What is Congestive Heart Failure?

It’s a terrifying moment for many patients: the moment when the doctor enters their hospital room and informs them they are suffering from congestive heart failure. Many people do not know what congestive heart failure is or what it means for their life, and they ask themselves, “Is congestive heart failure the end of my world as I know it?”

Congestive heart failure occurs when for whatever reason the heart is unable to effectively pump the blood through the body. This usually occurs when the heart muscle is weak due to disease or stressed beyond its ability to function. Congestive heart failure is usually a secondary disease following another cardiac condition, primarily either coronary artery disease, cardiomyopathies, myocarditis, valvular disease, or cardiac arrhythmias, with coronary artery disease carrying the poorest prognosis. It may also follow a myocardial infarction, renal failure, sepsis or severe anemia.

Each side of the heart has a different function, and therefore will have a slightly different effect on the body when it is unable to fulfill that function. If it is the left side of the heart that has failed accumulation of fluid in and around the lungs will cause the patient to experience difficulty breathing, and the kidneys will respond to the reduced blood in the circulation by retaining fluid as well. If it is the right side that fails the excess fluid accumulates in the venous system, giving the patient a generalized edema that becomes more severe as their condition deteriorates.

Dyspnea is the prevalent presenting symptom in congestive heart failure, although the severity will vary from patient to patient. Some will possess perfectly normal pulmonary function until under exertion, such as while exercising, walking up stairs or mowing their lawn; others will have so much fluid accumulated that simply rising from bed in the morning will prove difficult. These patients will also usually become easily fatigued due to a lack of oxygen to the tissues. Heart failure will also cause a condition known as pitting edema, in which the body retains fluid to the point that when pressure is applied to specific spot on the body the indentation remains (non-pitting edema is not caused by heart failure).

Treatment of congestive heart failure consists primarily of treating the symptoms. Vital signs should be taken regularly, and often diuretics will be prescribed to facilitate expulsion of accumulated fluid from the body. While in the hospital fluid intake and output will be measured very carefully. Patients will probably be placed in an upright position to assist in moving fluid from around the heart and lungs, given potassium supplements and prescribed bed rest for a period of time. BUN levels and serum creatinine, potassium, sodium, chloride and bicarbonate levels are monitered frequently by a physician.

There are several factors that contribute to congestive heart failure and, if diagnosed, should be treated and maintained. These include hypertension, anemia or poycythemia, endocrine disorders, malnutrition, drug or alcohol use and obesity. Therefore, it is very important that patients suffering from congestive heart failure pay particular attention to maintaining a healthy lifestyle. A doctor can aid in establishing the best diet and exercise plan with each individual to prevent placing undue stress on the heart and lungs.

While no said cure exists for congestive heart failure and the prognosis varies from case to case, by following a strict diet and exercise program, taking all prescribed medications regularly and maintaining a close relationship with their physicians many patients who suffer from heart failure can continue to lead a fairly normal life.

How the Acupuncture Practitioner Uses His Needles

The major focus of an acupuncture treatment is to return the circulation of body energy to its normal levels. To do this, needles are used at points on the body indicated by the set of symptoms for the particular client. These symptoms may be physical, emotional, behavioral, and/or mental. Simply, a needle is inserted at a point in order to either stimulate or dissipate energy. Energy may be dissipated from a point if there is too much activity, which can be indicated by such symptoms as heat or anger. Energy may need to be stimulated by acupuncture if there is seems to be a depletion, as in the case of dizziness or depression.

The points at which needles are to be inserted are determined by an analysis of the client’s symptoms, and the organs that are involved in those symptoms. Some change may be affected by simply using pressure on those points (a technique known as acupressure), but far superior results are obtained by being treated by an acupuncture practitioner. There are a number of techniques for using the needles, as well as several different types of needles that can be used. Many modern acupuncture practitioners use small, disposable needles. They can be inserted to different depths, depending on the symptom addressed. It is interesting to compare how the technique to stimulate energy is different than the technique to dissipate energy.

An acupuncture needle used to stimulate energy is sometimes more effective when warmed. The point where the needle is inserted should be massaged before insertion of the needle. Puncture superficially, and then slowly insert the needle to its correct depth slowly, and remove it slowly. The needle should be inserted as the patient exhales, and removed as the patient inhales. The different points should be punctured in the order of energy flow. The needles should remain in place for several minutes, up to ten minutes.

An acupuncture needle used to dissipate energy is rarely warmed, and is inserted and withdrawn rapidly. The needles on average are inserted more deeply than for energy stimulation. The different points should be punctured in the opposite order from the energy flow. The client should inhale as the needle is punctured, and exhale as it is withdrawn. The needle need only remain a few seconds in many cases. Comparing the two techniques, the technique to dissipate energy seems very similar to letting some air out of a balloon or other container: insert quickly and deeply. It is also interesting to note that the patient exhales as the needle is withdrawn, again releasing energy.

A good acupuncture practitioner never inflicts any pain. At most, there may be a slight feeling of a twinge upon the first insertion, but even that is not to be usual. A needle remaining in the skin is not felt at all as long as it is stationary, and most patients forget about them. There are a number of different kinds of needles, but the only noticeable difference to the client is the difference between a normal needle and a Japanese needle. A Japanese needle is generally thinner and is inside a guide tube, so it will look distinctly different. Needles can come in various widths, with acupuncture needles used for dissipating energy generally thicker than the needles used for energy stimulation. I hope this introduction has both intriguing and reassuring, enough for you to schedule a first trip to an acupuncture clinic.

What Evidence of Congestive Heart Failure is a Diagnosis Based

What Evidence of Congestive Heart Failure is a Diagnosis Based on?

While all cardiac conditions carry similar symptoms of chest pain and difficulty breathing, congestive heart failure generally presents with a very specific set of symptoms and lab results, giving doctors a very firm set of clues upon which to base a definite diagnosis.

Dyspnea, or difficulty breathing, coupled with severe pitting edema (when the body retains fluid to the point of holding the imprint of an object that is pressed into the skin for several minutes) are generally the first pieces of evidence pointing to congestive heart failure. Heart failure results in the heart not being able to efficiently pump blood throughout the body; as a result, fluid accumulates rather than being excreted and causes the body to swell as if it were a water balloon. Non-pitting edema, or fluid retention that does not hold an imprint, is not caused by heart failure and indicates that another diagnosis needs to be made. The patient may produce a frothy pink sputum when they cough.

In addition to the symptoms related to the fluid accumulation general weakness and malaise, particularly during times of physical exertion are frequent complaints of patients suffering from congestive heart failure, and should not be ignored. This is caused by a lack of nutrients and oxygen from the blood to the body tissues, and may result in permanent damage to the organs if they are left without these vital elements for a prolonged period of time. Anuria, or a lack of urination, is also evidential of heart failure as fluid accumulates in the tissues rather than being properly excreted. Patients may suffer from a changed mental status due to toxins accumulating in the body.

Once the physician suspects heart failure based on the physical evidence, blood samples will be sent to the laboratory. Beta-natriuretic peptide, or BNP, is an excellent screening tool in suspected cases of heart failure. This hormone is produced in greater quantities by the failing heart muscle as fluid levels rise, with a level between one hundred and five hundred pg/mg suggesting congestive heart failure and greater than five hundred being fairly diagnostic; however, an elevated BNP should not be considered to be sufficient evidence upon which to base a positive diagnosis, as conditions such as renal failure, ventricular strain, tumors or hypoxia can also cause BNP levels to rise. Arterial blood gases may be tested to determine the degree of hypoxemia. A decreased erythrocyte sedimentation rate, proteinuria (protein in the urine), and a mild azotemia (elevated blood urea level) can be seen in early to moderate disease. An increased serum creatinine, hyperbilirubinemia (increased bilirubin in the blood) and dilutional hyponatremia (decreased serum sodium levels) are evidence the patient is suffering from a more advanced case of heart failure.

Radiology will also wish to perform imaging studies to evaluate the condition of the heart. A chest x-ray will generally reveal cardiomegaly (enlargement of the heart) and pleural effusion (fluid around the heart). An echocardiogram may be performed to evaluate the internal structures of the heart to evaluate for any structural abnormalities, as in the case of mitral stenosis. This provides evidence to determine the underlying cause of congestive heart failure, particularly in suspected cases of valvular heart disease.

Physicians are like detectives, if you will. Once these tests have all been run they will gather these pieces of evidence together and put them together to form a fairly accurate picture of the patient’s condition, allowing for an accurate diagnosis leading to proper treatment.

Should I have Lasik or ICL?

A number of people who are considering the Lasik procedure to correct their nearsightedness or farsightedness have of some potential problems of Lasik, and are wondering if there are other options. Though more than 95 percent of the Lasik patients have a very successful procedure without any major side effects, there are choices for people who wish to improve their vision. Let’s compare two, and discuss these choices with a reputable ophthalmologist.

Traditional Lasik surgery uses a scalpel to create a small flap in the eye, and then a laser reshapes the eye in order to focus accurately. There are two more recent forms of Lasik, one that entirely uses a laser and does away with the scalpel. Another variation uses a three dimension waveform for people with unusual eye shapes, and both of these are worth discussing with your ophthalmologist.

Those people with very thin corneas or other issues that make Lasik not a good candidate for their particular case can consider implantable contact lens surgery. This is known as ICL in the eye surgeon’s lingo, and is a good alternative to Lasik to permanently correct vision. These lenses function in exactly the same way as removable lenses, except that they remain permanently in the eye. Like Lasik, they reshape the eye in order for it to focus accurately. The patient will not feel the lens once the operation has been performed.

Lasik and ICL are similar in several ways. Lasik can improve vision affected by nearsightedness and astigmatism, and ICL can improve these vision deficiencies also. Both Lasik and ICL also have some of the same risks, one of these being that the correction is not accurate after the first operation is done. Lasik is a much more frequently performed procedure, and less than 3 percent (according to the FDA) of these patients need to undergo additional surgery to further correct vision after the first Lasik procedure is done.

Like any operation, there is a chance of infection in either a Lasik procedure or an ICL operation. Good post-operative care by the patient will minimize this and regular checkups at the Lasik or eye care center will nearly always clear this up without further complication. In a small percentage of the cases, either Lasik or ICL patients may not achieve perfect vision and may need to continue to wear corrective eyewear, though usually not at the same strength as the original eyewear.

One advantage of ICL over Lasik is that ICL is a reversible procedure, where the implanted lens can be removed later if that becomes necessary. Lasik involves the reshaping of the cornea to bring objects accurately into focus, and is permanent. However, for a typical, healthy patient either Lasik or ICL will generally bring about the desired improvement in vision.

Lasik is generally a less invasive procedure, and this is reflected in the current cost of the operation. The current price for a Lasik procedure is between $500 and $2500 per eye, depending on the type of procedure and the presiding physician. A typical price for ICL is between $1500 and $3000 per eye. Do some investigation into the options offered, and select the eye procedure that is best for your personal case.