Pulmonary Embolism

What is a pulmonary embolism (PE)?

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

• Permanent damage to the lungs
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

What causes a pulmonary embolism (PE)?

The cause is usually a blood clot that breaks loose and travels through the bloodstream to the lungs. The clot is usually a deep vein thrombosis (DVT), a clot in the leg. In rare cases, material such as air bubbles, clumps of fat, or parts of a tumor can block the lung artery and cause PE.

Who is more likely to develop a pulmonary embolism (PE)?

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

• Having surgery, especially joint replacement surgery.
• Certain medical conditions, including
• Cancers
• Heart diseases
• Lung diseases
• A broken hip or leg bone or other trauma
• Hormone-based medicines, such as birth control pills or hormone replacement therapy.
• Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
• Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight.
• Age. Your risk increases as you get older, especially after age 40.
• Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
• Obesity.

What are the symptoms of a pulmonary embolism (PE)?

Symptoms of PE include:

• Shortness of breath
• Rapid breathing
• Chest pain or discomfort, which usually gets worse when you cough or take a deep breath
• Increased heart rate
• Coughing up blood
• Very low blood pressure, lightheadedness, or fainting

Sometimes people with PE don't have any symptoms until they have serious complications, such as pulmonary hypertension (high blood pressure in the arteries to your lungs).

How is a pulmonary embolism (PE) diagnosed?

It can be difficult to diagnose PE. To find out if you have a PE, your health care provider will:

• Take your medical history, including asking about your symptoms and risk factors for PE
• Do a physical exam
• Likely order some tests, including various imaging and blood tests

What are the treatments for a pulmonary embolism (PE)?

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines:

• Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
• Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures:

• Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
• A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Can pulmonary embolism (PE) be prevented?

Preventing new blood clots can prevent PE. Prevention may include:

• Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
• Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking.
Using compression stockings to prevent deep vein thrombosis (DVT).
• Moving your legs when sitting for long periods of time (such as on long trips).
• Moving around as soon as possible after surgery or being confined to a bed.

NIH: National Heart, Lung, and Blood Institute

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.

Alzheimer's Disease

What is Alzheimer's disease?

Alzheimer's disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects thinking and memory skills. If you have AD, it can impair your ability to reason or learn new skills until it becomes difficult to complete daily activities.

AD begins slowly over many years. It first involves the parts of the brain that control thought, memory, and language. It may be mistaken for normal memory changes with aging. However, AD is not a normal part of aging. The brain changes from the disease lead to symptoms that get worse over time.

What are the symptoms of Alzheimer's disease?

People with AD may have trouble remembering recent events or the names of people they know. Behavior may vary from person to person and day to day. AD progresses in stages. Late-onset AD occurs in adults aged 65 and older, which is when most people develop the disease. Early-onset AD happens before age 65, which is not common.

Some symptoms of AD can include:

• Getting lost in familiar places
• Repeating the same question
• Not recognizing family members
• Having trouble speaking, reading, or writing
• Not taking care of yourself, such as not bathing or eating poorly

In AD, over time, symptoms get worse. Later on, people with AD may become anxious or aggressive or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them.

Who is more likely to develop Alzheimer's disease?

Researchers don't fully understand what causes AD. Age is the biggest risk factor. Your risk is also higher if a family member has had the disease. Although people who develop Alzheimer's don't always have a history of the disease in their families.

Researchers believe the causes of AD may be a combination of age-related changes in the brain, along with genetic, health, and lifestyle factors. Some medical conditions that are associated with a higher risk of AD include:

• Hearing loss
• Depression
• Mild cognitive impairment
• Concussion or other traumatic brain injury (TBI)

A related problem, mild cognitive impairment (MCI), causes more memory problems than normal for people of the same age. Many, but not all, people with MCI will develop AD.

How is Alzheimer's disease diagnosed?

Some health conditions can cause memory loss or symptoms like AD. Talk with your health care provider if you're having noticeable changes in your memory. To determine if your symptoms are related to AD and not normal aging or another health condition, your provider may:

• Review your medical history and any medicines you're taking
• Conduct tests to check your memory, thinking, and problem-solving skills
• Ask about changes in behavior or personality
• Do tests to rule out any medical or mental health conditions
• Refer you to a provider that specializes in caring for older adults
• Recommend a neurologist, a doctor who specializes in treating diseases of the brain and nervous system

What are the treatments for Alzheimer's disease?

No treatment can stop the disease. However, some medicines may help keep symptoms from getting worse for a limited time.

Can Alzheimer's disease be prevented?

You can't change some risk factors, like your age. But changing certain lifestyle factors may promote your brain health and help you live a healthier lifestyle overall. This can include to:

• Manage chronic health issues such as high blood pressure or hearing loss
• Get regular physical activity
• Eat a healthy diet
• Quit smoking (or don't start)
• Get enough sleep
• Develop strong social connections

NIH: National Institute on Aging