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Example research essay topic: Low Blood Pressure Beats Per Minute - 2,499 words

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... when they occur in the cardiac cycle as well as by echocardiography and cardiac catheterization. MVP-see Mitral Valve Prolapse. Myocardial Infarction-Death of a region of the muscle supplied by an occluded coronary artery. This is commonly referred to as a 'heart attack. ' A previously stable atherosclerotic plaque in a coronary artery-one that was only partially occluding the artery and producing either a stable anginal pattern or no symptoms at all-ruptures its surface due to shear stress from the blood flow around it and / or inflammation in the plaque.

This results in blood clotting on the surface of the plaque which then totally occludes the artery. The symptoms are similar to what was described for angina above but much more severe and prolonged. They don't typically respond to nitroglycerin. Rarely, people can have silent heart attacks without symptoms. The myocardial infarction may lead to heart failure, arrhythmias and sudden death. Most deaths occur prior to arrival in the hospital.

That is why it is imperative to activate the emergency medical system (911 in the USA) and get to the nearest emergency room as soon as possible. There are two types of heart attack patterns seen on the initial ECG. One type requires administration of either clot dissolving agents or angiography followed by angioplasty within twelve hours of the onset of the event (the sooner the better) to get the artery open. The other type doesn't.

Both types are treated with antiplatelet therapy with aspirin, anticoagulant therapy with intravenous or subcutaneous heparin's, beta blockers and ACE inhibitors. Patients are initially admitted to the intensive care unit. The size of the heart attack is assessed by cardiac enzymes and echocardiography. If an angiogram was not done acutely, an angiogram or a stress test is generally performed before hospital discharge to see if an angioplasty or bypass operation may be needed. Patients with an uncomplicated myocardial infarction not requiring additional procedures often go home from the hospital after about 5 days. Long term therapy of the heart attack survivor includes risk factor modification, a cardiac rehabilitation program and continuation of aspirin, beta blockers and ACE inhibitors.

Quite frequently, patients present with symptoms suggestive of a heart attack but it cannot be determined right away whether it is a heart attack, severe (unstable) angina or a non cardiac event. Such patients are admitted to a cardiac unit or ICU and are treated with many of the same medicines used for clear cut heart attacks while awaiting the results of diagnostic testing which include repeated Ecg's, cardiac enzymes and possible echocardiography, stress testing or angiography. Myocarditis-Inflammation of the muscle of the heart. This may be due to a viral infection or result from unknown causes.

This is usually no specific treatment for the inflammation per se. The resulting weakness of the heart muscle and heart failure is treated with medications. Myocardium-The muscle of the heart. RETURN TO TOP -N- Normal Sinus Rhythm-The normal electrical activation pattern of the heart. This produces a heart rate between 60 and 100 beats per minute.

RETURN TO TOP -O- Orthopnea-Shortness of breath when lying flat. It is relieved by putting extra pillows under the head or sitting up. It is a symptom of heart failure. RETURN TO TOP -P- Palpitations-An awareness of one's heart beat. It may represent a true disturbance in the electrical activity of the heart (an arrhythmia-see above) or simply an awareness of a forceful but otherwise normal heart beat.

This latter cause is quite benign as are palpitations that are due to isolated skips in the heart beat. It is quite common for people to become aware of their heart beat when they first lie down in bed at night. It is also common to feel palpitations with excessive physical activity and anxiety. Palpitations are evaluated by recording the electrical activity of the heart during the event. Palpitations that are due to serious arrhythmias mandate complete evaluation and treatment of that arrhythmia. Palpitations due to other causes are often treated with the simple reassurance of their benign nature but if they are intolerable, medications such as beta blockers can be used.

Pericardial Constriction-Scarring of the pericardium squeezes and constricts the heart, preventing it from filling with the venous return from the body. This results in generalized swelling and weakness. It can be caused by prior pericarditis, radiation therapy to the chest and sometimes after open heart surgery. The diagnosis can be made by echocardiography, CT scans, MRI scans and cardiac catheterization. If the swelling cannot be controlled with diuretics, the pericardium can be stripped away surgically. Pericardial Effusion-A build-up of fluid within the pericardium.

It can be caused by pericarditis, tumors invading the heart, recent open heart surgery and an underactive thyroid gland. The diagnosis is made by echocardiography, CT scan or MRI scan. If the effusion is large or symptomatic and does not adequately resolve with treatment of the underlying cause, the fluid may be drained out-either by inserting a needle through the skin under a local anesthetic or by a minor surgical procedure. Pericardial Tamponade-When a pericardial effusion exerts pressure on the chambers of the heart, it may impair the return of blood to the heart. This, in turn, impairs the ability of the heart to pump blood out to the body. This results in low blood pressure, a rapid pulse, shortness of breath and weakness.

The diagnosis is made by echocardiography or cardiac catheterization. The treatment is urgent drainage of the fluid-either by inserting a needle through the skin under a local anesthetic or by a minor surgical procedure-as well as treating whatever caused the fluid to build up in the first place. Pericarditis-Inflammation of the pericardium. It may be caused by a viral infection of the pericardium, a systemic inflammatory process such as Lupus, and recent open heart surgery. Sometimes, no cause can be discovered. The typical symptom is chest pain that is worse as the patient breathes in and worse when lying down.

Fevers, palpitations and shortness of breath may also occur. Echocardiograms can be used to determine if there is an accompanying pericardial effusion. The diagnosis is typically made on the basis of the patient's symptoms, a characteristic sound from the heart heard with the stethoscope, called a rub, and by blood tests. Pericarditis is generally treated with anti-inflammatory agents such as aspirin, nonsteroidal anti-inflammatory agents such as ibuprofen or steroids. Frequently recurrent cases can be treated with colchicine. Rare bacterial infections of the pericardium are treated with antibiotics and surgical drainage of the associated pericardial effusion.

Pericardium-Tissue around the heart that folds back on itself to forms a sac. It provides a frictionless surrounding for the beating heart and helps prevent the heart from moving excessively within the chest. It is not essential for life and can be surgically removed in its entirety if diseased. Phlebitis-see Deep Vegas Thrombosis.

Pulmonary Embolism-See the above discussion of deep venous thrombosis. If the blood clot breaks off from the vein in the leg, it will travel to the right side of the heart and then lodge in a blood vessel of the lung, preventing the flow of blood through that vessel. This manifests as chest pressure or pain that is often worse when the patient breathes in, shortness of breath, low blood pressure and arrhythmias. This can result in sudden death. The diagnosis is made by a nuclear medicine test called a ventilation-perfusion lung scan, spiral CT scan of the chest or a pulmonary artery angiogram. The initial treatment may include clot dissolving agents, as well as anticoagulants such as heparin's.

Long term treatment is with the oral blood thinning agent warfarin. Sometimes a filter is placed in the main vein that returns blood to the heart from the lower body (the inferior vena cava) to prevent recurrent blood clots from traveling to the lungs. Rarely, surgery is needed to remove the blood clots from the arteries of the lungs. Pulmonary Hypertension-Elevated blood pressure in the blood vessels of the lungs. It can be caused by many different diseases of the heart and lungs as well as pulmonary emboli, certain systemic inflammatory conditions and certain medications. It sometimes occurs for no apparent cause.

Treatment is directed at the underlying cause, if there is one. Otherwise, the options include a calcium channel blocker called nifedipine, an ACE inhibitor called captopril, a medicine called prostacyclin (ilo prost) which may be inhaled or given intravenously or a lung transplant. Pulmonic Valve-The right vehicle pumps blood through this valve into the lungs. It is composed of three cusps.

When the right ventricle is finished ejecting blood, this valve closes so that blood does not leak backwards from the lungs to the right ventricle as the right ventricle fills with blood from the right atrium for the next heart beat. Pulmonic Valve Regurgitation-Leakage of the pulmonary valve. The blood flows backwards from the lungs to the right ventricle. This can lead to weakness and swelling.

Pulmonic Valve Stenosis-An inability of the pulmonic valve to open fully, making it difficult for the right ventricle to pump blood to the lungs. If severe, it can be treated with surgery or balloon valvuloplasty. RETURN TO TOP -Q- RETURN TO TOP -R- Regurgitation-When a heart valve does not close properly, the blood leaks backwards through the valve. Restenosis-The recurrence of an arterial narrowing (stenosis) after an angioplasty or stent procedure. Rheumatic Heart Disease-Rheumatic fever is caused by a streptococcal bacterial sore throat. If this is not treated promptly with antibiotics, an immune reaction to the bacteria begins that also damages the heart.

This most commonly results in stenosis and regurgitation of the valves of the heart. Acute rheumatic fever also causes arthritis, rashes and involuntary jerking motion of the body. The diagnosis is made by blood tests. Mild attacks are treated with aspirin.

More severe attacks are treated with steroids. The management of the chronic valvular problems that develop is discussed under the heading for each valve on this page. RETURN TO TOP -S- Shock-This medical term does not refer to an emotional state. Instead, it refers to a systolic blood pressure (that's the upper number of the blood pressure) less than 90 in association with symptoms due to decreased blood flow to the various organs in the body. Such symptoms can include impaired thinking or loss of consciousness and decreased urine output.

Shock can be caused by many things including hemorrhage, dehydration, many types of heart disease, infections and drug overdoses. Some rare people naturally run a systolic blood pressure less than 90 without the above mentioned symptoms. That is not shock. Shortness of Breath-see dyspnea and orthop nea Sinus Bradycardia-This refers to a slowing of the generation of the electrical impulses that cause the heart to beat. These impulses arise from a site high in the right atrium called the sino atrial or SA node.

If the bradycardia is severe and symptomatic, treatment with a pacemaker is required. Other reversible causes including low oxygen levels and medication side effects should first be excluded before a pacemaker is implanted. Stenosis-This refers to either a narrowing of a blood vessel (most commonly due to atherosclerosis) or to an inability of a heart valve to open fully. Stroke-see cerebrovascular accident Supra ventricular Tachycardia-This is an arrhythmia where the heart beats abnormally fast.

The mechanism is most commonly due to extra conduction tissue at the atrioventricular node-the part of the heart's electrical conduction system which sends the electrical signal generated in the upper chambers of the heart down to the lower chambers. The symptoms can include palpitations, chest discomfort, shortness of breath and fainting. Diagnosis is made by recording the ECG during the event. Treatment includes such antiarrhythmic medications as beta blockers, calcium blockers or digoxin, as well as radiofrequency ablation. SVT-see supra ventricular tachycardia.

Syncope-This means fainting. Fainting and near fainting can be caused by many things. Heart disease can cause fainting by impairing the blood flow to the brain. The heart diseases that most commonly cause this are certain types of arrhythmias and aortic stenosis. A very common form of syncope, called vaso vagal or neurocardiogenic syncope is discussed on the page on Tilt Table Testing. A normal pulse and blood pressure during any episode of fainting and near fainting pretty reliably excludes the heart as the cause.

Other possible causes include non cardiac causes of low blood pressure such as hemorrhage, dehydration and medications; neurologic disorders and psychiatric disorders. Sometimes, no cause can be found. When a person faints for no apparent reason, their heart rhythm is usually monitored for a period of time, often in the hospital. An echocardiogram and a tilt table test may be performed.

Rarely, electro physiologic testing is required. Systole-The portion of the cardiac cycle when the main pumping chambers, the ventricles, are ejecting blood. Systolic Blood Pressure-The upper higher number of the blood pressure. It should be less than 140. RETURN TO TOP -T- Tachycardia-A rapid heart rate (greater than 100 beats per minute).

Transient Ischemic Attack-Similar to a cerebrovascular accident but the symptoms resolve fully within 24 hours. Tricuspid Valve-This valve is composed of three leaflets and connects the right atrium to the right ventricle. It is closed when the right ventricle is ejecting blood up to the lungs so that no blood goes backwards to the right atrium. After the right ventricle finishes ejecting blood, the tricuspid valve opens to allow the right ventricle to fill with blood for the next ejection. Tricuspid Valve Regurgitation-The tricuspid valve is unable to close properly and blood leaks backwards from the right ventricle to the right atrium. This results in swelling and weakness.

Tricuspid regurgitation is most commonly caused by high blood pressure in the blood vessels of the lungs, which in turn is due to myriad diseases of the heart and lungs. Primary disease of the tricuspid valve is rare. The most common cause is rheumatic heart disease. The diagnosis is made by echocardiography. Open heart surgery to repair or replace the valve may be required. Tricuspid Valve Stenosis-The tricuspid valve is unable to open fully.

Blood cannot drain properly from the right atrium to the right ventricle. The right atrium becomes engorged with blood and the veins cannot bring blood back to the heart fast enough. This results in swelling and weakness. The diagnosis is made by echocardiography. Open heart surgery to repair or replace the valve may be required. RETURN TO TOP -U- Unstable Angina-This is caused by a process in the coronary artery similar to what is described above for a myocardial infarction, except that the blood clot in the artery does not totally occlude the artery.

It is characterized by a sudden worsening of a previously stable anginal pattern or by the new onset of angina occurring with minimal or no provocation. The anginal is typically more intense and prolonged than in stable angina and more resistant to treatment with nitroglycerin. This condition require hospitalization. Ecg's and cardiac enzymes are performed to insure this is n...


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