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domingo, 22 de abril de 2012

Leukemia

Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases affecting the blood, bone marrow, and lymphoid system, which are all known as hematological neoplasms.

Classification:

Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its acute and chronic forms:
  • Acute leukemia is characterized by a rapid increase in the numbers of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.
  • Chronic leukemia is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.

Signs and Symptoms:
Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).
White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some patients experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections.
Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.
Some patients experience other symptoms, such as feeling sick, having fevers, chills, night sweats, feeling fatigued and other flu-like symptoms. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. Blasts affected by the disease may come together and become swollen in the liver or in the lymph nodes causing pain and leading to nausea.
If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.

Causes:
No single known cause for any of the different types of leukemia exists. The known causes, which are not generally factors within the control of the average person, account for relatively few cases. The different leukemias likely have different causes.
Leukemia, like other cancers, results from mutations in the DNA. Certain mutations can trigger leukemia by activating oncogenes or deactivating tumor suppressor genes, and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances.
Among adults, the known causes are natural and artificial ionizing radiation, a few viruses such as Human T-lymphotropic virus, and some chemicals, notably benzene and alkylating chemotherapy agents for previous malignancies.Use of tobacco is associated with a small increase in the risk of developing acute myeloid leukemia in adults. Cohort and case-control studies have linked exposure to some petrochemicals and hair dyes to the development of some forms of leukemia. A few cases of maternal-fetal transmission have been reported. Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit.
Diagnosis:
Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms, however, in rare cases blood tests may not show if a patient has leukemia, usually this is because the leukemia is in the early stages or has entered remission. A lymph node biopsy can be performed as well in order to diagnose certain types of leukemia in certain situations.
Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the patient. When concerns arise about visible damage due to leukemia, doctors may use an X-ray, MRI, or ultrasound. These can potentially view leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound). Finally, CT scans are rarely used to check lymph nodes in the chest.
Despite the use of these methods to diagnose whether or not a patient has leukemia, many people have not been diagnosed because many of the symptoms are vague, unspecific, and can refer to other diseases. For this reason, the American Cancer Society predicts that at least one-fifth of the people with leukemia have not yet been diagnosed.
Treatment:
Most forms of leukemia are treated with pharmaceutical medication, typically combined into a multi-drug chemotherapy regimen. Some are also treated with radiation therapy. In some cases, a bone marrow transplant is useful.
Mortality Rate:


Anemia

Anemia is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency.
Because hemoglobin (found inside RBCs) normally carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences.
Anemia is the most common disorder of the blood. There are several kinds of anemia, produced by a variety of underlying causes. Anemia can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, and discernible clinical spectra, to mention a few. The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis).

Signs and Symptoms:
Anemia goes undetermined in many people, and symptoms can be minor or vague. The signs and symptoms can be related to the anemia itself, or the underlying cause.
Most commonly, people with anemia report non-specific symptoms of a feeling of weakness, or fatigue, general malaise and sometimes poor concentration. They may also report dyspnea (shortness of breath) on exertion. In very severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output. The patient may have symptoms related to this, such as palpitations, angina (if preexisting heart disease is present), intermittent claudication of the legs, and symptoms of heart failure.
On examination, the signs exhibited may include pallor (pale skin, mucosal linings and nail beds) but this is not a reliable sign. There may be signs of specific causes of anemia, e.g., koilonychia (in iron deficiency), jaundice (when anemia results from abnormal break down of red blood cells — in hemolytic anemia), bone deformities (found in thalassemia major) or leg ulcers (seen in sickle-cell disease).
In severe anemia, there may be signs of a hyperdynamic circulation: tachycardia (a fast heart rate), bounding pulse, flow murmurs, and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure.
Causes:
Broadly, causes of anemia may be classified as impaired red blood cell (RBC) production, increased RBC destruction (hemolytic anemias), blood loss and fluid overload (hypervolemia). Several of these may interplay to cause anemia eventually. Indeed, the most common cause of anemia is blood loss, but this usually doesn't cause any lasting symptoms unless a relatively impaired RBC production develops, in turn most commonly by iron deficiency.
Diagnosis:
Anemia is typically diagnosed on a complete blood count. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and is sometimes a necessity in regions of the world where automated analysis is less accessible.
In modern counters, four parameters (RBC count, hemoglobin concentration, MCV and RDW) are measured, allowing others (hematocrit, MCH and MCHC) to be calculated, and compared to values adjusted for age and sex. Some counters estimate hematocrit from direct measurements.
Treatment:
Oral iron supplements are the best way to restore iron levels for people who are iron deficient, but they should be used only when dietary measures have failed. However, iron supplements cannot correct anemias that are not due to iron deficiency.
Iron replacement therapy can cause gastrointestinal problems, sometimes severe ones. Excess iron may also contribute to heart disease, diabetes, and certain cancers. Doctors generally advise against iron supplements in anyone with a healthy diet and no indications of iron deficiency anemia.
Treatment of Anemia of Chronic Disease. In general, the best treatment for anemia of chronic diseases is treating the disease itself. In some cases, iron deficiency accompanies the condition and requires iron replacement. Erythropoietin, most often administered with intravenous iron, is used for some patients.
Mortality Rate:
Anemia is common in the elderly, and in many cases, despite its association with morbidity and mortality, is not treated properly. The prevalence of anemia in the elderly is highly variable, from 2.9% to 61% in men and 3.3% to 41% in older women.



Hypertension



Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). Normal blood pressure at rest is within the range of 100-140mmHg systolic and 60-90mmHg diastolic. High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.
Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause. The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.
Signs and Symptoms:
Hypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. A proportion of people with high blood pressure reports headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.
On physical examination, hypertension may be suspected on the basis of the presence of hypertensive retinopathy detected by examination of the optic fundus found in the back of the eye using ophthalmoscopy. Classically, the severity of the hypertensive retinopathy changes is graded from grade I–IV, although the milder types may be difficult to distinguish from each other. Ophthalmoscopy findings may also indicate how long a person has been hypertensive.
Causes:
Primary (essential) hypertension is the most common form of hypertension, accounting for 90–95% of all cases of hypertension. In almost all contemporary societies, blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable. Hypertension results from a complex interaction of genes and environmental factors. Numerous common genes with small effects on blood pressure have been identified as well as some rare genes with large effects on blood pressure but the genetic basis of hypertension is still poorly understood. Several environmental factors influence blood pressure. Lifestyle factors that lower blood pressure, include reduced dietary salt intake, increased consumption of fruits and low fat products (Dietary Approaches to Stop Hypertension (DASH diet), exercise, weight loss and reduced alcohol intake. The possible role of other factors such as stress, caffeine consumption, and vitamin D deficiency are less clear cut. Insulin resistance, which is common in obesity and is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension. Recent studies have also implicated events in early life (for example low birth weight, maternal smoking and lack of breast feeding) as risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain obscure.



Diagnosis:
Hypertension is diagnosed on the basis of a persistently high blood pressure. Traditionally, this requires three separate sphygmomanometer measurements at one monthly intervals. Initial assessment of the hypertensive people should include a complete history and physical examination. With the availability of 24-hour ambulatory blood pressure monitors and home blood pressure machines, the importance of not wrongly diagnosing those who have white coat hypertension has led to a change in protocols. In the United Kingdom, current best practice is to follow up a single raised clinic reading with ambulatory measurement, or less ideally with home blood pressure monitoring over the course of 7 days.

Treatment:
  • Losing weight if you are overweight or obese.
  • Quitting smoking.
  • Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).
  • Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure. Healthy adults need to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt).
  • Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
  • Limiting alcohol to two drinks a day for men, one drink a day for women.
There are several types of drugs used to treat high blood pressure, including:
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Diuretics
  • Beta-blockers
  • Calcium channel blockers
  • Alpha-blockers
  • Alpha-agonists
  • Renin inhibitors
  • Combination medications


Mortality Rate:


The relationship between blood pressure and risk of cardiovascular disease (CVD) is continuous, consistent and independent of other risk factors. For persons normotensive at 55 years of age have a 90% lifetime risk of developing hypertension. A70 After 40 years of age, each increment of 20 mmHg in systolic or 10 mm / Hg diastolic pressure doubles the risk of CVD in the entire range of 115/75 185/115 mmHg.1

In Mexico, the HAS for 2002 ranked the 9 th leading cause of death in the general population, with a total of 10, 696 deaths, with a rate of 10.38 deaths per 100, 000 habitantes.3 According to the Census of Population and Housing 2000, Mexico had 49.7 million between 20 and 69 years, of which 15.16 million (30.05%) were hypertensive. Taking the lowest rate of mortality from SAH (1.5%), meant that in 2000 there were 227.400 deaths attributable to hypertension and therefore potentially preventable. In other words, a death every 2 minutes. While this number of potential deaths subtract 14.6% of hypertensive patients, the figure would be reduced to 194.199, that is one death every 3 minutes.





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Arteriosclerosis

Arteriosclerosis refers to a stiffening of arteries. Arteriosclerosis is a general term describing any hardening (and loss of elasticity) of medium or large arteries.
Types:
  • Arteriosclerosis obliterans is typically seen in medium and large arteries of the lower extremity. Characterized by fibrosis of the intima and calcification of the media. The lumen of the vessel may be obliterated or markedly narrowed.
  • Medial calcific sclerosis (Monckeberg’s calcific sclerosis) is seen mostly in the elderly, commonly in arteries of the extremities. Characterized by calcification of the Tunica media but without thickening of the intima or narrowing of the vessel lumen. A similar form of an intramural calcification, presenting the picture of an early phase of arteriosclerosis, appears to be induced by a number of drugs that have an antiproliferative mechanism of action.



Signs And Symptoms:
Chest Pain - If the coronary arteries are involved, the patient may have sharp chest pains, characteristic of angina pectoris.
High Blood Pressure - If arteries leading to the kidneys are involved, the patient may suffer from high blood pressure and kidney disorders.
Leg pain - There may also be seen a leg pain when a leg artery is involved.
Brain Hemorrhage - There may be a condition leading to a Brain Hemorrhage when arteries leading to the brain are involved - the vessel may burst, causing hemorrhage in the brain tissues.
Other Common Symptoms are:
  • Headaches.
  • Ringing of ear.
  • Memory problems.
  • Mood changes.
  • Numbness of the legs or feet at rest.
  • Cold legs or feet.
  • Muscle pain in the thighs.
  • Loss of hair on the legs and/or feet.
  • Change of color of the legs.
  • Paleness or blueness.



Causes:
Improper diet - The consumption of saturated fats, coffee, caffeinated colas and alcohol are not good for arteriosclerotic patient. A diet rich in sweets, fast food and refined food, and a high fat diet with excessive cholesterol - may also lead to arteriosclerosis. So, stop eating such foods right now, if you are an arteriosclerosis patient.
High Stress: A high-stress lifestyle may increase your blood pressure and thus affect the heart and arteries, leading to arteriosclerosis.
Inadequate Blood Supply - Improper blood supply may leads to the occurrence of arteriosclerosis. Signs of inadequate blood supply generally appear first in the legs.
Lack of Physical Exercise - One more very important cause of arteriosclerosis is lack of physical exercise. So, doing lot of physical exercise is a must for arteriosclerosis patient.
Main Causes:
  • Hypertension.
  • Diabetes mellitus.
  • Smoking.
  • Obesity.
  • Gender.
  • Heredity.
  • Age.


Diagnosis:
Your doctor may find signs of narrowed, enlarged or hardened arteries during a physical exam. These include:
  • A weak or absent pulse below the narrowed area of your artery
  • Decreased blood pressure in an affected limb
  • Whooshing sounds (bruits) over your arteries, heard with a stethoscope
  • Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee
  • Evidence of poor wound healing in the area where your blood flow is restricted
Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:
- Blood Tests
- Doppler Ultrasound
- Ankle-brachial index
- Electrocardiogram
- Stress test

Treatment:
edication, surgical intervention and lifestyle modifications are all part of arteriosclerosis treatment.

• Medications for arteriosclerosis include those which help to slow down or reverse the fat buildup in the arterial walls. Anticoagulants may also be prescribed to reduce the risk of blood clots. Anti-platelet medication prevents blood from collecting within the narrowed arteries. 

• A procedure known as balloon angioplasty may be performed on the affected limb in order to open up the coronary artery. In many cases, surgery is preferred over medications because of its effectiveness. Surgical treatment for arteriosclerosis may include bypass surgery, removal of the arterial lining and repair or replacement of the affected blood vessel. 

• Lifestyle modifications for arteriosclerosis include several important measures. 

• Exercise is essential for good health of the cardiovascular system. Individuals who do not engage in regular exercise are at a higher risk for cardiovascular disease. Exercise helps to regulate blood flow throughout the body and also boosts immunity. 

• It is important to stop smoking immediately so that the arteries can loosen up and enable proper blood and oxygen flow. 

• The diet should be low in saturated and hydrogenated fats. Intake of processed foods should also be avoided.

• Alcohol should be avoided as it is converted into saturated fat in the body, thereby leading to weight gain. Excessive consumption of alcohol may double the cholesterol levels in the blood. 

• Excessive intake of coffee may be associated with arteriosclerosis. Some studies have shown that intake of five or more cups of coffee per day can raise the risk of heart disease.

There are some home remedies for arteriosclerosis that are believed to help in controlling the condition. However, they should not be used as a substitute medical treatment. Timely medical care is a must since arteriosclerosis is a progressive disease, which can eventually lead to heart failure. These home remedies may be used to supplement other treatment. It is advisable to consult your doctor before trying them out. Here are some popular remedies for keeping arteriosclerosis in check.

• Honey and lemon is known to be an effective treatment for narrowed arteries. It helps to loosen the plaque buildup in the arterial walls. You can consume a mixture of honey and lemon every evening. 

• Bromelain contained in pineapple helps to prevent sticking of the blood platelets. It also prevents blood clots from forming and reduces inflammation when there is damage or irritation to the arteries. 




Mortality Rate:

In 1994, the United States occurred in almost 1 million deaths from vascular disease (cancer twice and 10 times higher than for accidents). Although prevention and treatment of coronary artery disease (AC) produced a 28.6% decrease in adjusted mortality rates by age between 1984 and 1994 CAD and ischemic stroke combined are the murderer No. 1 in Western industrialized countries and is increasingly prevalent in the world.

The AC mortality rate among white men 25 to 34 years of age is approximately 1/10.000 and at age 55 to 64 years is almost 1/100.




Hyperchilesterolemia

Hypercholesterolemia is the presence of high levels of cholesterol in the blood. It is a form of "hyperlipidemia" (elevated levels of lipids in the blood) and "hyperlipoproteinemia" (elevated levels oflipoproteins in the blood).
Cholesterol is a sterol, a sort of fat, see the diagrammatic structure at the right. It is one of three major classes of lipids which all animal cells utilize to construct their membranes. It is also the precursor of the steroid hormones, bile acids and vitamin D and can be manufactured by all animal cells.
Since cholesterol is essentially insoluble in water, it is transported in blood in protein particles (lipoproteins). Low density lipoprotein (LDL) is the major carrier of cholesterol in humans. Elevated levels of cholesterol-containing lipoproteins in the blood may be a consequence of diet, obesity, inherited (genetic) diseases (such as LDL receptor mutations in familial hypercholesterolemia), or the presence of other diseases such as diabetes and an underactive thyroid.
Reducing dietary fat intake reduces total blood cholesterol and LDL cholesterol in adults and it is recommended in people with familial hypercholesterolemia, although dietary change alone is usually insufficient to achieve adequate lowering of cholesterol and medications which reduce cholesterol production or absorption are usually required. If necessary other treatments, including LDL apheresis or even surgery (for particularly severe subtypes) are performed.

Diagnosis:
There is not an absolute cutoff between normal and abnormal cholesterol levels and interpretation of values needs to occur in relation to other health factors. The ideal cholesterol level should be less than 4 mmol/l with a LDL cholesterol less than 2 mmol/l in those at high risk of cardiovascular disease.
Higher cholesterol levels lead to increased risk of several diseases, most notably cardiovascular diseases. Specifically, high levels of small LDL cholesterol particles are associated with increased risk. Larger LDL particles do not carry the same risk.
When measuring cholesterol, it is important to measure its subfractions before drawing a conclusion as to the cause of the problem. The subfractions are LDL, HDL and VLDL. In the past, LDL and VLDL levels were rarely measured directly due to cost concerns. VLDL levels are reflected in the levels of triglycerides (generally about 45% of triglycerides is composed of VLDL). LDL was usually estimated from the other fractions using the equation LDL \approx total cholesterol - HDL - (0.2 x triglycerides). This formula is known as the Friedewald calculation


Signs and Symptoms:
Atheromatous plaques (EYES)
Stenosis (LITTLE)
Occlusion (ALL)
Dizziness
Paresis ( LOOSE OF POWER)
Chest pain



Treatment:
Recommendations for both primary prevention and secondary prevention have been published. For those at high risk a combination of lifestyle modification and statins has been shown to decrease mortality.

Mortality Rate:
A recent study shows that high serum cholesterol in young adults is a risk for all cause mortality. Stamler and colleagues analyzed just over 11,000 men, middle-aged (40 to 64 years), who took as dosage baseline cholesterol values ​​obtained from at least 15 years ago in the context of other population studies, ie when they had aged between 18 and 39. Those patients who had elevated levels of plasma cholesterol (200 to 240 mg%) showed a significantly higher mortality risk compared with those with levels below 200 mg%. Moreover, those whose cholesterol was above 240 mg% had a risk of 2 to 4 times more likely to suffer cardiovascular death or heart and 1.4 times more likely to suffer death from all causes. On the other hand, those who had a baseline cholesterol within normal limits, ie less than 200 mg%, had a life expectancy of 3.8 to 8.7 years older than those with levels above this value.

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Palpitations


A palpitation is an abnormality of heartbeat often accompanied by difficulty breathing.
Heart palpitations can be symptoms of illnesses such as coronary heart disease, asthma, emphysema, and lung cancer.
Palpitations may also be associated with anxiety and panic attacks, in which case psychological assessment is recommended.
Palpitations can also occur from blood loss, excessive pain, or lack of oxygen.
The most important initial clue to the diagnosis is one's description of the palpitations.


Blood tests, particularly tests of thyroid gland function are also important baseline investigations.
Palpitations can be associated with other things such as tightness in the chest, shortness of breath, dizziness or light-headedness.
Another symptom is pain in arms or legs sometimes lasting through the night after the palpitation.
Palpitations have 3 main causes: hyperdynamic circulation, sympathetic overdrive or  cardiac dysrhythmias.




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Angina Pectoris


Angina pectoris is chest pain, due to schemia (a lack of blood , thus a lack of oxygen supply and waste removal).
Angina pectoris appears when cardiac work and myocardial demand of O2 exceed the capacity of the coronary arterial system to deliver oxygenated blood
There are 3 types of angina pectoris: Stable angina, unstable angina and micro vascular angina.
Stable Angina: Also known as effort angina, this refers to the more common understanding of angina related to myocardial ischemia.
Unstable Angina: Also "crescendo angina;" this is a form of acute coronary syndrome, is defined as angina pectoris that changes or worsens.


Micro Vascular Angina: Micro vascular Angina or Angina Syndrome X is characterized by angina-like chest pain, but has different causes.
The pain of angina pectoris is usually retrosternal.
May present as a minor nuisance, or may evolve into a painful and severe sensation.
Angina pectoris occurs commonly during physical activity, only a few minutes and heals with rest.
During the crisis may have an increase in heart rate.
The diagnosis of angina pectoris is clinical, based on the symptom of chest pain


Myocardial revascularization surgery is very effective in patients with advanced angina pectoris.
Angina pectoris gets better with rest.
Angina pectoris occurs commonly during physical activity, only a few minutes and heals with rest.
Annual mortality rate is 1.4%.



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Statics about angina pectoris 




Description of angina pectoris

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