Categories
Ailmemts & Remedies

Abdominal Aortic Aneurysm(AAA)

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Definition:
The aorta is the largest artery in your body, and it carries oxygen-rich blood pumped out of, or away from, your heart. Your aorta runs through your chest, where it is called the thoracic aorta. When it reaches your abdomen, it is called the abdominal aorta. The abdominal aorta supplies blood to the lower part of the body. In the abdomen, just below the navel, the aorta splits into two branches, called the iliac arteries, which carry blood into each leg.

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When a weak area of the abdominal aorta expands or bulges, it is called an abdominal aortic aneurysm (AAA). The pressure from blood flowing through your abdominal aorta can cause a weakened part of the aorta to bulge, much like a balloon. A normal aorta is about 1 inch (or about 2 centimeters) in diameter. However, an AAA can stretch the aorta beyond its safety margin as it expands. Aneurysms are a health risk because they can burst or rupture. A ruptured aneurysm can cause severe internal bleeding, which can lead to shock or even death.

Less commonly, AAA can cause another serious health problem called embolization. Clots or debris can form inside the aneurysm and travel to blood vessels leading to other organs in your body. If one of these blood vessels becomes blocked, it can cause severe pain or even more serious problems, such as limb loss.

Each year, physicians diagnose approximately 200,000 people in the United States with AAA. Of those 200,000, nearly 15,000 may have AAA threatening enough to cause death from its rupture if not treated.

Fortunately, especially when diagnosed early before it causes symptoms, an AAA can be treated, or even cured, with highly effective and safe treatments.

Symptoms:
Although you may initially not feel any symptoms with AAA, if you develop symptoms, you may experience one or more of the following:

*A pulsing feeling in your abdomen, similar to a heartbeat

*Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to burst.

*On rare occasions, your feet may develop pain, discoloration, or sores on the toes or feet because of material shed from the aneurysm

*If your aneurysm bursts, you may suddenly feel intense weakness, dizziness, or pain, and you may eventually lose consciousness. This is a life-threatening situation and you should seek medical attention immediately.

Causes:
Physicians and researchers are not quite sure what actually causes an AAA to form in some people. The leading thought is that the aneurysm may be caused by inflammation in the aorta, which may cause its wall to weaken or break down. Some researchers believe that this inflammation can be associated with atherosclerosis (also called hardening of the arteries) or risk factors that contribute to atherosclerosis, such as high blood pressure (hypertension) and smoking. In atherosclerosis fatty deposits, called plaque, build up in an artery. Over time, this buildup causes the artery to narrow, stiffen and possibly weaken. Besides atherosclerosis, other factors that can increase your risk of AAA include:

*Being a man older than 60 years

*Having an immediate relative, such as a mother or brother, who has had AAA

*Having high blood pressure

*Smoking

Your risk of developing AAA increases as you age. AAA is more common in men than in women.

Tests and Diagnosis:
Most abdominal aortic aneurysms are found during an examination for another reason. For example, during a routine exam, your doctor may feel a pulsating bulge in your abdomen, though it’s unlikely your doctor will be able to hear signs of an aneurysm through a stethoscope. Aortic aneurysms are often found during routine medical tests, such as a chest X-ray or ultrasound of the heart or abdomen, sometimes ordered for a different reason.

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Abdominal aortic aneurysms that are not causing symptoms are most often found when a physician is performing an imaging test, such as an ultrasound or CT scan, for another condition. Sometimes your physician may feel a large pulsing mass in your abdomen on a routine physical examination.  If your physician suspects that you may have AAA, he or she may recommend one of the following tests to confirm the suspicion:

*Abdominal ultrasound

*Computed tomography (CT) scan

*Magnetic resonance imaging (MRI)

Modern Treatment:
Watchful waiting
If your AAA is small, your physician may recommend “watchful waiting,” which means that you will be monitored every 6-12 months for signs of changes in the aneurysm size. Your physician may schedule you for regular CT scans or ultrasounds to watch the aneurysm. This method is usually used for aneurysms that are smaller than about 2 inches (roughly 5.0 to 5.5 centimeters) in diameter. If you also have high blood pressure, your physician may prescribe blood pressure medication to lower the pressure on the weakened area of the aneurysm. If you smoke, you should obtain help to stop smoking. An aneurysm will not “go away” by itself. It is extremely important to continue to follow up with your physician as directed because the aneurysm may enlarge to a dangerous size over time. It could eventually burst if this is not detected and treated.
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Open Surgical aneurysm repair…….click & see
A vascular surgeon may recommend that you have a surgical procedure called open aneurysm repair if your aneurysm is causing symptoms, or is larger than about 2 inches (roughly 5.0 to 5.5 centimeters), or is enlarging under observation. During an open aneurysm repair, also known as surgical aneurysm repair, your surgeon makes an incision in your abdomen and replaces the weakened part of your aorta with a tube-like replacement called an aortic graft. This graft is made of a strong, durable, man-made plastic material, such as Dacron®, in the size and shape of the healthy aorta. The strong tube takes the place of the weakened section in your aorta and allows your blood to pass easily through it. Following the surgery, you may stay in the hospital for 4 to 7 days. Depending upon your circumstances, you may also require 6 weeks to 3 months for a complete recovery. More than 90 percent of open aneurysm repairs are successful for the long term.

Endovascular stent graft…….....click & see
Instead of open aneurysm repair, your vascular surgeon may consider a newer procedure called an endovascular stent graft. Endovascular means that the treatment is performed inside your artery using long, thin tubes called catheters that are threaded through your blood vessels. This procedure is less invasive, meaning that your surgeon will usually need to make only small incisions in your groin area through which to thread the catheters. During the procedure, your surgeon will use live x-ray pictures viewed on a video screen to guide a fabric and metal tube, called an endovascular stent graft  (or endograft), to the site of the aneurysm. Like the graft in open surgery, the endovascular stent graft also strengthens the aorta. Your recovery time for endovascular stent grafting is usually shorter than for the open surgery, and your hospital stay may be reduced to 2 to 3 days. However, this procedure requires more frequent follow-up visits with imaging procedures, usually CT scans, after endograft placement to be sure the graft continues to function properly.  Also, the endograft is more likely to require periodic maintenance procedures than does the open procedure. In addition, your aneurysm may not have the shape that is suitable for this procedure, since not all patients are candidates for endovascular repair because of the extent of the aneurysm, or its relationship to the renal (kidney) arteries, or other issues. While the endovascular stent graft may be a good option for some patients who have suitable aneurysms and who have medical conditions increasing their risk, in some other cases, open aneurysm repair may still be the best way to cure AAA. Your vascular surgeon will help you decide what is the best method of treatment for your particular situation.

Endovascular treatment of AAA……...click & see
In the recent years, the endoluminal treatment of Abdominal Aortic Aneurysms has emerged as a minimally invasive alternative to open surgery repair. The first endoluminal exclusion of an aneurysm took place in Argentina by Dr. Parodi and his colleagues in 1991. The endovascular treatment of aortic aneurysms involves the placement of an endo-vascular stent via a percutaneous technique (usually through the femoral arteries) into the diseased portion of the aorta. This technique has been reported to have a lower mortality rate compared to open surgical repair, and is now being widely used in individuals with co-morbid conditions that make them high risk patients for open surgery. Some centers also report very promising results for the specific method in patients that do not constitute a high surgical risk group.

There have also been many reports concerning the endovascular treatment of ruptured Abdominal Aortic Aneurysms, which are usually treated with an open surgery repair due to the patient’s impaired overall condition. Mid-term results have been quite promising.[citation needed] However, according to the latest studies, the EVAR procedure doesn’t carry any overall survival benefit.

Endovascular treatment of other aortic aneurysms
The endoluminal exclusion of aortic aneurysms has seen a real revolution in the very recent years. It is now possible to treat thoracic aortic aneurysms, abdominal aortic aneurysms and other aneurysms in most of the body’s major arteries (such as the iliac and the femoral arteries) using endovascular stents and avoiding big incisions. Still, in most cases the technique is applied in patients at high risk for surgery as more trials are required in order to fully accept this method as the gold standard for the treatment of aneurysms.

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Prevention
Attention to patient’s general blood pressure, smoking and cholesterol risks helps reduce the risk on an individual basis. There have been proposals to introduce ultrasound scans as a screening tool for those most at risk: men over the age of 65. The tetracycline antibiotic, Doxycycline is currently being investigated for use as a potential drug in the prevention of aortic aneurysm due to its metalloproteinase inhibitor and collagen stabilising properties.

Research
Stanford University is conducting research to gather information on AAA risk factors, and to evaluate the effectiveness of an exercise program at preventing the growth of small AAAs in older individuals.

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.

 

Resources:
http://www.vascularweb.org/patients/NorthPoint/Abdominal_Aortic_Aneurysm.html
http://en.wikipedia.org/wiki/Aortic_aneurysm
http://www.mayoclinic.com/health/aortic-aneurysm/ds00017/dsection=tests-and-diagnosis

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Categories
Diagnonistic Test

Carotid Ultrasound (Carotid Doppler)

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Definition:
Ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures inside the body. This imaging technique works in a manner similar to radar and sonar, developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible. After coating your skin with a lubricant to reduce friction, a radiologist or ultrasound technician places an ultrasound transducer, which looks like a microphone, on your skin and may rub it back and forth to get the right view. The transducer sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor…….....CLICK & SEE

Doppler ultrasound is a variation of this technique that not only shows internal structures but also examines the flow of blood through blood vessels. Using the Doppler effect—the change in the frequency of sound or light waves as they bounce off a moving object—this kind of ultrasound produces an image of blood in motion…..CLICK & SEE

A Carotid ultrasound shows the amount of blood flow in the carotid arteries, the major blood vessels to the brain located on either side of your neck. With this imaging technique, your doctor can see if there is any narrowing of your carotid arteries because of cholesterol deposits or some other problem. This test is often used to evaluate people who have had a stroke or who might be at high risk for one because of reduced blood flow in the carotid arteries…......CLICK & SEE.

Who Needs Carotid Ultrasound?
Carotid ultrasound checks for plaque buildup in the carotid arteries. This buildup can narrow or block your carotid arteries. You may need a carotid ultrasound if you:

*Had a stroke or ministroke recently.
*Have an abnormal sound in your carotid artery called a carotid bruit (broo-E).

Your doctor can hear a carotid bruit with the help of a stethoscope put on your neck over the carotid artery. A bruit can mean that there’s a partial blockage in your carotid artery that could lead to a stroke.
Your doctor also may order a carotid ultrasound if he or she suspects you may have:

*Blood clots that can slow blood flow in your carotid artery
*A split between the layers of your carotid artery wall that weakens the wall or reduces the blood flow to your brain
A carotid ultrasound also may be done to see whether carotid artery surgery has restored normal blood flow. If you had a procedure called carotid stenting, your doctor may order a carotid ultrasound afterward to check the position of the stent put in your carotid artery. (The stent, a small mesh tube, helps prevent the artery from becoming narrowed or blocked again.)

Sometimes carotid ultrasound is used as a preventive screening test in people who have medical conditions that increase their risk of stroke, including high blood pressure and diabetes. People with these conditions may benefit from having their carotid arteries checked regularly even if they show no signs of plaque buildup.

What To Expect Before Carotid Ultrasound
Carotid ultrasound is a painless test, and typically there is little to do in advance. Your doctor will tell you how to prepare for your carotid ultrasound.

Process of Performing the Test.:
After squirting some clear jelly onto one side of your neck to help the ultrasound sensor slide around easily, a technician places the sensor against your skin. An image then appears on a video screen . As the technician moves the sensor back and forth on your neck, different views of the carotid artery appear on the screen. As the equipment measures the blood flow through the artery, you hear a noise that sounds like your heartbeat. The other side of your neck is checked in the same way. This test usually takes 15–30 minutes.

The ultrasound machine includes a computer, a video screen, and a transducer, which is a hand-held device that sends and receives ultrasound waves into and from the body.

You will lie down on your back on an exam table for the test. Your technician or doctor will put a gel on your neck where your carotid arteries are located. This gel helps the ultrasound waves reach the arteries better. Your technician or doctor will put the transducer against different spots on your neck and move it back and forth.

FIG-A

 

 

 
……….Fig->A.
The above Figure shows how the ultrasound probe is placed over the carotid artery. Figure B is a color ultrasound image showing blood flow (the red color in the image) in the carotid artery. Figure C is a waveform image showing the sound of flowing blood in the carotid artery.

The transducer gives off ultrasound waves and detects their echoes after they bounce off the artery walls and blood cells. Ultrasound waves can’t be heard by the human ear.

A computer uses the echoes of the ultrasound waves bouncing off the carotid arteries to create and record images of the insides of the arteries (usually in black and white) and your blood flowing through them (usually in color; this is the Doppler ultrasound). A video screen displays these live images for your doctor to review.

Risk Factor:
There are no risks linked to having a carotid ultrasound, because the test uses harmless sound waves. These are the same type of sound waves that doctors use to record pictures of fetuses in pregnant women.

What one must do after the test is over?
Carotid ultrasound is usually done in a doctor’s office or hospital. The test is painless and usually doesn’t take more than 30 minutes.
Usually there is nothing special you have to do after a carotid ultrasound, and you should be able to return to normal activities immediately.

Often your doctor will be able to tell you the results of the carotid ultrasound when it occurs or soon afterward.

What Does a Carotid Ultrasound Show?
A carotid ultrasound can show whether buildup of a fatty material called plaque has narrowed one or both of your carotid arteries and reduced blood flow to your brain.

.Fig->B………………….
The illustration shows a normal artery with normal blood flow (figure A) and an artery containing plaque buildup ( figure B).

If your carotid arteries are narrowed by plaque, you may be at risk for having a stroke. That risk depends on how much of your artery is blocked and how much blood flow is restricted. To reduce your risk for stroke, your doctor may recommend medical or surgical treatments to reduce or remove the plaque buildup in your carotid arteries.

How long is it before the result of the test is known?
The technician records the test on videotape for review by a radiologist. The radiologist then makes measurements from the video picture and submits a report to your doctor. Your doctor should have the results within a few days.

Key Points to Note:
*Carotid ultrasound is a test that uses high-frequency sound waves to create images of the insides of the two large arteries in your neck. These arteries, called carotid arteries, supply your brain with blood.

*A carotid ultrasound can show whether buildup of a fatty material called plaque has narrowed one or both of your carotid arteries and reduced blood flow to your brain.

*If your carotid arteries are narrowed by plaque, you may be at risk for having a stroke, depending on how much of your artery is blocked and how much blood flow is restricted.

*You may need a carotid ultrasound if you had a stroke or ministroke recently or are at high risk for having a stroke.

*Carotid ultrasound is a painless test done in a doctor’s office or hospital. It usually doesn’t take more than 30 minutes and requires no preparation or followup.

*There are no risks linked to having a carotid ultrasound, because the test uses harmless sound waves.

Resources:
http://www.health.harvard.edu/diagnostic-tests/carotid-ultrasound.htm
http://www.nhlbi.nih.gov/health/dci/Diseases/cu/cu_all.html

Categories
Healthy Tips News on Health & Science

Stents Reduces Clot Formation in Heart

myocardial infarction - Myokardinfarkt - scheme
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Stents, a new technology used in angioplasty is very effective, Dr Sunil Kapoor, Chief Cardiologist at Care Hospitals, said ...

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Kapoor attended the World Conference of Cardiologists at Washington recently.

Stents, used in angioplasty procedures, are thinner, coated with new drugs which were more effective in prevention of re-narrowing.

Stents also have biocompatible, biodegradable polymer which dissolves by itself after six months, thus reducing chances of clot formation, Dr Sunil Kapoor, Chief Cardiologist at Care Hospitals, who attended the conference, said here today.

He said that data presented in the USA showed new generation stents were significantly superior to the previously used standard, drug coated stents. Head-to-head comparison was done in the trials. The same stents have been made available in Hyderabad and used successfully, Dr Kapoor said.

“We have used the new technology-Stents and find them to be very good and data shows that re-narrowing and second heart attack can be prevented 98%. These stents have lesser chance of re-narrowing (only 1.5%) and clot formation in the stents was found to be zero per cent upto two years of follow up. This is likely to make Stents equal to bypass surgery. If not superior, but without the complications of surgery,” he said.

“This is a very significant development for treatment of heart patients and makes angioplasty and Stent procedures easier, safer and with better long lasting effect,” Dr Kapoor added.

Sources: The Times Of India

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