Input: What causes Diabetic Heart Disease ?

Output:
At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes.

Researchers continue to study these processes because all of the details aren't yet known.

Coronary Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside the arteries. The exact cause of atherosclerosis isn't known. However, studies show that it is a slow, complex disease that may start in childhood. The disease develops faster as you age.

Coronary atherosclerosis may start when certain factors damage the inner layers of the coronary (heart) arteries. These factors include:

Smoking

High amounts of certain fats and cholesterol in the blood

High blood pressure

High amounts of sugar in the blood due to insulin resistance or diabetes

Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.

Blood clots narrow the coronary arteries even more. This limits the flow of oxygen-rich blood to your heart and may worsen angina (chest pain) or cause a heart attack.

Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk of both CHD and type 2 diabetes.

If you have three or more of the five metabolic risk factors, you have metabolic syndrome. The risk factors are:

A large waistline (a waist measurement of 35 inches or more for women and 40 inches or more for men).

A high triglyceride (tri-GLIH-seh-ride) level (or youre on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.

A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries.

High blood pressure (or youre on medicine to treat high blood pressure).

A high fasting blood sugar level (or you're on medicine to treat high blood sugar).

It's unclear whether these risk factors have a common cause or are mainly related by their combined effects on the heart.

Obesity seems to set the stage for metabolic syndrome. Obesity can cause harmful changes in body fats and how the body uses insulin.

Chronic (ongoing) inflammation also may occur in people who have metabolic syndrome. Inflammation is the body's response to illness or injury. It may raise your risk of CHD and heart attack. Inflammation also may contribute to or worsen metabolic syndrome.

Research is ongoing to learn more about metabolic syndrome and how metabolic risk factors interact.

Insulin Resistance in People Who Have Type 2 Diabetes

Type 2 diabetes usually begins with insulin resistance. Insulin resistance means that the body can't properly use the insulin it makes.

People who have type 2 diabetes and insulin resistance have higher levels of substances in the blood that cause blood clots. Blood clots can block the coronary arteries and cause a heart attack or even death.

The Interaction of Coronary Heart Disease, High Blood Pressure, and Diabetes

Each of these risk factors alone can damage the heart. CHD reduces the flow of oxygen-rich blood to your heart muscle. High blood pressure and diabetes may cause harmful changes in the structure and function of the heart.

Having CHD, high blood pressure, and diabetes is even more harmful to the heart. Together, these conditions can severely damage the heart muscle. As a result, the heart has to work harder than normal. Over time, the heart weakens and isnt able to pump enough blood to meet the bodys needs. This condition is called heart failure.

As the heart weakens, the body may release proteins and other substances into the blood. These proteins and substances also can harm the heart and worsen heart failure. </s>


Input: Who is at risk for Diabetic Heart Disease? ?

Output:
People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways.

First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don't have diabetes, people who have the disease are more likely to:

Have heart attacks and other heart and blood vessel diseases. In men, the risk is double; in women, the risk is triple.

Have more complications after a heart attack, such as angina (chest pain or discomfort) and heart failure.

Die from heart disease.

The higher your blood sugar level is, the higher your risk of DHD. (A higher than normal blood sugar level is a risk factor for heart disease even in people who don't have diabetes.)

Type 2 diabetes raises your risk of having silent heart diseasethat is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.

Other Risk Factors

Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don't. You can control most of these risk factors, but some you can't.

For a more detailed discussion of these risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article.

Risk Factors You Can Control

Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called "bad" cholesterol) and low HDL cholesterol (sometimes called "good" cholesterol).

High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercurythe units used to measure blood pressure.)

Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues.

Prediabetes. This is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years.

Overweight or obesity. Being overweight or obese raises your risk of heart disease and heart attack. Overweight and obesity also are linked to other heart disease risk factors, such as high blood cholesterol, high blood pressure, and diabetes. Most people who have type 2 diabetes are overweight.

Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk of heart disease and type 2 diabetes. Metabolic syndrome also raises your risk of other health problems, such as stroke.

Lack of physical activity. Lack of physical activity can worsen other risk factors for heart disease, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.

Unhealthy diet. An unhealthy diet can raise your risk of heart disease. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other heart disease risk factors.

Stress. Stress and anxiety can trigger your arteries to tighten. This can raise your blood pressure and your risk of having a heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke or overeat foods high in fat and sugar.

Risk Factors You Can't Control

Age. As you get older, your risk of heart disease and heart attack rises. In men, the risk of heart disease increases after age 45. In women, the risk increases after age 55. In people who have diabetes, the risk of heart disease increases after age 40.

Gender. Before age 55, women seem to have a lower risk of heart disease than men. After age 55, however, the risk of heart disease increases similarly in both women and men.

Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.

Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of CHD, heart attack, heart failure, and high blood pressure. </s>


Input: What are the symptoms of Diabetic Heart Disease ?

Output:
Some people who have diabetic heart disease (DHD) may have no signs or symptoms of heart disease. This is called silent heart disease. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.

Thus, people who have diabetes should have regular medical checkups. Tests may reveal a problem before they're aware of it. Early treatment can reduce or delay related problems.

Some people who have DHD will have some or all of the typical symptoms of heart disease. Be aware of the symptoms described below and seek medical care if you have them.

If you think you're having a heart attack, call 911 right away for emergency care. Treatment for a heart attack works best when it's given right after symptoms occur.

Coronary Heart Disease

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

See your doctor if you think you have angina. He or she may recommend tests to check your coronary arteries and to see whether you have CHD risk factors.

Other CHD signs and symptoms include nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness.

Some people don't realize they have CHD until they have a heart attack. A heart attack occurs if a blood clot forms in a coronary artery and blocks blood flow to part of the heart muscle.

The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.

The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. Shortness of breath may occur with or before chest discomfort.

Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms include nausea, vomiting, light-headedness or sudden dizziness, breaking out in a cold sweat, sleep problems, fatigue, and lack of energy.

Some heart attack symptoms are similar to angina symptoms. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.

If you don't know whether your chest pain is angina or a heart attack, call 911 right away for emergency care.

Not everyone who has a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. Also, diabetes-related nerve damage can interfere with pain signals in the body. As a result, some people who have diabetes may have heart attacks without symptoms.

Heart Failure

The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins in your neck. As the heart weakens, heart failure symptoms worsen.

People who have heart failure can live longer and more active lives if the condition is diagnosed early and they follow their treatment plans. If you have any form of DHD, talk with your doctor about your risk of heart failure.

Diabetic Cardiomyopathy

Diabetic cardiomyopathy may not cause symptoms in its early stages. Later, you may have weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. </s>


Input: How to diagnose Diabetic Heart Disease ?

Output:
Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures.

Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms.

Initial Tests

No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests.

Blood Pressure Measurement

To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.

Most often, you'll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you're at risk for DHD.

A blood test also can check the level of a hormone called BNP (brain natriuretic peptide) in your blood. The heart makes BNP, and the level of BNP rises during heart failure.

Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records your heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.

An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress.

During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you cant exercise, you may be given medicine to raise your heart rate.

Urinalysis

For this test, you'll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD.

Other Tests and Procedures

Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.

The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD.

For more information about other tests and procedures, go to the diagnosis sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles. </s>


Input: What are the treatments for Diabetic Heart Disease ?

Output:
Diabetic heart disease (DHD) is treated with lifestyle changes, medicines, and medical procedures. The goals of treating DHD include:

Controlling diabetes and any other heart disease risk factors you have, such as unhealthy blood cholesterol levels and high blood pressure

Reducing or relieving heart disease symptoms, such as angina (chest pain or discomfort)

Preventing or delaying heart disease complications, such as a heart attack

Repairing heart and coronary artery damage

Following the treatment plan your doctor recommends is very important. Compared with people who don't have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease.

Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors.

Lifestyle Changes

Following a healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone.

Following a Healthy Diet

A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institutes (NHLBIs) Your Guide to Lowering Your Blood Pressure With DASH and the U.S. Department of Agricultures ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.

Maintaining a Healthy Weight

Controlling your weight helps you control heart disease risk factors. If youre overweight or obese, work with your doctor to create a reasonable weight-loss plan.

For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article.

Being Physically Active

Regular physical activity can lower many heart disease risk factors, and it helps control your blood sugar level. Physical activity also can improve how insulin works. (Insulin is a hormone that helps turn glucose into energy.)

Generally, adults should do at least 150 minutes (2hours and 30 minutes) of moderate-intensity physical activity each week. You dont have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each.

Talk with your doctor about what types and amounts and physical activity are safe for you. People who have diabetes must be careful to watch their blood sugar levels and avoid injury to their feet during physical activity.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Quitting Smoking

Smoking can damage your blood vessels and raise your risk of heart disease. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

Managing Stress

Research shows that strong emotions, such as anger, can trigger a heart attack. Learning how to managestress, relax, and cope with problems can improve your emotional and physical health.

Medicines

Medicines are an important part of treatment for people who have diabetes and for people who have DHD.

Medicines can help control blood sugar levels, lower blood pressure, reduce the risk of blood clots, improve blood cholesterol levels, reduce the heart's workload, and treat angina symptoms.

Your doctor will prescribe medicines based on your specific needs.

Medical Procedures

If you have DHD, your doctor may recommend a medical procedure. The type of procedure will depend on the type of heart disease you have.

For example, both percutaneous coronary intervention (PCI),also known as coronaryangioplasty, and coronary artery bypass grafting (CABG) are used to treat coronary heart disease (CHD). Both of these procedures improve blood flow to your heart. PCI also can relieve chest pain. CABG can relieve chest pain and may help prevent a heart attack.

If you have heart damage and severe heart failure symptoms, your doctor may recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).

A CRT device is a type of pacemaker. A pacemaker is a small device that helps control abnormal heart rhythms. Its placed under the skin of the chest or abdomen. A CRT device helps the heart's lower chambers contract at the same time, which may decrease heart failure symptoms.

An ICD is similar to a pacemaker. An ICD is a small device thats placed under the skin of the chest or abdomen. The device uses electrical pulses or shocks to help control dangerous heart rhythms.

Your doctor also may recommend a pacemaker or ICD to treat diabetic cardiomyopathy. Other types of surgery also are used to treat this type of heart disease.

For more information about medical procedures used to treat diabetes-related heart diseases, go to the treatment sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.

Diabetes-Specific Treatment Issues

The treatments described above are used for people who have DHD and for people who have heart disease without diabetes. However, some aspects of heart disease treatment differ for people who have diabetes.

Treatment for High Blood Pressure and High Blood Cholesterol

Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don't. People who have diabetes also may have more aggressive treatment goals.

For example, your doctor may prescribe medicines called statins even if your blood cholesterol levels are in the normal range. Your doctor also may prescribe statins if you're older than 40 and have other heart disease risk factors.

Target goals for LDL cholesterol (sometimes called "bad" cholesterol) and high blood pressure also are lower for people who have diabetes than for those who don't. Studies suggest that most people who have diabetes will need more than one blood pressure medicine to reach their goals.

Research also has shown that some people who have diabetes may benefit more from certain blood pressure and cholesterol medicines than from others.

One example is a group of cholesterol medicines called bile acid sequestrants (such as cholestyramine). This type of medicine may offer advantages for people who have type 2 diabetes. It appears to improve blood sugar control and lower LDL cholesterol.

Treatment for Heart Failure

Some studies suggest that certain medicines may have advantages for treating heart failure in people who have diabetes. These medicines include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and beta blockers.

Research shows that two blood sugar medicines (insulin and sulfanylureas) don't seem to reduce the risk of heart failure in people who have type 2 diabetes. A third medicine (metformin) shows promise, but research is still ongoing.

Heart Attack Prevention

Doctors may recommend aspirin for people with diabetes who are at increased risk for heart disease and heart attack. Taken each day, low-dose aspirin may prevent blood clots that can lead to a heart attack.

People with diabetes who are at increased risk include most men older than 50 and most women older than 60 who have one or more of the following risk factors:

Smoking

High blood pressure

High blood cholesterol

A family history of early heart disease

A higher than normal level of protein in their urine

Blood Sugar Control

Controlling blood sugar levels is good for heart health. For example, controlling blood sugar improves everyday heart function for people who have diabetes and heart failure. </s>


Input: How to prevent Diabetic Heart Disease ?

Output:
Taking action to control risk factors can help prevent or delay heart disease in people who have diabetes and in those who don't. Your risk of heart disease increases with the number of risk factors you have.

One step you can take is to adopt a healthy lifestyle. A healthy lifestyle should be part of a lifelong approach to healthy living. A healthy lifestyle includes:

Following a healthy diet

Maintaining a healthy weight

Being physically active

Quitting smoking

Managing stress

You also should know your family history of diabetes and heart disease. If you or someone in your family has diabetes, heart disease, or both, let your doctor know.

Your doctor may prescribe medicines to control certain risk factors, such as high blood pressure and high blood cholesterol. Take all of your medicines exactly as your doctor advises.

People who have diabetes also need good blood sugar control. Controlling your blood sugar level is good for heart health. Ask your doctor about the best ways to control your blood sugar level.

For more information about lifestyle changes and medicines, go to "How Is Diabetic Heart Disease Treated?" </s>


Input: What is (are) Endocarditis ?

Output:
Endocarditis (EN-do-kar-DI-tis) is an infection of the inner lining of the heart chambers and valves. This lining is called the endocardium (en-do-KAR-de-um). The condition also is called infective endocarditis (IE).

The term "endocarditis" also is used to describe an inflammation of the endocardium due to other conditions. This article only discusses endocarditis related to infection.

IE occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. The infection can damage your heart and cause serious and sometimes fatal complications.

IE can develop quickly or slowly; it depends on what type of germ is causing it and whether you have an underlying heart problem. When IE develops quickly, it's called acute infective endocarditis. When it develops slowly, it's called subacute infective endocarditis.

Overview

IE mainly affects people who have:

Damaged or artificial (man-made) heart valves

Congenital heart defects (defects present at birth)

Implanted medical devices in the heart or blood vessels

People who have normal heart valves also can have IE. However, the condition is much more common in people who have abnormal hearts.

Certain factors make it easier for bacteria to enter your bloodstream. These factors put you at higher risk for IE. For example, poor dental hygiene and unhealthy teeth and gums increase your risk for the infection.

Other risk factors include using intravenous (IV) drugs, having a catheter (tube) or another medical device in your body for long periods, and having a history of IE.

Common symptoms of IE are fever and other flu-like symptoms. Because the infection can affect people in different ways, the signs and symptoms vary. IE also can cause problems in many other parts of the body besides the heart.

If you're at high risk for IE, seek medical care if you have signs or symptoms of the infection, especially a fever that persists or unexplained fatigue (tiredness).

Outlook

IE is treated with antibiotics for several weeks. You also may need heart surgery to repair or replace heart valves or remove infected heart tissue.

Most people who are treated with the proper antibiotics recover. But if the infection isn't treated, or if it persists despite treatment (for example, if the bacteria are resistant to antibiotics), it's usually fatal.

If you have signs or symptoms of IE, see your doctor as soon as you can, especially if you have abnormal heart valves. </s>


Input: What causes Endocarditis ?

Output:
Infective endocarditis (IE) occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. Certain factors increase the risk of this happening.

A common underlying factor in IE is a structural heart defect, especially faulty heart valves. Usually your immune system will kill germs in your bloodstream. However, if your heart has a rough lining or abnormal valves, the invading germs can attach and multiply in the heart.

Other factors also can play a role in causing IE. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition.

Having a catheter (tube) or another medical device inserted through your skin, especially for long periods, also can allow bacteria to enter your bloodstream. People who use intravenous (IV) drugs also are at risk for IE because of the germs on needles and syringes.

Bacteria also may spread to the blood and heart from infections in other parts of the body, such as the gut, skin, or genitals.

Endocarditis Complications

As the bacteria or other germs multiply in your heart, they form clumps with other cells and matter found in the blood. These clumps are called vegetations (vej-eh-TA-shuns).

As IE worsens, pieces of the vegetations can break off and travel to almost any other organ or tissue in the body. There, the pieces can block blood flow or cause a new infection. As a result, IE can cause a range of complications.

Heart Complications

Heart problems are the most common complication of IE. They occur in one-third to one-half of all people who have the infection. These problems may include a new heart murmur, heart failure, heart valve damage, heart block, or, rarely, a heart attack.

Central Nervous System Complications

These complications occur in as many as 20 to 40 percent of people who have IE. Central nervous system complications most often occur when bits of the vegetation, called emboli (EM-bo-li), break away and lodge in the brain.

The emboli can cause local infections called brain abscesses. Or, they can cause a more widespread brain infection called meningitis (men-in-JI-tis).

Emboli also can cause strokes or seizures. This happens if they block blood vessels or affect the brain's electrical signals. These complications can cause long-term damage to the brain and may even be fatal.

Complications in Other Organs

IE also can affect other organs in the body, such as the lungs, kidneys, and spleen.

Lungs. The lungs are especially at risk when IE affects the right side of the heart. This is called right-sided infective endocarditis.

A vegetation or blood clot going to the lungs can cause a pulmonary embolism (PE) and lung damage. A PE is a sudden blockage in a lung artery.

Other lung complications include pneumonia and a buildup of fluid or pus around the lungs.

Kidneys. IE can cause kidney abscesses and kidney damage. The infection also can inflame the internal filtering structures of the kidneys.

Signs and symptoms of kidney complications include back or side pain, blood in the urine, or a change in the color or amount of urine. In some cases, IE can cause kidney failure.

Spleen. The spleen is an organ located in the left upper part of the abdomen near the stomach. In some people who have IE, the spleen enlarges (especially in people who have long-term IE). Sometimes emboli also can damage the spleen.

Signs and symptoms of spleen problems include pain or discomfort in the upper left abdomen and/or left shoulder, a feeling of fullness or the inability to eat large meals, and hiccups. </s>


Input: Who is at risk for Endocarditis? ?

Output:
Infective endocarditis (IE) is an uncommon condition that can affect both children and adults. It's more common in men than women.

IE typically affects people who have abnormal hearts or other conditions that put them at risk for the infection. Sometimes IE does affect people who were healthy before the infection.

Major Risk Factors

The germs that cause IE tend to attach and multiply on damaged, malformed, or artificial (man-made) heart valves and implanted medical devices. Certain conditions put you at higher risk for IE. These include:

Congenital heart defects (defects that are present at birth). Examples include a malformed heart or abnormal heart valves.

Artificial heart valves, an implanted medical device in the heart (such as a pacemaker wire), or an intravenous (IV) catheter (tube) in a blood vessel for a long time.

Heart valves damaged by rheumatic fever or calcium deposits that cause age-related valve thickening. Scars in the heart from a previous case of IE also can damage heart valves.

IV drug use, especially if needles are shared or reused, contaminated substances are injected, or the skin isn't properly cleaned before injection. </s>


Input: What are the symptoms of Endocarditis ?

Output:
Infective endocarditis (IE) can cause a range of signs and symptoms that can vary from person to person. Signs and symptoms also can vary over time in the same person.

Signs and symptoms differ depending on whether you have an underlying heart problem, the type of germ causing the infection, and whether you have acute or subacute IE.

Signs and symptoms of IE may include:

Flu-like symptoms, such as fever, chills, fatigue (tiredness), aching muscles and joints, night sweats, and headaches.

Shortness of breath or a cough that won't go away.

A new heart murmur or a change in an existing heart murmur.

Skin changes such as:   - Overall paleness.   - Small, painful, red or purplish bumps under the skin on the fingers or toes.   - Small, dark, painless flat spots on the palms of the hands or the soles of the feet.   - Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels.

Overall paleness.

Small, painful, red or purplish bumps under the skin on the fingers or toes.

Small, dark, painless flat spots on the palms of the hands or the soles of the feet.

Tiny spots under the fingernails, on the whites of the eyes, on the roof of the mouth and inside of the cheeks, or on the chest. These spots are from broken blood vessels.

Nausea (feeling sick to your stomach), vomiting, a decrease in appetite, a sense of fullness with discomfort on the upper left side of the abdomen, or weight loss with or without a change in appetite.

Blood in the urine.

Swelling in the feet, legs, or abdomen. </s>


Input: How to diagnose Endocarditis ?

Output:
Your doctor will diagnose infective endocarditis (IE) based on your risk factors, your medical history and signs and symptoms, and test results.

Diagnosis of IE often is based on many factors, rather than a single positive test result, sign, or symptom.

Diagnostic Tests

Blood Tests

Blood cultures are the most important blood tests used to diagnose IE. Blood is drawn several times over a 24-hour period. It's put in special culture bottles that allow bacteria to grow.

Doctors then identify and test the bacteria to see which antibiotics will kill them. Sometimes the blood cultures don't grow any bacteria, even if a person has IE. This is called culture-negative endocarditis, and it requires antibiotic treatment.

Other blood tests also are used to diagnose IE. For example, a complete blood count may be used to check the number of red and white blood cells in your blood. Blood tests also may be used to check your immune system and to check for inflammation.

Echocardiography

Echocardiography (echo) is a painless test that uses sound waves to create pictures of your heart. Two types of echo are useful in diagnosing IE.

Transthoracic (tranz-thor-AS-ik) echo. For this painless test, gel is applied to the skin on your chest. A device called a transducer is moved around on the outside of your chest.

This device sends sound waves called ultrasound through your chest. As the ultrasound waves bounce off your heart, a computer converts them into pictures on a screen.

Your doctor uses the pictures to look for vegetations, areas of infected tissue (such as an abscess), and signs of heart damage.

Because the sound waves have to pass through skin, muscle, tissue, bone, and lungs, the pictures may not have enough detail. Thus, your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE).

Transesophageal echo. For TEE, a much smaller transducer is attached to the end of a long, narrow, flexible tube. The tube is passed down your throat. Before the procedure, you're given medicine to help you relax, and your throat is sprayed with numbing medicine.

The doctor then passes the transducer down your esophagus (the passage from your mouth to your stomach). Because this passage is right behind the heart, the transducer can get detailed pictures of the heart's structures.

EKG

An EKG is a simple, painless test that detects your heart's electrical activity. The test shows how fast your heart is beating, whether your heart rhythm is steady or irregular, and the strength and timing of electrical signals as they pass through your heart.

An EKG typically isn't used to diagnose IE. However, it may be done to see whether IE is affecting your heart's electrical activity.

For this test, soft, sticky patches called electrodes are attached to your chest, arms, and legs. You lie still while the electrodes detect your heart's electrical signals. A machine records these signals on graph paper or shows them on a computer screen. The entire test usually takes about 10 minutes. </s>


Input: What are the treatments for Endocarditis ?

Output:
Infective endocarditis (IE) is treated with antibiotics and sometimes with heart surgery.

Antibiotics

Antibiotics usually are given for 2 to 6 weeks through an intravenous (IV) line inserted into a vein. You're often in a hospital for at least the first week or more of treatment. This allows your doctor to make sure the medicine is helping.

If you're allowed to go home before the treatment is done, the antibiotics are almost always continued by vein at home. You'll need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment.

You also will need close medical followup, usually by a team of doctors. This team often includes a doctor who specializes in infectious diseases, a cardiologist (heart specialist), and a heart surgeon.

Surgery

Sometimes surgery is needed to repair or replace a damaged heart valve or to help clear up IE. For example, IE caused by fungi often requires surgery. This is because this type of IE is harder to treat than IE caused by bacteria. </s>


Input: How to prevent Endocarditis ?

Output:
If you're at risk for infective endocarditis (IE), you can take steps to prevent the infection and its complications.

Be alert to the signs and symptoms of IE. Contact your doctor right away if you have any of these signs or symptoms, especially a persistent fever or unexplained fatigue (tiredness).

Brush and floss your teeth regularly, and have regular dental checkups. Germs from a gum infection can enter your bloodstream.

Avoid body piercing, tattoos, and other procedures that may allow germs to enter your bloodstream.

Research shows that not everyone at risk for IE needs to take antibiotics before routine dental exams and certain other dental and medical procedures.

Let your health care providers, including your dentist, know if you're at risk for IE. They can tell you whether you need antibiotics before exams and procedures. </s>


Input: What is (are) Hemophilia ?

Output:
Espaol

Hemophilia (heem-o-FILL-ee-ah) is a rare bleeding disorder in which the blood doesn't clot normally.

If you have hemophilia, you may bleed for a longer time than others after an injury. You also may bleed inside your body (internally), especially in your knees, ankles, and elbows. This bleeding can damage your organs and tissues and may be life threatening.

Overview

Hemophilia usually is inherited. "Inherited means that the disorder is passed from parents to children through genes.

People born with hemophilia have little or no clotting factor. Clotting factor is a protein needed for normal blood clotting. There are several types of clotting factors. These proteins work with platelets (PLATE-lets) to help the blood clot.

Platelets are small blood cell fragments that form in the bone marrowa sponge-like tissue in the bones. Platelets play a major role in blood clotting. When blood vessels are injured, clotting factors help platelets stick together to plug cuts and breaks on the vessels and stop bleeding.

The two main types of hemophilia are A and B. If you have hemophilia A, you're missing or have low levels of clotting factor VIII (8). About 8 out of 10 people who have hemophilia have type A. If you have hemophilia B, you're missing or have low levels of clotting factor IX (9).

Rarely, hemophilia can be acquired. "Acquired means you aren't born with the disorder, but you develop it during your lifetime. This can happen if your body forms antibodies (proteins) that attack the clotting factors in your bloodstream. The antibodies can prevent the clotting factors from working.

This article focuses on inherited hemophilia.

Outlook

Hemophilia can be mild, moderate, or severe, depending on how much clotting factor is in your blood. About 7 out of 10 people who have hemophilia A have the severe form of the disorder.

People who don't have hemophilia have a factor VIII activity of 100 percent. People who have severe hemophilia A have a factor VIII activity of less than 1 percent.

Hemophilia usually occurs in males (with rare exceptions). About 1 in 5,000 males are born with hemophilia each year. </s>


Input: What causes Hemophilia ?

Output:
A defect in one of the genes that determines how the body makes blood clotting factor VIII or IX causes hemophilia. These genes are located on the X chromosomes (KRO-muh-somz).

Chromosomes come in pairs. Females have two X chromosomes, while males have one X and one Y chromosome. Only the X chromosome carries the genes related to clotting factors.

A male who has a hemophilia gene on his X chromosome will have hemophilia. When a female has a hemophilia gene on only one of her X chromosomes, she is a "hemophilia carrier and can pass the gene to her children. Sometimes carriers have low levels of clotting factor and have symptoms of hemophilia, including bleeding. Clotting factors are proteins in the blood that work together with platelets to stop or control bleeding.

Very rarely, a girl may be born with a very low clotting factor level and have a greater risk for bleeding, similar to boys who have hemophilia and very low levels of clotting factor. There are several hereditary and genetic causes of this much rarer form of hemophilia in females.

Some males who have the disorder are born to mothers who aren't carriers. In these cases, a mutation (random change) occurs in the gene as it is passed to the child.

Below are two examples of how the hemophilia gene is inherited.

Inheritance Pattern for HemophiliaExample 1

Each daughter has a 50 percent chance of inheriting the hemophilia gene from her mother and being a carrier. Each son has a 50 percent chance of inheriting the hemophilia gene from his mother and having hemophilia.

Inheritance Pattern for HemophiliaExample 2

Each daughter will inherit the hemophilia gene from her father and be a carrier. None of the sons will inherit the hemophilia gene from their father; thus, none will have hemophilia. </s>


Input: What are the symptoms of Hemophilia ?

Output:
The major signs and symptoms of hemophilia are excessive bleeding and easy bruising.

Excessive Bleeding

The extent of bleeding depends on how severe the hemophilia is.

Children who have mild hemophilia may not have signs unless they have excessive bleeding from a dental procedure, an accident, or surgery. Males who have severe hemophilia may bleed heavily after circumcision.

Bleeding can occur on the body's surface (external bleeding) or inside the body (internal bleeding).

Signs of external bleeding may include:

Bleeding in the mouth from a cut or bite or from cutting or losing a tooth

Nosebleeds for no obvious reason

Heavy bleeding from a minor cut

Bleeding from a cut that resumes after stopping for a short time

Signs of internal bleeding may include:

Blood in the urine (from bleeding in the kidneys or bladder)

Blood in the stool (from bleeding in the intestines or stomach)

Large bruises (from bleeding into the large muscles of the body)

Bleeding in the Joints

Bleeding in the knees, elbows, or other joints is another common form of internal bleeding in people who have hemophilia. This bleeding can occur without obvious injury.

At first, the bleeding causes tightness in the joint with no real pain or any visible signs of bleeding. The joint then becomes swollen, hot to touch, and painful to bend.

Swelling continues as bleeding continues. Eventually, movement in the joint is temporarily lost. Pain can be severe. Joint bleeding that isn't treated quickly can damage the joint.

Bleeding in the Brain

Internal bleeding in the brain is a very serious complication of hemophilia. It can happen after a simple bump on the head or a more serious injury. The signs and symptoms of bleeding in the brain include:

Long-lasting, painful headaches or neck pain or stiffness

Repeated vomiting

Sleepiness or changes in behavior

Sudden weakness or clumsiness of the arms or legs or problems walking

Double vision

Convulsions or seizures </s>


Input: How to diagnose Hemophilia ?

Output:
If you or your child appears to have a bleeding problem, your doctor will ask about your personal and family medical histories. This will reveal whether you or your family members, including women and girls, have bleeding problems. However, some people who have hemophilia have no recent family history of the disease.

You or your child also will likely have a physical exam and blood tests to diagnose hemophilia. Blood tests are used to find out:

How long it takes for your blood to clot

Whether your blood has low levels of any clotting factors

Whether any clotting factors are completely missing from your blood

The test results will show whether you have hemophilia, what type of hemophilia you have, and how severe it is.

Hemophilia A and B are classified as mild, moderate, or severe, depending on the amount of clotting factor VIII or IX in the blood.

The severity of symptoms can overlap between the categories. For example, some people who have mild hemophilia may have bleeding problems almost as often or as severe as some people who have moderate hemophilia.

Severe hemophilia can cause serious bleeding problems in babies. Thus, children who have severe hemophilia usually are diagnosed during the first year of life. People who have milder forms of hemophilia may not be diagnosed until they're adults.

The bleeding problems of hemophilia A and hemophilia B are the same. Only special blood tests can tell which type of the disorder you or your child has. Knowing which type is important because the treatments are different.

Pregnant women who are known hemophilia carriers can have the disorder diagnosed in their unborn babies as early as 12 weeks into their pregnancies.

Women who are hemophilia carriers also can have "preimplantation diagnosis" to have children who don't have hemophilia.

For this process, women have their eggs removed and fertilized by sperm in a laboratory. The embryos are then tested for hemophilia. Only embryos without the disorder are implanted in the womb. </s>


Input: What are the treatments for Hemophilia ?

Output:
Treatment With Replacement Therapy

The main treatment for hemophilia is called replacement therapy. Concentrates of clotting factor VIII (for hemophilia A) or clotting factor IX (for hemophilia B) are slowly dripped or injected into a vein. These infusions help replace the clotting factor that's missing or low.

Clotting factor concentrates can be made from human blood. The blood is treated to prevent the spread of diseases, such as hepatitis. With the current methods of screening and treating donated blood, the risk of getting an infectious disease from human clotting factors is very small.

To further reduce the risk, you or your child can take clotting factor concentrates that aren't made from human blood. These are called recombinant clotting factors. Clotting factors are easy to store, mix, and use at homeit only takes about 15 minutes to receive the factor.

You may have replacement therapy on a regular basis to prevent bleeding. This is called preventive or prophylactic (PRO-fih-lac-tik) therapy. Or, you may only need replacement therapy to stop bleeding when it occurs. This use of the treatment, on an as-needed basis, is called demand therapy.

Demand therapy is less intensive and expensive than preventive therapy. However, there's a risk that bleeding will cause damage before you receive the demand therapy.

Complications of Replacement Therapy

Complications of replacement therapy include:

Developing antibodies (proteins) that attack the clotting factor

Developing viral infections from human clotting factors

Damage to joints, muscles, or other parts of the body resulting from delays in treatment

Antibodies to the clotting factor. Antibodies can destroy the clotting factor before it has a chance to work. This is a very serious problem. It prevents the main treatment for hemophilia (replacement therapy) from working.

These antibodies, also called inhibitors, develop in about 2030 percent of people who have severe hemophilia A. Inhibitors develop in 25 percent of people who have hemophilia B.

When antibodies develop, doctors may use larger doses of clotting factor or try different clotting factor sources. Sometimes the antibodies go away.

Researchers are studying new ways to deal with antibodies to clotting factors.

Viruses from human clotting factors. Clotting factors made from human blood can carry the viruses that cause HIV/AIDS and hepatitis. However, the risk of getting an infectious disease from human clotting factors is very small due to:

Careful screening of blood donors

Testing of donated blood products

Treating donated blood products with a detergent and heat to destroy viruses

Vaccinating people who have hemophilia for hepatitis A and B

Damage to joints, muscles, and other parts of the body. Delays in treatment can cause damage such as:

Bleeding into a joint. If this happens many times, it can lead to changes in the shape of the joint and impair the joint's function.

Swelling of the membrane around a joint.

Pain, swelling, and redness of a joint.

Pressure on a joint from swelling, which can destroy the joint.

Home Treatment With Replacement Therapy

You can do both preventive (ongoing) and demand (as-needed) replacement therapy at home. Many people learn to do the infusions at home for their child or for themselves. Home treatment has several advantages:

You or your child can get quicker treatment when bleeding happens. Early treatment lowers the risk of complications.

Fewer visits to the doctor or emergency room are needed.

Home treatment costs less than treatment in a medical care setting.

Home treatment helps children accept treatment and take responsibility for their own health.

Discuss options for home treatment with your doctor or your child's doctor. A doctor or other health care provider can teach you the steps and safety procedures for home treatment. Hemophilia treatment centers are another good resource for learning about home treatment (discussed in "Living With Hemophilia).

Doctors can surgically implant vein access devices to make it easier for you to access a vein for treatment with replacement therapy. These devices can be helpful if treatment occurs often. However, infections can be a problem with these devices. Your doctor can help you decide whether this type of device is right for you or your child.

Other Types of Treatment

Desmopressin

Desmopressin (DDAVP) is a man-made hormone used to treat people who have mild hemophilia A. DDAVP isn't used to treat hemophilia B or severe hemophilia A.

DDAVP stimulates the release of stored factor VIII and von Willebrand factor; it also increases the level of these proteins in your blood. Von Willebrand factor carries and binds factor VIII, which can then stay in the bloodstream longer.

DDAVP usually is given by injection or as nasal spray. Because the effect of this medicine wears off if it's used often, the medicine is given only in certain situations. For example, you may take this medicine prior to dental work or before playing certain sports to prevent or reduce bleeding.

Antifibrinolytic Medicines

Antifibrinolytic medicines (including tranexamic acid and epsilon aminocaproic acid) may be used with replacement therapy. They're usually given as a pill, and they help keep blood clots from breaking down.

These medicines most often are used before dental work or to treat bleeding from the mouth or nose or mild intestinal bleeding.

Gene Therapy

Researchers are trying to find ways to correct the faulty genes that cause hemophilia. Gene therapy hasn't yet developed to the point that it's an accepted treatment for hemophilia. However, researchers continue to test gene therapy in clinical trials.

For more information, go to the "Clinical Trials" section of this article.

Treatment of a Specific Bleeding Site

Pain medicines, steroids, and physical therapy may be used to reduce pain and swelling in an affected joint. Talk with your doctor or pharmacist about which medicines are safe for you to take.

Which Treatment Is Best for You?

The type of treatment you or your child receives depends on several things, including how severe the hemophilia is, the activities you'll be doing, and the dental or medical procedures you'll be having.

Mild hemophiliaReplacement therapy usually isn't needed for mild hemophilia. Sometimes, though, DDAVP is given to raise the body's level of factor VIII.

Moderate hemophiliaYou may need replacement therapy only when bleeding occurs or to prevent bleeding that could occur when doing certain activities. Your doctor also may recommend DDAVP prior to having a procedure or doing an activity that increases the risk of bleeding.

Severe hemophiliaYou usually need replacement therapy to prevent bleeding that could damage your joints, muscles, or other parts of your body. Typically, replacement therapy is given at home two or three times a week. This preventive therapy usually is started in patients at a young age and may need to continue for life.

For both types of hemophilia, getting quick treatment for bleeding is important. Quick treatment can limit damage to your body. If you or your child has hemophilia, learn to recognize signs of bleeding.

Other family members also should learn to watch for signs of bleeding in a child who has hemophilia. Children sometimes ignore signs of bleeding because they want to avoid the discomfort of treatment. </s>


Input: What is (are) Pleurisy and Other Pleural Disorders ?

Output:
Pleurisy (PLUR-ih-se) is a condition in which the pleura is inflamed. The pleura is a membrane that consists of two large, thin layers of tissue. One layer wraps around the outside of your lungs. The other layer lines the inside of your chest cavity.

Between the layers of tissue is a very thin space called the pleural space. Normally this space is filled with a small amount of fluidabout 4 teaspoons full. The fluid helps the two layers of the pleura glide smoothly past each other as you breathe in and out.

Pleurisy occurs if the two layers of the pleura become irritated and inflamed. Instead of gliding smoothly past each other, they rub together every time you breathe in. The rubbing can cause sharp pain.

Many conditions can cause pleurisy, including viral infections.

Other Pleural Disorders

Pneumothorax

Air or gas can build up in the pleural space. When this happens, it's called a pneumothorax (noo-mo-THOR-aks). A lung disease or acute lung injury can cause a pneumothorax.

Some lung procedures also can cause a pneumothorax. Examples include lung surgery, drainage of fluid with a needle,bronchoscopy (bron-KOS-ko-pee), andmechanical ventilation.

Sometimes the cause of a pneumothorax isn't known.

The most common symptoms of a pneumothorax are sudden pain in one side of the lung and shortness of breath. The air or gas in the pleural space also can put pressure on the lung and cause it to collapse.

Pleurisy and Pneumothorax

A small pneumothorax may go away without treatment. A large pneumothorax may require a procedure to remove air or gas from the pleural space.

A very large pneumothorax can interfere with blood flow through your chest and cause your blood pressure to drop. This is called a tension pneumothorax.

Pleural Effusion

In some cases of pleurisy, excess fluid builds up in the pleural space. This is called a pleural effusion. A lot of extra fluid can push the pleura against your lung until the lung, or part of it, collapses. This can make it hard for you to breathe.

Sometimes the extra fluid gets infected and turns into an abscess. When this happens, it's called an empyema (em-pi-E-ma).

You can develop a pleural effusion even if you don't have pleurisy. For example,pneumonia, (nu-MO-ne-ah),heart failure, cancer, or pulmonary embolism (PULL-mun-ary EM-bo-lizm) can lead to a pleural effusion.

Hemothorax

Blood also can build up in the pleural space. This condition is called a hemothorax (he-mo-THOR-aks). An injury to your chest, chest or heart surgery, or lung or pleural cancer can cause a hemothorax.

A hemothorax can put pressure on the lung and cause it to collapse. A hemothorax also can cause shock. In shock, not enough blood and oxygen reach your body's vital organs.

Outlook

Pleurisy and other pleural disorders can be serious, depending on their causes. If the condition that caused the pleurisy or other pleural disorder isn't too serious and is diagnosed and treated early, you usually can expect a full recovery. </s>


Input: What causes Pleurisy and Other Pleural Disorders ?

Output:
Pleurisy

Many conditions can cause pleurisy. Viral infections are likely the most common cause. Other causes of pleurisy include:

Bacterial infections, such as pneumonia (nu-MO-ne-ah) and tuberculosis, and infections from fungi or parasites

Pulmonary embolism, a blood clot that travels through the blood vessels to the lungs

Autoimmune disorders, such as lupus and rheumatoid arthritis

Cancer, such as lung cancer, lymphoma, and mesothelioma (MEZ-o-thee-lee-O-ma)

Chest and heart surgery, especially coronary artery bypass grafting

Lung diseases, such as LAM (lymphangioleiomyomatosis) or asbestosis (as-bes-TO-sis)

Inflammatory bowel disease

Familial Mediterranean fever, an inherited condition that often causes fever and swelling in the abdomen or lungs

Other causes of pleurisy include chest injuries, pancreatitis (an inflamed pancreas), and reactions to certain medicines. Reactions to certain medicines can cause a condition similar to lupus. These medicines include procainamide, hydralazine, and isoniazid.

Sometimes doctors can't find the cause of pleurisy.

Pneumothorax

Lung diseases or acute lung injury can make it more likely that you will develop a pneumothorax (a buildup of air or gas in the pleural space). Such lung diseases may include COPD (chronic obstructive pulmonary disease), tuberculosis, and LAM.

Surgery or a chest injury also may cause a pneumothorax.

You can develop a pneumothorax without having a recognized lung disease or chest injury. This is called a spontaneous pneumothorax. Smoking increases your risk of spontaneous pneumothorax. Having a family history of the condition also increases your risk.

Pleural Effusion

The most common cause of a pleural effusion (a buildup of fluid in the pleural space) is heart failure. Lung cancer, LAM, pneumonia, tuberculosis, and other lung infections also can lead to a pleural effusion.

Sometimes kidney or liver disease can cause fluid to build up in the pleural space. Asbestosis, sarcoidosis (sar-koy-DO-sis), and reactions to some medicines also can lead to a pleural effusion.

Hemothorax

An injury to the chest, chest or heart surgery, or lung or pleural cancer can cause a hemothorax (buildup of blood in the pleural space).

A hemothorax also can be a complication of an infection (for example, pneumonia), tuberculosis, or a spontaneous pneumothorax. </s>


Input: What are the symptoms of Pleurisy and Other Pleural Disorders ?

Output:
Pleurisy

The main symptom of pleurisy is a sharp or stabbing pain in your chest that gets worse when you breathe in deeply or cough or sneeze.

The pain may stay in one place or it may spread to your shoulders or back. Sometimes the pain becomes a fairly constant dull ache.

Depending on what's causing the pleurisy, you may have other symptoms, such as:

Shortness of breath or rapid, shallow breathing

Coughing

Fever and chills

Unexplained weight loss

Pneumothorax

The symptoms of pneumothorax include:

Sudden, sharp chest pain that gets worse when you breathe in deeply or cough

Shortness of breath

Chest tightness

Easy fatigue (tiredness)

A rapid heart rate

A bluish tint to the skin caused by lack of oxygen

Other symptoms of pneumothorax include flaring of the nostrils; anxiety, stress, and tension; and hypotension (low blood pressure).

Pleural Effusion

Pleural effusion often has no symptoms.

Hemothorax

The symptoms of hemothorax often are similar to those of pneumothorax. They include:

Chest pain

Shortness of breath

Respiratory failure

A rapid heart rate

Anxiety

Restlessness </s>


Input: How to diagnose Pleurisy and Other Pleural Disorders ?

Output:
Your doctor will diagnose pleurisy or another pleural disorder based on your medical history, a physical exam, and test results.

Your doctor will want to rule out other causes of your symptoms. He or she also will want to find the underlying cause of the pleurisy or other pleural disorder so it can be treated.

Medical History

Your doctor may ask detailed questions about your medical history. He or she likely will ask you to describe any pain, especially:

What it feels like

Where it's located and whether you can feel it in your arms, jaw, or shoulders

When it started and whether it goes away and then comes back

What makes it better or worse

Your doctor also may ask whether you have other symptoms, such as shortness of breath, coughing, or palpitations. Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or fast.

Your doctor also may ask whether you've ever:

Had heart disease.

Smoked.

Traveled to places where you may have been exposed to tuberculosis.

Had a job that exposed you to asbestos. Asbestos is a mineral that, at one time, was widely used in many industries.

Your doctor also may ask about medicines you take or have taken. Reactions to some medicines can cause pleurisy or other pleural disorders.

Physical Exam

Your doctor will listen to your breathing with a stethoscope to find out whether your lungs are making any abnormal sounds.

If you have pleurisy, the inflamed layers of the pleura make a rough, scratchy sound as they rub against each other when you breathe. Doctors call this a pleural friction rub. If your doctor hears the friction rub, he or she will know that you have pleurisy.

If you have a pleural effusion, fluid buildup in the pleural space will prevent a friction rub. But if you have a lot of fluid, your doctor may hear a dull sound when he or she taps on your chest. Or, he or she may have trouble hearing any breathing sounds.

Muffled or dull breathing sounds also can be a sign of a pneumothorax (a buildup of air or gas in the pleural space).

Diagnostic Tests

Depending on the results of your physical exam, your doctor may recommend tests.

Chest X Ray

Achest x rayis a painless test that creates a picture of the structures in your chest, such as your heart, lungs, and blood vessels. This test may show air or fluid in the pleural space.

A chest x ray also may show what's causing a pleural disorderfor example, pneumonia, a fractured rib, or a lung tumor.

Sometimes a chest x ray is taken while you lie on your side. This position can show fluid that didn't appear on an x ray taken while you were standing.

Chest CT Scan

A chest computed tomography (to-MOG-rah-fee) scan, orchest CT scan,is a painless test that creates precise pictures of the structures in your chest.

This test provides a computer-generated picture of your lungs that can show pockets of fluid. A chest CT scan also may show signs of pneumonia, a lung abscess, a tumor, or other possible causes of pleural disorders.

Ultrasound

This test uses sound waves to create pictures of your lungs. An ultrasound may show where fluid is located in your chest. The test also can show some tumors.

Chest MRI

A chest magnetic resonance imaging scan, orchest MRI,uses radio waves, magnets, and a computer to created detailed pictures of the structures in your chest. This test can show pleural effusions and tumors.

This test also is called a magnetic resonance (MR) scan or a nuclear magnetic resonance (NMR) scan.

Blood Tests

Blood testscan show whether you have an illness that increases your risk of pleurisy or another pleural disorder. Such illnesses include bacterial or viral infections, pneumonia, pancreatitis (an inflamed pancreas), kidney disease, or lupus.

Arterial Blood Gas Test

For this test, a blood sample is taken from an artery, usually in your wrist. The blood's oxygen and carbon dioxide levels are checked. This test shows how well your lungs are taking in oxygen.

Thoracentesis

Once your doctor knows whether fluid has built up in the pleural space and where it is, he or she can remove a sample for testing. This is done using a procedure calledthoracentesis(THOR-ah-sen-TE-sis).

During the procedure, your doctor inserts a thin needle or plastic tube into the pleural space and draws out the excess fluid. After the fluid is removed from your chest, it's sent for testing.

The risks of thoracentesissuch as pain, bleeding, and infectionusually are minor. They get better on their own, or they're easily treated. Your doctor may do a chest x ray after the procedure to check for complications.

Fluid Analysis

The fluid removed during thoracentesis is examined under a microscope. It's checked for signs of infection, cancer, or other conditions that can cause fluid or blood to build up in the pleural space.

Biopsy

Your doctor may suspect that tuberculosis or cancer has caused fluid to build up in your pleural space. If so, he or she may want to look at a small piece of the pleura under a microscope.

To take a tissue sample, your doctor may do one of the following procedures:

Insert a needle into your chest to remove a small sample of the pleura's outer layer.

Insert a tube with a light on the end (endoscope) into tiny cuts in your chest wall so that he or she can see the pleura. Your doctor can then snip out small pieces of tissue. This procedure must be done in a hospital. You'll be given medicine to make you sleep during the procedure.

Snip out a sample of the pleura through a small cut in your chest wall. This is called an open pleural biopsy. It's usually done if the sample from the needle biopsy is too small for an accurate diagnosis. This procedure must be done in a hospital. You'll be given medicine to make you sleep during the procedure. </s>


Input: What are the treatments for Pleurisy and Other Pleural Disorders ?

Output:
Pleurisy and other pleural disorders are treated with procedures, medicines, and other methods. The goals of treatment include:

Relieving symptoms

Removing the fluid, air, or blood from the pleural space (if a large amount is present)

Treating the underlying condition

Relieving Symptoms

To relieve pleurisy symptoms, your doctor may recommend:

Acetaminophen or anti-inflammatory medicines (such as ibuprofen) to control pain.

Codeine-based cough syrups to controlcoughing.

Lying on your painful side. This might make you more comfortable.

Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, you may developpneumonia.

Getting plenty of rest.

Removing Fluid, Air, or Blood From the Pleural Space

Your doctor may recommend removing fluid, air, or blood from your pleural space to prevent a lung collapse.

The procedures used to drain fluid, air, or blood from the pleural space are similar.

Duringthoracentesis, your doctor will insert a thin needle or plastic tube into the pleural space. An attached syringe will draw fluid out of your chest. This procedure can remove more than 6 cups of fluid at a time.

If your doctor needs to remove a lot of fluid, he or she may use a chest tube. Your doctor will inject a painkiller into the area of your chest wall where the fluid is. He or she will then insert a plastic tube into your chest between two ribs. The tube will be connected to a box that suctions out the fluid. Your doctor will use achest x ray to check the tube's position.

Your doctor also can use a chest tube to drain blood and air from the pleural space. This process can take several days. The tube will be left in place, and you'll likely stay in the hospital during this time.

Sometimes the fluid in the pleural space contains thick pus or blood clots. It may form a hard skin or peel, which makes the fluid harder to drain. To help break up the pus or blood clots, your doctor may use a chest tube to deliver medicines called fibrinolytics to the pleural space. If the fluid still won't drain, you may need surgery.

If you have a small, persistent air leak into the pleural space, your doctor may attach a one-way valve to the chest tube. The valve allows air to exit the pleural space, but not reenter. Using this type of valve may allow you to continue your treatment from home.

Treat the Underlying Condition

The fluid sample that was removed during thoracentesis will be checked under a microscope. This can tell your doctor what's causing the fluid buildup, and he or she can decide the best way to treat it.

If the fluid is infected, treatment will involve antibiotics and drainage. If you have tuberculosis or a fungal infection, treatment will involve long-term use of antibiotics or antifungal medicines.

If tumors in the pleura are causing fluid buildup, the fluid may quickly build up again after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, your doctor may seal the pleural space. Sealing the pleural space is called pleurodesis (plur-OD-eh-sis).

For this procedure, your doctor will drain all of the fluid out of your chest through a chest tube. Then he or she will push a substance through the chest tube into the pleural space. The substance will irritate the surface of the pleura. This will cause the two layers of the pleura to stick together, preventing more fluid from building up.

Chemotherapy or radiation treatment also may be used to reduce the size of the tumors.

Ifheart failureis causing fluid buildup, treatment usually includes diuretics (medicines that help reduce fluid buildup) and other medicines. </s>


Input: What is (are) Thrombocythemia and Thrombocytosis ?

Output:
Thrombocythemia (THROM-bo-si-THE-me-ah) and thrombocytosis (THROM-bo-si-TO-sis) are conditions in which your blood has a higher than normal number of platelets (PLATE-lets).

Platelets are blood cell fragments. They're made in your bone marrow along with other kinds of blood cells.

Platelets travel through your blood vessels and stick together (clot). Clotting helps stop any bleeding that may occur if a blood vessel is damaged. Platelets also are called thrombocytes (THROM-bo-sites) because a blood clot also is called a thrombus.

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.

Overview

The term "thrombocythemia" is preferred when the cause of a high platelet count isn't known. The condition sometimes is called primary or essential thrombocythemia.

This condition occurs if faulty cells in the bone marrow make too many platelets. Bone marrow is the sponge-like tissue inside the bones. It contains stem cells that develop into red blood cells, white blood cells, and platelets. What causes the bone marrow to make too many platelets often isn't known.

With primary thrombocythemia, a high platelet count may occur alone or with other blood cell disorders. This condition isn't common.

When another disease or condition causes a high platelet count, the term "thrombocytosis" is preferred. This condition often is called secondary or reactive thrombocytosis. Secondary thrombocytosis is more common than primary thrombocythemia.

Often, a high platelet count doesn't cause signs or symptoms. Rarely, serious or life-threatening symptoms can develop, such as blood clots and bleeding. These symptoms are more likely to occur in people who have primary thrombocythemia.

Outlook

People who have primary thrombocythemia with no signs or symptoms don't need treatment, as long as the condition remains stable.

Other people who have this condition may need medicines or procedures to treat it. Most people who have primary thrombocythemia will live a normal lifespan.

Treatment and outlook for secondary thrombocytosis depend on its underlying cause. </s>


Input: What causes Thrombocythemia and Thrombocytosis ?

Output:
Primary Thrombocythemia

In this condition, faulty stem cells in the bone marrow make too many platelets. What causes this to happen usually isn't known. When this process occurs without other blood cell disorders, it's called essential thrombocythemia.

A rare form of thrombocythemia is inherited. ("Inherited" means the condition is passed from parents to children through the genes.) In some cases, a genetic mutation may cause the condition.

In addition to the bone marrow making too many platelets, the platelets also are abnormal in primary thrombocythemia. They may form blood clots or, surprisingly, cause bleeding when they don't work well.

Bleeding also can occur because of a condition that develops called von Willebrand disease. This condition affects the blood clotting process.

After many years, scarring of the bone marrow can occur.

Secondary Thrombocytosis

This condition occurs if another disease, condition, or outside factor causes the platelet count to rise. For example, 35 percent of people who have high platelet counts also have cancermostly lung, gastrointestinal, breast, ovarian, and lymphoma. Sometimes a high platelet count is the first sign of cancer.

Other conditions or factors that can cause a high platelet count are:

Iron-deficiency anemia (uh-NEE-me-uh)

Hemolytic (HEE-moh-lit-ick) anemia

Absence of a spleen (after surgery to remove the organ)

Inflammatory or infectious diseases, such as connective tissue disorders, inflammatory bowel disease, and tuberculosis

Reactions to medicine

Some conditions can lead to a high platelet count that lasts for only a short time. Examples of such conditions include:

Recovery from serious blood loss

Recovery from a very low platelet count caused by excessive alcohol use and lack of vitamin B12 or folate

Acute (short-term) infection or inflammation

Response to physical activity

Although the platelet count is high in secondary thrombocytosis, the platelets are normal (unlike in primary thrombocythemia). Thus, people who have secondary thrombocytosis have a lower risk of blood clots and bleeding. </s>


Input: Who is at risk for Thrombocythemia and Thrombocytosis? ?

Output:
Primary Thrombocythemia

Thrombocythemia isn't common. The exact number of people who have the condition isn't known. Some estimates suggest that 24 out of every 100,000 people have primary thrombocythemia.

Primary thrombocythemia is more common in people aged 50 to 70, but it can occur at any age. For unknown reasons, more women around the age of 30 have primary thrombocythemia than men of the same age.

Secondary Thrombocytosis

You might be at risk for secondary thrombocytosis if you have a disease, condition, or factor that can cause it. (For more information, go to "What Causes Thrombocythemia and Thrombocytosis?")

Secondary thrombocytosis is more common than primary thrombocythemia. Studies have shown that most people who have platelet counts over 500,000 have secondary thrombocytosis. </s>


Input: What are the symptoms of Thrombocythemia and Thrombocytosis ?

Output:
People who have thrombocythemia or thrombocytosis may not have signs or symptoms. These conditions might be discovered only after routine blood tests.

However, people who have primary thrombocythemia are more likely than those who have secondary thrombocytosis to have serious signs and symptoms.

The signs and symptoms of a high platelet count are linked to blood clots and bleeding. They include weakness, bleeding, headache, dizziness, chest pain, and tingling in the hands and feet.

Blood Clots

In primary thrombocythemia, blood clots most often develop in the brain, hands, and feet. But they can develop anywhere in the body, including in the heart and intestines.

Blood clots in the brain may cause symptoms such as chronic (ongoing) headache and dizziness. In extreme cases, stroke may occur.

Blood clots in the tiny blood vessels of the hands and feet leave them numb and red. This may lead to an intense burning and throbbing pain felt mainly on the palms of the hands and the soles of the feet.

Other signs and symptoms of blood clots may include:

Changes in speech or awareness, ranging from confusion to passing out

Seizures

Upper body discomfort in one or both arms, the back, neck, jaw, or abdomen

Shortness of breath and nausea (feeling sick to your stomach)

In pregnant women, blood clots in the placenta can cause miscarriage or problems with fetal growth and development.

Women who have primary thrombocythemia or secondary thrombocytosis and take birth control pills are at increased risk for blood clots.

Blood clots are related to other conditions and factors as well. Older age, prior blood clots, diabetes, high blood pressure, and smoking also increase your risk for blood clots.

Bleeding

If bleeding occurs, it most often affects people who have platelet counts higher than 1million platelets per microliter of blood. Signs of bleeding include nosebleeds, bruising, bleeding from the mouth or gums, or blood in the stools.

Although bleeding usually is associated with a low platelet count, it also can occur in people who have high platelet counts. Blood clots that develop in thrombocythemia or thrombocytosis may use up your body's platelets. This means that not enough platelets are left in your bloodstream to seal off cuts or breaks on the blood vessel walls.

Another cause of bleeding in people who have very high platelets counts is a condition called von Willebrand Disease. This condition affects the blood clotting process.

In rare cases of primary thrombocythemia, the faulty bone marrow cells will cause a form of leukemia (lu-KE-me-ah). Leukemia is a cancer of the blood cells. </s>


Input: How to diagnose Thrombocythemia and Thrombocytosis ?

Output:
Your doctor will diagnose thrombocythemia or thrombocytosis based on your medical history, a physical exam, and test results. A hematologist also may be involved in your care. This is a doctor who specializes in blood diseases and conditions.

Medical History

Your doctor may ask you about factors that can affect your platelets, such as:

Any medical procedures or blood transfusions you've had

Any recent infections or vaccines you've had

The medicines you take, including over-the-counter medicines

Your general eating habits, including the amount of alcohol you normally drink

Any family history of high platelet counts

Physical Exam

Your doctor will do a physical exam to look for signs and symptoms of blood clots and bleeding. He or she also will check for signs of conditions that can cause secondary thrombocytosis, such as an infection.

Primary thrombocythemia is diagnosed only after all possible causes of a high platelet count are ruled out. For example, your doctor may recommend tests to check for early, undiagnosed cancer. If another disease, condition, or factor is causing a high platelet count, the diagnosis is secondary thrombocytosis.

Diagnostic Tests

Your doctor may recommend one or more of the following tests to help diagnose a high platelet count.

Complete Blood Count

A complete blood count (CBC) measures the levels of red blood cells, white blood cells, and platelets in your blood. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm.

If you have thrombocythemia or thrombocytosis, the CBC results will show that your platelet count is high.

Blood Smear

A blood smear is used to check the condition of your platelets. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm. Some of your blood is put on a glass slide. A microscope is then used to look at your platelets.

Bone Marrow Tests

Bone marrow tests check whether your bone marrow is healthy. Blood cells, including platelets, are made in the bone marrow. The two bone marrow tests are aspiration (as-pih-RA-shun) and biopsy.

Bone marrow aspiration might be done to find out whether your bone marrow is making too many platelets. For this test, your doctor removes a sample of fluid bone marrow through a needle. He or she examines the sample under a microscope to check for faulty cells.

A bone marrow biopsy often is done right after an aspiration. For this test, your doctor removes a small amount of bone marrow tissue through a needle. He or she examines the tissue to check the number and types of cells in the bone marrow.

With thrombocythemia and thrombocytosis, the bone marrow has a higher than normal number of the very large cells that make platelets.

Other Tests

Your doctor may recommend other blood tests to look for genetic factors that can cause a high platelet count. </s>


Input: What are the treatments for Thrombocythemia and Thrombocytosis ?

Output:
Primary Thrombocythemia

This condition is considered less harmful today than in the past, and its outlook often is good. People who have no signs or symptoms don't need treatment, as long as the condition remains stable.

Taking aspirin may help people who are at risk for blood clots (aspirin thins the blood). However, talk with your doctor about using aspirin because it can cause bleeding.

Doctors prescribe aspirin to most pregnant women who have primary thrombocythemia. This is because it doesn't have a high risk of side effects for the fetus.

Some people who have primary thrombocythemia may need medicines or medical procedures to lower their platelet counts.

Medicines To Lower Platelet Counts

You may need medicines to lower your platelet count if you:

Have a history of blood clots or bleeding

Have risk factors for heart disease, such as high blood cholesterol, high blood pressure, or diabetes

Are older than 60

Have a platelet count over 1 million

You'll need to take these medicines throughout your life.

Hydroxyurea. This platelet-lowering medicine is used to treat cancers and other life-threatening diseases. Hydroxyurea most often is given under the care of doctors who specialize in cancer or blood diseases. Patients on hydroxyurea are closely monitored.

Currently, hydroxyurea plus aspirin is the standard treatment for people who have primary thrombocythemia and are at high risk for blood clots.

Anagrelide. This medicine also has been used to lower platelet counts in people who have thrombocythemia. However, research shows that when compared with hydroxyurea, anagrelide has worse outcomes. Anagrelide also has side effects, such as fluid retention, palpitations (pal-pih-TA-shuns), arrhythmias (ah-RITH-me-ahs), heart failure, and headaches.

Interferon alfa. This medicine lowers platelet counts, but 20 percent of patients can't handle its side effects. Side effects include a flu-like feeling, decreased appetite, nausea (feeling sick to the stomach), diarrhea, seizures, irritability, and sleepiness.

Doctors may prescribe this medicine to pregnant women who have primary thrombocythemia because it's safer for a fetus than hydroxyurea and anagrelide.

Plateletpheresis

Plateletpheresis (PLATE-let-fe-REH-sis) is a procedure used to rapidly lower your platelet count. This procedure is used only for emergencies. For example, if you're having a stroke due to primary thrombocythemia, you may need plateletpheresis.

An intravenous (IV) needle that's connected to a tube is placed in one of your blood vessels to remove blood. The blood goes through a machine that removes platelets from the blood. The remaining blood is then put back into you through an IV line in one of your blood vessels.

One or two procedures might be enough to reduce your platelet count to a safe level.

Secondary Thrombocytosis

Secondary thrombocytosis is treated by addressing the condition that's causing it.

People who have secondary thrombocytosis usually don't need platelet-lowering medicines or procedures. This is because their platelets usually are normal (unlike in primary thrombocythemia).

Also, secondary thrombocytosis is less likely than primary thrombocythemia to cause serious problems related to blood clots and bleeding. </s>


Input: How to prevent Thrombocythemia and Thrombocytosis ?

Output:
You can't prevent primary thrombocythemia. However, you can take steps to reduce your risk for complications. For example, you can control many of the risk factors for blood clots, such as high blood cholesterol, high blood pressure, diabetes, and smoking.

To reduce your risk, quit smoking, adopt healthy lifestyle habits, and work with your doctor to manage your risk factors.

It's not always possible to prevent conditions that lead to secondary thrombocytosis. But, if you have routine medical care, your doctor may detect these conditions before you develop a high platelet count. </s>


Input: What is (are) Hemochromatosis ?

Output:
Hemochromatosis (HE-mo-kro-ma-TO-sis) is a disease in which too much iron builds up in your body (iron overload). Iron is a mineral found in many foods.

Too much iron is toxic to your body. It can poison your organs and cause organ failure. In hemochromatosis, iron can build up in most of your body's organs, but especially in the liver, heart, and pancreas.

Too much iron in the liver can cause an enlarged liver, liver failure, liver cancer, or cirrhosis (sir-RO-sis). Cirrhosis is scarring of the liver, which causes the organ to not work well.

Too much iron in the heart can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs) and heart failure. Too much iron in the pancreas can lead to diabetes.

If hemochromatosis isn't treated, it may even cause death.

Overview

The two types of hemochromatosis are primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron you absorb from food. Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload.

Most people who have primary hemochromatosis inherit it from their parents. If you inherit two hemochromatosis genesone from each parentyou're at risk for iron overload and signs and symptoms of the disease. The two faulty genes cause your body to absorb more iron than usual from the foods you eat.

Hemochromatosis is one of the most common genetic disorders in the United States. However, not everyone who has hemochromatosis has signs or symptoms of the disease.

Estimates of how many people develop signs and symptoms vary greatly. Some estimates suggest that as many as half of all people who have the disease don't have signs or symptoms.

The severity of hemochromatosis also varies. Some people don't have complications, even with high levels of iron in their bodies. Others have severe complications or die from the disease.

Certain factors can affect the severity of the disease. For example, a high intake of vitamin C can make hemochromatosis worse. This is because vitamin C helps your body absorb iron from food.

Alcohol use can worsen liver damage and cirrhosis caused by hemochromatosis. Conditions such as hepatitis also can further damage or weaken the liver.

Outlook

The outlook for people who have hemochromatosis largely depends on how much organ damage they have at the time of diagnosis. Early diagnosis and treatment of the disease are important.

Treatment may help prevent, delay, or sometimes reverse complications of the disease. Treatment also may lead to better quality of life.

For people who are diagnosed and treated early, a normal lifespan is possible. If left untreated, hemochromatosis can lead to severe organ damage and even death. </s>


Input: What causes Hemochromatosis ?

Output:
The two types of hemochromatosis are primary and secondary. Each type has a different cause.

Primary Hemochromatosis

Primary hemochromatosis is caused by a defect in the genes that control how much iron you absorb from food. This form of the disease sometimes is called hereditary or classical hemochromatosis. Primary hemochromatosis is more common than the secondary form of the disease.

The genes usually involved in primary hemochromatosis are called HFE genes. Faulty HFE genes cause the body to absorb too much iron. If you inherit two copies of the faulty HFE gene (one from each parent), you're at risk for iron overload and signs and symptoms of hemochromatosis.

If you inherit one faulty HFE gene and one normal HFE gene, you're a hemochromatosis "carrier." Carriers usually don't develop the disease. However, they can pass the faulty gene on to their children. Estimates suggest that about 1 in 10 people in the United States are hemochromatosis carriers.

If two parents are carriers of the faulty HFE gene, then each of their children has a 1 in 4 chance of inheriting two faulty HFE genes.

Although less common, other faulty genes also can cause hemochromatosis. Researchers continue to study what changes to normal genes may cause the disease.

Secondary Hemochromatosis

Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload. Examples of such diseases and conditions include:

Certain types of anemia, such as thalassemias and sideroblastic anemia

Atransferrinemia and aceruloplasminemiaboth are rare, inherited diseases

Chronic liver diseases, such as chronic hepatitis C infection, alcoholic liver disease, or nonalcoholic steatohepatitis

Other factors also can cause secondary hemochromatosis, including:

Blood transfusions

Oral iron pills or iron injections, with or without very high vitamin C intake (vitamin C helps your body absorb iron)

Long-term kidney dialysis </s>


Input: Who is at risk for Hemochromatosis? ?

Output:
Hemochromatosis is one of the most common genetic diseases in the United States. It's most common in Caucasians of Northern European descent. The disease is less common in African Americans, Hispanics, Asians, and American Indians.

Primary hemochromatosis is more common in men than in women. Also, older people are more likely to develop the disease than younger people. In fact, signs and symptoms usually don't occur in men until they're 40 to 60 years old.

In women, signs and symptoms usually don't occur until after the age of 50 (after menopause). Young children rarely develop hemochromatosis.

Inheriting two faulty HFE genes (one from each parent) is the major risk factor for hemochromatosis. However, many people who have two copies of the faulty gene don't develop signs or symptoms of the disease.

Alcoholism is another risk factor for hemochromatosis. A family history of certain diseases and conditions also puts you at higher risk for hemochromatosis. Examples of such diseases and conditions include heart attack, liver disease, diabetes, arthritis, and erectile dysfunction (impotence). </s>


Input: What are the symptoms of Hemochromatosis ?

Output:
Hemochromatosis can affect many parts of the body and cause various signs and symptoms. Many of the signs and symptoms are similar to those of other diseases.

Signs and symptoms of hemochromatosis usually don't occur until middle age. Women are more likely to have general symptoms first, such as fatigue (tiredness). In men, complications such as diabetes or cirrhosis (scarring of the liver) often are the first signs of the disease.

Signs and symptoms also vary based on the severity of the disease. Common signs and symptoms of hemochromatosis include joint pain, fatigue, general weakness, weight loss, and stomach pain.

Not everyone who has hemochromatosis has signs or symptoms of the disease. Estimates of how many people develop signs and symptoms vary greatly. Some estimates suggest that as many as half of all people who have the disease don't have signs or symptoms.

Hemochromatosis Complications

If hemochromatosis isn't found and treated early, iron builds up in your body and can lead to:

Liver disease, including an enlarged liver, liver failure, liver cancer, or cirrhosis (scarring of the liver)

Heart problems, including arrhythmias (irregular heartbeats) and heart failure

Diabetes, especially in people who have a family history of diabetes

Joint damage and pain, including arthritis

Reproductive organ failure, such as erectile dysfunction (impotence), shrinkage of the testicles, and loss of sex drive in men, and absence of the menstrual cycle and early menopause in women

Changes in skin color that make the skin look gray or bronze

Underactive pituitary and thyroid glands

Damage to the adrenal glands </s>


Input: How to diagnose Hemochromatosis ?

Output:
Your doctor will diagnose hemochromatosis based on your medical and family histories, a physical exam, and the results from tests and procedures.

The disease sometimes is detected while checking for other diseases or conditions, such as arthritis, liver disease, diabetes, heart disease, or erectile dysfunction (impotence).

Specialists Involved

Family doctors and internal medicine specialists may diagnose and treat hemochromatosis. Other doctors also may be involved in diagnosing and treating the disease, including:

Hematologists (blood disease specialists)

Cardiologists (heart specialists)

Endocrinologists (gland system specialists)

Hepatologists (liver specialists)

Gastroenterologists (digestive tract specialists)

Rheumatologists (specialists in diseases of the joints and tissues)

Medical and Family Histories

To learn about your medical and family histories, your doctor may ask:

About your signs and symptoms, including when they started and their severity.

Whether you take iron (pills or injections) with or without vitamin C supplements (vitamin C helps your body absorb iron from food). If so, your doctor may ask how much iron you take. This information can help him or her diagnose secondary hemochromatosis.

Whether other members of your family have hemochromatosis.

Whether other members of your family have a history of medical problems or diseases related to hemochromatosis.

Physical Exam

Your doctor will do a physical exam to check for signs and symptoms of hemochromatosis. He or she will listen to your heart for irregular heartbeats and check for arthritis, abnormal skin color, and an enlarged liver.

Diagnostic Tests and Procedures

Your doctor may recommend one or more tests or procedures to diagnose hemochromatosis.

Blood Tests

In hemochromatosis, the amount of iron in your body may be too high, even though the level of iron in your blood is normal. Certain blood tests can help your doctor find out how much iron is in your body.

During these tests, a sample of blood is taken from your body. It's usually drawn from a vein in your arm using a needle. The procedure usually is quick and easy, although it may cause some short-term discomfort.

The blood tests you have may include transferrin saturation (TS), serum ferritin level, and liver function tests.

Transferrin is a protein that carries iron in the blood. The TS test shows how much iron the transferrin is carrying. This helps your doctor find out how much iron is in your body.

Your doctor may test your serum ferritin level if your TS level is high. A serum ferritin level test shows how much iron is stored in your body's organs. A buildup of iron may suggest hemochromatosis.

You may have liver function tests to check for damage to your liver. Liver damage may be a sign of hemochromatosis. If you have hemochromatosis, liver function tests may show the severity of the disease.

Blood tests alone can't diagnose hemochromatosis. Thus, your doctor may recommend other tests as well.

Liver Biopsy

During a liver biopsy, your doctor numbs an area near your liver and then removes a small sample of liver tissue using a needle. The tissue is then looked at under a microscope.

A liver biopsy can show how much iron is in your liver. This procedure also can help your doctor diagnose liver damage (for example, scarring and cancer). Liver biopsies are less common now than in the past.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a safe test that uses radio waves, magnets, and a computer to create pictures of your organs. An MRI may be done to show the amount of iron in your liver.

Superconducting Quantum Interference Device

A superconducting quantum interference device (SQuID) is a machine that uses very sensitive magnets to measure the amount of iron in your liver. This machine is available at only a few medical centers.

Genetic Testing

Genetic testing can show whether you have a faulty HFE gene or genes. However, even if you do have two faulty HFE genes, the genetic test can't predict whether you'll develop signs and symptoms of hemochromatosis.

Also, genetic testing may not detect other, less common faulty genes that also can cause hemochromatosis.

There are two ways to do genetic testing. Cells can be collected from inside your mouth using a cotton swab, or a sample of blood can be drawn from a vein in your arm.

People who have hemochromatosis (or a family history of it) and are planning to have children may want to consider genetic testing and counseling. Testing will help show whether one or both parents have faulty HFE genes. A genetic counselor also can help figure out the likelihood of the parents passing the faulty genes on to their children. </s>