Tuesday 14 October 2008

Marfans Syndrome

Marfan syndrome is a genetic condition which affects the body's connective tissues. The connective tissues help to provide support and structure to other tissue and organs. Marfan syndrome can affect the connective tissues in many different areas of your body, such as your blood vessels, skeleton, and eyes.

Symptoms of Marfans Syndrome

The symptoms of Marfan syndrome vary from person to person. Some people are only mildly affected, while others develop more serious symptoms. Marfan syndrome is hereditary, which means that it is passed on to you from your parents. If you have Marfan syndrome, your child has a 50% chance of developing the condition.

Marfan syndrome is a relatively rare condition. Approximately 1 in 5,000 people have the syndrome. Men and women are equally affected. Although rare, Marfan syndrome is the most common connective tissue disorder.

As Marfan syndrome can affect your heart and blood vessels, it is a potentially serious condition. Although there is currently no cure for Marfan syndrome, treatments are available which can help to effectively manage your symptoms, greatly improving your prognosis and life expectancy.

Features Of Marfans Syndrome

Outwardly, sufferers are usually tall and thin with disproportionately long limbs. Indeed, their arms are often 10% longer than they should be. They may be scoliolitic (have a sideways twist of the spine) or kyphotic (hump-backed) and have a pigeon or stove chest. Their joint hypermobility could be such that sufferers can bend their thumbs back to touch their forearms, and their fingers back at 90 degrees, without discomfort.

Sufferers are often very myopic (short-sighted) and some have dislocation of the lens and detachment of the retina. Marfan patients may also suffer from overcrowded teeth and a high, arched palate.

The major problems affecting a person with Marfan's Syndrome are linked to the heart and major blood vessels. The aorta - the large artery carrying blood away from the heart, may become dilated. Usually the ascending aorta - the section directly after it leaves the heart - is at risk, but it can also occur further down the vessel where it leads to the abdomen and lower body. The danger with this is that a swollen area, known as an aneurysm, could eventually burst. The aorta itself is made up of two layers of tissue. These can be torn apart - a disastrous and life-threatening event, known as a dissection. Indeed, aortic dissection is the most common cause of death in Marfan patients today. This can often be prevented if it is known to be a risk factor by reinforcement with an artificial structure made from titanium.

The aortic and mitral valves of the heart can also be affected. Situated on the left side of the heart, these may become 'incompetent' and let blood through when they are closed. This means that the heart can't pump as much blood as is needed and eventually a mechanical valve may be necessary.

Diagnosis Of Marfans Syndrome

Generally, Marfan Syndrome is diagnosed after a careful physical examination focussing particularly on the the eyes, skeletal and cardiovascular systems.

Suspected Marfanoid patients can also be monitored by Echocardiogram (a sound-wave picture of the heart) for early signs of aneurysm or mitral valve prolapse (the valves can become floppy).

The affected gene, FBN1, was discovered in 1990 and the protein it codes for (fibrillin) was discovered the following year. This knowledge should help develop a more accurate diagnostic test which could be applied at a much earlier stage. Mutations in the FBN1 gene can be detected in 80% of patients, thus enabling family members to be screened. Diagnosis can then be confirmed by genetic linkage studies.

Effects on Lifestyle

Stretchy connective tissue means that the aorta is not as strong as it should be, and is thus prone to tearing. Consequently a Marfan's person needs to avoid strenuous exercise and stress, or anything that would put the heart under excessive load. Nevertheless, a person with Marfan Syndrome still needs to be physically fit in order to maintain muscle tone, as well as ensuring the effective functioning of the heart and blood vessels. Hence golf, fishing, walking and non-competitive cycling would be ideal activities. Contact sports such as basketball and rugby are probably best avoided.

Dietary Considerations

Although no special diet is required, it would be prudent for the Marfan patient to choose their food wisely to ensure a balanced diet, rich in vitamins and minerals, particularly copper, which encourage the production of connective tissue.

For sources of copper see Copper

Treatment

It used to be the case that Marfan's people died early of heart failure, but with modern drugs (ie, beta-blockers) and surgical intervention, longevity is now possible. Beta-blockers have been shown to slow the dilation of the aortic root.

Physiotherapy, attendance at pain clinics and bracing to stabilise curvature of the spine may be helpful with the skeletal effects. Lace-up shoes with ankle support, together with shoe inserts, may be helpful for weak ankles.

Spectacles or contact lenses may be prescribed to try and improve or correct visual defects; and surgery can replace ocular lenses and re-attach retinas.

Approximately 10% of Marfan patients suffer spontaneous pneumothorax (collapse of the lungs) and this requires hospital treatment.

My Profile

I am now forty three years old. I was diagnosed with Marfans Syndrome when I was a year and a half old. The main symptom that I suffer with is that I am partially sighted. I also am very tall and my joints are very flexible. I have had echocardiogram’s every two years but have not experienced any problems with my heart. I have experience some problems with my back and this has been greatly helped by my osteopath StSephen Sandler http://www.osteopath-help.co.uk/osteopaths/cranial-osteopathy/uk/london/regents_park/dr_stephen_sandler_great_portland_stwho is a world expert.

I suggest that if you are very tall and that your arms are very long (usually Marfans patients arm span is longer than their height) I would suggest that you have a word with your GP as you may have Marfans.

Postural Orthostatic Tachycardia Syndrome

POT's syndrome is where the blood pools http://heartdisease.about.com/cs/arrhythmias/a/Syncope2_2.htm in the legs and as a result of this the heart rate increases upon standing by over 30 beats per minute (usually within ten minutes). Patients very often go into tachycardia http://www.healthscout.com/ency/68/729/main.html and quite often pass out.

My Profile

n May 2008 I was sitting on the train travelling into London to work. The train was very crowded and suddenly I felt my heart rate going very fast and I had to get off the train. I had been experiencing a lot of stress at both home and work and I just thought that it was a bit of a panic attack. I went straight home but had to immediately call an ambulance as my pulse was racing. Apparently it was 200 beats per minute. I was admitted into hospital. I was lying on the stretcher for about an hour and by the time the nurse did the ECG my pulse had gone back to normal. I was dismissed from the hospital and given a beta blocker. This made my symptoms much worse and the following week I was admitted by ambulance again into hospital.

As I already had Marfans Syndrome the focus was on this condition. I had a CAT scan and various blood tests the results of which were all normal. I was hooked up to a heart monitor and I began to notice that if I stood up from either a lying or sitting position that my pulse would rise to 150 beats per minute. I informed my consultant of this and he carried out a standing ECG which showed the symptoms of tachycardia. I was released from hospital but needed further investigations. These included a tilt table test, various urine collection tests, numerious blood tests, tests on the adrenal gland, MRI scan, heart and blood pressure monitor tests and autonomic function test. All tests came back normal apart from the tilt table test and the heart monitor tests. I had to be admitted another two times into hospital as I was very unwell.

I have been more or less bed bound now since May as the doctors are finding it hard to give me suitable medications. I have researched POTS now and have found that a lot of patients are intolerant of certain medications. I am taking paediatric atenolol. I take 5ml syrup a day but have to split this three times a day as I can not take the full 5ml in one go. This does bring down the pulse but I can not seem to take enough of the medicine to enable me to exercise (or even walk up the stairs without becoming exhausted). I also take a steroid called fludrocortisone (0.5mcg per day). The purpose of this drug is to help the body retain salt and thus increase blood volumes.

I am due to be admitted into hospital again to trial a new drug with the atenolol. This drug is Midrodine. I hope that this drug will work because if it does not I may have to have a pace maker fitted and I do not relish the thought of this. I will let you know what happens, well that’s if I am here to tell the tale.

Symptoms of POTS

I have experienced the following symptoms:

Tachycardia, syncope (fainting), extreme fatigue, headaches, nausea and in particular morning sickness, extreme thirst, constant urination, restless legs at night, get very hot and can not tolerate heat, diarrhoea or constipation, difficulty swallowing, stomach pains, difficulty eating due to bloated feeling, weight loss, can not tolerate taking a bath or shower (the heat of the water exacerbates the symptoms).

Useful Tips

Drink plenty of water every day to increase the blood volume.

Wear support hosiery which provides compression of the veins. Tights would be preferable to stockings. These work in some patients. I have read that some patients use g-suits but I have not tried this myself yet.

When bathing do not have the water too hot.

Do not stand in the shower but sit on the floor.

Do not bend over, always bend with your knees.

Also when standing still try to cross your legs.

Do not drink alcohol as this makes symptoms much worse.

It is sometimes very difficult to eat large meals. I found that my tummy felt very bloated and that I often felt very sick. Also I had a very weird sensation in that I felt that my throat was closing up and that I could not chew my food properly. I also suffered with either diarrhoea or constipation. After researching POTS I found that food could play an important part in helping to improve symptoms. I now follow the GI diet http://www.the-gi-diet.org/lowgifoods/ (I do not actually diet but I mainly eat GI foods). I have also cut down on dairy products as I have read that they do not help POTS patients. I am mindful that my calcium intake is now lower and the only way that I can naturally address this is to eat nuts, oats and berries which I believe are high in calcium. I now also avoid garlic as this lowers the blood pressure as do nitrates (these can be found in greens and carrots and also I believe may be in tap water but I think this would depend on where you live). I also make sure I eat two bananas a day because the steroid depletes the body’s supply of potassium and magnesium (magnesium can also be found in nuts). Every morning I juice a lemon and add the juice and lemon to a cup of boiled water. I add a pinch of cinnamon, small pinch of ground cloves (only a pinch as this is a very strong spice and you should not use too much) and a pinch of ginger. These are all good for circulation. I also add half a teaspoon of honey as this is very good for the kidneys. I also drink one glass of Cranbury juice per day as this is also good for the kidneys (I am aware that this may increase my blood sugar levels). I have read that two strong cups of coffee in the morning can help to raise a low blood pressure but as I have eliminated all caffeine from my diet I have not tried this. This diet seems to be really working as for the first time in my life I have not suffered with the symptoms of irritable bowel syndrome in that I am regular now and have normal stools. The most important thing I think is to eat little and often. I eat at least every three hours so as to make sure my blood sugar levels do not drop. Some POTS patients recommend the sports drink Gatorade to help fight the fatigue symptoms. For myself I just found that it increased my heart rate so was of no use, it might be to you so it’s worth a try. I also find that high protein cereal bars are a handy and quick snack.

Exercise is very important although very difficult at times. In particular exercise the legs. An exercise bike is a good form of exercise for the legs and if you use one with a chair and so that you can lay flat this would be very helpful. Start off gradually to increase the muscles in the legs. If you can not get out of bed it is even more important to try and exercise the legs to keep the circulation going. Lie flat on your back and then you can raise your legs and pedal is if you were riding a bike. Or you can raise one leg at a time slightly then point your toe and then move the ankle so that the foot becomes straight again. You will feel this stretching the calf muscles at the back of your leg. With POTS even these simple exercises can be exhausting so do not be frustrated if you can not do these for long. Even if you can manage a minute several times a day it will help your circulation.

When you are in bed raise your head approximately 12 inches (use pillows but you could get an electric bed although this is an expensive option).

I would be really interested to hear if anyone has more useful tips?

Does anyone else suffer with both Marfans Syndrome and Pots Syndrome? I would be interested to hear!

Doctors Whom I Would Recommend

I have been extremely lucky in that I have had fantastic doctors to help with my diagnosis.

I first met Dr Rajiv Amersey MD MRCP http://www.drfoster.co.uk/Guides/ConsultantGuide/view.aspx?gmcno=3479388 who is a Consultant Cardiologist and Physician at Whipps Cross University Hospital, Holly House Hospital and Bart’s Hospital. He is a fantastic doctor and was very quick to spot the signs of POTS. He did not give me an immediate diagnosis as he wanted to eliminate all other conditions but I have never known a doctor to be so thorough and also kind.

After trials of various medications we decided that it might be time for me to see a specialist so I was referred to Professor Rodney Grahame CBE MD FRCP FACP http://www.ucl.ac.uk/medicine/bloomsbury-rheumatology/staff/rg.html who is a Consultant Rheumatologist/Honorary Professor at UCL in the Dept of Medicine. Professor Grahame is an expert in Marfans syndrome. Professor Grahame is semi retired now. He was a lovely man who spent a long time with me and finally concluded that I obtain an opinion from Professor Mathias who is an expert in POTS.

Professor Christopher J Mathias DPhil DSc FRCP FMedScihttp://www1.imperial.ac.uk/medicine/people/c.mathias/ works at both the Imperial College London (St Mary’s Hospital) and the National Hospital for Neurology and Neurosurgery & Institute of Neurology, University College London. Professor Mathias is a charming man whom immediately puts one at ease. He carried out various autonomic function tests and I am to be admitted into hospital at the end of October for more tests.

If anyone has any of the symptoms of either Marfans or POTS I would recommend that you seek out the advice of any of the above doctors.

Medications

The following are some medications that I know about that are used to treat POTS.

Midrodine

For information on Midodrine see patient information leaflet: http://www.uhsm.nhs.uk/patients/Documents/PHARMACY/midodrineforlowbloodpressurOct07-Oct09.pdf

Other Medications


Midodrine (Proamatine), is approved by the U.S. FDA to treat orthostatic hypotension, a condition related to POTS. It is a stimulant that causes vasoconstriction and thereby increases blood pressure and allows more blood to return to the upper parts of the body. Use of midodrine is often discontinued due to intolerable side-effects, and it is known to cause supine hypertension (high blood pressure when lying down

Fludrocortisone

For informaiton on Fludrocortisone see patient information leaflet:http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=19330

The first line of treatment for POTS is usually fludrocortisone, or Florinef, a corticosteroid used to increase sodium retention and thus increase blood volume and blood pressure. An increase in sodium and water intake must coincide with fludrocortisone therapy for effective treatment. Dietary increases in sodium and sodium supplements are often used. Gatorade is also effective in providing both sodium and fluid.

Beta Blockers

Beta blockers such as atenolol and propanolol are often prescribed to treat POTS. These medications work by blocking the effects of epinephrine and norepinephrine released by the autonomic nervous system. Beta blockers also reduce sympathetic activity by blocking sympathetic impulses.

Antidepressants

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Celexa, Lexapro, and Paxil, can be extremely effective in re-regulating the autonomic nervous system and raising blood pressure. Some studies indicate that serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor and Cymbalta are even more effective. Tricyclic antidepressants, tetracyclic antidepressants, and monoamine oxidase inhibitors are also occasionally, but rarely, prescribed. A combination of two antidepressants, usually an SSRI or SNRI with Wellbutrin or Remeron, is also shown to be very effective.

Stimulants

Medications used to treat ADD and ADHD such as Ritalin and Adderall are used to balance dopamine levels, increase vasoconstriction, and increase blood pressure.

AnxiolyticsAnti-anxiety medications, such as Xanax, Ativan, and Klonopin, can be used to combat imbalances of adrenaline usually seen with POTS patients.

Other medications

Angiotensin converting enzyme inhibitors, or ACE inhibitors, are used to increase vasoconstriction, cardiac output, and sodium and water retention.Clonidine can work in patients with reduced sympathetic activity.

Ironically an anti-hypertensive drug, Clonidine promotes production and release of epinephrine and norepinephrine.

Disopyramide, or Norpace, is an antiarrhythmic medication that inhibits the release of epinephrine and norepinephrine.

Erythropoietin, used to treat anemia via intravenous infusion, is very effective at increasing blood volume. It is seldom used, however, due to the dangers of increasing the hematocrit, the inconvenience of intravenous infusion, and its prohibitively expensive cost.

Pregabalin, or Lyrica, an anticonvulsant drug, has been shown to be especially effective in treating neuropathic pain associated with POTS. In fact, Lyrica is currently the only prescription drug approved by the FDA to treat fibromyalgia. Some POTS patients also report improvement in concentration and energy while on Lyrica.

Pseudoephedrine and phenylephrine, over the counter decongestants, increase vasoconstriction by promoting the release of norepinephrine.Pyridostigmine, or Mestinon, inhibits the breakdown of acetylcholine, promoting autonomic nervous system activity. It is especially effective in patients who exhibit symptoms of excessive sympathetic activity.

Theophylline, a drug used to treat respiratory diseases such as COPD and asthma, is occasionally prescribed at low doses for POTS patients. Theophylline increases cardiac output, increases blood pressure, and stimulates epinephrine and norepinephrine production. Due to its very narrow therapeutic index, Theophylline is known to cause a wide variety of side-effects and even toxicity.

Women who report a worsening of symptoms during menstruation will often use combined (containing both estrogen and progestin) forms of hormonal contraception to prevent hormonal changes and an aggravation of their condition.

Drugs That Can Make Symptoms Worse

Drugs that can cause or worsen orthostatic intolerance are:

A-Receptor blockers
Angiotensin-converting-enzyme inhibitors
B-Blockers
Bromocriptine
Calcium channel blockers
Diuretics
Ethanol
Ganglionic blocking agents
HydralazineMonoamine oxidase inhibitors
Nitrates
Opiates
Phenothiazines
Sildenafil citrate (Viagra)
Tricyclic antidepressants

Useful NHS Medicin Guide

http://medguides.medicines.org.uk/default.aspx

Disclaimer:

Statements and information regarding any products mentioned within this site have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease or heath condition. Any information on this site should be considered as general information only and should not be used to diagnose or treat any health condition.

Please seek medical advice for a diagnosis and treatment of any medical concerns you may have, and before implementing any diet, supplement, exercise, or other lifestyle changes.

What Is An ECG

What is an electrocardiogram?

An electrocardiogram or 'ECG' records the electrical activity of the heart. The heart produces tiny electrical impulses which spread through the heart muscle to make the heart contract. These impulses can be detected by the ECG machine. You may have an ECG to help find the cause of symptoms such as palpitations or chest pain. Sometimes it is done as part of routine tests, for example, before you have an operation.

The ECG test is painless and harmless. (The ECG machine records electrical impulses coming from your body - it does not put any electricity into your body.)

How is it done?

Small metal electrodes are stuck onto your arms, legs and chest. Wires from the electrodes are connected to the ECG machine. The machine detects and amplifies the electrical impulses that occur each heartbeat and records them onto a paper or computer. A few heartbeats are recorded from different sets of electrodes. The test takes about five minutes to do.

What does an ECG show?

The electrodes on the different parts of the body detect electrical impulses coming from different directions within the heart. There are normal patterns for each electrode. Various heart disorders produce abnormal patterns. The heart disorders that can be detected include:

Abnormal heart rhythms.

If the heart rate is very fast, very slow, or irregular. There are various types of irregular heart rhythm with characteristic ECG patterns.

A heart attack, and if it was recent or some time ago.

A heart attack causes damage to heart muscle, and heals with scar tissue. These can be detected by abnormal ECG patterns.

An enlarged heart.

Basically this causes bigger impulses than normal.Limitations of the ECG

An ECG is a simple and valuable test. Sometimes it can definitely diagnose a heart problem. However, a normal ECG does not rule out serious heart disease. For example, you may have an irregular heart rhythm that 'comes and goes', and the recording can be normal between episodes. Also, not all heart attacks can be detected by ECG. Angina, a common heart disorder, cannot usually be detected by a routine ECG. Specialised ECG recordings sometimes help to overcome some limitations. For example:

Exercise ECG.

This is where the tracing is done when you exercise (on a treadmill or exercise bike). This helps to assess the severity of the narrowing of the coronary arteries which causes angina.

24 hour ECG monitor.

This is where you wear a small monitor for 24 hours which constantly records your heart rhythm. It aims to detect abnormal heart rhythms that may 'come and go'.

What Is An Echocardiogram

What is an echocardiogram?

An echocardiogram is an ultrasound scan of the heart. It is sometimes just called an 'ECHO'. Ultrasound is a very high frequency sound that you cannot hear, but it can be emitted and detected by special machines. The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves.

What happens during the test

?You will need to undress to the waist and lie on the couch. A probe is placed on your chest (it is a bit like a very thick blunt pen). Also, lubricating jelly is put on your chest so the probe makes good contact with the skin. The probe is connected by a wire to the ultrasound machine and monitor. Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo ('bounce back') from the heart and various structures in the heart.The amount of ultrasound that echoes back depends on the density of the tissue the sound has hit. Therefore, the different structures send back different echoes. For example, ultrasound travels freely through fluid so there is little echo from blood in heart chambers. But, heart valves are dense tissues so ultrasound waves hitting a valve will echo back clearly.The echoes are detected by the probe and are sent to the echocardiogram machine. They are displayed as a picture on the monitor. The picture is constantly updated so the scan can show movement as well as structure. (For example, the valves of a heart opening and closing.) The operator moves the probe around over the skin surface to get views from different angles. Some abnormalities can be seen quite clearly. For example, damaged heart valves, thickened heart muscle, some congenital heart defects, etc.

The test is painless and takes about 30-45 minutes. You may have to turn on your side during the test so the operator can scan the heart from different angles.

You do not need any special preparation before the test. You eat and drink normally before and after the test. Continue to take your usual medication.

What Is A Tilt Table Test

What is a tilt table test?

Tilt table testing is designed to evaluate how your body regulates blood pressure in response to some very simple stresses.Blood pressure is regulated by a set of nerves which operate continuously and subconsciously and are part of the autonomic nervous system. This set of nerves detects certain bodily needs and they respond by causing the appropriate changes in blood pressure. The purpose of this part of the autonomic nervous system is to insure that there is always enough blood going to the brain, and to distribute blood to other organs according to their needs. For example, during exercise, blood is delivered preferentially to the muscles, whereas during eating blood is delivered preferentially to the intestines. These changes in blood pressure are accomplished by making changes in the way the heart beats and by making changes in the caliber or size of certain blood vessels.At times, the nerves which control blood pressure may not operate properly and may cause a reaction which paradoxically causes the blood pressure to drop suddenly. This reaction may produce a fainting spell or a number of symptoms including severe lightheadedness. Tilt table testing is designed to determine the likelihood that a patient is susceptible to this type of reaction.

Who needs a tilt table test?

Patients that have symptoms suggestive of a sudden drop in blood pressure may benefit from the evaluation of blood pressure regulation with a tilt table test. The tilt table test was originally designed to evaluate patients with fainting spells because many fainting spells are caused by a drop in blood pressure. Tilt table testing may also be useful for patients who have symptoms of severe lightheadedness or dizziness which don't actually cause them to faint, but force them to sit down or lie down. These symptoms, while not progressing on to an actual fainting spell, may still be indicative of a sudden drop in blood pressure. Many patients suffering from the chronic fatigue syndrome have symptoms of lightheadedness and have been referred for tilt table testing.

What does tilt table testing involve?

The first part of a tilt table test evaluates how blood pressure responds to the simple stress of standing up, or in other words, how the blood pressure responds to the stress of gravity. Patients are asked to remove their clothing above the waist, put on a hospital gown, and lie down on a special table. Patients are connected to an electrocardiogram (ECG) type machine, have a small cuff placed around a finger which measures blood pressure, and have a small intravenous line (IV) placed into a vein in the arm. We try to make the setting as relaxing as possible by dimming the lights and by turning on some soft music in the background. After everything is set up we collect baseline blood pressure and ECG data for 10 minutes while you lie quietly on the table.

How long will the tilt table test take?

The duration of the tilt table test depends in part on how you respond. Some patients demonstrate the reaction that causes their blood pressure to fall suddenly in the first 20 minutes of head-up tilt to 60 degrees. Given the time it takes to set up the equipment and collect baseline data, the shortest possible test is 30-40 minutes. Other patients finish the entire protocol without demonstrating any such reaction (a negative test); these patients therefore finish all three stages of the test. If you finish the entire test, it will take approximately 2 hours.

What is a positive test?

A tilt table test is called positive if a patient develops a drop in blood pressure associated with symptoms. The symptoms that patients experience are varied and have included lightheadedness, nausea, a cold and clammy feeling, sweating, a "spacey" feeling, or a feeling like you are about to black out. Rarely, blood pressure falls without the patient developing symptoms.

What does a positive test mean?

A positive tilt table test means that a patient is susceptible to one of the reactions that can cause a drop in blood pressure. Some of the reactions can be dangerous and require treatment, other reactions are benign and may not require treatment. Treatments vary from medication to a change in diet. The interpretation of the tilt table test is up to your physician.

How will I feel after the test?

Many patients who have a positive test feel a little unsettled and sometimes queasy for the first few minutes after the test. The vast majority of patients will return to feeling completely normal within 5 to 10 minutes after the test. Rarely, a patient may continue to experience weakness or fatigue for a longer period of time after the test. Patients that have a negative test often report that the test was tiring but otherwise feel fine. If the patient received isuprel during the test, the effects of isuprel wear off within a few minutes of stopping the infusion.

What Is A CT Scan

What is a CT scanner?

A CT (computerised tomography) scanner is a special kind of X-ray machine. Instead of sending out a single X-ray through your body as with ordinary X-rays, several beams are sent simultaneously from different angles.

How does a CT scanner work?

The X-rays from the beams are detected after they have passed through the body and their strength is measured.Beams that have passed through less dense tissue such as the lungs will be stronger, whereas beams that have passed through denser tissue such as bone will be weaker. A computer can use this information to work out the relative density of the tissues examined. Each set of measurements made by the scanner is, in effect, a cross-section through the body. The computer processes the results, displaying them as a two-dimensional picture shown on a monitor. The technique of CT scanning was developed by the British inventor Sir Godfrey Hounsfield, who was awarded the Nobel Prize for his work.

What are CT scans used for?

CT scans are far more detailed than ordinary X-rays. The information from the two-dimensional computer images can be reconstructed to produce three-dimensional images by some modern CT scanners. They can be used to produce virtual images that show what a surgeon would see during an operation. CT scans have already allowed doctors to inspect the inside of the body without having to operate or perform unpleasant examinations. CT scanning has also proven invaluable in pinpointing tumours and planning treatment with radiotherapy.

What is the CT scanner used for?

The CT scanner was originally designed to take pictures of the brain. Now it is much more advanced and is used for taking pictures of virtually any part of the body. The scanner is particularly good at testing for bleeding in the brain, for aneurysms (when the wall of an artery swells up), brain tumours and brain damage. It can also find tumours and abscesses throughout the body and is used to assess types of lung disease.In addition, the CT scanner is used to look at internal injuries such as a torn kidney, spleen or liver; or bony injury, particularly in the spine. CT scanning can also be used to guide biopsies and therapeutic pain procedures.

How is a CT scan prepared for?

If the patient is receiving an abdomen scan, for example, they will be asked not to eat for six hours before the test. They will be given a drink containing gastrografin, an aniseed flavoured X-ray dye, 45 minutes before the procedure. This makes the intestines easier to see on the pictures. Sometimes a liquid X-ray dye is injected into the veins during the test. This also makes it easier to see the organs, blood vessels or, for example, a tumour. The injection might be a little uncomfortable, and some people also experience a feeling of warmth in their arm.

How is a CT scan carried out?

The scanner looks like a large doughnut. During the scan the patient lies on a bed, with the body part under examination placed in the round tunnel or opening of the scanner. The bed then moves slowly backwards and forwards to allow the scanner to take pictures of the body, although it does not touch the patient. The length of the test depends on the number of pictures and the different angles taken.

Does a CT scan hurt?

The examination does not hurt but some people find it uncomfortable to lie in the tunnel. As there is little room inside the tunnel, people who suffer from severe claustrophobia sometimes have problems with CT scans. Let the doctors and radiographers know if this might be a problem. Other people get slightly nervous because of the whirring noise the machine makes while working.

Is a CT scan dangerous?

Far more X-rays are involved in a CT scan than in ordinary X-rays, so doctors do not recommend CT scans without a good medical reason. Some patients may experience side effects due to allergic reactions to the liquid dye injected into the veins.In very rare cases, this dye has been known to damage already weakened kidneys. It is important to let the X-ray doctors or technicians know if you have any allergies, asthma or kidney trouble, prior to having the X-ray dye injected.

How is a CT scan read?

A CT scan can give the doctor a much clearer picture of the inside of the body than an ordinary X-ray. For example, different types of tissue such as bone, muscle and fatty tissue are easy to see on a CT scan. When looking at the abdomen, the scan shows various organs such as the pancreas, spleen and liver. When it is necessary to look at the brain, the areas containing liquid - the ventricles - are also clearly defined. Very small shadows on the lungs can also be detected using CT and there are now studies looking into using it as a screening test for lung cancer.

What Is A MRI Scan?

What is an MRI scan?

MRI (magnetic resonance imaging) is a fairly new technique that has been used since the beginning of the 1980s.The MRI scan uses magnetic and radio waves, meaning that there is no exposure to X-rays or any other damaging forms of radiation.

How does an MRI scanner work?

The patient lies inside a large, cylinder-shaped magnet. Radio waves 10,000 to 30,000 times stronger than the magnetic field of the earth are then sent through the body. This affects the body's atoms, forcing the nuclei into a different position. As they move back into place they send out radio waves of their own. The scanner picks up these signals and a computer turns them into a picture. These pictures are based on the location and strength of the incoming signals. Our body consists mainly of water, and water contains hydrogen atoms. For this reason, the nucleus of the hydrogen atom is often used to create an MRI scan in the manner described above.

What does an MRI scan show?

Using an MRI scanner, it is possible to make pictures of almost all the tissue in the body. The tissue that has the least hydrogen atoms (such as bones) turns out dark, while the tissue that has many hydrogen atoms (such as fatty tissue) looks much brighter. By changing the timing of the radiowave pulses it is possible to gain information about the different types of tissues that are present. An MRI scan is also able to provide clear pictures of parts of the body that are surrounded by bone tissue, so the technique is useful when examining the brain and spinal cord. Because the MRI scan gives very detailed pictures it is the best technique when it comes to finding tumours (benign or malignant abnormal growths) in the brain. If a tumour is present the scan can also be used to find out if it has spread into nearby brain tissue. The technique also allows us to focus on other details in the brain. For example, it makes it possible to see the strands of abnormal tissue that occur if someone has multiple sclerosis and it is possible to see changes occurring when there is bleeding in the brain, or find out if the brain tissue has suffered lack of oxygen after a stroke. The MRI scan is also able to show both the heart and the large blood vessels in the surrounding tissue. This makes it possible to detect heart defects that have been building up since birth, as well as changes in the thickness of the muscles around the heart following a heart attack. The method can also be used to examine the joints, spine and sometimes the soft parts of your body such as the liver, kidneys and spleen.

How does an MRI scan differ from a CT scan?

With an MRI scan it is possible to take pictures from almost every angle, whereas a CT scan only shows pictures horizontally. There is no ionizing radiation (X-rays) involved in producing an MRI scan. MRI scans are generally more detailed, too. The difference between normal and abnormal tissue is often clearer on the MRI scan than on the CT scan.

How is an MRI scan performed?

The scan is usually done as an outpatient procedure, which means that the patient can go home after the test. During the scan it is important to lie completely still. For this reason it might be necessary to give a child an anaesthetic before they are tested. Since you are exposed to a powerful magnetic field during the MRI scan, it is important not to wear jewellery or any other metal objects.It is also important for the patient to inform medical staff if they use electrical appliances, such as a hearing aid or pacemaker, or have any metal in their body such as surgical clips, but orthopaedic metalware such as artificial hips or bone screws is not normally a problem.

Is an MRI scan dangerous?

There are no known dangers or side effects connected to an MRI scan. The test is not painful; you cannot feel it. Since radiation is not used, the procedure can be repeated without problems. There is a small theoretical risk to the foetus in the first 12 weeks of pregnancy, and therefore scans are not performed on pregnant women during this time. Because patients have to lie inside a large cylinder while the scans are being made some people get claustrophobic during the test. Patients who are afraid this might happen should talk to the doctor beforehand, who may give them some medication to help them relax. The machine also makes a banging noise while it is working, which might be unpleasant.

What Is A Chest X-ray

What is Chest X-ray (Chest Radiography)?

The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest.An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Relieve Stress With Recliner Chair Meditation Technique

Stress

Stress can exacerbate symptoms in POTS patients so it is really important to learn relaxation techniques. Therefore try the following:

Recliner Chair Meditation Technique

Sit in a recliner chair with the bare soles of your feet pressed against each other and your legs relaxed, knees pointed out to the sides of the chair. You can drape a towel or blanket over your bare feet for warmth. The hands can be locked together, laying comfortably in your lap, or pressed against the center of the chest, one on top of the other, on the center of the emotional heart. Your eyes can be fully closed or left slightly open, letting in just two small slits of light. If your eyes are fully closed be sure to keep the room brightly lit so that some light passes through the eyelids. Total darkness will evoke dullness and sleep, not meditation.Sit quietly for a period of between thirty minutes and one hour. While sitting, be gently aware of the breathing process felt at the belly. Feel your belly moving in and out slowly as you breathe. If you start to have distracting thoughts, simply bring your attention back to the belly and the process of breathing. Maintain alertness and do not let yourself drift into sleep.This meditation can be done once, twice, or even three times a day. After practicing this method for some time you may become aware of what the Japanese call the 'hara.' No one really knows what the hara is, but it may be related to the enteric nervous system. The hara is felt just behind and slightly below the navel as an ethereal ball of energy. When your consciousness is centered at the hara instead of in the head, your thinking process slows down and can even stop. When the thinking process slows down you relax deeply and experience pleasing sensations of spaciousness and comfort. Trying to stop distracting thoughts with will power alone leads to even more thoughts and a self-defeating inner struggle. By transferring your center of awareness to the hara, thoughts gradually disappear on their own, without any inner conflict.