Atherosclerosis

Atherosclerosis

Atherosclerosis is a disorder in which arterial wall stiffens and loses its elasticity caused by the formation of thickening (atherosclerotic plaque) in its inner layers, which can reduce or obstruct blood flow. Although it is more common in the male population, its prevalence increases in women after the menopause and equalizes with the prevalence of the men of the same age.

Atherosclerosis affects heart, brain, kidneys and other vital organs and extremities and thus represents the leading cause of illness and mortality in the US and most Western countries. Mortality due to coronary heart disease among white males between the age of 55 and 65 is 1 in 100.

How does it happen?

An atherosclerotic plaque is forming after the large amount of “bad cholesterol” LDL-c accumulates in arteries where they get oxidized, causing inflammation. In order to defend itself, the organism sends macrophages, a form of white blood cells to capture the cholesterol.

They transform the oxidized cholesterol into large foam cells which cause even more inflammation. As a consequence of that, arterial smooth muscle cells activate, migrate and proliferate forming a “cap” above the inflamed area.

This doesn’t represent good protection because lipid part beneath can be dangerous if it gets torn out, potentially causing a heart attack or stroke. Over time the organism forms a thick layer thus narrowing the space for blood flow even more.

Signs and symptoms

Since the atherosclerosis is a slowly developing disorder, at first it shows no symptoms that will warn you about it. The first symptoms are seen when the artery gets obstructed. Signs and symptoms depend on the body part where an arterial obstruction occurred.

Atherosclerosis in heart arteries will be expressed via chest pain, feeling a pressure or discomfort (angina) which may progress into arms, legs or neck.

Atherosclerosis in brain arteries can cause difficulty speaking, blurred vision, loss of coordination or balance, numbness, weakness or paralysis in one side of the face, arm or leg, etc (TIA signs and symptoms).

Atherosclerosis in leg arteries will manifest itself in leg pain, difficulty walking or intermittent claudication.

Atherosclerosis in kidney arteries can cause hypertension or kidney failure.

Some of the most dangerous consequences of atherosclerosis are a heart attack and stroke as it could cause both these health emergencies.

Atherosclerosis - risk factors

Risk factors for atherosclerosis

There are some risk factors for atherosclerosis on which we can’t influence such as family history, genetic abnormalities, advanced age, and male gender but many other risk factors are modifiable. You can find some of them in the text below.

Unhealthy diet – It is known that nutrition rich in saturated animal fats and carbohydrates is correlated to atherosclerosis development. Moreover, people who have a diet poor with vitamins, minerals, amino acids, and essential fatty acids have an even larger chance of atherosclerosis.

Obesity – Obesity is associated with high cholesterol levels, hypertension, diabetes, poor physical activity which all may potentially lead to various cardiovascular diseases, as well as atherosclerosis.

Lack of physical activity – People who are physically inactive have a greater chance to develop atherosclerosis.

DyslipidemiaHigh concentrations of LDL-c and low concentrations of “good cholesterol” HDL-c favors atherosclerosis.

Diabetes – Diabetes can cause many metabolic disorders which can affect change on arteries which supply different organs.

Hypertension – High blood pressure increases atherosclerotic changes significantly.

Smoking – Nicotine from tobacco smoke cause constriction of blood vessels increasing the atherosclerotic changes.

Atherosclerosis - prevention

Prevention

Primary prevention involves fighting risk factors in people who have no expressed symptoms and signs. First of all, it is necessary to carry out proper nutrition, reduce body weight and exercise adequately.

If the patient’s health condition is good but he/she has elevated cholesterol or triglycerides in the blood, stated preventive measures are recommended for 3 – 6 months. There is evidence that people with these conditions may benefit from Omega 3 unsaturated fatty acids.

Pharmacological treatment

If primary prevention does not help the usage of medications is needed. Here are some of the most used drug classes.

First line drugs are statins, lipid-lowering medications which can stop, reduce, or even reverse the atherosclerotic plaque (other lipid-lowering medications may be used). Likewise, a good antiplatelet drug that may prevent thrombotic complications of atherosclerosis is aspirin (100 mg) or some other medication from this class. Various other cardiovascular medication such as beta blockers, calcium channel blockers, ACE inhibitors or diuretics may also be introduced into therapy. Furthermore, control and treatment of hypertension and diabetes are part of the recommendations for the prevention of cardiovascular diseases.

Epistaxis (Nosebleed)

Epistaxis – epidemiology

Epistaxis represents bleeding from a nose, and it is fairly common phenomena which can occur at any age, but it is most common in young children (2 – 10 years) and elderly population as opposed to older children and adults. Moreover, epistaxis is very rare in very young children (< 2 years) where it is often caused by serious illness or trauma. Approximately more than 50% of all people will experience epistaxis at some point in their life. A nosebleed can be quite dramatic and abundant, but it is rarely life-threatening or deadly because around 10% of these nosebleeds are seen as serious conditions.

Classification and causes of epistaxis

Nosebleeds can be induced by various causes, and depending on them epistaxis can be divided into two categories – Anterior bleeding (frontal and the most common bleeding) and Posterior bleeding (less common, but more serious, back bleeding). Some of the main causes of both epistaxis types are listed below.

Anterior epistaxis causes

nose-picking – especially if it’s done with nails, and aggressively

nasal congestion – a blockage of the nasal passages, often due to cold or flu

nose lesion – small wound inside the nose

foreign body – epistaxis can occur after the elimination of the foreign body from the nose

nose-blowing – if it’s done aggressively

anatomical disorders – deviation of the nasal septum (the wall between the left and right nostrils) or sensitive nasal blood vessels

dry air – dry air or high temperatures that can affect the nasal mucous membrane

sinusitis – inflammation of the cavities around the nasal passage

allergic / nonallergic rhinitis – irritation or inflammation of nasal mucous membrane caused by allergens or other agents

overuse of nasal decongestants – rebound phenomenon of nasal sprays can cause a epistaxis

Epistaxis (nosebleed)

Posterior epistaxis causes

severe nasal injuries – such as a nasal fracture (broken nose) or surgeries done on the nose

anticoagulants (blood thinners) – drugs used to prevent blood clotting (coagulation) whose main side effect is bleeding as they decrease the blood clotting ability

antiplatelet drugsdrugs used to prevent arterial thrombosis, by inhibiting the platelet plug formation, which may induce bleeding

thrombolyticsclot-busting agents that may also lead to bleeding

coagulopathy – a disorder in a blood clotting ability such as Von Willebrand’s disease or hemophilia

malignant or benign tumor – in thenasal cavity

atherosclerosis – narrowing of the artery caused by a plaque

hypertensionalthough it is not a direct cause of epistaxis, people with high blood pressure can experience heavy nosebleeds that can be hard to stop

Signs and symptoms

The signs and symptoms of the people with epistaxis depend on bleeding intensity. A person will have visible signs of bleeding from the nose which can sometimes pass to the mouth. If the bleeding is severe, prominent paleness can be observed as well as accelerated pulse. The individual can be upset which can sometimes seem like a panic because of the dramatic effect caused by sudden bleeding.

First aid

A patient with epistaxis can take some steps that will ease the bleeding or stop it before coming to the doctor. One of the most important things to do is to stay focused and not panic. It is necessary to wash your face with cold water, pressing the soft part of your nose firmly for about 10 – 15minutes. Sitting upright while leaning your head forward can reduce the blood pressure in the nasal blood vessels. Moreover, it is advised to place an ice pack in a towel on the bridge of the nose to narrow the blood vessels. Don’t bend your head backward because blood from the nose will pass through your throat and you will swallow it. If the bleeding is serious and lasts long, and/or you have trouble breathing, call a doctor immediately.

Hypertension in pregnancy

Epidemiology of hypertension in pregnancy

Hypertension in pregnancy is the most common health disorder found in pregnant women, present in approximately 10% of this population. Nearly 8 – 13% of pregnant women in the United States are affected by this condition, and the prevalence is increasing in developing countries. Hypertension in pregnancy represents a major problem as it is one of the 3 main causes of death in pregnant women. About 50% of pregnant women with this condition develop hypertension in late pregnancy, especially last month.

Classification

Hypertensive disorders during pregnancy are divided into 4 categories including chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed on chronic hypertension, and gestational hypertension.

Chronic hypertension

Chronic hypertension is a blood pressure of 140 / 90 mm Hg or above for both systolic or diastolic, or one of those values separately, present before pregnancy or manifested before the 20th week of pregnancy. It is lasting more than 12 weeks after giving birth.

Preeclampsia and eclampsia

Preeclapmsia is a syndrome that occurs in pregnancy which is besides hypertension, characterized by increased concentration of proteins in urine (proteinuria). These disorders may affect the development and growth of the fetus. Some signs and symptoms of preeclampsia include swelling (edemas) which may cause upper abdominal pain if they occur in the liver; severe headaches, and visual disturbances.

Eclampsia represents the complication of preeclampsia, where a pregnant woman with preeclampsia develops epileptic-like seizures, caused by cerebral edemas.

hypertension in pregnancy

Preeclampsia superimposed on chronic hypertension

This condition occurs in pregnant women who were previously diagnosed with hypertension and it’s characterized by worsening of hypertension after the 20th week of pregnancy accompanied by proteinuria.

Gestational hypertension

Gestational hypertension is a type of hypertension that occurs in pregnant women after the 20th week of pregnancy in women who didn’t have hypertension before. This condition often draws back after 12 weeks after the delivery. Gestational hypertension isn’t accompanied by proteinuria.

Treatment of hypertension in pregnancy

Treatment of hypertension in pregnancy includes non-pharmacological measures and antihypertensive drugs. Women who are previously diagnosed with mild to medium hypertension usually continue to receive their therapy, if the drug isn’t contraindicated in pregnancy in which case it should be replaced with another one.

Non-pharmacological measures

Non-pharmacological measures are recommended to all women with hypertension. Women need to check their general condition and blood pressure regularly, resting frequently. It is advised to sleep in a left lateral position (left side). It is not advised to restrict the intake of calories and sodium, as sodium intake restriction can decrease the volume of intravascular fluid, and diet restriction may affect fetal growth, which isn’t desirable.

hypertension in pregnancy

Pharmacological measures

Treatment of hypertension in pregnancy with drugs are needed in women with blood pressure ≥ 140 / 90 mm Hg and with gestational hypertension, preeclampsia superimposed on chronic hypertension or with subclinical organ damage. In other conditions, treatment with drugs is recommended if blood pressure is ≥ 150 / 95 mm Hg.

Drugs which are mostly used in these conditions are methyldopa, labetalol, and niphedipine.

Methyldopa

Methyldopa is proven to be effective and safe in pregnancy by numerous clinical trials. It works on the central nervous system, as it is metabolically changed into α-methylnorepinephrine which activate α2 receptors decreasing blood pressure.

Labetalol

Lebetalol is both alpha and beta blocker. It decreases the blood pressure by inhibiting the β1 receptors in the heart, and α1 receptors within the vascular smooth muscle. It is effective in hypertension in pregnancy.

Niphedipine

Niphedipine is a calcium channel blocker. It blocks the L-type calcium channels in arteries causing vasodilation, decreasing the blood pressure.

Platelets (Thrombocytes)

Platelets (Thrombocytes) represent the fragments of the cell named megakaryocyte, which is a type of bone marrow cells sent into the circulation. Thrombocytes are small and oval plates with a diameter of only 2 – 4 mm. Normal platelet count range from 150.000 – 450.000 per μL of blood.

Platelet development

Megakaryocyte comes from hematopoietic stem cell precursors from the bone marrow like all other blood cells. Its transformation into a defined stem is the beginning of the thrombocytopoiesis process. Megakaryoblast is formed from the myeloid stem cell after which it becomes a megakaryocyte. Due to its large size, a megakaryocyte can‘t leave the bone marrow, but it adheres to the walls of the sinus capillary, partially participating in the formation of its wall. As the cell consists of segments, its parts are separated and put into circulation as platelets. Several thousand platelets can be made from one megakaryocyte. Thrombocytes do not come from the normal cell division, as they have no core, and in the true sense of the word, they are not cells. Therefore, the more adequate name is platelet. However, the name thrombocyte is still used sometimes.

platelets

Platelet maturation is regulated by factors of colony growth that controls the production of megakaryocytes. In addition to that, a plasma protein which facilitates the maturation of megakaryocytes and their fragmentation called thrombopoietin is constantly being generated in the liver and kidneys.

Structure of platelets

Membrane

Platelets have a very complex structure. Their membrane consists of three layers including

The outer shell – which is responsible for platelet adhesion and aggregation

Middle layer – which represents a source of platelet phospholipids involved in the blood clotting process

The inner layer – which is responsible for the platelet shape

Cytoplasm

Platelet cytoplasm also has a very complex structure. It contains an open channel system responsible for the discharge of the platelet granules’ content into the outer environment. Moreover, the cytoplasm contains a powerful contractile system that allows an easy change in the platelet‘s shape.

Role in the organism

The main role of platelets is in hemostasis, a process of bleeding stopping in an injured blood vessel. Hemostasis is a process that reduces or prevents blood loss in times of blood vessel injuries. As the blood in the blood vessels is under pressure, cutting or spraying the blood vessel results in blood leakage, and this phenomenon is called bleeding (hemorrhage). If a small blood vessel is injured, bleeding is usually spontaneously stopped by the hemostasis process. However, in the case of injuries of large arteries and veins, hemostasis is not as effective and the injuries must be surgically sanitized. After the damage to the wall of the blood vessel, blood clots accumulate at the site of the injury where they

1. Liberate the substances that cause the blood vessel to contract, which reduces the blood loss

2. Form an aggregate, a platelet plug at the site of the injury

3. Participate in the process of blood clotting, due to coagulation factors that contain

4. Take part in the healing of the injury.

platelets

Aggregation

Platelets begin to adhere to collagen fibers within a few seconds after the occurrence of the damage to the inner part of a blood vessel, and that process is called platelet adhesion. Adhered platelets are activated and they alter their shape while emptying their granules that stimulate further aggregation. The interconnection of a large number of platelets at the site of a blood vessel injury is called platelet aggregation.

Platelet life span

Circulating platelets have a lifespan of 1 to 2 weeks. Older blood platelets, which are not used during blood clotting, are destroyed by macrophages from liver and spleen. A spleen is not just a place which destroys old platelets, as it is also an important reservoir of these blood elements. It releases a large number of stored platelets into the circulation under the influence of the nervous system in certain occurrences including bleeding or burns.

Disorders

An increased platelet count called thrombocytosis increases the tendency of a pathological blood clot (thrombus) formation. That blood clot can induce life-threatening complications such as heart attack and ischemic stroke. A decrease in blood platelet count is called thrombocytopenia. Physiological thrombocytopenia occurs normally in the women immediately prior to menstrual bleeding. Female sex hormones reduce the formation and maturation of blood platelets. Severe thrombocytopenia causes spontaneous bleeding, especially in the gums and digestive tract.

Frank’s sign

Frank’s sign

Frank’s sign is a diagonal crease in the ear lobe which is considered as a predictive sign of heart disease. It was named after the American pulmonologist, Dr. Sanders T. Frank, who first noticed the connection between heart diseases and creases on one or both ear lobes. The crease is usually spread almost across the entire ear lobe, and in some cases, it looks as if it starts just from the hole through which the earring is placed.

The presence of Frank’s sign is associated with a decrease in telomere size, an accelerated aging marker, which may lead to atherosclerosis. It is thought to happen due to chronic local ischemia, leading to disruption and displacement of elastic fibers, associated with thickening of the intima of arterioles.

The first research of Frank’s sign

The first studies regarding Frank’s sign date back to 1973. the year in which Dr. S. Frank published a research article in which a possible correlation was hypothesized between the presence of this cutaneous marker and the development of cardiovascular diseases, especially coronary heart disease and diabetes. The article was published in the New England Journal of Medicine (NEJM) under the name “Aural sign of coronary-artery disease”. Many studies were conducted since then, showing a correlation between Frank’s sign and heart disease, exceptionally in people under the age of 60.

Frank's sign male ear

Frank’s sign classification

Classification of Frank’s sign was based on descriptive evaluation which includes:

  • Grade 1 – a small amount of wrinkling on the earlobe
  • Grade 2a – a superficial crease on the earlobe
  • Grade 2b – a crease that surpasses more than halfway across the earlobe
  • Grade 3 – a deep crease that affects the entire earlobe

Other indicators of heart diseases

Cardiovascular diseases are the leading cause of death, and commonly, the first sign of problems with heart may be a suffered heart attack, which is fatal in 30% of cases. Although it is impossible to detect all the warnings indicating that you have problems with your heart, there are some visible external signs that may predict a future cardiac event. Some of them include:

Frank's sign and other indicators

Nail clubbing

An occurrence recognized as nail clubbing can also represent a sign that there is something wrong with your heart. The nails are becoming thicker and wider, changing their shape. Such changes are often present in both hands, and they do not cause pain. The reason for nail clubbing is the insufficient supply of oxygenated blood to fingers, which they try to overcome with the increased production of growth factors.

Xanthomas

Large, yellow fatty bumps (Xanthomas) that can appear on your knees, elbows, or eyelids do not represent a danger on themselves, but their presence can indicate other problems. These fatty bumps are generally seen in people with familial hypercholesterolemia, a genetic disorder that causes exceptionally high levels of low-density lipoprotein cholesterol (LDL-c) that are making fat deposits on the skin. In addition to that, fat deposits can accumulate in the arteries that supply the heart, causing various cardiovascular problems.

Arcus senilis

Arcus senilis represents fat deposits manifested via the white, grey or blue ring located around the cornea. It is caused by lipid deposits in the edge of the cornea. Although it doesn’t affect the vision, arcus senilis is correlated with heart diseases

Soup – Why is soup healthy

Soup has had a special place in human nutrition for thousands of years. And since ancient times, it has special importance due to its health effects. In the whole world, beginning with the first civilizations and cultures, it has always been extremely appreciated thanks to its nutritional and medicinal properties, which in the past decades has become a scientifically based fact.

Soup is a very important part of every meal. Just like a salad, this dish allows you to intake a large number of nutrients that can keep you healthy.

If you plan to lose excess weight, you can replace one of the meals during the day with just a plate of soup. Although for some, this may be a challenge. But from a scientific aspect, it can meet energy and nutritional needs. Fiona Kirk has written a book on a diet based on soups. In her bestseller, “Soup can make you thin”, Kirk wrote: “The richness of ingredients in this meal ensures a balanced amount of carbohydrates, proteins, fats, as well as vitamins and minerals that are needed for good energy metabolism.” She concludes that the path to a slimline is simple, all you need is a full plate of fine and warm soup.

soup

It provides adequate intake of vegetables and fibers

A modern man’s diet is often based on fast food that can’t provide adequate intake of vegetables and fibers. Adding soup to your daily diet can help you to increase your intake of vegetables, especially if you choose a vegetarian one. One example is tomato soup that has been shown to produce positive effects on the cardiovascular system, primarily on the heart, thanks to a large amount of lycopene present in red tomatoes, the consumption of this dish can prevent the onset of the heart attack. A study published in The Journal of Nutritional Biochemistry in July 2006 showed that the daily intake of tomato soup over the course of two weeks increases the level of vitamin C in the respondents.

Cold soups, unlike warm, contain a higher amount of vitamin C, which is sensitive to high temperatures, so its concentration is considerably lower when it’s warmed up. On the other hand, warm meals such as vegetable or chicken noodle soup can satisfy about 50% of the daily requirements for vitamin A and more than 10 percent of the recommended daily intake for selenium and potassium.

It makes your stomach full

According to a study published in Physiology & Behavior in June 2005, as opposed to adding other liquid meals, the soup will make you feel full if you prepare it in an appropriate way. This means that you can serve it as a meal without worry that you will be hungry again after you finish eating. If you choose to have such a meal, be sure to select the one that contains a lot of proteins.

Regulation of metabolism and energy input

Soup with a higher amount of protein often has fewer calories per gram. Selection of foods with low energy density allows healthy and quick weight loss. A study published in Obesity Research in October 2005 showed that consumption of this dish twice a day as a part of low-calorie diet led to 50 percent more weight loss than consuming higher-density foods that contained the same amount of calories.

soup

Soup – Nutrition facts

Nutritional ingredients that are provided by eating the soup depend on the ingredients that are part of it. Generally speaking, each soup contains a high proportion of water. If it’s rich with meat it contains more proteins and minerals such as magnesium, calcium, selenium, iron, copper, and electrolytes. And soups with vegetables are rich in fiber and vitamins. Phytonutrients determine the color and texture, so, for this reason, the tomato soup is red due to the content of the lycopene antioxidant, and pumpkin soup is orange due to beta carotene.