Edema

Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles and legs, but it can involve your entire body.

Causes of edema include:

• Eating too much salt
• Sunburn
• Heart failure
• Kidney disease
• Liver problems from cirrhosis
• Pregnancy
• Problems with lymph nodes, especially after mastectomy
• Some medicines
• Standing or walking a lot when the weather is warm

To keep swelling down, your health care provider may recommend keeping your legs raised when sitting, wearing support stockings, limiting how much salt you eat, or taking a medicine called a diuretic - also called a water pill.

Gout

What is gout?

Gout is a common type of inflammatory arthritis. It causes pain, swelling, and redness in one or more joints. It usually happens as a flare, which can last for a week or two and then gets better. The flares often begin in your big toe or a lower limb.

Gout happens when too much uric acid (urate) builds up in your body over a long time. Uric acid is a waste product your body makes when it breaks down purines. Purines are substances that are in your body's tissues and in many foods.

When your body breaks down old cells or digests foods that contain purine, most of the uric acid that's made dissolves in your blood. Your kidneys filter the uric acid out of your blood, and it leaves your body in your urine (pee).

However, sometimes your body can make too much uric acid or does not remove enough of it. Then the uric acid levels build up in your body, including in your blood. Having too much uric acid in the blood is called hyperuricemia. It does not cause health problems for everyone. But in some people, uric acid forms needle-like crystals. They can form in your joints, which causes gout. The crystals can also cause kidney stones.

Calcium pyrophosphate arthritis, sometimes called pseudogout, is a related disease. It causes similar symptoms and is sometimes confused with gout. But it is caused by a buildup of calcium phosphate, not uric acid.

Many people develop gout. You are more likely to get it if you:

• Are male.
• Are older; it usually develops in middle age.
• Have obesity.
• Have certain health conditions, such as:
  • Heart failure
  • High blood pressure
  • Metabolic syndrome
  • Chronic kidney disease
  • Conditions that cause your cells to break down more quickly, such as psoriasis or some cancers
  • Rare genetic conditions that lead to increased uric acid
• Have a family history of gout.
• Have an unhealthy diet and eat foods that are rich in purines, such as red meat, organ meats, certain seafoods.
• Drink alcohol.
• Eat and drink lots of foods and beverages that contain fructose (a type of sugar).
• Take certain medicines, such as diuretics (water pills), low-dose aspirin, and some medicines that weaken your immune system.
• Take high amounts of niacin (vitamin B-3).

Gout usually happens in only one joint at a time. It is often found in the big toe, but can also affect other joints, including your other toes, ankle, and knee.

Gout flares often start suddenly at night, and the symptoms in the affected joint often include:

• Intense pain, which may be bad enough to wake you up
• Swelling
• Redness
• Warmth

The flares typically get better within a week or two. In between flares, you usually don't have symptoms. Some people may have flares often, while others may not have another flare for years. But over time, if left untreated, your flares may happen more often and last longer.

And if gout is untreated over long periods of time, you can develop tophi. Tophi are hard, uric acid deposits under the skin. They start out as painless, but over time, they can become painful. They can also cause bone and soft tissue damage and misshapen joints.

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

• Will take your medical history, which includes asking about your symptoms.
• Will do a physical exam, including examining the affected joint(s).
• May order various tests, such as:
  • A test of a sample of fluid from one of your painful joints. The fluid is examined under a microscope and is checked for uric acid crystals.
  • A uric acid blood or urine test.
  • An ultrasound or special CT scan to look for uric acid crystal buildup in the affected joint and check for other conditions that may be causing the symptoms.

There are effective treatments for gout. Which treatment you get will depend on your symptoms and the cause of your gout. The goals of your treatment will be to:

• Reduce the pain from gout flares, by using medicines such as:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
  • Acetaminophen and the anti-inflammatory drug colchicine.
  • Oral or injected corticosteroids.
• Prevent future flares, for example by:
  • Making lifestyle changes such as losing weight, limiting alcohol, and avoiding foods high in purines. If you are taking medicines that can cause high uric acid in the blood, your provider may suggest stopping or changing those medicines.
  • If needed, taking medicines to lower uric acid in the blood.
• Prevent tophi and kidney stones, for example with medicines that lower uric acid in the blood.

With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Treatment and lifestyle changes may help people avoid gout flares, lessen their symptoms, and sometimes even become gout free.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Heart Attack

Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die. But if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle. That's why it's important to know the symptoms of a heart attack and call 911 if you or someone else is having them. You should call, even if you are not sure that it is a heart attack.

The most common symptoms in men and women are:

• Chest discomfort. It is often in center or left side of the chest. It usually lasts more than a few minutes. It may go away and come back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
• Shortness of breath. Sometimes this is your only symptom. You may get it before or during the chest discomfort. It can happen when you are resting or doing a little bit of physical activity.
• Discomfort in the upper body. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.

You may also have other symptoms, such as nausea, vomiting, dizziness, and lightheadedness. You may break out in a cold sweat. Sometimes women will have different symptoms then men. For example, they are more likely to feel tired for no reason.

The most common cause of heart attacks is coronary artery disease (CAD). With CAD, there is a buildup of cholesterol and other material, called plaque, on their inner walls or the arteries. This is atherosclerosis. It can build up for years. Eventually an area of plaque can rupture (break open). A blood clot can form around the plaque and block the artery.

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery.

At the hospital, health care providers make a diagnosis based on your symptoms, blood tests, and different heart health tests. Treatments may include medicines and medical procedures such as coronary angioplasty. After a heart attack, cardiac rehabilitation and lifestyle changes can help you recover.

NIH: National Heart, Lung, and Blood Institute

Heart Disease in Women

What is heart disease?

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease in both men and women. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

In the United States, heart disease is the number one cause of death in women. But women are often not diagnosed with heart disease as quickly as men are. That's because:

• Women are more likely than men to have "silent" heart disease, meaning that they don't have symptoms.
• Health care providers may not recognize heart disease in women because women's symptoms may be different from men's symptoms.
• Women are more likely than men to have certain types of heart disease that can be harder to diagnose.

A delay in diagnosis may mean a delay in medical care that could help prevent serious problems, such as a heart attack. That's why it's important to learn about your risk for heart disease, the symptoms in women, and how to keep your heart healthy.

Women can get any type of heart disease. Like men, the most common type of heart disease among women is coronary artery disease. But there are certain types of heart disease which are less common, but affect women more often than men:

• Coronary microvascular disease - Chest pain from spasms (sudden tightening) in the smallest arteries of the heart that pinch off blood flow. It typically happens during rest or routine activities. This serious condition increases your risk of having a heart attack or other heart diseases. This type may be harder to diagnose since blockages in smaller arteries can be harder to see on imaging tests.
• Broken heart syndrome - Strong chest pain or other signs that look like a heart attack. It's caused by the stress of powerful emotions, such as deep grief, anger, or surprise. It can happen even if you're healthy. It mostly affects women after menopause and usually doesn't cause any lasting damage.
• Variant angina - A rare type of strong chest pain from spasms in the heart arteries. The pain usually happens in a pattern during sleep. Variant angina rarely causes a heart attack.

Your risk for developing heart disease increases with:

• Menopause. Women can develop heart disease at any age, but your risk increases after your periods stop, usually by age 55. Before menopause, your body makes more estrogen (a female hormone) which helps protect against heart disease. That's why women generally develop coronary artery disease 10 years later than men. During and after menopause, estrogen levels drop and your risk for heart diseases goes up. If your periods stop before age 40, your risk will be higher than other women your age.
• Family history of heart disease. Your risk for heart disease may be higher if your:
  • Mother or sister had heart disease before age 65.
  • Father or brother had heart disease before age 55.
• Problems during pregnancy, such as high blood pressure, gestational diabetes, anemia, and high blood pressure.
• Use of hormonal birth control (pills, patches, or vaginal rings with estrogen and progesterone).
• Endometriosis.
• Polycystic ovary syndrome.
• Inflammatory and autoimmune diseases.
• Metabolic syndrome.
• Mental health issues, such as stress, anxiety, or depression.
• Health risks from a lack physical activity.
• Obesity or being overweight.
• Diabetes.
• Low HDL cholesterol levels.
• Mild to moderate high blood pressure.
• Smoking.

If you have one or more risks for heart disease, ask your health care provider for help understanding your risk level. Ask if you need any heart tests to help catch heart disease early.

When women have symptoms of heart disease, they may include:

• Pain or discomfort in the chest that may be dull and heavy or sharp
• Pain in the neck, jaw, throat, upper belly, or back
• Nausea or vomiting
• Unusual fatigue
• Shortness of breath (feeling like you can't get enough air) during physical activity

Women who have coronary artery disease are more likely than men to have chest pain when resting or doing daily activities, rather than during exercise. They're also more likely than men to feel chest pain from mental stress.

Symptoms of a heart attack in women may also be different than in men. Chest pain is the most common symptom for both sexes. It may feel like crushing or squeezing. But women are somewhat less likely than men to have chest pain.

During a heart attack, women may feel:

• Pressure or tightness in the chest
• Pain in the upper back, arms, neck, jaw or throat
• Dizziness
• Unusual fatigue
• Indigestion, heartburn, nausea, or vomiting
• Stomach pain
• Shortness of breath

Heart attacks usually don't look like the sudden, dramatic events we see in the movies. The symptoms may be mild or strong. They may start slowly. They can stop and then come back.

You can help lower your risk by:

• Learning how to prevent heart disease and making heart-healthy habits part of your daily life.
• Asking your provider about your personal risk for heart disease and the best way to manage your heart health.

Remember, women can have heart disease without symptoms. But if you pay attention to your risk for heart disease, you can take action to prevent problems or keep them from getting worse.

NIH: National Heart, Lung, and Blood Institute

Heart Diseases

What is heart disease?

Heart disease is a general term that includes many types of heart problems. It's a type of cardiovascular disease, which means heart and blood vessel disease.

Heart disease is the leading cause of death in the United States, but there are ways to prevent and manage many types of heart disease.

There are many different types of heart disease. Some you may be born with, called congenital heart disease. Other types develop during your lifetime.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to other heart problems:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

Other types of heart diseases may affect your heart valves or heart muscle (cardiomyopathy).

The causes of heart disease depend on the type of disease. Some possible causes include lifestyle, genetics, infections, medicines, and other diseases.

There are many different factors that can make you more likely to develop heart disease. Some of these factors you can change, but others you cannot.

• Age. Your risk of heart disease goes up as you get older.
• Sex. Some factors may affect heart disease risk differently in women than in men.
• Family history and genetics. A family history of early heart disease raises your risk. And research has shown that some genes are linked to a higher risk of certain heart diseases.
• Race/ethnicity. Heart disease is the leading cause of death in most racial and ethnic groups in the United States. However, certain groups have higher risks than others. This includes Black people, White people, and American Indian/Alaska Native people.
• Lifestyle habits. Over time, unhealthy lifestyle habits can raise your risk of heart disease. These can include:
  • Eating a diet high in saturated fats, refined carbohydrates, and salt.
  • Not getting enough physical activity.
  • Drinking too much alcohol.
  • Smoking and exposure to secondhand smoke.
  • Too much stress.
• Having other medical conditions can raise your risk of heart diseases. These conditions include:
  • High blood pressure.
  • High cholesterol levels.
  • Diabetes.
  • Obesity.
  • Autoimmune and inflammatory diseases.
  • Chronic kidney disease.
  • Metabolic syndrome.

Your symptoms will depend on the type of heart disease you have. You may not have symptoms at first. In some cases, you may not know you have heart disease until you have a complication such as a heart attack.

To find out if you have heart disease, your health care provider will:

• Ask about your medical history, including your symptoms
• Ask about your family health history, including relatives who have had heart disease
• Do a physical exam
• Likely run heart tests and blood tests

In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

Treatment plans for heart disease depend on the type of heart disease you have, how serious your symptoms are, and what other health conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes
• Medicines
• Procedures or surgeries
• Cardiac rehabilitation

You may be able to lower your risk of certain heart diseases by making heart-healthy lifestyle changes and managing any other medical conditions you have.

NIH: National Heart, Lung, and Blood Institute