Severe Mitral Valve Regurgitation Symptoms and Treatment

Severe mitral valve regurgitation may be divided into two kinds: ischemic or non-ischemic. Ischemic mitral valve regurgitation is due to coronary artery disease and is associated with blocked arteries. It can occur in association with myocardial infarction or heart attack. Non-ischemic mitral valve regurgitation may be due to a myxomatous mitral valve such as what occurs in mitral valve prolapse. It can also occur due to infectious processes such as rheumatic fever or infective endocarditis or due to congenital anomalies.

Symptoms of Severe Mitral Valve Regurgitation

Most patients with severe mitral regurgitation suffer from chronic fatigue, difficulty of breathing or shortness of breath with activity or when lying flat on bed. Some develop palpitations which may be due to an abnormal heart rhythm called atrial fibrillation. Swelling or edema of the ankles and enlargement of the abdomen and the liver may also occur once the right side of the heart becomes involved.

Patients who develop acute severe mitral regurgitation, such as those who suffer from heart attack, may develop pulmonary congestion. This also results to difficulty of breathing.

Treatment of Severe Valve Mitral Regurgitation

Among symptomatic patients with severe mitral regurgitation, findings revealed by the two-dimensional echocardiogram (2D-echo) help the doctor decide the treatment. 

Mitral valve repair is the procedure of choice as the risks and the mortality rate of primary repair are lesser than that of replacement. For instance, for isolated mitral valve repair, the mortality rate is 1.8% versus 5% in mitral valve replacement. In addition, there are less long-term undesirable consequences in mitral valve repair.

Sometimes, the findings on 2D Echo are not favorable for either mitral valve repair or replacement. These findings include an ejection fraction of less than 30% and an end-systolic dimension of more than 50 mm. If this happens, medical therapy is preferred. 

What is a Strangulated Hernia?

A hernia simply refers to the protrusion of an organ outside of a cavity or space that normally encloses it due to a weakness in the walls of the cavity. In surgery, there are different types of hernias usually pertaining to the bowels. In most cases, a herniated bowel can be reduced, either spontaneously or with manual compression. Reduction means the return of the herniated organ into its original position.

However, strangulation of hernia can occur. So what is a strangulated hernia? A strangulated hernia is one that cannot be reduced to its original position and becomes trapped through the opening of the cavity. When it becomes trapped, the strangulated bowel eventually loses its blood, oxygen and nutrient supply.

Symptoms of a Strangulated Hernia

The symptoms of a strangulated hernia are the same as the symptoms of bowel strangulation. Bowel obstruction symptoms heralds bowel strangulationsymptoms. A person who has a strangulated hernia often experiences vomiting, constipation, bloatedness and abdominal enlargement or distention due to bowel obstruction. As the bowel strangulation progresses and the strangulated hernia loses its blood and oxygen supply, severe abdominal pain occurs, accompanied by the fever. One distinguishing characteristic of the pain of bowel strangulation is severe abdominal pain not relieved by any position.

When a patient with strangulated hernia presents at the emergency department, the patient is often septic due to the acute abdomen. Emergent surgical management is needed for these kinds of patients.

Diagnosis of a Strangulated Hernia

The diagnosis of a strangulated hernia is based on history and physical examination findings. Patients usually have a long-standing palpable lump on their groin or abdomen. Their past medical history might reveal a previous diagnosis of hernia while their recent history reveals the presence of intestinal obstruction symptoms. Imaging studies such as CT scan may be requested to document bowel strangulation. Blood counts often reveal elevated white blood cell counts with neutrophilic predominance as a sign of sepsis. Blood chemistry usually reveals deranged electrolytes due to fluid shifts and losses.

Treatment of a Strangulated Hernia

The definitive treatment for a strangulated hernia is surgery. The type of surgery depends on the type and location of the hernia. Different approaches may be used. Non-mesh repairs are advisable in cases of bowel resection.

Easy Ways on How to Relieve Constipation

One of the most irritating symptoms among adults is constipation. It is often a source of discomfort and embarrassment especially among working adults. Not many people are aware of ways of relieving constipation. However, the ways to relieve constipation are actually very easy. By following the following steps on how to relieve constipation, you can have easy and effortless bowel movements daily.

1)      Drink plenty of water.

Constipation can occur when there is not enough water in the stools. Because the large intestines reabsorb a lot of water from fecal material, the actual stools can become very hard if there is not enough water in one’s daily oral intake. The advice that one should drink 6-8 glasses of water per day can go a long way in relieving constipation. In times of warm weather where insensible losses such as sweating can further decrease the total body water, increasing water intake is the key to avoiding constipation.

2)      Eat a high-fiber diet.

Aside from cleansing the bowels, foods high in fiber can help prevent constipation by keeping fecal material softer. In a sense, a high fiber diet translates to soft stools because the collagen somehow serves as an absorbent, sponge-like material. This lessens the changes of passing hard stools. In addition, eating a high-fiber diet can help prevent straining, which in turn can cause hemorrhoids.

So what are examples of what to eat to relieve constipation? Green leafy vegetables and fruits with lots of collagen and water will do. These include lettuce, broccoli, watermelon, papaya and a lot of other fruits and vegetables.

3)      Eat less meat

While fruits and vegetables form the bulk of what to eat to relieve constipation, meat is at the other end of the spectrum. People who love to eat meat are more likely to suffer from constipation and hemorrhoids.

4)      Use stool softeners or laxatives

One way of how to relieve severe constipation is using stool softeners or laxatives to promote bowel movement. Unfortunately, like any other drug, these can have side effects. Although most can be bought over-the-counter, it is better to use them under the supervision of a physician so that such side effects can be avoided or monitored. 

If these ways to relieve constipation do not work and constipation is associated with other symptoms such as diarrhea, weight loss, or blood inthe stools, do not hesitate in seeking professional healthcare. While constipation is an embarrassing symptom and can often be addressed at home, the presence of other symptoms can herald more complicated diseases. Hence, if trying to relieve constipation on your own does not work, it is but wise to consult a doctor. 

Causes of Blood in Stools

One of the most common causes for consult in the Emergency Room or the Emergency Department is blood in stools. Most often than not, the patient is a middle-aged adult who had either saw gross blood in stools or who had blackish stools, signifying processed blood. Moreover, these patients are likely to be anemia and need blood transfusion.

So what causes bloody stools? The following are the most common diagnoses of bloody stools I have seen in the ER.

1. Hemorrhoids
Hemorrhoids commonly cause bloody stools. Irritation and inflammation of the anorectal mucosa because of straining and constipation from a low fiber diet leads to hemorrhoid formation. Fortunately, most hemorrhoids are not complicated and can be resolved by a diet containing high fiber and plenty of water and proper hemorrhoid care. Avoidance of straining is also a must. Sometimes, doctors may prescribe medications to help decrease the inflammation or to soften the stools.

2. Other Colorectal diseases 
Colorectal diseases can also cause blood and mucus in stools. Colorectal diseases include diverticulosis or diverticulitis and colorectal cancer. Diverticulosis can be addressed by dietary changes but diverticulitis is often treated with antibiotics and sometimes, surgery. Colorectal cancer should always be a consideration among adults who have a family history of bowel cancer.

3. Peptic ulcer
Peptic ulcer disease refers to both gastric and duodenal ulcers. These ulcers usually cause abdominal pain as well. Most ulcers, when they bleed, cause blackish foul-smelling stools medically termed as "melena". However, sometimes, when peptic ulcers bleed massively, they can cause grossly bloody stools we call "hematochezia". Bleeding peptic ulcers usually cause varying degrees of anemia. It is prudent to immediately cause a gastroenterologist when you suspect you have a peptic ulcer in order to have an endoscopy done as soon as possible.

4. Liver Disease
Chronic liver disease, whether it is due to alcoholic, viral or malignant causes, can cause bloody and mucus in stool through two main mechanisms: 1) acquired coagulopathy, 2) bleeding esophageal varices. Acquired coagulopathy simply means that the liver is failing to produce enough coagulation or clotting factors. Hence, any mucosal break in the gastrointestinal tract can bleed spontaneously. Esophageal varices are blood vessels that enlarge because of the high pressures causes by a dysfunctional and cirrhotic liver. They are often managed with ligation via endoscopy by a gastroenterologist.

5. Infection
Infection is still the most common cause of bloody mucus in stool among children. Bloody mucus in stools accompanied by severe abdominal pain and fever, often require antibiotics. However, infections are less common causes of blood in stools among adults due to higher rates of observance of hand hygiene. To prevent infection causing bloody stools, it is therefore prudent to always wash hands and eat only well-cooked food and drink clean water.

What Causes a Heart Attack?

What Causes a Heart Attack?

Just yesterday, I received a patient in the ER who suffered from heart attack. Heart attack, called in medical terms as myocardial infarction, is one of the top diagnoses in the ER and is also a leading cause of death in today’s world. The basic mechanism of a heart attack is the presence of a low blood supply to the heart in the face of great demand. Knowing what causes a heart attack is essential in preventing it.

There are several heart attack causes. One cause of heart attack is the formation of obstruction within the blood vessels of the heart, otherwise known as the coronary vessels. Several risk factors that cause heart attack of this type have been identified. These risk factors include the following: hypertension, diabetes, chronic kidney disease, atherosclerosis, chronic smoking and elevated cholesterol levels.

Another one that causes heart attack is the vasospasm of the coronary arteries. This cause of heart attack leads to constriction of the small blood vessels that supply the heart, leading to severe lack of supply of nutrients of oxygen. Several abused drugs, including nicotine and cocaine have been known to cause this type of heart attack.

Severe anemia can also be one of the causes of heart attack. In severe anemia, the oxygen-carrying capacity of the heart becomes severely limited due to the lack of hemoglobin. Patients who are at most risk of suffering from heart attack due to severe anemia are those who are going to undergo surgery or any other high-stress procedure. This is one of the reasons why a person who is going to undergo an operation have to be adequately evaluated and prepared.

Knowing what causes heart attacks helps in addressing the problem. The risk factors have to avoided prudently in order to lessen the risk of heart attack. 

What do High Potassium Levels in Blood Mean?

Among the most common laboratory test results I encounter in the clinic and in the ER are high potassium levels in blood. Potassium (K+) is a very essential substance which helps the cell maintain life. For instance, it helps in the generation of ATP (the energy currency of the cell) through the so called Na+-K+ ATPase. Normally, the potassium level in the blood is lower than the potassium level inside the cell. Hence, when there is low or high potassium levels in blood, we expect abnormalities in the function of the human body as well.

In my experience, the most common cause of high potassium in blood test is still kidney disease. Chronic kidney disease, sometimes called chronic renal failure, decreases the ability of the kidney to excrete potassium into the urine. Hence, potassium levels high in blood becomes the "norm". Unfortunately, when the high blood potassium scenario occurs, different organs are affected. For instance, the heart muscle becomes highly irritable. Therefore, a patient with high blood potassium is prone to undesirable cardiac rhythms or arrhythmias. High potassium levels in blood are known to cause cardiac arrest and death through this mechanism.

When potassium levels high in blood are detected, we can give several interventions. First of all, we can give a drug called calcium gluconate to protect the heart and make it less irritable. This is decrease the risk of arrhyhtmias. Second, we can give GI or glucose-insulin solution to promote the transport of potassium from the blood into the cells. Third, we can give a diuretic called Furosemide to promote excretion of potassium out of the body through the urine. When the potassium level in blood is only slightly elevated, potassium binders such as Sodium Polysterene (Kayexate) may be given. However, these interventions are only temporary measures and may not always work.

For people who already have End Stage Renal Disease (ESRD, also known as Chronic Kidney Disease Stage V), hemodialysis is usually done to promote potassium removal. The other more costly but also more effective option is renal transplant.

High potassium in blood tests should not be ignored because it may be the sole marker of kidney disease. If you have high blood potassium and you also have symptoms of renal disease such as edema, you should get yourself checked by a doctor.

Aloe Vera for Hemorrhoids

A common question which patients pose when they consult due to hemorrhoids is this: "Is aloe vera for hemorrhoids effective?" It really depends on what kind of hemorrhoid and how severe the hemorrhoid is. When the hemorrhoid is strangulated or thrombosed, home treatment is often necessary. However, if the hemorrhoid is of milder severity, home treatment of hemorrhoid with aloe may be enough.

Let me first discuss what aloe is. Aloe, short for aloe vera, is a well-known herbal medicine. In ancient Egypt, it was praised as the plant of immortality. The main advantages of aloe vera in alternative medicine lies in its soothing and moisturizing properties.

Since pain is a common complaint associated with hemorrhoids, aloe vera for hemorrhoid treatment may be effective. Treatment with aloe vera gel for hemorrhoid pain may be done using aloe gel preparations available in the market. Some people suggest cutting aloe vera leaves, freezing them and applying the strip to the hemorrhoid. However, I am of opinion that commercial preparations are better used as aloe hemorrhoid treatment for the following reasons.

First, commercial preparations are sterile. Hence, they do not bring with them the risk of secondary infection. Second, they usually have more concentrated active ingredients. Since concentration of bioactive ingredients correlates with effectiveness, these are preferable.

If you plan to use aloe for hemorrhoid home treatment, just make sure that what you use is very clean. Make sure to observe appropriate hand hygiene as well. Home remedies are often effective if they are applied properly.

What are the Symptoms of High Blood Pressure?

As I attend to patients in the ER, I realize that most people are not aware of the symptoms of high blood pressure. Many people take high blood pressure or hypertension for granted due to the supposed lack of symptoms of high blood. Unfortunately, it is this lack of awareness that leads to surprise heart attacks and strokes. In this article, I will discuss the most common high blood pressure symptoms I have encountered.

·         Headache

The symptoms high blood pressure cause can be as common as a simple headache. The headache caused by high blood pressure may be similar to tension headache or migraine. For people who have hypertension and experience headache, it is important to check the blood pressure at the time of headache. Blood pressures of equal to or more than 160/100 mmHg can cause headache. Urgent BP control is needed in these instances since uncontrolled blood pressure may lead to stroke (or cerebrovascular accidents).

·         Blurring of vision

Blurring of vision is also one of the symptoms of high blood pressure. High blood pressure can cause the small and fragile arteries of the eye to burst leading to blurring of vision. The blurring of vision may be acute or chronic. Documentation of the disease of the eye called hypertensive retinopathy can be done by ophthalmologists. Blood pressure control is still the most important preventive measure for this symptom of high blood pressure.

·         Nape pain

Nape pain or nape discomfort can also be one of the high blood pressure symptoms. Like headache, this is one of the high blood symptoms which are nonspecific. It tends to be taken for something else such as musculoskeletal spasm or strain. However, one clue that it is not musculoskeletal in nature is the fact that nape pain due to high blood is not preceded by any strenuous activity or exercise.

·        Chest pain

This is one of the more specific symptoms of high blood pressure and is also one of the most dangerous. Chest pain heralds angina, which is precipitated by exertion and relieved by rest. Chest pain may also be due to heart attack or myocardial infarction. Uncontrolled blood pressures accompanied by atherosclerosis or ischemic heart disease greatly increases the risk of heart attack. This is also the reason why blood pressure control is essential among patients who have had a heart attack. High blood pressure means more work for the heart and when there is a mismatch between the demand of the body and of the heart muscle (myocardium), heart attack ensues.

·         Difficulty of breathing

Dysfunction of the pumping capacity of the heart can occur due to greatly elevated blood pressures. Difficulty of breathing from high blood pressure can occur when the blood that should be pumped by the heart backflows into the lungs. When there is difficulty of breathing and/orchest pain occurring as high blood symptoms, immediate control of blood pressure should be done by using intravenous medications such as Nicardipine.

·         Focal weakness or loss of consciousness

Focal weakness or loss of consciousness due to high blood can occur. High blood pressure can cause rupture of arteries of the brain leading to stroke, which can manifest as weakness or decrease in sensorium. When a stroke occurs due to high blood pressure, rapid lowering of blood pressure is not advised because blood flow to the affected area of the brain has to be maintained. Neurologists are best equipped to manage strokes due to high blood pressure.

People with high blood pressure should not take their illness for granted because it has chronic debilitating consequences. If you have any of the aforementioned high blood pressure symptoms, do not hesitate to go to your doctor. Start blood pressure control early in order to ensure your well-being.

Treatment of Gastritis

Many adults come to my clinic complaining of gastritis. Gastritis most commonly manifests as abdominal pain, particularly in the epigastric area or the left upper quadrant of the abdomen. There are many causes of gastritis and these include food, drugs, and bacteria. Hence, the treatment of gastritis also involves the treating the causes of gastritis.

Gastritis treatment depends on the cause. Among the most common culprits are foods that increase the acidity of the stomach and relax the lower esophageal sphincter, thereby allowing the reflux of stomach contents and acids into the esophagus. These foods include the following:

• Coffee
• Soda
• Tea
• Milk
• Spices/Chili

If you think that any of these is causing your gastritis, you have to ensure that gastritis treatment and diet go hand in hand. To prevent your symptoms, you have to observe the gastritis treatment and diet. Treatment can involve oral or IV medications while diet involves avoidance of the said dietary culprits. Some people might not be able to avoid everything at once but gradually eliminating these from the diet is feasible.

Gastritis treatment drugs involve two major groups of medications. One group includes the major stomach acid-lowering drugs. These can be divided into the following:

• proton-pump inhibitors such as omeprazole, esomeprazole, pantoprazole and lansoprazole
• H2-blockers - such as ranitidine, famotidine
• antacids - such as Maalox

While proton pump inhibitors such as omeprazole are mong the most expensive gastritis treatment drugs, they are also the most effective. Usually, if there is no complicating infection, these drugs are given once a day for two weeks to decrease acid production while allowing the lining or the mucosa of the stomach to heal. 

Gastritis treatment antibiotics may be prescribed by a physician if there is suspicion or documentation of Helicobacter pylori infection. Helicobacter pylori or H. pylori is a bacterium that promotes ulcer formation in both the stomach and the duodenum. Complete eradication of this microorganism is necessary for ulcers to heal. Different gastritis antibiotic treatment combinations may be used. Gastritis treatment antibiotics include the following: Clarithromycin, Amoxicillin, and Metronidazole. The doctor decides which combination and which doses to prescribe. 

So can you treat gastritis at home? Definitely. A trial of proton-pump inhibitors (PPI) and gastritis diet can be done for 2 weeks to see if there is resolution of symptoms.  Patients who treat gastritis at home often succeed. However, when the symptom of abdominal pain is persistent and is accompanied by weight loss, dark-colored or bloody stools, and nausea or vomiting, it is important to go to a doctor for a formal consult. An endoscopy may be needed for more accurate diagnosis. If you have the aforementioned warning signs, do not hesitate to seek consult with your physician to find out what is the appropriate gastritis treatment for you.

Difficulty of Breathing and Chest Pain

Many patients go to the Emergency Room or Emergency Department (ER/ ED) with a chief complaint of difficulty breathing and chest pain. Among adults who have a history of hypertension or elevated blood pressure and diabetes mellitus (DM), the most common culprit for difficulty of breathing is not the lungs but the heart.

So how does one get difficulty of breathing and chest pain? Although the scientific terms and explanations or pathophysiology of the heart disease and difficulty of breathing is quite complex, it can be simplified as follows.

The heart is a muscular organ which is responsible for pushing blood to supply the various organs of the body. It pushes blood against the resistance of blood vessels, which is basically represented by blood pressure. Higher blood pressures, which can be due to clogged arteries from atherosclerosis or from elevated hormones (aldosterone, renin, angiotensin) leads to more strenuous work for the heart. To compensate, the heart hypertrophies. An analogy is a body builder who gets more muscular due to the hard work his muscles push against. 

Unfortunately, although the compensation is initially beneficial, it soon becomes detrimental. The heart's capacity to pump blood is also dependent on its ability to expand and fill with blood. When the heart hypetrophies, this ability becomes compromised and the cardiac output or the amount of blood it is able to supply to various organs decreases. Eventually, the heart cannot keep up with the body's demand and this leads to what we call "heart failure" and sometimes, "heart attack".

So how does heart failure and heart attack lead to difficulty of breathing? The lungs are connected to the heart via the pulmonary arteries and veins. The blood that goes into the heart is first oxygenated by the lungs. In a normal heart, the flow of this oxygenated blood is very efficient. Unfortunately, when the heart fails, this flow slows down and the blood from the lungs is stuck there. The lungs therefore become congested. The lungs, instead of containing air, become "wet" with blood. This is why heart failure is also called "congestive heart failure". In heart attack, the difficulty of breathing with chest pain can develop rapidly because the injured heart cannot keep up with the demand. The lungs basically "drown" in blood, hence, people who have heart failure also feel like they are drowning. This explains the association between difficulty breathing and chest pain. 

It is important to understand why heart disease can cause difficulty of breathing because many people who have heart disease ignore it until they develop the said symptom. As in any other illness, prevention is better than cure. When you become diagnosed with heart disease, be compliant with your medications. This is to ensure that your risk of developing difficulty of breathing is minimized and you maintain your functional capacity.