ICU Nursing-Nurse Interventions In Acute Exacerbations Of COPD

ICU Nursing

Intensive Care Unit (ICU) nursing is commonly referred to as critical care nursing. Critical care nursing deals specifically with the human response to life threatening conditions. Critical care nursing is challenging due to the life-threatening health situations in the ICU. Critical care nurses are often in highstress situations which demands complex assessments, highintensity therapies and interventions and continuous vigilance.

Acute Exacerbations of COPD

Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), is a term used to describe progressive lung diseases, which include emphysema, chronic bronchitis and chronic asthma. The common symptoms of COPD are progressive limitations of the airflow into and out of the lungs and shortness of breath. Emphysema and chronic bronchitis are closely related and patients with COPD may have both, which affects lung function. Emphysema involves destruction of the alveoli in the lungs. Chronic bronchitis is characterized by chronic cough and mucus production.

Over a period of time the patient experiences abnormal ventilationperfusion, insufficient oxygenation of blood (hypoxemia), hypoventilation and right-sided heart failure. People with COPD have a variety of illnesses such as, atelectasis which occurs due to the collapse of part or all of a lung by blockage of the bronchus or bronchioles or by very shallow breathing; bronchiectasis, which is an acquired disorder of the large bronchi that become dilated due to destructive infections of the lungs; congestive heart failure (CHF),a disorder in which the heart loses its ability to pump and cor pulmonale ,where the right ventricle gets enlarged because of pulmonary hypertension from lung disorders. COPD symptoms, when ignored, usually lead to hospitalization in intensive care (ICU) units.

Nurse Interventions in Acute Exacerbations

People with chest deformities or neurologic conditions that cause shallow breathing benefit from mechanical devices that assist breathing, such as continuous positive airway pressure, which delivers oxygen through a nose or face mask that prevent airways collapse, even at the end of a breath. Additional respiratory support can be provided with a mechanical ventilator. The primary treatment for acute massive atelectasis, a common complication in COPD is removal of the underlying cause (Brooks-Brunn, 1995).

If the blockage cannot be removed by coughing or by suctioning the airways then it should be removed by bronchoscopy. Antibiotics are to be given for any detected infection as in chronic atelectasis, when infection is almost inevitable. Treatment of atelectasis due to deficient or ineffective surfactant is done by treating the low blood oxygen either with mechanical ventilation or positive end expiratory pressure. For cor pulmonale, supplemental oxygen can be administered to increase the level of oxygen in the blood. A low salt diet is recommended. Diuretics are given to remove excess fluid from the body. Calcium channel blockers, intravenous prostacyclin, or the oral medication bosentan are frequently used to treat pulmonary hypertension. Blood thinning anticoagulants are also useful. Oxygen administration relieves symptoms and prolongs survival. Careful intervention is essential because progressive pulmonary hypertension and cor pulmonale often leads to severe fluid retention, lifethreatening shortness of breath, shock, and death.


Benzodiazepines are not recommended to relieve anxiety in patients with COPD because they decrease respiratory drive and compromise lung function (Brooks-Brunn, 1995). An anxiolytic, buspirone, have been found to be safe in reducing anxiety in COPD patients. Dyspnea is common in individuals with chronic obstructive pulmonary disease. Respiratory assessment of the patient should include present level of dyspnea measured using a quantitative scale such as a visual analogue or numeric rating scale. Usual dyspnea is measured using a quantitative scale such as the Medical Research Council (MRC) Dyspnea Scale.

The other assessments include Vital signs, pulse oximetry, chest auscultation, chest wall movement and shape/abnormalities, presence of peripheral edema, accessory muscle use, presence of cough and/or sputum, ability to complete a full sentence and the level of consciousness. By doing so, nurses should be able to detect stable and unstable dyspnea and acute respiratory failure (American Thoracic Society, 1998). Nurses should also be able to offer interventions for all levels of dyspnea including acute episodes of respiratory distress which includes acceptance of patients' self-report of present level of dyspnea, medications, controlled oxygen therapy, secretion clearance strategies, noninvasive and invasive ventilation modalities, energy conserving strategies, relaxation techniques, nutritional strategies and breathing retraining strategies. It is important for the nurses to remain with patients during episodes of acute respiratory distress. Nurses have to assess patients for hypoxemia/hypoxia and administer appropriate oxygen therapy for individuals for all levels of dyspnea. Medications include bronchodilators, beta 2 agonists, anticholinergics and methylxanthines, corticosteroids, antibiotics, psychotropics and opioids (www.guidelines.gov).

Patient safety checks

Patient safety checks include circuit leaks; maintenance of positive pressure; adequate inspiratory air flow and not leaving the patient alone. Continuous Positive Airway Pressure Oxygen therapy is part of any ICU and requires absolute attention.

Managing the therapy involves maintenance of the desired FIO2; level of positive airway pressure and time period for CPAP therapy, attaching CPAP machine medical air and oxygen gas lines to wall sources, preparation of humidification source ,selection of prescribed FIO2 on oxygen blender, turning flow on to level above 25 litres / min., positioning of rubber securing band behind the patient's head, centred on occiput, positioning of face mask over the patient, adjusting the level of positive expiratory pressure to prescribed level, adjusting inspiratory gas flow so that minimal fluctuations are present on pressure gauge, observing and documenting respiratory rate; work of breathing and SpO2, increasing inspiratory flow if respiratory work is excessive or the patient complains of continuing dyspnea, maintaining continuous SpO2 monitoring with alarm function in place, maintaining humidification temperature at 36 degree C or at temperature tolerated by the patient (American Thoracic Society, 1998).

Patient observations include, visual check every half an hour, documentation of respiratory rate, SpO2, nausea and vomiting, monitoring pulse rate and rhythm; blood pressure; peripheral circulation and proper functioning of humidification system every hour, checking the condition of skin around and under mask and rubber securing band, documentation of condition and interventions, condition of conjunctivae every two hours, auscultation of lungs for equal air entry and palpitation of abdomen for distension every four hours (Vollman,1997). Ventilator-Associated Pneumonia is a common nosocomial infection in the ICU accounting for 13% to 18% of all nosocomial infections (Rello et.al, 1996).

Infection may be even due to improper hand washing, not changing the gloves from patient to patient, and contamination of respiratory devices like nebulizers, spirometers, oxygen sensors, bag-valve mask devices, and suction catheters (Shelby Hixson, 1998). Oral care includes brushing the patient's teeth, use of solutions and mouthwash to cleanse the mouth, and periodical suctioning of oral secretions. Nasal care and proper cleansing of the nasopharynx reduces bacterial infection.

Conclusion

The ICU setting demands stressful nursing interventions and constant monitoring of the patients especially with conditions like COPD. Nurse interventions should be based on assessment of dyspnea, vital signs, pulse oximetry, chest auscultation, chest wall movement and presence of peripheral edema, cough and/or sputum, ability to complete a full sentence and the level of consciousness. Proper oral and nasal care reduces lung infection.

Reference

-- American Thoracic Society (1998).Research Priorities in Respiratory Nursing. Am. J. Respir. Crit. Care Med.158 (6): 2006-2015.
-- Brooks-Brunn, J. A (1995). Postoperative atelectasis and pneumonia. Heart Lung 24: 94-115. Link.Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD).
-- Kingston GW, Phang PT and Leathley MJ (1991). Increased incidence of nosocomial pneumonia in mechanically ventilated patients with subclinical aspiration. Am J Surg 161: 589-593.
-- Metheny N (1993). Minimizing respiratory complications of nasoenteric tube feedings: State of the science. Heart Lung 22:213-223.
-- Rello J, Sonora R, Jubert P, Artigas A, Rue M, Valles J (1996). Pneumonia in intubated patients: Role of respiratory airway care. Am J Respir Crit Care Med 154:111-115.
-- Shelby Hixson, Tracey King, Nursing Strategies to Prevent Ventilator-Associated Pneumonia. AACN Clinical Issues: Advanced Practice in Acute and Critical Care 9 (1).
-- Vollman, KM (1997). Prone positioning for the ARDS patient. Dimens Crit Care Nurs 16: 184-193.
-- Zaloga GP (1991). Bedside method for placing small bowel feeding tubes in critically ill patients: A prospective study. Chest 100:1643-1646.

-- Journal of Nursing

-- Journals belonging to the American Society of Registered Nurses

The American Society of Registered Nurses (ASRN) was founded in May 2003 for the purpose of bringing together professional nurses interested in creating a nursing "society" which is defined as "A group of humans broadly distinguished from other groups by mutual interests, participation in characteristic relationships, shared institutions, and a common culture".

This new Society brings together nurses from all fields of inquiry, regions, and specializations both inside and outside academe in order to expand the study and practice of nursing, and offer support, resources, education, and distinction to its members. The Society serves nurses in all 50 states as well as across the globe. ASRN represents a community for all nursing voices. We invite registered nurses, international professionals, and new graduates to discover ASRN. Our goal is to advance nursing as a science and profession.

American Society of Registered Nurses (ASRN)

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What Is Hay Fever? What Are The Symptoms Of Hay Fever?

Hay fever (or hayfever), also known as allergic rhinitis, is a common condition that shows signs and symptoms similar to a cold with sneezing, congestion, runny nose and sinus pressures.

This article is about allergic rhinitis. You can read about non-allergic rhinitis here.

Hay fever is caused by an allergic response to airborne substances, such as pollen - unlike a cold which is caused by a virus. The time of year in which you get hay fever depends on what airborne substance you are allergic to.

Despite its name, hay fever does not mean that the person is allergic to hay and has a fever. Hay is hardly ever an allergen, and hay fever does not cause fever.

Although hay fever and allergic rhinitis have the same meaning, most lay people refer to hay fever only when talking about an allergic reaction to pollen or airborne allergens from plants or fungi, and understand allergic rhinitis as an allergy to airborne particles, such as pollen, dust mites or pet dander which affect the nose, and maybe the eyes and sinuses as well.

The rest of this article focuses on hay fever caused by pollen and other airborne allergens that come from plants or fungi. Hay fever caused by pollen is also known as pollinosis.

Some people are only mildly affected by hay fever and rarely reach a point where they decide to seek medical advice. However, for many, symptoms may be so severe and persistent that they are unable to carry out their daily tasks at home, work or at school properly - these people will require treatment. Treatments may not get rid of the symptoms altogether, but they usually lessen them and make it easier to cope.

As with other allergies, the symptoms are a result of your immune system mistaking a harmless substance as a harmful one, and releasing chemicals that cause the symptoms.

It is estimated that about 20% of people in Western Europe and North America suffer from some degree of hay fever. Although hay fever can start affecting people at any age, it generally develops during childhood or perhaps early adulthood. The majority of hay fever sufferers find their symptoms become less severe as they get older.

What are the symptoms of hay fever?

Symptoms of hay fever may start at different times of year, it depends on what substance the patient is allergic to. If a person is allergic to a common pollen, then when the pollen count is higher his symptoms will be more severe.

Common symptoms include:

• Sneezing
• Watery eyes
• Itchy throat
• Itchy nose
• Blocked/runny nose

Severe symptoms may include:

• Sweats
• Headaches
• Loss of smell and taste
• Facial pain caused by blocked sinuses
• Itchiness spreads from the throat, to the nose and ears

Sometimes hay fever symptoms can lead to:

• Tiredness (fatigue)
• Irritability
• Insomnia

People with asthma may find that when hay fever symptoms emerge their wheezing and episodes of breathlessness become more severe. A significant number of people only have asthma symptoms when they have hay fever.

What are the causes of hay fever?

Hay fever occurs when the immune system mistakes a harmless airborne substance as a threat. As your body thinks the substance is harmful it produces an antibody called immunoglobulin E to attack it. It then releases the chemical histamine which causes the symptoms.

There are seasonal hay fever triggers which include pollen and spores that will only cause symptoms during certain months of the year.

The following are some examples of hay fever triggers:

• Tree pollen - these tend to affect people in the spring.
• Grass pollen - these tend to affect people later on in the spring and also in the summer.
• Weed pollen - these are more common during autumn (fall).
• Fungi and mold spores - these are more common when the weather is warm.

What are the risk factors for hay fever?

A risk factor is something that increases a person's chances of developing a disease or condition. Below are some risk factors for hay fever:

• Family history (inheritance, genetics) - if you have a close family member who has/had hay fever, your risk of developing it yourself is higher. There is also a slightly higher risk if a close family member has any type of allergy.


• Other allergies - people with other allergies are more likely to suffer from hay fever as well.


• Asthma - a significant number of people with asthma also have hay fever.


• Gender and age - hay fever affects more young males than young females. Before adolescence, twice as many boys as girls have hay fever. However, after adolescence many boys outgrow it and slightly more girls than boys are affected.


• Birth date - people born during the high pollen season have a slightly higher risk of developing hay fever than other people.


• Second-hand smoke - infants and babies who are regularly exposed to cigarette smoke during their first years of life are more likely to develop hay fever than babies who aren't.


• Being the first child - a higher percentage of firstborn children eventually develop hay fever, compared to other people.


• Babies from smaller families - a higher proportion of babies with no siblings, or just one sibling develop hay fever later on compared to babies born to larger families.


• Babies born to high income families - babies born to families with a high standard of living have a higher risk of developing hay fever later on, compared to other babies.

Experts believe that the last three risk factors are linked to childhood infections. If a baby and/or small child has had fewer infections, there is a greater risk of autoimmune problems.

How is hay fever diagnosed?

Generally, doctors can make a diagnosis based on the symptoms, which are usually fairly obvious. The doctor will also ask questions about the patient's personal and family medical history, and how signs and symptoms have been dealt with so far.

A blood or skin test can be followed up to identify which substance(s) the patient is allergic to.

• Skin test - the skin is pricked with a minute amount of a known allergen (substance that some people are allergic to). The amount of IgE antibodies (immunoglobulin E) is measured. IgE antibodies are produced in high amounts if a person has an allergy to something.


• Blood test - the test simply measures the level of IgE antibody in the blood. If it is zero there is no sensitivity, whereas 6 indicates very high sensitivity.

What are the treatment options for hay fever

There is a vast array of OTC (over-the-counter) and prescription medications for treating hay fever symptoms. Some patients may find that a combination of two or three medications works much better than just one.

It is important for parents to remember that some hay fever medications are just for adults. If you are not sure, talk to a qualified pharmacist, or ask your doctor.

Medications include:

• Antihistamine sprays or tablets - these are commonly available over the counter. The medication stops the release of the chemical histamine. They usually effectively relieve symptoms of runny nose, itching and sneezing. However, if your nose is blocked they don't work.
  
  Newer antihistamines are less likely to cause drowsiness than older ones - but older ones are just as effective. Examples of OTC antihistamines include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Examples of prescription antihistamines include Fexofenadine (Allegra) and the nasal spray azelastine (Astelin). Azelastine starts working very rapidly and can be used up to 8 times a day - however, it can cause drowsiness and leave a bad taste in the mouth after use.


• Eye Drops - these reduce itching and swelling in the eyes and are usually used alongside other medications. Eye drops containing cromoglycate are commonly used.


• Nasal Corticosteroids - These sprays treat the inflammation caused by hay fever, and are a safe and very effective long-term treatment. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Most patients may have to wait about a week before experiencing any significant benefits. Some patients may notice an unpleasant smell or taste, and have nose irritation.


• Oral corticosteroids - for very severe hay fever symptoms the doctor may prescribe prednisone in pill form. They should be prescribed only for short-term use, because of their long-term link to cataracts, muscle weakness and osteoporosis.


• Desensitization treatment (immunotherapy) - this treatment used to be more common in the UK, but is now very rarely used and is not used at all in the USA, because it can cause some very strong reactions. Increasing amounts of the allergen are introduced into the patient. This treatment is only done in very specialized centers for patients with severe symptoms.


• Alternative therapies - some alternative therapies claim to treat hay fever effectively.
  
  A study published in The Medical Journal of Australia carried out by researchers at the University of Melbourne, suggested that acupuncture is effective in the symptomatic treatment of persistent allergic rhinitis. (MJA 2007; 187 (6): 337-341).
  
  It is important to remember that although some patients do report benefits from alternative therapies, a lot of information one reads in books and on the internet is anecdotal. For therapy to be convincing, it should undergo proper clinical tests which are either compared to a placebo (dummy treatment) or some treatment known to be effective. Before undergoing any complementary/alternative therapy, check it out carefully.

How to prevent hay fever

There is not much you can do to prevent yourself from becoming allergic to pollen or allergens from plants or fungi. However, avoiding situations where your exposure might be high will help reduce the likelihood of an allergic reaction, or perhaps its severity. The following measures may be helpful:

• Be aware of the pollen count during your susceptible months. You can get information from the TV, radio, internet or daily newspapers. On humid and windy non-rainy days pollen counts tend to be higher. Pollen counts tend to be higher during the early evening.


• Keep windows and doors shut when pollen is high.


• Avoid mowing the lawn altogether during your susceptible months.


• Choose low pollen days for gardening.


• Keep away from grassy areas when pollen counts are high.


• Regularly splash your eyes with cool water. It will sooth them and clear them of pollen.


• If pollen counts are high and you come indoors, have a shower and change your clothes.


• Remember that wrap-around glasses protect your eyes from pollen getting through.


• A hat helps prevent pollen from collecting in your hair and then sprinkling down onto your eyes and face.


• When driving on a high count day or time of day keep windows closed. There are pollen filters for cars.


• Do not have flowers inside your home.


• Keep your surfaces, floors, carpets as dust free as possible.


• If you use a vacuum cleaner make sure it has a good filter.


• Ask smokers not to let their smoke get near you.


• If you are a smoker, giving up will help reduce your symptoms.


• Pets can bring in pollen from outside. Whenever a pet comes indoors on a high pollen count day, either wash it or smooth its fur down with a damp cloth. Sometimes pets can be a source of allergic rhinitis which makes your pollen allergy worse.


• Smear Vaseline around the inside edges of your nostrils - it helps stop pollen from getting through.


• If you know when your hay fever season starts, prepare yourself in advance. See your GP and ask him/her to develop a plan for you.

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What Is Dysentery? What Causes Dysentery?

Dysentery is an intestinal inflammation, especially in the colon, that can lead to severe diarrhea with mucus or blood in the feces. Patients typically experience mild to severe abdominal pain or stomach cramps. In some cases, untreated dysentery can be life-threatening, especially if the infected person cannot replace lost fluids fast enough.

When people in industrialized nations have dysentery, signs and symptoms tend to be mild. Many won't even see their doctor, and the problem resolves in a few days. Even so, if a doctor in Western Europe, North America and many other countries comes across a case of dysentery, local authorities need to be told - it is a notifiable disease.

According to Medilexicon's medical dictionary:

Dysentery is:"A disease marked by frequent watery stools, often with blood and mucus, and characterized clinically by pain, tenesmus, fever, and dehydration.

There are two main types of dysentery:

• Bacillary dysentery, caused by Shigella, a bacterium. In Western Europe and the USA it is the most common type of dysentery among people who have not recently been to the tropics.
• Amoebic dysentery (amoebiasis) This is caused by Entamoeba histolytica, a type of amoeba, and is more common in the tropics. An amoeba is a protozoan (single-celled) organism that constantly changes shape.

What are the signs and symptoms of dysentery?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor notice. For example, pain may be a symptom while a rash may be a sign.

In developed countries signs and symptoms of dysentery tend to be much milder than in developing nations or tropical areas. Patients with mild symptoms will have a slight stomach ache (cramping), and will frequently go to the toilet because of diarrhea.

Symptoms usually appear from one to three days after the person has become infected - this is called the incubation period. In most cases the patient recovers completely within a week. How often the individual goes to the toilet and has mucus or blood in feces usually depend on what is causing the disease.

In some cases people who get dysentery also develop lactose intolerance, which can take a long time to go away, sometimes even years.

Symptoms of amoebic dysentery include:

• abdominal pain
• fever and chills
• nausea and vomiting
• watery diarrhea, which can contain blood, mucus or pus
• painful passing of stools
• fatigue
• intermittent constipation

The amoeba can tunnel through the intestinal wall and spread into the bloodstream and infect other organs; ulcers can develop, these ulcers may bleed, causing blood in stools.

In some cases symptoms may persist for several weeks, but usually only last a few days. The amoebas may continue living within the host (the human) even after symptoms have gone, increasing the likelihood of a recurrence when the person's defenses are down. The amoebas are less likely to survive if the patient receives treatment.

Signs and symptoms of bacillary dysentery - as in other types, symptoms tend to appear from one to three days after the person has been infected. Most typically, there is just mild stomachache and diarrhea, and no blood or mucus in the feces. For many, symptoms are so mild they do not even bother going to the doctor, and the problem resolves in a few days. Initially, the infected person goes to the toilet frequently with diarrhea.

Although much less common, some people with bacillary dysentery may have blood or mucus in their feces, abdominal pain may be intense, there may be an elevated body temperature (fever), nausea and vomiting.

What are the causes of dysentery?

Dysentery is mainly caused by a bacterial or protozoan (one cell organism, such as an amoeba) infection. It can also be caused by a parasitic worm infestation. More rarely, a chemical irritant or viral infection can also be a cause.

Bacillary dysentery, an infection with a bacillus of the Shigella group is the most common type of dysentery. According to the National Health Service (NHS), UK, Shigella sonnei is the most common, followed by Shigella flexneri, Shigella boydii and Shigella dysenteriae, the last one listed produces the most severe symptoms.

Poor hygiene is the main cause of bacillary dysentery infection. However, it can also spread because of tainted food.

Amoebic dysentery is usually caused by infection with the Entamoeba histolytica amoeba.

Amoebic dysentery is more common in the tropics while bacillary dysentery is more common elsewhere. However, parts of rural Canada do get reports of amoebic dysentery.

The amoeba group together and form a cyst, the cysts come out of the body in human feces. In areas of poor sanitation, these cysts (which can survive for a long time), can contaminate food and water, and infect other humans. The cysts can also linger in infected people's hands after going to the toilet. Good hygiene practice reduces the risk of infecting other people.

How is dysentery diagnosed?

The doctor, initially usually a GP (general practitioner, primary care physician) will ask the patient about symptoms and carry out a physical examination. A stool sample may be ordered, especially if the patient has been abroad in the tropics.

In rare cases, if symptoms are severe, other diagnostic tests may be recommended, such as an ultrasound scan or an endoscopy.

What is the treatment for dysentery?

Rehydration therapy - initially this is done using oral rehydration; the patient is encouraged to drink plenty of liquids. Diarrhea, as well as vomiting results in loss of fluids that have to be replaced to prevent dehydration. If the diarrhea and/or vomiting is profuse the medical team may recommend intravenous fluid replacement - the patient will be on a drip.

Antibiotics and amoebicidal drugs - experts say that if possible, the administration of medications to kill the cause of the dysentery should be held back until lab tests determine whether the illness is being caused by a bacterium or amoeba. If this is not possible, depending on the severity of symptoms, the patient may be given a combinations of antibiotic and amoebicidal medication.

If symptoms are not severe and the doctor determines it is Bacillary dysentery (Shigella), the patient most likely will receive no medication - in the vast majority of cases the illness will resolve within a week. Oral rehydration is important.

If amoebic dysentery is diagnosed the patient will probably start with a 10-day course of an antimicrobial medication, such as Flagyl (metronidazole). Diloxanide furoate, paromomycin (Humatin), or iodoquinol (Yodoxin) may also be prescribed to make sure the amoeba does not survive inside the body after symptoms have gone.

What are the complications of dysentery?

Dehydration - diarrhea and vomiting can quickly lead to dehydration. This can happen especially quickly with infants and young children. Dehydration can be life-threatening.

Liver abscess - if the amoeba spreads to the liver.

How is dysentery prevented?

In most cases, dysentery is caused by poor hygiene. Individuals can take measures to reduce their risk of infection by regularly washing their hands, especially before and after going to the toilet and preparing food.

If you are in an area where the risk of dysentery is higher, only drink water from reliable sources (bottled water). If you drink from the bottle, make sure it is opened in front of you and clean the top of the rim. Make sure the food you eat is thoroughly cooked and beware of ice cubes; you may not know what type of water was used to make them. Use purified water to clean your teeth.

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What is Angina? What Causes Angina?

Angina - or angina pectoris (Latin for squeezing of the chest) - is chest pain, discomfort, or tightness that occurs when an area of the heart muscle is receiving decreased blood oxygen supply. It is not a disease itself, but rather a symptom of coronary artery disease, the most common type of heart disease. The lack of oxygen rich blood to the heart is usually a result of narrower coronary arteries due to plaque buildup, a condition called atherosclerosis. Narrow arteries increase the risk of pain, coronary artery disease, heart attack, and death.

Angina may manifest itself in the form of an angina attack, pain or discomfort in the chest that typically lasts from 1 to 15 minutes. The condition is classified by the pattern of attacks into stable, unstable, and variant angina.

• Stable (or chronic) angina is brought on when the heart is working harder than usual, such as during exercise. It has a regular pattern and can be predicted to happen over months or even years. Symptoms are relieved by rest or medication.


• Unstable angina does not follow a regular pattern. It can occur when at rest and is considered less common and more serious as it is not relieved by rest or medicine. This version can signal a future heart attack within a short time - hours or weeks.


• Variant (Prinzmetal's) angina and microvascular (smallest vessels) angina are rare and can occur at rest without any underlying coronary artery disease. This angina is usually due to abnormal narrowing or relaxation (spasm) of the blood vessels, reducing blood flow to the heart. It is relieved by medicine.

Who gets angina?

Those at an increased risk of coronary artery disease are also at an increased risk of angina. Risk factors include:

• Unhealthy cholesterol levels
• Hypertension (high blood pressure)
• Tobacco smoking
• Diabetes
• Being overweight or obese
• Metabolic syndrome
• Sedentary lifestyle
• Being over 45 for men and over 55 for women
• Family history of early heart disease

What causes angina?

Angina is most frequently the result of underlying coronary artery disease. The coronary arteries supply the heart with oxygen rich blood. When cholesterol aggregates on the artery wall and hard plaques form, the artery narrows. It is increasingly difficult for oxygen rich blood to reach the heart muscle as these arteries become too narrow. In addition, damage to the arteries from other factors (such as smoking and high levels of fat or sugar in the blood) can cause plaque to build up where the arteries are damaged. These plaques narrow the arteries or may break off and form blood clots that block the arteries.

The actual angina attacks are the result of this reduced oxygen supply to the heart. Physical exertion is a common trigger for stable angina, as the heart demands more oxygen than it receives in order to work harder. In addition, severe emotional stress, a heavy meal, exposure to extreme temperatures, and smoking may trigger angina attacks.

Unstable angina is often caused by blood clots that partially or totally block an artery. Larger blockages may lead to heart attacks. As blood clots form, dissolve, and form again, angina can occur with each blockage.

Variant angina occurs when an artery experiences a spasm that causes it to tighten and narrow, disrupting blood supply to the heart. This can be triggered by exposure to cold, stress, medicines, smoking, or cocaine use.

What are the symptoms of angina?

Angina is usually felt as a squeezing, pressure, heaviness, tightening, squeezing, burning or aching across the chest, usually starting behind the breastbone. This pain often spreads to the neck, jaw, arms, shoulders, throat, back, or even the teeth.

Patients may also complain of symptoms that include indigestion, heartburn, weakness, sweating, nausea, cramping, and shortness of breath.

Stable angina usually is unsurprising, lasts a short period of time, and may feel like gas or indigestion. Unstable angina occurs at rest, is surprising, last longer, and may worsen over time. Variant angina occurs at rest and is usually severe.

How is angina diagnosed?

A correct diagnosis for chest pain is important because it can predict your likelihood of having a heart attack. The process will start with a physical exam as well as a discussion of symptoms, risk factors, and family medical history. A physician who is suspicious of angina will order one or more of the following tests:

• Electrocardiogram (EKG) - records electrical activity of the heart and can detect when the heart is starved for oxygen


• Stress test - blood pressure readings and an EKG while the patient is increasing physical activity


• Chest X-ray - to see structures inside the chest


• Coronary angiography - dye and special X-rays to show the inside of coronary arteries (dye is inserted using cardiac catheterization)


• Blood tests - to check levels of fats, cholesterol, sugar, and proteins

How is angina treated?

Angina treatments aim to reduce pain, prevent symptoms, and prevent or lower the risk of heart attack. Medicines, lifestyle changes, and medical procedures may all be employed depending on the type of angina and the severity of symptoms.

Lifestyle changes recommended to treat angina include:

• Stopping smoking
• Controlling weight
• Regularly checking cholesterol levels
• Resting and slowing down
• Avoiding large meals
• Learning how to handle or avoid stress
• Eating fruits, vegetables, whole grains, low-fat or no-fat diary products, and lean meat and fish

Medicines called nitrates (like nitroglycerin) are most often prescribed for angina. Nitrates prevent or reduce the intensity of angina attacks by relaxing and widening blood vessels. Other medicines such as beta blockers, calcium channel blockers, ACE inhibitors, oral anti-platelet medicines, anticoagulants, and high blood pressure medications may also be prescribed to treat angina. These medicines are designed to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming.

In some cases, surgical medical procedures are necessary to treat angina. A heart specialist may recommend an angioplasty - a procedure where a small balloon is used to widen the narrowed arteries in the heart. Coronary artery bypass grafting is another common procedure; this is surgery where the narrowed arteries in the heart are bypassed using a healthy artery or vein from another part of the body.

How can angina be prevented?

Angina can be prevented by changing lifestyle factors and by treating related conditions that exacerbate or contribute to angina symptoms. To prevent or delay angina, eat healthfully, quit smoking, be physically active, and learn how to handle stress. In addition, make sure to receive proper treatment for high blood cholesterol, high blood pressure, diabetes, and obesity.

Video: What is Angina

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What Is COPD? What Is Emphysema?

Chronic obstructive pulmonary disease (COPD) is a chronic disease that makes it hard for the patient to breathe. It is a progressive disease - meaning, it gets worse with time. A patient with COPD coughs a lot; the coughing brings up a large amount of mucus (some patients might not cough a lot, see paragraph about this further down). The patient will most likely wheeze, be short of breath, experience tightness of the chest, as well as other symptoms.

The majority of people who suffer from COPD are either current regular smokers or people who used to smoke regularly. Air pollution, chemical fumes, and/or dust may also contribute to the development of COPD. However, smoking is by far the largest factor.

Understanding COPD and Emphysema

To understand COPD it is necessary to know how the lungs work. When you breathe in, the air goes down your windpipe into tubes in your lungs - these tubes are called bronchial tubes or airways. The airways look like upside down trees or broccoli, with several branches. At the end of the branches are tiny air sacs called alveoli.

The airways and alveoli are flexible (elastic). When you breathe in they fill up with air like a balloon, when you breath out they deflate.

The airways and alveoli of a person with COPD do not get as much air as those of a person who does not have COPD. This could be due to one or more of the following reasons (In the USA and many other countries COPD includes emphysema and chronic obstructive bronchitis):

• The airways and alveoli become less elastic
• The walls between many of the alveoli are destroyed
• The walls of the airways swell up (they become inflamed)
• The airways become clogged up with excess mucus
• The walls between many alveoli are damaged when a patient has emphysema. This causes them to lose their shape and become floppy. As the walls become totally destroyed, the patient ends up with a few large alveoli instead of many small ones
• In chronic obstructive bronchitis, the patient's airway lining is permanently irritated and inflamed. The lining consequently thickens. Thick mucus builds up in the airways, making it harder for the patient to breathe.
• The majority of COPD patients suffer from both chronic obstructive bronchitis and emphysema. In such cases the term COPD is more accurate.

How common is COPD?

COPD is the fourth major cause of death in the USA. Over 12 million Americans have been diagnosed with COPD. Health experts believe there could be another 12 million American who suffer from COPD but have not been diagnosed.

COPD develops gradually over a long period - it gets worse with time. Eventually, the patient finds it very hard and/or impossible to do routine activities. A person with severe COPD may not even be able to walk or cook.

COPD is nearly always diagnosed when the patient is middle-aged or elderly.

There is no cure for COPD. Once the damage to the airways and lungs has occurred, there is currently no way to reverse it. Measures can be taken to slow down the progression of the disease.

What causes COPD?

Approximately 80% to 90% of patients have COPD because of smoking. COPD can also be caused by air pollution, having repeated lung infections as a child, second-hand smoke (passive smoking), and a rare genetic disorder called Alpha-1 antitrypsin deficiency.

What are the Symptoms of COPD?

• shortness of breath
• coughing up a lot of phlegm (mucus)*
• a general feeling of tiredness
• frequent chest infections (flu, colds, etc)

*Some COPD patients don't cough much and don't bring up much mucus

Some patients with COPD never cough very much and when in hospital can barely produce enough sputum to cover half a teaspoon. Coughing up sputum and coughing in general appears to be less prevalent in those with Emphysema and of course, very common in patients with Chronic Bronchitis, both of which come under the COPD umbrella. If you don't cough or bring up mucus it does not necessarily mean you don't have COPD.

It is common for people to confuse the onset of COPD with the normal symptoms of getting older, such as tiredness and shortness of breath. It is important to get yourself diagnosed if you experience any of these symptoms.

How do I prevent COPD?

Do not smoke. If you smoke, give up. It is never too late to give up smoking.

If I already have COPD is it too late to give up smoking?

It is never too late to give up smoking. Quitting smoking will slow down the progression of COPD.

How is COPD treated?

• the patient stops smoking
• the patient has medications, including pills, inhalers (puffers) and supplemental oxygen
• the patient joins a pulmonary rehabilitation class - a specialized exercise program

What is COPD? - video

A video explaining about COPD, together with diagrams. Video by Illumistream.

View Here

How long does a COPD patient live?

A patient who is diagnosed with COPD can live for a long time after diagnosis - this may depend on many things, including:

• the patient's age
• how severe the lung damage is
• whether the smoking is stopped or cut down
• what type of medical care and treatment the patient receives
• what other health problems the patient might have

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What Is Pleurisy? What Causes Pleurisy?

Pleurisy, also known as pleuritis, is a condition that results from the swelling of the linings of the lungs and chest. The pleural cavity (area between lungs and inner chest wall) is created by two lubricated surfaces called pleura, the inner pleura lining the lungs and the outer lining the chest wall.

A variety of factors can cause the pleura to become inflamed and rub against one another, rather than slide smoothly, as one breathes. This is the cause of the chest pain associated with pleurisy (often called pleuritic pain).

Pleurisy used to be common complication of bacterial infections a long time ago; especially of pneumonia. Since the advent of antibiotics, however, rates have dropped substantially.

It is hard to estimate how many people get pleurisy worldwide because it is often a mild condition that resolves itself without any treatment; without the doctor being told.

Some famous people have had pleurisy, including Hernan Cortes (died of it), Catherine de Medici (died of it), Benjamin Franklin (died of it), Mahatma Gandhi, Elvis Presley (had recurring pleurisy), and Ringo Starr (at age 13), William Wordsworth (died of it), and Judy Garland.

What causes pleurisy?

Pleurisy is a common complication of several different medical conditions, the most pervasive being a viral infection of the lower respiratory system.

Other causes include:

• Bacterial infections such as pneumonia and tuberculosis
• A chest wound that punctured the pleural cavity
• A pleural tumor
• Autoimmune disorders like lupus and rheumatoid arthritis
• Sickle cell anemia
• Pancreatitis
• Pulmonary embolism
• A heart surgery complication
• Lung cancer or lymphoma
• A fungal or parasitic infection
• Familial Mediterranean fever
• Infections can sometimes spread from person to person, but it is rare to "catch" pleurisy.

Who is at risk of getting pleurisy?

Due to pleurisy being the result of one or more of many adverse conditions, anyone is at risk of contracting pleurisy. When being diagnosed with one of the myriad of conditions listed above, be aware of any symptoms you may be experiencing and their relation to pleurisy. Someone who is sickly or has had a chest injury or heart surgery has a higher chance of getting pleurisy.

What are the symptoms of pleurisy?

The main symptom of pleurisy is a sharp, stabbing pain in the chest. This pain can affect the shoulders and back as well, but is often on one side of the chest only. A person with pleurisy will sneeze, cough, and exercise shallow breathing due to the pain caused by deep breathing.

Patients often describe a constant aching pain that may vary in dullness with the cause of the inflammation. If your pleurisy is caused by a viral infection, you may also experience fever, chills, headaches, joint pain, and muscle aches. Difficulty breathing and a sore throat can also occur.

How is pleurisy diagnosed?

When diagnosing pleurisy, doctors often search for the cause of the inflammation. A patient may have a rib injury or infection of which he is not fully aware. Simple physical exams and chest x-rays will most likely be ordered. A blood sample can also be taken to check for autoimmune disorders. If one has a pleural effusion, a doctor can use a needle to get a fluid sample from the pleura in a procedure called a thoracentesis.

Pleurisy can also be diagnosed by:

• CT scan
• Ultrasound
• MRI scan
• Biopsy (if cancer is suspected)
• Arterial blood gas sampling (to test lung capacity)

How is pleurisy treated?

When treating pleurisy, doctors often seek to treat the root cause, such as a virus or other infection. Antibiotics will be prescribed if your pleurisy is a result of a bacterial infection. In some pleural effusion cases, one may need to have the fluid drained out of their pleural cavity via a tube inserted into the chest. To treat pleuritic pain, doctors may recommend aspirin, ibuprofen, or NSAIDs (non-steroidal anti-inflammatory drugs). In some severe cases, prescription pain and cough medicines may be used, including codeine-based cough syrups. Those found to have pulmonary embolisms may need to take anti-bloodclotting medicine to prevent future complications.

One procedure to treat pleurisy involves the placing of fibrinolytic drugs into the chest to break up blood clots and pus, which is then drained through a tube. If the fluids still do not drain, a surgical procedure can be undertaken. Native Americans utilized the Pleurisy root or butterfly weed to treat pleurisy due to its mucous thinning properties. This method is less effective, and may not always be successful. Ultimately, one's pleurisy treatment is tied to the severity of the underlying condition.

How can pleurisy be prevented?

Pleurisy can be prevented only by the early detection and management of the causal disease. For example, an early diagnosis and treatment of an infection can prevent fluid from building up in the pleural cavity. In other cases, management of a more serious disease can reduce the amount of inflammation or fluid build-up one may experience.

Pleurisy, stemming from so many other conditions, is often difficult to diagnose or confused with other diseases. When you are being treated for any condition, it is important to get plenty of rest and maintain a healthy diet so as to avoid developing complications such as pleurisy.

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