The
Pill - may cause blood clots
NEW YORK, Sep 24 (Reuters Health) -- The latest
generation of birth control pills, which were introduced in the 1980s and early
1990s, may raise a woman's risk of blood clots even more than earlier oral
contraceptives, according to a report from Denmark.
However, researchers caution that the increased risk
is small and the evidence is still preliminary.
From 1977 to 1993, a team of researchers led by Dr.
Lene Mellemkjaer, of the Danish Cancer Society, tracked hospital admissions for
venous thromboembolism, a group of disorders that includes pulmonary embolism
(clots in the lung), and deep venous thrombosis (most often clots in large
veins in the legs).
The study authors found that for both men and women
aged 15 to 49, the number of cases of venous thromboembolism was fairly steady
from 1977 to 1988. In the period from 1989 to 1993, however, the men's rate did
not change, but the hospitalization rate for women was more than 16% higher.
Although Mellemkjaer and colleagues were not able to
determine whether women who had blood clots were taking the third generation
birth control pills, the increase in hospitalizations did coincide with
increasing use of the newer drugs, they report. The so-called third generation
pills were used by just 0.2% of Danish women who took oral contraceptives in
1984, but that percentage increased to 17% in 1988, 40% in 1990, and 66% in
1993.
``Our study gives support to the hypothesis that third
generation birth control pills increase the risk of venous thromboembolism to a
larger extent than second generation birth control pills,'' Mellemkjaer told
Reuters Health. However, the Danish researcher stressed that the study could
not prove that the newer pills were to blame.
However, in the report, the authors note that earlier
studies have also suggested that the newer contraceptives increase the risk of
blood clots more than second generation birth control pills. Most birth control
pills contain either a combination of the hormones estrogen and progestogen or
progestogen alone. According to Mellemkjaer, the main difference between second
and third generation birth control pills is in the level of progestogen.
``The increased risk of venous thrombosis with third
generation pills is real and measurable, but it is also small in absolute terms,
although greatest in women starting the Pill,'' Dr. Paul A. O'Brien, of the
Parkside Health NHS Trust in London, UK, writes in an accompanying editorial.
He states that second generation birth control pills should be ``the first
choice.''
However, some women may be willing to accept the small
additional risk of blood clots in exchange for the potential benefits of the
third generation pills, such as reduced acne, according to O'Brien.
``It is not that third generation contraceptives are
unsafe -- it is just that we have something safer,'' he concludes.
SOURCE: British Medical Journal (1999): 319, 795-796,
820-821.
Alternative names: aneurysm, cerebral
Definition
A disorder that involves localized widening of one or
more blood vessel(s) in the brain.
Causes, incidence, and risk factors
Aneurysms in the brain occur when there is a weakened
area in the wall of a blood vessel. They may occur as a congenital defect or
may develop later in life.
A saccular aneurysm (berry aneurysm) is usually small
in size. The aneurysm resembles a sack of blood attached to one side of the
blood vessel by a narrow neck. These are more common in adults. Multiple berry
aneurysms are not unusual. They occur in any part of the brain but are most
often seen in the large arteries at the base of the brain. Berry aneurysm is
also associated with polycystic kidney disease and coarctation of the aorta.
Rarely, berry aneurysm can run in families.
Other types of cerebral aneurysm may involve widening
(dilatation) of the entire circumference of the blood vessel in an area, or may
appear as a ballooning out of part of a blood vessel. These types of aneurysms
can occur in any part of the brain.
Symptoms usually do not appear until complications
develop. Bleeding is the most common cause of symptoms, with subarachnoid
hemorrhage the usual type of bleed. Weakness, numbness, or other loss of nerve
function (neurological deficits) may occur because of pressure from the
aneurysm on adjacent brain tissue or because of reduced blood flow caused by a
spasm of other blood vessels near a ruptured aneurysm.
It is estimated that 5% of the population has some
type of aneurysm. However, the incidence of ruptured aneurysm is approximately
4 out of 100,000 people per year.
Prevention
There is no known way to prevent formation of a
cerebral aneurysm. If discovered in time, unruptured aneurysms can be treated
before causing problems.
Symptoms of a bleed may include:
á
sudden occurrence of a headache (severe or described as "the worst
in patient's experience")
á
headaches with nausea or vomiting
á
stiff neck (occasionally)
á
muscle weakness, difficulty moving any part of the body
á
numbness or decreased sensation in any part of the body
á
vision changes
á
eye lid drooping
á
changes in mental status, the person may be lethargic, sleepy, or
stuporous
á
seizures
á
slow, sluggish, lethargic movement
á
speech impairment
á
irritability or poor temper control
Note: Cerebral aneurysms have no symptoms until
complications such as bleeding occur.
Signs and Tests
There may be signs of increased pressure within the
brain (intracranial pressure) including swelling of the optic nerve
(papilledema) that is shown on eye examination.
Cerebral aneurysm is usually diagnosed by tests to
determine the cause of bleeding within the brain.
A CT scan of the head indicates bleeding and
occasionally locates the aneurysm.
A CSF (cerebrospinal fluid) examination may confirm
bleeding when CT scan is non-diagnostic.
An MRI of the head may be an alternative to a CT scan,
but is not as sensitive to bleeding within the brain (subarachnoid bleeding).
Cerebral angiography pinpoints the location of the
aneurysm(s).
EEG (electroencephalogram) may be performed if
seizures occur.
Treatment
Because symptoms often do not appear until bleeding
occurs, cerebral aneurysm may be an emergency condition when it is discovered.
The goal of treatment is to control symptoms and prevent further bleeding.
Surgery is the primary treatment for cerebral aneurysm. The base of the
aneurysm is closed off with clamps, sutures, or other methods that prevent
blood flow through the aneurysm. If surgery is not feasible because of the
location or size of the aneurysm or the condition of the person, medical
treatment is similar to treatment for subarachnoid hemorrhage. This may include
restricting activity (often complete bedrest is advised), treating symptoms
such as headache, and prescribing preventive (prophylactic) use of antiseizure
medications.
Expectations (prognosis)
The outcome varies. A cerebral aneurysm that does not
rupture may not cause any symptoms. However, about 25% of ruptured cerebral
aneurysms are fatal within 24 hours. Another 25% are fatal within about 3
months. Of the remaining people with ruptured cerebral aneurysm, more than
one-half will have some sort of permanent disability.
Complications
á
subarachnoid hemorrhage
á
stroke
á
epilepsy
á
paralysis of any part of the body
á
permanent loss of sensation of any part of the body
á
other neurologic deficits (such as vision changes, loss of speech
ability)
á
communicating hydrocephalus
The information contained above is intended for
general reference purposes only. It is not a substitute for professional
medical advice or a medical exam. Always seek the advice of your physician or
other qualified health professional before starting any new treatment. Medical
information changes rapidly and while Yahoo and its content providers make
efforts to update the content on the site, some information may be out of date.
No health information on Yahoo, including information about herbal therapies
and other dietary supplements, is regulated or evaluated by the Food and Drug
Administration and therefore the information should not be used to diagnose,
treat, cure or prevent any disease without the supervision of a medical doctor.
Definition
A birth defect in which the major artery from the
heart (the aorta) is narrowed somewhere along its length; most commonly the
narrowing is just past the point where the aorta and the subclavian artery come
together.
Causes, incidence, and risk factors
Coarctation is a birth defect (congenital disorder) in
which a portion of the aorta is narrowed, resulting in low blood pressure and
low blood flow past the defect and high blood pressure on the side that is
closer to the heart (proximal to the defect). Most commonly, coarctation is
located so that there is high blood pressure in the upper body and arms and low
blood pressure in the lower body and legs.
There is an increased risk for aortic coarctation in
some genetic conditions such as Turner's syndrome. It also occurs more often in
boys than in girls. Symptoms from coarctation may not develop until
adolescence, but can be present in infants depending on the severity of blood
flow restriction. The symptoms include localized hypertension (high blood
pressure in only certain parts of the body), cold feet or legs, decreased
exercise performance, and heart failure. The pulse, normally felt in the groin
(femoral pulse), is typically absent when a coarctation is present.
The disorder occurs in approximately 1 out of 10,000
people. It is usually diagnosed in children or adults less than 40 years old.
Prevention
There is no known way to prevent this disorder.
Awareness of risk may make early diagnosis and treatment possible.
Symptoms
á
dizziness
á
pounding headache
á
fainting
á
nosebleed - symptom
á
leg cramps with exercise
á
absent or diminished pulses in the arteries of the groin (femoral
pulses)
á
cold legs or feet
á
hypertension
Note: There may be no symptoms.
Signs and Tests
An examination reveals high blood pressure in the
arms, with significant blood pressure difference between arms and legs. The
femoral (groin) pulse is weaker than the carotid (neck) pulse, or the femoral
pulse may be absent. Listening to the heart through a stethoscope reveals a
murmur that is harsh and heard in the back. There may be signs of left-sided
heart failure (especially in infants) or signs of aortic regurgitation.
Coarctation os often discovered during a newborn
infant's first examination or during a well baby exam. The health care provider
will detect that the femoral pulses are absent or very weak. This is an
important part of the examination as there may not be any other symptoms or
findings until the child is older.
Coarctation of the aorta may be confirmed by:
á
coronary angiography, looking at the aorta
á
chest CT
á
MRI of the chest
á
echocardiography
á
Doppler ultrasound of the aorta
á
X-ray of the chest (may also show abnormal ribs or "notching"
of ribs caused by enlargement of the rib arteries)
á
ECG that indicates left ventricle enlargement
á
cardiac catheterization
Treatment
Surgery is usually advised. Occasionally, balloon
angioplasty (using a similar technique to that used to open the coronary
arteries, but performed on the aorta) may be an alternative to surgical repair.
With surgery, the narrowed segment of the aorta is removed then repaired by
anastomosis (placing the two free ends of the aorta back together) if the gap
is small, or the gap may be bridged with a Dacron graft (a synthetic material used
to fill larger gaps).
Expectations (prognosis)
Coarctation of the aorta is curable with surgery, and
rapid improvement of symptoms can be expected after the repair. There is an
earlier incidence of cardiovascular death among people with aortic repair than
among the general public; however, repair leads to a marked increase in
longevity over those do not have the repair made. Early surgical intervention
(before 10 years old) may improve these statistics. Today, diagnosis of a
coarctation and the subsequent repair typically occur during infancy.
Uncorrected, coarctation usually causes death before the person is 40 years
old.
Complications
á
aortic aneurysm
á
aortic dissection
á
aortic rupture
á
severe hypertension
á
endocarditis
á
intracerebral hemorrhage
á
stroke
á
heart failure
á
premature development of coronary artery disease (CAD)
Alternative names
aneurysm - aortic
Definition
An abnormal widening of the abdominal portion of the
aorta (the major artery from the heart).
Causes, incidence, and risk factors
Abdominal aortic aneurysm involves a widening,
stretching, or ballooning of the aorta. The exact cause is unknown, but risks
include atherosclerosis and hypertension. Some causes of an abdominal aortic
aneurysm are injury, infection, or congenital weakening of the connective
tissue component of the artery wall.
Abdominal aortic aneurysm can affect anybody, but it
is most often seen in men 40 to 70 years old. A common complication is ruptured
aortic aneurysm. This is a medical emergency where the aneurysm breaks open,
resulting in profuse bleeding. Ruptured aneurysm occurs in approximately 5 out
of 10,000 people. Aortic dissectionoccurs when the lining of the artery tears
and blood leaks into the wall of the artery. An aneurysm that dissects is at
even greater risk of rupture. In children, abdominal aortic aneurysm can result
from blunt abdominal injury or from Marfan's syndrome.
Prevention
Avoid blunt trauma to the abdomen, atherosclerosis,
and hypertension.
Symptoms
á
abdomen hernia or mass, midline, pulsating (rhythmic throbbing), with
tenderness to touch
á
pulsating sensation in the abdomen
á
pain in the abdomen
á
severe, sudden, persistent or constant
á
not colicky or spasmodic
á
may radiate to groin, buttocks, or legs
á
pain may begin suddenly
á
abdominal rigidity
á
pain in the lower back
á
severe, sudden, persistent, may radiate
á
paleness
á
rapid pulse
á
dry skin/mouth
á
excessive thirst
á
anxiety
á
nausea & vomiting
á
lightheadedness occurs with upright posture
á
fainting occurs with upright posture
á
sweating, excessive
á
skin, clammy
á
fatigue (tiredness or weariness) developing recently
á
heartbeat sensations
á
rapid heart rate(tachycardia) when rising to standing position
á
impaired ability to concentrate
á
shock
á
abdominal mass
Note: Aneurysms may develop slowly over many years
and often have no symptoms. If the aneurysm expands rapidly, tears open
(ruptured aneurysm), or blood leaks along the wall of the vessel (aortic
dissection), the above symptoms may develop suddenly.
Signs and Tests
Listening to the abdomen with a stethoscope
(auscultation) shows a "blowing" murmur over the aorta or a
"whooshing" sound (bruit). Physical examination of the abdomen is
performed. If a rupture is suspected, physical examination for signs of blood
loss (hypovolemia) and an evaluation of lower extremity pulses and circulation
are performed.
Abdominal aortic aneurysm may show on these tests:
á
abdominal X-ray
á
abdominal ultrasound
á
MRI of abdomen
á
CT scan-abdominal
á
angiography of aorta
á
A CBC may indicate loss of blood.
Treatment
If the aneurysm is small and there are no symptoms
(for example, if the aneurysm is found during a routine physical examination),
periodic evaluation to watch for changes may be recommended.
Symptomatic aneurysms may require treatment to prevent
complications. Antihypertensive medications may be prescribed to reduce blood
pressure. Other medications may include analgesics to relieve pain.
Surgical repair or replacement of the section of aorta
is often recommended. The goal of treatment is timely surgical intervention
before complications develop.
The risk of complications increases as the size of the
aneurysm increases. Because surgery for abdominal aortic aneurysm is risky, the
surgeon may wait for the aneurysm to expand to a certain size before operating
(that is, when the risk of complications exceeds the risk of surgery).
Expectations (prognosis)
The probable outcome is good when an aneurysm is
monitored carefully and if surgical repair is performed before the aorta
ruptures. Aortic rupture is life threatening. Less than 50% of all people with
a ruptured abdominal aortic aneurysm survive.
Complications
á
aortic rupture
á
bleeding from the aorta
á
hypovolemic shock
á
arterial embolism
á
insufficient circulation past the aneurysm
á
irreversible damage to the kidneys (kidney failure)
á
myocardial infarction
á
stroke
á
aortic dissection
Alternative names
aortic aneurysm (dissecting)
Definition
A condition in which there is bleeding into and along
the wall of the aorta (the major artery from the heart); this condition may also
involve abnormal widening or ballooning of the aorta (aneurysm).
Causes, incidence, and risk factors
Aortic dissection involves bleeding into and along the
wall of the aorta (the major artery from the heart), most often because of a
tear or damage to the inner wall of the artery. This usually occurs in the
thoracic (chest) portion of the aorta but may occur in the abdominal portion
also.
The exact cause is unknown, but risks include
atherosclerosis and hypertension. Traumatic injury is a major cause of aortic
dissection, especially blunt trauma to the chest as with the steering wheel of
a car during an accident. Aortic dissection may also be associated with other
injury, infection, congenital weakness of the aorta, collagen disorders such as
Marfan's syndrome, pseudoxanthoma elastoma, Ehlers-Danlos syndrome, relapsing
polychondritis, or abdominal aortic aneurysm. Pregnancy, valve disorders
(including aortic insufficiency), and coarctation of the aorta may also be
associated with aortic dissection.
Aortic dissection occurs in approximately 2 out of
10,000 people. It can affect anybody, but it is most often seen in men 40 to 70
years old.
Prevention
Adequate treatment and control of atherosclerosis and
hypertension may reduce risk. Use safety precautions to reduce the risk of
injury. Many cases are not preventable.
Symptoms
á
chest pain
á
sudden, severe
á
sharp, stabbing, tearing, or ripping
á
located below the sternum, under the shoulder blades, or in the back
á
pain may radiate to shoulder, neck, arm, jaw, abdomen, hips
á
location of pain may change
á
changes in thought ability, concentration (confusion, disorientation)
á
decreased movement, any location
á
decreased sensation, any location
á
anxiety
á
pallor
á
rapid pulse (heart rate)
á
profuse sweating
á
dry skin/mouth, thirst
á
nausea, vomiting
á
dizziness, fainting
á
shortness of breath (dyspnea)
á
difficulty breathing when flat (orthopnea)
á
difficulty breathing at night (paroxysmal nocturnal dyspnea)
Note: Symptoms may begin suddenly.
Additional symptoms that may be associated with this
disease:
á
yawning, excessive
á
skin, clammy
á
pulse, weak or absent
á
cough
á
blood pressure, high
Signs and Tests
Listening with a stethoscope (auscultation) at the
chest and abdomen may reveal a "blowing" murmur over the aorta, a
heart murmur, or other abnormality. There may be decreased (weak) pulses in the
upper extremities. There may be signs of tamponade or hypovolemia, or signs
resembling acute MI. There may be signs of shock but with normal blood
pressure.
Aortic dissection or aortic aneurysm may be revealed
on:
á
an aortic angiography
á
a chest MRI or CT scan of chest
á
an echocardiography
á
a chest X-ray (may show mediastinal widening)
á
a Doppler ultrasonography (occasionally performed)
á
ECG may show signs of cardiac tamponade.
á
CBC is performed to evaluate blood loss.
Treatment
The goal of treatment is prevention of complications.
Hospitalization is usually required.
Antihypertensives may be prescribed to reduce blood
pressure. These may be given through a vein (intravenous). Analgesics may be
needed for pain. Cardiac medications such as beta-blockers may reduce some of
the symptoms.
Surgical repair or replacement of the section of aorta
is curative.
Expectations (prognosis)
Aortic dissection may be life threatening. The
disorder is curable with surgical repair if it is performed before aortic
rupture. Less than half of the patients with ruptured aorta survive.
Complications
á
bleeding from the aorta
á
aortic rupture causing rapid blood loss, shock, death
á
clot formation
á
insufficient circulation past the area of the dissection
á
irreversible kidney failure
á
stroke
á
myocardial infarction (tissue death)
á
cardiac tamponade