vasculature

Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.

Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

NIH: National Heart, Lung, and Blood Institute

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein clots occur in the lower leg or thigh. If the vein swells, the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem in the lung, called a pulmonary embolism.

Sitting still for a long time can make you more likely to get a DVT. Some medicines and disorders that increase your risk for blood clots can also lead to DVTs. Common symptoms are :

• Warmth and tenderness over the vein
• Pain or swelling in the part of the body affected
• Skin redness

Treatment includes medicines to ease pain and inflammation, break up clots and keep new clots from forming. Keeping the affected area raised and applying moist heat can also help. If you are taking a long car or plane trip, take a break, walk or stretch your legs and drink plenty of liquids.

Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder which interferes with your daily life.

The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include:

• Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
• Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
• Frontotemporal disorders, which cause changes to certain parts of the brain:
  • Changes in the frontal lobe lead to behavioral symptoms
  • Changes in the temporal lobe lead to language and emotional disorders
• Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
• Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Other conditions can cause dementia or dementia-like symptoms, including:

• Creutzfeldt-Jakob disease, a rare brain disorder
• Huntington's disease, an inherited, progressive brain disease
• Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
• HIV-associated dementia (HAD)

Certain factors can raise your risk for developing dementia, including:

• Aging. This is the biggest risk factor for dementia.
• Smoking
• Uncontrolled diabetes
• High blood pressure
• Drinking too much alcohol
• Having close family members who have dementia

The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may:

• Get lost in a familiar neighborhood
• Use unusual words to refer to familiar objects
• Forget the name of a close family member or friend
• Forget old memories
• Need help doing tasks that they used to do by themselves

Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.

Certain types of dementia can also cause problems with balance and movement.

The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Tests of your thinking, memory, and language abilities
• Other tests, such as blood tests, genetic tests, and brain scans
• A mental health evaluation to see whether a mental disorder is contributing to your symptoms

There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include:

• Medicines may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
• Occupational therapy to help find ways to more easily do everyday activities
• Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy to reduce anxiety and improve well-being

Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.

Some eye problems are minor and don't last long. But some can lead to a permanent loss of vision.

Common eye problems include:

• Refractive errors
• Cataracts - clouded lenses
• Optic nerve disorders, including glaucoma
• Retinal disorders - problems with the nerve layer at the back of the eye
• Macular degeneration - a disease that destroys sharp, central vision
• Diabetic eye problems
• Conjunctivitis - an infection also known as pink eye

Your best defense is to have regular checkups, because eye diseases do not always have symptoms. Early detection and treatment could prevent vision loss. See an eye care professional right away if you have a sudden change in vision, if everything looks dim, or if you see flashes of light. Other symptoms that need quick attention are pain, double vision, fluid coming from the eye, and inflammation.

NIH: National Eye Institute

Gangrene is the death of tissues in your body. It happens when a part of your body loses its blood supply. Gangrene can happen on the surface of the body, such as on the skin, or inside the body, in muscles or organs. Causes include:

• Serious injuries
• Problems with blood circulation, such as atherosclerosis and peripheral arterial disease
• Diabetes

Skin symptoms may include a blue or black color, pain, numbness, and sores that produce a foul-smelling discharge. If the gangrene is internal, you may run a fever and feel unwell, and the area may be swollen and painful.

Gangrene is a serious condition. It needs immediate attention. Treatment includes surgery, antibiotics, and oxygen therapy. In severe cases an amputation may be necessary.

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hepatitis is inflammation of the liver. Inflammation is swelling that happens when tissues of the body are injured or infected. Inflammation can damage organs.

There are different types of hepatitis. One type, hepatitis C, is caused by the hepatitis C virus (HCV). Hepatitis C can range from a mild illness lasting a few weeks to a serious, lifelong illness.

Hepatitis C can be acute or chronic:

• Acute hepatitis C is a short-term infection. The symptoms can last up to 6 months. Sometimes your body is able to fight off the infection and the virus goes away. But for most people, an acute infection leads to chronic infection.
• Chronic hepatitis C is a long-lasting infection. If it is not treated, it can last for a lifetime and cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

Hepatitis C spreads through contact with the blood of someone who has HCV. This contact may be through:

• Sharing drug needles or other drug materials with someone who has HCV. In the United States, this is the most common way that people get hepatitis C.
• Getting an accidental stick with a needle that was used on someone who has HCV. This can happen in health care settings.
• Being tattooed or pierced with tools or inks that were not sterilized after being used on someone who has HCV.
• Having contact with the blood or open sores of someone who has HCV.
• Sharing personal care items that may have come in contact with another person's blood, such as razors or toothbrushes.
• Being born to a mother with HCV.
• Having unprotected sex with someone who has HCV.

Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. Since then, there has been routine testing of the U.S. blood supply for HCV. It is now very rare for someone to get HCV this way.

You are more likely to get hepatitis C if you:

• Have injected drugs
• Had a blood transfusion or organ transplant before July 1992
• Have hemophilia and received clotting factor before 1987
• Have been on kidney dialysis
• Have been in contact with blood or infected needles at work
• Have had tattoos or body piercings
• Have worked or lived in a prison
• Were born to a mother with hepatitis C
• Have HIV
• Have had more than one sex partner in the last 6 months
• Have had a sexually transmitted infection (STI)
• Are a man who has had sex with men (MSM)

If you are at high risk for hepatitis C, your health care provider will likely recommend that you get tested for it.

Most people with hepatitis C have no symptoms. Some people with acute hepatitis C do have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include:

• Dark yellow urine
• Fatigue
• Fever
• Gray- or clay-colored stools
• Joint pain
• Loss of appetite
• Nausea and/or vomiting
• Pain in your abdomen (belly)
• Jaundice (yellowish eyes and skin)

If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.

Without treatment, hepatitis C may lead to cirrhosis, liver failure, and liver cancer. Early diagnosis and treatment of hepatitis C can prevent these complications.

Providers diagnose hepatitis C based on your medical history, a physical exam, and blood tests.

If you do have hepatitis C, you may need additional tests to check for liver damage. These tests may include other blood tests, an ultrasound of the liver, and a liver biopsy.

Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.

If you have acute hepatitis C, your provider may wait to see if your infection becomes chronic before starting treatment.

If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.

There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by:

• Not sharing drug needles or other drug materials.
• Wearing gloves if you have to touch another person's blood or open sores.
• Making sure your tattoo artist or body piercer uses sterile tools and unopened ink.
• Not sharing personal items such toothbrushes, razors, or nail clippers.
• Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the more common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke.

Symptoms of stroke are:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage.

NIH: National Institute of Neurological Disorders and Stroke

Your skin is your body's largest organ. It has many different functions, including covering and protecting your body. It helps keep germs out. But sometimes the germs can cause a skin infection. It often happens when the germs enter your body through a break, cut, or wound on your skin. Other skin infections can happen in places where the skin rubs together, especially if the area is moist. Infections can also happen when you have a poor blood supply to an area of your body or if your immune system is weakened because of another disease or a medical treatment.

Some skin infections cover a small area on the top of your skin. Other infections can go deep into your skin or spread to a larger area.

Skin infections are caused by different kinds of germs. For example,:

• Bacteria cause cellulitis, impetigo, and staphylococcal (staph) infections
• Viruses cause shingles, warts, and herpes simplex
• Fungi cause athlete's foot and yeast infections
• Parasites cause body lice, head lice, and scabies

You are more likely to get a skin infection if you:

• Have poor circulation
• Have diabetes
• Are older
• Have an immune system disease, such as HIV
• Have a weakened immune system because of chemotherapy or other medicines that suppress your immune system
• Have to stay in one position for a long time, such as if you are sick and have to stay in bed for a long time or you are paralyzed
• Are malnourished
• Have excessive skinfolds, which can happen if you have obesity

The symptoms depend on the type of infection. Some symptoms that are common to many skin infections include rashes, swelling, redness, pain, pus, and itching.

To diagnose a skin infection, your health care provider will do a physical exam and ask about your symptoms. You may have lab tests, such as a skin culture. This is a test to identify what type of infection you have, using a sample from your skin. Your provider may take the sample by swabbing or scraping your skin or removing a small piece of skin (biopsy). Sometimes providers use other tests, such as blood tests.

The treatment depends on the type of infection and how serious it is. Some infections will go away on their own. When you do need treatment, it may include a cream or lotion to put on the skin. Other possible treatments include medicines and a procedure to drain pus.

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call 911 right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

There are two types of stroke:

• Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
• Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but if you have had a TIA, you are at a much higher risk of having a stroke.

Certain factors can raise your risk of a stroke. The major risk factors include:

• High blood pressure. This is the primary risk factor for a stroke.
• Diabetes.
• Heart diseases.Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
• Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
• A personal or family history of stroke or TIA.
• Age. Your risk of stroke increases as you get older.
• Race and ethnicity. African Americans have a higher risk of stroke.

There are also other factors that are linked to a higher risk of stroke, such as:

• Alcohol and illegal drug use
• Not getting enough physical activity
• High cholesterol
• Unhealthy diet
• Having obesity

The symptoms of stroke often happen quickly. They include:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking, or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden difficulty walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you think that you or someone else is having a stroke, call 911 right away.

To make a diagnosis, your health care provider will:

• Ask about your symptoms and medical history
• Do a physical exam, including a check of
  • Your mental alertness
  • Your coordination and balance
  • Any numbness or weakness in your face, arms, and legs
  • Any trouble speaking and seeing clearly
• Run some tests, which may include
  • Diagnostic imaging of the brain, such as a CT scan or MRI
  • Heart tests, which can help detect heart problems or blood clots that may have led to a stroke. Possible tests include an electrocardiogram (EKG) and an echocardiography.

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

• Acute treatment, to try to stop a stroke while it is happening
• Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
• Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke

Acute treatments for ischemic stroke are usually medicines:

• You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
• If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
• If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

• If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
• If an aneurysm if the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.
• If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through
  • Surgery
  • Injecting a substance into the blood vessels of the AVM to block blood flow
  • Radiation to shrink the blood vessels of the AVM

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and to have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

• Eating a heart-healthy diet
• Aiming for a healthy weight
• Managing stress
• Getting regular physical activity
• Quitting smoking
• Managing your blood pressure and cholesterol levels

If these changes aren't enough, you may need medicine to control your risk factors.

NIH: National Institute of Neurological Disorders and Stroke