Chronic Heart Failure

Etiology
Heart failure often develops after other conditions have damaged or weakened your
heart. Over time, the heart can no longer keep up with the normal demands placed
on it to pump blood to the rest of your body. The main pumping chambers of your
heart (the ventricles) may become stiff and not fill properly between beats. Also,
your heart muscle may weaken, and the ventricles stretch (dilate) to the point that
the heart can't pump blood efficiently throughout your body. The term "congestive
heart failure" comes from blood backing up into or congesting the liver,
abdomen, lower extremities and lungs. However, not all heart failure is congestive.
You might have shortness of breath or weakness due to heart failure and not have
any fluid building up.

Heart failure can involve the left side, right side or both sides of your heart.
Typically, heart failure begins with the left side specifically the left ventricle, your
heart's main pumping chamber.

Signs and symptoms
Shortness of breath (dyspnea) when you exert yourself or when you lie down
Fatigue and weakness
Swelling (edema) in your legs, ankles and feet
Rapid or irregular heartbeat
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged phlegm
Increased need to urinate at night
Swelling of your abdomen (ascites)
Sudden weight gain from fluid retention
Lack of appetite and nausea
Difficulty concentrating or decreased alertness
Sudden, severe shortness of breath and coughing up pink, foamy mucus
Elevated blood pressure
Chest pain, if your heart failure is caused by a heart attack

Diabetes

Etiology
How insulin works
Insulin is a hormone that comes from the pancreas, a gland situated behind and
below the stomach.
The pancreas secretes insulin into the bloodstream.
The insulin circulates, enabling sugar to enter your cells.
Insulin lowers the amount of sugar in your bloodstream.
As your blood sugar level drops, so does the secretion of insulin from your
pancreas.
The role of glucose
Glucose a sugar is a main source of energy for the cells that make up muscles
and other tissues.
Glucose comes from two major sources: food and your liver.
Sugar is absorbed into the bloodstream, where it enters cells with the help of
insulin.
Your liver stores and makes glucose.
When your insulin levels are low, such as when you haven't eaten in a while,
the liver metabolizes stored glycogen into glucose to keep your glucose level
within a normal range.

Causes of type 1 diabetes
In type 1 diabetes, your immune system which normally fights harmful bacteria
or viruses attacks and destroys your insulin-producing cells in the pancreas. This
leaves you with little or no insulin. Instead of being transported into your cells,
sugar builds up in your bloodstream. Type 1 is thought to be caused by a
combination of genetic susceptibility and environmental factors, though exactly
what many of those factors are is still unclear.

Causes of prediabetes and type 2 diabetes
In prediabetes which can lead to type 2 diabetes and in type 2 diabetes, your
cells become resistant to the action of insulin, and your pancreas is unable to make
enough insulin to overcome this resistance. Instead of moving into your cells where
it's needed for energy, sugar builds up in your bloodstream. Exactly why this
happens is uncertain, although as in type 1 diabetes, it's believed that genetic and
environmental factors play a role in the development of type 2. Being overweight is
strongly linked to the development of type 2 diabetes, but not everyone with type 2
is overweight.

Causes of gestational diabetes
During pregnancy, the placenta produces hormones to sustain your pregnancy.
These hormones make your cells more resistant to insulin. As your placenta grows
larger in the second and third trimesters, it secretes more of these hormones
making it even harder for insulin to do its job.
Normally, your pancreas responds by producing enough extra insulin to overcome
this resistance. But sometimes your pancreas can't keep up. When this happens, too
little glucose gets into your cells and too much stays in your blood. This is
gestational diabetes.

Signs and symptoms
Diabetes symptoms vary depending on how much your blood sugar is elevated.
Some people, especially those with prediabetes or type 2 diabetes, may not
experience symptoms initially. In type 1 diabetes, symptoms tend to come on
quickly and be more severe. Some of the signs and symptoms of type 1 and type 2
diabetes include:
Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
Presence of ketones in the urine (ketones are a byproduct of the breakdown
of muscle and fat that happens when there's not enough insulin)
Fatigue
Blurred vision
Slow-healing sores
High blood pressure
Frequent infections, such as gums or skin infections and vaginal or bladder
infections
Although type 1 diabetes can develop at any age, it typically appears during
childhood or adolescence. Type 2 diabetes, the more common type, can develop at
any age and is often preventable.

Chronic obstructive pulmonary disease
The main cause of COPD is tobacco smoking. However, in the developing world,
COPD often occurs in women exposed to fumes from burning fuel for cooking and
heating in poorly ventilated homes. Only about 20 percent of chronic smokers
develop COPD. Some smokers develop less common lung conditions. They may be
misdiagnosed as having COPD until a more thorough evaluation is performed.

How your lungs are affected
Air travels down your windpipe (trachea) and into your lungs through two large
tubes (bronchi). Inside your lungs, these tubes divide many times like the
branches of a tree into many smaller tubes (bronchioles) that end in clusters of
tiny air sacs (alveoli). The air sacs have very thin walls full of tiny blood vessels
(capillaries). The oxygen in the air you inhale passes into these blood vessels and
enters your bloodstream. At the same time, carbon dioxide a gas that is a waste
product of metabolism is exhaled.
Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force
air out of your body. COPD causes them to lose their elasticity and partially collapse,
which leaves some air trapped in your lungs when you exhale.

Causes of airway obstruction
Emphysema. This lung disease causes destruction of the fragile walls and
elastic fibers of the alveoli. Small airways collapse when you exhale,
impairing airflow out of your lungs.
Chronic bronchitis. In this condition, your bronchial tubes become inflamed
and narrowed and your lungs produce more mucus, which can further block
the narrowed tubes. You develop a chronic cough trying to clear your
airways.

Cigarette smoke and other irritants
In the vast majority of cases, the lung damage that leads to COPD is caused by long-
term cigarette smoking. But there are likely other factors at play in the development
of COPD, such as a genetic susceptibility to the disease, because only about 20
percent of smokers develop COPD.
Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe
smoke, air pollution and workplace exposure to dust, smoke or fumes.

Signs and symptoms
Symptoms of COPD often don't appear until significant lung damage has occurred,
and they usually worsen over time. For chronic bronchitis, the main symptom is a
cough that you have at least three months a year for two consecutive years. Other
signs and symptoms of COPD include:
Shortness of breath, especially during physical activities
Wheezing
Chest tightness
Having to clear your throat first thing in the morning, due to excess mucus in
your lungs
A chronic cough that produces sputum that may be clear, white, yellow or
greenish
Blueness of the lips or fingernail beds (cyanosis)
Frequent respiratory infections
Lack of energy
Unintended weight loss (in later stages)
People with COPD are also likely to experience episodes called exacerbations,
during which their symptoms become worse and persist for days or longer.

Pneumonia
Pneumonia has many possible causes. The most common are bacteria and viruses in
the air we breathe. Your body usually prevents these germs from infecting your
lungs. But sometimes these germs can overpower your immune system, even if your
health is generally good.
Pneumonia is classified according to the types of germs that cause it, and where you
acquired the infection.

Community-acquired pneumonia
Community-acquired pneumonia is the most common type of pneumonia. It occurs
outside of hospitals and other health care facilities, and may be caused by:
Bacteria, such as Streptococcus pneumoniae. Bacterial community-acquired
pneumonia can occur on its own or after you have a cold or respiratory flu.
This type of pneumonia often affects one area (lobe) of the lung, a condition
called lobar pneumonia.
Bacteria-like organisms, such as Mycoplasma pneumoniae, which typically
produce milder signs and symptoms than do other types of pneumonia.
"Walking pneumonia," a term used to describe pneumonia that isn't severe
enough to require bed rest, may result from Mycoplasma pneumoniae.
Viruses, including some that are the same type of viruses that cause colds
and flu. Viruses are the most common cause of pneumonia in children
younger than 2 years. Viral pneumonia is usually mild. But viral pneumonia
caused by certain influenza viruses, such as sudden acute respiratory
syndrome (SARS), can become very serious.
Fungi, which can be found in soil and in bird droppings. This type of
pneumonia is most common in people with an underlying health problem or
weakened immune system and in people who have inhaled a large dose of
the organisms.

Hospital-acquired pneumonia
Hospital-acquired pneumonia is a bacterial infection that occurs in people 48 hours
or more after being hospitalized for another condition. Hospital-acquired
pneumonia can be serious because the bacteria causing it may be more resistant to
antibiotics.
People who are on a breathing machine (ventilator), often used in intensive care
units, are at higher risk of this type of pneumonia.

Health care-acquired pneumonia
Health care-acquired pneumonia is a bacterial infection that occurs in people who
are living in long-term care facilities or have been treated in outpatient clinics,
including kidney dialysis centers. Like hospital-acquired pneumonia, health care-
acquired pneumonia can be caused by bacteria more resistant to antibiotics.

Aspiration pneumonia
Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your
lungs. This aspiration may happen if something disturbs your normal gag reflex,
such as a brain injury, swallowing problem, or excessive use of alcohol or drugs.

Signs and symptoms
The signs and symptoms of pneumonia vary from mild to severe, depending upon
factors such as the type of germ causing the infection and your age and overall
health. Mild signs and symptoms often are similar to those of a cold or flu, but they
last longer.
Signs and symptoms of pneumonia include:
Fever, sweating and shaking chills
Lower than normal body temperature in people older than age 65, and in
people with poor overall health or weakened immune systems
Cough, which may produce thick, sticky fluid
Chest pain when you breathe deeply or cough
Shortness of breath
Fatigue and muscle aches
Nausea, vomiting or diarrhea
Headache
Newborns and infants may not show any sign of the infection. Or they may vomit,
have a fever and cough, appear restless or tired and without energy, or have
difficulty breathing and eating.
Older people who have pneumonia sometimes have sudden changes in mental
awareness.