Author Archives: Mukul


Cholestasis is a condition in which the flow of bile is impaired at some point between the liver cells and the small intestine. Bile is the digestive fluid that’s produced by the liver. When bile flow is stopped, the pigment bilirubin, a waste product that’s formed when old or damaged red blood cells are broken down, escapes into the bloodstream and accumulates.

Normally, bilirubin binds with bile in the liver and moves through the bile ducts into the digestive tract, where it’s eliminated in stool, but for people with cholestasis, substances that are normally excreted into bile are retained.


The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy, and metabolic types of cholestasis which are disturbances in bile formation that can occur because of genetic defects or acquired as a side effect of many medications.

Itchiness (pruritus). Pruritus is the primary symptom of cholestasis and is thought to be due to interactions of serum bile acids with opioidergic nerves. In fact, the opioid antagonist naltrexone is used to treat pruritus due to cholestasis.

* Jaundice. Jaundice is an uncommon occurrence in intrahepatic (metabolic) cholestasis, but is common in obstructive cholestasis.

* Pale stool. This symptom implies obstructive cholestasis.

* Dark urine

Possible causes:

* Pregnancy
* Androgens
* Birth control pills
* Antibiotics (such as TMP/SMX)
* Abdominal mass (e.g. cancer)
* Biliary atresia and other pediatric liver diseases
* Biliary trauma
* Congenital anomalies of the biliary tract
* Gallstones
* Acute hepatitis
* Cystic fibrosis
* Intrahepatic cholestasis of pregnancy (obstetric cholestasis)
* Primary biliary cirrhosis, an autoimmune disorder
* Primary sclerosing cholangitis, associated with inflammatory bowel disease
* Some drugs (e.g. flucloxacillin and erythromycin)

Drugs such as gold salts, nitrofurantoin, anabolic steroids, chlorpromazine, prochlorperazine, sulindac, cimetidine, erythromycin, estrogen, and statins can cause cholestasis and may result in damage to the liver.

Cholestasis can be suspected when there is an elevation of both 5′-nucleotidase and ALP enzymes. With a few exceptions, the optimal test for cholestasis would be elevations of serum bile acid levels. However, this is not normally available in most clinical settings. The gamma-glutamyl transferase (GGT) enzyme was previously thought to be helpful in confirming a hepatic source of ALP; however, GGT elevations lack the necessary specificity to be a useful confirmatory test for ALP. Normally GGT and ALP are anchored to membranes of hepatocytes and are released in small amounts in hepatocellular damage. In cholestasis, synthesis of these enzymes is induced and they are made soluble. GGT is elevated because it leaks out from the bile duct cells due to pressure from inside bile ducts.

In a later stage of cholestasis AST, ALT and unconjugated bilirubin may be elevated due to hepatocyte damage as a secondary effect of cholestasis.

Under a microscope, the individual hepatocytes will have a brownish-green stippled appearance within the cytoplasm, representing bile that cannot get out of the cell. Canalicular bile plugs between individual hepatocytes or within bile ducts may also be seen, representing bile that has been excreted from the hepatocytes but cannot go any further due to the obstruction. When these plugs occur within the bile duct, sufficient pressure (caused by bile accumulation) can cause them to rupture, spilling bile into the surrounding tissue, causing hepatic necrosis. These areas are known as bile lakes, and are typically seen only with extra-hepatic obstruction.

Extrahepatic cholestasis can usually be treated by surgery. Pruritis in cholestatic jaundice is treated by antihistamines, ursodeoxycholic acid, and phenobarbital. Nalfurafine hydrochloride can also treat pruritus caused by chronic liver disease and was recently approved in Japan for this purpose.

Herbal & Natural Treatments for Cholestasis:

1. Guar Gum:

Guar gum is a fiber from the seed of the guar plant. It’s commonly used as a laxative, for reducing cholesterol and preventing diabetes and obesity. Guar gum works as a binding and stabilizing agent, which is why it may be useful in relieving symptoms of cholestasis.

A study published in the European Journal of Clinical Investigation investigated whether intestinal binding of bile by guar gum relieves cholestasis and pruritus in intrahepatic cholestasis of pregnancy (ICP. Forty-eight pregnant women with cholestasis and pruritus were given either guar gum or placebo until the time of delivery, and 20 healthy pregnant women were used as control subjects. Researchers found that the increase in serum bile acids and worsening of pruritus were prevented by guar gum in relation to placebo.

2. Activated Charcoal:

Studies show that activated charcoal may be considered an alternative therapy in the treatment of intrahepatic cholestasis of pregnancy. Activated charcoal is a potent natural treatment that’s used to trap toxins and chemicals in the body, allowing them to be flushed out before they’re absorbed. The porous surface of activated charcoal has a negative electric charge that causes positive charged toxins and gas to bond with it.

A 1994 study found that after eight days of treatment, activated charcoal (at 30 grams, three times per day) was able to lower total bile acid concentrations in patients with ICP.

3. Milk Thistle:

Milk thistle is a natural herb that’s commonly used to detoxify the body, especially the liver. It’s able to promote healthy digestive function by increasing bile production and decreasing inflammation. Several studies indicate that milk thistle is effective in a variety of liver diseases, including cholestasis. (3) It’s also safe to use during pregnancy and while breastfeeding.

4. Dandelion Root:

Dandelion root and dandelion tea are safe natural remedies for cholestasis of pregnancy and have been proven to strengthen and benefit the liver. Dandelion root is used for gallstones, and it increases urine production and serves as a natural laxative. Research shows that the vitamins and nutrients present in dandelions help cleanse the liver and keep them working properly. Dandelions aid the digestive system by maintaining the proper flow of bile, and they promote mineral absorption.

5. SAMe:

SAMe, or S-adenosyl-L-methionine, is a molecule that’s formed naturally in the body and is also made in the laboratory to help the body form, activate and break down chemicals in the body. A study published in Drugs involving 639 patients with cholestasis due to acute or chronic liver disease found that SAMe may act by promoting transsulfuration pathway reactions, which means that it helps metabolic pathways function properly and consequently improves the detoxifying capacity of the metabolic system.

Researchers report that SAMe appears to be the first safe and effective approach to the treatment of this syndrome, and it also protects against the adverse effects of small doses of estrogen in patients with a history of ICP.

6. Vitamin K:

Vitamin K can be taken to improve blood clotting, unless your liver is severely damaged. It’s a suggested course of treatment for mothers with ICP because it reduces the absorption of fat-soluble vitamins that can lead to a vitamin K deficiency. For women who are pregnant, a vitamin K deficiency can lead to serious complications for the mother and infant.

7. Vitamin D and Calcium:

Research shows that metabolic bone disease is common in patients with cholestatic liver disease. Researchers measured intestinal calcium absorption in relation to vitamin D status in 14 patients with chronic cholestatic liver disease, including 11 with primary biliary cirrhosis. They found that 57 percent of patients had a decreased calcium absorption compared to controls, and a significant correlation was observed between serum vitamin D levels and calcium absorption. Treatment with oral vitamin D3 helped correct low vitamin D levels, which thereby improved calcium absorption.

8. Avoid Alcohol and Certain Drugs:

People with cholestasis are advised to avoid or stop using any substance that’s toxic to the liver, including alcohol and certain drugs. According to research conducted at the University of Sydney in Australia, agents known for many years to cause cholestasis include estrogens and anabolic steroids, chlorpromazine, erythromycin, and oxypenicillins. Contemporary drugs linked to cholestastic liver injury include ticlopidine, terfenadine, terbinafine, nimesulide, irbesartan, fluoroquinolones and cholesterol-lowering statins. Offending drugs should be withdrawn immediately in order to treat drug-induced cholestasis.

While there is increasing evidence of a genetic predisposition to cholestatic drug reactions, there are currently no pretreatment tests to predict drug safety. Therefore, prevention of severe reactions relies on early detection of liver injury and prompt drug withdrawal.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.



Diabetes Insipidus

Diabetes insipidus, is a debilitating and rare disease, with a prevalence of 1 out of 25,000 people. Often referred to as “water diabetes,” it is a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. It’s caused by a defect in the pituitary gland or in the kidneys.

While the names diabetes insipidus and diabetes mellitus sound similar, they’re not related. Diabetes mellitus — which can occur as type 1 or type 2 — is the more common form of diabetes.

There are four types of DI, each with a different set of causes.

* Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone). This can be due to damage to the hypothalamus or pituitary gland or genetics.

* Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin.

* Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy. Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test.

* Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.

There’s no cure for diabetes insipidus, but treatments are available to relieve your thirst and normalize your urine output.

The most common signs and symptoms of diabetes insipidus are:

* Extreme thirst

* Excretion of an excessive amount of diluted urine

Depending on the severity of the condition, urine output can be as much as 16 quarts (about 15 liters) a day if you’re drinking a lot of fluids. Normally, a healthy adult will urinate an average of less than 3 quarts (about 3 liters) a day.

Other signs may include needing to get up at night to urinate (nocturia) and bed-wetting.

Infants and young children who have diabetes insipidus may have the following signs and symptoms:

* Unexplained fussiness or inconsolable crying
* Trouble sleeping
* Fever
* Vomiting
* Diarrhea
* Delayed growth
* Weight loss

Diabetes insipidus occurs when your body can’t regulate how it handles fluids. Normally, your kidneys remove excess body fluids from your bloodstream. This fluid waste is temporarily stored in your bladder as urine, before you urinate.

When your fluid regulation system is working properly, your kidneys conserve fluid and make less urine when your body water is decreased, such as through perspiration.

The volume and composition of your body fluids remain balanced through a combination of oral intake and excretion by the kidneys. The rate of fluid intake is largely governed by thirst, although your habits can increase your intake far above the amount necessary. The rate of fluid excreted by your kidneys is greatly influenced by the production of anti-diuretic hormone (ADH), also known as vasopressin.

Your body makes ADH in the hypothalamus and stores the hormone in your pituitary gland, a small gland located in the base of your brain. ADH is released into your bloodstream when your body starts to become dehydrated. ADH then concentrates the urine by triggering the kidney tubules to release water back into your bloodstream rather than excreting as much water into your urine.

The way in which your system is disrupted determines which form of diabetes insipidus you have:

* Central diabetes insipidus. The cause of central diabetes insipidus in adults is usually damage to the pituitary gland or hypothalamus. This damage disrupts the normal production, storage and release of ADH.

The damage is commonly due to surgery, a tumor, an illness (such as meningitis), inflammation or a head injury. For children, the cause may be an inherited genetic disorder. In some cases the cause is unknown.

* Nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus occurs when there’s a defect in the kidney tubules — the structures in your kidneys that cause water to be excreted or reabsorbed. This defect makes your kidneys unable to properly respond to ADH.

The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or the antiviral medications cidofovir and foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.

* Gestational diabetes insipidus. Gestational diabetes insipidus is rare and occurs only during pregnancy and when an enzyme made by the placenta — the system of blood vessels and other tissue that allows the exchange of nutrients and waste products between a mother and her baby — destroys ADH in the mother.

* Primary polydipsia. This condition — also known as dipsogenic diabetes insipidus or psychogenic polydipsia — can cause excretion of large volumes of dilute urine. Rather than a problem with ADH production or damage, the underlying cause is intake of excessive fluids.

Prolonged excessive water intake by itself can damage the kidneys and suppress ADH, making your body unable to concentrate urine. Primary polydipsia can be the result of abnormal thirst caused by damage to the thirst-regulating mechanism, situated in the hypothalamus. Primary polydipsia has also been linked to mental illness.

In some cases of diabetes insipidus, doctors never determine a cause.

Since the signs and symptoms of diabetes insipidus can be caused by other conditions, your doctor will perform a number of tests. If your doctor determines you have diabetes insipidus, he or she will need to determine which type of diabetes insipidus you have, because the treatment is different for each form of the disease.

Some of the tests doctors commonly use to diagnose and determine the type of diabetes insipidus and in some cases, its cause, include:

* Water deprivation test. This test confirms the diagnosis and helps determine the cause of diabetes insipidus. Under medical supervision, you’ll be asked to stop drinking fluids for a time so that your doctor can measure changes in your body weight, urine output and the concentration of your urine and blood when fluids are withheld.

Your doctor may also measure blood levels of ADH or administer synthetic ADH during this test. The water deprivation test is performed under close supervision in children and pregnant women to make sure no more than 5 percent of body weight is lost during the test.

* Urinalysis. Urinalysis is the physical and chemical examination of urine. If your urine is less concentrated — meaning the amount of water is high relative to other excreted substances — it could be due to diabetes insipidus.

* MRI (Magnetic resonance imaging.) An MRI of the head is a noninvasive procedure that uses a powerful magnetic field and radio waves to construct detailed pictures of brain tissues. Your doctor may want to perform an MRI to look for abnormalities in or near the pituitary gland.
Genetic screening

If your doctor suspects an inherited form of diabetes insipidus, he or she will look at your family history of polyuria and may suggest genetic screening.

The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration. Depending on what type of diabetes insipidus you have, treatment for constant thirst and frequent urination will vary.

Since its introduction in 1972, desmopressin has been the most widely used drug for the treatment of diabetes insipidus. Desmopressin is a synthetic, man-made hormone that comes as an injection, nasal spray or pill. It works by replacing the vasopressin that a patient’s body would normally produce, which can control the amount of urine your kidneys make. Desmopressin helps a patient to manage her symptoms, but it does not cure the disease.

Desmopressin can cause a low level of sodium in the blood. This is rare, but can be serious and possibly life-threatening. Drinking too much water or other fluids increases your risk of having low sodium levels in your blood. It’s important to follow your doctor’s directions if you are using this drug and limit your fluids as instructed. Signs of low levels of sodium in the blood include: loss of appetite, severe nausea, vomiting, severe headache, mental and mood chances, muscle weakness, cramps and spasms, shallow breathing and loss of consciousness.

Health care providers commonly prescribe diuretics to help patients’ kidneys remove fluid from the body. On the the other hand, there’s a class of diuretics called thiazides that help to reduce urine production and help patients’ kidneys concentrate urine. Patients with nephrogenic diabetes insipidus would use these. Thiazide diuretics are sometimes combined with amiloride to prevent hypokalemia, or low potassium levels in the blood. Amiloride works to increase the amount of sodium and decrease the amount of potassium.

Aspirin or ibuprofen is sometimes used to help reduce urine volume as well. Do not use these drugs on a regular basis because of the risk of overdose. Symptoms of a ibuprofen overdose to look out for include: a ringing in the ears, blurred vision, headaches, confusion, dizziness, drowsiness and skin rashes.

Home remedies and Natural Treatment:

1. Change Your Diet:

A diet containing nutrient-dense whole foods with plenty of water-heavy fruits and vegetables can be helpful for people with diabetes insipidus. (10) Some examples of water-based, hydrating foods to consume regularly include: cucumbers, zucchini, dark leafy green vegetables (such as spinach and kale), red cabbage, red peppers, blueberries, watermelon, kiwi, citrus fruit, pineapple and strawberries. Starchy vegetables like sweet potatoes, squash, bananas and avocados are also great options. You may also find that coconut water is hydrating and helps to balance your electrolytes.

While you focus on adding these nourishing foods into your diet, try to avoid eating processed foods that are typically high in sodium and other chemicals that are used as preservatives. Removing caffeine from your diet may also be helpful, which includes carbonated soft drinks.

2. Avoid Dehydration:

It’s vital for diabetes insipidus patients to drink enough liquids to replace their urine losses and to relieve excessive thirst. You need to drink extra water to compensate for fluid loss, especially after being active or exercising. Research shows that without enough water present in the body, dehydration and deficits can cause cardiovascular complications, muscle cramping, fatigue, dizziness and confusion.

Make sure to always carry water with you wherever you go. Wearing a medical alert bracelet will alert professionals of your condition and advise them of your need for fluids.

3. Keep Your Electrolytes Balanced:

The major electrolytes found within the body include calcium, magnesium, potassium, sodium, phosphate and chloride. These nutrients help to stimulate nerves throughout the body and balance fluid levels. You can keep your electrolytes balanced by avoiding packaged or processed foods because of their sodium content. Sodium is an electrolyte that plays a significant role in the body’s ability to retain or release water. So if your diet is very high in sodium, the kidneys excrete more water. This can cause complications balancing other electrolytes. It’s also important to drink enough water throughout the day and to increase your water intake after exercise, when you are sick or any time you are losing fluids. (12)

4. Keep Your Mouth Moist:

Sucking on ice chips or sour candies can help to moisten your mouth and increase saliva flow, reducing your desire to drink. This can be especially helpful later in the evening when you don’t want to consume as much water and be up in middle of the night to use the bathroom.

5. Check Your Medications:

Some medications can impact your electrolyte balance, a complication of diabetes insipidus. These include antibiotics, diuretics, hormonal pills, blood pressure medications and cancer treatments. Cancer patients who are receiving chemotherapy usually experience the most serious forms of electrolyte imbalances. Laxatives and diuretics also change potassium and sodium levels within the blood and urine. It’s also possible to develop electrolyte imbalances due to hormonal interactions from antidiuretic hormone medications, aldosterone and thyroid hormones. Even high levels of physiological stress can impact hormones to the point that fluid and electrolyte levels can become thrown out of balance.

If you begin experiencing the signs and symptoms of diabetes insipidus, be sure to consider whether a new medication or supplement can be causing fluid or electrolyte imbalances.

Risk factors:

Nephrogenic diabetes insipidus that’s present at or shortly after birth usually has a genetic cause that permanently alters the kidneys’ ability to concentrate the urine. Nephrogenic diabetes insipidus usually affects males, though women can pass the gene on to their children.



Except for primary polydipsia, which causes you to retain too much water, diabetes insipidus can cause your body to retain too little water to function properly, and you can become dehydrated. And this  dehydration can cause:

* Dry mouth
* Changes in skin elasticity
* Low blood pressure (hypotension)
* Elevated blood sodium (hypernatremia)
* Fever
* Headache
* Rapid heart rate
* Weight loss
* Electrolyte imbalance

Diabetes insipidus can also cause an electrolyte imbalance. Electrolytes are minerals in your blood — such as sodium and potassium — that maintain the balance of fluids in your body. Electrolyte imbalance can cause symptoms, such as:

* Fatigue or lethargy
* Nausea
* Loss of appetite
* Muscle cramps
* Confusion

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.



Other Name:Crepitation

Crepitus is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.


Various types of crepitus that can be heard in joint pathologies are:

*Bone crepitus: This can be heard when two fragments of a fracture are moved against each other.

*Joint crepitus: This can be obtained when the affected joint is passively moved with one hand, while the other hand is placed on the joint to feel the crepitus.

*Crepitus of bursitis: This is heard when the fluid in the bursa contains small, loose fibrinous particles.
Crepitus of tenosynovitis. In most cases, crepitus is harmless if it occurs in normal people. But if crepitus is associated with an injury, or, if there is knee pain or swelling, then further investigations are required.

Crepitus, or joint sounds, can be a normal part of movement. Many people experience popping joints, especially as they get older. You may notice:

*Popping or cracking when you bend your knee or elbow
*Crunching sounds in your knee when you go up or down stairs or kneel
*Crackling or grinding sounds or a crunching sensation when you move your shoulder
*Occasional or continual swelling around the joint

How to protect the nee:
Orthopedic surgeons say that the best way to protect the knee is to warm up prior to exercise. By strengthening the quadriceps, one can decrease the load on the patellofemoral joint and also reduce the risk of eroding the cartilage. Other means of protecting the knee include stretching and wearing suitable shoes. It is also important to maintain a healthy weight to decrease stress on the knee joint.

If crepitus occurs during exercise, one should:
* Not stop but modify the exercise
* Avoid running on hills or inclines
* When cycling, maintain tension on the pedals
* If you are using quadriceps to lift weights, use lightweights and increase the frequency
Finally during an exercise listen to your body, if you develop pain, stop the activity.

The sound can be created when two rough surfaces in an organism’s body come into contact—for example, in osteoarthritis or rheumatoid arthritis when the cartilage around joints erodes and the surfaces in the joint grind against one another, or when the fractured surfaces of two broken bones rub together. Crepitus is a common sign of bone fracture.

Crepitus can easily be created and observed by exerting a small amount of force on a joint, thus ‘cracking it’. This is caused by bubbles of nitrogen forming in the synovial fluid bursting. Almost every joint in the body can be ‘cracked’ in this way, but the joints which require the least amount of effort include the hallux, knuckles and neck joints.

In soft tissues, crepitus can be produced when gas is introduced into an area where it is normally not present.

The term can also be used when describing the sounds produced by lung conditions such as interstitial lung disease—these are also referred to as “rales”. Crepitus is often loud enough to be heard by the human ear, although a stethoscope may be needed to detect instances caused by respiratory diseases.

In times of poor surgical practice, post-surgical complications involved anaerobic infection by Clostridium perfringens strains, which can cause gas gangrene in tissues, also giving rise to crepitus.

Subcutaneous crepitus (or surgical emphysema) is a crackling sound resulting from subcutaneous emphysema, or air trapped in the subcutaneous tissues.

Treating Crepitus in the Knee, Shoulder or Other Joints:
Many causes of joint popping and cracking improve with home remedies, like taking anti-inflammatory medications or using the RICE method (rest, ice, compression and elevation). Other causes might require a doctor’s help.

Noninvasive Treatments for Crepitus:
Your doctor will talk with you about possible treatments, including:

*Bracing or splinting: Sometimes, a brace or splint can help align the joint so an injury can heal.
Physical therapy: Our physical therapy teams tailor treatment plans to your condition, activities and goals. Get more information about physical therapy.

*Custom orthotics: Orthotics – special shoe inserts that stabilize the foot and knee – can relieve pain and help you stay active. Learn more about custom foot orthotics.

*Pain relief: We take pain management very seriously. Handled correctly, pain relief methods can eliminate discomfort and inflammation and may let you get back to your favorite activities safely. Read more about orthopedic pain we treat.

Surgical Options to Eliminate Pain-Causing Crepitus:
Some causes of crepitus might require surgical treatment. We’ll advise you on the least invasive treatment to relieve joint pain and minimize future damage. You might consider:

*Arthroscopic surgery: Arthroscopy is a minimally invasive surgery that uses small instruments inserted through tiny incisions to access the joint. For PFS, your surgeon can remove bits of damaged tissue or reposition tendons to provide more knee movement. Learn more about treatments for knee pain.

*Debridement: Some types of PFS and arthritis improve with debridement. In this minimally invasive surgery, the surgeon can smooth damaged cartilage to reduce rubbing.

*Joint replacement: When arthritis or joint damage is advanced, you might consider joint replacement. Joint replacement surgery implants an artificial joint in place of a damaged joint. Find out more about orthopedic medicine and orthopedic surgery.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Crepitus of the Knee: When is it Serious?


Bradycardia is an abnormally slow heart rate of less than 60 beats per minute. Each time the heart beats, oxygen-rich blood is pumped through the body. When an individual has an extremely low resting heart rate, his or her organs may not receive enough oxygen to operate properly.


Bradycardia typically does not cause symptoms until the rate drops below 50 BPM. When symptomatic, it may cause fatigue, weakness, dizziness, sweating, and at very low rates, fainting.

During sleep, a slow heartbeat with rates around 40–50 BPM is common, and is considered normal. Highly trained athletes may also have athletic heart syndrome, a very slow resting heart rate that occurs as a sport adaptation and helps prevent tachycardia during training.

The term relative bradycardia is used in explaining a heart rate that, although not actually below 60 BPM, is still considered too slow for the individual’s current medical condition.

Atrial bradycardias are divided into three types. The first, respiratory sinus arrhythmia, is usually found in young and healthy adults. Heart rate increases during inhalation and decreases during exhalation. This is thought to be caused by changes in the vagal tone during respiration.[3] If the decrease during exhalation drops the heart rate below 60 bpm on each breath, this type of bradycardia is usually deemed benign and a sign of good autonomic tone.

The second, sinus bradycardia, is a sinus rhythm of less than 60 BPM. It is a common condition found in both healthy individuals and those considered well-conditioned athletes. Studies have found that 50–85% of conditioned athletes have benign sinus bradycardia, as compared to 23% of the general population studied.[4] The heart muscle of athletes has become conditioned to have a higher stroke volume, so requires fewer contractions to circulate the same volume of blood.

The third, sick sinus syndrome, covers conditions that include severe sinus bradycardia, sinoatrial block, sinus arrest, and bradycardia-tachycardia syndrome (atrial fibrillation, flutter, and paroxysmal supraventricular tachycardia).

Atrioventricular nodal:
An atrioventricular nodal bradycardia or AV junction rhythm is usually caused by the absence of the electrical impulse from the sinus node. This usually appears on an EKG with a normal QRS complex accompanied with an inverted P wave either before, during, or after the QRS complex.

An AV junctional escape is a delayed heartbeat originating from an ectopic focus somewhere in the AV junction. It occurs when the rate of depolarization of the SA node falls below the rate of the AV node.[3] This dysrhythmia also may occur when the electrical impulses from the SA node fail to reach the AV node because of SA or AV block.[5] This is a protective mechanism for the heart, to compensate for an SA node that is no longer handling the pacemaking activity, and is one of a series of backup sites that can take over pacemaker function when the SA node fails to do so. This would present with a longer PR interval. A junctional escape complex is a normal response that may result from excessive vagal tone on the SA node. Pathological causes include sinus bradycardia, sinus arrest, sinus exit block, or AV block.

A ventricular bradycardia, also known as ventricular escape rhythm or idioventricular rhythm, is a heart rate of less than 50 BPM. This is a safety mechanism when a lack of electrical impulse or stimuli from the atrium occurs. Impulses originating within or below the bundle of His in the atrioventricular node will produce a wide QRS complex with heart rates between 20 and 40 BPM. Those above the bundle of His, also known as junctional, will typically range between 40 and 60 BPM with a narrow QRS complex. In a third-degree heart block, about 61% take place at the bundle branch-Purkinje system, 21% at the AV node, and 15% at the bundle of His. AV block may be ruled out with an EKG indicating “a 1:1 relationship between P waves and QRS complexes.” Ventricular bradycardias occurs with sinus bradycardia, sinus arrest, and AV block. Treatment often consists of the administration of atropine and cardiac pacing.

For infants, bradycardia is defined as a heart rate less than 100 BPM (normal is around 120–160). Premature babies are more likely than full-term babies to have apnea and bradycardia spells; their cause is not clearly understood. The spells may be related to centers inside the brain that regulate breathing which may not be fully developed. Touching the baby gently or rocking the incubator slightly will almost always get the baby to start breathing again, which increases the heart rate. Medications (theophylline or caffeine) can be used to treat these spells in babies if necessary. Neonatal intensive-care unit (NICU) standard practice is to electronically monitor the heart and lungs for this reason.

If one has bradycardia, his or her brain and other organs might not get enough oxygen, possibly causing these symptoms:

*Near-fainting or fainting (syncope)

*Dizziness or lightheadedness


*Shortness of breath

*Chest pains

*Confusion or memory problems

*Easily tiring during physical activity

This cardiac arrhythmia can be underlain by several causes, which are best divided into cardiac and noncardiac causes. Noncardiac causes are usually secondary, and can involve recreational drug use or abuse; metabolic or endocrine issues, especially in the thyroid; an electrolyte imbalance; neurologic factors; autonomic reflexes; situational factors such as prolonged bed rest; and autoimmunity. Cardiac causes include acute or chronic ischemic heart disease, vascular heart disease, valvular heart disease, or degenerative primary electrical disease. Ultimately, the causes act by three mechanisms: depressed automaticity of the heart, conduction block, or escape pacemakers and rhythms.

In general, two types of problems result in bradycardias: disorders of the sinoatrial node (SA node), and disorders of the atrioventricular node (AV node).

With sinus node dysfunction (sometimes called sick sinus syndrome), there may be disordered automaticity or impaired conduction of the impulse from the sinus node into the surrounding atrial tissue (an “exit block”). Second-degree sinoatrial blocks can be detected only by use of a 12-lead EKG.[8] It is difficult and sometimes impossible to assign a mechanism to any particular bradycardia, but the underlying mechanism is not clinically relevant to treatment, which is the same in both cases of sick sinus syndrome: a permanent pacemaker.

Atrioventricular conduction disturbances (AV block; primary AV block, secondary type I AV block, secondary type II AV block, tertiary AV block) may result from impaired conduction in the AV node, or anywhere below it, such as in the bundle of His. The clinical relevance pertaining to AV blocks is greater than that of sinoatrial blocks.

Patients with bradycardia have likely acquired it, as opposed to having it congenitally. Bradycardia is more common in older patients.

Beta-blocker medicines also can slow the heart rate and decrease how forcefully the heart contracts. Beta blockers may slow the heart rate to a dangerous level if prescribed with calcium channel blocker-type medications.

Bradycardia is also part of the mammalian diving reflex.


Your physician may hear an abnormally slow heart rate when listening to your heart with a stethoscope during a physical exam. He or she also may detect normal or low blood pressure. Tests used to help in the diagnosis include the following:

Electrocardiogram (ECG or EKG):

An electrocardiogram, also called an ECG or EKG, is a primary tool for evaluating bradycardia. Using small sensors (electrodes) attached to your chest and arms, it records electrical signals as they travel through your heart.

Because an ECG can’t record bradycardia unless it happens during the test, your doctor might have you use a portable ECG device at home. These devices include:

Holter monitor. Carried in your pocket or worn on a belt or shoulder strap, this device records your heart’s activity for 24 to 48 hours.

Your doctor will likely ask you to keep a diary during the same 24 hours. You’ll describe any symptoms you experience and record the time they occur.

Event recorder. This device monitors your heart activity over a few weeks. You push a button to activate it when you feel symptoms so that it records your heart’s activity during that time.
Your doctor might use an ECG monitor while performing other tests to understand the impact of bradycardia. These tests include:

Tilt table test. This test helps your doctor better understand how your bradycardia contributes to fainting spells. You lie flat on a special table, and then the table is tilted as if you were standing up to see if the change in position causes you to faint.
Exercise test. Your doctor might monitor your heart rate while you walk on a treadmill or ride a stationary bike to see whether your heart rate increases appropriately in response to physical activity.

Laboratory and other tests:

Your doctor will order blood tests to screen for conditions that might be contributing to bradycardia, such as an infection, hypothyroidism or an electrolyte imbalance.

If sleep apnea is suspected of contributing to bradycardia, you might undergo tests to monitor your sleep.

The treatment of bradycardia is dependent on whether or not the person is stable or unstable. If oxygen saturations are low, supplemental oxygen should be provided.

Emergency treatment is not needed if the person is asymptomatic or minimally symptomatic.

If a person is unstable, the initial recommended treatment is intravenous atropine. Doses less than 0.5 mg should not be used, as this may further decrease the rate. If this is not effective, intravenous inotrope infusion (dopamine, epinephrine) or transcutaneous pacing should be used.[10] Transvenous pacing may be required if the cause of the bradycardia is not rapidly reversible.

Regular walking for 30 minutes, Yoga & meditation is the best way to get releve from Bradycardia.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Few Health Quarries & Answers


Q : I feel that my face is asymmetrical and I am very self-conscious about it.

Ans: People do have asymmetrical faces. In some, it may be more pronounced. It can be present from birth, when one side of the face develops less than the other. It may come on later as a result of a viral infection (herpes), facial palsy or injury. It can occur because of sleeping regularly only on one side. It can also be due to bad teeth, as a result of which you tend to chew on any one side. It is possible to correct some of the acquired conditions. Sometimes surgery may be required.

Bamboo spine:

Q :  I have a severe backache, and the doctor has diagnosed ankylosing spondylitis. Will it become worse?

Ans:  Ankylosing spondylitis is a condition when the bones of the spine become stiff and rigid, leading to limited flexibility and eventually a “bamboo spine”. It is more common in people who carry the HLA B27 gene and can run in families. Its symptoms are controlled with medication and regular physiotherapy, but it cannot be cured.

Caregiver woes:

Q : I am a 52-year-old woman. I work in an office and also care for my teenage children as well as my mother-in-law who has mild dementia. I find it all rather overwhelming.

Ans: Many women are caught in the never-ending spiral of caring. Remember, you also have to care for yourself. The important thing is to realise that you do the job out of love and not a sense of obligation. Look after yourself, and try to get in 30 minutes of aerobic activity, five minutes of meditation and 10 minutes of stretching every day. Unless you are healthy, you will not be able to care for others.

Medical kit:

Q:  My son as he is starting college and I need to send a medical kit with him to the hostel.

Ans: It is more important that you son’s immunisations against typhoid, hepatitis A, chickenpox and flu are up to date so that he does not go to college and immediately fall sick.

Other than this, paracetamol for fever, levocetirizine and a few ORS sachets for diarrhoea are probably enough.

Sources: The Telegraph (Kolkata, India)