ISCHAEMIC HEART DISEASE
Ischaemic or ischemic heart disease (IHD), or myocardial ischaemia, is a disease characterized by ischaemia (reduced blood supply) of the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolaemia (high cholesterollevels), diabetes, and hypertension (high blood pressure), and is more common in men and those who have close relatives with ischaemic heart disease.
Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention(angioplasty) or coronary artery bypass surgery (CABG).
It is as of 2012 the most common cause of death in the world,[1] and a major cause of hospital admissions.[2] There is limited evidence for population screening, but prevention (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk of complications.
The medical history distinguishes between various alternative causes for chest pain (such as dyspepsia, musculoskeletal pain, pulmonary embolism). As part of an assessment of the three main presentations of IHD, risk factors are addressed. These are the main causes ofatherosclerosis (the disease process underlying IHD): age, male sex, hyperlipidaemia (high cholesterol and high fats in the blood), smoking,hypertension (high blood pressure), diabetes, and the family history.[3]
myocardial [ˌmaɪəʊˈkɑːdɪəl]
adj(Life Sciences & Allied Applications / Anatomy) of or relating to the muscular tissue of the heart
Collins English Dictionary – Complete and Unabridged © HarperCollins Publishers 1991, 1994, 1998, 2000, 2003
Noun 1. contractility – the capability or quality of shrinking or contracting, especially by muscle fibers and even some other forms of living matter
ability – the quality of being able to perform; a quality that permits or facilitates achievement or accomplishment
stypsis, astringency – the ability to contract or draw together soft body tissues to check blood flow or restrict secretion of fluids
Based on WordNet 3.0, Farlex clipart collection. © 2003-2012 Princeton University, Farlex Inc.
Hypertrophic Cardiomyopathy
Cardiomyopathy is an ongoing disease process that damages the muscle wall of the lower chambers of the heart. Hypertrophic cardiomyopathy is a form of cardiomyopathy in which the walls of the heart’s chambers thicken abnormally. Other names for hypertrophic cardiomyopathy are idiopathic hypertrophic subaortic stenosis and asymmetrical septal hypertrophy.
sternum /ster·num/ (ster´num) [L.] a longitudinal unpaired plate of bone forming the middle of the anterior wall of the thorax, articulating above with the clavicles and along its sides with the cartilages of the first seven ribs. Its three parts are the manubrium, body, and xiphoid process.
Sternum-pain-4
epigastric
[-gas′trik]
Etymology: Gk, epi, above, gaster, stomach
pertaining to the epigastrium, the area above the stomach.
Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.
interscapular
between the scapulae.
levator-and-rhomboids
per·i·car·di·tis (pr-kär-dts)
n.
Adj. 1. uremic – of or involving excess nitrogenous waste products in the urine (usually due to kidney insufficiency)uremic – of or involving excess nitrogenous waste products in the urine (usually due to kidney insufficiency)
azotemic, uraemic
pericardial friction rub
Etymology: Gk, peri, around, kardia, heart; L, fricare, to rub; ME, rubben
the rubbing together of inflamed membranes of the pericardium, as may occur in pericarditis or after a myocardial infarction. It produces a sound audible on auscultation. Also called pericardial murmur, pericardial rub.
Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.
Peripheral cyanosis
Finger Clubbing
JVP (JUGULAR VENOUS PRESSURE)
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
APEX BEAT
The apex beat (lat. ictus cordis), also called the point of maximum impulse (PMI), is the furthermost point outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt.
Popliteal Pulse
What is pitting edema and how does it differ from non-pitting edema?
Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema. This type of edema may be normal depending on the severity. Almost everyone wears socks all day will have mild pitting edema by the end of the day.
In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulationthat may occur after a mastectomy,lymph node surgery, or congenitally. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hypothyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.
SACRAL EDEMA
Hyperresonant sounds that are louder and lower pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults.
Cholecystogram
A cholecystogram is an x-ray procedure used to help evaluate the gallbladder. For the procedure, a special diet is consumed prior to the test and contrast tablets are also swallowed to help visualize the gallbladder on x-ray. The test is used to help in diagnosing disorders of the liver and gallbladder, including gallstones and tumors.
Principles of Barium meal
A barium meal is a diagnostic test used to detect abnormalities of the esophagus, stomach and small bowel using X-ray imaging. X-rays can only highlight bone and other radio-opaque tissues and would not usually enable visualization of soft tissue. However, infusion of the contrast medium barium sulfate, a radioopaque salt, coats the lining of the digestive tract, allowing accurate X-ray imaging of this part of the abdomen.
The images produced are fluoroscopic and can be viewed in real-time as well as on plates.
bariumm
Who can perform a Barium meal test?
A barium meal can be performed by a radiologist (or radiographer) who has specialist skills in imaging studies and works as a healthcare professional to diagnose and treat illness.
Procedure
Before a barium meal test is performed, the duodenum needs to be empty to allow clear visualization of structures. A patient may be given a laxative the night before the procedure to ensure the small bowel is empty at the time of the test, which is usually performed on an empty stomach.
The patient is first asked to change into a hospital gown and remove all jewellery, dentures, glasses, metal objects and clothing as these items can interfere with imaging.
First, some fizzy granules, called carbex granules are given to the patient to create gas and expand the stomach for clearer viewing. Next, the barium contrast liquid is given to the patient to drink.
Some initial images are taken to check that the barium has passed through the esophagus, and into the stomach and small bowel. The radiographer then takes a series of X-ray images over time as the barium contrast moves through the digestive system. This may mean images are taken over anywhere between 1 and 4 hours. Once the barium contrast has passed through to the large bowel or the colon, more pictures are taken. The whole test may take around 5 hours.
Why is this procedure performed?
Barium meal examination is usually performed to help diagnose various diseases or disorders of the digestive system. These include constrictions, hernias, obstructions or masses in the esophagus or stomach, and inflammatory or other diseases of the intestines.
Risks
Exposure to X-rays carries a similar risk as exposure to ionizing radiation. However, the amount of radiation a person is exposed to during an X-ray is is very low and risks are minimal. There are no risks associated with the barium liquid because it is not absorbed by the body.
Some patients, however, are at risk of breathing in or aspirating the barium. X-rays are also harmful to unborn babies and should be avoided by women who are or may be pregnant. Women are asked details of the dates of their last menstruation to ensure the test is performed while the risk of pregnancy is at its lowest.
After the test
Some patients may feel abdominal bloating after a barium meal test and the test may also lead to constipation. Patients are therefore advised to drink plenty of fluid and eat plenty of fruit and vegetables. Mild laxatives may also help. Stools may be pale or whitish for a few days after the test.
Reviewed by Sally Robertson, BSc
References
http://www.nationalcapitaldiagnosticimaging.com.au/wp-content/uploads/2010/06/NCDI_018_BariumMeal_PIB-web.pdf
http://www.ouh.nhs.uk/patient-guide/leaflets/files%5C100204bariummeal.pdf
http://www.guysandstthomas.nhs.uk/resources/patient-information/radiology/Havingabariummealandfollowthrough.pdf
http://www.scumj.eg.net/pdf/vol11-n1-2008/19.pdf
http://prpimaging.com.au/Assets/Downloadablefile/PRP-Barium-Meal-15253.pdf
http://www.liv.ac.uk/HumanAnatomy/phd/mbchb/travel/ba2.Surgical procedures
Oophorectomy
(Ovariectomy; Salpingo-Oophorectomy; Bilateral Oophorectomy; Oophorectomy, Bilateral)
Pronounced: o-frek-toe-me
Oophorectomy is the removal of one or both ovaries. This may be combined with removing the fallopian tubes (salpingo-oophorectomy). Removal of the ovaries and/or fallopian tubes is often done as part of a complete or total hysterectomy.
An oophorectomy may be done to:
Treat cancer
Remove a large ovarian cyst
Treat chronic pelvic pain
Treat pelvic inflammatory disease (PID)
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have an oophorectomy, your doctor will review a list of possible complications. These include:
Changes in sex drive
Hot flashes and other symptoms of menopause if both ovaries are removed
Depression and other forms of psychological distress
Reaction to anesthesia
Bleeding
Blood clots, particularly in the veins of the legs
Damage to other organs
Infection
Factors that may increase the risk of complications include:
Previous pelvic surgery or serious infection
Obesity
Smoking
Diabetes
Salpingectomy
Salpingectomy is the removal of one or both of a woman’s fallopian tubes, the tubes through which an egg travels from the ovary to theuterus.
Purpose
A salpingectomy may be performed for several different reasons. Removal of one tube (unilateral salpingectomy) is usually performed ifthe tube has become infected (a condition known as salpingitis).
Salpingectomy is also used to treat an ectopic pregnancy, a condition in which a fertilized egg has implanted in the tube instead ofinside the uterus. In most cases, the tube is removed only after drug treatments designed to save the structure have failed. (Women withone remaining fallopian tube are still able to get pregnant and carry a pregnancy to term.) The other alternative to salpingectomy issurgery to remove the fetus from the fallopian tube, followed by surgery to repair the tube.
A bilateral salpingectomy (removal of both the tubes) is usually done if the ovaries and uterus are also going to be removed. If thefallopian tubes and the ovaries are both removed at the same time, this is called a salpingo-oophorectomy. A salpingo-oophorectomy isnecessary when treating ovarian and endometrial cancer because the fallopian tubes and ovaries are the most common sites to whichcancer may spread.
Description
Regional or general anesthesia may be used. Often a laparoscope (a hollow tube with a light on one end) is used in this type of operation,which means that the incision can be much smaller and the recovery time much shorter.
In this procedure, the surgeon makes a small incision just beneath the navel. The surgeon inserts a short hollow tube into the abdomenand, if necessary, pumps in carbon dioxide gas in order to move intestines out of the way and better view the organs. After a wider doubletube is inserted on one side for the laparoscope, another small incision is made on the other side through which other instruments can beinserted. After the operation is completed, the tubes and instruments are withdrawn. The tiny incisions are sutured and there is very littlescarring.
In the case of a pelvic infection, the surgeon makes a horizontal (bikini) incision 4-6 in (10-15 cm) long in the abdomen right above thepubic hairline. This allows the doctor to remove the scar tissue. (Alternatively, a surgeon may use a vertical incision from the pubic bonetoward the navel, although this is less common.)
