History
Dr. William Heberden is credited with being the first to describe in a 1768 publication the occurrence of chest pain attacks (i.e. angina pectoris) that appeared due to pathologically occluded coronary arteries. These attacks were triggered by exercise or other forms of exertion and relieved by rest and nitroglycerin. In 1959, Dr. Myron Prinzmetal described a type of angina that differed from the classic cases of Heberden angina in that it commonly occurred in the absence of exercise or exertion. Indeed, it often woke patients from their normal sleep. This variant angina differed from the classical angina described by Dr. Heberden in that it appeared due to episodic vasospasm of coronary arteries that were typically not occluded by pathological processes such as atherosclerosis, emboli, or spontaneous dissection (i.e. tears in the walls of coronary arteries). Variant angina had been described twice in the 1930s by other authors and was referred to as cardiac syndrome X (CSX) by Kemp in 1973, in reference to patients with exercise-induced angina who nonetheless had normal coronary angiograms. CSX is now termed microvascular angina, i.e. angina caused by disease of the hearts small arteries.Some key features of variant angina are chest pain that is concurrently associated with elevations in the ST segment on electrocardiography recordings, that often occurs during the late evening or early morning hours in individuals who are at rest, doing non-strenuous activities, or asleep, and that is not associated with permanent occlusions of their coronary vessels.
As the first part of the worm emerges, it is typically wrapped around a piece of gauze or a stick to maintain steady tension on the worm, encouraging its exit. Each day, several centimeters of the worm emerge from the blister, and the stick is wound to maintain tension. This is repeated daily until the full worm emerges, typically within a month. If too much pressure is applied at any point, the worm can break and die, leading to severe swelling and pain at the site of the ulcer.Treatment for dracunculiasis also tends to include regular wound care to avoid infection of the open ulcer while the worm is leaving. The U.S. Centers for Disease Control and Prevention (CDC) recommends cleaning the wound before the worm emerges. Once the worm begins to exit the body, the CDC recommends daily wound care: cleaning the wound, applying antibiotic ointment, and replacing the bandage with fresh gauze. Painkillers like aspirin or ibuprofen can help ease the pain of the worms exit. Outcomes
Dracunculiasis is a debilitating disease, causing substantial disability in around half of those infected. People with worms emerging can be disabled for the three to ten weeks it takes the worms to fully emerge. When worms emerge near joints, the inflammation around a dead worm, or infection of the open wound can result in permanent stiffness, pain, or destruction of the joint. Some people with dracunculiasis have continuing pain for 12 to 18 months after the worm has emerged.