Hemorrhage

Hemorrhage, excessive discharge of blood from blood vessels, caused by pathological condition of the vessels or by traumatic rupture of one or more vessels. Hemorrhage is a complication of many diseases. Peptic ulcer, for example, may cause hemorrhage by eroding a blood vessel. Stroke is sometimes due to hemorrhage in the brain. Hemophilia, a hereditary blood disease, is characterized by failure of the blood to coagulate. Sudden loss of more than about 1 liter (1 qt) of blood may lead to shock; unless the blood is replaced by transfusion, this shock can be fatal.

Bleeding normally stops through the process of coagulation, or clotting of the blood, and methods used to stop hemorrhage depend on stanching the flow of blood sufficiently for a clot to form. The hemorrhage is most effectively stopped by the application of pressure directly over the wound. Bleeding is also lessened by placing the body so that the wound is uppermost. A tourniquet should never be applied if there is another way to stop the bleeding, as application of a tourniquet increases the likelihood that amputation will be required.

Fibrin film and fibrin foam, plastics made from the blood protein fibrinogen, are extensively used in surgery. Fibrin foam is used in the form of a surgical sponge that rapidly stops bleeding by forming clots. Fibrin film is used to wrap nerves or tendons or as a membrane to cover the brain or other organs. Fibrin may be left without harm in the body, where it slowly dissolves.

Heartburn

Heartburn, condition characterized by a burning feeling in the chest and a sour or bitter taste in the mouth. Heartburn typically develops when the acidic contents of the stomach flow back, or regurgitate, into the esophagus, the muscular tube that carries food from the throat to the stomach.

Heartburn is generally diagnosed with a complete description of the symptoms. In severe cases, a physician may order a barium X ray of the stomach and esophagus to rule out other problems. Alternatively, a physician may examine the esophagus with an endoscope, an instrument that can view the interior of the digestive tract, and take tissue and fluid samples.

Treatments for heartburn in mild cases, over-the-counter medications such as antacids can relieve occasional bouts. Chronic heartburn can be treated with medications that prevent the production of acid in the stomach.

Lifestyle changes, such as quitting smoking or losing weight, also can alleviate or prevent heartburn. Sleeping with the head of the bed elevated 15 cm (6 in) helps prevent the stomach's contents from flowing back into the esophagus. Going to bed on an empty stomach, and cutting back on consumption of alcohol, fat, chocolate, and peppermint also can prevent heartburn.

Pravastatin

Pravastatin, drug used to lower cholesterol levels in the bloodstream in cases when dietary changes, weight loss, and exercise are ineffective in lowering cholesterol. Pravastatin works by blocking the liver enzyme that controls the manufacture of cholesterol. It is primarily effective against low-density lipoproteins (LDL), the form of cholesterol associated with increased risk of heart disease.

Available only by prescription, tablets of pravastatin are taken with or without food, usually at bedtime. The typical dosage ranges between 10 and 40 mg per day. Typically, cholesterol levels begin falling four to six weeks after the medication is started. Pravastatin is often prescribed in combination with a cholesterol-lowering diet.

Pregnant or nursing women, or children under the age of 18, should not take pravastatin. Patients with liver or kidney disease, muscular disorders, cataracts, or a history of alcohol abuse should use this drug with caution. Pravastatin can cause damage to the liver or muscle tissue, although problems can usually be detected early using well-established laboratory tests.

Possible side effects of this drug include dizziness, headache, skin rash, itchiness, stomach pain, nausea, diarrhea, constipation, gas, muscle cramps, or flulike symptoms. Pravastatin may be contraindicated for patients who are also taking the following drugs: cholestyramine, cimetidine, colestipol, cyclosporine, erythromycin, gemfibrozil, ketoconazole, niacin, warfarin, and immunosuppressive drugs.

Brand Name: Pravachol

Simvastatin

Simvastatin, drug used to lower cholesterol levels. It is typically prescribed by a physician when dietary changes, weight loss, and exercise are not effective in reducing cholesterol. Simvastatin works by blocking the liver enzyme that controls the production of cholesterol. It is primarily effective against low-density lipoproteins (LDL), the form of cholesterol associated with increased risk of coronary heart disease.

Tablets are taken with or without food, usually at bedtime. The typical dosage ranges between 5 and 40 mg per day. Effectiveness is usually apparent after four to six weeks of treatment. Simvastatin is usually prescribed in combination with a cholesterol-lowering diet.

This drug should not be taken by patients with liver disease, by pregnant or nursing women, or by young people under the age of 20. Patients with impaired liver function, muscular disorders, cataracts, or a history of alcohol abuse should use this drug with caution.

Possible side effects of this drug include headache, stomach pain, nausea, diarrhea, constipation, gas, muscle weakness, or lowered blood pressure. Other side effects sometimes observed are muscle pain, skin rash, impaired vision, or hepatitis. Simvastatin may interact adversely with the drugs cholestyramine, cimetidine, clofibrate, cyclosporine, erythromycin, gemfibrozil, digoxin, ketoconazole, nicotinic acid, warfarin, and spironolactone.

Brand Name:Zocor

Lovastatin

Lovastatin, drug used to reduce high blood cholesterol levels and slow the progression of coronary atherosclerosis, or hardening of the heart’s arteries. Lovastatin interferes with an enzyme in the liver responsible for making cholesterol, a fatlike substance that can both harden and clog the arteries. This drug reduces low-density lipoproteins (LDL), the type of cholesterol that increases the risk of coronary heart disease, and increases high-density lipoproteins (HDL), the type of cholesterol thought to reduce the risk of heart disease.

Available by prescription only, this drug is dispensed in 10-mg, 20-mg, and 40-mg tablets, which are taken orally. The initial adult dosage is 20 mg taken once a day, after which the dosage may be increased up to 40 mg twice a day. The maximum dosage should not exceed 80 mg daily. Effectiveness should be apparent within two weeks.

This drug should be taken with food, preferably with evening meals. It should not be used by persons who have had an allergic reaction to lovastatin; persons with active liver disease or active peptic ulcers; or pregnant or breast-feeding women. It should be used with caution by persons with reduced liver function and habitual users of alcohol. The safety and effectiveness of lovastatin for people under the age of 20 have not been established. Driving and other risk-related activities should be restricted if dizziness and blurred vision occur while taking this drug.

Common side effects of lovastatin include constipation, diarrhea, dizziness, gas, headache, heartburn, nausea, skin rash, and stomach pain. Less common side effects are blurred vision, fever, muscle aches or cramps, severe stomach pain, and unusual tiredness or weakness. Long-term use of this drug may result in abnormal liver function tests.

Lovastatin may interact adversely with certain drugs including clofibrate, cyclosporine, erythromycin and other macrolide antibiotics such as asithromycin and clarithromycin, gemfibrozil, niacin, and warfarin.

Brand Name:Mevacor

Coronary Heart Disease

Coronary heart disease, the most common type of heart disease caused by atherosclerosis, the buildup of fatty material called plaque on the inside of the coronary arteries (see Arteriosclerosis). Over the course of many years, this plaque narrows the arteries so that less blood can flow through them and less oxygen reaches the heart muscle.

The most common symptom of coronary heart disease is angina pectoris, a squeezing chest pain that may radiate to the neck, jaw, back, and left arm. Angina pectoris is a signal that blood flow to the heart muscle falls short when extra work is required from the heart muscle. An attack of angina is typically triggered by exercise or other physical exertion, or by strong emotions. Coronary heart disease can also lead to a heart attack, which usually develops when a blood clot forms at the site of a plaque and severely reduces or completely stops the flow of blood to a part of the heart. In a heart attack, also known as myocardial infarction, part of the heart muscle dies because it is deprived of oxygen. This oxygen deprivation also causes the crushing chest pain characteristic of a heart attack. Other symptoms of a heart attack include nausea, vomiting, and profuse sweating.

One of the primary risk factors for coronary heart disease is the presence of a high level of a fatty substance called cholesterol in the bloodstream. High blood cholesterol is typically the result of a diet that is high in cholesterol and saturated fat, although some genetic disorders also cause the problem. Other risk factors include smoking, high blood pressure, diabetes mellitus, obesity, and a sedentary lifestyle.

Coronary heart disease cannot be cured, but it can often be controlled with a combination of lifestyle changes and medications. Patients with coronary heart disease are encouraged to quit smoking, exercise regularly, and eat a low-fat diet. Doctors may prescribe a drug such as lovastatin, simvastatin, or pravastatin to help lower blood cholesterol. A wide variety of medications can help relieve angina, including nitroglycerin, beta blockers, and calcium channel blockers. Doctors may recommend that some patients take a daily dose of aspirin, which helps prevent heart attacks by interfering with platelets, tiny blood cells that play a critical role in blood clotting.

Gingivitis

Gingivitis, painless inflammation or degeneration of the gum tissue, or gingiva, considered the first stage of gum disease. The gum tissue between the teeth becomes swollen and uneven; the tissue at the gum line becomes darker; and gums bleed easily. In advanced cases, the mouth will develop a noticeably unpleasant odor.

Gingivitis is caused by the buildup of plaque, a film of bacteria that sticks to the teeth at the gum line. Toxins released from the bacteria irritate the gums, causing the gums to swell and bleed. This enables the bacteria to penetrate just below the gum line into an area known as the gingival sulcus. Warm, moist, and protected from the tongue and the chewing movement of the teeth, the gingival sulcus provides the perfect environment for bacteria to breed. Moreover, the delicate tissues of the sulcus are particularly vulnerable to the strong toxins produced by the bacteria. As the bacteria grow and continue to release toxins, they create a solid pocket of plaque beneath the gum line. This bacteria-filled pocket causes the gums to become more inflamed, which weakens the tissue, allowing even more plaque to be trapped in the expanding pocket.

Left untreated, gingivitis progresses to the next stage of gum disease known as periodontitis. In periodontitis, the inflammation from plaque not only damages the gums but also destroys the bones and ligaments that support the teeth. Eventually, the gums detach from the teeth and the teeth may begin to fall out.

The first step in treating gingivitis is scaling—a thorough professional cleaning of the teeth to remove any plaque. This is particularly important because plaque can harden into a mineral form called calculus or tartar, which can be removed only by professional instruments. In addition, dental structures that can interfere with plaque removal, such as broken fillings or bridges, may be fixed during regular dental cleanings. Most important, the patient will be instructed in proper home care, including regular brushing and effective flossing.