5 Things We Now Know About Pulmonary Arterial Hypertension
Girl, 17, Left 'screaming In Pain' With Life-threatening Blood Clot Just One Week After Taking Contraceptive Pill
A TEENAGER was left "screaming and crying in pain" from a life-threatening blood clot caused by the contraceptive pill.
Nicole Leadbitter developed severe back pain and noticed one leg looked bigger than the other a week after she started taking the combined pill aged 17.
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Nicole Leadbitter, now 20, suffered a life-threatening blood clot after taking the combined contraceptive pillCredit: Nicole Leadbitter/TriangleNews6
Nicole was rushed to the hospital after developing severe back pain and noticing one leg looked bigger than the otherCredit: Nicole Leadbitter/TriangleNewsShe was finally diagnosed with a deep vein thrombosis (DVT) in her left leg and a pulmonary embolism in her lungs, which could have killed her if she had waited much longer to seek medical advice.
Now, three years later, Nicole, 20, wants to warn other women to be aware of the symptoms because she didn't think it would happen to her.
"I had looked at the general side effects and common ones, but I didn't think too much of the uncommon or rare side effects as I never thought they would happen to me," she said.
"I would urge people to consider the risks of taking the pill.
"Just because someone you know is on it and is fine, that doesn't mean you will be.
"And I would also want to raise awareness among young girls that this is a side effect, as I didn't know what was happening until I was screaming in pain in hospital."
'I was in agony'Nicole began taking the progesterone-only pill Cerazette aged 17 but a few months later was changed to the combined pill.
It uses artificial versions of the female hormones oestrogen and progesterone, which are produced naturally in the ovaries.
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We woke to Sophia's screams before she stopped breathing and had 20 seizuresThe combination pill stops you getting pregnant by preventing your ovaries releasing eggs each month, while also thickening the mucus in the neck of the womb to make it harder for sperm to penetrate it.
However, it has been linked to an increased risk of some serious health conditions, such as blood clots and breast cancer, according to the NHS.
Just seven days after taking her first tablet, Nicole started to get bad back pain.
It got so severe she visited a hospital near her home in Kendal, Cumbria, but was sent home without doctors taking her blood.
In the middle of the night, she began suffering from really bad leg cramps so went to take some painkillers.
Nicole explained: "I then tried to massage my calf and realised my left leg looked a lot bigger and felt swollen so I took a video and sent it to my friends to see if I was just seeing things from being sleepy.
If I had not gone to the hospital the doctors told me that I could have lost my leg or died
Nicole Leadbitter"They told me it looked a lot bigger than my right one.
"I was in agony and felt extremely light headed so I crawled my way to the bathroom in case I needed to throw up.
"Fortunately my mum had heard me so she came to see if I was okay or needed anything and she looked and my legs and instantly rung the hospital to try and get an ambulance.
"By this time I was screaming and crying in pain."
In hospital, Nicole was diagnosed with a pulmonary embolism, a blood clot that blocks an artery in the lung, which usually starts in a deep vein in the leg.
"The first question they asked was if I was taking the contraceptive pill and which one," Nicole added.
"By this time I had been on it a week and they came to the conclusion that it was the pill."
Long-term consequencesNicole was told that she needed keyhole surgery to remove the clots after several were found in her legs and lungs.
However, she was found to have a deformation of the channels connecting her heart and lungs which would have made surgery dangerous.
Instead, powerful anti-coagulants were used to break the clots up, which fortunately worked, but she couldn't walk for six weeks.
She had to take blood thinners for two years, must now take them whenever she travels and has to wear a compression stocking every day.
My hands still shake when I think about my condition and I panic because what has come isn't the last of it
Nicole LeadbitterNicole also has the marks from where she was injected and still has visible veins in her legs.
Before the thrombosis, she had ambitions to join the army but is now studying marketing.
It is possible she will suffer more clots, doctors told her.
"If I had left it and not gone to the hospital the doctors told me that I could have lost my leg or even possibly died," Nicole said.
Know the risksAfter her harrowing experience in November 2020, Nicole wants to tell other young girls to make sure they understand risks of blood clots, even though they're slight.
"The contraception pill nearly killed me," she said.
"Only one in 1,000 people per year get what I got at that age.
"My hands still shake when I think about my condition and I panic because what has come isn't the last of it.
"Unfortunately, doctors say I am prone to DVT and blood clots and my recent one won't be my last.
"They also told me that it would be rare for me to be able to have kids or survive the carrying and labour, as they said it would be a miracle if I didn't get another clot, especially if I was pregnant, so that's another big lifestyle change to be told at 17 years old.
"To know I have to try and live with a life threatening condition just makes me stronger.
"It won't stop me from doing what I love, it may slow me down but that's all."
What are the symptoms of a blood clot?
There are two types of blood clots.
A blood clot in one of the large veins in someone's leg or arm is called deep vein thrombosis (DVT).
If not treated, DVT can move or break off and travel into the lungs.
A blood clot in the lung is called a pulmonary embolism (PE) - this can be deadly and requires immediate medical attention.
Symptoms of a DVT include:
Symptoms of PE include:
Source: NHS, CDC
The Medicines and Healthcare Products Regulatory Agency is the government body that oversees how safe prescriptions are to the general public.
A spokesperson said: "The risk of blood clots associated with using the contraceptive pill is very small and has been known about for many years.
"The decision to prescribe or use the pill should take into consideration any risk factors for blood clots, which includes any family history of thrombosis.
"Prescribers and women should, however, be aware of the possible risk factors for blood clots and the key signs and symptoms, which are described in detail in product information.
"If women have questions, they should discuss them with their GP or healthcare provider but should keep taking their contraceptive until they have done so.
"These are very safe, highly effective medicines for preventing unintended pregnancy and the benefits associated with their use far outweigh the risks for the majority of people.
"If you suspect you've had a side effect from the contraceptive pill you can report it using our Yellow Card scheme."
According to the NHS, you may have to seek alternative contraception options other than the combined pill if you have:
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Nicole was diagnosed with deep vein thrombosis and a pulmonary embolismCredit: Nicole Leadbitter/TriangleNews6
Though she survived the ordeal, it's possible she'll suffer blood clots again later in lifeCredit: Nicole Leadbitter/TriangleNews6
Nicole was also told she might not be able to have children for fear of suffering a blood clot during pregnancyCredit: Nicole Leadbitter/TriangleNews6
Nicole still has visible veins on her leg years after the ordeal and has to wear compression socks dailyCredit: Nicole Leadbitter/TriangleNewsPericarditis: Understanding A Diagnosis
Inflammation of the Heart Lining
Medically reviewed by Christopher Lee, MD
Pericarditis is inflammation or irritation of the pericardium, the thin, elastic sac covering the heart. The cardinal symptom of pericarditis is sudden, sharp chest pain that worsens when taking a breath and when lying down.
While treatable and generally not considered dangerous, pericarditis can mimic potentially life-threatening conditions like a heart attack. It is crucial to see a healthcare provider immediately to evaluate the cause of the pain.
This article will provide an overview of pericarditis, including what it feels like, possible causes, diagnosis, and treatment. It will also explore pericarditis prognosis and what happens when episodes recur.
Pericarditis, Inflammation, and Chest PainThe pericardium encloses the heart and comprises two thin layers of tissue with a small fluid-filled space between them.
The purpose of the pericardium is to stabilize and fix the heart's position within the chest. It also serves as a physical barrier, minimizing friction with nearby structures, like the lung, and preventing infection spread from those structures.
Sharp chest pain is the principal symptom of an inflamed pericardium, of which there are several possible causes.
Related: The Heart: Anatomy, Function, and Conditions
What Causes Pericarditis?Pericarditis can manifest in people of any sex and at any age, although it's most common in males between the ages of 16 and 65.
Pericarditis causes include:
Infection from a virus (most common), bacteria (e.G., tuberculosis), and, very rarely, a parasite or fungus
Chest trauma/post-cardiac injury—for example, from a car accident, heart-related surgery, or heart attack
Metabolic disorders, including kidney failure and an underactive thyroid gland (hypothyroidism)
Prior chest radiation—for example, as part of treatment for lung cancer
Cancer metastasis (spread) to the heart
Autoimmune diseases, such as lupus, rheumatoid arthritis, and scleroderma
Medications —for example, the chemotherapy drug Adriamycin (doxorubicin), heart medicines Apresoline (hydralazine) and Pronestyl (procainamide), and blood-thinning drugs warfarin and heparin
In an estimated 85% of cases, the cause of a person's pericarditis remains unknown and is termed "idiopathic." In such scenarios, healthcare providers typically presume the culprit to be a viral infection.
Can COVID-19 Cause Pericarditis?Pericarditis can occur during an acute COVID-19 infection or after recovery. COVID-19 is thought to cause inflammation of the pericardium by:
Directly invading the heart's lining
Reducing blood flow to parts of the heart, causing injury
Initiating a cytokine storm (a severe immune system response)
Pericarditis most frequently causes a rapid onset of sharp or stabbing chest pain that worsens with breathing and coughing and improves when sitting up or leaning forward.
Less commonly, pericarditis causes a dull or throbbing pain in the chest that radiates (travels or spreads) to the left shoulder and neck area.
The chest pain of pericarditis can be accompanied by shortness of breath (dyspnea) and a mild fever.
Learn More: What Causes Chest Pain?
Types of PericarditisThe different types of pericarditis are:
Acute pericarditis manifests suddenly and lasts less than four to six weeks.
Incessant pericarditis is acute pericarditis that lasts more than four to six weeks without an interval of symptom recovery.
Recurrent pericarditis is when new symptoms of acute pericarditis develop after a symptom-free period of four to six weeks.
Chronic pericarditis is when the signs and symptoms of pericarditis develop over time and last more than three months.
Constrictive pericarditis is when a chronically inflamed pericardium thickens and stiffens due to scarring, preventing the heart from filling and functioning correctly.
Pericarditis is a reasonably common condition, accounting for an estimated 0.1% of people hospitalized for chest pain and 5% of cases of chest pain seen in the emergency room for chest pain not caused by heart attack.
The condition is generally considered benign (harmless), although the disease can recur, and symptoms can be challenging to control. Moreover, there is a rare risk of cardiac tamponade developing.
Cardiac tamponade is a medical emergency that occurs when excess fluid within the pericardium (pericardial effusion) dangerously squeezes the heart muscle, impairing its function.
Cardiac Tamponade: Signs and SymptomsSigns and symptoms of cardiac tamponade include:
Chest pain
Respiratory distress
Low blood pressure
Muffled heart sounds
Swollen neck veins
Other markers of a more severe illness and poorer prognosis include:
Fever
Presence of large pericardial effusion
Lack of response to treatment after one week
Subacute onset (when pericarditis symptoms gradually develop over weeks or months)
A nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, Advil and Motrin (ibuprofen), or Indocin (indomethacin), is the cornerstone treatment of acute pericarditis.
Another anti-inflammatory medication, colchicine, is often given in combination with an NSAID. Besides alleviating symptoms, research has found that colchicine reduces the likelihood of pericarditis recurring.
If NSAIDs and colchicine cannot be taken or are not effective or tolerated, corticosteroids ("steroids") may be prescribed.
Besides anti-inflammatory treatments, the underlying cause of the pericarditis must be addressed. For example, bacterial pericarditis requires treatment with one or more antibiotics.
Likewise, a person with lupus-related pericarditis may take the disease-modifying antirheumatic drug (DMARD) Plaquenil (hydroxychloroquine) and steroids in addition to NSAIDs.
ComplicationsFor significant pericardial effusions or for cardiac tamponade, an invasive procedure called a pericardiocentesis is performed.
During a pericardiocentesis, a needle is typically inserted into the pericardial cavity under the guidance of an ultrasound (echocardiogram) or an X-ray imaging technique (fluoroscopy). The fluid is then drained out through a thin tube called a catheter.
While pericardiocentesis is the preferred treatment for draining excess fluid from the pericardium, a surgical technique—pericardial window—may be performed in select cases (e.G., individuals with recurrent pericardial effusion or effusion with cancer cells).
During this open-heart surgery, a surgeon makes incisions in the chest to visualize and remove a small portion (a window) of the pericardium, allowing fluids to be sucked or drained out.
HospitalizationMost people with pericarditis can be treated at home under the guidance of a healthcare provider.
Features that can help identify who should be hospitalized for their care include individuals with:
Fever greater than 100.4 degrees F
Persistence of pericarditis, despite taking an NSAID
Large pericardial effusion
Cardiac tamponade (medical emergency)
Around 15% to 30% of people with acute pericarditis develop recurrent episodes, or their disease evolves into incessant or chronic pericarditis.
The risk of developing recurrent or chronic pericarditis is lower in people with idiopathic pericarditis and in those who took colchicine to treat the initial episode.
Inadequate treatment regimens regarding drug duration or dose, for example, can also impact the likelihood of recurrent pericarditis episodes.
Negative Impact on Quality of LifeThe impact of recurrent pericarditis goes beyond burdensome and distressing symptoms. Research has found that subsequent pericarditis episodes reduce health-related quality of life and work productivity.
Health-related quality of life includes how a person assesses their physical and mental health in general and how often their physical or mental health prevents them from doing their usual activities.
In cases of recurrent pericarditis, NSAIDs and colchicine are usually tried first. Steroids may also be given in select cases.
Interleukin 1 (IL-1) blockers, namely Kineret (anakinra) and Arcalyst (rilonacept), are also sometimes given, either concurrently or if the above medications are not effective. IL-1 is a specific cytokine, a protein that regulates inflammatory responses in the body.
As a last resort, or in cases of constrictive pericarditis, a surgical procedure called a pericardiectomy may be performed. This operation entails removing part or most of the pericardium.
How Do Providers Diagnose Pericarditis?Healthcare providers diagnose pericarditis by considering a person's symptoms, findings from a physical examination, and results from laboratory and imaging tests.
Medical History and Physical ExamWhen evaluating for possible pericarditis, a healthcare provider will inquire about symptoms, medications, and past and current health conditions, like cancer or a prior viral infection.
During the physical exam, after vital signs (temperature, heart rate, blood pressure, breathing rate) are taken, the healthcare provider listens to the heart with a stethoscope.
Findings may include:
A fast heartbeat (tachycardia)
A low-grade fever
A pericardial friction rub—an abnormal scratching or grating heart sound caused by the two inflamed tissues of the pericardium rubbing together
Findings based on the underlying cause may also be revealed during the medical history and physical exam.
For example, a rash or joint swelling may be seen with an autoimmune disease like lupus or rheumatoid arthritis, whereas weight loss and night sweats may be reported in a person with tuberculosis.
Related: How Lupus Can Lead to Pericarditis
Imaging TestsThe imaging tests used to help diagnose pericarditis are:
A chest X-ray is usually the first imaging test ordered for a person with possible pericarditis. If a pericardial effusion is present, the heart looks like a boot, known as the "water bottle sign."
An electrocardiogram (ECG or EKG) measures the heart's electrical activity and reveals characteristic findings in pericarditis.
An echocardiogram uses sound waves to visualize the heart and can detect pericardial effusion and help determine if cardiac tamponade is occurring.
Cardiac magnetic resonance imaging (MRI) produces three-dimensional (3D) images of the heart using magnetic fields and radio waves (not radiation). This imaging test is useful if echocardiogram findings are inconclusive.
An elevated inflammatory blood marker—C-reactive protein (CRP)—can support a pericarditis diagnosis.
CRP levels can also be followed as a person is being treated for pericarditis to monitor their response and assess their risk for developing complications or recurrent episodes.
Finally, if a pericardial effusion is present, and the cause is suspected to be infectious (other than viral) or cancerous, the drained fluid may be examined under a microscope by a pathologist (a physician specializing in evaluating body tissues/cells) for diagnostic purposes.
Rule Out Alternative DiagnosesPericarditis is not usually a serious condition, although potentially life-threatening conditions such as a heart attack can mimic it. Examples of other diagnoses with overlapping symptoms include:
How to Support Heart Health With PericarditisIf you or a loved one has been diagnosed with pericarditis, know that most people recover well with rest and treatment, although it can take a month or longer. While recovering, take the medication your healthcare provider prescribes and attend your follow-up appointments as directed.
Also, ask your provider about specific exercise and sleep instructions. For example, your provider may recommend sleeping in an elevated position to minimize chest discomfort.
Regarding physical activity, exercise is generally restricted in nonathletes until symptoms resolve and clinical markers (e.G., CRP level) return to normal. For athletes, at least three months of exercise restriction is often advised.
In addition, even though there is no surefire way to prevent initial or recurrent episodes of pericarditis, you can maximize your chances by doing the following:
Avoid potential chest injuries (e.G., wearing a seatbelt)
Prevent infection by washing your hands frequently and maintaining updated vaccinations
Pericarditis is irritation of the pericardium, the sac covering the heart. Its hallmark symptom is sharp chest pain that worsens when taking a deep breath and improves when leaning forward. Potential causes include a viral infection, autoimmune disease, cancer, or chest trauma.
While not considered dangerous (unless a rare complication called cardiac tamponade develops), pericarditis can mimic life-threatening conditions like a heart attack. A prompt diagnosis through a physical exam, blood tests, electrocardiogram, and imaging tests, namely an echocardiogram, is essential.
Treatment of pericarditis aims to ease chest pain and inflammation and often includes taking an NSAID, colchicine, or some combination. Invasive procedures like a pericardiocentesis to drain fluid around the heart or, rarely, a pericardiectomy to remove part or all of the pericardium may also be performed.
Read the original article on Verywell Health.
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Nine Heart-related Symptoms Heart Surgeon Warns To Take Seriously
NHS cardiologist explains symptoms of a heart attackHeart attack and heart failure are two heart conditions that can have life-threatening consequences. Heart attack is when there is a loss of blood supply to the heart, while heart failure is when the heart is unable to pump blood around the body efficiently.
Early intervention can be critical in the case of heart-related emergencies like these. One way for this to happen is to recognise when symptoms are serious.
As a Consultant Cardiothoracic Surgeon at St Bartholomew's Hospital London, Mr Shyam Kolvekar is well versed in the warning signs of a serious heart issue.
According to Mr Kolvekar there are nine to look out for:
1. Chest pain or discomfortSevere chest pain, pressure, squeezing, or tightness that may radiate to the arms, neck, jaw, back, or stomach could signal a heart attack or unstable angina.
Sudden and severe shortness of breath, especially if it occurs at rest or with minimal exertion, may be a sign of a heart attack, heart failure, or pulmonary embolism.
3. Persistent nausea or vomitingUnexplained nausea or vomiting, especially when accompanied by other heart-related symptoms, could be indicative of a heart attack.
4. Pain or discomfort in the upper bodyDiscomfort, pain, or pressure in the arms (especially the left arm), back, neck, jaw, or stomach may be associated with a heart attack.
Rapid, irregular heartbeats or a fluttering sensation in the chest may suggest an arrhythmia, which can be serious and may require immediate attention.
6. Sudden dizziness or lightheadednessA sudden onset of severe dizziness or lightheadedness, especially if it is accompanied by other symptoms, may indicate a heart issue.
7. Cold sweatsProfuse sweating, particularly cold and clammy sweats, can be a sign of a heart attack and should not be ignored.
8. Swelling in the legs or abdomenSudden or severe swelling in the legs, ankles, or abdomen may be a sign of heart failure.
9. Extreme fatigueUnexplained and severe fatigue, especially if it occurs with other symptoms, may be a sign of heart failure or other heart-related issues.
These symptoms can vary in intensity and may not always be present in the same way, said Mr Kolvekar.
He added: "Remember, timely medical attention can make a significant difference in outcomes."
The Heart Surgeon's Cookbook is the brainchild of New York-based Cardiovascular and Thoracic Surgeon Dr Nirav Patel MD and Fredrik Berselius, holder of two Michelin stars and Founder and Owner of Aska restaurant in New York.
They accepted the challenge from the global medtech provider Getinge to create a cookbook that not only celebrates the physical and mental dexterity of both doctor and chef, but also serves as a unique training tool for heart surgeons, no matter what stage of their career. To find out more visit https://www.Getinge.Com/uk/campaigns/cookbook/flipbook/
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