Aphasia

Aphasia

Definition  :

Aphasia is a condition that robs you of the ability to communicate. Aphasia can affect your ability to express and understand language, both verbal and written.
Aphasia typically occurs suddenly after a stroke or a head injury. But it can also come on gradually from a slowly growing brain tumor or a degenerative disease. The amount of disability depends on the location and the severity of the brain damage.

Once the underlying cause has been treated, the primary treatment for aphasia is speech therapy that focuses on relearning and practicing language skills and using alternative or supplementary communication methods. Family members often participate in the therapy process and function as communication partners of the person with aphasia.

Symptoms:

Aphasia is a sign of some other condition, such as a stroke or a brain tumor.
A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that don't make sense
• Speak unrecognizable words
• Not comprehend other people's conversation
• Interpret figurative language literally
• Write sentences that don't make sense

The severity and scope of the problems depend on the extent of damage and the area of the brain affected. Some people may comprehend what others say relatively well but struggle to find words to speak. Other people may be able to understand what they read but yet can't speak so that others can understand them.

Types of aphasia
Your doctor may refer to aphasia as nonfluent, fluent or global:

• Nonfluent aphasia. Damage to the language network near the left frontal area of the brain usually results in Broca aphasia, which is also called nonfluent aphasia. People with this disorder struggle to get words out, speak in very short sentences and leave out words. A person might say "Want food" or "Walk park today." Although the sentences aren't complete, a listener can usually understand the meaning. A person with Broca aphasia may comprehend what other people say to some degree. People with this type of aphasia are often aware of their own difficulty in communicating and may get frustrated with these limitations. Additionally, people with Broca aphasia may also have right-sided paralysis or weakness.
  
• Fluent aphasia. Wernicke aphasia is the result of damage to the language network in the middle left side of the brain. It's often called fluent aphasia. People with this form of aphasia may speak fluently in long, complex sentences that don't make sense or include unrecognizable, incorrect or unnecessary words. They usually don't comprehend spoken language well and often don't realize that others can't understand what they're saying.
  
• Global aphasia. Global aphasia results from extensive damage to the brain's language networks. People with global aphasia have severe disabilities with expression and comprehension.

When to see a doctor
Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you suddenly develop:

• Difficulty speaking
• Trouble comprehending speech
• Difficulty with word recall
• Problems with reading or writing

Causes:

The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. This disruption of the blood supply leads to brain cell death or damage in areas of the brain controlling language. Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A TIA occurs when blood flow is temporarily blocked to an area of the brain. People who've had a TIA are at an increased risk of having a stroke in the near future.

Complications:

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Job
• Relationships
• Day-to-day function

Language barriers may lead to embarrassment, depression and relationship problems.


Treatments and drugs:

If the brain damage is mild, a person may recover language skills without treatment. However, most people undergo speech and language therapy to rehabilitate their language skills and supplement their communication experiences. Researchers are currently investigating the use of medications, alone or in combination with speech therapy, to help people with aphasia.

Speech and language rehabilitation
Recovery of language skills is usually a relatively slow process. Although most people make significant progress, few people regain full pre-injury communication levels. In aphasia, speech and language therapy:

• Starts early. Therapy is most effective when it begins soon after the brain injury.
  
• Builds on success. The speech-language pathologist uses exercises to improve and practice communication skills. These may begin with simpler tasks such as naming objects and evolve into more complex exercises of explaining the purpose of an object.
  
• Shifts focus. The speech-language pathologist might teach the person ways to compensate for the language impairment and to communicate more effectively with gestures or drawings. Some people with aphasia may use a book or board with pictures and words to help them recall commonly used words or help them when they're stuck.
  
• Often works in groups. In a group setting, people with aphasia can try out their communication skills in a safe environment. Participants can practice initiating conversations, speaking in turn, clarifying misunderstandings and fixing conversations that have completely broken down.
  
• May include outings. Participating in real-life situations — such as going to a restaurant or a grocery store — puts rehabilitation efforts into practice.
  
• May include use of computers. Using computer-assisted therapy can be especially helpful for relearning verbs and word sounds (phonemes).

Medications
Certain drugs are currently being studied for the treatment of aphasia. These include drugs that may improve blood flow to the brain, enhance the brain's recovery ability or help replace depleted chemicals in the brain (neurotransmitters). Several medications, such as memantine (Namenda) and piracetam, have shown promise in small studies. But more research is needed before these treatments can be recommended.

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Aortic valve stenosis

Aortic valve stenosis

Definition  :

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body.

When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump and may weaken your heart muscle, leading to symptoms, such as fatigue and dizziness.

If you have severe aortic valve stenosis, you'll usually need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.

Symptoms:

Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms typically develop when narrowing of the valve is severe and can include:

• Chest pain (angina) or tightness
• Feeling faint or fainting with exertion
• Shortness of breath, especially with exertion
• Fatigue, especially during times of increased activity
• Heart palpitations — sensations of a rapid, fluttering heartbeat
• Heart murmur

The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.

Aortic valve stenosis may not produce warning signs right away, making it difficult to detect at first. The condition is often discovered during a routine physical when a doctor hears an abnormal heart sound (heart murmur). This murmur may occur long before other signs and symptoms develop.
Depending on the amount of narrowing, an infant or child with aortic valve stenosis may have no symptoms, may tire easily or may have chest pain with vigorous physical activity.

When to see a doctor
Aortic valve stenosis usually affects adults, but can occur in children. Infants and children with the condition may experience symptoms similar to those of adults. If you or your child experiences such signs or symptoms, see a doctor — especially if you or your child has a known heart problem.

Causes:

Aortic valve stenosis is narrowing of the aortic valve. Many things can narrow this passageway between your heart and aorta. Causes of aortic valve stenosis include:

• Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called leaflets. Some children are born with an aortic valve that has only one (unicuspid) or two (bicuspid) leaflets — not three. This deformity may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced. Having a unicuspid or bicuspid aortic valve requires regular evaluation by a doctor to watch for signs of valve problems. In most cases, doctors don't know why a heart valve fails to develop properly, so it isn't something you could have prevented.
  
• Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can accumulate on the valve's leaflets. These deposits may never cause any problems. However, in some people — particularly those with a bicuspid aortic valve — calcium deposits result in stiffening of the leaflets of the valve. This stiffening narrows the aortic valve. This cause of aortic valve stenosis is most common in people older than 65, and symptoms often don't appear until age 70.
  
• Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.

How your heart works
Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.

Blood returning to your heart enters the right upper chamber (right atrium). From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Blood from your lungs then returns to your heart, but this time to the left side — to the left upper chamber (left atrium). Blood then flows into the left ventricle — your heart's main pump. With each heartbeat, the left ventricle forces blood through the aortic valve into the aorta, your body's largest artery.

Blood flows through your heart's chambers, aided by four heart valves. These valves open and close to let blood flow in only one direction through your heart:

• Tricuspid valve
• Pulmonary valve
• Mitral valve
• Aortic valve

The aortic valve — your heart's gateway to the aorta — consists of three tightly fitting, triangular-shaped flaps of tissue called leaflets. These leaflets connect to the aorta via a ring called the annulus.
Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When all of the left ventricular blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.

A defective heart valve is one that fails to either open or close fully. When a valve doesn't close tightly, blood can leak backward. This backward flow through a valve is called regurgitation. When a valve narrows, the condition is called stenosis.


Complications:

Aortic valve stenosis — of any cause — can be a serious condition because it can weaken the heart. If the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. In response, the left ventricle may thicken and enlarge. At first these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and your heart overall.

Left unchecked, aortic valve stenosis can lead to life-threatening heart problems, including:

• Chest pain (angina)
• Fainting (syncope)
• Heart failure
• Irregular heart rhythms (arrhythmias)
• Cardiac arrest

Treatments and drugs:

Medications sometimes can ease symptoms of aortic valve stenosis. However, the only way to eliminate aortic valve stenosis is surgery to repair or replace the valve and open up the passageway.
Surgery isn't always needed right away. If tests reveal that you have mild to moderate aortic valve stenosis and you have no symptoms, your doctor will schedule checkups to carefully monitor the valve so that surgery can be done at the appropriate time.

In general, surgery is necessary when narrowing becomes severe and symptoms develop. Some people never develop severe aortic valve stenosis, so they never need surgery. For others, the condition gets worse and surgery is necessary.

Medications
No medications can reverse aortic valve stenosis. However, your doctor may prescribe certain medications to help your heart, such as ones to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure or cholesterol may prevent or slow the development of aortic stenosis. Ask your doctor if you need to lower your cholesterol or blood pressure with medications.

Procedures
You may need valve repair or replacement to treat aortic valve stenosis. Although less invasive approaches are possible in some cases, surgery is the primary treatment for this condition.
Therapies to repair or replace the aortic valve include:

• Balloon valvuloplasty (valvotomy). Occasionally, repairing the aortic valve is an option. Balloon valvuloplasty uses a soft, thin tube (catheter) tipped with a balloon. A doctor guides the catheter through a blood vessel in your arm or groin to your heart and into your narrowed aortic valve. Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open the aortic valve and stretches the valve opening, improving blood flow. The balloon is then deflated and the catheter with balloon is guided back out of your body. Balloon valvuloplasty may relieve aortic valve stenosis and its symptoms, especially in infants and children. However, in adults, the procedure isn't usually successful, and the valve tends to narrow again even after initial success. For these reasons, doctors rarely use balloon valvuloplasty today to treat aortic valve stenosis in adults, except in people who are too sick to undergo surgery.
  
• Aortic valve replacement. This is the primary surgical treatment for aortic valve stenosis. Your surgeon removes the narrowed aortic valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves — which may come from a pig, cow or human deceased donor — often eventually need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible. Your doctor can discuss the risks and benefits of each type of heart valve with you.
  
• Transcatheter aortic valve replacement (TAVR). Aortic valve replacement, the most common treatment for aortic valve stenosis, has traditionally been performed with open-heart surgery. A less invasive approach — transcatheter aortic valve replacement — involves replacing the aortic valve with a prosthetic valve via the femoral artery in your leg (transfemoral) or the left ventricular apex of your heart (transapical). TAVR is usually reserved for individuals at increased risk of complications from aortic valve surgery. TAVR is sometimes referred to as transcatheter aortic valve implantation (TAVI).
  
• Surgical valvuloplasty. In rare cases, surgical repair may be a more effective option than balloon valvuloplasty, such as in infants born with an aortic valve in which the leaflets of the valve are fused together. Using traditional surgical tools, a cardiac surgeon operates on the valve and separates these leaflets to reduce stenosis and improve blood flow.

Aortic valve stenosis can be treated effectively with surgery. However, you may still be at risk of irregular heart rhythms even after you've been treated for aortic valve stenosis. You may need to take medications to lower that risk. If your heart has become weakened from aortic stenosis, you may need medications to treat heart failure.

If you've had aortic valve replacement surgery, you may need to take antibiotics before certain dental or medical procedures due to the risk of infection in your heart tissue (endocarditis).

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Aortic valve regurgitation

Aortic valve regurgitation

Definition:

Aortic valve regurgitation — or aortic regurgitation — is a condition that occurs when your heart's aortic valve doesn't close tightly. Aortic valve regurgitation allows some of the blood that was just pumped out of your heart's main pumping chamber (left ventricle) to leak back into it.
The leakage of blood may prevent your heart from efficiently pumping blood out to the rest of your body. As a result, you may feel fatigued and short of breath.

Aortic valve regurgitation can develop suddenly or over decades. Aortic valve regurgitation has a variety of causes, ranging from congenital heart defects to complications of infectious illnesses. Once aortic valve regurgitation becomes severe, surgery is often required to repair or replace the aortic valve.

Symptoms:

Most often, aortic valve regurgitation develops gradually, and your heart compensates for the problem. You may have no signs or symptoms for many years, and you may even be unaware that you have this condition.
However, as aortic valve regurgitation gets worse, signs and symptoms usually appear and may include:

• Fatigue and weakness, especially when you increase your activity level
• Shortness of breath with exertion or when you lie flat
• Chest pain (angina), discomfort or tightness, often increasing during exercise
• Fainting
• Irregular pulse (arrhythmia)
• Heart murmur
• Heart palpitations — sensations of a rapid, fluttering heartbeat
• Swollen ankles and feet (edema)

When to see a doctor
Take the signs and symptoms of aortic valve regurgitation seriously and call or see a doctor right away if they develop. Sometimes the first indications of aortic valve regurgitation are those of its major complication, congestive heart failure. Signs and symptoms of congestive heart failure — a serious condition — include fatigue, shortness of breath, and swollen ankles and feet.

Causes:

Aortic valve regurgitation disrupts the way blood normally flows through your heart and its valves.
Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood to your lungs and to the rest of your body. Blood flows through your heart's chambers, aided by four heart valves.
The aortic valve consists of three tightly fitting, triangular flaps of tissues called leaflets. These leaflets connect to the aorta through a ring called the annulus.

Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When the blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.

A defective heart valve is one that fails to either open or close fully. When a valve doesn't close tightly, blood can leak backward. This backward flow through a valve is called regurgitation.

Numerous causes
Any condition that damages a valve can cause regurgitation. Causes of aortic valve regurgitation may be:

• A congenital heart defect. You may have been born with an aortic valve that has one leaflet (unicuspid valve) or two leaflets (bicuspid valve) rather than the normal three leaflets. This puts you at risk of developing aortic valve regurgitation at some time in your life.
  
• Deterioration of the valve with age. The aortic valve opens and shuts tens of thousands of times a day, every day of your life. Aortic valve regurgitation may result from age-related wear and tear on the valve, especially if you have high blood pressure.
  
• Endocarditis. The aortic valve may be damaged by endocarditis — an infection inside your heart that involves heart valves.
  
• Rheumatic fever. Rheumatic fever — a complication of strep throat and once a common childhood illness in the United States — can damage the aortic valve, leading to aortic valve regurgitation later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close completely — or both. Rheumatic fever is still prevalent in developing countries, and many older adults in the United States were exposed to rheumatic fever as children.
  
• Disease. Other, rarer conditions that can damage the aortic valve and lead to regurgitation include Marfan syndrome (a disease of connective tissue), ankylosing spondylitis (a spine disorder) and syphilis (a sexually transmitted infection).
  
• Trauma. Damage to the aorta near the site of the aortic valve, such as damage from injury to your chest or from a tear in the aorta, also can cause backward flow of blood through the valve.

Aortic valve regurgitation — of any cause — can weaken your heart. In aortic valve regurgitation, some blood leaks back into the left ventricle instead of flowing onward to the rest of your body after being pumped into the aorta. This forces the left ventricle to hold more blood. In response, this chamber of your heart may enlarge and thicken. At first, these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and your heart overall.

Complications:

Aortic valve regurgitation — or any heart valve problem — puts you at risk of endocarditis. Endocarditis is an infection of the heart's inner lining — the endocardium. This membrane lines the four chambers and four valves of your heart. Typically, this infection involves one of the heart valves, especially if it's already damaged. If the aortic valve is leaky, it's more prone to infection than is a healthy valve. You can develop endocarditis when bacteria from another part of your body spread through your bloodstream and lodge in your heart.

When it's mild, aortic valve regurgitation may never cause a serious threat to your health. But when it's severe, aortic valve regurgitation may lead to heart failure. Heart failure is a serious condition in which your heart is unable to pump enough blood to meet your body's needs.


Treatments and drugs:

Treatment of aortic valve regurgitation depends on how severe your regurgitation is, your signs and symptoms, and whether the regurgitation is affecting your heart function. If you have aortic valve regurgitation, your doctor will evaluate your heart with regular echocardiograms to determine whether damage to your heart is getting worse.

Observation
Some people, especially those with mild regurgitation, don't need treatment. However, even if you don't have signs and symptoms of aortic valve regurgitation, schedule regular evaluations with your doctor. Observation isn't the same as ignoring the condition. Actively observing the stability or the progression of the condition is important so that you can receive the right treatment at the right time.

Medications
Medication can't eliminate aortic valve regurgitation. However, your doctor may prescribe certain medications to reduce the severity of aortic valve regurgitation, control blood pressure, and try to prevent or treat fluid buildup.

Surgery
Once signs and symptoms of aortic valve regurgitation develop, you'll usually need surgery. However, if aortic valve regurgitation is weakening your heart, you may need surgery even if you feel well. While the heart is generally good at counteracting problems caused by a leaky aortic valve, the problem is that if the valve isn't fixed or replaced in time, the strength of your heart may decline so much that it's permanently weakened. You can avoid that by having surgery at the appropriate time.

The overall function of your heart and the amount of regurgitation help to determine when surgery is necessary. Surgical procedures include:

• Valve repair. Aortic valve repair is surgery to preserve the valve and to improve its function. Occasionally, surgeons can modify the original valve (valvuloplasty) to eliminate backward blood flow. You don't need long-term medications to prevent blood clots (anticoagulation therapy) after a valvuloplasty.
•  
• Valve replacement. In many cases, the aortic valve has to be replaced to correct aortic valve regurgitation. Your surgeon removes your aortic valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical aortic valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves — which may come from a pig, cow or human cadaver donor — often need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible.
  
  Traditionally, aortic valve replacement has been performed with open-heart surgery. A less invasive approach — transcatheter aortic valve implantation — delivers the new valve through a catheter via the femoral artery in your leg (transfemoral) or the left ventricular apex of your heart (transapical). For now, this procedure is usually limited to individuals who have a narrowed aortic valve (aortic stenosis) rather than aortic regurgitation and are considered at high-risk for surgical complications. In the future, however, transcatheter aortic valve implantation may be an option for treatment of aortic regurgitation.
  

Aortic valve regurgitation can be eliminated with surgery, and you can usually resume normal activities within a few months. The prognosis following surgery is generally good.

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Aortic dissection

Aortic dissection

Definition:

An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.

Aortic dissection, also called dissecting aneurysm, is relatively uncommon. Anyone can develop the condition, but it most frequently occurs in men between 60 and 70 years of age. Symptoms of aortic dissection may mimic those of other diseases, often leading to delays in diagnosis. However, when an aortic dissection is detected early and treated promptly, your chance of survival greatly improves.


Symptoms:

Aortic dissection symptoms may be similar to those of other heart problems, such as a heart attack. Typical signs and symptoms include:

• Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates to the neck or down the back
• Loss of consciousness (fainting)
• Shortness of breath
• Sudden difficulty speaking, loss of vision, weakness, or paralysis of one side of your body, such as having a stroke
• Sweating
• Weak pulse in one arm compared to the other

When to see a doctor
If you have signs or symptoms such as severe chest pain, fainting, sudden onset of shortness of breath, or symptoms of a stroke, call 911 or emergency medical assistance. While experiencing such symptoms doesn't always mean that you have a serious problem, it's best to get checked out quickly. Early detection and treatment may help save your life.

Causes:

An aortic dissection occurs in a weakened area of the aortic wall. Chronic high blood pressure may stress the aortic tissue, making it more susceptible to tearing. You can also be born with a condition associated with a weakened and enlarged aorta, such as Marfan syndrome or bicuspid aortic valve. Rarely, aortic dissections may be caused by traumatic injury to the chest area, such as during motor vehicle accidents.

Aortic dissections are divided into two groups, depending on which part of the aorta is affected:

• Type A. This is the more common and dangerous type of aortic dissection. It involves a tear in the part of the aorta just where it exits the heart or a tear extending from the upper to lower parts of the aorta, which may extend into the abdomen.
• Type B. This type involves a tear in the lower aorta only, which may also extend into the abdomen.

Complications:

An aortic dissection can lead to:

• Death, due to severe internal bleeding, including into the lining around the heart (pericardial sac)
• Organ damage, such as kidney failure or life-threatening damage to the intestines
• Stroke, possibly including paralysis
• Aortic valve damage, such as causing the aortic valve to leak (aortic regurgitation)

Treatments and drugs:

An aortic dissection is a medical emergency requiring immediate treatment. Therapy may include surgery or medications, depending on the area of the aorta involved.

Type A aortic dissection
Type A aortic dissections are the more common and dangerous type of aortic dissection. These dissections involve a tear in the ascending portion of the aorta just where it exits the heart or a tear extending from the ascending portion down to the descending portion of the aorta, which may extend into the abdomen. Surgery is the preferred treatment for type A aortic dissections.

During the surgical procedure, surgeons remove as much of the dissected aorta as possible, block the entry of blood into the aortic wall and reconstruct the aorta with a synthetic tube called a graft. Some people with type A aortic dissection will need to have their aortic valve replaced at the same time if there's valve leakage related to the damaged aorta. If aortic valve replacement is required, the valve is placed within the graft that is used to reconstruct the aorta.

Type B aortic dissection
This type of aortic dissection involves a tear in the descending aorta only, which may also extend into the abdomen. People with type B aortic dissection can be treated medically or with surgery. Surgical options for type B aortic dissection are similar to the procedures used to correct a type A aortic dissection. Sometimes stents — small wire mesh tubes that act as a sort of scaffolding — may be placed in the aorta to repair type B aortic dissections.

Medications for aortic dissection
Aortic dissections may be treated with medications, such as beta blockers and sodium nitroprusside (Nitropress), to relieve the force of blood on the aortic wall by reducing the heart rate and lowering blood pressure. With reduced blood force, the aortic dissection is less likely to worsen. These medications may be used to prepare a person for surgery. Most people with type B dissections can be treated with medications alone.

After treatment many people with aortic dissections need to take blood pressure lowering medication for the rest of their lives. In addition, they'll often need follow-up CT or MRI scans periodically to monitor their condition. How often you'll need imaging tests depends on your underlying condition.

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Anxiety

Anxiety

 Definition:

Anxiety happens as a normal part of life. It can even be useful when it alerts you to danger. But for some people, anxiety persistently interferes with daily activities such as work, school or sleep. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to health concerns and other problems.

In some cases, anxiety is a mental health condition that requires treatment. Generalized anxiety disorder, for example, is characterized by persistent worry about major or minor concerns. Other anxiety disorders — such as panic disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) — have more-specific triggers and symptoms. Sometimes, anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, lifestyle changes, counseling or medications — or a combination of these approaches — can help.

Symptoms:

Common anxiety signs and symptoms include:

• Feeling apprehensive
• Feeling powerless
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired

Several types of anxiety disorders exist:

• Panic attacks can start suddenly and cause apprehension, fear or terror. You may have feelings of impending doom, shortness of breath, heart palpitations or chest pain. You may feel as if you're choking, being smothered or that you're "going crazy."
  
• Agoraphobia is anxiety about, or avoidance of, places or situations where you might feel trapped or helpless if you start to feel panicky.
  
• Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
  
• Social phobias are characterized by major anxiety provoked by exposure to certain types of social or performance situations and a desire to avoid them.
  
• Obsessive-compulsive disorder (OCD) includes persistent, recurring thoughts, images or impulses (obsessions) or an irresistible desire to perform irrational or seemingly purposeless acts or rituals (compulsions). Often it involves both obsessive and compulsive behavior.
  
• Post-traumatic stress disorder (PTSD) includes the feeling that you're re-experiencing an extremely traumatic event. It causes intense emotions and physical reactions along with a desire to avoid anything that might remind you of the event.
  
• Acute stress disorder includes symptoms similar to those of PTSD that occur immediately after an extremely traumatic event.
  
• Generalized anxiety disorder includes at least six months of persistent and excessive anxiety and worry about small or large concerns. This type of anxiety disorder often begins at an early age. It frequently occurs along with other anxiety disorders or depression.
  
• Anxiety disorder due to a medical condition includes prominent symptoms of anxiety that are directly caused by a physical health problem.
  
• Substance-induced anxiety disorder is characterized by prominent symptoms of anxiety that are a direct result of abusing drugs, taking medications or being exposed to a toxic substance.
  
• Separation anxiety disorder is a childhood disorder characterized by anxiety related to separation from parents or others who have parental roles.
  
• Anxiety disorder not otherwise specified is a term for prominent anxiety or phobias that don't meet the exact criteria for any of the other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor
See your doctor if:

• You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life
• You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety
• You think your anxiety could be linked to a physical health problem
• You have suicidal thoughts or behaviors (seek emergency treatment immediately)

Your worries may not go away on their own, and they may actually get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It may be easier to treat if you address it early.

Causes:

As with many mental health conditions, the exact cause of anxiety disorders isn't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to becoming anxious. Inherited traits also are a factor.

Medical causes
For some people, anxiety is linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators that you have a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order lab tests and other tests to look for signs of a problem.
Physical problems that can be linked to anxiety include:

• Heart disease
• Diabetes
• Thyroid problems (such as hypothyroidism or hyperthyroidism)
• Asthma
• Drug abuse
• Alcohol withdrawal
• Withdrawal from anti-anxiety medications (benzodiazepines)
• Rare tumors that produce certain "fight-or-flight" hormones
• Muscle cramps or spasms
• Tingling, burning or prickling sensations that may have no apparent cause

It's more likely that your anxiety may be due to an underlying medical condition if:

• Your anxiety symptoms started after age 35
• You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder
• You didn't have an anxiety disorder as a child
• You don't avoid certain things or situations because of anxiety
• No events have occurred in your life that were triggered by significant anxiety
• Medications used to treat feelings of panic (such as benzodiazepines) don't ease your anxiety symptoms

Complications:

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical health conditions, such as:

• Depression (which often occurs with anxiety disorder)
• Substance abuse
• Trouble sleeping (insomnia)
• Digestive or bowel problems
• Headaches
• Teeth grinding (bruxism)

Treatments and drugs:

When anxiety is severe, disrupts your day-to-day life, causes panic attacks or doesn't get better over time, you may have a disorder that needs to be diagnosed and treated.
The two main treatments for anxiety disorders are behavior therapy (psychotherapy) and medications. You may benefit most from a combination of the two. It may take some trial and error to discover exactly what treatments work best for you.

Psychotherapy
Also known as behavior or talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.
Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you have avoided because of anxiety. Through this process, your symptoms improve as you build upon your initial success.

Medications
Several different types of medications are used to treat anxiety disorders, including those below. Talk with your doctor about benefits, risks and possible side effects.

• Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat anxiety disorders include fluoxetine (Prozac), imipramine (Tofranil), paroxetine (Paxil, Pexeva), sertraline (Zoloft), and venlafaxine (Effexor XR). Citalopram (Celexa) and escitalopram (Lexapro) also can be effective, but dosages of about 40 milligrams (mg) a day of citalopram or 20 mg a day of escitalopram warrant discussion of risks versus benefits.
  
• Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
  
• Benzodiazepines. In limited circumstances your doctor may prescribe one of these sedatives for relief of anxiety symptoms. Examples include alprazolam (Niravam, Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you've had problems with alcohol or drug abuse.

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Antisocial personality disorder

Antisocial personality disorder

Definition  :

Antisocial personality disorder is a type of chronic mental illness in which a person's ways of thinking, perceiving situations and relating to others are abnormal — and destructive.

People with antisocial personality disorder typically have no regard for right and wrong. They may often violate the law and the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems. And people with antisocial personality disorder may not be able to fulfill responsibilities to family, work or school.

Antisocial personality disorder is sometimes known as sociopathic personality disorder. A sociopath is a particularly severe form of antisocial personality disorder.

Symptoms:

Antisocial personality disorder symptoms may include:

• Disregard for right and wrong
• Persistent lying or deceit
• Using charm or wit to manipulate others
• Recurring difficulties with the law
• Repeatedly violating the rights of others
• Child abuse or neglect
• Intimidation of others
• Aggressive or violent behavior
• Lack of remorse about harming others
• Impulsive behavior
• Agitation
• Poor or abusive relationships
• Irresponsible work behavior

The intensity of antisocial symptoms tends to peak during the 20s and then may decrease over time. It's not clear whether this is a result of aging or an increased awareness of the consequences of antisocial behavior. But while people with this disorder might be less likely to commit crimes against others later in life, they may still have trouble functioning in relationships, work or school.

If a loved one has antisocial personality disorder
It's unlikely you'll be able to convince a person with antisocial personality disorder that he or she has a problem — much less convince him or her to seek care. Make your own well-being your priority. Ask your doctor to refer you to a mental health provider who has experience helping families affected by antisocial personality disorder. A therapist familiar with this condition can help you learn how to cope — and stay safe.

Causes:

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It's the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of two factors:

• Inherited tendencies, or genes. These are aspects of a person's personality passed on by parents, such as shyness or having a happy outlook. This is sometimes called temperament. It's the "nature" part of the nature vs. nurture debate.
  
• Environment, or life situations. This is the surroundings a person grows up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting a person experienced, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some people may have a genetic vulnerability to developing antisocial personality disorder — and life situations may trigger its actual development.

There may be a link between an early lack of empathy — understanding the perspectives and problems of others, including other children — and later onset of antisocial personality disorder. These personality problems may be inherited and identifying them early may help improve long-term outcomes.

Complications:

Complications and problems of antisocial personality disorder include:

• Depression
• Anxiety
• Aggression or violence
• Suicidal behavior
• Reckless behavior
• Risky sexual behavior
• Child abuse
• Alcohol or substance abuse
• Gambling problems
• Incarceration
• Relationship difficulties
• Social isolation
• School and work problems
• Strained relationships with health care providers

Treatments and drugs:

Antisocial personality disorder is notoriously difficult to treat. People with this disorder may not even want treatment or think they need treatment. But because antisocial personality disorder is essentially a way of being, rather than a curable condition, affected people are likely to need close, long-term care and follow-up.

People with antisocial personality disorder may also need treatment for other conditions, such as depression, anxiety or thyroid disorders. Medical and mental health providers with experience treating antisocial personality disorder and commonly associated conditions are most likely to be helpful.
Those involved in treatment may include:

• A family or primary care doctor
• A psychiatrist
• A psychotherapist
• A pharmacist
• Family members
• Social workers

Treatment options
Several treatments are available for antisocial personality disorder. They include:

• Psychotherapy
• Stress and anger management skills
• Medications
• Hospitalization

The best treatment or combination of treatments depends on each person's particular situation and severity of symptoms.

Psychotherapy
Psychotherapy is the main way to treat antisocial personality disorder. Psychotherapy is a general term for the process of treating a condition by talking about it with a mental health provider.
Types of psychotherapy used to treat antisocial personality disorder may include:

• Cognitive behavioral therapy. This type of therapy helps to uncover unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
  
• Psychodynamic psychotherapy. This approach aims to raise awareness of unconscious thoughts and behaviors and — by bringing them to light — change their negative impact.
  
• Psychoeducation. This education-based therapy teaches about all aspects of a condition, including treatments, coping strategies and problem-solving skills.

Psychotherapy may be provided in individual sessions, in group therapy, or in sessions that include family or even friends. The right type of psychotherapy depends on each person's individual situation.

Skills for family members
If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself. Mental health professionals with experience managing this condition can help teach you skills to protect yourself from the aggression, violence and anger common to antisocial personality disorder. They can also recommend strategies for coping. Ask the people on your loved one's treatment team for a referral. They may also be able to recommend support groups for families and friends affected by antisocial personality disorder.

Medications
There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. However, several types of psychiatric medications may help with certain conditions sometimes associated with antisocial personality disorder:

• Antidepressant medications. Antidepressants may help improve depressed mood, anger, impulsivity, irritability or hopelessness.
  
• Mood-stabilizing medications. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.
  
• Anti-anxiety medications. These may help with anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior.
  
• Antipsychotic medications. Also called neuroleptics, these may be helpful if symptoms include losing touch with reality (psychosis) or, in some cases, anxiety or anger problems are present.

Hospitalization and residential treatment programs
In some cases, antisocial personality disorder symptoms may be so severe that psychiatric hospitalization is required. Psychiatric hospitalization is generally recommended only when people aren't able to care for themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.

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Antiphospholipid syndrome

Antiphospholipid syndrome

Definition  :

Antiphospholipid syndrome is a disorder in which your immune system mistakenly produces antibodies against certain normal proteins in your blood. Antiphospholipid syndrome can cause blood clots to form within your arteries or veins as well as pregnancy complications, such as miscarriages and stillbirths.

Antiphospholipid syndrome may lead to the formation of blood clots in your legs, a condition known as deep vein thrombosis (DVT). Antiphospholipid syndrome may also cause blood clots to form in organs, such as your kidneys or lungs. Damage depends on the extent and location of the clot. For instance, a clot in your brain can cause stroke.

There's no cure for antiphospholipid syndrome, but medications can be effective in reducing your risk of blood clots.

Symptoms:

Signs and symptoms of antiphospholipid syndrome may include:

• Blood clots in your legs (deep vein thrombosis, or DVT) that may travel to your lungs (pulmonary embolism)
• Repeated miscarriages or stillbirths and other complications of pregnancy, such as premature delivery and high blood pressure during pregnancy (preeclampsia)
• Stroke

Other less common signs and symptoms include:

• Neurological symptoms. Chronic headaches, including migraines, dementia and seizures are possible when a blood clot blocks blood flow to parts of your brain.
• Rash. Some people develop a red rash with a lacy, net-like pattern (livedo reticularis) on their wrists and knees.
• Cardiovascular disease. Heart valve problems are common among people with antiphospholipid syndrome. Heart valves open and close to keep blood flowing through your heart's four chambers in only one direction. Typically, the mitral valve — the valve between your heart's upper left and lower left chambers — develops masses or thickens, which can cause blood to leak backward through it (regurgitation). The aortic valve — the valve between your heart's lower left chamber and aorta — also may be affected.
• Bleeding. Some people experience a decrease in platelets, blood cells necessary for normal clotting. If you have this condition (thrombocytopenia), you may have few or no symptoms. However, if your platelet count drops too low, you may have episodes of bleeding, particularly from your nose and gums. You can also bleed into your skin, which will appear as patches of small, red spots (petechiae).

Infrequent signs and symptoms include:

• Movement disorder, in which your body and limbs jerk uncontrollably (chorea)
• Cognitive problems, such as poor memory
• Sudden hearing loss
• Mental health problems, such as depression or psychosis

When to see a doctor
If you already have an autoimmune condition, talk to your doctor about whether you should be tested for antiphospholipid antibodies.
Other reasons to contact your doctor include:

• Pain or swelling in your leg or arm. See your doctor especially if your vein is red, swollen or tender. Seek emergency care if vein swelling and pain are severe or are accompanied by a high fever or shortness of breath, which could indicate DVT and an increased chance of a blood clot traveling to your lungs (pulmonary embolism).
• Vaginal spotting or bleeding during the first 20 weeks of your pregnancy. This may be a sign of miscarriage. However, many women spot or bleed without miscarrying. If you've had repeated pregnancy losses or unexplained severe complications of pregnancy, it could be related to antiphospholipid syndrome. Talk to your doctor about whether testing would be right for you.

If you have antiphospholipid syndrome and you're thinking of attempting pregnancy, treatments are available during your pregnancy. But be sure to seek the care of an expert obstetrical provider to discuss your options.

When it's an emergency
Seek emergency care if you have certain other serious signs and symptoms. Look for:

• Signs and symptoms of stroke. These include sudden numbness, weakness or paralysis of your face, arm or leg; sudden difficulty speaking or understanding speech; sudden visual disturbances; sudden, severe headache; and dizziness.
• Signs and symptoms of pulmonary embolism. These include sudden shortness of breath, chest pain and coughing up blood-streaked sputum.
• Signs and symptoms of deep vein thrombosis. These include the development of leg swelling or pain.

Causes:

The role of phospholipids
In antiphospholipid syndrome, your body mistakenly produces antibodies against proteins that bind phospholipids, a type of fat present in your blood that plays a key role in clotting (coagulation). Antibodies are specialized proteins that normally attack body invaders, such as viruses and bacteria. When antibodies attack your phospholipid-binding proteins, your blood may clot abnormally.

Classifications
There are two main classifications of antiphospholipid syndrome:

• Primary. If you have no other autoimmune disorder, such as systemic lupus erythematosus (SLE), you have primary antiphospholipid syndrome.
• Secondary. If you do have lupus or another autoimmune disorder, your antiphospholipid syndrome is secondary.

With secondary antiphospholipid syndrome, the cause is considered to be your lupus or other autoimmune disorder.

The cause of primary antiphospholipid syndrome is unknown. However, some factors are associated with developing antiphospholipid antibodies — though not necessarily developing the syndrome. They include:

• Infections. People with syphilis, HIV infection, hepatitis C and malaria, among others, have a higher incidence of having antiphospholipid antibodies.
• Medications. Taking certain drugs, such as the high blood pressure medication hydralazine, the heart rhythm-regulating medication quinidine, the anti-seizure medication phenytoin (Dilantin) and the antibiotic amoxicillin may lead to an increased risk.
• Genetic predispositions. Although the disorder isn't considered hereditary, research indicates that relatives of people with antiphospholipid syndrome are more likely to have the antibodies.

Complications  :

Depending on which organ is affected by a blood clot and how severe the obstruction of blood flow to that organ is, untreated antiphospholipid syndrome can lead to permanent damage or death. Complications may include:

• Kidney failure. This can result from decreased blood flow to your kidneys.
• Stroke. Decreased blood flow to a part of your brain can cause a stroke, which can result in permanent neurological damage, such as partial paralysis and loss of speech (aphasia).
• Cardiovascular problems. If a clot forms in your leg (deep vein thrombosis), the clot can damage the valves in the veins in your affected leg, which normally serve to keep the blood flowing upward to your heart. This may result in a condition called chronic venous insufficiency, which causes chronic swelling and discoloration in your lower legs, because of the impaired blood flow upward to your heart. Another possible complication is heart damage.
• Lung problems. Complications related to your lungs may include high blood pressure in your lungs (pulmonary hypertension) and pulmonary embolism.
• Pregnancy complications. These may include miscarriages, stillbirths, premature delivery and high blood pressure during pregnancy (preeclampsia).

Treatments and drugs:

Doctors generally use medications that reduce your blood's tendency to clot to treat antiphospholipid syndrome.

Standard initial treatment
If you have thrombosis, standard initial treatment initially involves a combination of anticoagulant (blood-thinning) medications.

• Heparin. Typically, you'll first be given a shot or infusion of the blood thinner heparin, combined with another blood thinner in pill form, likely warfarin (Coumadin).
• Warfarin. After several days of combined heparin and warfarin, your doctor will discontinue the heparin and continue the warfarin, possibly for the rest of your life.
• Aspirin. In some cases, your doctor may recommend adding low-dose aspirin to your treatment plan.

Treatment during pregnancy
Anticoagulation therapy is particularly complex during pregnancy. The therapy is expensive, requires regular injections and carries some significant risks of side effects.

• Heparin. Some forms of heparin — enoxaparin (Lovenox) and dalteparin (Fragmin) — are known as low molecular weight heparin, which you can inject yourself under your skin (subcutaneously). Heparin is considered safe to take during pregnancy.
• Aspirin. Along with heparin, your doctor may recommend taking one tablet of aspirin daily throughout your pregnancy to increase your chances of a successful pregnancy.

Rarely, warfarin can cause birth defects, so it isn't usually recommended during pregnancy. Rarely, a doctor may prescribe warfarin during pregnancy, but only if the benefits of using it outweigh the risks.
Though anticoagulation therapy during pregnancy may be complicated, the good news is that it usually prevents antiphospholipid syndrome-related miscarriages.

If you're taking anticoagulant medication, your doctor will monitor your dosage with blood tests to be sure your blood is capable of clotting enough to stop your bleeding if you bruise or cut yourself.

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