Premature ventricular contractions (PVCs)

Premature ventricular contractions (PVCs)

Definition:

Premature ventricular contractions (PVCs) are extra, abnormal heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a flip-flop or skipped beat in your chest. Premature ventricular contractions are very common — they occur in most people at some point.
Premature ventricular contractions are also called:

• Premature ventricular complexes
• PVCs
• Ventricular premature beats
• Extrasystoles

If you have occasional premature ventricular contractions, but you're an otherwise healthy person, there's generally no reason for concern, and no treatment is needed. If you have frequent premature ventricular contractions or underlying heart disease, you may need treatment to help you feel better and treat underlying heart problems.

Symptoms:

Premature ventricular contractions often cause no symptoms. But you may feel an odd sensation in your chest, such as:

• Flip-flops
• Fluttering
• Pounding or jumping
• Skipped beats or missed beats
• Increased awareness of your heartbeat

When to see a doctor
If you feel flip-flops, a sensation of skipped heartbeats or odd feelings in your chest, talk to your doctor. You'll want to identify the source of these symptoms. Premature ventricular contractions may be the problem, but other conditions also may be to blame, including other rhythm problems, serious heart problems, anxiety, anemia or infections.

Causes:

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by the sinoatrial node (SA node) — or sinus node — an area of specialized cells located in the right atrium. This natural pacemaker produces the electrical impulses that trigger the normal heartbeat.

 From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood out to your lungs and body.
Premature ventricular contractions are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat. And they often interrupt the normal order of pumping, which is atria first, then ventricles. As a result, the extra, out-of-sync beats are usually less effective in pumping blood throughout the body.

Why do extra beats occur?
The reasons aren't always clear. Certain triggers, heart diseases or changes in the body can make cells in the ventricles electrically unstable. Underlying heart disease or scarring may also cause electrical impulses to be misrouted. Premature ventricular contractions may be associated with:

• Chemical changes or imbalances in the body
• Certain medications, including common asthma medications
• Alcohol or illegal drugs
• Increased levels of adrenaline in the body that may be caused by caffeine, exercise or anxiety
• Injury to the heart muscle from coronary artery disease, congenital heart disease, high blood pressure or infections (myocarditis)

Complications:

 If you have frequent premature ventricular contractions or certain patterns of premature ventricular contractions, you may be at increased risk of developing heart rhythm problems (arrhythmias). Rarely, when accompanied by underlying heart disease, frequent premature contractions can lead to chaotic, dangerous heart rhythms and possibly sudden cardiac death

Treatments and drugs:

Most people with premature ventricular contractions and an otherwise normal heart won't need treatment. Rarely, if you have frequent, bothersome symptoms, you may be offered treatment to help you feel better, but PVCs are typically not harmful.

In some cases, if you have underlying heart disease that could lead to more serious rhythm problems, you may need to make efforts to avoid triggers or perhaps take medications.

• Lifestyle changes. Eliminating common PVC triggers — such as caffeine or tobacco — can decrease the frequency and severity of your symptoms.
  
• Medications. Beta blockers — which are often used to treat high blood pressure and heart disease — can suppress premature contractions. Other medications, such as calcium channel blockers, or anti-arrhythmic drugs, such as amiodarone, also may be used if you have ventricular tachycardia or very frequent premature ventricular contractions that interfere with your heart's function, causing severe symptoms.

If you have very frequent PVCs associated with underlying heart disease and periods of ventricular tachycardia, your doctor might recommend treatment for the underlying condition.

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Pulmonary embolism

Pulmonary embolism

Definition:

Pulmonary embolism is blockage in one or more arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to your lungs from another part of your body — most commonly, your legs. Pulmonary embolism is a complication of deep vein thrombosis (DVT), which is clotting in the veins farthest from the surface of the body.

Pulmonary embolism can occur in otherwise healthy people. Common signs and symptoms include sudden and unexplained shortness of breath, chest pain and a cough that may bring up blood-tinged sputum.

Pulmonary embolism can be life-threatening, but immediate treatment with anti-clotting medications can greatly reduce the risk of death. Taking measures to prevent blood clots in your legs also can help protect you against pulmonary embolism.

Symptoms:

Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clot and your overall health — especially the presence or absence of underlying lung disease or heart disease.
Common signs and symptoms include:

• Shortness of breath. This symptom typically appears suddenly, and occurs whether you're active or at rest.
  
• Chest pain. You may feel like you're having a heart attack. The pain may become worse when you breathe deeply, cough, eat, bend or stoop. The pain will get worse with exertion but won't go away when you rest.
  
• Cough. The cough may produce bloody or blood-streaked sputum.

Other signs and symptoms that can occur with pulmonary embolism include:

• Wheezing
• Leg swelling, usually in only one leg
• Clammy or bluish-colored skin
• Excessive sweating
• Rapid or irregular heartbeat
• Weak pulse
• Lightheadedness or fainting

When to see a doctor
Pulmonary embolism can be life-threatening. Seek immediate medical attention if you experience unexplained shortness of breath, chest pain or a cough that produces bloody sputum.

Causes:

Pulmonary embolism occurs when a clump of material, most often a blood clot, gets wedged into an artery in your lungs. These blood clots most commonly originate in the deep veins of your legs, but they can also come from other parts of your body. This condition is known as deep vein thrombosis (DVT). Not all DVT blood clots result in pulmonary embolism.
Occasionally, other substances can form blockages within the blood vessels inside your lungs. Examples include:

• Fat from within the marrow of a broken bone
• Part of a tumor
• Air bubbles

It's rare to experience a solitary pulmonary embolism. In most cases, multiple clots are involved. The lung tissue served by each blocked artery is robbed of fuel and may die. This makes it more difficult for your lungs to provide oxygen to the rest of your body.
Because pulmonary embolism almost always occurs in conjunction with deep vein thrombosis, most doctors refer to the two conditions together as venous thromboembolism (VTE).

Treatments and drugs:


Prompt treatment of pulmonary embolism is essential to prevent serious complications or death.
Medications
Medications to treat pulmonary embolism include:

• Anticoagulants. The drugs heparin and warfarin (Coumadin) prevent new clots from forming. Heparin works quickly and is usually delivered with a needle. Warfarin (Coumadin) comes in pill form and doesn't start working until a few days after your first dose. Risks include bleeding and easy bruising.
  
• Clot dissolvers (thrombolytics). While clots usually dissolve on their own, certain medications can dissolve clots quickly. Because these clot-busting drugs can cause sudden and severe bleeding, they usually are reserved for life-threatening situations.

Surgical and other procedures
In some cases, your doctor might recommend a procedure to treat pulmonary embolism, such as:

• Clot removal. If you have a very large clot in your lung and you're in shock, your doctor may thread a thin flexible tube (catheter) through your blood vessels and suction out the clot. It can be difficult to remove a clot this way, and this procedure isn't always successful.
  
• Vein filter. A catheter can also be used to place a filter in the main vein — called the inferior vena cava — that leads from your legs to the right side of your heart. This filter catches and stops blood clots moving through the blood stream toward your lungs. Filter insertion is typically reserved for people who can't take anticoagulant drugs or when anticoagulant drugs don't work well enough.
  
• Surgery. If you're in shock and thrombolytic medication isn't working quickly enough, your doctor might attempt emergency surgery. This happens infrequently, and the goal is to remove as many blood clots as possible, especially if there's a large clot in your main (central) pulmonary artery.

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Plague

Plague

Definition:

Plague was known as the Black Death during medieval times, when it killed up to a third of the population of Europe. Currently, plague occurs in fewer than 3,000 people per year worldwide. It can be deadly if not treated promptly with antibiotics.

The organism that causes plague, Yersinia pestis, lives in a variety of small rodents on every continent except Australia. The organism is transmitted to humans when they are bitten by fleas that have previously fed on infected rodents.

The most common form of plague results in swollen and tender lymph nodes — called buboes — in the groin, armpits or neck. The rarest and deadliest form of plague affects the lungs, and it can be spread from person to person.

Symptoms:

Plague is divided into three main types — bubonic, septicemic and pneumonic — depending on which part of your body is involved. Signs and symptoms vary depending on the type of plague.

Bubonic plague
Bubonic plague is the most common variety of the disease. It's named after the buboes — swollen lymph nodes — which typically develop within a week after an infected flea bites you. Buboes may be:

• Located in the groin, armpit or neck
• About the size of a chicken egg
• Tender and warm to the touch

Other signs and symptoms may include:

• Sudden onset of fever and chills
• Headache
• Fatigue or malaise
• Muscle aches

Septicemic plague
Septicemic plague occurs when plague bacteria multiply in your bloodstream. Signs and symptoms include:

• Fever and chills
• Abdominal pain, diarrhea and vomiting
• Bleeding from your mouth, nose or rectum, or under your skin
• Shock
• Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose

Pneumonic plague
Pneumonic plague affects the lungs. It's the least common variety of plague but the most dangerous, because it can be spread from person to person via cough droplets. Signs and symptoms can begin within a few hours after infection, and may include:

• Cough, with bloody sputum
• Difficulty breathing
• High fever
• Nausea and vomiting
• Weakness

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. If antibiotic treatment isn't initiated within a day after signs and symptoms first appear, the infection is likely to be fatal.

When to see a doctor
Seek immediate medical attention if you begin to feel ill and have been in an area where plague has been known to occur. This includes parts of several states in the western portion of the United States — primarily New Mexico, Arizona and Colorado.

Causes:

The plague bacteria, Yersinia pestis, is transmitted to humans when they are bitten by fleas that have previously fed on infected animals, such as:

• Rats
• Squirrels
• Rabbits
• Prairie dogs
• Chipmunks

The bacteria can also enter your body if you have a break in your skin that comes into contact with an infected animal's blood. Domestic cats can become infected with plague from flea bites or from eating infected rodents.
Pneumonic plague, which affects the lungs, is spread by inhaling infectious droplets coughed into the air by a sick animal or person.

Complications:

Complications of plague may include:

• Death. Most people who receive prompt antibiotic treatment survive plague. Untreated plague has a fatality rate over 50 percent.
• Gangrene. Blood clots in the tiny blood vessels of your fingers and toes can disrupt the flow of blood and cause that tissue to die. The portions of your fingers and toes that have died may need to be amputated.
• Meningitis. Rarely, plague may cause meningitis, an inflammation of the membranes surrounding your brain and spinal cord. 

Treatments and drugs:

Medications
As soon as your doctor suspects that you have plague, you'll need to be admitted to an isolation room in a hospital. There, you'll receive powerful antibiotics, such as:

• Streptomycin
• Gentamicin
• Doxycycline (Vibramycin)
• Ciprofloxacin (Cipro)
• Chloramphenicol

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Plantar warts

Plantar warts

Definition:

Plantar warts are noncancerous skin growths on the soles of your feet caused by the human papillomavirus (HPV), which enters your body through tiny cuts, breaks or other vulnerable sites on the skin of your feet.
Plantar warts often develop beneath pressure points in your feet, such as the heels or balls of your feet. This pressure also may cause a plantar wart to grow inward beneath a hard, thick layer of skin (callus).

Most plantar warts aren't a serious health concern and may not require treatment. However, plantar warts can be bothersome or painful. If self-care treatments for plantar warts don't work, you may need to see your doctor to have them removed.

Symptoms:

Signs and symptoms of plantar warts include:

• Small, fleshy, grainy lesions, or growths, on the soles of your feet
• Hard, thickened skin (callus) over a well-defined "spot" on the skin, where a wart has grown inwards
• Black pinpoints, which are commonly called "wart seeds" but are actually small, clotted blood vessels
• Lesions that interrupt the normal lines and ridges in the skin of your feet
• Pain or tenderness when walking or standing

When to see a doctor
See your doctor if:

• The lesions are painful or change in appearance or color
• The warts persist, multiply or recur, despite home treatment
• The warts interfere with your activities
• You have diabetes or nerve damage (neuropathy) in your feet — in which case, you should not use at-home treatments
• You have a weakened immune system because of HIV/AIDS, immune-suppressing drugs or other immune system disorders
• You have any doubt that the lesion is a wart

In these cases, your doctor may prescribe a closely monitored treatment plan or consider a different diagnosis.

Causes:


Plantar warts are caused by an infection with the human papillomavirus (HPV) in the outer layer of skin on the sole of your feet.
There are more than 100 types of HPV, but only a few types are known to cause warts on your feet. Other types of HPV are more likely to cause warts on other areas of your skin or on mucous membranes.
Transmission of the virus
Each person's immune system responds differently to HPV, so not everyone who comes in contact with the virus develops warts. Even people in the same family react to the virus differently.
The HPV strains that cause plantar warts aren't highly contagious. Therefore, it isn't easily transmitted by direct contact from one person to another. However, the virus does thrive in warm, moist environments — such as shower floors, locker rooms and public swimming areas. Consequently, you may contract the virus by walking barefoot around pools or gyms.
The virus also needs to have a point of entry into the skin:

• Cracks in dry skin
• Cuts or scrapes
• Wet, softened, fragile skin from prolonged water exposure (macerated skin)

Multiple warts
If the virus spreads from the original site of infection, multiple warts may appear. These may include:

• Several individual warts at different sites on the foot
• "Kissing warts," a pair of warts that appear where two parts of the foot touch, such as a point of contact between two toes or between a toe and the ball of foot
• Mosaics, clusters of warts that essentially form a large, single lesion

Complications:

 When plantar warts cause pain, you may alter your normal posture or gait — perhaps without realizing the change. A difference in how you stand, walk or run can eventually cause muscle or joint discomfort.

Treatments and Drugs :

Plantar warts often don't require treatment. Most warts resolve on their own without treatment within a couple of years. However, if they are causing pain or spreading, they should be treated. It's much easier to treat a few small warts than several large warts.
Plantar warts can stubbornly resist treatment. Therefore, most treatments require patience, persistence and multiple interventions.
People with diabetes, nerve damage in their feet or weakened immunity need treatment under a doctor's supervision. Your doctor will closely monitor the treatment effect and the quality of wound healing.

Treatments provided by your doctor
If home remedies aren't working, your doctor may recommend other treatments. Doctors generally start with the method that is least likely to result in pain, side effects and scarring. Scarring on the sole of the foot can be painful and is usually irreversible. Treatments often need to be repeated, and warts may return at a later time.
Treatment options include the following:

• Freezing (cryotherapy). Your doctor can apply liquid nitrogen with a spray canister or cotton-tipped applicator to freeze and destroy your wart. The chemical causes a blister to form around your wart, and the dead tissue sloughs off within a week or so. The application itself can be painful, and cryotherapy can result in painful or tender blisters that resolve on their own.
• Cantharidin. Your doctor may use cantharidin — a substance extracted from the blister beetle — on your plantar warts. Typically, the extract is paired with salicylic acid, applied to the plantar wart and covered with a bandage. The initial application is painless, but the subsequent blister that forms can be quite painful. Your doctor clips away the dead part of the wart in about a week.
• Immunotherapy. This therapy attempts to harness your body's immune system to remove tough-to-treat warts. This can be accomplished in a couple of ways. Your doctor may inject your warts with interferon, a medication that boosts your immune system's instinct to reject warts. Or your doctor may inject your warts with a foreign substance (antigen) that stimulates your immune system. Doctors often use mump antigens, because many people are immunized against mumps. As a result, the antigen sets off an immune reaction that may fight off warts. Interferon treatment may result in flu-like symptoms for a few hours after treatment. Both treatments may cause pain.
• Imiquimod (Aldara). This prescription cream applied directly to a wart is an immunotherapy medication that encourages your body to release immune system proteins (cytokines) to attack HPV. This treatment can result in severe inflammation near the site and damage to the tissues beyond the wart. If this occurs, the treatment is dropped. The drug may also result in flu-like symptoms that may lessen with a lower dosage.
• Minor surgery. This involves cutting away the wart or destroying the wart by using an electric needle in a process called electrodesiccation and curettage. Your doctor will anesthetize your skin before this procedure. This treatment is avoided if possible with plantar warts because of the risk of scarring.
• Laser treatment. A type of laser treatment called pulse dye laser treatment burns closed (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. This treatment can cause pain and scarring.

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