Pheochromocytoma Symptoms Diagnosis And Treatment

Pheochromocytoma is an important cause of secondary Hypertension. We have adnenal gland located at upper portion of each kidney. It is divided into adrenal cortex and adrenal medulla. Pheochromocytoma is a tumor of Adrenal Medulla. Normal function of adrenal medulla is to produce epinephrine or adrenaline. Which is responsible for controlling blood pressure and to help cope with stressful situations.
So majority of symptoms of pheochromocytoma are due to excess secretion of adrenaline from adrenal medulla. Most patients of pheochromocytoma have recurrent episodes of headache, sweating and a feeling of high anxiety. The following symptoms are listed from the most common to the least common
Headaches (severe)
sweating Episodes (generalized)
heart palpitations (tachycardia and palpitations)
Anxiety
nervousness (feelings of impending death)
tremors
Pain in the lower chest or upper abdomen
Nausea (with or without nausea)
Weight loss
Heat intolerance

These symptoms may come by situations which causes pressure over tumor like physical activity, exercise, defecation, anesthesia, or change in body position.

Who should be examined for Pheochromocytoma
Those who have uncontrolled hypertension
Those who have age between 40 and 60
Those who are already taking 4 antihypertensive drugs but blood pressure is not controllable.
Those who have episodes of above symptoms

Cause of pheochromocytoma is unknown, however some forms of this tumor runs in families like,
a-Multiple endocrine neoplasia, type II (MEN-II). In addition to a pheochromocytoma, people with MEN-II also have thyroid cancer. Other forms of MEN-II include pheochromocytoma with thyroid cancer and hyperparathyroidism (MEN-IIA), and pheochromocytoma with thyroid cancer and tumors of nerves in the eyes lips, mouth and digestive tract (MEN-IIB).
b-Neurofibromatosis 1 (NF1). Pheochromocytomas can occur in a small percentage of people with NF1, a syndrome that includes multiple tumors in the skin (neurofibromas), pigmented skin spots, tumors of the optic nerve of the eye, and bone diseases.
c-Von Hippel-Lindau (VHL) disease. People with this rare multi system disorder are at high risk of pheochromocytoma brain eye and kidney tumors.

Most pheochromocytomas are benign tumors and they don’t spread to other parts of body however some forms do show metastasis (spread) to other parts of body like lungs, bones and brains. Usually only one gland is involved however this tumor can be present in both adrenal glands.

Investigations:
Blood and Urine tests: We perform blood and urine tests to diagnose pheochromocytoma. 24 hr urine collection is tested for epinephrine, norepinephrine and dopamine. This test is called VMA. Idea is just to check level of epinephrine and its metabolites in urine. If these are detected in urine in excess quantity, then tumor is diagnosed.

Abdominal scan.
Now you have diagnosed tumor by blood and urine tests, after that to find out location of tumor, do Ultrasound, CT scan of abdomen.

Complications:
If high blood pressure remained uncontrolled it may lead to complications of heart failure, infarction, cerebrovascular accident, vision damage and kidney failure.

Treatment:
First treatment is to control high blood pressure with medication like Alpha Blockers and Beta Blockers. When epinephrine is secreted by this tumor it acts on alpha and beta receptors present on heart and blood vessels, result is vasoconstriction and increase heart rate. Now if if we take drugs like alpha blocker and beta blocker, epinephrine will be blocked by these drugs to act on these receptors so result is vasodilation and slow heart rate. Common Alpha blockers are Prazosin (Minipress), Terazosin (Hytrin) Phenoxybenzamine( Dibenzaline). Common Beta Blockers are Atenolol(Tenormin), Carvedilol(Carveda), Metoprolol(Mepressor), Inderal.

Treatment of choice for this tumor is Surgery. After removal of this gland by surgery, blood pressure becomes normal with a day. There are two types of surgeries. General and Laproscopic surgery. However Surgery is not an option for those tumors which show metastasis to other parts of body. For that we use chemotherapy and radiations.

Whenever you have high blood pressure with any symptom, don’t ignore it, you may be the patient of Pheochromocytoma. Always contact your Doctor.

Open Heart Surgery Recovery Is a Full-Time Job

You are now home from the hospital, and while the healing process is well underway, or you would not have been discharged, there are miles to go. There seem to be so many instructions to remember. You simply will not be up to much in the first few weeks, and in some cases, for several more. I won’t understate this. Yes, an upbeat approach by the hospital medical staff may have sent you waltzing home and it’s thrilling to be leaving the hospital, where you haven’t been permitted to sleep through the night. Yet you are returning home greatly fatigued, with a medications schedule to manage, possibly a tank of oxygen, and perhaps recurrent irregular heartbeats or other complications that remain unresolved. Now is the time to dedicate yourself to the hard work of recovery. Alternating rest and exercise, and above all patience with the physical and emotional trials ahead, is your assignment for the next several weeks.

You and your caregiver will mostly be on your own unless your particular situation requires a treatment plan that includes post-op visits from a home health care nurse. Even if that’s the case, now is the time to review any guidelines your hospital medical team has given you about what to be aware of.

If you have purchased the paperback or downloaded the e-book version of The Open Heart Companion: Preparation and Guidance for Open-Heart Surgery Recovery, it’s time to reread Chapter 5, “The Challenges You May Face.” This chapter provides detailed information not only on challenges that may arise in your recovery, but it also supplies solutions as well. For example, on the subject of feeling isolated: “This is the time to find other open-heart surgery survivors and their caregivers to talk to. Swap stories, share information, hear what other families have gone through. Just knowing that you are not alone as you go through your rehabilitation can lift the veil of isolation. There can be a tendency to hold one’s surgery and recovery experiences too privately, but not reaching out to others will only deprive you of receiving compassionate support. If you are feeling isolated, do yourself a favor: reach out to friends and family, and look for a heart surgery support group locally or online.” However, whenever in doubt about what you may be experiencing specifically, contact your designated medical liaison for professional diagnosis or medical attention. No question or concern is too trivial.

For most of us, there is a difficult recovery challenge from the time we leave the hospital until we are healed and strong enough to enroll in a local rehab program. That’s one of the reasons for my book, to bridge this gap as so little medical attention is focused on the recuperation period that lasts anywhere from four to eight weeks. We thought getting through surgery was the biggest hurdle. However, the hurdle is greater when we are home on our own with not much progress to report fast enough — and without all those experts in the hospital to lean on.

Every recovery is different. If you’ve been told to expect improvement “two days forward, one day back,” you might be disappointed to experience instead only one good day (a period of energetic spunk) followed by two, three, or even four days of just plain feeling lousy. Even to meet the assignment of increasing your walking time from five minutes to ten minutes a day may feel like an insurmountable task at first. You may also be swinging in and out of temporary depression. (In my case, I wished the discharge nursing staff had emphasized the psychological challenges of recovery, not just the physical stresses.) Or, you may feel “off,” and think you might be coming down with a virus. That might be the case, but feeling off can be due to other things as well: you may have become anemic (as I did); you may be having an allergic reaction; sleep deprivation may have caught up with you—there are many possibilities. Know that everyone goes through discouragement, yet those who are informed to expect ups and downs will fare far better.

Recovery after surgery takes time. There’s often a feeling of “being all alone.” Because I, and dozens of patients and caregivers who were interviewed for The Open Heart Companion, have gone through open-heart surgery recovery ourselves, I offer the help you need via a free monthly phone support group, a newsletter specifically on recovery, a highly informational paperback (also available as an e-book), and general practical tips.

New Technology Brings Improved Diagnosis of Heart Disease

Heart disease is the leading killer of Americans. According to the American Heart Association, more than 13 million Americans are affected and, when diagnosing heart disease, using the best medical imaging technology available is crucial.

Until recently, diagnosing heart disease was difficult without a costly and invasive surgical procedure, especially for patients with little or no history of a heart condition.

But now, new medical imaging technology has vastly improved the area of computed tomography or CT scanning, which renders 3-D images of internal parts of the body, including the heart, brain and other organs, to make noninvasive diagnoses of heart disease and even stroke faster and more accurate.

As with most medical imaging procedures, image quality is key. If the scanned image does not clearly represent all the minute details, the diagnosis may not be as accurate. And today’s latest CT technology allows doctors to not only see things they’ve never seen before, meaning patients are getting the most accurate diagnosis possible, but also conduct faster exams on critically ill patients who might find it difficult to remain still for long periods of time.

For instance, the new Toshiba Aquilion 32 CFX multislice CT system is currently the industry’s finest resolution scanner available for cardiovascular imaging, producing 32 slices of detailed images as thin as .5 millimeters.

Using this new equipment, a detailed three-dimensional image is produced to allow doctors to see the heart from virtually any angle, which results in greater confidence in diagnosing heart diseases and abnormalities.

Inevitably, better diagnosis leads to better treatment. As we become more aware of the dangers of heart disease, we should also be aware of the medical technology available to our doctors. If you have the option of seeing a doctor with access to the latest medical imaging technology versus another doctor with access to dated technology, which one would you prefer?

You can be a better-informed patient. Ask your doctor about the quality of the imaging equipment on which you will be scanned.

New Guidelines For High Blood Pressure Treatment

Today, high blood pressure treatment emphasizes lifestyle as much as medicine. Approaches to lowering blood pressure may also involve using alternative medicines to supplement traditional medication.

In other words, sole reliance on drugs is now being replaced by more comprehensive methods of disease management.

One of the centerpieces of this approach is replacing a sedentary lifestyle with a more active one. Physical activity is very helpful in reducing hypertension.

Increasing levels of physical fitness has many benefits including bringing blood pressure closer to normal levels. Of course, taking up an exercise regimen should be done under medical supervision, particularly if the patient has been leading a sedentary lifestyle.

Exercise also cuts down on excess weight, which is another factor that pushes up blood pressure above normal levels. There is a strong correlation between obesity and hypertension and the latter can often be controlled by taking care of the former.

Stress is a big factor in most people’s lives these days. And stress can contribute significantly to hypertension. Therefore contemporary treatment for hypertension includes making patients aware of the factors that contribute to stress levels.

They are also taught to manage these stress factors better. That includes managing the stress-causing situations better as well as managing the patients’ internal reactions to the stress. The latter can include, among other things, yoga, meditation and relaxation exercises.

Many stressors cannot be eliminated, but may be successfully reduced. Both work and home related stress needs to be managed to help control high blood pressure.

A healthy diet is, of course, essential for hypertensive patients. They are advised to avoid excessive intake of dairy products and salt. Blood pressure can be controlled much more easily when diet is managed well.

Alcohol consumption needs to be moderated or eliminated. Now, there is some evidence that alcohol in small quantities can actually be beneficial to the body. However, continued excess consumption of alcohol puts considerable strain on many organs of the body including the heart. Part of the problem arises from the sheer bulk of alcohol, particularly if beer is consumed.

Foods like garlic and onions as well as some herbs have been found to contribute to lower blood pressure. Herbs that contain an amino acid called L-arginine are said to be useful for this purpose. Utilizing alternate medicine should be done only under adequate supervision.

There are also newer drugs to control high blood pressure, including calcium channel blockers. Some of these drugs effectively counteract side effects caused by medication.

High blood pressure treatment has evolved into a well-rounded approach that relies on more than just medication to handle the condition.

Natural Therapy for Maintaining Healthy Blood Pressure Part 3

While there are many common pharmaceutical treatments for high blood pressure including beta blockers and A.C.E. inhibitors there are some very effective alternatives including pomegranate juice, passion flower and physical exercise.

There is evidence that pomegranate juice offers protection against cardiovascular disease. While pomegranates (punica granatum) have been around for thousands of years, not much research had been done until recently. Most of the research was first conducted in Israel and has been ongoing. One of the first studies to gain attention showed that pomegranate juice had potent antiatherogenic (biologically active substance that prevents atherogenesis, the accumulation of lipid containing plaques on the innermost layers of the arteries) effects in healthy humans and in atherosclerotic mice that may be attributable to its anti oxidative properties. A few months later, the results of a study conducted at the University of California showed an antioxidant activity three times higher than those of red wine and green tea.

Then, another study in Israel showed that pomegranate juice reduced the development of atherosclerosis in mice that already had advanced atherosclerosis. The next month , results of another study showed a 36% decrease in serum ACE activity and a 5% reduction in systolic blood pressure in patients who drank pomegranate juice. The study concluded that pomegranate juice can offer a wide protection against cardiovascular diseases which could be related to its inhibitory effect on oxidative stress and on serum ACE activity.

In the past 5 years, 150+ more studies and publications involving the pomegranate have been indexed at U.S. National Library of Medicine’s PubMed database, with findings that suggest many healthy benefits of this fruit. Probably the most significant is in the reduction of cardiovascular disease.

Another exciting study in March, 2005 tested the effects of pomegranate juice on samples of cultured human coronary artery cells exposed to extreme stress in vitro (as they would be in someone with high blood pressure), and also on hypercholesterolemic mice. The study showed that administration of pomegranate juice significantly reduced the progression of atherosclerosis, and that the proatherogenic effects induced by perturbed shear stress can be reversed by chronic administration of pomegranate juice. Implications of this is that chronic administration of pomegranate juice may be effective in both prevention and treatment of atherosclerosis.

The results of another 3-year study suggest that pomegranate juice decreases carotid intima-media thickness and systolic blood pressure in patients with carotid artery stenosis.

In the most recent article about pomegranates, posted at PubMed on January 17, 2007, the authors stated, “The last 7 years have seen over seven times as many publications indexed by Medline dealing with pomegranate and Punica granatum than in all the years preceding them.” They noted that the seed, juice, peel, leaf, flower, bark and roots each have pharmacologic activity. They concluded that “the phytochemistry and pharmacological actions of all Punica granatum components suggest a wide range of clinical applications for the treatment and prevention of cancer, as well as other diseases where chronic inflammation is believed to play an essential etiologic role.”

Passion Flower has also shows promise of lowering high blood produce by regulating nervous system neurotransmitters that reduce anxiety. (Passiflora incarnata) is accepted for medicinal use in Germany, France, and other European countries for the treatment of nervous anxiety, and was at one time approved as a sedative and sleep aid over-the-counter drug in the U.S. After a review of night-time sleep aids by the FDA in 1978, it was no longer recognized as effective by the FDA since no American company submitted data on safety and efficacy as required by the FDA, so it was dropped as an over-the-counter drug.

Although passion flower is a native American plant, it has been more widely researched and used in Europe than in the United States. In Germany, France, and other European countries, it is accepted for the treatment of nervous anxiety. Standardized passion flower products contain flavonoids as the primary chemical marker. While flavonoids are generally considered among the most active components of the plant, scientists have not been able to pinpoint the single chemical compound or group of compounds responsible for its sedative action.

Passion flower increases levels of a neurotransmitter known as gamma-amino butyric acid (GABA), which decreases the activity of nerve cells in the brain, causing relaxation and relieving anxiety. It contains chemicals known as harmala alkaloids, which are thought to block an enzyme involved in depression.

A pilot randomized controlled trial comparing the efficacy of Passiflora extract to the drug Oxazepam in the treatment of Generalized Anxiety Disorder (GAD) showed that Passiflora extract is effective for the management of GAD, with no significant difference between the efficacy of it and Oxazepam. An advantage seen with the Passiflora extract was that fewer problems relating to impairment of job performance were encountered.

Everyone experiences anxiety. It is the body’s normal reaction to uncertainty, trouble, feeling unprepared, or a perceived, anticipated or imagined danger or threatening situation. Normal anxiety can be a good thing. It helps motivate a person who works well under pressure, resulting in an increase in productivity. But when anxiety and worry are exaggerated without cause, it is a sign of anxiety disorder such as GAD.

People with GAD, like those participating in the trial above, experience pathological anxiety, which is excessive, chronic, and typically interferes with their ability to function in normal daily activities, and is not triggered by any specific object or situation. Passion Flower appears to be helpful in relieving stress not only in individuals with normal anxiety, but in those with GAD as well.

Although there are many available blood pressure medications and natural therapy (such as Melaleuca’s Prostolic) are both helpful in reducing and maintaining healthy blood pressure, your body’s best defense against high blood pressure and the risk of cardiovascular disease begins with a change in lifestyle. The time to change is now, no matter what your age is.

Begin by eating a healthy diet of fresh fruits and vegetables, low-fat dairy products, whole grains, and other heart healthy foods. Lower your salt intake, and avoid processed foods that destroy potassium and generally have high levels of salt added that further robs your body of this vital nutrient. Get plenty of exercise, limit alcohol intake and don’t smoke.

Your blood pressure rises as your weight increases, but losing just 10 percent of your body weight over a period of six months can lower your blood pressure and reduce your risk of developing diabetes, which are two major risk factors for heart disease. Those who are overweight and already have hypertension will see the greatest effect of a 10-lb. weight loss.

A February, 2006 Scientific Statement from the American Heart Association:

“In view of the continuing epidemic of BP-related diseases and the increasing prevalence of hypertension, efforts to reduce BP in both non hypertensive and hypertensive individuals are warranted. In non hypertensive individuals, dietary changes can lower BP and prevent hypertension. In uncomplicated stage I hypertension (systolic BP of 140 to 159 mm Hg or diastolic BP of 90 to 99 mm Hg), dietary changes serve as initial treatment before drug therapy. In those hypertensive patients already on drug therapy, lifestyle modifications, particularly a reduced salt intake, can further lower BP. The current challenge to health care providers, researchers, government officials, and the general public is developing and implementing effective clinical and public health strategies that lead to sustained dietary changes among individuals and more broadly among whole populations.”

Natural Therapy for Maintaining Healthy Blood Pressure Part 2

One of the more common treatments for high blood pressure are ACE inhibitors. When your kidneys detect low blood pressure, they release an enzyme called renin, which stimulates the formation of a protein called angiotensin I. Angiotensin I is then converted by the angiotensin-converting enzyme (ACE) in the lungs to a very potent chemical called angiotensin II. Angiotensin II is a powerful blood vessel constrictor that causes muscles surrounding the blood vessels to contract, resulting in narrowing of the blood vessels. This narrowing of the vessels increases pressure in the vessels and can result in high blood pressure.

The ACE Inhibitors block the action of the angiotensin-converting enzyme in the lungs so that angiotensin I is not converted into angiotensin II. This allows blood vessels to remain widened, which results in lowering of the blood pressure. ARBs block the action of angiotensin II itself, so that vessels dilate, making it easier for the heart to pump blood, and results in lower blood pressure .

The natural bioactive casein hydrolysate tripeptides in Melaleuca’s ProStolic™ act as a natural blocker to the formation of angiotensin II. Also included in this proprietary blend is pomegranate juice powder, which inhibits activity of the angiotensin-converting enzyme as well. A third ingredient is passionflower extract. Although researchers don’t know exactly how passionflower works, they believe that flavonoid and alkaloid compounds in the plant regulate the neurotransmitters in your nervous system that reduce anxiety. One of these flavonoids in particular, chrysin, helps to calm your central nervous system and lower your blood pressure.

Combined with the proprietary blend of tripeptides, pomegranate juice powder and passion flower extract, ProStolic™ also contains potassium and calcium to provide a well-rounded natural remedy to help promote healthy blood flow and naturally maintain healthy blood pressure, but without the side effects so common with medications.

Tripeptides are formed when milk casein is broken down into smaller pieces. Several different peptides have been studied, but a significant amount of research has determined that the tripeptides Isoleucine-Proline-Proline (IPP) and Valine-Proline-Proline (VPP) have the most supportive evidence for their efficacy, safety and bioavailability The natural bioactive hydrolyzed casein (a combination of tripeptides IPP and VPP) is an active ingredient included in the proprietary blend in Melaleuca’s ProStolic™. These tripeptides are derived from nonfat milk casein, and have been clinically proven to help maintain healthy blood pressure. Most studies show that blood pressure is lower after 2 weeks of daily consumption of IPP and VPP, and reach a stable level after 4-6 weeks.

Like the mechanism of action of the commonly prescribed ACE Inhibitors, the natural action of tripeptides block the formation of Angiotensin II, which normally causes the blood vessels to narrow. But that’s where the similarity ends. Studies show that IPP and VPP tripeptides accomplish the blockage of Angiotensin II without the side effects so common in ACE and ARB medications. In 2001, an 8-week placebo-controlled, double-blind study was conducted on 30 people with mild or moderate hypertension. Results of the study showed a significant decrease in blood pressure of IPP and VPP test subjects, but no change was seen in the placebo group. In addition, no adverse reactions such as dry cough, digestive tract symptoms or abnormal changes were observed.

Over 20 human clinical trials have been conducted with the IPP and VPP peptides over the past 10 years and more than 10 double-blind clinical studies have been conducted on the particular formulation of tripeptides used in Melaleuca’s proprietary blend. A 1996 placebo-controlled study on the blood pressure of 30 elderly hypertensive patients, most of whom were taking antihypertensive medication, showed a significant decrease in both systolic and diastolic blood pressure after 4 and 8 weeks, but no significant changes were observed in the placebo group.

A British Journal of Nutrition article reported a single blinded, placebo controlled study of 131 people with high-normal blood pressure or mild hypertension to determine the efficacy of hydrolyzed casein containing IPP and VPP in reducing blood pressure. The authors concluded that these peptides could assist in the prevention of hypertension in people with blood pressure that is above normal.

Melaleuca’s Prostolic also contains other natural hypertension treatments including pomegranate juice, passion flower, potassium and calcium. All the benefits of these natural ingredients will be discussed in Natural Therapy for Maintaining Healthy Blood Pressure Part 3.

Mitral Valve Prolapse (MVP) – A Heart Condition

Mitral Valve allows blood to flow in one direction from the atrium (upper chamber) to the ventricle (lower chamber). It is one of the four valves separating different chambers of the heart. Mitral valve causes problem if it doesn’t open and close as per its functionality.

It causes blood to leak backwards into the upper chamber of the heart, leading to a ‘heart murmur’. This is called as Mitral Valve Prolapse. The functioning of your heart is normal at this point of time. This does not worsen over a period of time, but is one of the main reasons for cardiac problems.

Mitral valve prolapse is very common among women although men are targeted too. It can strike in early adulthood. It is considered to be a hereditary problem. Mitral Valve Prolapse syndrome is also called as dysautonomia.

One of the main reasons which cause an increase in mitral valve prolapse syndrome is stress. The cause of stress can be due to childbirth, drastic events, and life turning experiences and day to day stress in life. Nearly 60% of the patients with MVP do not show symptoms. The other 40% does show some sign, which you should be aware of.

Some Signs and Symptoms of Mitral Valve Prolapse Syndrome

-Irregular Heartbeat
-Fatigue
-Chest Pain
-Racing Heart
-Dizziness
-Headaches
-Shortness of Breath
-Palpitation
-Anxiety

Causes of Mitral Valve Prolapse Syndrome

-Hereditary
-Stress
-Caffeine
-Stimulants
-Sweets
-Alcohol
-Smoking
-Menopause
-Skipping Meals
-Dehydration

Measures to be taken

Complications in this condition are very less. Attributable to the fact, that it does not affect much of your health. But people who suffer from this condition have to take extreme care. You may have to cut down on your physical activity, have a surgery and may be put you on medications – beta blockers.

You may have to follow a strict diet routine. Do not have any stimulants in your diet like coffee, tea, colas and even chocolates. Intake of sugar should come down. Have high-protein snack for afternoons. Drink as much water as you want. Fresh fruit juice is also good.

Regular exercise is good to maintain good health. Do not exert yourself. You should consult your doctor before doing any physical activity. Being aware about your condition would help you from any bacterial infection from any kind of surgery. Inform your doctors in advance about your condition, to avoid complication.

Home Care

Cinnamon helps in reducing high cholesterol and triglycerides. These can be used in your daily diet.

Flax seed oil contributes with good amounts of omega 3 fatty acids. This helps your cardiovascular system by reducing bad cholesterol including lowering blood pressure.

Hawthorn Berries helps with a clean and clear cardiovascular system. It is very good for your heart.

Malignant Hypertension Causes Symptoms And Treatment

Malignant Hypertension and accelerated high blood pressure are two emergency conditions which should be treated promptly. Both conditions have same outcome and therapy. However Malignant hypertension is a complication of high blood pressure characterized by very elevated high blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. (Edema of optic disc of eye) Systolic and diastolic blood pressures are usually greater than 240 and 120, respectively. While Accelerated high blood pressure is condition with high blood pressure, target organ damage, on fundoscopy we have flame shaped hemorrhages, or soft exudates, but without papilledema.

There are two things. Hypertensive Urgency and Hypertensive emergency. In hypertensive urgency we don’t see any target organ damage while in emergency we see target organ damage along with high blood pressure greater than systolic >220. Now depending upon target organ damage you will decide whether you have hypertensive emergency or urgency. It is essential to bring down high blood pressure in hypertensive emergency immediately, while in urgency, bring down blood pressure very rapidly is not required.

Pathogenesis of malignant hypertension is fibrinoid necrosis of arterioles and small arteries. Red blood cells are damaged as they flow through vessels obstructed by fibrin deposition, resulting in microangiopathic hemolytic anemia. Another pathologic process is the dilatation of cerebral arteries resulting in increased blood flow to brain which leads to clinical manifestations of hypertensive encephalopathy. Common age is above 40 years and it is more frequent in man rather than women. Black people are at higher risk of developing hypertensive emergencies than the general population.

Target organs are mainly Kidney, CNS and Heart. So symptoms of Malignant hypertension are oligurea, Headache, vomiting, nausea, chest pain, breathlessness, paralysis, blurred vision. Most commonly heart and CNS are involved in malignant hypertension. The pathogenesis is not fully understood. Up to 1% of patients with essential hypertension develop malignant hypertension, and the reason some patients develop malignant hypertension while others do not is unknown. Other causes include any form of secondary hypertension; use of cocaine, MAOIs, or oral contraceptives; , beta-blockers, or alpha-stimulants. Renal artery stenosis, withdrawal of alcohol, pheochromocytoma {most pheochromocytomas can be localized using CT scan of the adrenals}, aortic coarctation, complications of pregnancy and hyperaldosteronism are secondary causes of hypertension. Main Investigations to access target organ damage are complete renal profile, BSR, Chest Xray, ECG, Echocardiography, CBC, Thyroid function tests.

Management:
Patient is admitted in Intensive Care Unit. An intravenous line is taken for fluids and medications. The initial goal of therapy is to reduce the mean arterial pressure by approximately 25% over the first 24-48 hours. However Hypertensive urgencies do not mandate admission to a hospital. The goal of therapy is to reduce blood pressure within 24 hours, which can be achieved as an outpatient department. Initially, patients treated for malignant hypertension are instructed to fast untill stable. Once stable, all patients with malignant hypertension should take low salt diet, and should focus on weight lowering diet. Activity is limited to bed rest until the patient is stable. Patients should be able to resume normal activity as outpatients once their blood pressure has been controlled.

Hospitalization is essential until the severe high blood pressure is under control. Medications delivered through an IV line, such as nitroglycerin, nitroprusside, or others, may reduce your blood pressure. An alternative for patients with renal insufficiency is IV fenoldopam. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Also available parenterally are enalapril, diltiazem, verapamil, Hydralazine is reserved for use in pregnant patients as it also increases uterine profusion, while phentolamine is the drug of choice for a pheochromocytoma crisis. After the severe high blood pressure is brought under control, regular anti-hypertensive medications taken by mouth can control your blood pressure. The medication may need to be adjusted occasionally.

Remember, It is very necessary to control malignant hypertension, otherwise it can lead to life threatening conditions like Heart Failure, Infarction, Kidney failure and even blindness.

Low Blood Pressure Symptoms

When the pressure of the blood that is exerted against the walls of the blood vessels after and during every heart beat is lower than normal, you have low blood pressure. This can result in insufficient blood flow to the important body organs like the heart and the brain. And this can lead to various low blood pressure symptoms.

You may detect low blood pressure symptoms during the use of various drugs such as those used for surgery, anti-anxiety agents, treatment for high blood pressure, diuretics, heart medicines, antidepressants, narcotics, alcohol, and other types of drugs. You may notice the low blood pressure symptoms also because of dehydration, heart failure, or heart attack, anaphylaxis, shock, diabetes (especially in advanced stage), etc.

The most common low blood pressure symptoms are dizziness and lightheartedness. But there are other low blood pressure symptoms, and they are: a tendency to faint, black or maroon stools, chest pain, wheezing, irregular heart beat, consistent high fever, head ache, back pain, or stiff neck. If you happen to spot any of the low blood pressure symptoms, it is recommended that you consult a doctor as soon as possible.

Because of low blood pressure not enough blood reaches to all parts of the body and thus the cells do not receive the correct amount of oxygen and nutrients. Therefore, the waste products in the blood are not removed.

Don’t overlook the risk of low blood pressure if you cough with phlegm or if you are suffering from prolonged diarrhea, or if you are unable to eat or drink, or if you experience burning urinary symptoms or even if you are taking new medicines, because all these are low blood pressure symptoms.

When you start experiencing low blood pressure symptoms remember that the brain is the first organ to malfunction in such situations because it’s located at the top of the body and as a result you will experience dizziness or even fainting. You should be aware that if you don’t treat low blood pressure seriously it might lead to brain damage.

When you have low blood pressure, blood is not adequately supplied to the heart muscles and therefore breathlessness and chest tightness forms one of the common low blood pressure symptoms. When you have prolonged low blood pressure all organs start malfunctioning and this leads to shock.

You must take precautionary measures to avoid the situation from getting worse when you have low blood pressure and you must take your doctor’s advice. You must try to be more physically active and must try to lose weight. You should also maintain a healthy diet and limit your alcohol intake. All these will help you to keep your low blood pressure symptoms under control.

In spite of all the harmful aspects of low blood pressure, researchers say that it is better than high blood pressure because people experiencing low blood pressure symptoms tend to live longer than people suffering from high blood pressure symptoms do.

If you suspect you are suffering with low blood pressure you should consult your primary care physician straight away.

Living with Congestive Heart Failure

Congestive Heart Failure (CHF) is a condition in which the heart does not pump the blood through the body properly. When the blood is not properly pumped throughout the body, the oxygen that the blood carries is not appropriately dispersed to the muscles and other places that require oxygen. At this time in medical technology, Congestive Heart Failure is not curable. However there are medical treatments for the condition and adhering to these treatments helps patients with CHF to live as comfortably and as normally as possible. There are ways to cope with CHF.

First, when a patient is diagnosed with CHF, he or she needs to find a heart specialist that he or she goes to regularly. The patient also needs a regular practitioner to be able to keep on top of prescriptions and other things. Certain medications will be prescribed and one of the best things that a CHF patient can do is to take medications on time regularly and in the correct amounts. Another thing that will help your doctor determine the right combination of medications for you is to record when you take your medications and how you feel after taking your medications. If a certain medicine is causing side affects, your doctor might possibly be able to prescribe a substitute for that particular medication.

Another important aspect of keeping a relatively healthy and comfortable lifestyle is diet. Most patients are placed on a restrictive diet. Many are required to eat heart-healthy low-fat, low-sodium diet. In most cases, 2 g of sodium is the daily limit. Excessive sodium in a diet may cause water retention, making it difficult to breathe. Since CHF already causes problems with water retention, it is helpful to retain as little water with diet as possible. Another thing that causes water retention is drinking excessive liquids. This is another thing the doctor may limit.

Besides medicine and adjusted diet, exercise is a way to cope with Congestive Heart Failure. Many people with CHF think that physical activity will harm them. However, though strenuous activity is not be appropriate, light to moderate activity can be healthy when done carefully.

Another way to cope and live comfortably with Congestive Heart Failure is to make sure you reduce stress as much as possible. Stress has a very negative effect on your heart and as a result, has a negative effect on the functions of your body. Any worry or burden that your family, friends, or caregivers can take from your shoulders is a positive action toward relieving your stress.

Obviously health risks such as smoking should be ceased. The use of nicotine uses up precious available oxygen in the system and therefore should be stopped to allow as much oxygen as possible to exist in the body.

One last thing to remember is to watch physical symptoms. Always record how you feel and make sure you tell your doctor of the slightest change in the way you feel. Listen to the signs your body is giving you in order to stay on top of your condition. Remember, CHF is a condition that can be coped with and treated, but you must alter your lifestyle to get the best quality out of your life.