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PCCN Hyperthyroidism

Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated.

Signs and Symptoms

Hyperthyroidism can mimic other health problems, which can make it difficult for your doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

• Unintentional weight loss, even when your appetite and food intake stay the same or increase
• Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute
• Irregular heartbeat (arrhythmia)
• Pounding of your heart (palpitations)
• Increased appetite
• Nervousness, anxiety and irritability
• Tremor — usually a fine trembling in your hands and fingers
• Sweating
• Changes in menstrual patterns
• Increased sensitivity to heat
• Changes in bowel patterns, especially more frequent bowel movements
• An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
• Fatigue, muscle weakness
• Difficulty sleeping
• Skin thinning
• Fine, brittle hair

Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities.

Causes

Hyperthyroidism can be caused by a number of conditions, including Graves' disease, Plummer's disease and thyroiditis. Your thyroid is a small, butterfly-shaped gland at the base of your neck, just below your Adam's apple. The thyroid gland has an enormous impact on your health. Every aspect of your metabolism is regulated by thyroid hormones. Your thyroid gland produces two main hormones, thyroxine (T4) and triiodothyronine (T3), that influence every cell in your body. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of protein. Your thyroid also produces a hormone that helps regulate the amount of calcium in your blood (calcitonin).

Risk Factors

Risk factors for hyperthyroidism, include:

• A family history, particularly of Graves' disease
• Female sex
• A personal history of certain chronic illnesses, such as type 1 diabetes, pernicious anemia and primary adrenal insufficiency

Complications

• Heart Problems
• Brittle Bones
• Eye Problems
• Thyrotoxic Crisis
• Red, swollen skin

Treatment

Several treatments for hyperthyroidism exist. The best approach for you depends on your age, physical condition, the underlying cause of the hyperthyroidism, personal preference and the severity of your disorder. Possible treatments include:

• Radioactive Iodine
• Anti-thyroid Meds
• Beta-blockers
• Thyroidectomy 

 

PCCN Hypothyroidism

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Hypothyroidism may not cause noticeable symptoms in the early stages. Over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease.

Signs and Symptoms

Hypothyroidism signs and symptoms may include:

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory
• Enlarged thyroid gland (goiter)

Causes

When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body can be upset. There can be a number of causes, including autoimmune disease, hyperthyroidism treatments, radiation therapy, thyroid surgery and certain medications. Your thyroid is a small, butterfly-shaped gland situated at the base of the front of your neck, just below your Adam's apple. Hormones produced by the thyroid gland — triiodothyronine (T3) and thyroxine (T4) — have an enormous impact on your health, affecting all aspects of your metabolism. These hormones also influence the control of vital functions, such as body temperature and heart rate. Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including:

• Radiation Therapy
• Autoimmune Disease
• Thyroid Surgery

Risk Factors

• Are a woman
• Are older than 60
• Have a family history of thyroid disease
• Have an autoimmune disease, such as type 1 diabetes or celiac disease
• Have been treated with radioactive iodine or anti-thyroid medications
• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby within the past six months

Complications

• Goiter
• Heart Problems
• Mental Health Issues
• Myxedema
• Peripheral Neuropathy
• Birth Defects

Treatment

Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.  

PCCN Restrictive Cardiomyopathy

Restrictive cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. The pumping or systolic function of the ventricle may be normal but the diastolic function (the ability of the heart to fill with blood) is abnormal. Therefore, it is harder for the ventricles to fill with blood, and with time, the heart loses the ability to pump blood properly leading to heart failure.

Signs and Symptoms

Many people with restrictive cardiomyopathy have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress as heart function worsens. Symptoms occur at any age and may include:

• Shortness of breath (at first with exercise; but over time it occurs at rest)
• Fatigue (feeling overly tired)
• Inability to exercise
• Swelling of the legs and feet
• Weight gain
• Nausea, bloating, and poor appetite (related to fluid retention)
• Palpitations (fluttering in the chest due to abnormal heart rhythms)

Causes

Restrictive cardiomyopathy is not usually inherited and its cause is often unknown. Known causes include:

• Build-up of scar tissue (idiopathic is the most common cause)
• Build-up of abnormal proteins (amyloidosis) in the heart muscle
• Chemotherapy or chest exposure to radiation
• Excess iron (hemochromatosis) in the heart
• Other systemic diseases (sarcoidosis)

Treatment

The condition causing the cardiomyopathy is treated when it can be found.  Few treatments are known to work well for restrictive cardiomyopathy.  The main goal of treatment is to control symptoms and improve quality of life. The following treatments may be used to control symptoms or prevent problems:

• Blood thinning medicines
• Chemotherapy (in some situations)
• Diuretics to remove fluid and help improve breathing
• Medicines to prevent or control abnormal heart rhythms
• Steroids or chemotherapy for some causes
• A heart transplant may be considered if the heart function is very poor and symptoms are severe.

 

PCCN Endocarditis

Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves. Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. If it's not treated quickly, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in certain cases, surgery. Since there are many ways to develop endocarditis, your doctor might not be able to pinpoint the exact cause of your condition. However, people at greatest risk of endocarditis usually have damaged heart valves, artificial heart valves or other heart defects.

Signs and Symptoms

Endocarditis may develop slowly or suddenly, depending on what germs are causing the infection and whether you have any underlying heart problems. Endocarditis signs and symptoms can vary from person to person. Common signs and symptoms of endocarditis include:

• Flu-like symptoms, such as fever and chills
• A new or changed heart murmur, which is the heart sounds made by blood rushing through your heart
• Fatigue
• Aching joints and muscles
• Night sweats
• Shortness of breath
• Chest pain when you breathe
• Swelling in your feet, legs or abdomen
• Unexplained weight loss
• Blood in your urine, which you might be able to see or that your doctor might see when he or she views your urine under a microscope
• Tenderness in your spleen, which is an infection-fighting abdominal organ just below your rib cage on the left side of your body
• Osler's nodes, which are red, tender spots under the skin of your fingers or toes
• Petechiae which are tiny purple or red spots on the skin, whites of your eyes, or inside your mouth

Causes

Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Certain types of bacteria cause most cases, but fungi or other microorganisms also may be responsible. Usually, your immune system destroys harmful bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection. However, bacteria that live in your mouth, throat or other parts of your body, such as your skin or your gut, can sometimes cause serious infections like endocarditis under the right circumstances.

Risk Factors

If your heart is healthy, you could be less likely to develop endocarditis, although it is still possible. The germs that cause infection tend to stick to and multiply on damaged or surgically implanted heart valves, or on endocardium that has a rough surface. People at highest risk of endocarditis are those who have:

• Artificial or Congenital Heart Valves
• Damaged Heart Valves
• IV Drug Use

Complications

In endocarditis, clumps of bacteria and cell fragments form in your heart at the site of the infection. These clumps, called vegetations, can break loose and travel to your brain, lungs, abdominal organs, kidneys or limbs. As a result, endocarditis can cause several major complications, including:

• Heart problems, such as heart murmur, heart valve damage and heart failure
• Stroke, Seizure
• Loss of the ability to move part of all of your body (paralysis)
• Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other organs
• Pulmonary embolism — an infected vegetation that travels to the lungs and blocks a lung artery
• Kidney damage or Enlarged spleen

Treatment

Many cases of endocarditis are successfully treated with antibiotics. Sometimes, surgery may be required to fix damaged heart valves and clean up any remaining signs of the infection.  

PCCN Cardiogenic Shock

Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. Cardiogenic shock is rare, but it's often fatal if not treated immediately. If treated immediately, about half the people who develop the condition survive.

Signs and Symptoms

• Rapid breathing
• Severe shortness of breath
• Sudden, rapid heartbeat (tachycardia)
• Loss of consciousness
• Weak pulse
• Low blood pressure (hypotension)
• Sweating
• Pale skin
• Cold hands or feet
• Urinating less than normal or not at all

Causes

n most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood circulating to that area of your heart, the heart muscle can weaken and go into cardiogenic shock. Rarely, damage to your heart's right ventricle, which sends blood to your lungs to receive oxygen, leads to cardiogenic shock. Other possible causes of cardiogenic shock include:

• Inflammation of the heart muscle (myocarditis)
• Infection of the heart valves (endocarditis)
• Weakened heart from any cause
• Drug overdoses or poisoning with substances that can affect your heart's pumping ability

Risk Factors

If you have a heart attack, your risk of developing cardiogenic shock increases if you:

• Are older
• History of heart failure or heart attack
• Coronary artery disease in several of your heart's main arteries
• Have diabetes or high blood pressure
• Are female

Complications

If not treated immediately, cardiogenic shock can be fatal. Another serious complication is damage to your liver, kidneys or other organs from lack of oxygen, which can be permanent.

Treatment

Cardiogenic shock treatment focuses on minimizing the damage from lack of oxygen to your heart muscle and other organs.  

PCCN Pulmonary Edema

Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe. In most cases, heart problems cause pulmonary edema. But fluid can accumulate for other reasons, including pneumonia, exposure to certain toxins and medications, trauma to the chest wall, and visiting or exercising at high elevations. Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency requiring immediate care. Pulmonary edema can sometimes be fatal, but the outlook improves if you get treated quickly. Treatment for pulmonary edema varies depending on the cause but generally includes supplemental oxygen and medications.

Signs and Symptoms

Depending on the cause, pulmonary edema signs and symptoms may appear suddenly or develop over time.

• Extreme shortness of breath or difficulty breathing (dyspnea) that worsens with activity or when lying down
• A feeling of suffocating or drowning that worsens when lying down
• Wheezing or gasping for breath
• Cold, clammy skin
• Anxiety, restlessness or a sense of apprehension
• A cough that produces frothy sputum that may be tinged with blood
• Blue-tinged lips
• A rapid, irregular heartbeat (palpitations)

Causes

Cardiogenic pulmonary edema is a type of pulmonary edema caused by increased pressures in the heart. This condition usually occurs when the diseased or overworked left ventricle isn't able to pump out enough of the blood it receives from your lungs (congestive heart failure). As a result, pressure increases inside the left atrium and then in the veins and capillaries in your lungs, causing fluid to be pushed through the capillary walls into the air sacs. Medical conditions that can cause the left ventricle to become weak and eventually fail include:

• CAD, Cardiomyopathy, HTN
• Heart Valve Problems
• ARDS, High Altitudes
• Pulmonary Embolism
• Viral Infections, Toxins
• Smoke Inhalation, Near Drowning

Complications

If pulmonary edema continues, it can raise pressure in the pulmonary artery (pulmonary hypertension), and eventually the right ventricle in your heart becomes weak and begins to fail. The right ventricle has a much thinner wall of muscle than does the left side of your heart because it is under less pressure to pump blood into the lungs. The increased pressure backs up into the right atrium and then into various parts of your body, where it can cause:

• Lower extremity and abdominal swelling
• Buildup of fluid in the membranes that surround your lungs (pleural effusion)
• Congestion and swelling of the liver

Left untreated, acute pulmonary edema can be deadly. In some instances, it may be fatal even if you receive treatment.

Treatment

Giving oxygen is the first step in the treatment for pulmonary edema. You usually receive oxygen through a face mask or nasal cannula — a flexible plastic tube with two openings that deliver oxygen to each nostril. This should ease some of your symptoms. Your doctor will monitor your oxygen level closely. Sometimes it may be necessary to assist your breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. Depending on your condition and the reason for your pulmonary edema, you may also receive one or more of the following medications:

• Diuretics, Morphine
• BP Meds