include:
y y y y y y y

Feeling like you can't get enough air into your lungs Rapid breathing Low oxygen levels in the blood Cough and fever (if your ARDS is caused by pneumonia) Low blood pressure Confusion Extreme tiredness

How is ARDS Diagnosed? Your doctor makes a diagnosis of ARDS based on your medical history, a physical exam and medical tests. Your doctor will listen for abnormal breathing sounds, listen to your heart and look for signs that your body has too much fluid, which could mean your heart or kidneys are not working properly. Medical tests for ARDS include:
y y y y y

An arterial blood gas test, which checks the oxygen level in your blood Chest x-ray, which can show extra fluid in your lungs Other blood tests that can find an infection that may be causing ARDS CT scan, which can show problems in the lungs Heart tests to look for signs of heart failure. This can cause fluid buildup in the lungs.

ARDS is usually diagnosed in a patient who is in the hospital from a critical illness such as shock, sepsis or other trauma. How is ARDS Treated? There is no specific treatment for ARDS. A person with ARDS is treated in the intensive care unit at the hospital. Often a person with ARDS will need a machine's help to breathe (called mechanical ventilation) and oxygen therapy. Treatments may include:
y y y y

Oxygen through tubes in your nose or through a mask Oxygen through a breathing tube. The tube is flexible and goes through your mouth or nose into your windpipe. The tube is connected to a ventilator, a machine that helps you breathe. Fluids through an IV line to improve your blood flow and to provide nutrition Medicine to prevent and treat infections and to relieve pain

Asbestosis

Asbestosis is a disease that involves scarring of lung tissue as a result of breathing in asbestos fibers. The scarring makes it hard for you to breathe and for oxygen to get into the blood. The disease worsens slowly over time. In some people the disease causes no symptoms, while in others it can cause severe symptoms. There is no cure for asbestosis. A doctor can help you manage your symptoms. If you have trouble breathing, shortness of breath and a very low blood oxygen level, your doctor may recommend oxygen therapy. Asbestos was previously widely used as an insulator and fire retardant until it became known that its microscopic fibers cause disease, including cancer. Asbestos exposure occurred in industries including the asbestos mining and milling industries, construction, and fireproofing. Today asbestos is a well recognized health hazard, and is highly regulated by the government. The Occupational Safety and Health Administration (OSHA) established regulations dealing with asbestos exposure on the job, specifically in construction work, shipyards, and general industry that employers are required to follow. How Serious is Asbestosis? Asbestos is potentially deadly. Between 1999 and 2004, there were 3,211 deaths due to asbestosis in the United States. Breathing in asbestos fibers can cause scar tissue to form inside the lung. The severity of your disease depends on how long you were exposed to asbestos and the amount you inhaled. Often, symptoms and lung scarring do not occur and are not noticed for 20 years or more after the asbestos exposure. Asbestosis usually develops slowly. Breathing becomes more difficult over time. A person with asbestosis may eventually need supplemental oxygen therapy to help them breathe. The disease can lead to failure of the heart and lungs. What Causes Asbestosis? When you breathe in tiny asbestos fibers, they can get stuck deep inside your lungs. Inhaling asbestos fibers can cause scar tissue to form inside the lungs. This scar tissue does not expand and contract normally, which interferes with breathing. Asbestos fibers may remain in the lungs for a lifetime. In some cases, the fibers might damage the lungs or the membrane covering the lungs, leading to illness and even death. What are the Signs and Symptoms of Asbestosis?
y y y y y y

Shortness of breath A persistent and productive cough (a cough that expels mucus) Chest tightness Chest pain Loss of appetite A dry, crackling sound in the lungs while breathing in

How is Asbestosis Detected?

y y y

Physical exam Chest x-ray Lung function test

y y

Biopsy, where small samples of lung tissue are surgically removed and then examined to see if tiny asbestos fibers are in them CT scan

How is Asbestosis Treated? There is no cure for asbestosis. The most important steps you can take are to prevent further exposure to asbestos and to quit smoking. Treatments to ease symptoms include pounding your chest and back repeatedly with your hands or a device to loosen the mucus from your lungs so that you can cough it up. You may sit with your head tilted down or lay on your stomach with your head down to help drain the mucus from your lungs. Other treatments may include:
y y y y

Aerosol medications to thin secretions Oxygen by mask or by a plastic piece that fits into the nostrils Lung transplantation Asbestos is a well recognized health hazard, and is highly regulated by the government. An estimated 1.3 million workers in the construction and general industry face significant exposure to asbestos on the job. The heaviest exposures are in the construction industry, especially during the removal of asbestos during renovation or demolition. Workers also can be exposed to asbestos during the manufacture of asbestos products (such as textiles, friction products, insulation and other building materials) and during automotive brake and clutch repair work. If you work with asbestos, you should use all protective equipment provided by your employer and follow recommended workplace practices and safety procedures. You can find information about work rules designed to protect yourself against asbestos-related disease through the Occupational Safety and Health Administration.

Bronchiectasis

Bronchiectasis is a condition in which the lungs' airways are abnormally stretched and widened. This stretching and widening is caused by mucus blockage. More and more mucus builds up in the airways, allowing bacteria to grow. This leads to infection. Bronchiectasis can develop at any age. It begins most often in childhood, but symptoms may not appear until much later. Bronchiectasis can occur as part of a birth defect or as a result of injury or other diseases, like tuberculosis, pneumonia and influenza. It also can be caused by a blockage in your airways due to a growth or something you inhaled as a child such as a piece of a toy or peanut. Bronchiectasis cannot be cured. But with proper treatment most people with bronchiectasis can live a normal life. ow Serious is Bronchiectasis? Bronchiectasis causes your airways to slowly lose their ability to clear out mucus. This causes mucus to build up, and allows bacteria to grow. The result can be repeated, serious lung infections. Each lung infection can damage your airways. Gradually, your airways lose their ability to move air in and out. This can mean your organs won't get enough oxygen to function properly.

Bronchiectasis can lead to serious health problems including respiratory failure, heart failure and collapsed lung. But with treatment, most people can lead normal lives without major disability. What Causes Bronchiectasis? Bronchiectasis is caused by an injury to your airway walls. The injury could be caused by a lung infection such as severe pneumonia, pertussis (whooping cough), tuberculosis or fungal infections. Some underlying conditions that damage the airways and increase lung infections can cause bronchiectasis as cystic fibrosis and primary ciliary dyskinesia. Bronchiectasis also can be caused by a blockage in your airways due to a growth or something you inhaled as a child such as a piece of a toy or peanut. A form of the disease called congenital bronchiectasis is the result of a problem with how the lungs form in a fetus. This type of bronchiectasis usually affects infants and children. What are the Symptoms of Bronchiectasis? Symptoms include:
y y y y y y

Coughing (worse when lying down) Shortness of breath Abnormal chest sounds Daily production of large amounts of coughed up mucus Chest pain Clubbing (flesh under your fingernails and toenails becomes thicker)

How is Bronchiectasis Detected? Tests used to detect the disease include:

y y y y

Chest x-ray Lung function tests Sputum culture (test of mucus you cough up) CT scan

How is Bronchiectasis Treated? Bronchiectasis is not curable. But with proper treatment most people with the disease can have a good quality of life. Treatments include:
y y y y y y y

Antibiotics for infection Bronchodilator medicines to open airways Mucus-thinning medicines Expectorants to help you cough up mucus Physical therapy techniques to help clear mucus Oxygen therapy (if the disease is widespread) Surgery (if the disease is in only one part of the lung or if there is a lot of bleeding)

Preventing Bronchiectasis Preventing lung infections and lung damage can help prevent bronchiectasis. You can do this through:
y y y y

Vaccinations for measles and pertussis Avoiding toxic fumes, gases, smoke and other substances that can harm your lungs Properly treating lung infections in children Avoiding inhaling small objects and seeking prompt medical care if this occurs

Bronchiolitis

Bronchiolitis is an inflammation of the bronchioles, the small airways in the lungs. It is most common in early infancy. It often occurs due to viral infections, over half of which are caused by the respiratory syncytial virus or RSV. How Serious is Bronchiolitis? In children and adults, the infection is usually mild. But it may be severe and is the cause of many hospitalizations. In infants, bronchioles are narrower and more easily blocked by mucus and inflammation. Symptoms often are present for 4 to 6 days. Most healthy infants recover in 7 to 10 days. What Causes Bronchiolitis? Bronchiolitis often occurs due to viral infections, over half of which are caused by the respiratory syncytial virus (RSV). Being exposed to a parent's smoking may be a risk factor for bronchiolitis. The illness is more common in the fall and winter. What are the Symptoms of Bronchiolitis? Symptoms of bronchiolitis may include:
y y y y y y y

Wheezing Wheezy cough Rapid breathing Bluish skin (due to lack of oxygen) Nostrils flaring with each breath Muscles between the ribs retract with each breath Fever

How is Bronchiolitis Detected? To diagnose bronchiolitis, the doctor may test for decreased blood oxygen levels and listen for wheezing and crackling sounds in the chest through the stethoscope. The doctor may order a chest x-ray and do a test of nasal fluids to find out which virus is present. How is Bronchiolitis Treated? Some cases of bronchiolitis do not need treatment. Treatment of symptoms can include:

y y y y

Chest clapping Drinking clear fluids Breathing in humidified air Rest

Antibiotics are not effective against bronchiolitis. If your child is hospitalized for bronchiolitis, he or she may be given albuterol (a medication normally used in asthma) or steroids. Extremely ill children may be given antiviral medications such as ribavirin. This treatment may decrease the severity and length of the illness. They must be given early in the course of the illness in order to be effective. Usually, breathing difficulties improve by the third day of the illness, and overall, symptoms improve within a week. When Should I Call the Doctor? Call your health care provider immediately, or go to the emergency room if your child with bronchiolitis:
y y y y y y

Develops a bluish color in the skin, nails, or lips Develops rapid, shallow breathing Has a cold that suddenly gets worse Has trouble breathing Flares nostrils or retracts chest muscles when trying to breathe Becomes lethargic

Preventing Bronchiolitis It is not easy to prevent bronchiolitis, because the viruses that cause it are widespread. Careful handwashing can help spread this and other viral infections. If you have an upper respiratory infection, be careful around infants, and wash your hands often, especially before touching a baby. Avoid smoking around your baby, since breathing in secondhand smoke increases the risk of respiratory illness. There is no RSV vaccine currently available. There is a medication called palivizumab (Synagis) for infants who are at high risk of developing severe disease from RSV. These may include:
y y y

Babies born prematurely at 35 weeks or less Babies born with heart disease Babies with chronic lung disease

Your baby's doctor can tell you if your baby should get Synagis
y

Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a lung disease that occurs most often in babies who were born severely premature more than 10 weeks before their due date. Babies with BPD have inflammation and scarring in the lungs. BPD usually is a complication in premature infants being treated for respiratory distress syndrome (RDS). RDS is a condition in which the baby's lungs are not developed enough to take in the air they need. Babies with RDS must have oxygen and often need to be on a breathing machine to prevent brain damage and to save their lives. But the oxygen premature babies need can damage their lungs. When it must be delivered into the babies' lungs by a machine, it may be even more damaging. The infants whose lungs require this treatment are at risk for developing BPD.

Many infants with BPD recover and improve with time, achieving normal or near normal function. How Serious is BPD? Most babies with BPD recover, and many are able to have normal, active lives. Recovery may be a slow process. After your baby leaves the hospital he or she may need continued medication, breathing treatments, or even oxygen at home. Although most children can come off supplemental oxygen by the end of their first year, a few with serious cases may need a breathing machine called a ventilator for several years or, in rare cases, their entire lives. During the first two years, a child with BPD may have a number of lung infections. You should see the doctor when your baby has a cold, runny nose, cough, chest cold or fever. Within a year or two, most children who had BPD have few breathing problems. They are not restricted in their activities and do not need special medical treatment. What Causes BPD? BPD most commonly occurs as a complication of respiratory therapy in premature infants with respiratory distress syndrome (RDS). RDS is a condition in which the baby's lungs are not developed enough to take in the air they need. Babies with RDS must have oxygen and often need a machine to help them breathe to prevent brain damage and to save their lives. But, the oxygen premature babies need can damage their lungs by causing inflammation. This can injure the airways. High levels of oxygen also may slow the normal development of the lungs in very premature babies. When oxygen must be delivered into the babies' lungs by a breathing machine (ventilator or respirator), it may be even more damaging. These machines use pressure to push air into the lungs. But the pressure can irritate the lungs and cause them to become more inflamed. To help avoid this problem, babies may instead be given oxygen through the nose with a nasal continuous positive airway pressure (CPAP) machine. Infections in premature babies' lungs can be another cause of BPD. The infection causes inflammation, which narrows breathing passages. What are the Symptoms of BPD? Babies with BPD may have:
y y y y y y

Rapid, shallow breathing Blue coloring around the lips and nails due do the low amount of oxygen in the blood Sucked-in ribs and chest Coughing Wheezing Poor posture of the neck, shoulders and trunk

How is BPD Detected? The doctor usually finds BPD by taking an X-ray of the infant's chest when the baby is recovering from respiratory distress syndrome. In babies with BPD, the X-rays may show lungs that appear spongy. How is BPD Treated?

Babies with BPD are usually treated in the hospital's neonatal intensive care unit (NICU) until they are able to breathe well enough on their own without the support of a machine. The time an infant with BPD spends in the NICU can range from several weeks to a few months. While they are in the NICU, babies are kept warm using a radiant warmer or incubator. They are given fluids and nutrients through a vein. Their blood pressure, heart rate, breathing, temperature and fluid intake are monitored. Infants with BPD also are treated with medications:
y y y

Bronchodilators (such as albuterol) to help keep the airways open Diuretics (such as furosemide) to reduce the buildup of fluid in the lungs Antibiotics sometimes are needed to fight bacterial infections because babies with BPD are more likely to develop pneumonia.

Preventing Bronchopulmonary Dysplasia (BPD) There are things you can do to help prevent your baby from being born before his or her lungs are fully developed:
y y y y y

Visit your healthcare provider regularly during your pregnancy Eat a healthy diet Avoid tobacco smoke, alcohol and illegal drugs Take proper care of any medical problems you may have Prevent infection by regular handwashing and avoiding others who have colds or the flu

If you gave birth too early in a previous pregnancy, your doctor may give you medicine to help delay delivery. If your doctor thinks your baby will be premature, you may be given injections of a medicine to help speed development of the lungs and other organs. The medicine also will reduce the chance of the baby developing respiratory distress syndrome. http://www.lungusa.org/lung-disease/list.html

Heart Diseases:
Atrial Myxoma
y

Author: Gyanendra K Sharma, MD, FACP, FACC; Chief Editor: Park W Willis IV, MD

Atrial myxomas are the most common primary heart tumors. Because of nonspecific symptoms, early diagnosis may be a challenge. Left atrial myxoma may or may not produce characteristic findings on auscultation. Two-dimensional echocardiography is the diagnostic procedure of choice. Most atrial myxomas are benign and can be removed by surgical resection. Pathophysiology Myxomas account for 40-50% of primary cardiac tumors. Approximately 90% are solitary and pedunculated, and 75-85% occur in the left atrial cavity. Up to 25% of cases are found in the right atrium. Most cases are sporadic. Approximately 10% are familial and are transmitted in an autosomal dominant mode. Multiple tumors occur in approximately 50% of familial cases and are more frequently located in the ventricle (13% vs 2% in sporadic cases). Myxomas are polypoid, round, or oval. They are gelatinous with a smooth or lobulated surface and usually are white, yellowish, or brown. The most common site of attachment is at the border of the fossa ovalis in the left atrium, although myxomas can also originate from the posterior atrial wall, the anterior atrial wall, or the atrial appendage. The mobility of the tumor depends upon the extent of attachment to the interatrial septum and the length of the stalk. Although atrial myxomas are typically benign, local recurrence due to inadequate resection or malignant change has been reported. Occasionally, atrial myxomas recur at a distant site because of intravascular tumor embolization. The risk of recurrence is higher in the familial myxoma syndrome.[1] Symptoms are produced by mechanical interference with cardiac function or embolization. Being intravascular and friable, myxomas account for most cases of tumor embolism. Embolism occurs in about 30-40% of patients. The site of embolism is dependent upon the location (left or right atrium) and the presence of an intracardiac shunt. Jong-Won Ha and associates reported a more frequent occurrence of systemic embolism in polypoid tumors as compared to round (58% vs 0%).[2] Also, polypoid tumors more frequently prolapse into the ventricle. Prolapse of a tumor through the mitral or tricuspid valve may result in the destruction of the annulus or valve leaflets. In one study, 19% of the patients had atrial fibrillation associated with large atrial myxoma. Left atrial myxomas produce symptoms when they reach about 70 g. Right atrial myxomas grow to approximately twice this size before becoming symptomatic. Tumors vary widely in size, ranging from 1-15 cm in diameter. Rate of growth is not exactly known. In one case report, right atrial myxoma had a growth rate of 1.36 x 0.03 cm/month. Myxomas have been demonstrated to produce numerous growth factors and cytokines, including vascular endothelial growth factor, resulting in angiogenesis and tumor growth and an increased expression of the inflammatory cytokine, interleukin-6.

Epidemiology

Frequency

United States

Based upon the data of 22 large autopsy series, the prevalence of primary cardiac tumors is approximately 0.02% (200 tumors per million autopsies). About 75% of primary tumors are benign, and 50% of benign tumors are myxomas, resulting in 75 cases of myxoma per million autopsies.
International Surgical incidence in the Republic of Ireland from 1977-1991 was 0.50 atrial myxomas per million population per year. Mortality/Morbidity
y y

Sudden death may occur in 15% patients with atrial myxoma. Death is typically caused by coronary or systemic embolization or by obstruction of blood flow at the mitral or tricuspid valve. Morbidity is related to symptoms produced by tumor embolism, heart failure, mechanical valvular obstruction, and various constitutional symptoms.

Sex
y y

Approximately 75% of sporadic myxomas occur in females. Female sex predominance is less pronounced in familial atrial myxomas.

Age
y y

Myxomas have been reported in patients aged 3-83 years. The mean age for sporadic cases is 56 years. In a retrospective review of 171 patients from India, the mean age of presentation was 37.1 years. Most of these patients were symptomatic; dyspnea was the most common symptom.[6] The mean age for familial cases is 25 years.

Hypertrophic cardiomyopathy
Cardiomyopathy - hypertrophic (HCM); IHSS; Idiopathic hypertrophic subaortic stenosis; Asymmetric septal hypertrophy; ASH; HOCM; Hypertrophic obstructive cardiomyopathy Last reviewed: May 17, 2010. Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood. Causes, incidence, and risk factors Hypertrophic cardiomyopathy is often asymmetrical, meaning one part of the heart is thicker than the other parts. The condition is usually passed down through families (inherited). It is believed to be a result of several problems (defects) with the genes that control heart muscle growth. Younger people are likely to have a more severe form of hypertrophic cardiomyopathy. However, the condition is seen in people of all ages.

Symptoms
y y y y y y y y

Chest pain Dizziness Fainting, especially during exercise Heart failure (in some patients) High blood pressure (hypertension) Light-headedness, especially with or after activity or exercise Sensation of feeling the heart beat (palpitations) Shortness of breath

Other symptoms that may occur are:

y y

Fatigue, reduced activity tolerance Shortness of breath when lying down

Some patients have no symptoms. They may not even realize they have the condition until it is found during a routine medical exam. The first symptom of hypertrophic cardiomyopathy among many young patients is sudden collapse and possible death. This is caused by very abnormal heart rhythms (arrhythmias), or from the blockage of blood leaving the heart to the rest of the body. Hypertrophic cardiomyopathy is a major cause of death in young athletes who seem completely healthy but die during heavy exercise. However, certain normal changes in athletes' hearts can confuse the diagnosis. Signs and tests The health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Listening with a stethoscope may reveal abnormal heart sounds or a murmur. These sounds may change with different body positions. The pulse in your arms and neck will also be checked. The doctor may feel an abnormal heartbeat in the chest. Tests used to diagnose heart muscle thickness, problems with blood flow, or leaky heart valves (mitral valve regurgitation) may include:
y y y y y y y

24-hour Holter monitor (heart monitor) Cardiac catheterization Chest x-ray ECG Echocardiography (the most common test) with Doppler ultrasound MRI of the heart Transesophageal echocardiogram (TEE)

Not all of these tests are useful for evaluating all of these conditions. Blood tests may be done to rule out other possible diseases. If you are diagnosed with hypertrophic cardiomyopathy, your health care provider may recommend that your close blood relatives (family members) be screened for the condition.

Treatment The goal of treatment is to control symptoms and prevent complications. Some patients may need to stay in the hospital until the condition is under control (stabilized). If you have symptoms, you may need medication to help the heart contract and relax correctly. Some medications used include beta-blockers and calcium channel blockers, which may reduce chest pain and other symptoms, particularly with exercise. Medications will often relieve symptoms so patients do not need more invasive treatments. Some people with arrhythmias may need anti-arrhythmic medications. If the arrhythmia is due to atrial fibrillation, blood thinners may also be used to reduce the risk of blood clots. Some patients may have a permanent pacemaker placed. However, pacemakers are used less often today than they were in the past. When blood flow out of the heart is severely blocked, an operation called surgical myectomy may be done. This procedure cuts and removes a portion of the thickened part of the heart. Patients who have this procedure often show significant improvement. If the heart's mitral valve is leaking, surgery may be done to repair or replace the valve. In some cases, patients may be given an injection of alcohol into the arteries that feed the thickened part of the heart (alcohol septal ablation), essentially causing a controlled heart attack. An implantable-cardioverter defibrillator (ICD) may be needed to prevent sudden death. ICDs are used in high-risk patients. High risks include:
y y y y y y

Drop in blood pressure during exercise Family history of cardiac arrest History of cardiac arrest or ventricular tachycardia History of unexplained fainting Life-threatening heart rhythms on a Holter monitor Severe heart muscle thickness

Complications
y y y y

Dilated cardiomyopathy Heart failure Life-threatening heart rhythm problems (arrhythmias) Severe injury from fainting

Prevention If you are diagnosed with hypertrophic cardiomyopathy, your health care provider may recommend that your close blood relatives (family members) be screened for the condition. Some patients with mild forms of hypertrophic cardiomyopathy are only diagnosed by screening echocardiograms because of their known family history. If you have high blood pressure, make sure you take your medication and follow your doctor's recommendations.

References 1. Maron BJ. Hypertrophic cardiomyopathy. Zipes DP, Libby P, Bonow RO, Braunwald E, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 65. 2. Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: An overview. Am Fam Physician. 2009;79:778-784. 3. Bernstein D. Diseases of the myocardium. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 439. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001243/

Wolff-Parkinson-White syndrome
Preexcitation syndrome; WPW Last reviewed: May 4, 2010. Wolff-Parkinson-White syndrome is a heart condition in which there is an extra electrical pathway (circuit) in the heart. The condition can lead to episodes of rapid heart rate (tachycardia). Wolff-Parkinson-White is one of the most common causes of fast heart rate disorders in infants and children. Causes, incidence, and risk factors Normally, electrical signals in the heart go through a pathway that helps the heart beat regularly. The wiring of the heart prevents extra beats from occurring and keeps the next beat from happening too soon. In people with Wolff-Parkinson-White syndrome, there is an extra, or accessory, pathway that may cause a very rapid heart rate. This is called supraventricular tachycardia. Symptoms How often the rapid heart rate occurs depends on the patient. Some people with Wolff-Parkinson-White syndrome may have just a few episodes of rapid heart rate. Others may have the rapid heart rate once or twice a week. Sometimes there are no symptoms, and the condition is detected when a heart tests are done for another reason. A person with WPW syndrome may have:
y y y y y y

Chest pain or chest tightness Dizziness Light-headedness Fainting Palpitations (a sensation of feeling your heart beat) Shortness of breath

Signs and tests An exam performed during a tachycardia episode will reveal a heart rate greater than 230 beats per minute and blood pressure that is normal or low. A normal heart rate is 60 - 100 beats per minute in adults, and under 150 beats per minute in neonates, infants, and small children. If the patient is currently not having tachycardia, the physical exam may be completely normal.

A test called EPS may help identify the location of the extra electrical pathway. Wolff-Parkinson-White syndrome may be revealed by the following tests:
y y

ECG (electrocardiogram) may show an abnormality called a "delta" wave. Continuous ambulatory monitoring (Holter monitor)

Treatment Medication may be used to control or prevent rapid heart beating. These include adenosine, antiarrhythmics, and amiodarone. If the heart rate does not return to normal with medication, doctors may use a type of therapy called electrical cardioversion (shock). The current preferred therapy for Wolff-Parkinson-White syndrome is catheter ablation. This procedure involves inserting a tube (catheter) into an artery through a small cut near the groin up to the heart area. When the tip reaches the heart, the small area that is causing the fast heart rate is destroyed using a special type of energy called radiofrequency. Open heart surgery may also provide a permanent cure for Wolff-Parkinson-White syndrome. However, surgery is usually done only if the patient must have surgery for other reasons. Expectations (prognosis) Catheter ablation cures this disorder in most patients. The success rate for the procedure ranges between 85 - 95%. Success rate will vary depending on location of accessory pathway and number of accessory pathways. Complications
y y y y

Complications of surgery Reduced blood pressure (caused by continous rapid heart rate) Heart failure Side effects of medications

The most severe form of a rapid heart beat is atrial fibrillation. It may rapidly lead to shock, and requires emergency treatment (cardioversion). http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001206/

Pericarditis - constrictive
Constrictive pericarditis Last reviewed: June 1, 2010. Constrictive pericarditis is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening, scarring, and muscle tightening (contracture). See also:

y y y

Bacterial pericarditis Pericarditis Pericarditis after heart attack

Causes, incidence, and risk factors Constrictive pericarditis is most commonly caused by conditions or events that cause inflammation to develop around the heart, including:
y y y

Heart surgery Radiation therapy to the chest Tuberculosis

Less common causes include:

y y

Abnormal fluid buildup in the covering of the heart due to bacterial or viral infection or surgical complications Mesothelioma

Constrictive pericarditis may also develop without apparent cause. The inflammation causes the covering of the heart to become thick and rigid, making it hard for the heart to stretch properly when it beats. As a result, the heart chambers don't fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure. The condition is relatively rare in children. Symptoms Symptoms of chronic constrictive pericarditis include:
y y y y y

Difficulty breathing (dyspnea) that develops slowly and gets worse Fatigue, excessive tiredness Long-term swelling (edema) of the legs and ankles Swollen abdomen Weakness

Signs and tests Constrictive pericarditis is very difficult to diagnose. Signs and symptoms are similar to restrictive cardiomyopathy and cardiac tamponade. Your doctor will need to rule out these conditions when making a diagnosis. A physical exam may show that your neck veins stick out, suggesting increased blood pressure in the area. This is called Kussmaul's sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope. The physical exam may also reveal liver swelling and fluid in the belly area. The following tests may be ordered:
y y y y

Chest MRI Chest CT scan Chest x-ray Coronary angiography or cardiac catheterization

y y

ECG Echocardiogram

Treatment The goal of treatment is to improve heart function. The cause must be identified and treated. This may include antibiotics, antituberculosis medications, or other treatments. Diuretics ("water pills") are commonly prescribed in small doses to help the body remove excess fluid. Analgesics may be needed to control pain. Decreased activity may be recommended for some patients. A low-sodium diet may also be recommended. The definitive treatment is a type of surgery called a pericardiectomy. This involves cutting or removing the scarring and part of the sac-like covering of the heart. Expectations (prognosis) Constrictive pericarditis may be life threatening if untreated. However, surgery to treat the condition is associated with a relatively high complication rate and is usually reserved for patients who have severe symptoms. Complications
y y y y y

Cardiac tamponade Damage to the coronary arteries Heart failure Pulmonary edema Scarring of the heart muscle

Calling your health care provider Call your health care provider if you have symptoms of constrictive pericarditis. Prevention Constrictive pericarditis in some cases is not preventable. However, conditions that can lead to constrictive pericarditis should be adequately treated.

Pericarditis - constrictive
Constrictive pericarditis Last reviewed: June 1, 2010. Constrictive pericarditis is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening, scarring, and muscle tightening (contracture).

See also:
y y y

Bacterial pericarditis Pericarditis Pericarditis after heart attack

Causes, incidence, and risk factors Constrictive pericarditis is most commonly caused by conditions or events that cause inflammation to develop around the heart, including:
y y y

Heart surgery Radiation therapy to the chest Tuberculosis

Less common causes include:

y y

Abnormal fluid buildup in the covering of the heart due to bacterial or viral infection or surgical complications Mesothelioma

Constrictive pericarditis may also develop without apparent cause. The inflammation causes the covering of the heart to become thick and rigid, making it hard for the heart to stretch properly when it beats. As a result, the heart chambers don't fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure. The condition is relatively rare in children. Symptoms Symptoms of chronic constrictive pericarditis include:
y y y y y

Difficulty breathing (dyspnea) that develops slowly and gets worse Fatigue, excessive tiredness Long-term swelling (edema) of the legs and ankles Swollen abdomen Weakness

Signs and tests Constrictive pericarditis is very difficult to diagnose. Signs and symptoms are similar to restrictive cardiomyopathy and cardiac tamponade. Your doctor will need to rule out these conditions when making a diagnosis. A physical exam may show that your neck veins stick out, suggesting increased blood pressure in the area. This is called Kussmaul's sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope. The physical exam may also reveal liver swelling and fluid in the belly area. The following tests may be ordered:
y y

Chest MRI Chest CT scan

y y y y

Chest x-ray Coronary angiography or cardiac catheterization ECG Echocardiogram

Treatment The goal of treatment is to improve heart function. The cause must be identified and treated. This may include antibiotics, antituberculosis medications, or other treatments. Diuretics ("water pills") are commonly prescribed in small doses to help the body remove excess fluid. Analgesics may be needed to control pain. Decreased activity may be recommended for some patients. A low-sodium diet may also be recommended. The definitive treatment is a type of surgery called a pericardiectomy. This involves cutting or removing the scarring and part of the sac-like covering of the heart. Expectations (prognosis) Constrictive pericarditis may be life threatening if untreated. However, surgery to treat the condition is associated with a relatively high complication rate and is usually reserved for patients who have severe symptoms. Complications
y y y y y

Cardiac tamponade Damage to the coronary arteries Heart failure Pulmonary edema Scarring of the heart muscle

Calling your health care provider Call your health care provider if you have symptoms of constrictive pericarditis. Prevention Constrictive pericarditis in some cases is not preventable. However, conditions that can lead to constrictive pericarditis should be adequately treated. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002093/