By I. Kirk. College of William and Mary. 2018.
The heart is enlarged with hypertrophy of both ventricles and there is a diffuse 40 mg innopran xl fast delivery blood pressure chart spanish, reticular fibrosis with a non-inflammatory retrogressive alteration of myofibrils discount innopran xl 80mg with mastercard blood pressure xl cuff. There is approximately 50% of patients with progressive muscular dystrophy under myocardial changes with diffuse myocardial fibrosis, but with only minor changes in myocytes. In myotonic muscular dystrophy, 60% of patients have cardiac enlargement and failure in which myocyte atrophy and fatty infiltration may occur. Rheumatic fever, rheumatoid arthritis, and systemic lupus erythematosus often have a greater effect on the cardiac valves than the myocardium. Toxins and Physical Forces: Trauma (contusions) and radiation are well recognized causes of myocardial cell damage or interstitial myocardial fibrosis, or both. Many drugs, such as digitalis, isoproterenol, ephedrine, antibiotics and emetine, damage myocardial cells. The anti-neoplastic drug Adriamycin and its analogs may produce cardiotoxicity in large Cardiomyopathy, Myocarditis & Atrial Myxoma - Gerald Berry, M. Cobalt, arsenic, antimony, fluoride, mercury and lead alter myocardial structure and function. Hypersensitivity and Immunologic Cardiac Diseases: The evidence for the existence of immune mechanisms in myocardial disease to date is inconclusive. The presence of the various anti-heart antibodies, whether circulating or bound to the myocardium, does not necessarily provide a mechanism for an immune disorder of the heart. Several reports of heart-reactive antibodies in patients with cardiomyopathy have shown gamma and immunoglobulins, as well as Complement, bound to the myocardium. Figure 1: Diagram illustrating the various types of cardiomyopathies, compared to the normal, discussed herein. In the hypertrophic type of cardiomyopathy the left ventricular cavity is small, and in the constrictive variety, as illustrated by amyloidosis, the left ventricular cavity is of normal size. In the dilated type the largest circumference of the left ventricle is not at its base but midway between the apex and base. Please note: The tumors are listed for completeness but only myxomas and rhabdomyomas are clinically important. In common with tumors elsewhere in the body, tumors of the heart pericardium may be classified as benign or malignant. Myxomas: An exophytic tumor which may fill a cardiac chamber or prolapse through one of the A-V valves. Microscopically: Irregular vacuolization of cell cytoplasm producing “spider cells. Tumor is circumscribed, sessile, polypoid or intramuscular and are often symptomless. Fibromas (Fibrohistiocytomas): More often occur in the interventricular septum of the anterior wall of the left ventricle. They are nonencapsulated and consist of interlacing bundles of fibrous tissue of varying cellularity. Tumors of the heart valves: Fibromas, myxomas, hamartomas and papillary tumors have a predilection for heart valves. One variety is polypoid or flat and occurs in children and the other is papillary and occurs in adults. Sarcomas: Either of smooth or skeletal muscle, appear to be the commonest cardiac malignant tumors. Malignant vascular tumors (angiosarcomas), Kaposi’s sarcoma, malignant hemangioendothelioma and malignant hemangiopericytomas have been reported. Primary lymphoma: Involvement may be diffuse, nodular or rarely as an endocardial polypoid growth. Rare examples of primary cardiac neoplasms include granular cell myoblastoma, neurogenic sarcoma, ganglioneuroma and malignant mesenchymoma. Of all patients with disseminated malignant disease, up to 15 percent have cardiac lesions. The commonest primary sites of origin are carcinomas of the lung, breast, large bowel and stomach, followed by malignant lymphoma. While metastases are often asymptomatic, patients may present with cardiac failure, arrhythmias or a pericarditis.
A common myth about hormones is that you don’t need to worry about them until menopause order innopran xl 80mg with visa hypertension vs high blood pressure. The truth is purchase innopran xl 40 mg free shipping heart attack vol 1 pt 3, many hormone levels, such as estrogen and testosterone, start to drift downward when you’re in your twenties. Some hormones, such as cortisol, may spike too high and pull other hormones offline. Women younger than thirty may not yet feel affected by the aging process, but perhaps they want to get pregnant or avoid the diagnosis of breast cancer their mom just received. Those in their thirties may feel increasingly tense and overwhelmed, in need of better strategies on how to relax. They may want to prevent the high blood pressure, prediabetes, and accelerated aging that come with chronically high stress levels. Women in their forties and fifties may want to regain some of the buoyancy of their youth. Perhaps they want to wake up feeling restored again, without the brain fog from disrupted sleep. Women in their sixties, seventies, and eighties may want to optimize their cognitive and executive functioning—to improve their thinking, memory, and competitive edge. I don’t want women to suffer; I don’t want them to be underserved by their doctors, miseducated by the media, tired, frazzled, and ashamed. I’m not a magician who can turn back the hands of time and make you twenty- five again, nor do I believe that’s best for you. What I can do is return something you’ve lost: the properly proportioned hormonal organization that provides clarity, confidence, and longevity. The human body has an innate ability to repair and self-regulate, but that ability often gets bulldozed by the enduring stressors, distractions, and interruptions of modern life. Once you rediscover your body’s ability to shift toward balance, informed by the new science of integrative women’s health and aided by The Gottfried Protocol, you’ll find that it’s easier to move toward balance than to stay imbalanced. Attend to your hormones today, and the process will serve your mood, weight, energy, sex drive, sleep, and resilience for decades to come. I designed several questionnaires, which I use in my practice, to identify the most common hormonal problems that can occur during premenopause, perimenopause, and menopause. Then I’ll guide you toward the chapters that can best help you in your quest for hormonal balance. It’s the basis of a nourishing meal (like those we’re often too busy to prepare or enjoy). It’s a soul-infused pie chart, where all the pieces complement one another and feed our spirit. We know that balance can help us run the gauntlet of working, child rearing, grocery shopping, caregiving, errand running, and juggling our other interests while keeping our health and sanity intact. Balance enables us to take on those tasks in a less harried, frantic, and fragile way. It might be instead that your hormones are off, and that’s what’s making you feel off balance. When your hormones are disordered, you can feel lethargic, irritable, weepy, grumpy, unappreciated, anxious, depressed. The biological processes of our bodies, whether they’re functioning ideally or are disordered, affect our mood, psyche, and the way we live. Stress is the top reason behind most visits to the doctor, and it contributes to all the big causes of death, including heart disease, diabetes, stroke, and cancer. If any one of them is left out, we might not find the root cause of the hormone imbalance. My questions have been adjusted over the years through my own study and experience with the women in my medical practice, and integrated with a hefty dose of evidence. I encourage my patients to see the path toward hormone balance as an epic journey—a womanly version of an odyssey. That’s what these questionnaires are: the journey-starting, readiness- testing task for balance- seeking sheroes. Quest(ionnaires) for Hormonal Balance The following questionnaires, similar to the ones I administer in my practice, are designed to identify correctly the undiagnosed hormone problems you may face. I use the results to find the sweet spot between mainstream medicine’s tendency to underdiagnose without the tendency to overdiagnose that I sometimes observe in alternative medicine. Read carefully through the list of symptoms, put a checkmark next to any you experience, and add up the checks within each grouping.
In what manner this influence is exercised is unknown cheap innopran xl 80mg with visa arrhythmia games, but in any disease that involves the gland cheap 80 mg innopran xl amex blood pressure medication memory loss, this remedy must be considered, and if there are no contraindications it can be tried, and in many cases as with the ductless glands, it seems to act in a direct manner. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 433 Thuja is directly indicated, first, as a peculiar alterative, in improving diathetic conditions of the blood. Again, it acts directly upon abnormal growths-perversions, such as peculiar conditions of the cell structure of the skin, and other external structures. It exercises a specific influence upon catarrhal discharges, correcting the glandular faults that are to blame for such a condition wherever they may be. It is specific to urinary irritation in aged people especially; also in childhood. Andrews uses thuja in chronic diarrheas, and in the treatment of ulceration of the bowels. In a bad case of polyuria with great sensation of debility and weakness of the entire sexual apparatus and some loss of sexual strength, a man of 65 was given five drops of thuja every two hours with complete success. Thuja is an important remedy in the treatment of spermatorrhea, especially if from exhaustion from over-indulgence, or from masturbation. In those cases in which the mind is seriously depressed by the physical condition, it is of especial service, as it stimulates the nerve forces and delays the discharge until, by general improvement of the entire nervous system, the condition is restored. The influence of the agent will be enhanced by a combination with avena sativa, saw palmetto, or staphysagria, in cases of this character, when Thuja should be given in doses of from two to ten drops, four or five times daily. As an external application Thuja produces at first a sensation of smarting or tingling when applied to open sores or wounds and it is usually best to dilute it with one, two or four parts of water, or to combine the non- alcoholic extract with an ointment base in the above proportion. This constitutes an excellent mildly antiseptic and actively stimulating dressing to indolent, phagedenic or gangrenous ulcers. It is of much service in bed sores and in other open ulcers dependent upon local or general nerve exhaustion. In chronic skin diseases of either a non-specific or specific character, it Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 434 is a useful remedy. Vegetations of all kinds, especially those upon mucous surfaces, will yield to it readily. A small dose internally four or five times daily, with the application of fluid hydrastis in a spray, will quickly retard or remove such abnormal growths. It is also applicable to sloughing wounds, and to phagedena of the venereal organs. It causes gangrenous surfaces to dry without hemorrhage or other discharge, destroys offensive odors and influences granulation. Recent reports have been made concerning the very beneficial action of thuja on papilloma of the larynx and affections of that character in the post nasal region. Moreau Brown has reported a number of cases satisfactorily treated with this remedy. The same writer uses this agent in the treatment of growths in the posterior nares. He treats chronic enlargement of the tonsils with this remedy and has succeeded in reducing many severe cases to the normal size. He has treated some cases of disease of the turbinated bones with the same remedy. He believes that in all cases of normal hypertrophy, where there is no diathesis, underlying the difficulty, in the post nasal region, this remedy is of inestimable value. The use of thuja persistently in these cases is as effectual as it is when used in the same manner for syphilitic ulcerations. Mix thoroughly by drawing a quantity into the syringe, and forcing it back repeatedly for a few times, then draw up about two drams of the dilute mixture in the barrel of the syringe to be ready for use. Introduce a large exploring needle into the sac of the tunica vaginalis testis and allow the fluid to escape. Then in order to cause the liquid to enter every crevice of the sac of the hydrocele, pinch and knead the scrotum with the fingers quite vigorously. The pain induced is quite considerable for at least half an hour, then the patient goes about his business and usually no additional treatment is required. The non-alcoholic preparation is combined with vaseline or other unctuous substance and applied once or twice daily. However severe the case, he had no case especially where there was severe granulation of the lids that was so stubborn but that he could benefit it with a mild solution of thuja. It is applied directly to the growth as often as possible without inducing inflammation.
Drug molecules were divided into acyclic and cyclic structures buy generic innopran xl 40 mg line blood pressure medication how long to take effect, which were then further subdivided purchase innopran xl 80mg otc hypertension yoga. For example, the cyclic mol- ecules were categorized into steroids, heterocycles, and so on. These were then subcat- egorized; for instance, heterocycles had many subcategories including benzodiazepines, imidazolidinediones, dihydropyridines, etc. Regrettably, this classification system is too extensive and too cumbersome to be useful. It starts at the level of the biomolecule and works up to the pathological processes (traumatic, toxic, …), then to the physiological systems (cardiovascular, endocrine, …) and ultimately to the diseases affecting these systems. Because of its molecular-based approach, it offers def- inite advantages for drug design. The goal of medicinal chemistry is to design novel chemical compounds that will favorably influence ongoing biochemistry in the host organism in some beneficial manner. As discussed in chapters 4–6, one of the most obvious approaches is to either mimic or block endogenous messengers used by the organism itself to control or alter its own bio- chemistry. These endogenous messengers may be neurotransmitters (fast messengers), hormones (intermediate), or immunomodulators (slow), working at the electrical, mole- cular, or cellular levels, respectively. However, not all pathologies that afflict the human organism can be addressed by manipulation of these messengers. Accordingly, it becomes necessary to directly target other cellular components and/or endogenous macromolecules that are not normally directly controlled through binding to endogenous messengers. These endogenous macromolecules are the catalysts and molecular machinery that enable the cell to perform its normal metabolic functions; accordingly, they afford numerous druggable targets. Finally, if that approach is not sufficient, it would next be necessary to attack the agent causing the disease process, perhaps a bacterium or virus. Design the drug to manipulate endogenous messengers that would normally respond to the disease process. Design the drug to influence endogenous targets involved in the disease but not influenced by messenger systems. For example, when confronted with the task of designing drugs for systemic arterial hypertension and atherosclerosis, there are many targets. Following Step 1, drugs could be designed to interact with messenger neurotransmitter (adrenergic) receptors (e. Following Step 2, drugs could be designed to interact with non-messenger pro- tein targets such as enzymes involved in fluid homeostasis (e. Similarly, drugs used for the treatment of epilepsy may produce untoward events in individuals susceptible to heart arrhythmias because seizures and cardiac arrhythmias are both mediated by voltage-gated ion channels. It provides a structural and concep- tual framework that enables this knowledge and information to be stored and logically manipulated in a meaningful way for purposes of practical drug design. This page intentionally left blank 4 Messenger Targets for Drug Action I Neurotransmitters and their receptors 4. Since most of these messengers act on nerve cells (neurons), it is appropriate to review the anatomy and physiology of the nervous system and to discuss briefly the neuronal networks that can be manipulated therapeutically. Since the nervous system also influences homeostasis throughout the entire body, neurotransmitters are ideal messengers to target when designing drugs within a rational biochemical conceptual framework. Drugs based on neurotransmitters are not restricted to brain diseases; they can be used for the treatment of diseases affecting virtually any organ system within the body. Neurons are highly specialized cells that trigger and conduct bioelectric impulses, communicate with each other through intricate networks, and regulate all tissues and organs within the body. The membrane of the nerve cell is “excitable” because it can undergo changes in its permeability, mediated by trans- membrane ion channel proteins and triggered by small, endogenous neurotransmitter molecules. The cell body carries short, branching dendrites, which receive and transfer incoming signals to the cell; these signals are then transmitted to the next neuron (or to a tissue) by the long axon. The axon of a neuron is insulated by the lipid myelin sheath, which is interrupted by the nodes of Ranvier. The axon terminates in a nerve ending, which may be a neuromuscular endplate that communi- cates with the membranes of muscle cells. In other neurons, the nerve ending can be a knoblike synaptic bouton in contact with the dendrites, axon, or cell body of another nerve cell, with chemical signals rather than electric impulses being used for transmis- sion. The synaptic end of a neuron contains mitochondria and one or more types of synaptic vesicles—spheres of 0.