Breathlessness Health Dictionary

Di?culty in breathing (see BREATHLESSNESS; ORTHOPNOEA).... dyspnoea

Asthma is a common disorder of breathing characterised by widespread narrowing of smaller airways within the lung. In the UK the prevalence among children in the 5–12 age group is around 10 per cent, with up to twice the number of boys affected as girls. Among adults, however, the sex incidence becomes about equal. The main symptom is shortness of breath. A major feature of asthma is the reversibility of the airway-narrowing and, consequently, of the breathlessness. This variability in the obstruction may occur spontaneously or in response to treatment.

Cause Asthma runs in families, so that parents with asthma have a strong risk of having children with asthma, or with other atopic (see ATOPY) illnesses such as HAY FEVER or eczema (see DERMATITIS). There is therefore a great deal of interest in the genetic basis of the condition. Several GENES seem to be associated with the condition of atopy, in which subjects have a predisposition to form ANTIBODIES of the IgE class against allergens (see ALLERGEN) they encounter – especially inhaled allergens.

The allergic response in the lining of the airway leads to an in?ammatory reaction. Many cells are involved in this in?ammatory process, including lymphocytes, eosinophils, neutrophils and mast cells. The cells are attracted and controlled by a complex system of in?ammatory mediators. The in?amed airway-wall produced in this process is then sensitive to further allergic stimuli or to non-speci?c challenges such as dust, smoke or drying from the increased respiration during exercise. Recognition of this in?ammation has concentrated attention on anti-in?ammatory aspects of treatment.

Continued in?ammation with poor control of asthma can result in permanent damage to the airway-wall such that reversibility is reduced and airway-narrowing becomes permanent. Appropriate anti-in?ammatory therapy may help to prevent this damage.

Many allergens can be important triggers of asthma. House-dust mite, grass pollen and animal dander are the commonest problems. Occupational factors such as grain dusts, hard-metals fumes and chemicals in the plastic and paint industry are important in some adults. Viral infections are another common trigger, especially in young children.

The prevalence of asthma appears to be on the increase in most countries. Several factors have been linked to this increase; most important may be the vulnerability of the immature immune system (see IMMUNITY) in infants. High exposure to allergens such as house-dust mite early in life may prime the immune system, while reduced exposure to common viral infections may delay the maturation of the immune system. In addition, maternal smoking in pregnancy and infancy increases the risk.

Clinical course The major symptoms of asthma are breathlessness and cough. Occasionally cough may be the only symptom, especially in children, where night-time cough may be mistaken for recurrent infection and treated inappropriately with antibiotics.

The onset of asthma is usually in childhood, but it may begin at any age. In childhood, boys are affected more often than girls but by adulthood the sex incidence is equal. Children who have mild asthma are more likely to grow out of the condition as they go through their teenaged years, although symptoms may recur later.

The degree of airway-narrowing, and its change with time and treatment, can be monitored by measuring the peak expiratory ?ow with a simple monitor at home – a peak-?ow meter. The typical pattern shows the peak ?ow to be lowest in the early morning and this ‘morning dipping’ is often associated with disturbance of sleep.

Acute exacerbations of asthma may be provoked by infections or allergic stimuli. If they do not respond quickly and fully to medication, expert help should be sought urgently since oxygen and higher doses of drugs will be necessary to control the attack. In a severe attack the breathing rate and the pulse rate rise and the chest sounds wheezy. The peak-?ow rate of air into the lungs falls. Patients may be unable to talk in full sentences without catching their breath, and the reduced oxygen in the blood in very severe attacks may produce the blue colour of CYANOSIS in the lips and tongue. Such acute attacks can be very frightening for the patient and family.

Some cases of chronic asthma are included in the internationally agreed description CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) – a chronic, slowly progressive disorder characterised by obstruction of the air?ow persisting over several months.

Treatment The ?rst important consideration in the treatment of asthma is avoidance of precipitating factors. When this is a speci?c animal or occupational exposure, this may be possible; it is however more di?cult for house-dust mite or pollens. Exercise-induced asthma should be treated adequately rather than avoiding exercise.

Desensitisation injections using small quantities of speci?c allergens are used widely in some countries, but rarely in the UK as they are considered to have limited value since most asthma is precipitated by many stimuli and controlled adequately with simple treatment.

There are two groups of main drugs for the treatment of asthma. The ?rst are the bronchodilators which relax the smooth muscle in the wall of the airways, increase their diameter and relieve breathlessness. The most useful agents are the beta adrenergic agonists (see ADRENERGIC RECEPTORS) such as salbutamol and terbutaline. They are best given by inhalation into the airways since this reduces the general side-effects from oral use. These drugs are usually given to reverse airway-narrowing or to prevent its onset on exercise. However, longer-acting inhaled beta agonists such as salmeterol and formoterol or the theophyllines given in tablet form can be used regularly as prevention. The beta agonists can cause TREMOR and PALPITATION in some patients.

The second group of drugs are the antiin?ammatory agents that act to reduce in?ammation of the airway. The main agents in this group are the CORTICOSTEROIDS. They must be taken regularly, even when symptoms are absent. Given by inhalation they have few side-effects. In acute attacks, short courses of oral steroids are used; in very severe disease regular oral steroids may be needed. Other drugs have a role in suppressing in?ammation: sodium cromoglycate has been available for some years and is generally less e?ective than inhaled steroids. Newer agents directed at speci?c steps in the in?ammatory pathway, such as leukotriene receptor-antagonists, are alternative agents.

Treatment guidelines have been produced by various national and international bodies, such as the British Thoracic Society. Most have set out treatment in steps according to severity, with objectives for asthma control based on symptoms and peak ?ow. Patients should have a management plan that sets out their regular treatment and their appropriate response to changes in their condition.

Advice and support for research into asthma is provided by the National Asthma Campaign.

See www.brit-thoracic.org.uk

Prognosis Asthma is diagnosed in 15–20 per cent of all pre-school children in the developed world. Yet by the age of 15 it is estimated that fewer than 5 per cent still have symptoms. A study in 2003 reported on a follow-up of persons born in 1972–3 who developed asthma and still had problems at the age of nine. By the time these persons were aged 26, 27 per cent were still having problems; around half of that number had never been free from the illness and the other half had apparently lost it for a few years but it had returned.... asthma

An unusually fast but regular beating of the HEART occurring for periods that may last several hours or days. In most people with this abnormality the heart rate is between 140 and 180 beats a minute; rarely, the rate may rise as high as 250–300 beats. The condition occurs when abnormal electrical impulses that arise in the upper chambers (atria) of the heart override the normal control centre – the sinoatrial node – for the heartbeat. Symptoms usually include breathlessness, palpitations, pain in the chest and fainting. An ELECTROCARDIOGRAM (ECG) is taken to help make the diagnosis. An acute episode can sometimes be stopped by VALSAVA’S MANOEUVRE or by drinking cold water. Anti-arrhythmic drugs (see ARRHYTHMIA) such as adenosine and digoxin are used to treat recurrent attacks. Occasionally, a severe attack may need to be treated with an electric shock to the heart: this is known as DEFIBRILLATION.... supraventricular tachycardia

Blood disorder. Characterised by reduction in haemoglobin level.

Symptoms: breathlessness on exertion, fatigue, facial pallor, infection-prone, and others according to type. See appropriate entries: IRON DEFICIENCY ANAEMIA, HAEMOLYTIC ANAEMIA, APLASTIC ANAEMIA, SICKLE CELL ANAEMIA, PERNICIOUS ANAEMIA, SPORTS ANAEMIA, PREGNANCY – ANAEMIA, LEUKAEMIA. ... anaemia

An unnatural narrowing of the aortic opening of the heart or of the aortic vessel. A serious defect which may lead to chronic heart enlargement. Hardening or scarring of the valve and ultimately calcification may follow rheumatic fever, syphilis or other chronic disease and may be congenital. Incompetence of the valve may be observed in arteries that throb. More common in men. Symptoms: pain over the breast bone, fainting, vertigo, breathlessness, headache. Where heart is resilient, compensation can minimise effects. Most popular agent among practitioners is Cactus. See entry.

Without addition of a diuretic, (Dandelion or Buchu) dropsy of legs and feet, and breathlessness tend to worsen.

Treatment. Surgical valve replacement now the treatment of choice. Improve the circulation.

Formula. Liquid extracts: Cactus 10ml; Pulsatilla 5ml; Hawthorn 20ml; Tincture Capsicum BPC 1934 0.25ml. Dose: 10-30 drops thrice daily before meals.

A. Barker FNIMH. Liquid extract Garden Thyme 15ml; Liquid extract Pulsatilla 5ml; Liquid extract Passion flower 15ml; Tincture Capsicum 0.25ml. Emuls aqua Menth Pip conc (1 in 64) 2ml . . . Aqua to 250ml. Dose: 1 dessertspoon (8ml) in water every 4 hours.

Diet. See: DIET – HEART AND CIRCULATION. ... aortic stenosis

Arrhythmia. Heart flutter. Disorderly uncoordinated contraction of atrial muscle wall, the ventricles responding irregularly.

Causes: thyrotoxicosis, valvular or coronary disease. Present in mitral stenosis and myocarditis. Precursor of heart failure. Carrying a bucket of coal upstairs may be sufficient to precipitate an attack. Symptoms. Pulse irregular in time and force, breathlessness, visible pulse in neck, excessive heart beats of sudden onset or permanent, with breathlessness often from emotional excitement.

Treatment. Patient should avoid excessive physical exercise or give way to anxiety and depression. Alternatives:– Tea. Equal parts: Hawthorn (berries or blossoms), Broom, Valerian. 1-2 teaspoons in each cup boiling water; infuse 5-15 minutes; dose – half-1 cup thrice daily.

Tablets/capsules. Hawthorn, Valerian, Motherwort.

Formula. Hawthorn 2; Passion flower 2; Broom 3. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or honey thrice daily. Practitioner. Tincture Gelsemium (BPC 1973): 2-5 drops. Tincture Lily of the Valley: 0.5-1ml.

Undue violence. Tincture Gelsemium 1; Tincture Cactus 2. Mix. Dose: 5-10 drops. Where heart muscle is damaged, add 1 part Liquid Extract Black Cohosh.

Broom. Spartiol Drops, 20 drops thrice daily. (Klein)

Diet. See: DIET – HEART AND CIRCULATION. ... atrial fibrillation

In normal breathing the lungs spring back into their usual shape after expansion by the act of breathing-in. In emphysema, elasticity has lost its spring so the lungs become permanently expanded. Differs from chronic bronchitis by destroying walls of the air sacs. The chest is barrel-shaped through hyperinflation. Trumpeter’s lung; glass-blower’s disease, smoker’s disease. Stethoscope reveals ‘distant’ heart sounds of right heart failure, for which Hawthorn is indicated. Breathlessness on exertion. The victim cannot dispel the sensation of puffed-up lungs.

Through a lack of oxygen other muscles weaken. Rate of breathing may increase from 14-30 times per minute. Always ‘clearing the throat’. Overweight worsens.

Alternatives. Lobelia, Wild Thyme, Coltsfoot. Ephedra (practitioner only).

To loosen and thin tough mucus: Iceland Moss, Garlic, Coltsfoot, Gum ammoniac, Fenugreek seeds, Liquorice, Khella.

Decoction. Equal parts: Valerian, Liquorice root. 1-2 teaspoons to each cup boiling water; simmer 15 minutes. Dose: 1 cup once or twice daily and at bedtime.

Tablets/capsules. Lobelia, Iceland Moss, Garlic.

Formula. Equal parts: Elecampane, Iceland Moss, Wild Thyme. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. In water, honey or banana mash, thrice daily, and during the night if necessary.

Practitioner. Alternatives.

Formula (1). Liquid extracts: Ephedra 2; Elecampane 1; Lobelia 1. Dose – 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons in water etc as above.

Formula (2). Liquid extracts: Ephedra 2; Liquorice 1. Dosage same as Formula 1. The action of both formulae is improved when taken in cup of Fenugreek decoction.

Hyssop Wine. Good responses observed. 1oz herb macerated in 1 pint white wine or Vodka for 3-4 weeks; shake daily.

A. Barker FNIMH. Liquid extract Mouse Ear 60 drops; Liquid extract Pleurisy root 30 drops; Tincture Goldenseal 30 drops; Tincture Myrrh 20 drops; Tincture Ginger 20 drops. Pure bottled or distilled water to 8oz (240ml). Dose: 2 teaspoons every 3 hours.

Diet. Low salt. High fibre. Avoid all dairy products.

Supplements. Daily. Vitamin A 7500iu. Vitamin E 400iu. Folic acid 1mg. Vitamin C 200mg. Iodine, iron. Deep-breathing exercises. 2 Garlic tablets/capsules at night. For acute respiratory infections that irritate emphysema add Echinacea. ... emphysema

Allergic alveolitis. An occupational lung disease due to inhaling dust and mouldy grain, hay or other mouldy vegetable produce. Usually affects farm workers and those exposed to its wide range of allergens.

Symptoms: Influenza-like fever, breathlessness, cough.

Prognosis: Chronic lung damage and progressive disability.

Indicated: antifungals, antibiotics.

Alternatives. Teas. Marigold, Ground Ivy, Scarlet Pimpernel, Yarrow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.

Tablets/capsules. Garlic, Echinacea, Goldenseal, Thuja.

Powders. Combine, parts, Echinacea 3; Goldenseal 1; Thuja 1. Dose: 500mg, (two 00 capsules or one- third teaspoon) thrice daily.

Decoction. Irish Moss, to promote expectoration and eliminate debris.

Tinctures. Alternatives. (1) Echinacea 2; Lobelia 1; Liquorice 1. (2) Equal parts: Wild Indigo, Thuja and Pleurisy root. (3) Echinacea 2; Marigold 1; Thuja half; Liquorice half. Dosage: two 5ml teaspoons in water thrice daily. Acute cases: every 2 hours.

Topical. Inhalation of Eucalyptus or Tea Tree oils.

Diet. See: DIET – GENERAL. Yoghurt in place of milk.

Note: Bronchodilators of little value. Those at risk should have an X-ray at regular intervals. ... farmer’s lung

A disorder that occurs in the transmission of impulses between the atria (upper chambers) and ventricles (lower chambers) of the heart. A blocking of the normal route of electrical conduction through the ventricles not responding to initiation of the beat by the atria. Beats are missed with possible blackouts.

Causes: myocardial infarction, atherosclerosis, coronary thrombosis or other heart disorder.

Symptoms: slow feeble heart beats down to 36 beats per minute with fainting and collapse, breathlessness, Stoke Adams syndrome.

Treatment. Intensive care. Until the doctor comes: 1-5 drops Oil of Camphor in honey on the tongue or taken in a liquid if patient is able to drink. Freely inhale the oil. On recovery: Motherwort tea, freely. OR, Formula of tinctures: Lily of the Valley 2; Cactus 1; Motherwort 2. Mix. Dose – 30-60 drops in water thrice daily. A fitted pace-maker may be necessary.

Spartiol. 20 drops thrice daily. (Klein) ... heart block

A bubble of air in a blood vessel that affects the ?ow of blood from the heart. Air may enter the circulation after injury, infusions into the venous circulation, or surgery. The victim suffers breathlessness, chest discomfort, and acute heart failure.... air embolism

In?ammation of the bronchial tubes (see AIR PASSAGES; BRONCHUS; LUNGS). This may occur as an acute transient illness or as a chronic condition.

Acute bronchitis is due to an acute infection – viral or bacterial – of the bronchi. This is distinguished from PNEUMONIA by the anatomical site involved: bronchitis affects the bronchi whilst pneumonia affects the lung tissue. The infection causes a productive cough, and fever. Secretions within airways sometimes lead to wheezing. Sometimes the speci?c causative organism may be identi?ed from the sputum. The illness is normally self-limiting but, if treatments are required, bacterial infections respond to a course of antibiotics.

Chronic bronchitis is a clinical diagnosis applied to patients with chronic cough and sputum production. For epidemiological studies it is de?ned as ‘cough productive of sputum on most days during at least three consecutive months for not less than two consecutive years’. Chronic bronchitis is classi?ed as a CHRONIC PULMONARY OBSTRUCTIVE DISEASE (COPD); chronic ASTHMA and EMPHYSEMA are the others.

In the past, industrial workers regularly exposed to heavily polluted air commonly developed bronchitis. The main aetiological factor is smoking; this leads to an increase in size and number of bronchial mucous glands. These are responsible for the excessive mucus production within the bronchial tree, causing a persistent productive cough. The increased number of mucous glands along with the in?ux of in?ammatory cells may lead to airway-narrowing: when airway-narrowing occurs, it slows the passage of air, producing breathlessness. Other less important causative factors include exposure to pollutants and dusts. Infections do not cause the disease but frequently produce exacerbations with worsening of symptoms.

Treatments involve the use of antibiotics to treat the infections that produce exacerbations of symptoms. Bronchodilators (drugs that open up the airways) help to reverse the airway-narrowing that causes the breathlessness. PHYSIOTHERAPY is of value in keeping the airways clear of MUCUS. Cessation of smoking reduces the speed of progression.... bronchitis

A persistent or recurring condition or group of symptoms. Chronic disorders are customarily contrasted with acute diseases which start suddenly and last a short time. The symptoms of acute disease often include breathlessness, fever, severe pain and malaise, with the patient’s condition changing from day to day or even hour to hour. Those suffering from chronic conditions – for example, severe arthritis, protracted lung disease, ASTHMA or SILICOSIS – should be distinguished from those with a ‘static disability’ following a stroke or injury. Chronic disorders steadily deteriorate, often despite treatment and the patient is increasingly unable to carry out his or her daily activities.... chronic disorder

Coca leaves are obtained from two South American plants, Erythroxylum coca and Erythroxylum truxillense, and contain an alkaloid, cocaine. Cocaine has marked effects as a stimulant, and, locally applied, as an anaesthetic by paralysing nerves of sensation. The dried leaves have been used from time immemorial by the South American Indians, who chew them mixed with a little lime. Their e?ect is to dull the mucous surfaces of mouth and stomach, with which the saliva, produced by chewing them, comes into contact – thus blunting, for long periods, all feeling of hunger. The cocaine, being absorbed, stimulates the central nervous system so that all sense of fatigue and breathlessness vanishes for a time. It was by the use of coca that the Indian post-runners of South America were able to achieve their extraordinary feats of endurance. The continued use of the drug, however, results in emaciation, loss of memory, sleeplessness and general breakdown. DEPENDENCE on cocaine or a derivative, ‘crack’, is now a serious social problem in many countries.

Uses Before the serious effects that result from its habitual use were realised, the drug was sometimes used by hunters, travellers and others to relieve exhaustion and breathlessness in climbing mountains and to dull hunger. Derivatives of cocaine are used as locally applied analgesics via sprays or injections in dentistry and for procedures in the ear, nose and throat. Because of its serious side-effects and the risk of addiction, cocaine is a strictly controlled Class A drug which can be prescribed only by a medical practitioner with a Home O?ce licence to do so.... cocaine

SIMPLE GOITRE A benign enlargement of the THYROID GLAND with normal production of hormone. It is ENDEMIC in certain geographical areas where there is IODINE de?ciency. Thus, if iodine intake is de?cient, the production of thyroid hormone is threatened and the anterior PITUITARY GLAND secretes increased amounts of thyrotrophic hormone with consequent overgrowth of the thyroid gland. Simple goitres in non-endemic areas may occur at puberty, during pregnancy and at the menopause, which are times of increased demand for thyroid hormone. The only e?ective treament is thyroid replacement therapy to suppress the enhanced production of thyrotrophic hormone. The prevalence of endemic goitre can be, and has been, reduced by the iodinisation of domestic salt in many countries. NODULAR GOITRES do not respond as well as the di?use goitres to THYROXINE treatment. They are usually the result of alternating episodes of hyperplasia and involution which lead to permanent thyroid enlargement. The only e?ective way of curing a nodular goitre is to excise it, and THYROIDECTOMY should be recommended if the goitre is causing pressure symptoms or if there is a suspicion of malignancy. LYMPHADENOID GOITRES are due to the production of ANTIBODIES against antigens (see ANTIGEN) in the thyroid gland. They are an example of an autoimmune disease. They tend to occur in the third and fourth decade and the gland is much ?rmer than the softer gland of a simple goitre. Lymphadenoid goitres respond to treatment with thyroxine. TOXIC GOITRES may occur in thyrotoxicosis (see below), although much less frequently autonomous nodules of a nodular goitre may be responsible for the increased production of thyroxine and thus cause thyrotoxicosis. Thyrotoxicosis is also an autoimmune disease in which an antibody is produced that stimulates the thyroid to produce excessive amounts of hormone, making the patient thyrotoxic.

Rarely, an enlarged gland may be the result of cancer in the thyroid.

Treatment A symptomless goitre may gradually disappear or be so small as not to merit treatment. If the goitre is large or is causing the patient di?culty in swallowing or breathing, it may need surgical removal by partial or total thyroidectomy. If the patient is de?cient in iodine, ?sh and iodised salt should be included in the diet.

Hyperthyroidism is a common disorder affecting 2–5 per cent of all females at some time in their lives. The most common cause – around 75 per cent of cases – is thyrotoxicosis (see below). An ADENOMA (or multiple adenomas) or nodules in the thyroid also cause hyperthyroidism. There are several other rare causes, including in?ammation caused by a virus, autoimune reactions and cancer. The symptoms of hyperthyroidism affect many of the body’s systems as a consequence of the much-increased metabolic rate.

Thyrotoxicosis is a syndrome consisting of di?use goitre (enlarged thyroid gland), over-activity of the gland and EXOPHTHALMOS (protruding eyes). Patients lose weight and develop an increased appetite, heat intolerance and sweating. They are anxious, irritable, hyperactive, suffer from TACHYCARDIA, breathlessness and muscle weakness and are sometimes depressed. The hyperthyroidism is due to the production of ANTIBODIES to the TSH receptor (see THYROTROPHIN-STIMULATING HORMONE (TSH)) which stimulate the receptor with resultant production of excess thyroid hormones. The goitre is due to antibodies that stimulate the growth of the thyroid gland. The exoph-

thalmos is due to another immunoglobulin called the ophthalmopathic immunoglobulin, which is an antibody to a retro-orbital antigen on the surface of the retro-orbital EYE muscles. This provokes in?ammation in the retro-orbital tissues which is associated with the accumulation of water and mucopolysaccharide which ?lls the orbit and causes the eye to protrude forwards.

Although thyrotoxicosis may affect any age-group, the peak incidence is in the third decade. Females are affected ten times as often as males; the prevalence in females is one in 500. As with many other autoimmune diseases, there is an increased prevalence of autoimmune thyroid disease in the relatives of patients with thyrotoxicosis. Some of these patients may have hypothyroidism (see below) and others, thyrotoxicosis. Patients with thyrotoxicosis may present with a goitre or with the eye signs or, most commonly, with the symptoms of excess thyroid hormone production. Thyroid hormone controls the metabolic rate of the body so that the symptoms of hyperthyroidism are those of excess metabolism.

The diagnosis of thyrotoxicosis is con?rmed by the measurement of the circulating levels of the two thyroid hormones, thyroxine and TRIIODOTHYRONINE.

Treatment There are several e?ective treatments for thyrotoxicosis. ANTITHYROID DRUGS These drugs inhibit the iodination of tyrosine and hence the formation of the thyroid hormones. The most commonly used drugs are carbimazole and propylthiouricil: these will control the excess production of thyroid hormones in virtually all cases. Once the patient’s thyroid is functioning normally, the dose can be reduced to a maintenance level and is usually continued for two years. The disadvantage of antithyroid drugs is that after two years’ treatment nearly half the patients will relapse and will then require more de?nitive therapy. PARTIAL THYROIDECTOMY Removal of three-quarters of the thyroid gland is e?ective treatment of thyrotoxicosis. It is the treatment of choice in those patients with large goitres. The patient must however be treated with medication so that they are euthyroid (have a normally functioning thyroid) before surgery is undertaken, or thyroid crisis and cardiac arrhythmias may complicate the operation. RADIOACTIVE IODINE THERAPY This has been in use for many years, and is an e?ective means of controlling hyperthyroidism. One of the disadvantages of radioactive iodine is that the incidence of hypothyroidism is much greater than with other forms of treatment. However, the management of hypothyroidism is simple and requires thyroxine tablets and regular monitoring for hypothyroidism. There is no evidence of any increased incidence of cancer of the thyroid or LEUKAEMIA following radio-iodine therapy. It has been the pattern in Britain to reserve radio-iodine treatment to those over the age of 35, or those whose prognosis is unlikely to be more than 30 years as a result of cardiac or respiratory disease. Radioactive iodine treatment should not be given to a seriously thyrotoxic patient. BETA-ADRENOCEPTOR-BLOCKING DRUGS Usually PROPRANOLOL HYDROCHLORIDE: useful for symptomatic treatment during the ?rst 4–8 weeks until the longer-term drugs have reduced thyroid activity.

Hypothyroidism A condition resulting from underactivity of the thyroid gland. One form, in which the skin and subcutaneous tissues thicken and result in a coarse appearance, is called myxoedema. The thyroid gland secretes two hormones – thyroxine and triiodothyronine – and these hormones are responsible for the metabolic activity of the body. Hypothyroidism may result from developmental abnormalities of the gland, or from a de?ciency of the enzymes necessary for the synthesis of the hormones. It may be a feature of endemic goitre and retarded development, but the most common cause of hypothyroidism is the autoimmune destruction of the thyroid known as chronic thyroiditis. It may also occur as a result of radio-iodine treatment of thyroid overactivity (see above) and is occasionally secondary to pituitary disease in which inadequate TSH production occurs. It is a common disorder, occurring in 14 per 1,000 females and one per 1,000 males. Most patients present between the age of 30 and 60 years.

Symptoms As thyroid hormones are responsible for the metabolic rate of the body, hypothyroidism usually presents with a general sluggishness: this affects both physical and mental activities. The intellectual functions become slow, the speech deliberate and the formation of ideas and the answers to questions take longer than in healthy people. Physical energy is reduced and patients frequently complain of lethargy and generalised muscle aches and pains. Patients become intolerant of the cold and the skin becomes dry and swollen. The LARYNX also becomes swollen and gives rise to a hoarseness of the voice. Most patients gain weight and develop constipation. The skin becomes dry and yellow due to the presence of increased carotene. Hair becomes thinned and brittle and even baldness may develop. Swelling of the soft tissues may give rise to a CARPAL TUNNEL SYNDROME and middle-ear deafness. The diagnosis is con?rmed by measuring the levels of thyroid hormones in the blood, which are low, and of the pituitary TSH which is raised in primary hypothyroidism.

Treatment consists of the administration of thyroxine. Although tri-iodothyronine is the metabolically active hormone, thyroxine is converted to tri-iodothyronine by the tissues of the body. Treatment should be started cautiously and slowly increased to 0·2 mg daily – the equivalent of the maximum output of the thyroid gland. If too large a dose is given initially, palpitations and tachycardia are likely to result; in the elderly, heart failure may be precipitated.

Congenital hypothyroidism Babies may be born hypothyroid as a result of having little or no functioning thyroid-gland tissue. In the developed world the condition is diagnosed by screening, all newborn babies having a blood test to analyse TSH levels. Those found positive have a repeat test and, if the diagnosis is con?rmed, start on thyroid replacement therapy within a few weeks of birth. As a result most of the ill-effects of cretinism can be avoided and the children lead normal lives.

Thyroiditis In?ammation of the thyroid gland. The acute form is usually caused by a bacterial infection elsewhere in the body: treatment with antibiotics is needed. Occasionally a virus may be the infectious agent. Hashimoto’s thyroiditis is an autoimmune disorder causing hypothyroidism (reduced activity of the gland). Subacute thyroiditis is in?ammation of unknown cause in which the gland becomes painful and the patient suffers fever, weight loss and malaise. It sometimes lasts for several months but is usually self-limiting.

Thyrotoxic adenoma A variety of thyrotoxicosis (see hyperthyroidism above) in which one of the nodules of a multinodular goitre becomes autonomous and secretes excess thyroid hormone. The symptoms that result are similar to those of thyrotoxicosis, but there are minor di?erences.

Treatment The ?rst line of treatment is to render the patient euthyroid by treatment with antithyroid drugs. Then the nodule should be removed surgically or destroyed using radioactive iodine.

Thyrotoxicosis A disorder of the thyroid gland in which excessive amounts of thyroid hormones are secreted into the bloodstream. Resultant symptoms are tachycardia, tremor, anxiety, sweating, increased appetite, weight loss and dislike of heat. (See hyperthyroidism above.)... goitre

Heart disease can affect any of the structures of the HEART and may affect more than one at a time. Heart attack is an imprecise term and may refer to ANGINA PECTORIS (a symptom of pain originating in the heart) or to coronary artery thrombosis, also called myocardial infarction.

Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.

Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.

The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.

•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.

In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.

In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be

caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.

Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.

Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.

Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.

Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.

If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.

Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)

Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.

Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.

The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.

Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.

Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.

Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).

Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.

PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of

A craving for food or other substance necessary to bodily activity. Hunger for food is supposed to be directly produced by strong contractions of the stomach which occur when it is empty, or nearly so. (See also THIRST.)

Air hunger is an instinctive craving for oxygen resulting in breathlessness, either when a person ascends to great heights where the pressure of air is low, or in some diseases such as pneumonia and DIABETES MELLITUS which affect the body’s METABOLISM and therefore its need for oxygen – an essential constituent in this process.... hunger

Drugs used in pulmonary oedema (excess ?uid in the lungs) caused by failure of the left VENTRICLE of the HEART. DIURETICS cause an increase in excretion of URINE, thus reducing the amount of ?uid in the body. Intravenous administration of loop diuretics relieves patients’ breathlessness. They work by inhibiting resorption of ?uid in the renal tubule loops of the KIDNEYS. Frusemide and bumetanide are commonly used loop diuretic drugs that act quickly and last for six hours so that they can be given twice in 24 hours without disturbing the patient’s sleep.... loop diuretics

This is an irritant poison that is used domestically for cleaning purposes. It is also found in many plants including rhubarb and sorrel. Oxalic acid, when swallowed, produces burning of the mouth and throat, vomiting of blood, breathlessness and circulatory collapse. Calcium salts, lime water or milk should be given by mouth. An injection of calcium gluconate is an antidote.... oxalic acid

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

PNEUMONIA caused by a species of the genus of PROTOZOA, a parasitic micro-organism. Pneumocystis carinii causes an opportunistic infection in the lung which is dangerous to people whose immune system is impaired (see IMMUNITY), thus reducing their resistance to infections. People with AIDS/HIV or LEUKAEMIA have impaired immune systems and P. carinii is a major cause of death in the former. Fever, dry cough and breathlessness are among the symptoms; treatment is with high doses of antibiotic drugs such as CO-TRIMOXAZOLE or PENTAMIDINE.... pneumocystis pneumonia

A condition which may develop in both LUNGS (interstitial pulmonary ?brosis) or part of one lung. Scarring and thickening of lung tissues occur as a consequence of previous lung in?ammation, which may have been caused by PNEUMONIA or TUBERCULOSIS. Symptoms include cough and breathlessness and diagnosis is con?rmed with a chest X-ray. The patient’s underlying condition should be treated, but the damage already done to lung tissue is usually irreversible. (See also ALVEOLITIS.)... pulmonary fibrosis

A disorder of the HEART in which obstruction of the out?ow of blood from the right ventricle occurs. Narrowing of the pulmonary valve at the exit of the right ventricle and narrowing of the pulmonary artery may cause obstruction. The condition is usually congenital, although it may be caused by RHEUMATIC FEVER. In the congenital condition, pulmonary stenosis may occur with other heart defects and is then known as Fallot’s tetralogy. Breathlessness and enlargement of the heart and eventual heart failure may be the consequence of pulmonary stenosis. Surgery is usually necessary to remove the obstruction.... pulmonary stenosis

A de?ciency of glucose in the blood – the normal range being 3·5–7·5 mmol/l (see DIABETES MELLITUS). It most commonly occurs in diabetic patients – for example, after an excessive dose of INSULIN and heavy exercise, particularly with inadequate or delayed meals. It may also occur in non-diabetic people, however: for example, in very cold situations or after periods of starvation. Hypoglycaemia is normally indicated by characteristic warning signs and symptoms, particularly if the blood glucose concentration is falling rapidly. These include anxiety, tremor, sweating, breathlessness, raised pulse rate, blurred vision and reduced concentration, leading – in severe cases – to unconsciousness. Symptoms may be relieved by taking some sugar, some sweet biscuits or a sweetened drink. In emergencies, such as when the patient is comatose (see COMA), an intramuscular injection of GLUCAGON or intravenous glucose should be given. Early treatment is vital, since prolonged hypoglycaemia, by starving the brain cells of glucose, may lead to irreversible brain damage.... hypoglycaemia

This occurs as a result of left ventricular failure (see HEART, DISEASES OF). There is an abrupt increase in the venous and capillary pressure in the pulmonary vessels, followed by ?ooding of ?uid into the interstitial spaces and alveoli. The commonest cause of acute pulmonary oedema is myocardial infarction (see HEART, DISEASES OF) which reduces the ability of the left ventricular myocardial muscle to handle the blood delivered to it. Pulmonary oedema may result from other causes of left ventricular failure such as HYPERTENSION or valvular disease of the mitral and aortic valves. The initial symptoms are cough with breathlessness and occasionally with wheezing (once called ‘cardiac asthma’). The patient becomes extremely short of breath and in a severe attack the patient is pale, sweating and cyanosed and obviously gasping for breath. Frequently, frothy sputum is produced which may be blood-stained. Treatment is with DIURETICS and measures to deal with the myocardial infarction or other underlying cause.... oedema of the lungs

A tranquilliser is a popular name for a drug which induces a mental state free from agitation and anxiety, and renders the patient calm. Tranquillisers are classi?ed as major and minor. The former are used to treat psychotic illness such as SCHIZOPHRENIA; the latter are sedatives used to treat anxiety and emotional upsets (see NEUROSIS) and are called antianxiety drugs or ANXIOLYTICS. Major tranquillisers or antipsychotic drugs are given to patients with psychotic disorders which disrupt their normal lives (see PSYCHOSIS). They do not cure the patient, but do help to control his or her symptoms so that the person can live in the community and be admitted to hospital only for acute episodes. The drug chosen depends upon the type of illness and needs of a particular patient as well as the likely adverse effects. Antipsychotic drugs modify the transmission of nerve-signals by making brain cells less sensitive to the excitatory neurotransmitter chemical called DOPAMINE. Among the antipsychotic tranquillisers are CHLORPROMAZINE, HALOPERIDOL, CLOZAPINE and ?upenthixol.

Anxiety is a consequence of too much STRESS and may occur without being serious enough to need treatment. Clinically it arises when the balance between certain chemicals in the brain is disturbed: this increases activity in the sympathetic system, thus provoking physical symptoms such as breathlessness, tachycardia, headaches and indigestion. Anxiolytics help to alleviate these symptoms but do not necessarily cure the underlying cause. Two main classes of drug relieve anxiety: BENZODIAZEPINES and beta blockers (see BETA-ADRENOCEPTORBLOCKING DRUGS). The latter, which include atenolol and propanolol, reduce the physical symptoms such as tachycardia and are useful in circumstances – for example, examinations – known to cause anxiety attacks. They block the action of NORADRENALINE, a key chemical of the sympathetic nervous system. Benzodiazepines depress activity in that part of the brain controlling emotion by stimulating the action of a chemical called gammaaminobutyric acid (GABA). Among the benzodiazepines are chlordiazepoxide and diazepam. (See also MENTAL ILLNESS.)... tranquillisers

Unreasonable fear of crowded places and of being unable to escape from a confined space, with symptoms of breathlessness, tension and stress. Treatment as for anxiety. See: ANXIETY STATES. ... claustrophobia

Excessive anxiety about the condition of the heart, usually following a myocardial infarction (heartattack) or heart surgery but sometimes occurring when there is no previous heart trouble. The person experiences symptoms, such as breathlessness and chest pain, that are typical of heart disease, and may be reluctant to exercise or work for fear of an attack. Medical investigation reveals no physical cause. Psychotherapy may be of benefit.... cardiac neurosis

One of a group of tests used to assess the function of the heart in people who experience chest pain, breathlessness, or palpitations during exercise. The test establishes whether the patient has coronary artery disease. An ECG machine records the patterns of the heart’s electrical activity while the heart is stressed. This is usually achieved by the patient exercising on a treadmill or cycling. Specific changes in the electrical pattern as exercise levels increase indicate angina. Cardiac stress testing may be used in conjunction with radionuclide scanning to identify damaged areas of heart muscle.... cardiac stress test

Various conditions affecting the LUNGS are dealt with under the following headings: ASTHMA; BRONCHIECTASIS; CHEST, DEFORMITIES OF; CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD); COLD, COMMON; EMPHYSEMA; EXPECTORATION; HAEMOPTYSIS; HAEMORRHAGE; OCCUPATIONAL HEALTH, MEDICINE AND DISEASES; PLEURISY; PNEUMONIA; PULMONARY EMBOLISM; TUBERCULOSIS.

In?ammation of the lungs is generally known as PNEUMONIA, when it is due to infection; as ALVEOLITIS when the in?ammation is immunological; and as PNEUMONITIS when it is due to physical or chemical agents.

Abscess of the lung consists of a collection of PUS within the lung tissue. Causes include inadequate treatment of pneumonia, inhalation of vomit, obstruction of the bronchial tubes by tumours and foreign bodies, pulmonary emboli (see EMBOLISM) and septic emboli. The patient becomes generally unwell with cough and fever. BRONCHOSCOPY is frequently performed to detect any obstruction to the bronchi. Treatment is with a prolonged course of antibiotics. Rarely, surgery is necessary.

Pulmonary oedema is the accumulation of ?uid in the pulmonary tissues and air spaces. This may be caused by cardiac disease (heart failure or disease of heart valves – see below, and HEART, DISEASES OF) or by an increase in the permeability of the pulmonary capillaries allowing leakage of ?uid into the lung tissue (see ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)).

Heart failure (left ventricular failure) can be caused by a weakness in the pumping action of the HEART leading to an increase in back pressure which forces ?uid out of the blood vessels into the lung tissue. Causes include heart attacks and HYPERTENSION (high blood pressure). Narrowed or leaking heart valves hinder the ?ow of blood through the heart; again, this produces an increase in back pressure which raises the capillary pressure in the pulmonary vessels and causes ?ooding of ?uid into the interstitial spaces and alveoli. Accumulation of ?uid in lung tissue produces breathlessness. Treatments include DIURETICS and other drugs to aid the pumping action of the heart. Surgical valve replacement may help when heart failure is due to valvular heart disease.

Acute respiratory distress syndrome Formerly known as adult respiratory distress syndrome (ARDS), this produces pulmonary congestion because of leakage of ?uid through pulmonary capillaries. It complicates a variety of illnesses such as sepsis, trauma, aspiration of gastric contents and di?use pneumonia. Treatment involves treating the cause and supporting the patient by providing oxygen.

Collapse of the lung may occur due to blockage of a bronchial tube by tumour, foreign body or a plug of mucus which may occur in bronchitis or pneumonia. Air beyond the blockage is absorbed into the circulation, causing the affected area of lung to collapse. Collapse may also occur when air is allowed into the pleural space – the space between the lining of the lung and the lining of the inside of the chest wall. This is called a pneumothorax and may occur following trauma, or spontaneously

– for example, when there is a rupture of a subpleural air pocket (such as a cyst) allowing a communication between the airways and the pleural space. Lung collapse by compression may occur when ?uid collects in the pleural space (pleural e?usion): when this ?uid is blood, it is known as a haemothorax; if it is due to pus it is known as an empyema. Collections of air, blood, pus or other ?uid can be removed from the pleural space by insertion of a chest drain, thus allowing the lung to re-expand.

Tumours of the lung are the most common cause of cancer in men and, along with breast cancer, are a major cause of cancer in women. Several types of lung cancer occur, the most common being squamous cell carcinoma, small- (or oat-) cell carcinoma, adenocarcinoma, and large-cell carcinoma. All but the adenocarcinoma have a strong link with smoking. Each type has a di?erent pattern of growth and responds di?erently to treatment. More than 30,000 men and women die of cancer of the trachea, bronchus and lung annually in England and Wales.

The most common presenting symptom is cough; others include haemoptisis (coughing up blood), breathlessness, chest pain, wheezing and weight loss. As well as spreading locally in the lung – the rate of spread varies – lung cancer commonly spawns secondary growths in the liver, bones or brain. Diagnosis is con?rmed by X-rays and bronchoscopy with biopsy.

Treatment Treatment for the two main categories of lung cancer – small-cell and nonsmall-cell cancer – is di?erent. Surgery is the only curative treatment for the latter and should be considered in all cases, even though fewer than half undergoing surgery will survive ?ve years. In those patients unsuitable for surgery, radical RADIOTHERAPY should be considered. For other patients the aim should be the control of symptoms and the maintenance of quality of life, with palliative radiotherapy one of the options.

Small-cell lung cancer progresses rapidly, and untreated patients survive for only a few months. Because the disease is often widespread by the time of diagnosis, surgery is rarely an option. All patients should be considered for CHEMOTHERAPY which improves symptoms and prolongs survival.

Wounds of the lung may cause damage to the lung and, by admitting air into the pleural cavity, cause the lung to collapse with air in the pleural space (pneumothorax). This may require the insertion of a chest drain to remove the air from the pleural space and allow the lung to re-expand. The lung may be wounded by the end of a fractured rib or by some sharp object such as a knife pushed between the ribs.... lungs, diseases of

Any of a group of salts of hydrocyanic acid. Most are highly poisonous; inhalation or ingestion can rapidly lead to breathlessness, paralysis, and death.... cyanide

An accumulation of pus in a body cavity or in certain organs.

Empyema can occur around a lung as a rare complication of an infection such as pneumonia or pleurisy.

The main symptoms are chest pain, breathlessness, and fever.

Treatment is by aspiration (removal of the pus by suction) and the injection of antibiotic drugs, or by an operation to open the chest cavity and drain the pus.

Empyema of the gallbladder may occur as a complication of cholecystitis, when it causes abdominal pain, fever, and jaundice.

It is treated by surgical removal of the gallbladder.... empyema

A complication of a bone marrow transplant in which immune system cells in the transplanted marrow attack the recipient’s tissues. Graft-versus-host (GVH) disease may occur soon after transplantation or appear some months later. The first sign is usually a skin rash. This may be followed by diarrhoea, abdominal pain, jaundice, inflammation of the eyes and mouth, and breathlessness.

GVH disease can usually be prevented by administration of immunosuppressant drugs. If the disease develops, it can be treated with corticosteroid drugs and immunosuppressant drugs such as ciclosporin In some cases, however, it can be difficult to control.... graft-versus-host disease

A blood condition due to abnormal destruction of red blood cells in the spleen.

Causes: hereditary background with deficiency of cell enzymes or cell membrane weakness; wrongly matched blood transfusion, environmental chemicals, food additives, colourings, drugs, infections. Symptoms. Pale face, sore tongue, headache, dizziness, palpitations, breathlessness, angina, weakness, loss of weight and appetite, jaundice (yellow skin), feverishness, vague aches and pains, enlarged spleen and pain under left ribs.

Treatment. Under hospital supervision.

Echinacea has a long reputation for regeneration of red blood cells: experience shows it beneficial for this type of anaemia. To assist control of symptoms: Gentian, Motherwort, Mugwort, Barberry, Hops, Saw Palmetto.

Bitter herbs stimulate the stomach, liver and pancreas. By increasing the appetite they benefit digestion and are given half an hour before meals by tea or decoction: Hops, Quassia chips, Angostura, Feverfew, Bogbean.

Formula. Tea. Milk Thistle 2; Betony 1; Hops 1. Mix. 1-2 teaspoon to each cup boiling water. Infuse 5-15 minutes. 1 cup, thrice daily.

Decoction. Echinacea 1; Sarsaparilla 1; Peruvian bark half; Saw Palmetto half. Mix. 2 teaspoons to 2 cups water, simmer gently 20 minutes. Half a cup, cold, thrice daily before meals.

For weak heart add one part Hawthorn; neurasthenia (Ginkgo); swelling of ankles (Lily of the Valley); loss of hormonal balance (Ginseng).

Prognosis. Surgical removal of spleen may be necessary.

Diet. Dandelion coffee, molasses, desiccated or fresh calves’ liver. Green leafy vegetables, dried beans, apricots. Shellfish, milk, eggs, Soya, meats. Supplements. Daily. Vitamin B12 1mg; Vitamin C, 1g; Folic acid 400mcg; Floradix. ... anaemia: haemolytic

An estimated 15 per cent of the female population suffers from this form of anaemia. A deficiency of nutritional iron is responsible for oxygen starvation of the blood due to insufficient haemoglobin. Number of red cells is reduced.

Aetiology: heavy menstrual loss, feeble constitution from hereditary weakness, poor diet, hidden or known blood loss from gastric ulcer, pregnancy, bleeding piles or insufficient food minerals: iron, copper, calcium, etc, chronic liver or kidney disease, worms, anorexia nervosa, rheumatoid arthritis, tuberculosis. Symptoms. Tiredness, dizziness, breathlessness, palpitations, pale face and mucous membranes. White of eyes may be blue. Enlarged flabby tongue often bears impression of teeth marks. Hair lifeless, fingernails brittle and ridged. There may be angina, tinnitus and general reduced efficiency.

Treatment. The object is to achieve absorption of iron to raise normal haemoglobin levels and increase red cells. Echinacea has a reputation for regeneration of red cells. Herbs used with success: Echinacea, Gentian, Motherwort, Mugwort, Barberry, Hops, Nettles, Saw Palmetto, Chaparral, Red Clover, Dandelion.

Bitter herbs stimulate absorption of vital nutrients from the stomach, toning liver and pancreas, increasing the appetite; usually given half hour before meals. See: BITTERS.

Gentian. 1 teaspoon fine-cut chips to 2 cups cold water steeped 8 hours (overnight). Dose: Half-1 cup thrice daily before meals.

Tea. Formula. Combine: Agrimony 1; Barberry bark 1; Nettles 2; White Poplar bark half. Place 1oz (30g) in 1 pint (500ml) cold water and bring to boil. Simmer 10 minutes. Drink cold: Half-1 cup thrice daily, before meals.

Powders. Formula. Echinacea 2; Gentian 1; Kelp 1; pinch Red Pepper. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.

Liquid extracts. Formula: Echinacea 1; Queen’s Delight 1; Ginseng 1; Ginger quarter. Dose: 30-60 drops in water, thrice daily, before meals.

Infusion Gentian Co Conc BP (1949). Dose: 30-60 drops.

Diet. Dandelion coffee, as desired. Molasses. Desiccated liver.

Floradix. A pre-digested iron preparation. Readily assimilable by the body. Compounded by Dr Otto Greither (Salus Haus). Iron is fed onto yeast which breaks down the metal and absorbs its cells. Other tonic ingredients include extracts of nettles, carrots, spinach, fennel, Vitamin C plus supplements;

Angelica root, Mallow, Horsetail, Yarrow, Juniper and Rosehips. Not chemically preserved.

Avoid chocolate, egg yolk, tea, coffee, wheat bran.

Supplements. Daily. Vitamin C (1g morning and evening). Vitamin B12, Folic acid 400mcg. Vitamin C is the most potent enhancer of iron absorption. Multivitamin containing iron.

Note: Iron absorption is decreased by antacids, tetracyclines, phosphates, phytates (phytic acid from excessive intake of wholewheat bread), and excessive calcium supplements. Lack of stomach hydrochloric acid impairs iron absorption, especially in the elderly. ... anaemia: iron deficiency

A collection of blood in the pleural cavity (see pleura).

Haemothorax is most commonly caused by chest injury, but it may arise spontaneously in people with defects of blood coagulation or as a result of cancer.

Symptoms include pain in the affected side of the chest and upper abdomen, and breathlessness.

If extensive, there may be partial lung collapse.

Blood in the pleural cavity is withdrawn through a needle.... haemothorax

Inflammation of the heart muscle, usually due to infection by the coxsackievirus. Myocarditis is a characteristic feature of rheumatic fever.

There are often no symptoms. Rarely, there may be a serious disturbance of the heartbeat, breathlessness, chest pain, and heart failure. In severe cases, death may result from cardiac arrest.Myocarditis may be suspected from the patient’s history and from a physical examination. An ECG will show characteristic abnormalities of the heartbeat. Diagnosis also involves echocardiography and blood tests.

There is no specific treatment.

Bed rest is usually recommended and corticosteroid drugs may be prescribed.... myocarditis

Awareness of the heartbeat or a sensation of having a rapid and forceful heartbeat. Palpitations are usually felt in tense situations, or after strenuous exercise or a scare. When

experienced at rest or when calm, they are usually due to ectopic heartbeats and are felt as fluttering or thumping in the chest.

Palpitations may also be due to cardiac arrhythmias and hyperthyroidism.

Recurrent palpitations, or those causing chest pain, breathlessness, or dizziness, may be investigated by a 24-hour ECG and thyroid function tests.

Treatment depends on the cause.... palpitation

A term that describes physical disorders that seem to have been caused, or made worse, by psychological factors. Common examples of conditions that may be psychosomatic are headache, breathlessness, nausea, asthma, irritable bowel syndrome, peptic ulcer, and types of eczema. (See also somatization disorder.)... psychosomatic

A local widening (dilatation) in the wall of an artery usually the aorta or a major artery. May grow into a pulsating tumour and finally burst. Situation is important; aneurysm in chest, abdomen or head being most at risk. Where not due to excessive athletic performance, it is a sign that arteries are already diseased. Excessive athletic exercise and high living predispose.

Usually painless, it is recognised by touch as a round swelling about the size of a plum and visibly expands and contracts with each heart beat. A difference in the pulse on both sides of the body or inequality of pupils of the eyes may determine diagnosis. Tendency for blood to clot, indicating need for large doses of Vitamin E to prevent formation of a solid mass.

Symptoms: breathlessness, difficult swallowing, cough, change in tone of voice.

Treatment: Directed towards reduction of volume of blood and blood pressure. Rest in bed.

Teas: Single or in combination. Yarrow, Cactus flowers, Motherwort.

Tinctures: Lily of the Valley 1; Pulsatilla 1; Hawthorn 2. Dose: 10-30 drops in water thrice daily. Practitioner: Tincture Selenicereus grand, 10ml . . . Tincture Crataegus Oxy., 20ml . . . Tincture Pulsatilla, 10ml . . . Tincture Scutellaria lat., 10ml. Aqua to 100ml. Dose: 5ml (3i) tds aq. cal. pc.

Diet. See: DIET – HEART AND CIRCULATION. ... aneurysm

The ‘English Disease’. The result of repeated attacks of the acute condition. Menace to the elderly when bronchi becomes thickened and narrowed. Inelastic walls secrete a thick purulent mucus of fetid odour which plugs tubes and arrests oxygen intake. Aggravated by cold and damp, hence the need of a warm house with warm bedroom. Causes are many: smoking, industrial pollution irritants, soot, fog, etc. Breathlessness and audible breathing sounds may present an alarming spectacle.

A steady herbal regime is required including agents which may coax sluggish liver or kidneys into action (Dandelion, Barberry). Sheer physical exhaustion may require Ginseng. For purulent sputum – Boneset, Elecampane, Pleurisy root. To increase resistance – Echinacea. Where due to tuberculosis – Iceland Moss. For blood-streaked mucus – Blood root. For fever – Elderflowers, Yarrow. To conserve cardiac energies – Hawthorn, Motherwort. A profuse sweat affords relief – Elderflowers.

Alternatives. Capsicum, Ephedra, Fenugreek, Garlic, Grindelia, Holy Thistle, Iceland Moss, Lobelia, Mullein, Pleurisy Root, Wild Cherry.

Tea. Formula. Iceland Moss 2; Mullein 1; Wild Cherry bark 1. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily.

Powders. Pleurisy root 2; Echinacea 1; Holy Thistle 1. Pinch Ginger. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Tinctures. Formula. Iceland Moss 2; Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 1-2 teaspoons two or more times daily.

Practitioner. Liquid Extract Ephedra BHP (1983), dose 1-3ml. Or: Tincture Ephedra BHP (1983), dose 6-8ml.

Topical. Same as for acute bronchitis.

Note: In a test at Trafford General Hospital, Manchester, blowing-up balloons proved of benefit to those with chronic bronchitis. Fourteen patients were asked to inflate balloons and 14 refrained from doing so. After 8 weeks, the balloon-blowers showed considerable improvement in walking and a sense of well- being. Breathlessness was reduced. Condition of the others was either unchanged or worse. ... bronchitis, chronic

Accumulation of fluid in the lungs, usually due to leftsided heart failure. It may also be due to chest infection, inhalation of irritant gases, or to any of the causes of generalized oedema. The main symptom is breathlessness, which is usually worse when lying flat and may disturb sleep. There may be a cough, producing frothy, sometimes pink, sputum. Breathing may sound bubbly or wheezy.

A diagnosis is made by a physical examination and by a chest X-ray. Treatment may include morphine, diuretic drugs, aminophylline, and oxygen therapy; artificial ventilation may also be given.... pulmonary oedema

Atheroma is a name given to the disease where fatty and mineral deposits attach themselves to the walls of the arteries. Usually starts from a deposit of cholesterol which leaks into the inner surface of the artery causing a streak of fat to appear within the wall. As the fatty streak grows deeper tissue within the arterial wall is broken down and the mechanism for clotting blood is triggered. The result is formation of atheromatous plaque that may clog an artery, precipitate a clot (known as an embolism) and travel to a smaller artery which could become blocked. The end result of atherosclerosis is invariably arteriosclerosis in which thickening and hardening leads to loss of elasticity.

Atherosclerosis can be the forerunner of degenerative heart and kidney disease, with rise in blood pressure.

A study of Australian ’flu epidemic diseases revealed influenza as a major cause of cardiovascular disease and in particular, atherosclerosis.

Causes. Excessive smoking and alcohol, fatty foods, hereditary weakness, stress and emotional tension that release excessive adrenalin into the bloodstream. Toxic effects of environmental poisons (diesel fumes). Fevers.

Symptoms. Cold hands and feet, headache, giddiness. Diminished mental ability due to thickening of arteries in the brain. Pain on exertion, breathlessness and fatigue. Diagnosis of atheroma of main arteries: by placing stethoscope over second right intercostal space, half inch from the sternum, the second aortic sound will be pronounced.

Treatment. Surface vasodilators, Cardioactives. Anti-cholesterols.

Alternatives. Teas. To lower cholesterol levels and shrink hardened plaque: Alfalfa, Chamomile, Borage, Olive leaves, Mint, Nettles, Marigold, Garlic, Lime flowers, Yarrow, Horsetail, Hawthorn, Ginkgo, Orange Tree leaves, Meadowsweet, Eucalyptus leaves, Ispaghula, Bromelain. Rutin (Buckwheat tea).

Artichoke leaves. Spanish traditional. 2 teaspoons to each cup of water; simmer 2 minutes. Drink cold: 1 cup 2-3 times daily.

Mistletoe leaves. 1-2 teaspoons to each cup cold water steeped 8 hours (overnight). Half-1 cup thrice daily.

Tablets, or capsules. Garlic, Mistletoe, Poke root, Rutin, Hawthorn, Motherwort, Ginkgo, Bamboo gum. Liquid Extracts. Mix Hawthorn 2; Mistletoe 1; Barberry 1; Rutin 1; Poke root half. Dose: 30-60 drops thrice daily.

Tinctures. Mix: Hawthorn 2; Cactus flowers 2; Mistletoe 1; Capsicum half. Dose: 1-2 teaspoons thrice daily in water before meals.

Powders. Mix equal parts: Bamboo gum, Hawthorn, Mistletoe, Rutin, Ginger. Fill 00 capsules. Dose: 2-4 capsules, or quarter to half a teaspoon (375-750mg) thrice daily before meals.

Threatened stroke. Tincture Arnica BPC (1949): 3-5 drops in water morning and evening. Practitioner only.

Evening Primrose oil. Favourable results reported. (Maxepa)

Diet. Vegetarian. Low fat. Low salt. High fibre. Lecithin, polyunsaturated oils, artichokes, oily fish (see entry). Linseed on breakfast cereal. Garlic at meals, or Garlic tablets or capsules at night to reduce cholesterol.

Vitamins. A, B-complex, B6, B12, C (2g), E (400iu), daily.

Minerals. Chromium, Iodine, Potassium, Selenium, Magnesium, Manganese, Zinc.

“A man is as old as his arteries” – Thomas Sydenham, 17th century physician.

“A man’s arteries are as old as he makes them” – Robert Bell MD, 19th century physician. ... atherosclerosis

Dropsy of heart origin is distinguished from renal dropsy by an increase in oedema as the day proceeds. In the morning there may be no swelling but by the evening legs become swollen from the ankles upwards. Fluids stagnate in the tissues from inability of the heart to perform efficiently as a pump. The condition is a symptom of heart failure with increasing breathlessness which may lead to general dropsy.

Symptoms: worse after exercise, breathlessness, headache, general weakness, feeble pulse, pale face, skin cold, swollen tissues pit on pressure.

Treatment. Alternatives:– Teas. Black Cohosh, Broom tops, Buchu, Dandelion, Hawthorn, Parsley root. Tea. Formula. Equal parts: Broom tops, Motherwort, Yarrow. 2 teaspoons to each cup water brought to boil and simmered 5 minutes in covered vessel. 1 cup 3-4 times daily.

Tablets/capsules. Buchu, Dandelion, Hawthorn, Juniper, Motherwort.

Formula. Dandelion 2; Hawthorn 2; Stone root 1. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily.

Practitioner. Lily of the Valley, BPC 1934: 5-20 drops, 2-3 times daily.

Squills, tincture: resembles Digitalis in action. Dose: 1-3 drops, as prescribed.

Tinctures. Dandelion 2; Lily of the Valley 2; Stone root 1; Cayenne (tincture) quarter. Mix. Dose: 1 to 2 teaspoons thrice daily.

Popular formula. Tincture Scilla 5.0; Tincture Crataegus 10.0; Tincture Valerian to make 30.0. 15 drops thrice daily. (German Extemporaneous Formulae)

Diet. High protein. See: DIET – HEART AND CIRCULATION. ... cardiac dropsy

An open wound in the chest wall through which air passes, causing the lung on that side to collapse.

Severe breathlessness and a life-threatening lack of oxygen result.... sucking chest wound

Compression of the heart by fluid within the pericardium, which may cause breathlessness and collapse.

Causes include pericarditis, complications after heart surgery, or a chest injury.

A diagnosis is made by echocardiography, and the fluid is removed through a needle.... tamponade

A form of angina that causes chest pain at rest, often during sleep.

The pain may occur with breathlessness and palpitations.

The cause is thought to be narrowing of the coronary arteries by muscular spasm in their walls.

Treatment with calcium channel blockers or nitrates is usually effective.... variant angina

the characteristic appearance of a patient suffering from heart failure as a result of *chronic obstructive pulmonary disease, marked by *cyanosis, oedema, and breathlessness at rest. The left ventricle of the heart is enlarged (see cor pulmonale).... blue bloater

a form of congenital heart disease affecting the right side of the heart: the tricuspid valve is displaced towards the apex to a varying extent, resulting in impaired right ventricular function. It can cause breathlessness, *failure to thrive, cyanosis, and abnormalities of heart rhythm, although if mild it may be asymptomatic. If mild, life expectancy is normal. If severe, corrective surgery may be necessary. [W. Ebstein (1836–1912), German physician]... ebstein’s anomaly

The cause of: coronary occlusion, coronary blockage, coronary thrombosis. A heart attack occurs when a coronary artery becomes blocked by swellings composed, among other things, of cholesterol. Such swellings may obstruct the flow of blood leading to a blood clot (thrombus). Cholesterol is a major cause of CHD.

Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.

Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.

The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.

For cholesterol control target the liver. Coffee is a minor risk factor.

Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)

Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)

Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.

Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.

Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.

Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.

Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.

Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.

Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.

Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.

Prevention: Vitamin E – 400iu daily.

Diet. See: DIET – HEART AND CIRCULATION.

Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.

Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease

n. thickening and scarring of connective tissue, most often a consequence of inflammation or injury. Pulmonary interstitial fibrosis is thickening and stiffening of the lining of the air sacs (alveoli) of the lungs, causing progressive breathlessness. See also cystic fibrosis; retroperitoneal fibrosis. —fibrotic adj.... fibrosis

Two types – simple and ulcerative. Inflammation of the membrane lining of the heart with the appearance of small fibrin accumulations on the valves. These may form during a specific fever – rheumatic, scarlet, etc, due to bacterial infection. In Bacterial Endocarditis, fragments of tissue may be shed from the main seat of infection and borne to other parts of the body, promoting inflammation or ischaemia elsewhere.

Affects more women than men, ages 20 to 40 years. Most cases have a history of rheumatic fever as a child. Thickening of the valves renders them less efficient in regulating the flow of blood through the heart thus allowing leakage by improper closure. Increased effort is required from the heart muscle to pump blood through the narrowed valves giving rise to fatigue and possible heart failure.

Prolapsus of the mitral valve is now recognised as predisposing to bacterial endocarditis. It is concluded that herbal antibiotic prophylaxis is justified in heart patients undergoing dental extraction, or other surgery where there is exposure to infection.

Symptoms: Breathlessness on exertion. Swelling of legs and ankles, palpitations, fainting, blue tinge to the skin and a permanent pink flush over the cheek bones. Clubbing of fingers. Enlarged spleen. Stethoscope reveals valvular regurgitation. The most common organism remains streptococcus viridans, by mouth. It may reach the heart by teeth extraction, scaling and intensive cleaning which may draw blood, posing a risk by bacteria.

Treatment. Acute conditions should be under the authority of a heart specialist in an Intensive Care Unit.

Absolute bedrest to relieve stress on the heart’s valves. For acute infection: Penicillin (or other essential antibiotics). Alternatives, of limited efficacy: Echinacea, Myrrh, Wild Indigo, Nasturtium, Holy Thistle. Avoid: excitement, chills, colds, fatigue and anything requiring extra cardiac effort. Convalescence will be long (weeks to months) during which resumption to normal activity should be gradual.

Aconite. With full bounding pulse and restless fever. Five drops Tincture Aconite to half a glass (100ml) water. 2 teaspoons hourly until temperature falls.

To sustain heart. Tincture Convallaria (Lily of the Valley), 5-15 drops, thrice daily.

To stimulate secretion of urine. Tincture Bearberry, 1-2 teaspoons, thrice daily.

Rheumatic conditions. Tincture Colchicum, 10-15 drops, thrice daily.

Various conventional treatments of the past can still be used with good effect: Tincture Strophanthus, 5 to 15 drops. Liquid Extract Black Cohosh, 15 to 30 drops. Spirits of Camphor, 5 to 10 drops. Bugleweed (American), 10 to 30 drops. To increase body strength: Echinacea. To sustain heart muscle: Hawthorn. Endocarditis with severe headache: Black Cohosh.

Teas: single or in combination (equal parts) – Nettles, Motherwort, Red Clover flowers, Lime flowers. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.

Decoction: equal parts: Hawthorn berries, Echinacea root, Lily of the Valley leaves. Mix. 2 teaspoons to each 2 cups water in a non-aluminium vessel, gently simmer 10 minutes. Dose: 1 cup 2-3 times daily. Formula. Echinacea 20; Cactus 10; Hawthorn 10; Goldenseal 2. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily.

Diet. See entry: DIET – HEART AND CIRCULATION. Pineapple juice. Treatment by or in liaison with general medical practitioner or cardiologist. ... endocarditis

Ephedra sinica stapf., Ephedra equisentina Bunge and Ephedra gerardiana Wall (including Ephedra nebrodensis Tineo). Twigs. German: Meertra?ubchen. French: Ephe?dre. Italian: Uva di mare. Iranian: Huma. Japanese: Ma oh. Indian: Butshur. Chinese: Ma Huang.

Constituents: Alkaloids – ephedrine, pseudoephedrine.

Action: brain, heart and circulatory stimulant, antasthmatic, bronchodilator, anti-allergic, vasodilator, hypertensive, diaphoretic. Dilates vessels of the heart causing a rise in blood pressure. Cough sedative. Febrifuge, antispasmodic. The essential oil has antibacterial and antiviral properties.

Uses: Practitioner’s first choice for asthma. Bronchitis, breathlessness, whooping cough. Used for such chest conditions for over a millennia in Chinese medicine.

Allergies: hay fever, irritative skin rashes. Low blood pressure. Hypothermia. Bed-wetting. Myasthenia gravis BHP (1983). Chinese Barefoot doctors inject the tea into nostrils for hay fever.

Usually given with expectorants: Liquorice, Lobelia, Senega, Sundew. “Combines well with Lobelia and Skunk Cabbage for bronchitis; and with Horsetail for frequency of urine.” (Fletcher Hyde) Contra-indications: hypertension, coronary thrombosis, thyrotoxicosis, glaucoma. Not given with anti- depressants (MAO inhibitors).

Preparations: Thrice daily. Average dose: 15-60mg.

Tea. Quarter to half a teaspoon herb to cup water simmered gently 5 minutes. Half a cup. Liquid extract. BHP (1983) 1:1 in 45 per cent alcohol. Dose: 15-45 drops (1-3ml). Tincture BHP (1983) 1 part to 4 parts 45 per cent alcohol. Dose: 6-8ml.

Ephedrine. Maximum dose: 30mg. Maximum daily dose 60mg.

Store in airtight container out of the light. Pharmacy only medicine. Practitioners only. ... ephedra

n. a drug used to control irregular heart rhythms (see arrhythmia). Possible side-effects include oedema, dizziness, vertigo, breathlessness, fever, and visual disturbances.... flecainide

depression of the breastbone and inward curving of the costal cartilages articulating with it, resulting in deformity of the chest. It may displace the heart to the left and can cause slight breathlessness. Medical name: pectus excavatum.... funnel chest

a collection of symptoms resulting from an increase in the viscosity of blood. These symptoms include epistaxis (nosebleed), blurred vision, dizziness, headaches, drowsiness, confusion, and breathlessness. Hyperviscosity of the blood occurs in conditions such as polycythaemia, plasma-cell myeloma, leukaemia, and Waldenström’s macroglobulinaemia.... hyperviscosity syndrome

an infection of the lungs caused by the bacterium Legionella pneumophila, named after an outbreak at the American Legion convention in Pennsylvania in 1976. Legionella organisms are widely found in water; outbreaks of the disease have been associated with defective central heating, air conditioning, and other ventilating systems. Symptoms appear after an incubation period of 2–10 days: malaise and muscle pain are succeeded by a fever, dry cough, chest pain, and breathlessness. X-ray of the lungs shows patchy consolidation. Erythromycin provides the most effective therapy.... legionnaires’ disease

An uncommon cause of kidney failure in children. The association of three processes: reduced platelets, haemolytic anaemia and kidney failure. Foodborne infection is spread by micro-organisms (E. coli, etc) with an affinity for the alimentary canal. The central nervous system is involved.

Onset: diarrhoea with streaks of blood, vomiting, breathlessness, feverishness, dizziness, jaundice and enlargement of the spleen.

Other causes may be mismatched food transfusion, environmental chemicals, nitrite food preservatives and analgesic drugs.

Alternatives. Tea. Combine herbs: Red Clover (to increase platelets) 3; Yarrow (kidneys) 2; Hops (cerebrospinal supportive) 1. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely.

Formula: Combine, Tinctures. Red Clover 2; Fringe Tree 1; Hops half. Dose: one 5ml teaspoon. Babies: 2 drops in feed; infants 3-5 years 10 drops in water and honey thrice daily.

Supplementation. Vitamin B-complex. C.

To be treated by or in liaison with a qualified medical practitioner. ... haemolytic-uraemia syndrome (hus)

A deposit and infiltration of fat on the heart in the obese and heavy consumers of alcohol. Distinct from true degeneration in which there is no destruction of tissue. Symptoms. Breathlessness and palpitation on slight exertion. Anginal pain: see ANGINA. Mental dullness. May follow enlargement of the heart and acute infections such as influenza.

Alternatives. Teas. Alfalfa, Clivers, Yarrow, Motherwort.

Tablets/capsules. Poke root, Kelp, Motherwort.

Formula. Equal parts: Bladderwrack, Motherwort, Aniseed, Dandelion. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons in water thrice daily. Black Cohosh. Introduced into the medical world in 1831 when members of the North American Eclectic School of physicians effectively treated cases of fatty heart.

Diet. Vegetarian protein foods, high-fibre, whole grains, seed sprouts, lecithin, soya products, low-fat yoghurt, plenty of raw fruit and vegetables, unrefined carbohydrates. Oily fish: see entry. Dandelion coffee. Reject: alcohol, coffee, salt, sugar, fried foods, all dairy products except yoghurt.

Supplements. Daily. Broad-spectrum multivitamin including Vitamins A, B-complex, B3, B6, C (with bioflavonoids), E, Selenium. ... heart – fatty degeneration

(MPA) an autoimmune disease characterized by inflammation of small blood vessels, leading to reduced kidney function and breathlessness. It is associated with the presence of antinuclear cytoplasmic antibodies (*ANCA) and can be treated with corticosteroids, cyclophosphamide, or rituximab.... microscopic polyangiitis

n. breathlessness that prevents the patient from lying down, so that he has to sleep propped up in bed or sitting in a chair. —orthopnoeic adj.... orthopnoea

n. a group of lung diseases caused by inhaling dust. The dust particles must be less than 0.5 ?m in diameter to reach the depths of the lung and there is usually a long period after initial exposure before shadows appear on the chest X-ray and breathlessness develops. In practice industrial exposure to coal dust (see coal-worker’s pneumoconiosis), silica (see silicosis), and asbestos (see asbestosis) produces most of the cases of pneumoconiosis. In Britain such cases are examined by the Medical Boarding Centres (Respiratory Diseases), on whose advice statutory compensation for industrial injury may be awarded.... pneumoconiosis

combining form denoting a condition of breathing. Example: dyspnoea (breathlessness).... pnoea

n. a lung disease – a form of *pneumoconiosis – produced by inhaling silica dust particles. It affects workers in hard-rock mining and tunnelling, quarrying, stone dressing, sand blasting, and boiler scaling. Silica stimulates *fibrosis of lung tissue, which produces progressive breathlessness and considerably increased susceptibility to tuberculosis.... silicosis

Failure of the left ventricle to receive blood from the pulmonary circulation and to maintain efficient output of incoming blood to the arterial system. Failure to do so leads to congestion of blood in the lungs followed by fluid retention. If uncorrected, leads to kidney disturbance, low blood pressure, cyanosis (blueness of the skin). Onset may be tragically sudden.

Failure of the left ventricle may occur in cases of pericarditis, disease of the aortic valve, nephritis or high blood pressure.

Left ventricular failure is often of sudden onset, urgent, and may manifest as “cardiac asthma”.

Causes: blood clot, anaemia, thyroid disorder, coronary disease, congenital effects, drug therapy (beta blockers, etc), and to fevers that make heavy demands on the left ventricle.

Symptoms: breathlessness, wheezing, sweating, unproductive cough, faintness, bleeding from the lungs, palpitation. Cardiac asthma at night: feels he needs air; better upright than lying flat. Exertion soon tires. Sensation as if heart would stop. Blueness of lips and ears from hold-up in circulation of the blood through the lungs. Frequent chest colds. Awakes gasping for breath. Always tired. Cold hands and feet. Symptoms abate as compensation takes place. ‘Cream and roses’ complexion. The failure of left ventricle soon drags into failure of the right ventricle.

Right ventricular failure leads to congestive heart failure, with raised venous pressure in neck veins and body generally, causing oedema, ascites and liver engorgement.

Treatment. Agents to strengthen, support, and eliminate excess fluids from the body. BHP (1983) advises four main remedies: Hawthorn, Motherwort, Broom and Lily of the Valley. The latter works in a digitaloid manner, strengthening the heart, contracting the vessels, and lessening congestion in the lungs. Tinctures. Hawthorn 2; Stone root 1. Lily of the Valley 1. Dose: 15-45 drops thrice daily.

Broom tea. 2 teaspoons flowers, or 2-3 teaspoons tops and flowers, in cup water brought to boil and simmered one minute. 1 cup freely.

To remove fluid retention in the lungs, diuretics are indicated; chief among which is Dandelion root because of its high potassium content to prevent hypokalaemia. Dandelion coffee. As urinary excretion increases, patient improves.

Vitamin E. Not to be taken in left ventricular disorders.

Diet. See entry: DIET – HEART AND CIRCULATION.

UK Research. Researchers found that left ventricular failure was reduced by a quarter when patients were given magnesium intravenously for the first 24 hours after admission to the coronary care unit. They conclude that it should be given before any other heart therapy is commenced, and that patients should receive regular infusions if no other drug treatment is used. (The Lancet, 2.4.1994). This supports the use of magnesium sulphate (Epsom’s salts) by a past generation of herbal practitioners for the condition. ... heart – left ventricular failure (lvf)

Lower than normal level of calcium in the blood. Due to (a) Vitamin D deficiency, (b) underactivity of parathyroid glands. Muscular spasms may follow from tetany or seizure. Babies fed on cow’s milk may be at risk.

Symptoms: breathlessness, vomiting, spasm, convulsions. The calcium balance is governed by hormones from the parathyroid gland. Absorption of the mineral depends upon dietary calcium and Vitamin D. (See: CALCIUM, VITAMIN D)

Abnormality may be shown by decrease of serum calcium levels in the blood, or by increase in size and density of bones and other tissues.

Causes: tumour, hardened arteries, bone-wasting diseases, chronic kidney disease.

Alternatives. Horsetail tea. Comfrey root powder: 2-4g, 1 to 3 times daily. Comfrey: potential benefit outweighs possible risk.

Diet. Cod Liver oil. Fish oils generally. Fresh Carrot juice.

Supplementation. Vitamins A, C, D (up to 20,000 units daily). Calcium, Magnesium, Beta Carotene, Dolomite, Phosphorus.

See: CALCIUM DISORDERS. RICKETS: OSTEOPOROSIS: OSTEOMALACIA. ... hypocalcaemia

Presence of abnormally low levels of potassium in the blood. May occur, with dehydration, in the elderly or in diabetics. A common cause is the prolonged use of the thiazides and loop diuretic drugs that leech potassium from the body. In severe degree may cause muscle weakness or paralysis. May also be caused by excessive fluid loss due to chronic diarrhoea.

Symptoms: Always tired. Lethargy. Irregular heart-beats from heart-muscle irritability. Possible cardiac arrest. Breathlessness.

Alternatives. Teas. Plantain, Chamomile, Mullein, Coltsfoot. Mistletoe. Nettles, Gotu Kola, or Yarrow. Decoction. Irish Moss, Agar-Agar, Kelp, Dandelion root.

Powders. Formula. Dandelion, Hawthorn, Liquorice. Equal parts. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Hawthorn, Dandelion, Liquorice. Dose: 1-2 teaspoons, thrice daily. Diet. Bananas: (fruit with highest potassium). Dates, Raisins. Oily fish. Figs. Prunes, Carrot leaves, Cider vinegar (impressive record), Black Molasses. ... hypokalaemia

n. a *protein kinase inhibitor used for the treatment of advanced renal cell carcinoma. It targets a serine threonine kinase that regulates a signalling cascade controlling cell proliferation. Side-effects include hypersensitivity reactions (flushing, chest pain, breathlessness).... temsirolimus

n. a *retinoid drug applied as a solution for the treatment of acne and sun-damaged skin; side-effects include redness and burning of the skin and increased sensitivity to sunlight. It is also taken by mouth to treat acute promyelocytic leukaemia; side-effects may include fever, breathlessness, flushing, headache, and fetal abnormalities (it should not be taken during pregnancy).... tretinoin

a rare form of congenital heart disease in which there is no communication between the right atrium and the right ventricle. Affected babies present with *cyanosis, breathlessness, particularly on feeding, and *failure to thrive. Diagnosis is by *echocardiography. Treatment involves surgical intervention, but the prognosis is often poor.... tricuspid atresia

(angiitis) n. (pl. vasculitides) a patchy inflammation of the walls of blood vessels that leads to damage and thrombosis. It can occur on its own (primary vasculitis) or in association with other conditions, for example rheumatoid arthritis. All the organs in the body can be affected but common symptoms include skin rashes, arthritis, headaches, breathlessness, and kidney failure. Treatment with corticosteroids or immunosuppressant drugs may be beneficial.... vasculitis

High blood pressure. The World Health Organisation defines high blood pressure (arterial hypertension) as that with a persistent sphygomanometer reading of 160/90, and over. Average blood pressure is 120/80 for men but lower in women. The diastolic pressure (lower figure) represents pressure to which the arterial walls are subject and is the more important figure.

Main causes of a raised pressure include increase in blood thickness, kidney disorder or loss of elasticity in the arteries by hardening or calcification.

Well defined physical problems account for 10 per cent of high blood pressure cases. By the age of 60, a third of the peoples of the West are hypertensive. Other causes: genetic pre-disposition, endocrine disorders such as hyperactive thyroid and adrenal glands, lead and other chemical poisoning, brain tumour, heart disorder, anxiety, stress and emotional instability.

Other causes may be food allergies. By taking one’s pulse after eating a certain food one can see if the food raises the pulse. If so, that food should be avoided. Most cases of high blood pressure are related to lifestyle – how people think, act and care for themselves. When a person is under constant stress blood pressure goes up. It temporarily increases on drinking the stimulants: alcohol, strong tea, coffee, cola and caffeine drinks generally.

Symptoms. Morning headache (back of the head), possible palpitation, visual disturbances, dizziness, angina-like pains, inability to concentrate, nose-bleeds, ringing in the ears, fatigue, breathlessness (left ventricular failure).

Dr Wm Castelli, Director of the Framlingham Heart Study in Massachusetts, U.S.A., records: “The greatest risk is for coronary heart disease (CHD). Hypertensives have more than double the risk of people with normal blood pressure and seven times the risk of strokes.”

In countries where salt intake is restricted, a rise in blood pressure with age is not seen.

Simple hypotensive herbs may achieve effective control without the side-effects of sleep disturbance, adverse metabolic effects, lethargy and impaired peripheral circulation.

Essential hypertension is where high blood pressure is not associated with any disease elsewhere; it accounts for 90 per cent cases. Most of the remainder have kidney disease except for a few other abnormalities.

Alternatives. Balm, Black Haw, Black Cohosh (blood pressure of the menopause), Cactus, Cramp bark, Chamomile (German). Garlic, Buckwheat, Lily of the Valley, Balm, Mistletoe, Motherwort. Passion flower, Nettles, Lime flowers, Wood Betony, Yarrow, Rosemary, Hawthorn flowers, Olive leaves, Dandelion. Where there is nerve excitability: Valerian.

Tea No 1. Equal parts: Hawthorn leaves and flowers, Mistletoe, Lime flowers. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily. Alternative:–

Tea No 2. Equal parts: Nettles, Lime flowers, Yarrow, Passion flower. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily.

Nettles. Nettle tea is capable of removing cholesterol deposits (“fur”) from artery walls, increasing their elasticity. Like so many herbs they are rich in chlorophyll. The tea may be made as strong as desired. Mistletoe. 2-3 teaspoons cut herb (fresh or dried) to cup cold water. Allow to infuse overnight (at least 8 hours). 1 cup morning and evening.

Garlic. Juice from one Garlic corm expressed through a juicer taken morning and evening. Garlic dilates blood vessels. Alternative: 2-3 Garlic capsules at night.

Blood pressure of pregnancy: See – PREGNANCY.

Tablets/capsules: Cramp bark, Mistletoe, Motherwort, Rutin, Garlic.

Powders. Formula. Buckwheat (rutin) 1; Motherwort 1; Mistletoe half; Valerian quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Liquid extracts, tinctures. Formula. Equal parts: Cactus, Mistletoe, Valerian. Dose: liquid extracts, one 5ml teaspoon; tinctures, two 5ml teaspoons; thrice daily.

Practitioner Formula. Tinctures: equal parts: Lily of the Valley, Mistletoe, Valerian. Dose: 30-60 drops thrice daily.

Where high blood pressure is due to faulty kidney function diuretics such as Dandelion or Bearberry will be added according to individual requirements. Dandelion root is one of the most widely-used potassium-conserving agents for increasing flow of urine, as well as being a mild beta-blocker to reduce myocardial infarction. Broom (Sarothamnus scoparius) (diuretic) is not used in cases of high blood pressure. It is good practice to assess kidney function in all new cases of hypertension for renal artery stenosis.

Evidence from two major studies confirms that diuretics rather than beta-blockers should be the treatment of choice for most elderly hypertensives. The addition of a diuretic (Yarrow, etc) to prescriptions for the elderly is commended.

Prevention. Chances of developing high blood pressure are said to be reduced by a daily dose of Cod

Liver oil. Results from studies at the University of Munich, Germany, show that when an ounce of Cod Liver oil was added to the typical Western diet, better pressure readings and lower cholesterol levels followed. When the flavour renders it objectionable to the palate, taste may be masked by stirring briskly into fruit juice.

General. Stop smoking. Watch weight. Moderate exercise. Avoidance of stress by relaxation, yoga, music, etc. These relieve constriction of peripheral blood vessels. Curb temper

Diet. Avoid processed and fast foods high in fat and salt, and empty calories. Cheese and meat sparingly. Eat plenty of natural foods. Positively reject coffee, strong tea and alcohol. “There is a significant drop in plasma Cortisol with a fall in blood pressure after stopping alcohol.” (Dr J.F. Potter, University of Birmingham, England) It is well-documented that a vegetarian diet is associated with a lower blood pressure.

Salt. The association of salt with blood pressure is larger than generally appreciated and increases with age and initial blood pressure. Even a small reduction in salt (3g) may reduce a systolic and diastolic pressure by 5mmHg and 2.5mmHg respectively. All processed foods containing salt should be avoided. Supplementation. Inositol, zinc, Vitamin C, Vitamin B6. (Dr C. Pfeiffer) Vitamin E to improve circulation. Check with practitioner pressure level before starting 200iu increasing to 400iu daily. Magnesium: 300mg daily. Choline.

See: BLOOD PRESSURE. ... hypertension

the measured distance that a patient can walk before he or she is stopped by pain in the muscles, usually the calf muscles, or breathlessness. It is a useful estimate of the degree of impairment of the blood supply. See claudication.... walking distance

Lead colic. Toxic hazards of lead may arise from the use of lead pipes in plumbing, petrol, paints in decoration, drinking water, ingestion by children by painted toys, and many other environmental causes. As lead is slowly excreted by the body, its symptoms differ according to tissue in which it accumulates: brain, nerves, intestines, muscles, teeth, gums, liver, pancreas and bones. Symptoms: pain, constipation, nausea, ‘always tired’, vertigo, headache, irritability, breathlessness, burning in throat, cramps, convulsions.

Alternatives. Stomach wash-out (acute cases). Chelating herbs assist in removal of lead from tissues: Comfrey, Slippery Elm, Quince seeds, Marshmallow root, Aloe Vera, Houseleek.

Teas. Catmint, St John’s Wort, Chorella, Chickweed, German Chamomile.

Decoctions. Irish Moss, Iceland Moss, Fenugreek seeds, Dandelion root, Echinacea root, Yellow Dock. Tablets/capsules. Echinacea. Poke root. Dandelion. Comfrey. Slippery Elm. Iceland Moss.

Formula. Fringe Tree 1; Ginkgo 1; German Chamomile 1; Goldenseal quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Thrice daily.

Diet. Lacto vegetarian. Low salt. 2/3 fatty meals weekly. Guar gum preparations.

Supplementation. Vitamins: A, B-complex, B12, C, D. Minerals: Iodum (Kelp), Chromium, Selenium, Magnesium, Zinc.

Note: Cholesterol and fats are metabolised by the liver while metals are excreted by the kidneys. Potential benefits of Comfrey for this condition outweigh possible risk. ... lead poisoning

Greek word ‘white blood’. (Leukosis) Acute myeloid and lymphoblastic. Cancer of the white blood cells of two main types; myeloid, involving the polymorph type and lymphatic involving lymphocytes. Each type may take acute or chronic form, the acute being more serious. The disease is not an infection.

Causes: exposure to chemicals, X-rays or radioactive material. Genetic factors are believed to predispose. The condition may be acute or chronic and may follow chemotherapy.

Remissions are known to have been induced by a preparation from the Periwinkle plant (Vinca rosea) now re-classified as Catharanthus roseus.

“Smokers suffer a significantly increased risk of developing acute myelocytic leukaemia.” (“Cancer”: 1987 vol 60, pp141-144)

Acute Leukaemia. Rapid onset with fatality within weeks or months. Fever. Proliferation of white cells in the bone marrow which are released and blood-borne to the liver, spleen and lymphatics. There may be bleeding from kidneys, mouth, bowel and beneath the skin. (Shepherd’s Purse, Yarrow) The acute form is known also as acute lymphoblastic or acute myeloblastic leukaemia. May be mis-diagnosed as tuberculosis.

Chronic Leukaemia. Gradual onset. Breathlessness from enlargement of the spleen. Swelling of glands under arms, in neck and groin. Loss of weight, appetite, strength, facial colour and body heat. Anaemia, spontaneous bleeding and a variety of skin conditions. Diarrhoea. Low grade fever.

No cure is known, but encouraging results in orthodox medicine promise the disease may be controlled, after the manner of diabetes by insulin. Successful results in such control are reported by Dr Hartwell, National Cancer Institute, Maryland, USA, with an alkaloid related to Autumn Primrose (Colchicum officinale). Vinchristine, a preparation from Periwinkle is now well-established in routine treatment. Red Clover, also, is cytotoxic to many mammalian cells. Vitamin C (present in many herbs and fruits) inhibits growth of non-lymphoblastic leukaemia cells. Good responses have been observed by Dr Ferenczi, Hungary, by the use of raw beet root juice.

Also treated with success by Dr Hartland (above) has been lymphocytic leukaemia in children which he treated with a preparation from Periwinkle.

Choice of agents depends largely upon the clinical experience of the practitioner and ease of administration. Addition of a nerve restorative (Oats, Kola, Black Cohosh or Helonias) may improve sense of well-being. To support the heart and circulatory system with cardiotonics (Hawthorn, Motherwort, Lily of the Valley) suggests sound therapy.

Herbal treatment may favourably influence haemoglobin levels and possibly arrest proliferation of leukaemic cells and reduce size of the spleen. It would be directed towards the (a) lymphatic system (Poke root), (b) spleen (Tamarinds), (c) bone marrow (Yellow Dock), and (d) liver (Blue Flag root).

An older generation of herbalists prescribed Blue Flag root, Yellow Dock, Poke root, Thuja and Echinacea, adding other agents according to indications of the particular case.

Tea. Formula. Equal parts: Red Clover, Gotu Kola, Plantain. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.

New Jersey tea (ceanothus). 1 teaspoon to each cup boiling water. Half-1 cup thrice daily.

Periwinkle tea (Vinca rosea). 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Decoction. Formula. Equal parts: Echinacea, Yellow Dock, Blue Flag root. 1 teaspoon to each cup water gently simmered 20 minutes. 1 cup before meals thrice daily.

Formula. Red Clover 2; Yellow Dock 1; Dandelion root 1; Thuja quarter; Poke root quarter; Ginger quarter. Dose: Liquid Extract: 1 teaspoon. Tinctures: 1-2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Vinchristine. Dosage as prescribed. In combination with other medicines.

Wheatgrass. Juice of fresh Wheatgrass grown as sprouts and passed through a juicer. Rich in minerals. One or more glasses daily.

Beetroot juice. Rich in minerals. Contains traces of rare rabidium and caesium, believed to contribute to anti-malignancy effect. (Studies by Dr A. Ferenczi, Nobel Prize-winner, published 1961)

Diet: Dandelion coffee.

Supplements. B-complex, B12, Folic acid, Vitamin C 2g morning and evening, Calcium ascorbate 2g morning and evening. Copper, Iron, Selenium, Zinc.

Childhood Leukaemia. Research has linked the disease with fluorescent lighting. “Fluorescent tubes emit blue light (400mm wavelength). Light penetrates the skin and produces free radicals. Free radicals damage a child’s DNA. Damaged DNA causes leukaemia to develop. The type and intensity of lighting in maternity wards should be changed. This could be prevented by fitting cheap plastic filters to fluorescent lights in maternity wards.” (Peter Cox, in “Here’s Health”, on the work of Dr Shmuel Ben-Sasson, The Hubert Humphrey Centre of Experimental Medicine and Cancer Research, Jerusalem)

Treatment by hospital specialist. ... leukaemia

A rare but serious type of anaemia in which the red cells, white cells, and platelets in the blood are all reduced in number. Aplastic anaemia is caused by a failure of the bone marrow to produce stem cells, the initial form of all blood cells.

Treatment of cancer with radiotherapy or anticancer drugs can temporarily interfere with the cell-producing ability of bone marrow, as can certain viral infections and other drugs. Long-term exposure to insecticides or benzene fumes may cause more persistent aplastic anaemia, and a moderate to high dose of nuclear radiation is another recognized cause. An autoimmune disorder is responsible in about half of all cases. Aplastic anaemia sometimes develops for no known reason.

A low level of red blood cells may cause symptoms common to all types of anaemia, such as fatigue and breathlessness. White-cell deficiency increases susceptibility to infections; platelet deficiency may lead to a tendency to bruise easily, bleeding gums, and nosebleeds.

The disorder is usually suspected from blood-test results, particularly a blood count, and is confirmed by a bone marrow biopsy.

Blood and platelet transfusions can control symptoms.

Immunosuppression is used to treat anaemia due to an autoimmune process.

Severe persistent aplastic anaemia may be fatal unless a bone marrow transplant is carried out.... anaemia, aplastic

A form of anaemia caused by premature destruction of red cells in the bloodstream (haemolysis). Haemolytic anaemias can be classified according to whether the cause of haemolysis is inside or outside the red cells.

When haemolysis is due to a defect inside the red cells, the underlying problem is abnormal rigidity of the cell membrane. This causes the cells to become trapped, at an early stage of their life-span, in the small blood vessels of the spleen, where they are destroyed by macrophages (cells that ingest foreign particles). Abnormal rigidity may result from an inherited defect of the cell membrane (as in hereditary spherocytosis), a defect of the haemoglobin in the cell (as in sickle-cell anaemia), or a defect of one of the cell’s enzymes. An inherited deficiency of the glucose-6phosphate dehydrogenase enzyme (see G6PD deficiency) may result in episodes of haemolytic anaemia since the red cells are prone to damage by infectious illness or certain drugs or foods.

Haemolytic anaemias due to defects outside the red cells fall into 3 main groups. First are disorders in which red cells are destroyed by buffeting (by artificial surfaces such as replacement heart valves, abnormal blood-vessel linings, or a blood clot in a vessel, for example). In the 2nd group, the red cells are destroyed by the immune system. Immune haemolytic anaemias may occur if foreign blood cells enter the bloodstream, as occurs in an incompatible blood transfusion, or they may be due to an autoimmune disorder. In haemolytic disease of the newborn, the baby’s red cells are destroyed by the mother’s antibodies crossing the placenta. Thirdly, the red cells may be destroyed by microorganisms; the most common cause is malaria. People with haemolytic anaemia may have symptoms common to all types of anaemia, such as fatigue and breathlessness, or symptoms specifically due to haemolysis, such as jaundice.

Diagnosis is made by examination of the blood (see blood film). Some inherited anaemias can be controlled by removing the spleen (see splenectomy). Others, such as G6PD deficiency, can be prevented by avoiding the drugs or foods that precipitate haemolysis. Anaemias due to immune processes can often be controlled by immunosuppressant drugs. Transfusions of red cells are sometimes needed for emergency treatment of life-threatening anaemia.... anaemia, haemolytic

The most common form of anaemia caused by a deficiency of iron, an essential constituent of haemoglobin. The main cause of iron-deficiency anaemia is iron loss due to heavy or persistent bleeding; the most common cause in women of childbearing age is menstruation. Other causes include blood loss from the digestive tract due to disorders such as erosive gastritis, peptic ulcer, stomach cancer, inflammatory bowel disease, haemorrhoids, and bowel tumours (see colon, cancer of). Prolonged use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal bleeding. In some countries, hookworm infestation of the digestive tract is an important cause of anaemia. Rarely, bleeding may also occur as a result of disorders of the urinary tract (such as kidney tumours or bladder tumours).

Iron deficiency may also be caused or worsened by lack of iron in, or its poor absorption from, the diet.

The symptoms are those of the underlying cause, along with a sore mouth or tongue, and those common to all forms of anaemia, such as fatigue and breathlessness. The diagnosis is made from blood tests and tests to look for an underlying cause. Treatment is given for the cause, along with a course of iron tablets or, very rarely, injections.... anaemia, iron-deficiency

A group of drugs used to prevent or treat arrhythmia (irregular heartbeat). This group includes those given intravenously in hospital to treat arrhythmias that are causing symptoms such as breathlessness or chest pain. Adenosine and bretyllium are examples of drugs used only in hospital.

A number of drugs are used to prevent intermittent arrhythmias or to slow the rate if an arrhythmia is persistent. These include amiodarone, beta-blocker drugs, calcium channel blockers, digitalis drugs, disopyramide, flecainide, lidocaine (lignocaine), mexiletine, and procainamide. Side effects are common and often include nausea and rash. Some antiarrhythmics can result in tiredness or breathlessness because they reduce the heart’s pumping ability.... antiarrhythmic drugs

An abnormality of the rhythm or rate of the heartbeat. Arrhythmias, which are caused by a disturbance in the electrical impulses in the heart, can be divided into 2 main groups: tachycardias, in which the rate is faster than normal, and bradycardias, in which the rate is slower.

In sinus tachycardia, the rate is raised, the rhythm is regular, and the beat originates in the sinoatrial node (see pacemaker). Supraventricular tachycardia is faster and the rhythm is regular. It may be caused by an abnormal electrical pathway that allows an impulse to

circulate continuously in the heart and take over from the sinoatrial node. Rapid, irregular beats that originate in the ventricles are called ventricular tachycardia. In atrial flutter, the atria (see atrium) beat regularly and very rapidly, but not every impulse reaches the ventricles, which beat at a slower rate. Uncoordinated, fast beating of the atria is called atrial fibrillation and produces totally irregular ventricular beats. Ventricular fibrillation is a form of cardiac arrest in which the ventricles twitch very rapidly in a disorganized manner.

Sinus bradycardia is a slow, regular beat. In heart block, the conduction of electrical impulses through the heart muscle is partially or completely blocked, leading to a slow, irregular heartbeat. Periods of bradycardia may alternate with periods of tachycardia due to a fault in impulse generation (see sick sinus syndrome).

A common cause of arrhythmia is coronary artery disease, particularly after myocardial infarction. Some tachycardias are due to a congenital defect in the heart’s conducting system. Caffeine can cause tachycardia in some people. Amitriptyline and some other antidepressant drugs can cause serious arrhythmias if they are taken in high doses.

An arrhythmia may be felt as palpitations, but in some cases arrhythmias can cause fainting, dizziness, chest pain, and breathlessness, which may be the 1st symptoms.

Arrhythmias are diagnosed by an ECG. If they are intermittent, a continuous recording may need to be made using an ambulatory ECG.

Treatments for arrhythmias include antiarrhythmic drugs, which prevent or slow tachycardias.

With an arrhythmia that has developed suddenly, it may be possible to restore normal heart rhythm by using electric shock to the heart (see defibrillation).

Abnormal conduction pathways in the heart can be treated using radio frequency ablation during cardiac catheterization (see catheterization, cardiac).

In some cases, a pacemaker can be fitted to restore normal heartbeat by overriding the heart’s abnormal rhythm.... arrhythmia, cardiac

A variety of diseases caused by inhalation of asbestos fibres. Asbestos is a fibrous mineral formerly used as a heat- and fire-resistant insulating material. There are 3 main types of asbestos fibre: white, which is widely used; blue; and brown, the most dangerous. The use of all types is now carefully controlled.

In asbestosis, widespread fine scarring occurs in the lungs. The disease causes breathlessness and a dry cough, eventually leading to severe disability and death. It develops mostly in industrial workers who have been heavily exposed to asbestos. The period from initial exposure to development of the disease is usually at least 20 years. Diagnosis is by chest X-ray. Asbestosis increases the risk of lung cancer.

Mesothelioma is a cancerous tumour of the pleura (the membrane surrounding the lungs) or the peritoneum (the membrane lining the abdominal cavity). In the pleura, mesotheliomas cause pain and breathlessness; in the peritoneum they cause enlargement of the abdomen and intestinal obstruction. The condition cannot be treated and usually leads to death within 1 or 2 years. The average interval between initial exposure to asbestos and death is 20–30 years. Mesothelioma affects people who have worked with blue or brown asbestos.

In diffuse pleural thickening, the outer and inner layers of the pleura become thickened, and excess fluid may accumulate in the cavity between them.

This combination restricts the ability of the lungs to expand, resulting in shortness of breath.

The condition may develop even after short exposure to asbestos.... asbestos-related diseases

A nutritional disorder resulting from a lack of thiamine (vitamin B1) in the diet. Without thiamine, the brain, nerves, and muscles (including the heart muscle) are unable to function properly. In developed countries, the illness is seen only in people who are starving or on an extremely restricted diet, such as alcoholics. There are 2 forms of the illness. In dry beriberi, thiamine deficiency mainly affects the nerves and skeletal muscles. Symptoms include numbness, a burning sensation in the legs, and muscle wasting. In severe cases, the patient becomes virtually paralysed, emaciated, and bedridden. In wet beriberi, the main problem is heart failure, which leads to oedema (swelling caused by fluid accumulation) in the legs, and sometimes also in the trunk and face. Other symptoms of wet beriberi include poor appetite, rapid pulse, and breathlessness.

Beriberi is treated with thiamine, given orally or by injection.... beriberi

The process by which air passes into and out of the lungs to allow the blood to take up oxygen and dispose of carbon dioxide. Breathing is controlled by the respiratory centre in the brainstem. When air is inhaled, the diaphragm contracts and flattens. The intercostal muscles (muscles between the ribs) contract and pull the ribcage upwards and outwards. The resulting increase in chest volume causes the lungs to expand, and the reduced pressure draws air into the lungs. When air is exhaled, the chest muscles and diaphragm relax, causing the ribcage to sink and the lungs to contract, squeezing air out.

In normal, quiet breathing, only about a 10th of the air in the lungs passes out to be replaced by the same amount of fresh air (tidal volume). This new air mixes with the stale air (residual volume) already held in the lungs. The normal breathing rate for an adult at rest is 13–17 breaths per minute. (See also respiration.)breathing difficulty Laboured or distressed breathing that includes a change in the rate and depth of breathing or a feeling of breathlessness. Some degree of breathlessness is normal after exercise, particularly in unfit or overweight people. Breathlessness at rest is always abnormal and is usually due to disorders that affect the airways (see asthma), lungs (see pulmonary disease, chronic obstructive), or cardiovascular system (see heart failure). Severe anxiety can result in breathlessness, even when the lungs are normal (see hyperventilation). Damage to the breathing centre in the brainstem due to a stroke or head injury can affect breathing. This may also happen as a side effect of certain drugs. Ventilator assistance is sometimes needed.

At high altitudes, the lungs have to work harder in order to provide the body with sufficient oxygen (see mountain sickness). Breathlessness may occur in severe anaemia because abnormal or low levels of the oxygen-carrying pigment haemoglobin means that the lungs need to work harder to supply the body with oxygen. Breathing difficulty that intensifies on exertion may be caused by reduced circulation of blood through the lungs. This may be due to heart failure, pulmonary embolism, or pulmonary hypertension. Breathing difficulty due to air-flow obstruction may be caused by chronic bronchitis, asthma, an allergic reaction, or lung cancer. Breathing difficulty may also be due to inefficient transfer of oxygen from the lungs into the bloodstream. Temporary damage to lung tissue may be due to pneumonia, pneumothorax, pulmonary oedema, or pleural effusion. Permanent lung damage may be due to emphysema. Chest pain (for example, due to a broken rib) that is made worse by chest or lung movement can make normal breathing difficult and painful, as can pleurisy, which is associated with pain in the lower chest and often in the shoulder tip of the affected side.

Abnormalities of the skeletal structure of the thorax (chest), such as severe scoliosis or kyphosis, may cause difficulty in breathing by impairing normal movements of the ribcage.... breathing

Enlargement of the heart. Cardiomegaly may take the form of hypertrophy (thickening) of the heart muscle or of dilatation (increase in volume) of 1 or more of the heart chambers. Hypertrophy occurs in conditions in which the heart has to work harder than normal to pump blood around the body. These include hypertension, pulmonary hypertension, and one type of cardiomyopathy. Dilatation of a heart chamber may be due to heart valve incompetence (failure of a valve to close properly after a contraction) such as occurs in aortic insufficiency.

Symptoms may not occur until the heart has enlarged to the point where it cannot cope with additional stress. Its reduced pumping efficiency leads to heart failure, with symptoms of breathlessness and ankle swelling. Cardiomegaly is diagnosed by physical examination, chest X-ray, and ECG. Treatment is directed at the underlying cause.... cardiomegaly

An uncommon condition in which the lining of the small intestine is damaged due to hypersensitivity to gluten, a protein found in wheat, rye, and some other cereals. Damage to the intestinal lining causes malabsorption, weight loss, and vitamin and mineral deficiencies that can lead to anaemia and skin problems. Faeces are bulky and foul-smelling. The disease tends to run in families and varies in severity. In babies, symptoms usually develop within 6 months of the introduction of gluten into the diet. The baby may become listless and irritable, develop vomiting and acute diarrhoea, and become dehydrated and seriously ill. In adults, symptoms such as tiredness, breathlessness, diarrhoea, vomiting, abdominal pain, and swelling of the legs may develop gradually over months. A chronic, distinctive rash called dermatitis herpetiformis may develop. Some people suffer damage to the intestinal lining but never develop symptoms.

Diagnosis is made by blood, urine, and faeces tests and jejunal biopsies, in which small samples of the lining of the intestine are taken for examination.

Coeliac disease is treated by a lifelong gluten-free diet, which usually relieves symptoms within weeks of introduction.... coeliac disease

Physical and psychological care with the aim of making the final period of a dying person’s life as free from pain, discomfort, and emotional distress as possible. Carers may include doctors, nurses, other medical professionals, counsellors, social workers, clergy, family, and friends.

Pain can be relieved by regular low doses of analgesic drugs. Opioid analgesics, such as morphine, may be given if pain is severe. Other methods of pain relief include nerve blocks, cordotomy, and TENS. Nausea and vomiting may be controlled by drugs. Constipation can be treated with laxatives. Breathlessness is another common problem in the dying and may be relieved by morphine.

Towards the end, the dying person may be restless and may suffer from breathing difficulty due to heart failure or pneumonia. These symptoms can be relieved by drugs and by placing the patient in a more comfortable position.

Emotional care is as important as the relief of physical symptoms.

Many dying people feel angry or depressed and feelings of guilt or regret are common responses.

Loving, caring support from family, friends, and others is important.

Many terminally ill people prefer to die at home.

Few terminally ill patients require complicated nursing for a prolonged period.

Care in a hospice may be offered.

Hospices are small units that have been established specifically to care for the dying and their families.... dying, care of the

Blockage of an artery by an embolus. Blood clots that have broken off from a larger clot located elsewhere in the circulation are the most common type of embolus. Pulmonary embolism is usually the result of a fragment breaking off from a deep vein thrombosis and being carried via the heart to block an artery supplying the lungs; this is a common cause of sudden death. Blood clots may form on the heart lining after a myocardial infarction, or in the atria in atrial fibrillation, and then travel to the brain, resulting in a cerebral embolism, which is an important cause of stroke. Air embolism, in which a small artery is blocked by an air bubble, is rare. Fat embolism, in which vessels are blocked by fat globules, is a possible complication of a major fracture of a limb.

Symptoms of an embolism depend on the site of the embolus. Pulmonary embolism can lead to breathlessness and chest pains. If the embolus lodges in the brain, a stroke may occur, affecting speech, vision, or movement. If an embolism blocks an artery to the leg, the limb will become painful and turn white or blue. Untreated, gangrene may develop. In serious cases of fat embolism, heart and breathing rates rise dramatically, and there is restlessness, confusion, and drowsiness.

Embolectomy (surgery to remove the blockage) may be possible. If surgery is not possible, thrombolytic and anticoagulant drugs may be given.... embolism

Any abnormality of the heart present from birth. Defects may affect the heart chambers, valves, or main blood vessels. Major abnormalities are septal defects, coarctation of the aorta, transposition of the great vessels, patent ductus arteriosus, tetralogy of Fallot, hypoplastic left heart syndrome, pulmonary stenosis, and aortic stenosis.

Developmental errors leading to defects arise early in the life of the embryo. In most cases, there is no known cause. Rubella in the mother is the most common known cause.

The onset and severity of symptoms depend on the defect. Some anomalies cause cyanosis and breathlessness but others may go undetected. Possible complications of an untreated heart defect include impaired growth, pneumonia as a result of mild respiratory infections, rapid tiring during exercise, and Eisenmenger complex.

Antenatal diagnosis, using specialized ultrasound scanning, is possible for most defects. After birth, any suspected defect is investigated using chest Xrays, ECG, or echocardiography.

Oxygen and various drug treatments may improve the symptoms of heart block. Some conditions, such as small septal defects or patent ductus arteriosus, may get smaller or disappear of their own accord. Other defects will require surgical correction. Narrowed heart valves can often be treated by balloon valvuloplasty. In other cases, open heart surgery or a heart transplant may be required.

Children with heart defects are at an increased risk of bacterial endocarditis; to prevent this, they are given antibiotic drugs before all surgical procedures including dental treatments.... heart disease, congenital

An operation to correct a heart valve defect or to remove a diseased or damaged valve. A heart valve may have to be repaired, widened, or replaced because it is either incompetent (leaky) or stenotic (narrowed). Widening of a valve may involve valvotomy or valvuloplasty. A damaged valve can be replaced by a mechanical one (fashioned from metal and plastic), a valve constructed from human tissue, a pig valve, or a valve taken from a human donor after death. A heart–lung machine is used during replacement.After heart-valve surgery, symptoms such as breathlessness may take weeks to improve and require medication to be continued. Some people need longterm treatment with anticoagulant drugs to prevent the formation of blood clots around the new valve.... heart-valve surgery

The kidneys are susceptible to a wide range of disorders. However, since only 1 normal kidney is needed for good health, disease is rarely life-threatening unless it affects both kidneys and is at an advanced stage.

Congenital abnormalities, such as horseshoe kidney, are fairly common and usually harmless. Serious inherited disorders include polycystic kidney disease (see kidney, polycystic), Fanconi’s syndrome, and renal tubular acidosis.

Blood vessels in the kidneys can be damaged by shock, haemolytic–uraemic syndrome, polyarteritis nodosa, diabetes mellitus, and systemic lupus erythematosus. The filtering units may be inflamed (see glomerulonephritis). Allergic reactions to drugs, prolonged treatment with analgesic drugs, and some antibiotics can damage kidney tubules. Noncancerous kidney tumours are rare, as is kidney cancer. Metabolic disorders, such as hyperuricaemia, may cause kidney stones (see calculus, urinary tract). Infection of the kidney is called pyelonephritis. Hydronephrosis is caused by urinary tract obstruction. In crush syndrome, kidney function is disrupted by proteins released into the blood from damaged muscle. Hypertension can be a cause and an effect of kidney damage.Other effects of serious damage include nephrotic syndrome and kidney failure. kidney failure A reduction in the function of the kidneys. Kidney failure can be acute or chronic. In acute kidney failure, kidney function often returns to normal once the underlying cause has been discovered and treated; in chronic kidney failure, function is usually irreversibly lost. Causes of acute kidney failure include a severe reduction in blood flow to the kidneys, as occurs in shock; an obstruction to urine flow, for example due to a bladder tumour; or certain rapidly developing types of kidney disease, such as glomerulonephritis. Chronic kidney failure can result from a disease that causes progressive damage to the kidneys, such as hypertension, longstanding obstruction to urine flow, and excessive use of analgesic drugs.

The most obvious symptom of acute kidney failure is usually oliguria (reduced volume of urine). This leads to a build-up of urea and other waste products in the blood and tissues, which may cause drowsiness, nausea, and breathlessness. Symptoms of chronic kidney failure develop more gradually and may include nausea, loss of appetite, and weakness. If acute kidney failure is due to sudden reduction in blood flow, blood volume and pressure can be brought back to normal by saline intravenous infusion or blood transfusion. Surgery may be needed to remove an obstruction in the urinary tract. Acute kidney disease may be treated with corticosteroid drugs. Treatment may also involve diuretic drugs and temporary dialysis (artificial purification of the blood). A high-carbohydrate, lowprotein diet with controlled fluid and salt intake is important for both types of kidney failure. Chronic kidney failure may progress over months or years towards end-stage kidney failure, which is life-threatening. At this stage, longterm dialysis or a kidney transplant is the only effective treatment.... kidney disorders

A type of leukaemia in which excessive numbers of immature white blood cells called blasts are produced in the bone marrow. If untreated, acute leukaemia can be fatal within a few weeks or months. The abnormal cells may be of 2 types: lymphoblasts (immature lymphocytes) in acute lymphoblastic leukaemia, and myeloblasts (immature forms of other types of white cell) in acute myeloblastic leukaemia.

Exposure to certain chemicals (such as benzene and some anticancer drugs) or high levels of radiation may be a cause in some cases. Inherited factors may also play a part; there is increased incidence in people with certain genetic disorders (such as Fanconi’s anaemia) and chromosomal abnormalities (such as Down’s syndrome). People with blood disorders such as chronic myeloid leukaemia (see leukaemia, chronic myeloid) and primary polycythaemia are at increased risk, as their bone marrow is already abnormal.

The symptoms and signs of acute leukaemia include bleeding gums, easy bruising, headache, bone pain, enlarged lymph nodes, and symptoms of anaemia, such as tiredness, pallor, and breathlessness on exertion. There may also be repeated chest or throat infections. The diagnosis is based on a bone marrow biopsy. Treatment includes transfusions of blood and platelets, the use of anticancer drugs, and possibly radiotherapy. A bone marrow transplant may also be required. The outlook depends on the type of leukaemia and the age of the patient. Chemotherapy has increased success rates and 6 in 10 children with the disease can now be cured, although treatment is less likely to be completely successful in adults.... leukaemia, acute

Failure of the mitral valve of the heart to close properly, allowing blood to leak back into the left atrium (upper chamber) when pumped out of the left ventricle (lower chamber). The disorder, which is also known as mitral regurgitation, may occur in conjunction with mitral stenosis.

Symptoms include increasing breathlessness and fatigue, sometimes with palpitations. Later, the ankles may swell.

Diagnosis may be made by hearing a characteristic heart murmur, and from chest X-rays, ECG, and echocardiography. Cardiac catheterization may also be performed. Treatment may include diuretic drugs, vasodilator drugs, and anticoagulant drugs. If symptoms are disabling, heart-valve surgery may be considered.

Before dental or other surgery, patients with mitral incompetence are given antibiotic drugs to prevent endocarditis. mitral stenosis Narrowing of the opening of the mitral valve in the heart. The left atrium (upper chamber) has to work harder to force blood through the narrowed valve. Mitral stenosis is more common in women and may be accompanied by mitral incompetence. Stenosis is usually due to damage to the valve caused by rheumatic fever.

The main symptom is breathlessness on exertion. As mitral stenosis worsens, breathing difficulty eventually occurs when at rest. Other signs include palpitations, atrial fibrillation, and flushed cheeks. There may also be coughing up of blood and fatigue. Possible complications are as for mitral incompetence.

A diagnosis is made from the patient’s history, listening to heart sounds, and by investigations such as an ECG, chest X-rays, echocardiography, and cardiac catheterization.

Drug treatment is broadly the same as for mitral incompetence.

If symptoms persist, balloon valvuloplasty may be carried out to stretch the valve.

Alternatively, heart-valve surgery may be performed to replace the valve.... mitral incompetence

Sudden death of part of the heart muscle due to a blockage in the blood supply to the heart. The disorder is popularly known as a heart attack. It is usually characterized by severe, unremitting chest pain. Myocardial infarction is the most common cause of death in developed countries.

Men are more likely to have a heart attack than women, and smokers are at greater risk. Other risk factors include increased age, unhealthy diet, obesity, and disorders such as hypertension and

diabetes mellitus. Atherosclerosis of the coronary arteries is usually a factor.

Symptoms include sudden pain in the centre of the chest, breathlessness, feeling restless, clammy skin, nausea and/or vomiting, or loss of consciousness. Myocardial infarction may cause immediate heart failure or arrhythmias.

Diagnosis is made from the patient’s history and tests including ECG and measurement of enzymes released into the blood from damaged heart muscle.

A myocardial infarction is a medical emergency. Initial treatment may include aspirin, thrombolytic drugs, analgesic drugs, and oxygen therapy. Diuretic drugs, intravenous infusion of fluids, antiarrhythmic drugs, and beta-blocker drugs may also be given. Electrical defibrillation may be used to control severe arrhythmias.

After recovery, preventive measures such as taking more exercise, losing weight, stopping smoking, and dietary changes are recommended.

Statin drugs are usually given to lower blood cholesterol; aspirin or beta-blocker drugs are given to reduce the risk of further attacks.... myocardial infarction

Excess amniotic fluid surrounding the fetus during pregnancy. It occurs in about 1 in 250 pregnancies and often has no known cause. The condition sometimes occurs if the fetus has a malformation that makes normal swallowing impossible, or if the pregnant woman has diabetes mellitus. The excess amniotic fluid usually accumulates in the 2nd half of pregnancy, producing symptoms from about week 32. The main symptom is abdominal discomfort. Other possible symptoms are breathlessness and swelling of the legs. The uterus is larger than would usually be expected. Occasionally, fluid accumulates rapidly, causing abdominal pain, breathlessness, nausea, and vomiting, and leg swelling. Premature labour may result.

The condition is usually evident from a physical examination, but ultrasound scanning may be needed.

In mild cases, only rest is needed.

In more severe cases, amniotic fluid may be withdrawn using a needle.

In late pregnancy, induction of labour may be performed.... polyhydramnios

A rare disease of unknown cause in which there is inflammation of tissues throughout the body, especially the lymph nodes, lungs, skin, eyes, and liver. It occurs mainly in young adults.

Symptoms do not always occur, but when they do, they include fever, generalized aches, painful joints, and painful, bloodshot eyes. Sarcoidosis may also cause enlargement of the lymph nodes, breathlessness, erythema nodosum, a purplish facial rash, and areas of numbness. Possible complications include hypercalcaemia, which may damage the kidneys, and pulmonary fibrosis.

Treatment of sarcoidosis is not always needed.

Most people recover completely within 2 years, with or without treatment, but some develop a persistent, chronic form of the disease.

Corticosteroids are given to treat persistent fever or erythema nodosum, to prevent blindness in an affected eye, and to reduce the risk of lung damage.... sarcoidosis

A congenital heart abnormality in which there is a hole in the septum between the left and right ventricles of the heart or, more rarely, between the left and right atria. Usually, the cause is unknown. The hole allows freshly oxygenated blood to mix with deoxygenated blood in the heart.

A small defect has little or no effect. A large ventricular hole may cause heart failure to develop 6–8 weeks after birth, causing breathlessness and feeding difficulties. A large atrial defect may never cause heart failure, but there may be fatigue on exertion. Pulmonary hypertension may develop in both types of defect. Diagnosis may be aided by a chest X-ray, ECG, or echocardiography.

Atrial holes are repaired surgically if they cause symptoms or if complications develop.

As the child grows, small ventricular holes often become smaller, or even close, on their own.

A ventricular defect that is causing heart failure is treated with diuretics and digitalis drugs.

If the hole does not close spontaneously, it may be repaired by open heart surgery.... septal defect

A form of congenital heart disease in which the heart has 4 coexisting anomalies: displacement of the aorta, narrowing of the pulmonary valve, a hole in the ventricular septum, and thickening of the right ventricle wall. These cause poor oxygenation of the blood pumped to the body, resulting in cyanosis and breathlessness. Tetralogy of Fallot occurs in about 1 in 1,000 infants. Affected infants appear normal at birth. Severely affected infants may become cyanosed and breathless early in life. Other symptoms include failure to gain weight and poor development.

An ECG, echocardiogram (see echocardiography), and sometimes cardiac catheterization are performed to confirm the diagnosis and assess the severity of the condition. The disorder is corrected by open heart surgery.... tetralogy of fallot

a leak of the aortic valve resulting in reflux of blood from the aorta into the left ventricle during diastole. Aortic regurgitation is most commonly due to degenerative ‘wear and tear’ of the aortic valve. Other causes include dilatation of the aortic root with secondary dilatation of the aortic valve, scarring of the aortic valve as a result of previous acute rheumatic fever, or destruction of the valve by infection (see endocarditis). Mild cases are symptom-free, but patients more severely affected develop breathlessness, angina pectoris, and enlargement of the heart; all have a diastolic murmur. A badly affected valve may be replaced surgically with a prosthesis.... aortic regurgitation

n. any deviation from the normal rhythm (sinus rhythm) of the heart. Arrhythmias result from a disturbance of the generation or the conduction of electrical impulses from the *sinoatrial node and may be intermittent or continuous. They are subdivided into tachyarrhythmias (fast rate) and bradyarrhythmias (slow rate). They include *ectopic beats (extrasystoles), *re-entry tachycardia, ectopic tachycardias (see supraventricular tachycardia; ventricular tachycardia), atrial and ventricular *fibrillation, and *heart block (which is often associated with slow heart rates). Symptoms include palpitations, breathlessness, and chest pain. In more serious arrhythmias the *Stokes-Adams syndrome or *cardiac arrest may occur. Arrhythmias may result from most heart diseases but they also occur without apparent cause.... arrhythmia

(COPD, chronic obstructive airways disease) a disease of adults, especially those over the age of 45 with a history of smoking or inhalation of airborne pollution, characterized by airflow obstruction that is not fully reversible. The disease has features of *emphysema, chronic *bronchitis, and asthmatic bronchitis. It is now diagnosed, according to the *GOLD guidelines, at different stages:

Stage 0: the presence of risk factors and symptoms (e.g. cough and wheeze) with normal *forced expiratory volume in 1 second (FEV1).

Stage 1: FEV1 is normal, but the ratio of FEV1 to forced *vital capacity (FVC) is less than 70%.

Stage 2: FEV1 is less than 80% but more than 50% of the predicted value for the patient’s age and height.

Stage 3: FEV1 less than 50% but more than 30%.

Stage 4: FEV1 less than 30% or the presence of chronic respiratory failure.

The guidelines for COPD recommend different treatment regimens for different stages. Although the response to inhaled corticosteriods is less for COPD than for asthma, these drugs, especially combined with inhaled long-acting beta agonists (e.g. *salmeterol), can improve quality of life and survival in stages 3 and 4. There is also a decrease in the number of acute exacerbations of COPD (AECOPD): increased sputum volume or purulence and/or breathlessness, with or without symptoms (e.g. cough, wheeze, chest pain, malaise, fever).... chronic obstructive pulmonary disease