Medical Misdiagnosis: How common is it?

Medical misdiagnosis statistics: It is more common than you think

How common is misdiagnosis in today’s medical practice? The answer to this question is very alarming. Doctors and scientists have devised several ways to arrive at medical misdiagnosis statistics. Here are some of them:

1.Misdiagnosis statistics from autopsy report:

Based on the latest studies, 8.4 percentage of all people who die in American hospitals have at least one major misdiagnosis. A major misdiagnosis occurs when the misdiagnosis contributes directly to the death of the patient. In other words, doctors might have been able to save those patients if they were diagnosed properly. The average number of Americans who die in hospitals every year is around 850000. Just looking at major misdiagnosis (8.4% of 850000), seventy one thousand and four hundred Americans die every year from misdiagnosis of major life threatening diseases. When the study looked at all misdiagnosis , the percentage of misdiagnosis was as high as 28%.

2.Review of medical records to estimate percentage of misdiagnosis during office visits:

The most recent medical misdiagnosis statistics for doctor’s office visits was obtained by reviewing the medical records of the patients. It was actually a combined review of three studies. The first 2 studies used triggers to identify possible misdiagnosis and selected the charts for review. For example, if someone visited a doctor and went home with a diagnosis but later required hospitalization, it would trigger a chart review to make sure the first doctor did not misdiagnose the condition. The third study did chart review specifically to look if doctor misdiagnosed cancer. They only reviewed the charts of people who were eventually diagnosed with lung cancer. They looked for signs of misdiagnosis early on and evaluated if the doctor gave a misdiagnosis when everything pointed to a clear diagnosis of lung cancer. Using an average of these 3 studies, it was estimated that the percentage of misdiagnosis at doctor’s office was around 5%. It means that 1 in 20 adults who visit doctor’s office get a misdiagnosis and that includes misdiagnosis of cancer. Considering the very high number of doctor’s office visit in America, that translated to about 12 millions adults a year that get misdiagnosed.

3.Misdiagnosis lawsuits as a source of medical misdiagnosis statistics:

Considering the very alarming percentage of misdiagnosis that happens everyday throughout America, many people wonder, “Can you sue for misdiagnosis?”. Yes, you can. However, only a small percentage of patients who get misdiagnosed actually file misdiagnosis lawsuit. People tend to file misdiagnosis lawsuit only when there is significant harm associated with the misdiagnosis or missed diagnosis. For example people file failure to diagnose lawsuit when a missed diagnosis of cancer resulted in missed opportunity to treat that cancer early. The doctor could have misdiagnosed lung cancer as pneumonia or could have failed to review the result of a biopsy or a CT scan. Although misdiagnosis lawsuit are only filed in a small percentage of patients who get misdiagnosed, misdiagnosis lawsuits represent about 29% of all paid malpractice lawsuits. It is hard to estimate the actual percentage of misdiagnosis based on review of misdiagnosis lawsuits but it shows us that misdiagnosis is a major in malpractice lawsuits. Misdiagnosis of cancer (ovarian cancer misdiagnosis, colon cancer misdiagnosis, thyroid cancer misdiagnosis, kidney cancer misdiagnosis), misdiagnosis of heart disease and misdiagnosis of stroke are some examples of most common misdiagnosis cases that end up getting paid in a malpractice claim.

4.Medical misdiagnosis statistics derived from insurance claim review:

Insurance companies maintain a large database of patients and their diagnoses. When doctors or hospitals bill insurance companies for patent care, they have to list the names and codes of all the diagnoses they made for that patient. If used properly, this data help estimate misdiagnosis occurrence. One such study was done to estimate missed diagnosis of stroke. They looked at patients that were in the hospital with a diagnosis of stroke. They reviewed the files for those patients and checked to see if they had possible stroke like symptoms in the recent past. The review showed that 12.7 percent of those patients had possible stroke during ER or doctor visit that went undiagnosed. It showed almost definite evidence of missed stroke in 1.2 percent of the patients.

5.Medical misdiagnosis from lab error:

Lab test results and review of specimens by pathologists heavily influence the diagnosis made by doctors. Measurement and analysis of these lab errors give important insight to medical misdiagnosis statistics. Study reveals that majority (anywhere from 32% to 75%) of lab error related misdiagnosis occur during the ordering, labeling, and correctly identifying the sample that goes to the medical lab.

6.Medical misdiagnosis from wrong interpretation of x-rays, CT scans and MRIs:

Doctors rely on these imaging studies to make correct diagnosis. If the scans were improperly reviewed by radiologists, it can lead to misdiagnosis. Doctors rely on the expertise of the radiologists to make those judgement calls. However, it seems like the experts miss important findings anywhere from 26 to 32 percent of the times they look at the scans. It seems like less experienced radiologists make the most mistakes.

7.Survey of doctors:

One way to get statistical data about misdiagnosis is to survey the doctors with direct questions about misdiagnosis. It seems like most doctors recall instances of misdiagnosis they were involved in. In one such study, more than 50% of doctors recalled making a wrong diagnosis at least once or twice in the last month.

8.Survey of patients:

Another way of obtaining medical misdiagnosis statistics is by asking the patients directly about it. It seems like patients recall more instances of misdiagnosis than doctors do. On several studies 23 to 42 percent of patients reported having at least one misdiagnosis.

Medical misdiagnosis happens more frequently than it should. You have probably heard heart wrenching medical misdiagnosis stories from patients or their loved ones. It happens to a lot of people. Doctors and hospital know about this. You can wait for them to improve their diagnostic skills or you can become proactive and learn how doctors make diagnosis. This book “Symptoms and Diagnosis” shows you how doctors make diagnosis and how you can learn to do the same. You will find that you or your loved one can play a much bigger role than you think in helping your doctor make the correct diagnosis.

Reference: Institute of Medicine September 22, 2015

Tired all the time

Why am I so tired all the time?

In today’s stressful lifestyle, you may think that feeling somewhat tired and weak may be just a sign of stress. However, if you are so tired all the time that daily tasks seem like a burden, you need to seek medical attention.

Medical causes for feeling tired all the time

If you have been wondering, “Why am I tired all the time?”, you need to visit your doctor first and rule out medical causes. I will first list common medical causes of fatigue and describe why they make you feel like you have no energy at all. I will then tell you what blood test your doctor needs to order to find out why you are so tired all the time.

  1. Anemia: Many patients with anemia come to medical attention asking the question “Why am I tired all the time?” Anemia is the reduction of red oxygen carrying hemoglobin in your blood. When your hemoglobin goes down, your body is unable to carry enough oxygen from your lungs to the rest of your body. Each and every organ in your body needs oxygen to function properly. When your body does not get enough oxygen, you feel tired all the time. Women lose blood regularly during menstrual bleeding and can develop severe anemia if they have significantly increased menstrual bleeding compared to their baseline. Anemia from any cause can result in the same symptom of feeling tired all the time. Causes of anemia may include menstrual bleeding in women, internal stomach or intestine bleeding in men or women, excessive nose bleeding, any kind of leukemia or blood cancer, defect in blood cells, problems with bone marrow or certain nutritional deficiencies.
  2. Low thyroid: Low thyroid is a very common cause of what makes you tired all the time. Symptoms of low thyroid can be very complex and bizarre but many people simply wonder, “I’m tired all the time what’s wrong with me?” Thyroid hormone is a natural catalyst in our body. It influences the speed of almost all chemical reactions in our body. Low thyroid hormone can slow down all energy production and utilization in the body and make you feel like you have no energy. With the low energy utilization, you naturally feel tired all the time. Disease of the thyroid gland can affect all or most of your organ symptoms. In addition to feeling tired all the time, you may also feel cold all the time. You may also fell sleepy and drowsy all the time. You may feel like you can’t focus on task at hand. You may also have trouble remembering details about your work.
  3. Sleep apnea: Sleep apnea can make you feel tired all the time even with enough sleep. When you have sleep apnea, the quality of your sleep goes down. When you go into deep sleep, your airway collapses and you wake up momentarily before falling asleep again. You may go through many instances of these sleep-wake cycles during the night and may not even know about them. The end result is severe disruption of sleep cycle. That can make you tired all the time during the day. You may also have trouble staying awake while at work. Untreated sleep apnea can cause problems with your blood pressure and breathing, and may eventually lead to heart failure.
  4. Kidney failure: Feeling tired all the time may be the only major symptom of kidney failure if it develops slowly. Kidney failure can happen quickly over a few days or can take years to develop. A rapid kidney failure can have many worrisome symptoms but a slow developing kidney failure can go undetected for years. When you ask yourself, “Why am I so tired all the time this year when I could do so much last year?”, do not dismiss it as just a symptom of getting old. In addition to symptoms of lethargy, slow developing kidney failure can cause decreased appetite, nausea, itching and muscle cramps.
  5. Obesity hypoventilation syndrome: If you are so tired all the time and putting on weight, you need to be concerned about obesity hypoventilation syndrome. When you gain so much weight that it starts to interfere with your lung ventilation, you have obesity hypoventilation syndrome. It does not happen in everyone who is obese but obesity is obviously the biggest risk factor for developing obesity hypoventilation syndrome. When your lungs are unable to move enough air, you start to accumulate carbon-dioxide in your blood. A high carbon-dioxide makes your blood acidic. You may also develop low oxygen levels in your blood as your carbon dioxide levels go up. As a end result, you become tired all the time, drowsy all the time and may become confused at times.
  6. Diabetes: If you are tired all the time and hungry, you need to think about diabetes. Feeling tired, hungry and thirsty is a common way of presenting with undiagnosed diabetes. It can happen with both type 1 or type 2 diabetes. When your blood sugar goes up, you lose a lot of water in your urine. It makes you very dehydrated and weak. Complications from your untreated diabetes can lead to severe metabolic derangement and you can go from feeling tired all the time to severe lethargy and even coma.
  7. Adrenal insufficiency: Tired all the time, low blood pressure, weight loss, loss of appetite and muscle weakness are some of the common symptoms of adrenal insufficiency. In adrenal insufficiency, your adrenal gland fails to produce enough hormone to properly regulate your body. Just like thyroid hormone deficiency, adrenal insufficiency can take a long time to develop. These slowly developing symptoms may go undetected for years until you are so tired all the time that you can barely walk.
  8. Certain heart diseases: You may feel tired all the time from certain types of heart failure but you usually also have some other symptoms. If you are tired all the time and run out of breath easily with minimal activity, you need to think about heart disease.

Tired all the time: blood tests your doctor needs to order

Simple blood tests can detect many of things that make you tired all the time. You doctor orders common blood tests first and then go on to order more specific tests. However, if you have any symptom that point towards a particular diagnosis, you need to be proactive and ask your doctor about that particular test so that you can get diagnosed early.

  1. Complete blood count or CBC: It can help your doctor make sure you don’t have anemia or any other blood disorder.
  2. Comprehensive metabolic panel or CMP: It can detect diabetes as well as kidney failure.
  3. Thyroid Stimulating hormone or TSH: It can detect thyroid problems.
  4. Arterial blood gas or ABG: It can detect obesity hypoventilation syndrome.
    Cortisol level with ACTH stimulation test: This test is designed to detect adrenal insufficiency.

Tired all the time: other diagnostic tests

  1. Sleep study: This will help detect obstructive sleep apnea.
  2. Heart tests: Several heart tests may be done to detect possible heart problems if you have any chest pain or shortness of breath in addition to feeling tired all the time.

Tired all the time but blood tests normal

When you are tired all the time with no motivation and no energy but all your blood tests, heart tests and sleep study come back normal, you need to think about depression, anxiety, stress related or mental health issues. It is important that you wait until all medical causes of fatigue symptoms are ruled out before you consider these conditions.

Silent heart attack

Silent heart attack symptoms

By definition, a silent heart attack occurs when you do not have any symptoms from your heart attack. However, it is difficult to distinguish between completely silent heart attacks and atypical heart attack symptoms you may have ignored. A silent heart attack is usually diagnosed after the fact and it may not be possible to determine when the actual heart attack happened. A silent heart attack is detected on an EKG(electrocardiogram, also called ECG) as a specific finding called “Q wave.” When you get a routine ECG done for some other reason and they see this Q wave, they ask you if you had a heart attack in the past. If you do not recall having any heart attack symptoms in the past, you probably had a silent heart attack. However, it is also possible that you may have had some atypical heart attack symptoms in the past that you ignored and did not seek medical attention. If the silent heart attack symptom was a minor discomfort, you may have completely forgotten about it.

Silent heart attack due to atypical heart attack symptoms you may have ignored

Strictly speaking silent heart attack does not have any symptom. However, you may be diagnosed with a silent heart attack if you had unknowing ignored one of the following atypical symptoms and did not know you had a heart attack:

  1. Chest discomfort: You may have had a vague discomfort in your chest that was not severe enough to characterize as pain. It could have been a slight uneasiness or tightness that you did not pay any particular attention to.
  2. Nausea: You may have felt somewhat nauseated for a while without any obvious reason.
  3. Sweating: You may have had an unexplained episode of sweating profusely for a while.
  4. Feeling tired: You may have felt extremely tired and exhausted for a few hours.
  5. A little lightheadedness: You may have had an epidote of mild dizziness or lightheadedness for a few hours that went away on its own.
  6. Heartburn: You may have had an episode of bad heartburn lasting a few hours
  7. Chocking sensation: You may have had an unexplained choking sensation lasting a few hours

This list only gives you some examples of atypical heart attack symptoms that eventually result in the diagnosis of a silent heart attack when you ignore them. For a full list of atypical heart attack symptoms, please refer to this comprehensive article about heart attack symptoms.

Consequences of a silent heart attack:

A silent heart attack occurs when part of your heart muscles die from a lack of blood supply. A silent heart attack may not have any recognizable symptom but it will have consequences similar to regular heart attacks. In fact, silent heart attacks can be more detrimental to your heart because of the missed opportunity to get urgent heart muscle saving treatment. When you have symptoms from a regular heart attack, you seek medical attention immediately. Due to the advancement in heart attack treatments in the last decade, your doctors are usually able to restore blood flow to your dying heart muscles before there is significant permanent damage. However, part of your heart muscle is already dead by the time you are diagnosed with a silent heart attack. Silent heart attack prognosis may be worse than the prognosis of overt heart attack for this reason.

Silent heart attack reasons:

A silent heart attack occurs when you have risk factors for heart disease. A significant number of silent heart attacks happen because of lack of patient awareness about atypical heart attack symptoms. However, some patients have issues with nerves in the chest that result in blunted symptoms of heart attack or they may lead to completely silent heart attacks. Here are some specific risk factors for having truly silent heart attacks.

  1. Diabetes: Patients with type 2 diabetes experience significantly higher proportion of silent heart attacks than any other group of patients. The exact reason for silent heart attacks in diabetics is unclear but it is thought to be secondary to nerve damage from high blood sugars. Diabetics are known to develop a condition called diabetic neuropathy that usually cause pain, numbness and tingling in hands or feet. However, diabetes can also affect heart nerves that can result in blunted or completely masked symptoms during a heart attack.
  2. Certain nerve diseases: Certain diseases of the nervous system such as Parkinson’s disease can directly affect your autonomic nervous system. The nerve supply of your heart is part of this autonomic nervous system. The patients suffering form these nerve diseases are more likely to have few or no symptom from a heart attack.
  3. People with advanced age: Elderly people usually have more silent heart attacks than younger people. The exact reason for this in unclear but it could be related to overall slowing and decreased responsiveness of the nervous system in the elderly.
  4. Women: It is a known fact that women usually have more atypical symptoms of a heart attack than men do. It is , therefore, not surprising that more women are diagnosed with silent heart attacks than men. It is important to raise awareness of this fact to recognize atypical heart attack symptoms in women and avoid getting diagnosed with silent heart attack.

Silent heart attack treatment:

The treatment of a silent heart attack is difficult because a silent heart attack occurs when you miss the window of opportunity when it could be treated. However, there are certain steps you can take to prevent bad outcomes.

  1. Be vigilant for atypical heart attack symptoms: If you have any symptom that makes you think about a possible heart attack, do not hesitate to seek immediate medical attention.
  2. Treat high blood pressure: High blood pressure is one of the most important risk factors for all heart attacks. By treating your high blood pressure, you can significantly reduce your chances of all heart attacks including silent heart attacks.
  3. Blood sugar control for diabetics: If you have diabetes, a tight control of your blood sugar reduces your risks of all cardiovascular events including silent heart attacks.
  4. Quit smoking: Smoking is one of the biggest risk factors for all heart diseases. You can greatly reduce your risk of getting a silent heart attack by getting rid of this unhealthy habit.
  5. Get your cholesterol checked: A bad cholesterol profile along with other risk factors significantly increases your risk for silent heart attack. You need to get your cholesterol levels analyzed and reviewed by your doctor. If you follow the treatment guidelines and control your cholesterol in accordance with your cardiovascular risk profile, you can reduce your chances of having a silent heart attack.
  6. Listen to your body: This is the most important advice for proper and timely diagnosis of any life threatening condition. When you have any symptom that feels very unusual to you and the diagnosis you get does not fit what you are feeling, do not hesitate to tell your doctor about it. You may uncover a silent heart attack otherwise being diagnosed as a heartburn or shoulder strain or upset stomach.

congestive heart failure life expectancy

Congestive heart failure life expectancy: overview

Congestive heart failure or CHF is not exactly failure of the heart. Despite the name “heart failure”, it does not mean complete failure of the heart. When we talk about heart failure, we are talking about failure in the effective pumping of the heart. Your heart is basically a pump. When that pump gets less efficient in keeping your blood circulated, we call it pump failure or heart failure. Despite the name, you do not die instantly from heart failure. The recent advances in treatment of heart failure has significantly improved life expectancy of people living with heart failure but the actual numbers are still not very encouraging.

Congestive heart failure life expectancy in numbers:

Despite the overall better care and improved prognosis, life expectancy of people already diagnosed with heart failure remains somewhat worrisome when we look at the long term numbers.

Based on data obtained in the late 1990s, here are the mortality and life expectancy numbers of men and women. They first looked at 1 month and 1 year mortality rate:

  • 11% of men died within one month of diagnosis of heart failure
  • 10% of women died within one month of diagnosis of heart failure
  • 28% of men died within one year of diagnosis of heart failure
  • 24% of women dies within one year of diagnosis of heart failure

Looking at the survivors, they calculated five year mortality and life expectancy as follows:

  • 59% of men died within 5 years of diagnosis of heart failure
  • 45% of women died within 5 years of diagnosis of heart failure

From these numbers, we can see that congestive heart failure life expectancy varies widely in different people. Since then, scientists have looked at many different factors to try to estimate congestive heart failure life expectancy in different groups of patient. Several institutions have even started calculating it for individual patients by putting their individual data in the system. It will not be possible to explore such sophisticated systems here. However, several specific points about life expectancy and survival from heart failure deserve closer look.

  1. Hospital admission adversely affects congestive heart failure life expectancy
    It appears like being sick enough to require hospitalization is an indicator of poor prognosis. After a hospital stay, one month survival rate goes down. However, if the patient improves enough to stay away from hospital, the survival rate slowly improves and goes back to baseline.
  2. Medication compliance has positive effect on congestive heart failure life expectancy
    Patients who stick to their medical regimen seem to have better prognosis than who do not.
  3. Congestive heart failure life expectancy depends on the functional stage of the disease

4 Classes of congestive heart failure :

Here are the the all 4 stages of heart failure classified based on the functional level of the patient. This classification system is also called New York Heart Association functional classification.

  • Class I : Basically, these patients have no symptoms of heart failure. They feel OK with all normal physical activity and do not run out of breath with activity. They do not have any functional limitations. Patients in this class have the best life expectancy.
  • Class II: These patients are just starting to feel some symptoms of heart failure. These patients feel OK at rest but have some symptoms with physical exertion. They may run out of breath walking at a faster pace or climbing stairs. They usually feel OK with they take their time and limit their activity. These patients do not have any symptoms at rest.
  • Class III: These patients run out of breath with minimal activity. They may huff and puff just walking at a normal pace. They usually have to significantly lower their physical activity in order to feel comfortable with their breathing. They still do not have any symptoms at rest.
  • Class IV: These patients have symptoms at rest. They are unable to engage in any physical activity without significant worsening of their symptoms. Patients in this class have the worst life expectancy.

Past studies have shown that patients with Class IV and Class III NYHA heart failure symptoms have significantly reduced life expectancy than people with Class II symptoms. Patients with Class IV symptoms were 4.1 times less likely to survive as compared to patients with Class II symptoms. Similarly, patients with Class III symptoms were 2.1 times less likely to survive compared to patients with Class II symptoms.

Congestive heart failure life expectancy in elderly patients with advanced heart failure:

This is the group of patients who have the worst life expectancy among all heart failure patients. Many elderly patients with advanced heart failure have life expectancy of less than a year. There are some invasive and aggressive treatment modalities that can increase the survival rate but those treatment can have major complications resulting in significant suffering. If your elderly parent or grandparent is suffering from advanced heart failure, you need to get your family together to discuss the goals of care. Some elderly heart failure patients do not want these aggressive invasive treatment and want to be as comfortable as possible and spend quality time at home with their loved ones. Some patients may want to accept the risk of complications and opt for invasive treatment in hope of prolonging their lives. It is important to have this discussion before it is too late. When many elderly people get admitted to the hospital with severe symptoms of advanced heart failure, their family tend to make emotional decision that may or may not be in accordance with the patients’ values. You can avoid this situation by having a clear discussion well before it gets to that stage.

Congestive heart failure life expectancy in young patients

Most of the studies done about life expectancy in heart failure patients included older patients. It was not clear what to expect in young patients with heart failure. It was assumed that younger patients with heart failure would have better life expectancy than their older counterparts. A few studies in the last 15 years have looked at this and they did find a difference in life expectancy in young people vs older people with similar stages of heart failure. However, this difference was somewhat less than what they expected. They also noted that many young people had harder time complying with the recommended treatment compared to their older counterparts. Many young patients in the study did not follow the recommended diet and did not take their medications as religiously as the older patients did.

Although the exact life expectancy of young people with heart failure who comply with all recommended treatment is unclear, it is assumed that they would do much better. Young people also better tolerate invasive procedures and heart surgeries if required. Treatment guidelines for heart failures have been evolving and getting better every year. With the amount of research being done currently, young patients can hope to get even better care in the future that may significantly increase their life expectancy.

Heart attack symptoms

Heart attack symptoms: What is a heart attack??

Your heart pumps blood to your whole body. Symptoms of heart attack happen when your heart itself does not get enough blood. How can the heart not get enough blood when it is the main supplier of blood?

heart attack symptoms

heart attack symptoms

Here is a very detailed description of heart attack events inside your arteries.

This is a very important concept you need to grasp if you truly want to understand heart attack symptoms. Your heart pumps blood to the whole body but it also needs to pump blood to its own wall. Pumping blood to the whole body requires a lot of force. Your heart has strong muscles to generate this force. These muscles need a lot of blood supply to be able to generate that force. Special arteries come out of your heart to supply blood to its own muscular walls. These arteries are called coronary arteries. When these arteries get blocked, you get a heart attack. Loss of blood supply to your hard working heart muscles result in heart attack symptoms. Another name for a heart attack is Myocardial Infarction. It literally means death of heart muscles.

When you have symptoms of heart attack, it is your heart telling you that heart muscles are not getting enough blood.

Our media and movies portray heart attack as a dramatic event where you get sudden chest pain, clutch your heart and collapse to the ground. That is not how most people get heart attack symptoms in real life. In most heart attacks, your heart still keeps beating, it continues to pump blood to the rest of your body and you do not collapse. It is your heart muscles that do not get blood supply when you suffer a heart attack. Heart damage after a heart attack may continue for hours, days or even weeks.

Chest pain: the most important symptom of a heart attack

Anytime you have unexplained pain in your chest, you need to think about possible heart attack. It is not a good idea to dismiss any episode of chest pain as “probably not a heart attack” just because it does not fit the description of a typical heart attack symptom. When reading any heart attack pain description, you need to aware that you will probably not have the same symptom that someone else had.

When there is a sudden interruption in the flow of blood to your heart muscles, they suffer immediate changes. These muscle require a lot of oxygen and nutrients to work. When the supply of oxygen and nutrition is interrupted, they send out stress signals. This is called Myocardial Ischemia. Your brain analyzes these signals and you feel chest pain.

You do not necessarily feel the chest pain where your heart is located. Unlike your skin or your arm muscle, your heart does not directly feel pain or pressure. When your heart muscles send out the stress signal, your brain cannot pinpoint the location of the pain. Chest pain from heart attack is usually poorly localized and is usually felt somewhere in the mid front chest area. It usually feels like pressure, like someone sitting on your chest. It is usually not a very sharp pain. It may radiate to your jaw, shoulder or your neck. There is no way to predict how exactly you feel your chest pain when you have a heart attack.

Do not dismiss your chest pain if it does not fit this general description. The way your brain interprets stress signal from your oxygen deprived heart muscle is your unique experience.

The only one thing predictable with heart attack symptoms is that they are always associated with some degree of bodily stress. When your heart muscle does not get enough oxygen, your brain feels the stress. In fact, this stress can also be recognized by someone close to you. When you have heart attack symptoms, people close to you will recognize that you look different than usual, you look more stressed out. If you feel a sudden overwhelming sense of bodily distress, you need to think about possible heart attack. If you have any kind of chest pain associated this feeling of bodily distress, you need to call 911 right away.

Heart attack symptoms other than chest pain

Here is a list of heart attack symptoms other than chest pain. You need to understand that this list only helps you recognize a pattern of symptoms associated with heart attacks. This is , in no way , a list of all possible heart attack symptoms. It is not possible to list all heart attack symptoms because individual symptoms can vary significantly.

  1. squeezing sensation in your chest
  2. heartburn that would not go away
  3. feel like indigestion
  4. severe nausea
  5. Jaw pain
  6. sudden palpitations
  7. dull chest pressure
  8. achy feeling in the chest
  9. feel like sore chest muscles
  10. pain in between the shoulder blades
  11. pain in your upper back
  12. pain in the left arm
  13. pain in the right arm
  14. fullness and tightening of throat
  15. numbness and heaviness of shoulder
  16. choking sensation
  17. feel like a lump inside the chest
  18. sudden shortness of breath
  19. feel like fire burning inside the chest
  20. stuttering chest discomfort
  21. impending sense of doom
  22. sudden incredible fatigue
  23. sudden profuse sweating

Chest pain from a heart attack may not feel like pain at all. It may simply feel like a squeezing sensation in your chest. Some people describe it as a feeling that someone is gripping your heart and twisting it from inside.

Heartburn like sensation can also be a symptom of possible heart attack. If you have a new unexplained heartburn that feels different from your usual heartburn, you need to think about possible heart attack. Heart attack symptoms may also simply present as indigestion. If you have a new or unusual indigestion type feeling along with other signs of bodily distress, you need to think of it as a possible heart attack symptom. Similarly sudden onset strong nausea or sick stomach may represent a heart attack symptom in the right setting.

Sometimes, you may feel the distress signal from your heart muscle as palpitation. You may feel like your heart is jumping inside your heart. You may feel each and every beat of your heart. If you have new and unusual palpitation associated with bodily distress, you need to think about possible heart attack.

A dull pressure-like sensation in your chest without any pain is another heart attack symptom that may go unrecognized. You may also feel vague uneasiness or achy feeling in your chest instead of chest pain. If you have a history of asthma, the chest tightness of your heart attack symptom may feel similar to the tightness you have with asthma attack. Chest discomfort from a heart attack may also feel like sore chest muscles. It may feel similar to how you feel after a vigorous exercise that involves your chest muscles. Dumbbell press, bench press and chest push-ups are the examples of exercises that involve your chest muscles. When you over-indulge yourself in these types of exercises, you feel a certain soreness in your chest muscles. If you feel a similar soreness in your chest muscles that came out of nowhere, you need to think about possible heart attack.

Chest pain is an important symptom of heart attack but pain from heart attack may not be confined to your chest. When you have a heart attack, your chest pain may radiate to other parts of your body. Left arm, left shoulder, neck and jaw are the most common body parts where chest pain from a heart attack radiates to. However, chest pain from heart attack may also radiate to right arm, right shoulder, in between your shoulder blades or even to your upper back. It is also important to note that pain from heart attack may only be felt at the radiation sites without involving your chest. In other words, pain in your left arm, left shoulder, neck, jaw, right arm, in between your shoulder blades or your upper back could be a possible symptom of heart attack.

You need to be aware that heart attack symptoms in your shoulder or your shoulder blades may not feel like pain at all. You may simply feel numbness or heaviness in your shoulder blades. Heart attack symptom may involve just one shoulder or you could feel it in both your shoulders at the same time. If you suddenly feel like you are carrying a lot of weight in your shoulder/shoulders, you need to think about possible heart attack.

Your throat is another important body part where you may feel your heart attack symptoms. Apart from throat pain, you may only have fullness or tightening of your throat. Sometimes, your heart attack symptom could present as a choking sensation in your throat.

Sometimes, heart attack symptoms may present as unusual or weird sensation inside your chest. Some people feel like there is a new lump inside the chest that is growing in size as they speak. Some people literally feel like their chest is on fire. Some people feel a sudden warmth inside their chest. These types of unusual chest sensations may represent heart attack symptoms.

Occasionally, heart attack symptoms may not be localized to any particular part of your body. Sudden onset severe profuse sweating is an example of a non-localized heart attack symptom. Some people with heart attack symptoms simply describe it as “feeling very bad”. It may simply be a feeling of impending doom. They may simply feel very tired or fatigued. They may feel like life energy is being sucked out of their bodies. These kinds of heart attack symptoms may be very difficult to describe and may be dismissed as possible anxiety or paranoia.

What does a heart attack feel like?

The personal feeling associated with your symptoms is very important when you are worried about a possible heart attack. Your body has a unique way of warning you when something bad is happening inside. Do not discard how you feel just because your symptom is not listed as a possible heart attack symptom.

When your heart muscles do not get enough blood, you feel bad. You just need to listen to your body and recognize your unique signs of bodily stress. When you recognize bodily stress, you will be in a better position to identify a possible heart attack even when you do not have the typical heart attack symptoms. When you feel like you are in imminent danger, just call 911 and get emergent medical evaluation.

Pre- heart attack symptoms: Early warning signs of heart attack

 

It is important to know what pre-heart attack symptoms are. As I explained at the beginning of this article, heart attack symptoms occur when the supply of blood to your heart muscles is blocked. You can understand pre-heart attack as temporary shortage of blood to your heart muscles without a permanent blockage. You can have all the same heart attack symptoms during a pre-heart attack. However, the way you experience pre-heart attack symptoms is somewhat different from the way you experience actual heart attack symptoms.
During a pre-heart attack, your symptoms are usually provoked by increased demand on your heart muscles. You may have just enough blood flowing to your heart muscle at rest but when you exert yourself your heart needs to work harder. When your heart muscles try to pump extra blood, they are unable to get the extra blood they need to do the extra work and you go into a pre-heart attack stage. Pre-heart attack symptoms are usually provoked by mental or physical stress and they last a short time. Pre-heart attack symptoms go away as soon as the additional stress on heart muscles go away. If your pre-heart attack symptoms are produced by walking too fast, they go away as soon as you slow down or stop.

Just like heart attack symptoms, your pre-heart attack symptoms may or may not include chest pain. You may have any of the 23 heart attack symptoms listed above. They usually occur with a waxing and waning characteristic associated with exertion and rest. When your pre-heart attack symptoms start, it is hard to decide if it is a pre-heart attack or the beginning of an actual heart attack. That is why it is important to call 911 as soon as you recognize it. If your symptoms go away shortly after rest, you would still benefit from urgent evaluation in ER. If you heart attack symptoms continue, you will be really glad you called 911.

Heart attack symptoms: why call 911?

Heart attack symptoms happen when blood flow to your heart muscles is blocked. Without blood supply, your heart muscles start to die. Fortunately, there is a few hours window before your heart muscles get permanent damage after a heart attack. The chances of successfully restoring blood flow to your heart muscles increases with rapid ER evaluation. You will have the best chance of saving your heart muscles if you get the blood flow re-started within 90 minutes of your heart attack symptoms.

Can heart muscle damage be reversed with heart attack treatment in hospital?

Yes, it can be reversed if you get to the hospital as soon as possible.

Pancreas pain

Pancreas location

location of pancreas pain

Where do you feel your pancreas pain?

To understand pancreatic pain, you need to know where your pancreas is located. Pancreas is an elongated gland and it sits deep inside your belly. When measured from the surface of your body, your pancreas location is closer to your upper back than your front abdomen. Your pancreas can be divided into 4 different parts. The location of these parts of your pancreas can help you make sense of your pancreatic pain.

Head of pancreas location: Most of your pancreas is located to the left of your body. However, the head of your pancreas crosses the midline and is located slightly to the right. It wraps around the upper part of your small intestine.

Neck of pancreas location: The pancreatic neck is the somewhat constricted part of your pancreas. The pancreatic neck connects the pancreatic head on the right with the pancreatic body on the left of your midline. Your pancreas curves towards your left from here on.

Body of pancreas location: The pancreatic body connects the pancreatic neck to the pancreatic tail. It curves upwards and to the left. It looks somewhat triangular when viewed from below.

Tail of pancreas location: The tail of the pancreas is its thin tip. Tail of your pancreas is the leftmost part of your pancreas. It has a slight forward curve and it goes all the way left to touch your spleen.

Pancreas location and its relation to pancreatic pain

Pancreatic pain feels like it is coming from deep inside your abdomen because of the deep location of your pancreas. Pain is usually felt in the middle or left of your midline. It can also occur on your right but that is less common. You can see that pancreatic pain corresponds to your pancreas location. As you recall, most of your pancreas is in your midline and left ,and that is where you feel the pain most of the times. A part of the pancreas crosses to your right and you can sometimes feel the pain in that location too. Because your pancreas is an elongated organ, pancreas pain can feel stretched out like a band. Your pain may radiate out in a band-like fashion and go all the way to your back.

Acute pancreatitis symptoms: what does pancreas pain feel like?

Acute pancreatitis is the inflammation of pancreas that happens quickly. Your pancreas has many important functions in your body. Producing digestive juice is only a part of your pancreas function. However, these digestive juices play an important role in the inflammation of pancreas. Symptoms of acute pancreatitis are caused by this inflammation. They also play the main role in causing many of the other acute pancreatitis symptoms listed below.

Let us look at the list first and I will explain how digestive juices and inflammation of pancreas leads to those pancreatitis symptoms.

  1. Abdominal pain (Pancreatic pain)
  2. Burning and swelling of abdomen
  3. Nausea and vomiting
  4. Fever
  5. Weakness and lightheadedness
  6. Chest pain with inspiration
  7. Shortness of breath

Pancreatic juice contains enzymes designed to digest nutrients in your food. Pancreatic juice is very corrosive because it is designed to breakdown tough organic materials including protein and fat. It is so strong that it can digest your own organ tissues. It is not surprising because our organ tissues are mainly made up of protein and fat. The production and use of these enzymes is normally highly regulated. These enzymes only flow in special ducts and have no contact with your organ tissues. They are only released inside your intestines to act on your food and not on your internal organs.

When something disrupts the flow of that corrosive juice, it initiates a series of events leading to acute pancreatitis. As soon as the corrosive juice leaks out in the open, it starts to digest your own tissue. The protein and fat inside your abdominal organs get exposed to this corrosive pancreatic juice and they start to dissolve. You feel this burning pancreatic pain.

At first, your pancreatitis pain location may vary, but it is usually somewhere in the upper mid abdomen. As the corrosion progresses, your pancreatitis pain location starts to expand. You may feel a tight band like area of severe pain spreading from side to side in the your mid upper abdomen. This type of severe pancreatitis pain may radiate all the way to your back. The corrosion of your organ tissues caused by spilling of pancreatic juice causes wide spread inflammation. This inflammation causes fevers and chills throughout your body.

When this inflammation spreads to your stomach, you may have severe unrelenting nausea and vomiting that may last for hours.

You may have pain with inspiration as your diaphragm gets inflamed. When you have severe acute pancreatitis symptoms, your inflammation continues to spread outwards and may go all the way up to your lungs. Your pancreatitis pain location may expand to include your chest. When your lungs get inflamed, you start to have shortness of breath. Lung inflammation caused by severe acute pancreatitis may interfere with your breathing and your body may not get enough oxygen.

The widespread inflammation resulting from severe acute pancreatitis may push your body towards a state of shock. Increased flow of blood to your inflamed organs may result in reduction of blood flowing to the rest of your body. This may result in low blood pressure. You may feel weak and dizzy when your blood pressure starts to go down. When the symptoms of your acute pancreatitis get this severe, it becomes a life threatening condition. Treatment for pancreatitis requires close monitoring in ICU when symptoms are severe.

Acute pancreatitis diagnosis

Acute pancreatitis diagnosis is established by measuring the levels of pancreatic enzymes in your blood. In severe acute pancreatitis, the enzyme levels are significantly elevated. CT scan of the abdomen may show the inflammation surrounding your pancreas. CT is also helpful to look for possible complications.

Chronic pancreatitis symptoms

Chronic pancreatitis symptoms : Pancreatic pain in chronic pancreatitis comes and goes. It is a recurrent condition. Pancreatitis pain location in chronic pancreatitis is similar to the pancreatitis pain location in acute pancreatitis. However, chronic pancreatitis symptoms do not usually spread up to the chest.

Here is a list of common chronic pancreatitis symptoms

  1. Pancreatic pain (Abdominal pain) on and off for a long time
  2. Nausea and vomiting
  3. Weight loss
  4. Diarrhea on and off
  5. Loss of appetite
  6. Malnutrition
  7. Indigestion with undigested fat and other food particles in stool

Chronic pancreatitis symptoms are debilitating and hard to control. Pancreatitis pain relief is the main goal of treatment in patients with chronic pancreatitis symptoms.

What causes pancreatitis in most patients?

Here are the 2 important causes of pancreatitis:

 1. Alcohol

Drinking too much alcohol is the most common cause of chronic pancreatitis. It is the second most common cause of acute pancreatitis. The only effective treatment of pancreatitis from alcohol use is cessation of drinking.

2. Gallstones

Gallstones is the number one cause of acute pancreatitis. If you want to learn more details about gallbladder symptoms, you can follow this link. Gallbladder symptoms may progress into acute gallstone pancreatitis when the gallstones move out of gallbladder and obstruct the flow of pancreatic juice. The common bile duct connects pancreatic duct with the duct coming out of the gallbladder. Treatment of gallstone pancreatitis requires cleaning of this duct to make sure pancreatic juice has a passage to flow freely.

What causes pancreatitis in other patients?

Here are some other causes of acute pancreatitis:

  1. Trauma to the abdomen
  2. Certain medications
  3. Certain surgical procedure
  4. Very high blood triglycerides (visit this link if you want to learn about triglycerides)
  5. Certain infections
  6. High blood calcium levels
  7. Certain immune diseases
  8. Certain tumors

Here are some other causes of chronic pancreatitis:

  1. Certain autoimmune diseases
  2. Certain toxins
  3. Certain genetic conditions such as cystic fibrosis
  4. Certain bodily stress
  5. Due to repeated episodes of acute pancreatitis

Low potassium symptoms

A complete list of all possible symptoms of low potassium

This list of low potassium symptoms includes all possible symptoms. I have personally encountered all of the symptoms on this list while treating patients with low potassium. However, it is important to note that the symptoms differ significantly based on the severity of low potassium. A single patient will not have all of the symptoms in this list. It is important that you read the whole article if you want to properly understand what low potassium does to you. I have explained what low potassium does to you by exploring each organ system it affects. This complete list of low potassium symptoms is only a summary of what I have explained in this detailed article.

Here is the list:

  1. Muscle weakness
  2. Difficulty walking
  3. Muscle cramps all over body
  4. Muscle pain all over body
  5. Muscle soreness after workout
  6. Complete paralysis
  7. Heart palpitations
  8. Skipped heart beats
  9. Fast heart rate
  10. Weak heart muscle
  11. Sudden cardiac arrest
  12. Labored breathing due to respiratory muscle weakness
  13. Inability to breathe
  14. Death from respiratory failure
  15. Feeling irritable
  16. Feeling confused
  17. Hallucinations
  18. Delusions
  19. constipation symptoms
  20. Nausea and vomiting
  21. Loss of appetite
  22. Stomach bloating after eating

Low potassium symptoms and potassium levels

To understand low potassium symptoms, you need to know what normal potassium level is and how it is measured. Potassium level is usually measured as a part of a panel of labs called Basic Metabolic Panel or BMP. BMP also measures other electrolytes and nitrogenous substances along with potassium. It is commonly performed as a routine test in most people who are sick enough to be admitted to hospital. Potassium level in blood is commonly measured as milliEquivalents per liter (mEq/l). Most labs list the normal range of blood potassium level as 3.5mEq/l to 5meq/l.

It is important to know your actual numbers because low potassium symptoms are usually proportional to how low your blood potassium levels are. Low potassium symptoms are relatively mild when your potassium level is in between 3 and 3.5 mEq/l. You may not have any specific symptom at this level. The symptoms can be more prominent when your potassium level gets to 2.5 -3 mEq/l range. Potassium levels of less than 2.5 mEq/l is considered medical emergency and severe life threatening symptoms may appear at this level.

understand potassium levels in your blood

potassium levels in and out your organ cells

Physiology of low potassium symptoms(what low potassium does to you)

To understand the mechanism of how low potassium symptoms develop in your body, you need to know the basic role of potassium. Potassium is an electrolyte. Along with sodium, Potassium controls how your nerves and muscles react to electric signal. Most of your potassium is contained inside your body cells while most of the sodium lives outside your body cells.

Your body cells have special pumps that keep your sodium and potassium where they are supposed to be. The ratio of potassium inside and outside your cells is very important because this ratio controls how responsive your muscle and nerve cells are. When you have low potassium in your blood, this ratio gets disrupted and your muscle and nerves become less responsive to stimulus. As the potassium level goes further down, your cells may get completely unresponsive and become paralyzed.

Low potassium symptoms in your muscles

Your muscle cells are very vulnerable to low potassium levels. Your muscles move when they get signal from your nerves to move. This movement happens when your muscle cells respond to the signal. Low blood potassium makes your muscle cells less responsive. As a result, your muscles get weak. As your low potassium symptoms worsen, you have difficulty walking. Symptoms of muscle weakness from low potassium start in your legs and work their way up. As your potassium levels go down, your muscle weakness spreads to your core muscles and then to your arms. Eventually, you have hard time moving any muscle in your body and you get completely paralyzed.

Muscle cramping is another symptom of low potassium. When you exercise, your muscles need more oxygen. Your body supplies more oxygen to your muscles by increasing blood supply to the muscle. Potassium released from your muscles help increase local blood supply by dilating blood vessels in the area. When your body is low in potassium, your muscles may not be able to release the extra potassium. When this happens, your exercising muscles may not get enough oxygen to meet the demand and you experience muscle cramps all over body.

Low potassium symptoms in women may be sometimes confused with menstrual cramps. Low potassium symptoms in women may also be missed during pregnancy. Pregnant women may also develop potassium deficiency because of nausea and vomiting associated with morning sickness.

Low potassium symptoms in your heart

Low potassium symptoms in your heart result from the change in responsiveness of your heart muscles. Like your other muscles, heart muscles depend on the correct ratio of potassium in and out of the cells. When blood potassium goes down, it disrupts this ratio and heart muscles do not respond properly to stimulus. It leads to weak heart muscle symptoms.

When potassium deficiency affects your heart muscles, you can see significant distinctive changes in the electrical tracing(EKG) of your heart. It is one of the warning signs of low potassium. You doctors can detect this change. At this stage, your low potassium must be corrected as soon as possible to avoid serious heart problems. If your potassium continues to go down after the EKG changes, it will affect your heart rhythm. Initially, you may have some skipped beats or low heart rate. As things worsen, your heart rhythm gets funkier. It may cause rapid unstable heartbeat. Low potassium symptoms in your heart may eventually lead to sudden cardiac arrest with dangerous arrhythmias (abnormal heart rhythms). When your potassium is critically low, your weak heart muscles may be too weak to pump any blood. Your circulation may collapse and you may die from low potassium symptoms in your heart.

Low potassium symptoms in your lungs

Severe potassium deficiency symptoms can affect your breathing. When you breathe, you are basically using muscles in your chest to help expand and contract your lungs. This muscle movement is essential to keep you breathing. When your potassium level is so low that your muscles are not contracting very well, it compromises your breathing capacity. Weakness of the muscles that help you breathe will result in labored breathing. If your low potassium symptoms continue to worsen, you may develop respiratory failure from inadequate gas exchange. It may eventually lead to respiratory arrest and death.

Low potassium symptoms in your brain

Potassium deficiency affects the responsiveness of your nerve cells in the same way it affects your muscle cells. Your muscles have trouble contracting with low potassium while your nerves have trouble rapidly conducting and relaying the signal. Your nervous system as a whole slows down with low potassium. Symptoms arising from your brain include irritability and confusion. You may not know what is going on around you. You may see or hear things that are not there. You may have hard time making sense of your environment.

Low potassium symptoms in your digestive tract

Your digestive tract starts from your mouth and continues to your food pipe, stomach, small intestine, large intestine and finally opens up in your rectum. Food in your stomach has to be churned and mixed. It has to be sent down your intestine. You have various muscles in your gut that help in pushing your food down the pipe. Potassium deficiency affect these muscles in your gut. When your potassium is too low, your gut muscles have trouble moving. As a result food gets stuck in your intestines.

When you have mild potassium deficiency, you may only feel like you have constipation. However, severe low potassium symptoms in your gut may manifest as bowel obstruction. Other digestive symptoms of low potassium may include distension, nausea, vomiting, bloating and loss of appetite. Severe potassium deficiency may even lead to complete paralysis of your gut.

Causes of potassium deficiency

Decreased intake of potassium, increased loss of potassium or shift of potassium from your blood to your organ cells may cause low potassium. Now, we will look at each individual cause of low potassium.

Low potassium symptoms due to loss of potassium from your digestive tract

This is one of the most common causes of low potassium. You lose some potassium directly when you have persistent vomiting or persistent diarrhea. However, the direct loss of potassium in your vomit or your diarrhea only account for a part of how you develop low potassium symptoms from vomiting or diarrhea. When you lose body fluid from vomiting or diarrhea, you get dehydrated. When you get dehydrated, your body tries to conserve water. Sodium is the main electrolyte in your blood that helps retain water in your blood. When you body needs to conserve water, your kidneys conserve sodium. The mechanism by which your kidneys conserve sodium is linked to how they excrete potassium. When your kidneys try to preserve more sodium, they end up losing more potassium. Dehydration leading to sodium conservation and potassium excretion by your kidneys accounts for the bulk of your low potassium symptoms in those situations.

Low potassium symptoms due to loss of potassium from your kidneys

Your kidneys play a very important role in regulating the amount of sodium and potassium in your body. The mechanism by which your kidneys regulate your potassium is complex and is influenced by several hormones and feedback mechanisms. Increased levels of certain hormone called aldosterone can directly cause low potassium symptoms by increasing the loss of potassium in your urine.

Different medications interfere with salt and water handling of your body to achieve different goals. Certain medications called diuretics (commonly known as water pills) promote removal of more water and salt from your body. These medications may be needed to lower your blood pressure or treat swelling or fluid retention. These medications may also cause excessive loss of potassium in your urine. If you are taking these types of water pills, you need to check your potassium level frequently and increase your potassium intake to avoid getting symptoms of low potassium. Your doctor may also prescribe some potassium supplements if you are on a high dose of water pills.

A small change in the level of acidity of your blood can greatly influence how your kidneys handle potassium. Disorders resulting in acid-base imbalance can cause low potassium symptoms by increasing loss of potassium from your kidneys. Change in blood acidity also affects movement of potassium in and out of body cells. The shift of potassium from your blood to your organ cells may also cause low potassium symptoms.

Low potassium symptoms due to decreased potassium in your diet

Not eating enough potassium is an obvious cause of nutritional potassium deficiency. However, severe low potassium symptoms do not usually develop from dietary habit alone. Your kidneys have the ability to compensate for varying amounts of potassium intake. If your diet contains foods high in potassium and your body is getting too much potassium, your kidneys excrete the extra potassium in your urine. If your diet does not contain foods high in potassium and your body is getting less potassium, your kidneys conserve potassium by decreasing the concentration of potassium in your urine.

In absence of dehydration, it takes significant change in dietary habit to get low potassium symptoms from diet alone. It usually happens in people with extreme nutritional problems. Alcoholics and anorectics are the most common examples of people that get low potassium symptoms from diet alone. It may also happen in people with cancer when they get nutritionally deficient because of poor appetite and side effects of chemotherapy.

For normal healthy people to get low potassium symptoms from decreased intake, they need to have another factor contributing to it. Dehydration and use of water pills are the most common associated factors that magnify the effects of less than adequate potassium intake and result in low potassium symptoms. That is why many patients who are on water pills routinely take potassium supplements.

How much potassium is needed daily?

There has been some new changes in nutritional guidelines about daily potassium requirements for adults. World health organization has recently published guidelines advocating at least 3.51 grams of dietary potassium everyday for adults. How much potassium is needed daily to prevent potassium deficiency symptoms is not the same as how much potassium intake is recommended by WHO.

Recommendation on daily potassium requirements for adults are made to achieve beneficial effects of higher potassium intake. It is not the amount of potassium needed to avoid low potassium symptoms.

Recent studies have suggested that increased daily intake of potassium may have certain health benefits. Some people advocate increasing daily potassium intake as one of the natural ways to lower blood pressure. Higher potassium intake has also been associated with a reduced risk of stroke. Foods high in potassium seem to be beneficial for people with high blood pressure and heart disease.

Risks of taking potassium supplement without talking with your doctor

Based on our discussion, you may think about taking potassium supplements to improve your health. People looking for a quick answer to the question “how to lower blood pressure” may look at potassium supplement for the answer to their problem.

I am warning you not to do that. Please do not take potassium supplements without talking with your doctor first. Before taking potassium supplements, you need to get your potassium level checked. You may also need to have your kidney function evaluated by your doctor. If your kidneys have trouble getting rid of the extra potassium in your blood, you blood potassium may rise to a dangerous level. Symptoms of high potassium can be dangerous. High potassium levels in you blood can cause life threatening medical emergencies.

What causes vertigo?

What causes vertigo at organ level?

At organ level, vertigo is a problem of abnormal motion sensation. Vertigo is always caused by one of the two things: Motion sensor Motion analyzer

what causes vertigo at organ level

what causes vertigo at organ level

Your body has two intricately designed motion sensors, one inside each ear. Each motion sensor is made up of three semicircular tubes and two bags. Medically, each motion sensor is known as a vestibular labyrinth.

motion sensor inner ear

motion sensor inner ear

The three semicircular tubes placed strategically in three different planes at three different angles detect angular motion. They are like pipe levels. When you move your head in any angular direction, the tubes detect that motion and send the signal to your brain.

The two bags below the semicircular canals are called the utricle and the saccule. The utricle is larger tube and it detects linear motion and head tilt in the vertical plane. The saccule is the smaller bag and detects linear motion and head tilt in the horizontal plane.

Vertigo is simply an abnormal motion sensation. You may feel motion that does not exist or your feeling of motion could be exaggerated or distorted. Some people perceive that as room spinning while others perceive it as head spinning or room tilting or losing balance. The vestibular labyrinth sends the signal to your brain for analysis. The nerve that connects your motion sensor with your motion analyzer in your brain is called the vestibular nerve.

Your vertigo symptoms may be caused by problems in your motion sensor or it could be caused by problem in your brain. Vertigo caused by problems in your motion sensor is called peripheral vertigo. Vertigo caused by problems inside your brain is called central vertigo.

What causes vertigo related to motion sensor?

Vertigo caused by your motion sensor is called peripheral vertigo. As you have just learned, your motion censors include semicircular canals, the utricle and the saccule. More than 80% of vertigo is caused by abnormalities in the motion censors. Here are some common conditions that cause vertigo related to motion sensor

Benign paroxysmal positional vertigo (BPPV)

It is one of the most commonly recognized types of vertigo. This type of vertigo is caused by presence of debris or small stones in the back part of your semicircular canals. When you move your head, the small stones move and may create turbulence. This movement results in inappropriate or exaggerated sensation of motion. It improves as soon as the stones settle down. You only feel vertigo when you move your head fast enough to make the stones move. Your vertigo caused by BPPV only lasts for few seconds at a time. However, your symptoms may continue for a long time as long as the stones exist. The treatment for this kind of vertigo includes special maneuver that you can do at home. This maneuver is called Epley maneuver. I will be writing a separate article on it and I will post the link here once it is done.

Meniere disease

Vertigo from Meniere disease is caused by the presence of too much fluid inside the motion sensor. The increased pressure caused by excess fluid can damage the delicate membranes and it can throw the motion sensor off balance. You may have episodes of vertigo that usually last longer than that caused by BPPV. They may last anywhere from twenty minutes to a whole day at a time. Because of the prolonged vertigo, you usually have nausea. You may also vomit. In addition to vertigo, Meniere disease will also cause problems with your hearing. It may also make you feel a constant low pitch ringing sensation in your ears. This kind of ringing sensation is called tinnitus.

When you have hearing loss, tinnitus and long episodic vertigo with nausea and vomiting, you can be fairly certain that Meniere disease is what’s causing your vertigo.

Nerve inflammation

Vertigo caused by the inflammation of nerve coming out of the motion censor is called vestibular neuritis. It simply means inflammation of this particular nerve. It is usually caused by virus but sometimes happens without any obvious reason. Unlike BPPV and Meniere disease, vertigo caused by nerve inflammation is persistent and may last for several days. It usually starts abruptly. It may make you feel imbalanced. You may also have nausea and vomiting.

Inner ear injury

Vertigo caused by inner ear injury happens after head trauma. If you have been involved in head trauma affecting your temporal region, you may have had inner ear injury. Vertigo may be caused by direct blow to your motion sensor in your inner ear or it may be caused by indirect trauma related to rapid blow to your head. You may have bleeding in your ear. You may also have trouble hearing after such a trauma.

Depending on the severity of trauma, vertigo caused by inner ear injury may last weeks to months. It is also associated with nausea, vomiting and sense of imbalance.

Bone opening

Thinning and opening of the bone surrounding the semicircular canal may cause vertigo. This type of vertigo is evoked by loud noise, sneezing, coughing or straining. The opening of the bone allows the pressure from the middle ear to be transmitted to the inner ear where the motion sensor is located. Anything that increases ear pressure results in increased pressure in the motion sensor causing abnormal sensation of motion, which is vertigo.

Vertigo caused by this type of bone opening is medically called Semicircular canal dehiscence syndrome.

What causes vertigo related to motion analyzer?

Vertigo caused by problems in your motion analyzer is called central vertigo. When you have vertigo caused by central causes, the motion signal sent out by the motion sensor in your inner ear is normal. The problem lies inside your brain.

As the nerve coming out of motion sensor (vestibular nerve) goes inside your brain, it follows a specific pathway. Once inside your brain, these nerves branch out and make connections with different nerves coming out of other parts of your body. The connection with the nerves from your eyes help co-ordinate your motion with your vision. The connection with the nerves coming out of your spine and balance center of your brain help maintain balance and posture. The motion analyzer in your brain is complex and has different centers that connect and coordinate with each other. As a result, vertigo caused by central causes tends to be more complex than vertigo caused by peripheral causes. Here are some common central causes of vertigo:

Vertigo associated with Migraine headaches

Some people with migraine have episodes of vertigo associated with the headaches. Medically, these types of migraines are called vestibular migraine. Remember, vestibular labyrinth is the medical name for your inner ear motion sensor. The exact mechanism of what causes vertigo associated with migraine is still not properly understood. It is an area of ongoing medical research. However, the association between migraine and these types of vertigo is very clear.

If you have episodes of vertigo and have migraine headaches with them, you have vestibular migraine. The severity of your vertigo caused by vestibular migraine can vary widely. Some people have severe debilitating vertigo with nausea and vomiting while others just have mild symptoms.

It is important to distinguish between vestibular migraines and other central causes of migraine that include headache. If you have any other neurological signs or symptoms associated with vertigo and headaches, you need to work with your doctor to identify the actual cause of your vertigo before settling with the diagnosis of vestibular migraine. Vestibular migraine does not cause any other complicated neurological symptoms.

Vertigo associated with stroke

Yes, stroke can cause vertigo. In fact, stroke is always the major concern anytime you go to ER with new vertigo. Whenever the ER doctor sees a new patient with vertigo, he/she wants to make sure that it is not a stroke before considering other possible causes of vertigo. Different types of strokes affecting different parts of your brain can cause vertigo. As we learned earlier, the motion analyzer in your brain is complex and is connected to different parts of your brain receiving other nerves. It is hard to predict what exact symptoms you may have from vertigo caused by stroke. Here are a few warning signs that require further investigation to rule out stroke when you go to ER with a new vertigo:

  1. You have a prior history of stroke
  2. You have history of heart attacks or other clogged artery
  3. Along with vertigo, you have numbness, weakness or tingling in a part of your face or your body
  4. Your balance and coordination is significantly impaired in comparisons to your vertigo
  5. You have new visual problem (such as seeing double or unable to focus) associated with your vertigo
  6. Any problem with speaking or swallowing associated with your vertigo

Vertigo caused by multiple sclerosis

Multiple sclerosis or MS is a disease of your central nervous system caused by your immune system. Your immune system gets over-active and causes inflammation and damage of parts of your brain and your spinal cord. You have different symptoms at different times based on what part of your brain or spinal cord has been damaged. The exact symptoms of multiple sclerosis is hard to predict but any new unexplained weakness of a part of your body, any unexplained visual disturbance, any unexplained numbness, tingling, stiffness and similar symptoms may prompt your doctor to think about possible multiple sclerosis.

About 20% of patients with multiple sclerosis present with vertigo. Vertigo in multiple sclerosis is caused by inflammation and damage of one of the several places where your vestibular nerve travels and makes connections inside your brain.

What causes vertigo: things you need to note

As you can see there are so many things that can cause vertigo. It could be a challenge to find out what exactly caused your vertigo. However, you can help your doctor find the exact cause of your vertigo by noting a few things about your vertigo. If you can clearly communicate these things about your vertigo to your doctor, it will greatly help him/her find out what exactly caused your vertigo:

  1. How your vertigo started is important. Please note if it started abruptly or build up slowly.
  2. Note what exactly you were doing when your vertigo started.
  3. If you had episodes of vertigo, get your watch ready and note the exact duration of how long each episode of vertigo lasted.
  4. Note what makes your vertigo worse
  5. Note what makes your vertigo better
  6. Look in a mirror and note if your eye twitches with your vertigo
  7. Note how your vertigo has affected your balance
  8. Note if you feel nauseated with your vertigo
  9. Note if you have any other unusual symptom associated with your vertigo

White blood cells in urine

Finding White Blood Cells in urine

Increased number of White Blood Cells (WBCs) in urine signifies inflammation or infection. Medically, presence of WBCs in urine is called pyuria or pus in urine. White Blood Cells (also called leukocytes) are important part of your immune system. They are your inflammatory cells. They are your first responders to any kind of foreign invasion. White Blood Cells can squeeze out of your blood vessels and pass through tissue to reach organs with infection or irritation.

You can see White Blood Cells in urine by looking at the prepared slide of your urine sample under a microscope. You can count the number of White Blood Cells using the high power setting in the microscope. It may be normal to see up to 5 WBCs in a high power field of the microscope. More than 5 WBCs per high power field is considered abnormal.

Urinalysis usually involves dipstick and microscopic examinations. Dipstick exam is simply dipping a piece of strip to detect specific chemicals in your urine. Dipsticks cannot directly find leukocytes (WBCs) in urine but they can detect chemicals that provide indirect evidence of leukocytes. One of the chemicals they can detect is leukocyte esterase. It is a chemical released from breakdown of White Blood Cells in urine. When the dipstick is positive for leukocyte esterase, it is important to do a microscopic exam to look for actual White Blood Cells.

white blood cells in urine

white blood cells in urine

As you can see, your urinary tract includes two kidneys that connect to your single bladder with two ureters. The bladder connects to outside with your urethra. White Blood Cells in urine can originate in any of these places.

Now, we will explore the significance of White Blood Cells in urine in different settings.

White Blood Cells in urine with bacteria: definite infection

bacteria and WBCs in urine

bacteria and WBCs in urine

The presence or absence of significant number of WBCs in your urine is very important in making a diagnosis of urinary tract infection. Bacteria from your digestive tract or skin can climb up your urethra and settle down in your bladder. However, they are not always successful in causing infection. When you have a normal healthy urinary tract, you may be able to flush out these bacteria in your urine before they can cause any problems. When they examine your urine just after you flush them out, they may detect these bacteria.

Presence of bacteria in your urine is called bacteriuria and it may or may not suggest infection. Bacteria in urine can be from transient colonization without infection. If they leave your urine sample sitting down in the lab for some time, bacteria in the environment may contaminate the sample. This type of contamination may be another explanation of why bacteria were seen under the microscope.

Unlike bacteria, White Blood Cells cannot get in your urine by contamination. If they see bacteria as well as increased number of White Blood Cells in your urine, you can be fairly certain that you have actual urinary tract infection (UTI).

White Blood Cells in urine without bacteria: possible infection

Sometimes, they may find White Blood Cells in urine without bacteria. They may not see any bacterium in your urine when looking under the microscope but they may find significant number of White Blood Cells. This finding does not mean that you have no bacterial infection. The most common reason for White Blood Cells in urine with no bacteria is partially treated UTI. If you have taken antibiotics for UTI, it may have cleared your bacteria but the White Blood Cells may be present for some time.

However, there may be times when you have White Blood Cells in urine with possible infection from microorganisms that you cannot see in the microscope. Here is a list of some of the infections that can produce White Blood Cells in urine without being detected by the microscope:

  1. Tuberculosis and other mycobacterial infections: This category of bacteria needs special stain and specialized techniques to be detected in urine. They are not normally performed in routine urinalysis. People with these infections will only have WBCs seen in the usual microscopic examination.
  2. Viral infection (herpes, adenoviruses, varicella-zoster): Viruses are too small to be seen by a regular microscope but can cause white blood cells in urine.
  3. Yeast(fungi) infections: Yeasts may or may not be seen in the microscope but they usually grow in urine culture if present in the urine sample. Increased white blood cells along with detection of yeast in urine may signify fungal urinary tract infection.

White blood cells in urine: no infection

Irritation, trauma, cancer, blood vessel damage and other similar processes can cause White Blood Cells in urine.

Here is list of diseases affecting your whole body that may also result in White Blood Cells in urine with no infection:

  1. Diabetic nephropathy (kidney disease from uncontrolled diabetes)
  2. Sickle cell disease nephropathy (kidney disease as a result of complication of sickle cell anemia)
  3. Sarcoidosis (a disease of the immune system causing widespread inflammation in the body)
  4. Kawasaki disease (a rare disease that results in inflammation of blood vessels)
  5. Reactive Arthritis (a disease that results in inflammation of joints after certain infections)
  6. Systemic lupus erythematosis (commonly called “Lupus”- a disease of the immune system that may cause damage of multiple organ systems)

Here is a list of urinary tract and kidney specific diseases that may cause WBCs in urine with no infection:

  1. Polycystic kidney disease (an inherited disease that may lead to kidney failure)
  2. Backward flow of urine from bladder to kidneys called Vesicoureteral Reflux
  3. Kidney or ureter stones
  4. Retained foreign body
  5. Trauma from prostate surgery
  6. Any obstruction in normal flow of urine
  7. Accident or trauma involving urinary tract
  8. Extreme dehydration
  9. Interstitial nephritis (a type of swelling or inflammation of kidneys)
  10. When body rejects transplanted kidney
  11. Glomerulonephritis (inflammation and damage of urine making component of kidneys)
  12. Interstitial cystitis (Bladder inflammation of unknown cause)
  13. Tumor or cancer of any part of the urinary tract

White Blood Cells in urine as casts

Sometimes when you look at WBCs in urine under a microscope, you can see that they are not floating freely. They can be seen as groups of White Blood Cells joined together to form cylinder type shapes. These cylindrical shaped structures are called White Blood Cell casts. They are formed inside the kidneys. Our kidneys have small tubes where urine is formed. White Blood Cells originating in the kidneys get pressed into casts while coming down these tubes.

Finding WBCs in urine in the form of such casts is very important because they tell you where they came from. If you have bacteria in your urine and other signs of infection, presence of WBC casts confirms that the infection is inside your kidneys. If you have no signs of infection, you may have any one of the diseases that can cause inflammation of your kidneys.

Thank you for reading. I hope you learned more about white blood cells in urine. Please click on the book image to see if you would be interested in learning very useful practical medical facts that may one day save your life. All you have to do is read 20 medical stories with life saving medical knowledge embedded in them.

Bad cholesterol

What’s so bad about bad cholesterol?

Is cholesterol bad in itself? No, it’s not, not at all.

So, what is cholesterol?

Cholesterol is an essential organic compound needed to make all steroid hormones. Our body can get cholesterol from food or make it from scratch in liver. Cholesterol does not mix with blood because it belongs to a class of fat-like substances called lipids. As you know, fat does not dissolve in water.

To transport cholesterol in our blood, they have to be packaged with special proteins called Apo-proteins. The package of cholesterol, fats and Apo-proteins are called Lipo-proteins. There are different types of packages that carry cholesterol in blood. The same cholesterol can be good or bad depending on what type of package it is carried in.

The particular package of Lipo-protein called Low Density Lipoprotein or LDL is the main cholesterol supplier. It takes cholesterol out of the liver to supply it to organs that need it. LDL is considered the bad cholesterol because it promotes deposition of cholesterol in organs, particularly arteries.

Bad cholesterol or LDL is bad because of how it is packaged and transported. The problem is the faulty transportation system that takes cholesterol where it is not needed. However, the organs that need cholesterol would not get it if LDL did not exist.

What’s so good about good cholesterol?

Just like bad cholesterol, good cholesterol is not actual cholesterol. It is also the package containing cholesterol, fats and Apo-proteins. Good cholesterol is also a type of Lipo-protein. This particular type of cholesterol package is called high density Lipo-protein or HDL.

HDL is the good cholesterol because it is the main scavenger of cholesterol. This particular type of package of Lipo-protein is made to collect excess cholesterol from all over the body and bring them back to your liver. Since HDL promotes removal of cholesterol from organs, they also help protect arteries from getting cholesterol deposits.

Good cholesterol package is good because of how it is transported and packaged. The actual cholesterol inside the HDL package is the same cholesterol that was initially inside the LDL package.

How is your good and bad cholesterol levels measured and reported?

When you get your cholesterol checked, the actual test that is ordered is fasting lipid profile. Lipids are fat like substances. Cholesterol is a type of lipid. Your lipid profile report includes the following items:

  1. Total Cholesterol
  2. HDL Cholesterol
  3. Triglycerides
  4. LDL cholesterol

Total cholesterol includes all types of cholesterol present in all packages. It is measured directly in lab. HDL cholesterol is the amount of cholesterol packaged inside the HDL Lipo-protein. Triglycerides are not cholesterol, they are simply fats similar to butter and oil. Triglycerides are measures along with cholesterol because they are also packaged inside similar Lipo-protein packages.

Triglycerides and HDL are commonly measured directly in most labs. LDL or bad cholesterol level is usually calculated by using a formula.

LDL = Total cholesterol minus (HDL + triglyceride/5)

This formula only holds true if the triglyceride level is less than 400. If it is higher than that, LDL or bad cholesterol has to be measured directly in special labs.

Bad cholesterol or LDL level

Among the numbers you get reported in your lipid profile, the number associated with your bad cholesterol or LDL level is one of the most important ones. The recommendation about what the ideal cholesterol number should be has changed many times since they were first measured. The latest set of recommendation is based on the 2013 guidelines published jointly by the American College of Cardiology and American Heart Association.

According to the new guidelines, there is no universal normal or ideal level of LDL that applies to everyone. The decision to treat your bad cholesterol with cholesterol lowering medication depends not only on your bad cholesterol level but also on your overall risks of heart attack. The only kind of blood cholesterol lowering medication that has been proven to lower your risk of heart attack is the kind called statin.  Two things are used to decide whether you need stain:

  1. Your risk profile
  2. Your bad cholesterol level

If you have a history of heart attack or stroke, you have the highest risk. They recommend you take your statin regardless of your bad cholesterol level.

If your bad cholesterol level is 190 or higher, you need to take statin regardless of your heart attack risk. Bad cholesterol level higher than 190, in itself, is a major risk factor for heart attack.

If your bad cholesterol level is less than 70, you do not need statin unless you have a history of heart attack or stroke.

When your bad cholesterol level is between 70 and 189, you need to look at your heart attack risks before you decide about statin treatment. If you have diabetes and you are above 40 years old, your risk is already high enough to warrant statin treatment at this LDL level. Otherwise, you need to calculate your risk of heart attack.

You can calculate the risk percentage by using this calculator http://tools.acc.org/ASCVD-Risk-Estimator/ provided by American College of Cardiology. If your number comes out to be higher than 7.5%, you need statin treatment if you are between 40 and 75 years of age. If you do not meet any of these conditions, the decision to start statin should be based on individual risk-benefit discussion with your doctor.

What to do with your HDL or good cholesterol level?

Your HDL or good cholesterol level plays an important role in calculating your heart attack risks. The calculator provided by American College of Cardiology needs your HDL number to calculate your heart attack risk percentage. If your LDL or bad cholesterol level is in between 70 and 189, you need this number to make decision about taking statin. Low HDL levels increase your risks and high HDL levels decrease your risk.

In the past, HDL or good cholesterol level was individually evaluated and treated with medications that raised HDL level. However, recent research did not show any significant benefit in reducing heart attacks using that approach. Currently, HDL level is mostly used in deciding the need for statin treatment. Lowering LDL with stain is more beneficial in reducing heart attacks than raising HDL even in patients with abnormally low HDL levels.

What do you do with the total cholesterol level?

There is no real significance in knowing your total cholesterol level. However, some people still remember this number and use old reference numbers to see if their cholesterol is high, normal or low. This is wrong. Please forget your total cholesterol level, it is irrelevant. It is only used by your lab in the cholesterol formula to calculate your LDL or bad cholesterol level. That is the only place where total cholesterol level is useful.

What do you do with your triglyceride level?

Triglycerides are not cholesterol. If you want to learn more about them, you can read this separate detailed article on triglycerides.