This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!) On episode 1 of season 7 (named “Now What”), the hospital’s only neurosurgeon, Dr. Richardson, has a severe nausea which doesn’t respond to strong anti-nausea drugs. The team treats him with stronger medications for his nausea – it passes but he starts to hallucinate and behave oddly. At first, the team thinks his behavior is a side effect of the drugs they gave him and test for a bunch of diseases like hepatitis and peptic ulcer. Only when they start to think of his behavior as a new symptom, and after they find out he was at a sea-food festival several days before, they diagnose him with toad egg poisoning

[Photo from episode]

Photo by Fox

Danger Level: High

What is it?

The poison in toad eggs is the venom of the Cane Toad. The venom is usually located in the salivary glands of the frog and on the skin, and rarely it can also pass to the eggs. The toad venom is also used in Chinese medications, so consuming these medications might also cause poisoning: it is the main ingredient in a medicine called Chan-Su which is used mostly as a topical aphrodisiac (and was banned from the Uniter States after four men died after trying to swallow it), and is also an ingredient of Kyushin, which is used in Chinese medicine to treat heart problems.

What causes it?

The toad poison contains a substance called Bufotenin, which is very similar to a cardiac medication called Digoxin (used to treat heart failure and certain abnormal heart rhythms). Digoxin can be toxic in high doses, and the toad venom causes symptoms similar to an overdose.

How does it feel?

The venom of the toad causes several symptoms:

• Nausea with vomiting and possible abdominal pain.
• Cardiac symptoms – mostly problems with the heart rate (which are called arrhythmias), which can be deadly. You might feel heart palpitations.
• Mental symptoms, such as hallucinations. The cane toad is also known as the “hallucinogenic toad” – licking its skin can cause hallucinations which last for about an hour. However, mental symptoms are less described in toad venom poisoning.

Photo by Doug Greenberg

How is it discovered?

The doctors will suspect this if there is a story of eating certain foods such as toad soup, toad cake or toad eggs, or if the patient uses one of the Chinese medications mentioned above. They will test your blood for potassium levels (if it’s high – this is usually a bad sign, since it may cause the heart rhythm problems mentioned above) and for the level of Digoxin (this test can also identify the poison). They will also do an ECG to look for problems with the heart rate.

How is it treated?

There is an antibody for Digoxin which can be used to treat toad venom poisoning as well and has been proved to save lives. Besides that, the treatment focuses on stopping the symptoms.

The bottom line – how do I avoid it?

It’s important to be aware of the possibility of poisoning, and seek medical help if you start feeling nausea or have heart palpitations after eating foods which contain toad. Also, avoid topical aphrodisiacs containing Chan-Su, which are marketed as “Rockhard”, “Love Stone”, or “chan su” – and are forbidden to import to the United States.

Related posts:

1. Radiation Poisoning– What it Can Do To You (As Seen on House MD)
2. Organophosphate Poisoning – Getting Poisoned by Pesticides (As Seen on House MD)
3. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)

We’re big advocates of the fight against heart disease here on A Disease A Day (you can read our series – “Understanding heart attacks” – part 1, 2, 3). Yet when people think about heart attacks, they usually think about older people.

According to a new research, younger people are also at risk. In fact, very young – the study, reported on WebMD, included 63 children at the average age of just 13. The study found that obese children’s blood vessels are stiffer. Stiffness in blood vessels is usually associated with aging and predicts heart disease. Specifically, stiffness in the aorta, as was found in the study, is associated with cardiovascular events and early death.

Photo by Patrick J. Lynch

According to Doctor Beth Abramson, quoted in the article, poor nutrition and inactivity are threatening children’s health and well-being. No word yet about a possible treatment, such as improved diet or more exercise.

The bottom line – if you feared that prolonged sitting in front of the TV or video games isn’t healthy for your kids, we may have first proof you were right.

For the full article, follow the link.

Obese Kids Have Signs of Heart Disease [WebMD]

Related posts:

1. Kawasaki Disease – A Childhood Disease That Can Endanger The Heart
2. Your Hair Could Predict an Upcoming Heart Attack
3. Alzheimer Disease – Are You at Risk?

A few hours ago it was reported that actress Brittany Murphy, known from such films as Clueless, Girl, Interrupted, and 8 Mile has died as a result of a cardiac arrest.

As you may recall (who can forget?), just half a year ago Michael Jackson has also died of the same cause. You can visit our article from back then – Michael Jackson – What is a Sudden Cardiac Death to learn more about the condition.

In the case of Michael Jackson, police were investigating his doctor for allegedly prescribing a drug that may have killed him. In Brittany Murphy’s case, it’s still too early to tell, but we gathered a few headlines hot from the press. As always in such cases, take them with a healthy grain of salt -

• Brittany Murphy’s cardiac arrest might be a result of too much medicines intake
• Brittany Murphy: Drug Use, Eating Disorder Rumors Dogged Actress
• Brittany Murphy dead, 32, husband refuses autopsy
• Was Brittany Murphy’s death caused by a combination of stress, a horrible diet, lack of exercise?

Brittany Murphy – Photo by Rob & Jules

Related posts:

1. Could Mold Have Killed Brittany Murphy? And Can It Kill You?
2. In The News – Michael Jackson – What is A Sudden Cardiac Arrest?
3. The 5 Most Popular Posts in June

A few hours ago, pop star Michael Jackson died at age 50 after suffering a cardiac arrest. As you’ll read in this article, there are many possible causes behind a cardiac arrest, and at the moment the exact cause behind Jackson’s isn’t clear. You can subscribe to our RSS or eMail feed to get updates on the situation, or follow us on Twitter, where relevant news will be published.

Danger level: High

What is it?

Sudden cardiac arrest (or sudden cardiac death) occurs when the heart suddenly stops beating.

Who gets it?

About 325,000 people in the United States die each year of a sudden cardiac arrest (more than lung cancer, breast cancer, or AIDS). Some studies claim that it is more common in people of African American origin than in white people.

Men have a higher chance of having a sudden cardiac arrest (3 times as much as women).

Since, as you’ll see ahead, the main reason behind a sudden cardiac arrest is a problem in the coronary arteries of the heart, the age when people die of it is about the same age when people have heart attacks – it is most common between ages 45-75.

Michael Jackson. Photo by Richard Pflaume.

There are a few risk factors which can put you at risk of having a cardiac arrest:

1. The same risk factors which put you at risk of having a heart attack (You can read about them here).
2. If you had a previous episode of a cardiac arrest, or someone in your family had it
3. If you or someone close in your family have had a history of other types of heart disease, such as heart rhythm problems, congenital heart defects, heart failure or cardiomyopathy.
4. If you use illegal drugs such as cocaine or amphetamines
5. If you get electrocuted or get hit by lightning
6. If you immerse yourself in cold water

What causes it?

There are many things which can cause a cardiac arrest. The common thing is that they all can lead to an abnormality in the rhythm of your heart, which causes your heart to stop. Our heart has to beat at a certain rhythm in order for it to pass blood to our body. If it beats too fast, too slow, or irregularly, it can lead to problems with the heart’s function, and to a cardiac arrest.

The most common type of heart rhythm problem causing a cardiac arrest is called a ventricular fibrillation – in which the ventricles of your heart beat at an extremely rapid rate. This leads to those chambers not being able to fill properly, and so they can’t pump blood to important organs in the body, such as the brain and other important organs. If it’s not reversed within 4-5 minutes, death can occur.

In healthy people, usually cardiac arrest doesn’t develop. It needs some sort of trigger, such as:

1. An electrical shock
2. The use of illegal drugs
3. An injury to the chest
4. The most common situation – A pre-existing heart condition. This can include:
   a. People with atherosclerosis – more than 80% of cardiac arrests occur because of a disease in the heart’s arteries.
   b. Heart attack – A hear attack can trigger a ventricular fibrillation, causing a cardiac arrest.
   c. Cardiomyopathy – This means an enlarged heart. It can lead to a sudden death – most cases of young athletes dying suddenly occur as a result of this.
   d. A problem in the heart’s valves.
   e. A congenital heart disease – This means a problem you were born with.
   f. Problems with the conducting system of the heart – This is the system responsible for the regular beats of the heart.

How is it treated?

The heart can be “restarted” after it stops. This can be done by performing a CPR (cardiopulmonary resuscitation) and shocking the heart with a defibrillator. The CPR helps to maintain a flow of oxygen-rich blood to the body’s vital organs. The defibrillator stops the rhythm problem and “restarts” the heart.

A defibrillator. Photo by Ernstl.

It’s important to know that each minute without CPR and defibrillation cuts chances of survival by 7-10%, and few resuscitation attempts succeed after 10 minutes. In the United States, more than 95 percent of people who suffer cardiac arrest die before reaching a hospital.

Since there is no way to know if you are bound to have a cardiac arrest, it’s important to have regular doctor checkups, including checking your heart’s condition. Other measures that can help include:

1. Quit smoking
2. Eat a balanced diet
3. Keep physically active

In some cases (such as a heart condition) medications can help. See your doctor about that.

For some people, an implantable cardioverter-defibrillator (ICD) can be transplanted under the skin. It works like a normal defibrillator (the one in the picture above), but can prevent the cardiac arrest from occurring in the first place. It is usually given to people at high risk of developing a cardiac arrest.

Related posts:

1. Brittany Murphy Dead at 32 from Cardiac Arrest
2. Vitiligo, or Why Michael Jackson Has Turned White
3. The 5 Most Popular Posts in June

Danger level: High

What is it?

The aorta is the largest blood vessel in our body, and it responsible for supplying blood to all of our organs. Aortic dissection is a life-threatening situation which occurs when a tear develops in the inner layer of the aorta.

Who gets it?

Aortic dissection is 3 times more common in men than in women. Mostly it tends to occur between the ages 40 and 70, with most cases occurring between ages 50-65.

Aortic dissection is more common in African Americans than in white people, and is even less common in people of Asian origin.

There are a few risk factors which put you at risk of having an aortic dissection:

1. High blood pressure – In more than 70% of the cases of aortic dissection, it happens to people with high blood pressure.
2. Diseases in the connective tissue – Connective tissue is a material of which certain things in our body are built, such as tendons, bones and cartilage. There are a few diseases that are specific to this tissue, including Marfan syndrome, Ehlers-Danlos and others. People with these conditions are at risk of having an aortic dissection.
3. Problems in the aorta from birth – There are all sorts of variations in the build of the aorta, with which we can be born (such as a bicuspid aortic valve and others). Having them puts you at risk of having a dissection.
4. Inflammation in your aorta – There are diseases which can cause this, including syphilis, Takayasu, Giant cell arteritis and Behcet’s disease.
5. Pregnancy – If it occurs during pregnancy, it is more common in the 3rd trimester.
6. Injury to the aorta – Such as during a motor vehicle accident.

What causes it?

Our blood vessels, including the aorta, are made of 3 layers. The innermost layer (the one in touch with the blood) is called the intima. The middle layer is called the media, and the outermost layer is called the adventitia.

In aortic dissection, a tear develops in the innermost layer – the intima. Blood enters through the tear, which causes the inner and middle layers to separate.

In an aortic dissection, there is a tear in the innermost layer, through which blood enters the middle layer. Drawing by J. Heuser.

After the blood enters between these two layers, there is a lot of pressure there, caused by the force of the blood flow. This can cause the split between the two layers to continue further down or up the aorta.

This video shows the process:

The tear which runs backwards or forwards along the aorta can cause tears in blood vessels coming out of the aorta and supplying organs in our body. This can lead to a heart attack if it gets to the blood vessels supplying the heart; a stroke, if the blood vessels supplying the brain are involved; kidney failure if it reaches the arteries supplying the kidney, and so on.

Besides that, the main risk in an aortic dissection is that the outer layer (the adventitia) will give way and tear, causing a massive blood loss and death.

How does it feel?

The main thing felt in aortic dissection is a sudden and severe chest pain. It feels as if you have been stabbed with a knife, and radiates to your back. The pain can be associated with cold sweat.

As the dissection gets worse, the pain tends to move with it.

How is it discovered?

There are a few things a doctor can do to discover if you have an aortic dissection:

1. X-rays or CT scans of the chest – They will show the problem in the aorta.
2. Echocardiography – This is an ultrasound of the heart and the area around it. It will also show if you have a dissection.

There are other methods as well, which are used less frequently to detect if you have a dissection.

How is it treated?

An aortic dissection is considered an emergency and requires an immediate treatment. According to the area in the aorta in which the tear occurred, there are two options for treating it:

1. Surgery – In the surgery, the problematic area is taken out, the tear area is blocked, and then a tube is inserted into the aorta – this “builds” the shape of the aorta again. The tube is called a graft.
2. Medications – These are drugs which take down the blood pressure, causing less stress in the area of the tear.

What happens after treatment?

About 20% of people with a dissection die before reaching the hospital. If not treated, the chances of dying from it are high.

After treatment many people will need to take medications to lower their blood pressure for the rest of their lives, in order to prevent this from happening again.

The bottom line – How do I avoid it?

The most important things is to lower your blood pressure if you have hypertension.

If you have any of the conditions mentioned above in the risk factors, you should consult your doctor on how to prevent a future dissection.

Also, when in a car, be sure to wear a seatbelt. This will reduce the risk of injury to your chest.

Related posts:

1. Migraine Headaches – How To Tell If Your Headaches Are Life Threatening, and What You Can Do About Them
2. 10 Screening Tests That Can Save Your Life
3. Peripheral Arterial Disease – A Narrowing of Blood Vessels that Will Shorten Your Life

Danger level: High

What is it?

Hypertension is an elevated level of the blood pressure, which can lead to serious complications.

Who gets it?

Hypertension affects about 60 million people in the US (30% of the population), and about 1 billion worldwide. It’s been estimated that hypertension is responsible for 6% of deaths worldwide.

The older you are, the more likely you are to have hypertension (after age 60, about 65% of the population has it).

There are certain risk factors which increase your risk of having a hypertension. These include:

1. Obesity – The more overweight your are, the more likely you are to get hypertension.
2. Eating foods rich in salt.
3. Having a family history of high blood pressure, heart disease or diabetes.
4. African American origin.
5. Being sedentary – Not doing any physical activity can raise your risk
6. Drinking alcohol excessively
7. Smoking
8. Using certain medications

What causes it?

First of all, what is a blood pressure?

It’s the force of blood pushing against our arteries as the blood flows through the body. You can understand it better if you think about a garden hose. As more water passes through the hose at a certain time, the more force works against the hose. This can damage the hose, or in real life, damage the blood vessels.

The reason for the development of hypertension in a person isn’t always known. Most of the time (95% of cases), the cause is unknown. In such cases, the condition is called essential hypertension.

The other, less common, type of hypertension is called secondary hypertension, since it’s secondary to other conditions. Causes here include Cushing’s syndrome, sleep apnea, drugs, kidney diseases, pheochromocytoma, thyroid problems and others (we will cover all of those in the future).

How does it feel?

That’s the main problem: Usually you don’t feel a hypertension. That’s why it’s been called “the silent killer” – you may walk around not knowing you have it until something happens.

That’s why regular checkup at your doctor’s office are important.

How is it discovered?

The doctor uses a cuff which they put around your arm to measure your blood pressure.

A blood pressure cuff.

When measured, the blood pressure appears as 2 numbers: The first (and higher) one is called the systolic blood pressure (this is the pressure that is measured when the heart beats and fills the arteries with blood). The second one is called the diastolic blood pressure (the pressure that’s measured when the heart rests between beats).

Generally speaking, when you have a blood pressure reading of 140/90 or higher (taken at least twice) you are said to have a high blood pressure.

How is it treated?

Treating a high blood pressure contains a few stages:

First – Modifying your lifestyle

Before starting with drugs, hypertension is usually treated first with lifestyle modifications. These include:

1. Weight loss – In people who are overweight or obese.
2. Starting a healthy diet – The diet recommended for people with hypertension is called the DASH diet (short for Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables and low-fat dairy products, with reduced fats.
3. Taking off salts in your diet
4. Physical activity
5. Drinking less alcohol

Each of these things can contribute to lowering your blood pressure. If that’s not enough, the next step follows.

Second – Medications

There are many types of drugs to treat hypertension, and they are beyond the scope of this article. Your doctor will recommend which ones to start with, and what drugs to add if the first one doesn’t do the trick.

What happens after treatment?

If the blood pressure is treated, everything is fine and dandy. The problem is, a lot of people don’t stick to their pills. Like we said above – you don’t feel hypertension, so why should you stick with those pills (and their side effects)?

Which takes us to the “silent killer” part. Untreated, hypertension can cause damage to organs in our body:

1. The heart – Hypertension can lead to atherosclerosis and heart attacks.
2. The brain – Hypertension can lead to strokes, especially those caused by bleeding to the brain.
3. The kidneys – Hypertension can lead to kidney failure.

Yes, 30% of the population has a high blood pressure. It doesn’t mean that YOU have to be one of them. There are certain things you can do today to lower your risk of developing hypertension:

1. Maintaining a normal weight – Your target BMI should be 18.5 to 24.9 (for explanations about that and for a starter’s guide for losing weight, you can visit our article about using the Internet to lose weight).
2. Reducing salt in your diet – The nutrition labels on foods you buy can help you. You should aim at less than 2,300mg of sodium (salt) a day. This is the equivalent of about 1 teaspoon of salt.
3. Exercising – For at least 30 minutes on most days of the week.
4. Limiting your alcohol intake – To 2 drinks a day if you’re a man or 1 if you’re a woman.
5. Following the DASH diet

This video sums it up (it talks mostly about Canada, but applies to every country) -

Got any tips of your own? Share them in the comments.

Related posts:

1. Preeclampsia – A Dangerous Rise in Blood Pressure During Pregnancy
2. Pheochromocytoma – A Rare Tumor That Can Cause Hypertension (As Seen on House MD)
3. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)

Danger level: High

What is it?

Deep vein thrombosis (DVT for short) is a blood clot (or thrombus in Greek) that forms in a deep vein in the body.

Who gets it?

There are a few risk factors for developing DVT:

1. Conditions that cause the blood to move slower– For example if you are bedridden for a long time or paralyzed, or if you sit in an airplane for a prolonged time (usually for more than 8 hours).
2. Injury to our blood vessels: This can happen after a trauma or after a major surgery (such as orthopedic surgeries).
3. A propensity for clotting – In some people, clots can form more commonly than in others. This includes people with blood disorders which can cause this, as well as women taking contraceptive pills (and those taking hormones after menopause), and it can also happen after taking other types of drugs.
4. Cancer – Can raise your risk of developing DVT.
5. Pregnancy
6. People who have had it before – Are more prone to developing DVT again.

Oral contraceptive pills. They can cause DVT. Photo by Gnarls Monkey.

What causes it?

Our body has a clotting system. This is the system that’s responsible for the clot that forms when you are wounded. Platelets (a type of blood cell) in our blood aggregate in the area of the wound, and along with other materials in the blood form the clot. Usually in our body there is a balance between the system that forms clots and systems that prevent clots from happening or dissolve them when they do.

In DVT, as a result of the risk factors above, the clotting system works more than the systems which prevent or melt clots, which causes the clot to form inside the blood vessel.

A blood clot inside a vein.

How does it feel?

Clots form mostly in the veins of the legs or in the pelvis (the hip area). Less commonly, they can form in our arms.

As a result of the clot, the leg gets swollen, and may feel warm and look redder than the other leg. It can also hurt or be tender to touch.

You can see above that this disease is tagged as danger: high. If all it does is pain in the leg, you might ask yourself what’s so dangerous. The danger is that these clots can break loose from their original location, travel through the bloodstream to the lungs, and block the blood flow in the lungs (a condition called pulmonary embolism). This is life threatening.

Other than that, DVT can damage the veins in the leg in the long run (a condition called chronic venous insufficiency).

How is it discovered?

There are a few ways to discover DVT:

1. An ultrasound of the legs – It can detect the blood flow in the legs and show if it’s blocked by the clot.
2. A blood test – Which can discover if you have DVT (the test is called D-Dimer).
3. Venography – This is an X-ray picture of the blood flow through your veins.

How is it treated?

There are 2 ways to treat DVT:

1. Above we mentioned that as well as the system in our body which is responsible for clotting, there are systems responsible for stopping the clotting process and for dissolving the clots.

   There are drugs which help these other systems. These drugs are called blood thinners (or in their medical name, anticoagulants). Examples of such drugs are heparin and warfarin. These drugs are usually given for at least a few months until you are out of risk (and if you have a permanent condition which makes your blood clot, you may have to take it for life).

2. Inferior vena cava (IVC) filter – There are people who can’t get blood thinners, and there are also people who still get DVTs although they take these drugs. For these people, a type of filter is inserted into our vena cava, which is a vein in which the blood travels from the lower body to the heart. Putting the filter there prevents clots from reaching the heart and the lungs.

What happens after treatment?

Treating this condition on time prevents its complications (pulmonary embolism and venous insufficiency).

The bottom line – How do I avoid it?

There are a few things you can do to prevent DVT:

1. On long flights – Some doctors recommend that you wear compression stockings (they’re available at medical supply stores) during the flight. On long flights you should walk up and down the aisle hourly (working your leg muscles squeezes the veins and moves the blood in them), drink plenty of water (since dehydration, which is more common when you’re on an airplane, can make your blood thicker and drive clot formation), flex and point your feet occasionally, and avoid alcohol and drinks which contain caffeine (since they contribute to dehydration).

   This also applies to long travels by car, when you sit most of the time.

2. If you have a family history of blood clotting, inform your doctor – This can potentially prevent conditions which run in families and cause blood clotting from putting you at risk for DVT.
3. When you undergo a surgery or when bedridden – You will be given medications and other measures to prevent DVT from occurring.

This video sums it up:

Related posts:

1. Blood Clotting Tendency (Thrombosis) – Are You at Risk? (As Seen on House MD)
2. Wilson Disease – The Return (As Seen on House MD)
3. Understanding Heart Attacks – Part 3 – Myocardial Infarction

Danger level: High

What is it?

Acute pericarditis is an inflammation of the heart’s cover.

Who gets it?

Acute pericarditis is more common in men than women. It’s more common in adults than in children.

What causes it?

Around our heart there is a sac, called the pericardium. It’s job is to protect the heart and reduce the friction between the heart and the surrounding organs when it’s pumping.

This drawing shows what’s left when you take the heart out – its cover, the pericardium.

A bunch of things can cause this sac to get inflamed (like we mentioned here before, when something in medicine ends with an “itis” it means it’s inflamed). Here are a few of them:

1. Infection – Mostly viruses.
2. Radiation – People who had radiation to their chests in the past (such as for a tumor) are in more danger of developing pericarditis.
3. Injury – An injury to the chest, such as in car accidents (when the wheel hits the chest) or when a knife or bullet hit the area.
4. After a heart attack – This is one of the complications that can happen as a result of a heart attack.
5. Drugs – There are certain drugs that can cause this.
6. Kidney failure
7. Tumors – When some tumors (such as breast cancer, lung cancer or Hodgkin’s lymphoma) spread to the heart, they can cause this.
8. Lupus and rheumatoid arthritis – Can cause pericarditis as part of the disease. (There are also other similar disease which can cause this).
9. Inflammatory bowel diseases – Such as crohn’s disease or ulcerative colitis.

But most of the time, the cause is simply unknown.

(There are still other reasons, such as tuberculosis and others).

How does it feel?

The basic feature of pericarditis is chest pain. The pain is sharp and can radiate to the trapezius muscle (the muscle between our shoulders, on both sides of the neck). It gets worse by breathing and by lying down, and gets better when you lean forward.

Sometimes fever can accompany the pain.

How is it discovered?

There are a few things the doctor can do to tell if you have pericarditis:

1. Listen to your heart – A special sound called a “pericardial friction rub” is heard when you listen to the heart in this condition. It’s causes by the rubbing of the layers of inflamed sac around the heart.
2. Do an ECG – Like in a heart attack, here too, the ECG has a special pattern which the doctor can recognize (and which is different than the one in a heart attack).
3. X-ray of the chest or an echocardiogram – An echocardiogram is an ultrasound of the heart. As you’ll read ahead, pericarditis can lead to fluid in the sac surrounding the heart (called a pericardial effusion). The echo can discover that.

How is it treated?

There are a few things used to treat pericarditis:

1. Aspirin or anti-inflammatory drugs – These are used to control the pain and the inflammation.
2. Treating the cause – Such as an infection.

What happens after treatment?

Usually the outcome of the disease is good if it’s caused by a virus or by some unknown cause, and if it’s treated on time. Most people recover in 2 weeks to 3 months (even though it may return).

If not treated, pericarditis can cause complications:

1. Pericardial effusion – This is a buildup of fluid around the heart.
2. Cardiac tamponade – If a fluid builds up too quickly around the heart, the heart may suddenly develop difficulties pumping the appropriate volume of blood it’s used to, since the fluid takes all the space around it. This is a life threatening situation.
3. Constrictive pericarditis – This can happen in a longstanding disease. The sac around the heart gets stiff and thick, which makes it harder for the heart to pump blood.

(We’ll cover these conditions in future posts).

Acute pericarditis usually can’t be prevented. But you can prevent it from coming back by treating it properly.

This video shows the story of attorney David Geller, 26, who suffered from the disease for months until it was treated properly:

Related posts:

1. Understanding Heart Attacks – Part 3 – Myocardial Infarction
2. Understanding Heart Attacks – Part 2 – Angina Pectoris
3. Are Obese Kids at Risk for Heart Disease?

This is part 3 of a 3-part series about hearts attacks. In part 1 we covered atherosclerosis. Part 2 dealt with angina pectoris.

This part deals with the real thing – the heart attack that can be caused by the plaques in the heart’s coronary arteries.

Danger level: High

What is it?

A heart attack (or myocardial infarction by its medical name) occurs when the blood supply to part of the heart is interrupted, causing the heart cells in that part to die.

Who gets it?

People in danger of having a heart attack are the same ones who have the risk factors for developing atherosclerosis (for a reminder, see part 1).

What causes it?

In parts 1 and 2 of this series, we explained about the heart’s arteries, which supply it with oxygen, getting blocked by plaque. We also mentioned that if they get narrow and the blood supply to the heart diminishes, a pain in the chest called angina can occur.

The plaque that builds up inside the artery can eventually burst, tear or rupture. When the plaque ruptures, the body recognizes this as damage to the artery. Remember what happens when you have a wound on your skin? Within a short time it clots, sealing down the wound so that blood won’t spill from it. The same thing happens here: The “wound” in the artery clots.

How does this clotting happen? Platelets are the cells in our blood responsible for clotting. They aggregate together, helping the clot form. The clot is called a thrombus.

You might think to yourself – “the body has done its job right. The wound in the artery is healed.”. But the clotting process here is actually what brings about the heart attack. The clot in the artery can lead to an occlusion of the blood flow inside the artery, causing blood to not pass in the artery anymore. This leads to blood not reaching where it should in the heart.

When blood doesn’t reach a part of the heart, that part doesn’t get oxygen. When this happens, the cells in that part start dying. When they finally die, they can’t grow back, and that part of the heart is lost and will not function anymore.

The time it takes for the cells to die is a few hours. If the condition is treated within that time frame, the heart can be saved.

This video shows the process visually -

How does it feel?

A heart attack feels like angina, but lasts more than 30 minutes and is not relieved by nitroglycerine or by rest. Here’s a reminder of the symptoms:

1. Pain, pressure, discomfort or heaviness in the chest. It can radiate to the left arm, the neck or the jaw.
2. Sweating, nausea, vomiting or dizziness may accompany the pain.
3. Rapid or irregular heartbeats may be felt as well.

How is it discovered?

There are a few things that can be done when you reach the ER to see if you have a heart attack:

1. ECG: You can read an explanation about that in part 2.
2. Blood tests: When the cells in the heart start dying, certain materials (called enzymes) start leaking out from them and into the blood. These enzymes are called troponins. When their level in the blood is high, this hints to a heart attack.
3. Coronary angiography – (see an explanation in part 2) can be used to visualize the arteries in the heart to see if they are blocked.

How is it treated?

Perfusion is a word that means blood coming into an organ. In a heart attack, blood is not reaching the heart muscle properly. In order to bring blood back into the heart, the artery needs to be re-opened. This process is called re-perfusion.

There are 3 ways to get the artery opened:

1. Percutaneous coronary intervention (PCI) – This is a long and complicated name, but the procedure is simple to understand. Remember when we spoke about coronary angiography being able to show your heart’s arteries?
   It can also be used to treat the arteries. The catheter which is inserted into the arteries is used to do one of two things. It can inflate a balloon, which will open the block in the artery. Then it can insert something called a stent – which is a tube inserted into the artery to keep it open.

   This video shows how it works:
   
2. Thrombolysis – In this procedure a material is injected into the blood vessels, which causes the clot to “melt”. This opens the heart’s arteries back. While it sounds easier than the first method, it’s not as efficient, and not everyone is suitable for this procedure.
3. Coronary artery bypass surgery (CABG) – Sometimes neither of the first two treatments fit. In this setting, a surgery has to be performed. In it, the chest is opened and the heart is exposed. The surgeon then takes an artery or vein from somewhere else in the body and implants it to the heart’s arteries. In this way, the occlusion is bypassed by a new, open, blood vessel.

Besides those, some drugs are given to everyone having a heart attack. They include aspirin (which stops the platelets from aggregating and so slows down the process), pain killers, oxygen and others.

What happens after treatment?

Without treatment, death rates are high for people who undergo a heart attack. But even with treatment, death can occur, especially before reaching the hospital. This is mainly due to complications that can occur as part of the heart attack, such as problems with the heart rhythm, failure of the heart’s muscle to pump properly, problems with the heart’s valves and others.

The bottom line – How do I avoid it?

The best way to avoid a heart attack is to prevent the process of atherosclerosis from happening (see part 1).

If you do have atherosclerosis or if you had a heart attack before, you can prevent it from happening by visiting your doctor. They will prescribe some drugs for you (including statins, beta blockers, aspirin, and others. All have been mentioned in this 3 part series). Taking these drugs regularly will lower your chances of getting a heart attack.

Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Understanding Heart Attacks – Part 1 – Atherosclerosis
3. Heart Attacks and Women

Yesterday we started a 3 part series about heart attacks. Part 1 talked about atherosclerosis. Now we’re moving on to what atherosclerosis can do to your heart. One of those things is called angina pectoris.

Danger level: High

What is it?

Angina pectoris is the medical name for chest pain or discomfort due to a disease in the heart’s arteries.

Who gets it?

As discussed in part 1, atherosclerosis causes a narrowing of the heart’s blood vessels. If more than 50% of the artery gets blocked, angina pectoris may start.

What causes it?

Our heart is a muscle. Muscles in our body, like any other organ, need oxygen in order to function. They get that oxygen when our blood, which is rich in oxygen, reaches them.

When the arteries which supply the heart with blood (called coronary arteries) are narrowed, like in atherosclerosis, the heart doesn’t get enough blood. In medicine, an insufficient blood supply is called ischemia. This is why you may hear the term “ischemic heart disease”, for the condition caused by atherosclerosis.

When the heart doesn’t get enough blood it “shouts” at you by producing pain, as you’ll see in the “how does it feel” section.

Angina occurs when our arteries are narrowed enough by a plaque that not enough blood reaches the heart.

How does it feel?

Angina is manifested as chest pain. It’s usually felt under the breast bone (around the center of the chest) like a deep pain. It usually lasts less than 30 minutes, and can radiate to the neck, the jaw or the left arm. It can be accompanied by breathlessness, cold sweat and nausea or vomiting.

There are 2 types of angina:

1. Stable angina – These occur when you exert yourself (such as when walking or running) or when you’re under mental or emotional stress. Normally the pain subsides when you rest or when you take a drug called nitroglycerin.
2. Unstable angina – This occurs when the narrowing of the coronary arteries is more severe. In this stage, the pain occurs even when you rest, meaning you don’t even have to have your heart pumping stronger than usual for it to feel the lack of oxygen – it will feel it even when it pumps regularly. This is a dangerous situation which signals a possible upcoming heart attack.The pain here can last longer and be more painful than in stable angina.

How is it discovered?

There are a few things a doctor can do to diagnose angina -

1. The typical story helps to point in the right direction. Also doing a physical exam will help.
2. An ECG (electrocardiogram) is done – This is a graph showing the electrical activity of the heart. To have this graph drawn, electrodes are attached to your chest, which detect the heart’s activity. This isn’t painful at all. When the heart lacks oxygen, a pattern can be seen on the ECG which the doctor will recognize.
   Example of an ECG graph.
3. Stress testing – Like mentioned above, angina doesn’t occur all the time, and sometimes a person with angina will come to the doctor when they don’t have pain at the moment. This is why stress testing is done. In it you run on a treadmill (like in a gym), causing your heart to work harder. This will trigger the pain of angina and the ECG changes, if your arteries are narrow. (There are people who can’t exercise for whatever reason. For these people a drug is given which makes their heart work harder, causing the same effect).
4. Coronary angiography – When there is a high suspicion that you are at risk for a heart attack, or when the other tests are positive, a coronary angiography (also called catheterization) may be done. In this exam, a small tube-like device called a catheter is inserted through large arteries in the body, and reaches the coronary arteries. There it injects a material which can be seen in real time under X-ray. This shows the coronary arteries, and will show if they are narrowed.
   The heart’s arteries (coronary arteries) as seen in a coronary angiography. Photo by Bleiglass.

How is it treated?

There are a few things that can be done to treat this condition:

1. Changing risk factors which are reversible – Such as quitting smoking, lowering blood pressure, changing the diet. (For a complete list of the risk factors, see part 1).
2. Drugs – There are several drugs given in this condition -
   a. Antiplatelet drugs – As you will see in part 3, angina can be a step before a heart attack. Since platelets are involved in the development of heart attacks (again, you’ll see why in part 3), inhibiting their action can help prevent a heart attack from happening. An example of such a drug is aspirin.
   b. Beta-blockers – These are drugs that make the heart work less strenuously, lowering the chance that it will reach a point where it lacks oxygen.
   c. Nitroglycerin – This drug causes widening of blood vessels, causing more blood to reach the heart. It’s usually taken when needed – when there’s pain.
   d. Statins – These are drugs that take down the “bad cholesterol” (LDL cholesterol) in the blood.

There are also other drugs which can be used, but the ones above are the most common.

If the narrowing is severe or if the above treatment doesn’t help, procedures for opening the narrowing in the heart’s arteries are performed (you can read about those in part 3).

What happens after treatment?

When not treated, heart attacks are likely to develop in people with angina, putting you at risk for death. When treated, however, this condition can be followed, with the chances of having a heart attack being greatly reduced.

If you follow the tips for avoiding atherosclerosis (see part 1), you’ll greatly reduce your chances of developing angina or heart attacks.

This movie sums it all up:

Related posts:

1. Understanding Heart Attacks – Part 3 – Myocardial Infarction
2. Understanding Heart Attacks – Part 1 – Atherosclerosis
3. Heart Attacks and Women