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Stress

What is stress?

Stress is how your brain and body respond to a challenge or demand. When you are stressed, your body releases certain hormones. Hormones are chemicals that travel in your bloodstream and control how different parts of your body work. The hormones that are released when you are stressed make you alert and ready to act. They can raise your blood pressure, heart rate, and blood glucose (blood sugar) levels. This response is sometimes called a "fight or flight" response.

Everyone gets stressed from time to time. There are different types of stress. It can be short-term or long-term. It can be caused by something that happens once or something that keeps happening.

Not all stress is bad. In fact, it can help you survive in a dangerous situation. For example, one kind of stress is the jolt you may feel when a car pulls out in front of you while you are driving. This jolt of hormones helps you quickly hit the brakes to avoid an accident. A little short-term stress can sometimes be helpful. For example, the stress of having a deadline for school or your job may push you to get your work done on time. Once you finish it, that stress goes away.

But stress that lasts a long time can harm your health.

What causes long-term stress?

Long-term stress, or chronic stress, lasts for weeks, months, or longer. As you go about your life, your body is acting as if you're being threatened.

Causes of long-term stress include:

  • Routine stress from the demands of work, school, family needs, money problems, and other daily pressures that don't stop.
  • Stress from sudden, difficult changes in your life, such as divorce, illness, losing your job, or other unhappy life events that often have a long impact.
  • Traumatic stress, which may happen when you're in danger of serious harm or death. Examples include being in a bad accident, a war, a flood, earthquake, or other frightening event. This type of stress can cause a long-lasting problem called post-traumatic stress disorder (PTSD).
How can long term-stress harm my health?

People respond to stress in different ways. If you're stressed for a long time you may notice that you are:

  • Getting sick more often than usual because stress weakens your body's ability to fight germs
  • Having stomach problems or trouble digesting food
  • Having trouble sleeping
  • Having headaches
  • Feeling sad, angry, or easily upset

When stress keeps going, your body acts as if you're always in danger. That's a lot of strain that may play a part in developing serious health problems, including:

  • Depression
  • Anxiety
  • Heart disease
  • High blood pressure
  • Diabetes

It's possible to get used to the symptoms of stress and not even realize there's a problem. So when there's a lot of stress in your life, it's important to pay attention to how it affects you so you can do something about it.

How can I manage long-term stress?

Simple things that improve your mental health may be helpful in managing long-term stress, such as:

  • Get regular exercise. A 30-minute daily walk can help you feel better and help keep your immune system strong, so you don't get sick.
  • Try relaxing activities. You could look for an app or wellness program that uses breathing, meditation, or muscle relaxation exercises.
  • Get enough sleep every night.
  • Avoid too much caffeine.
  • Decide what you need to do now and what can wait. And focus on what you got done each day, not on what you weren't able to do.
  • Ask your family or friends for support.
When should I ask my health care provider for help with stress?

Get help if you're having severe symptoms for 2 weeks or more, including:

  • Trouble sleeping
  • Changes in your eating that cause unwanted changes in your weight
  • Troubles getting out of bed because of your mood
  • Difficulty focusing your thoughts
  • Losing interest in things you usually enjoy
  • Not being able to do your usual daily activities

Always get help right away if stress is causing you to:

  • Have thoughts of suicide
  • Feel you can't cope
  • Use drugs or alcohol more often than usual

Your health care provider may refer you to a mental health professional such as a psychologist or social worker.

NIH: National Institute of Mental Health

Sudden Cardiac Arrest

What is sudden cardiac arrest (SCA)?

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly stops beating. When that happens, blood stops flowing to the brain and other vital organs. If it is not treated, SCA usually causes death within minutes. But quick treatment with a defibrillator may be lifesaving.

How is sudden cardiac arrest (SCA) different from a heart attack?

A heart attack is different from an SCA. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With an SCA, the heart stops beating.

Sometimes an SCA can happen after or during recovery from a heart attack.

What causes sudden cardiac arrest (SCA)?

Your heart has an electrical system that controls the rate and rhythm of your heartbeat. An SCA can happen when the heart's electrical system is not working right and causes irregular heartbeats. Irregular heartbeats are called arrhythmias. There are different types. They may cause the heart to beat too fast, too slow, or with an irregular rhythm. Some can cause the heart to stop pumping blood to the body; this is the type that causes SCA.

Certain diseases and conditions can cause the electrical problems that lead to SCA. They include:

  • Ventricular fibrillation, a type of arrhythmia where the ventricles (the heart's lower chambers) don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs.
  • Coronary artery disease (CAD), also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. The plaque blocks some or all of the blood flow to the heart.
  • Some types of physical stress can cause your heart's electrical system to fail, such as
    • Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems.
    • Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.
    • Major blood loss
    • Severe lack of oxygen
  • Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart
  • Structural changes in the heart, such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart.
Who is at risk for sudden cardiac arrest (SCA)?

You are at higher risk for SCA if you:

  • Have coronary artery disease (CAD). Most people with SCA have CAD. But CAD usually doesn't cause symptoms, so they may not know that they have it.
  • Are older; your risk increases with age
  • Are a man; it is more common in men than women
  • Are Black or African American, especially if you have other conditions such as diabetes, high blood pressure, heart failure, or chronic kidney disease
  • Have a personal history of heartbeats that aren't regular (arrhythmia)
  • Have a personal or family history of SCA or inherited disorders that can cause arrhythmia
  • Have a problem with drug or alcohol use
  • Have had a heart attack
  • Have heart failure
What are the symptoms of sudden cardiac arrest (SCA)?

Usually, the first sign of SCA is loss of consciousness (fainting). This happens when the heart stops beating.

Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. And sometimes people have chest pain, shortness of breath, nausea, or vomiting in the hour before they have an SCA.

How is sudden cardiac arrest (SCA) diagnosed?

SCA happens without warning and requires emergency treatment. Health care providers rarely diagnose SCA with medical tests as it's happening. Instead, it is usually diagnosed after it happens. Providers do this by ruling out other causes of a person's sudden collapse.

If you are at high risk for SCA, your provider may refer you to a cardiologist, a doctor who specializes in heart diseases. The cardiologist may ask you to get various heart health tests to see how well you heart is working. He or she will work with you to decide whether you need treatment to prevent SCA.

What are the treatments for sudden cardiac arrest (SCA)?

SCA is an emergency. A person having SCA needs to be treated with a defibrillator right away. A defibrillator is a device sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating. To work well, it needs to be done within minutes of the SCA.

Most police officers, emergency medical technicians, and other first responders are trained and equipped to use a defibrillator. Call 9-1-1 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin.

What should I do if I think that someone has had an SCA?

Many public places such as schools, businesses, and airports have automated external defibrillators (AEDs). AEDs are special defibrillators that untrained people can use if they think that someone has had SCA. AEDS are programmed to give an electric shock if they detect a dangerous arrhythmia. This prevents giving a shock to someone who may have fainted but isn't having SCA.

If you see someone who you think has had SCA, you should give cardiopulmonary resuscitation (CPR) until defibrillation can be done.

People who are at risk for SCA may want to consider having an AED at home. Ask your cardiologist to help you decide whether having an AED in your home might help you.

What are the treatments after surviving sudden cardiac arrest (SCA)?

If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA.

They will also try to find out what caused your SCA. If you're diagnosed with coronary artery disease, you may have an angioplasty or coronary artery bypass surgery. These procedures help restore blood flow through narrowed or blocked coronary arteries.

Often, people who have had SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen. An ICD uses electric pulses or shocks to help control dangerous arrhythmias.

Can sudden cardiac arrest (SCA) be prevented?

You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA. If you have had an SCA, getting an implantable cardioverter defibrillator (ICD) can lower your chance of having another SCA.

NIH: National Heart, Lung, and Blood Institute

Vascular Diseases

What are vascular diseases?

Your vascular system is your body's network of blood vessels. It includes your:

  • Arteries, which carry oxygen-rich blood from your heart to your tissues and organs
  • Veins, which carry the blood and waste products back to your heart
  • Capillaries, which are tiny blood vessels that connect your small arteries to your small veins. The walls of the capillaries are thin and leaky, to allow for an exchange of materials between your tissues and blood.

Vascular diseases are conditions which affect your vascular system. They are common and can be serious. Some types include:

  • Aneurysm - a bulge or "ballooning" in the wall of an artery
  • Atherosclerosis - a disease in which plaque builds up inside your arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.
  • Blood clots, including deep vein thrombosis and pulmonary embolism
  • Coronary artery disease and carotid artery disease, diseases that involve the narrowing or blockage of an artery. The cause is usually a buildup of plaque.
  • Raynaud phenomenon - a disorder that causes the blood vessels to narrow when you are cold or feeling stressed
  • Stroke - a serious condition that happens when blood flow to your brain stops.
  • Varicose veins - swollen, twisted veins that you can see just under the skin
  • Vasculitis - inflammation of the blood vessels
What causes vascular diseases?

The causes of vascular diseases depend on the specific disease. These causes include:

  • Genetics
  • Heart diseases such as high cholesterol and high blood pressure
  • Infection
  • Injury
  • Medicines, including hormones

Sometimes the cause is unknown.

Who is at risk for vascular diseases?

The risk factors for vascular diseases can vary, depending on the specific disease. But some of the more common risk factors include:

  • Age - your risk of some diseases goes up as you get older
  • Conditions that can affect the heart and blood vessels, such as diabetes or high cholesterol
  • Family history of vascular or heart diseases
  • Infection or injury that damages your veins
  • Lack of exercise
  • Obesity
  • Pregnancy
  • Sitting or standing still for long periods of time
  • Smoking
What are the symptoms of vascular diseases?

The symptoms for each disease are different.

How are vascular diseases diagnosed?

To make a diagnosis, your health care provider will do a physical exam and ask about your symptoms and medical history. You may have imaging tests and/or blood tests.

How are vascular diseases treated?

Which treatment you get depends on which vascular disease you have and how severe it is. Types of treatments for vascular diseases include:

  • Lifestyle changes, such as eating a heart-healthy diet and getting more exercise
  • Medicines, such as blood pressure medicines, blood thinners, cholesterol medicines, and clot-dissolving drugs. In some cases, providers use a catheter to send medicine directly to a blood vessel.
  • Non-surgical procedures, such as angioplasty, stenting, and vein ablation
  • Surgery
Can vascular diseases be prevented?

There are steps you can take to help prevent vascular diseases:

  • Make healthy lifestyle changes, such as eating a heart-healthy diet and getting more exercise
  • Don't smoke. If you are already a smoker, talk to your health care provider for help in finding the best way for you to quit.
  • Keep your blood pressure and cholesterol in check
  • If you have diabetes, control your blood sugar
  • Try not to sit or stand for up long periods of time. If you do need to sit all day, get up and move around every hour or so. If you are traveling on a long trip, you can also wear compression stockings and regularly stretch your legs.

Anabolic Steroids

What are anabolic steroids?

Anabolic steroids are synthetic (man-made) versions of testosterone. Testosterone is the main sex hormone in men. It is needed to develop and maintain male sex characteristics, such as facial hair, deep voice, and muscle growth. Women do have some testosterone in their bodies, but in much smaller amounts.

What are anabolic steroids used for?

Health care providers use anabolic steroids to treat some hormone problems in men, delayed puberty, and muscle loss from some diseases. But some people misuse anabolic steroids.

Why do people misuse anabolic steroids?

Some bodybuilders and athletes use anabolic steroids to build muscles and improve athletic performance. They may take the steroids orally, inject them into muscles, or apply them to the skin as a gel or cream. These doses may be 10 to 100 times higher than doses used to treat medical conditions. Using them this way, without a prescription from a health care provider, is not legal or safe.

What are the health effects of misusing anabolic steroids?

Misuse of anabolic steroids, especially over a long period of time, has been linked to many health problems, including:

  • Acne
  • Stunted growth in teens
  • High blood pressure
  • Changes in cholesterol
  • Heart problems, including heart attack
  • Liver disease, including cancer
  • Kidney damage
  • Aggressive behavior

In men, it can also cause:

  • Baldness
  • Breast growth
  • Low sperm count/infertility
  • Shrinking of the testicles

In women, it can also cause:

  • Changes in your menstrual cycle (period)
  • Growth of body and facial hair
  • Male-pattern baldness
  • Voice deepening
Are anabolic steroids addictive?

Even though they don't cause a high, anabolic steroids can be addictive. You can have withdrawal symptoms if you stop using them, including:

  • Fatigue
  • Restlessness
  • Loss of appetite
  • Sleep problems
  • Decreased sex drive
  • Steroid cravings
  • Depression, which can sometimes be serious and even lead to suicide attempts

Behavioral therapy and medicines can be helpful in treating anabolic steroid addiction.

NIH: National Institute on Drug Abuse

Atherosclerosis

What is atherosclerosis?

Atherosclerosis is a condition in which plaque builds up inside your arteries. Plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium, and other substances found in the blood. Over time, plaque hardens and causes your arteries to narrow. That limits the flow of oxygen-rich blood to your body.

Some people may confuse atherosclerosis and arteriosclerosis, but they are not the same thing:

  • Arteriosclerosis is hardening of the arteries, which means that the arteries thicken and become less flexible. It can have several different causes.
  • Atherosclerosis, which develops from plaque buildup, is a common type of arteriosclerosis.

Atherosclerosis can affect most of the arteries in the body. It has different names, based on which arteries are affected:

  • Coronary artery disease (CAD) is plaque buildup in the arteries of your heart.
  • Peripheral artery disease (PAD) is plaque buildup in the arteries that carry blood away from the heart to other parts of the body. It most often affects the arteries of your legs, but it can also affect the arteries of your arms or pelvis.
  • Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain.
  • Renal artery stenosis is plaque buildup in the arteries that supply blood to your kidneys.
  • Vertebral artery disease is plaque buildup in the arteries that supply blood to the back of your brain.
  • Mesenteric artery ischemia is plaque buildup in the arteries that supply your intestines with blood.
What causes atherosclerosis?

Plaque often starts to build up during childhood and gets worse with age. The exact cause is unknown, but researchers believe that this buildup happens when there is damage to the arteries. This damage may be caused by unhealthy lifestyle habits, medical conditions, and your genes.

Who is more likely to develop atherosclerosis?

You may be more likely to develop atherosclerosis if you:

  • Have certain medical conditions, including:
    • High blood pressure
    • High blood cholesterol
    • Diabetes
    • Metabolic syndrome
    • Inflammatory diseases such as rheumatoid arthritis and psoriasis
  • Have a family history of high blood cholesterol
  • Eat a lot of foods high in saturated fats
  • Smoke or chew tobacco
  • Are older - the risk increases after age 45 men and age 55 in women
What are the symptoms of atherosclerosis?

In the early stages, atherosclerosis often does not cause any symptoms. You may first notice some symptoms at times when your body needs more oxygen. For example, this could be when you are having physical or emotional stress.

Your symptoms will depend on which arteries are affected and how much blood flow is blocked:

  • With coronary artery disease, the symptoms may include angina (a type of chest pain), palpitations (racing or pounding heart), and shortness of breath.
  • With carotid artery disease, you may have a bruit. This is a whooshing sound that your health care provider hears when using a stethoscope. You could also have a transient ischemic attack (TIA), sometimes called a mini-stroke.
  • With peripheral artery disease, you may have pain, aching, heaviness, or cramping in the legs when walking or climbing stairs.
  • With vertebral artery disease, you may have problems with thinking and memory, weakness or numbness on one side of the body or face, and vision trouble. You could also have a transient ischemic attack.
  • With mesenteric artery ischemia, the symptoms can include severe pain after meals, weight loss, and diarrhea.

For men, erectile dysfunction (ED) is an early warning sign that you may be at higher risk for atherosclerosis and its complications. If you have ED, talk with your provider about your risk of plaque buildup.

What other problems can atherosclerosis cause?

Atherosclerosis can cause other health problems, or complications. For example, if a plaque bursts, a blood clot may form. The clot could block the artery completely or travel to another part of the body. Other possible complications can vary, depending on which arteries are affected. For example, blockages in different parts of the body can lead to complications such as a heart attack, stroke, vascular dementia, or limb loss.

How is atherosclerosis diagnosed?

To find out if you have atherosclerosis, your provider:

  • Will ask about your medical and family health history
  • Will ask about your lifestyle and risk factors for plaque buildup in the arteries
  • Will do a physical exam, which will include listening to your heart and the blood flow in your arteries
  • Will likely order tests, such as blood tests and heart health tests
What are the treatments for atherosclerosis?

If you have atherosclerosis, your provider will work with you to create a treatment plan that works for you. Your plan will depend on which arteries are affected, how much the blood flow is blocked, and what other medical conditions you have. Possible treatments may include:

  • Heart-healthy lifestyle changes.
  • Medicines to:
    • Manage your risk factors.
    • Treat atherosclerosis or its complications.
    • Treat any medical conditions you have that can worsen plaque buildup.
  • Procedures or surgeries to treat diseases or complications that were caused by plaque buildup. The specific type of procedure or surgery will depend on which arteries are affected.
  • Cardiac rehabilitation, if you have had certain complications from atherosclerosis.
Can atherosclerosis be prevented?

There are steps you can take to try to prevent atherosclerosis:

  • Choose heart-healthy foods, such fruits, vegetables, and whole grains. Limit foods that are high in saturated fats, salt, and added sugars.
  • Do regular physical activity. But before you start an exercise program, ask your provider what level of physical activity is right for you.
  • Aim for a healthy weight.
  • Limit how much alcohol you drink. Drinking less is better for health than drinking more. Men should limit their intake to 2 drinks or less in a day. Women should drink 1 drink or less per day.
  • Manage stress.
  • If you smoke, quit smoking.
  • Avoid secondhand smoke.
  • Get enough good-quality sleep.

NIH: National Heart, Lung, and Blood Institute

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