Congestive cardiac failure Health Dictionary

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Congestive Cardiac Failure: From 1 Different Sources

Cardiac Arrest

Absence of a palpable pulse, and thus of circula tion of blood around the body by the heart contraction. The cause may be asystole or ventricular fibrillation.... cardiac arrest

Cardiac

Relating to the heart... cardiac

Cardiac Cycle

The various sequential movements of the heart that comprise the rhythmic relaxation and expansion of the heart muscles as ?rst the atria contract and force the blood into the ventricles (diastole), which then contract (systole) to pump the blood round the body. (See ELECTROCARDIOGRAM (ECG).)

Cardiac Disease

See HEART, DISEASES OF.... cardiac cycle

Cardiac Output

The volume of blood pumped out per minute by the ventricles of the heart. It is one measure of the heart’s e?ciency. At rest, the heart of a healthy adult will pump between 2.5 and 4.5 litres of blood every minute. Exercise will raise this to as much as 30 litres a minute but, if this ?gure is low, it suggests that the heart muscle may be diseased or that the person has suffered severe blood loss.... cardiac output

Cardiac Glycosides

Drugs whose main actions are to increase the force of myocardial contraction and reduce the conductivity of the nerve ?bres in the atrioventricular node of the heart. They are useful in treating supraventricular tachycardias (rapid heart rhythm) and some forms of heart failure. Glycosides are a traditional group of cardiac drugs, originally derived from the leaves of foxglove plants and used as digitalis. The active principle has long been synthesised and used as DIGOXIN. They are potentaially toxic and their use, especially during initial treatment, should be monitored. Side-effects include ANOREXIA, nausea, vomiting, diarrhoea and abdominal pain; drowsiness, confusion and DEPRESSION may occur. An abnormally slow heart rate may develop. The glycosides should be used with special care in the elderly who are sometimes particularly susceptible to their toxic effects.... cardiac glycosides

Cardiac Massage

The procedure used to restart the action of the heart if it is suddenly arrested. In many cases the arrested heart can be made to start beating again by rhythmic compression of the chest wall. This is done by placing the patient on a hard surface – a table or the ?oor – and then placing the heel of the hand over the lower part of the sternum and compressing the chest wall ?rmly, but not too forcibly, at the rate of 60–80 times a minute. At the same time arti?cial respiration must be started by the mouth-tomouth method. (See APPENDIX 1: BASIC FIRST AID.) Open heart massage is sometimes undertaken if an arrest occurs during a chest operation – the heart being directly handled by the resuscitator.... cardiac massage

Cardiac Muscle

The muscle, unique to the heart, which comprises the walls of the atria and ventricles. It consists of long broadening cells (?bres) with special physiological characteristics which enable them to keep contracting and expanding inde?nitely.... cardiac muscle

Cardiac Neurosis

Obsessional fear about the state of the heart. It tends to occur after a heart attack and may result in the patient’s experiencing the symptoms of another attack.... cardiac neurosis

Cardiac Tamponade

Compression of the heart due to abnormal accumulation of ?uid within the ?brous covering of the heart (PERICARDIUM). The result is irregular rhythm and death if the ?uid is not removed.... cardiac tamponade

Failure To Thrive

Failure of expected growth in an infant or toddler, usually assessed by comparing the rate at which a baby gains weight with a standardized growth chart. An undiagnosed illness such as a urinary infection may be the cause. Emotional or physical deprivation can also cause failure to thrive. A child who fails to grow at the appropriate rate needs tests to determine the cause.... failure to thrive

Heart Failure

Inability of the heart to cope with its workload of pumping blood to the lungs and to the rest of the body. Heart failure can primarily affect the right or the left side of the heart, although it most commonly affects both sides, in which case it is known as congestive, or chronic, heart failure.

Left-sided heart failure may be caused by hypertension, anaemia, hyperthyroidism, a heart valve defect (such as aortic stenosis, aortic incompetence, or mitral incompetence), or a congenital heart defect (see heart disease, congenital). Other causes of left-sided heart failure include coronary artery disease, myocardial infarction, cardiac arrhythmias, and cardiomyopathy.

The left side of the heart fails to empty completely with each contraction, or has difficulty in accepting blood that has been returned from the lungs. The retained blood creates a back pressure that causes the lungs to become congested with blood. This condition leads to pulmonary oedema.

Right-sided heart failure most often results from pulmonary hypertension, which is itself caused by left-sided failure or by lung disease (such as chronic obstructive pulmonary disease (see pulmonary disease, chronic obstructive). Right-sided failure can also be due to a valve defect, such as tricuspid incompetence, or a congenital heart defect.

There is back pressure in the circulation from the heart into the venous system, causing swollen neck veins, enlargement of the liver, and oedema, especially of the legs and ankles. The intestines may become congested, causing discomfort.

Immediate treatment consists of bed rest, with the patient sitting up. Diuretic drugs are given, and digitalis drugs and vasodilators, especially ACE inhibitors, may also be administered. Morphine and oxygen may be given as emergency treatment in acute left-sided failure.... heart failure

Cardiac Arrhythmia

Abnormal rhythm of the heartbeat. Most commonly seen after someone has had a myocardial infarction, but also present in some normal individuals – especially if they have taken a lot of co?ee or other stimulant – and in those with a congenital abnormality of the heart-muscle conducting system. The cause is interference in the generation or transmission of electrical impulses through the heart’s conducting system. Occasional isolated irregular beats (ectopic beats) do not necessarily mean that conduction is faulty. Arrhythmias can be classi?ed as tachycardias (more than 100 beats a minute) or bradycardias (slower than 60 beats a minute). Heartbeats may be regular or irregular. (See HEART, DISEASES OF.)... cardiac arrhythmia

Cardiac Catheterisation

A diagnostic procedure in which a tube is inserted into a blood vessel under local anaesthetic and threaded through to the chambers of the heart to monitor blood ?ow, blood pressure, blood chemistry and the output of the heart, and to take a sample of heart tissue. The technique is used to diagnose congenital heart disease and coronary artery disease. Another application is in the diagnosis and treatment of valvular disease in the heart.... cardiac catheterisation

Cardiac Depressant

Slowing the action of the heart... cardiac depressant

Cardiac Pump

See HEART, ARTIFICIAL.... cardiac pump

External Cardiac Compression

Compression of the outside of the sternum and ribs, effectively emptying and filling the heart to push blood through arteries to supply oxygen to the body - particularly to the brain.... external cardiac compression

Renal Failure (acute)

Inefficient functioning of the kidney, leading to death unless acute medical attention is available. Envenomation (especially snake bite) is a common cause, as well as a range of medical conditions, including infection..... renal failure (acute)

Adrenal Failure

Insufficient production of hormones by the adrenal cortex (the outer part of the adrenal glands).

It can be acute or chronic.

Adrenal failure may be caused by a disorder of the adrenal glands, in which case it is called Addison’s disease, or by reduced stimulation of the adrenal cortex by ACTH, a hormone produced by the pituitary gland.... adrenal failure

Asthma, Cardiac

Breathing difficulty in which bronchospasm and wheezing are caused by accumulation of fluid in the lungs (pulmonary oedema). This is usually due to reduced pumping efficiency of the left side of the heart (see heart failure) and is not true asthma. Treatment is with diuretic drugs.... asthma, cardiac

Cardiac Pacemaker

The natural pacemaker is the sinuatrial node, found at the base of the heart. The heart normally controls its rate and rhythm; heart block occurs when impulses cannot reach all parts of the heart. This may lead to ARRHYTHMIA, or even cause the heart to stop (see HEART, DISEASES OF). Arti?cial pacemakers may then be used; in the United Kingdom these are required for around one person in every 2,000 of the population. Usually powered by mercury or lithium batteries, and lasting up to 15 years, they are either ?xed to the outside of the chest or implanted in the armpit, and connected by a wire passing through a vein in the neck to the heart. Normally adjusted to deliver 65–75 impulses a minute, they also ensure a regular cardiac rhythm. Patients with pacemakers may be given a driving licence provided that their vehicle is not likely to be a source of danger to the public, and that they are receiving adequate and regular medical supervision from a cardiologist.

Although there are numerous possible sources of electrical interference with pacemakers, the overall risks are slight. Potential sources include anti-theft devices, airport weapon detectors, surgical diathermy, ultrasound, and short-wave heat treatment. Nevertheless, many pacemaker patients lead active and ful?lling lives.... cardiac pacemaker

Cardiac Dropsy

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

Dropsy: Cardiac

 Oedema (excess fluid in the tissues) may be due to poor circulation from impaired heart action. The condition is worse at the end of the day.

Treatment. Agents in frequent use: Broom, Lily of the Valley, Hawthorn (blossoms or berries), Motherwort.

Tea. Combine equal parts: Dandelion root, Motherwort, Yarrow. 2 teaspoons to each cup boiling water; infuse 5-15 minutes; 1 cup thrice daily.

Powders. Equal parts: Dandelion root, Juniper berries, Hawthorn berries. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon).

Practitioner. Lily of the Valley. Dose as BHP (1983): Liquid Extract: 1:1 in 25 per cent alcohol, 0.6-2ml. Tincture: 1:5 in 40 per cent alcohol, 0.5-1ml. Thrice daily.

Dropsy in children: cucumber juice extracted from vegetable with aid of a juicer. As many cupfuls as well-tolerated. If vomiting is induced, it should be regarded as favourable.

Diet. Lacto-vegetarian, salt-free, bottled or spring water, honey. ... dropsy: cardiac

Heart – Left Ventricular Failure (lvf)

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)

Heart – Right Ventricular Failure (rvf)

Failure of the right ventricle to hold its own with the return flow of blood and to re-direct it through the lungs where it is re-oxygenated before entering the left ventricle for completing the circulatory cycle. Usually secondary to failure of the left ventricle. May be caused by valvular disease, especially narrowing of the orifice of the mitral valve.

Mitral disease leads to heart failure either by a narrowing of the orifice (stenosis) or a regurgitation blocks the passage of blood from the left atrium (auricle) to the left ventricle. The left atrium enlarges (hypertrophies) in an effort to counter the impediment. Real compensation – increased thrust of the blood – is provided by the right ventricle. In order to overcome a mitral impediment the right ventricle has to enlarge.

Sooner or later the right ventricle cannot enlarge any further and general heart failure sets in. Though caused primarily by a lesion of the mitral valve, it may be secondary to left ventricular failure (LVF), thyroid disorder (thyrotoxicosis), pericarditis, congenital heart disease, or any disease which weakens ventricular muscle.

Venous congestion and back pressure of RVF leads to congestion and accumulation of fluid in the lungs, cough and spitting of blood, painful swelling of the liver, nausea, loss of appetite and severe wasting.

Where the right ventricle fails to move the blood forward as it arrives from the systemic circulation, generalised dropsy sets in. Congestion of the kidneys leads to reduced urinary excretion and presence of albumin in the urine.

The picture is well known to the cardiac practitioner: blueness of the skin, congestion of the brain circulation with sleeplessness and delirium. Soon the tension of water-logged tissues results in pain and extreme anxiety. Feet are swollen and ankles pit on pressure; chest cavities fill with fluid and the abdomen swells (ascites).

Alternatives. Cardio-tonics would be given to strengthen the ventricle and diuretics to correct fluid retention: Lily of the Valley, Hawthorn, Motherwort, Broom. BHP (1983).

Due to rheumatic fever: Hawthorn.

High Blood Pressure: Mistletoe.

Effort Syndrome: Motherwort.

Tinctures. Combine, Lily of the Valley 2; Hawthorn 2; Motherwort 3. Dose: 1 teaspoon thrice daily after meals.

Diet. Low salt, low fat, high fibre. Restricted fluids, vegetarian protein foods, yoghurt. See also: DIET – HEART AND CIRCULATION.

Supplements. Potassium (bananas), Vitamin B6.

General. Stop smoking. Correction of overweight. Complete bed-rest with legs raised above level of the abdomen and patient propped-up to relieve difficult breathing. ... heart – right ventricular failure (rvf)

Arrhythmia, Cardiac

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

Brain Failure

See brain syndrome, organic.... brain failure

Cardiac Stress Test

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

Catheterization, Cardiac

A diagnostic test in which a fine, sterile catheter is introduced into the heart via a blood vessel. It is used to diagnose and assess the extent of congenital heart disease (see heart disease, congenital) and coronary artery disease, and to diagnose and treat some disorders of the heart valves (see valvuloplasty). During the procedure, the pressure within the heart’s chambers can be measured, samples of blood and tissue can be taken, and a radiopaque substance can be injected to allow the heart’s cavities to be X-rayed.... catheterization, cardiac

Congestive Heart Failure

See heart failure.... congestive heart failure

Dysrhythmia, Cardiac

A medical term meaning disturbance of heart rhythm, sometimes used as an alternative to arrhythmia (see arrhythmia, cardiac).... dysrhythmia, cardiac

Liver Failure

Severe impairment of liver function that develops suddenly or at the final stages of a chronic liver disease. Because the liver breaks down toxins in the blood, liver failure causes the levels of the toxins to rise, affecting the functioning of other organs, particularly the brain. Liver failure may be acute or chronic. Symptoms of acute liver failure develop rapidly and include impaired memory, agitation, and confusion, followed by drowsiness. The functioning of other organs may become impaired, and the condition may lead to coma and death. Features of chronic liver failure develop much more gradually and include jaundice, itching, easy bruising and bleeding, a swollen abdomen due to accumulated fluid, red palms and, in males, gynaecomastia (enlarged breasts) and shrunken testes. Chronic liver failure may suddenly deteriorate into acute liver failure.

Acute liver failure requires urgent hospital care.

Although no treatment can repair damage that has already occurred in acute and chronic liver failure, certain measures, such as prescribing diuretic drugs to reduce abdominal swelling, may be taken to reduce the severity of symptoms.

Consumption of alcohol should cease in all cases.

The prognoses for sufferers of chronic liver failure vary depending on the cause, but some people survive for many years.

For acute liver failure, a liver transplant is necessary to increase the chances of survival.... liver failure

Renal Failure

See kidney failure.... renal failure

Respiratory Failure

A condition in which there is a buildup of carbon dioxide and a fall in the level of oxygen in the blood (see hypoxia). Causes include lung disorders, such as severe asthma, emphysema, or chronic bronchitis (see pulmonary disease, chronic obstructive), or damage to the respiratory centre in the brain due to, for example, an overdose of opioid drugs, a stroke, or serious head injury.

Treatment is with ventilation and oxygen for the underlying cause.... respiratory failure

Ventilatory Failure

A life-threatening condition in which the amount of carbon dioxide in the blood rises, and the amount of oxygen falls, due to disruption of the normal exchange of gases between the air in the lungs and the blood. Ventilatory failure may be due to brain damage or to depression of the respiratory centres by excessive doses of drugs such as morphine. Treatment may involve artificial ventilation or, in some cases, the use of respiratory stimulant drugs. (See also respiratory failure.)... ventilatory failure

Acute Renal Failure

acute kidney injury (see AKI).... acute renal failure

Acute Respiratory Failure

(ARF) a primary disorder of gaseous exchange (as distinct from failure of the mechanical process of breathing). The prototype of ARF is *adult respiratory distress syndrome, but the term sometimes also refers to disruption of any other part of the respiratory system, including the respiratory control centre in the brain with its *efferent and *afferent pathways.... acute respiratory failure

Cardiac Arrest Simulation

a form of education in resuscitation skills using a *resuscitation mannikin wired up to a heart rhythm simulator that can mimic all common cardiac arrest situations. Candidates may be expected to perform basic life support as well as advanced life support and display skills in airway maintenance and team leadership. This form of teaching and assessment is widely used in advanced life support courses.... cardiac arrest simulation

Cardiac-arrest Team

a designated team of doctors in a hospital who attend *cardiac arrests as they occur and administer protocol-driven treatment according to the latest guidelines. See also medical emergency team.... cardiac-arrest team

Cardiac Index

the volume of blood pumped from the heart’s left ventricle divided by body surface area, expressed as litres per minute per square metre (l/min/m2). It is determined by heart rate and stroke volume index (the volume of blood pumped by the heart with each beat), and provides a normal range (2.5–4.0 l/min/m2) regardless of the size of the patient.... cardiac index

Cardiac Reflex

reflex control of the heart rate. Sensory fibres in the walls of the heart are stimulated when the heart rate increases above normal. Impulses are sent to the cardiac centre in the brain, stimulating the vagus nerve and leading to slowing of the heart rate.... cardiac reflex

Cardiac Rehabilitation

a programme of staged exercises and lifestyle classes designed for people recovering from a heart attack and run through the local hospital by dedicated health care professionals, who may include specialist nurses, occupational therapists, and physiotherapists.... cardiac rehabilitation

Cardiac Resynchronization Therapy

(CRT) a treatment for heart failure that involves ventricular pacing with multiple *leads. The aim is to restore coordinated ventricular contraction and hence improve cardiac function.... cardiac resynchronization therapy

End-stage Renal Failure

(ESRF, CKD 5) the most advanced stage of kidney failure, which is reached when the *glomerular filtration rate (GFR) falls to 15 ml/min (normal GFR = 100 ml/min).... end-stage renal failure

Left Ventricular Failure

see heart failure.... left ventricular failure

Multi-organ Failure

(MOF) see multiple organ dysfunction syndrome.... multi-organ failure

Myoglobinuric Acute Renal Failure

acute kidney injury caused by myoglobin that is released from damaged skeletal muscle (*rhabdomyolysis). This is usually the result of trauma and the condition was first recognized in victims trapped and crushed during the London Blitz. Muscle injury can also occur with pressure necrosis, particularly in the unconscious or immobile patient, or with a *compartment syndrome. Rarely it may complicate intensive muscular exercise or extensive viral myositis and it is a recognized complication of modest overexertion in some inherited disorders of muscle metabolism, such as *McArdle’s disease.... myoglobinuric acute renal failure

Premature Ovarian Failure

menopause occurring before the age of 40. It may be caused by autoimmunity, chemotherapy, radiotherapy, or genetic factors, for example a mutation in the FSH receptor gene causing excess secretion of gonadotrophins and small underdeveloped ovaries. Treatment is by hormone replacement, either with the contraceptive pill or HRT. *Oocyte donation should be discussed if the patient wishes for assisted conception.... premature ovarian failure

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