During breathing activity, chest wall moves out & in, lungs expand & relax. For the smooth movement of the lungs inside the chest cavity, they are lined by pleura.

Pleura includes two thin linings, the layer lining lungs is called visceral pleura and the one lining chest wall is called parietal pleura. The cavity formed between these two layers is called Pleural cavity. It contains a small amount of lubricant called Pleural fluid which helps smooth sliding of two pleural surfaces. Any condition which results in inflammation of the pleural surfaces or accumulation of excessive fluid in the pleural cavity gives rise to symptoms attributable to pleural involvement or disease.

Pleural effusion is nothing but the collection of excess fluid in the pleural cavity. Excess fluid in the pleural space is not normal and can occur due to a variety of reasons. Depending on the chemical composition it is broadly divided into two categories, transudate and exudate. 


What Causes Pleural Effusion?

1. Transudate pleural effusions 

Transudate pleural effusion is formed when fluid leaks from blood vessels into the pleural space. Chemically, transudates contain less protein and LDH than exudates. It is generally seen in the following conditions.

Congestive heart failure

Liver failure or cirrhosis

Kidney failure or nephrotic syndrome

Peritoneal dialysis

2. Exudate pleural effusions 

Exudate pleural effusion is caused by inflammation of the pleura itself and are often due to diseases involving the lung. Following are some common illnesses giving rise to exudate pleural effusion.

Tuberculosis
Pneumonia
Lung or breast cancer
Lymphoma
Pulmonary embolism
Post chest wall trauma or surgery
Asbestosis and mesothelioma
Secondary to intra-abdominal pathology 
Pancreatic pseudocyst, etc
Symptoms of Pleural Effusion -

Chest Pain: Chest pain is mainly due to irritation of the pleural lining. The pain is sharp, localized and worsens with a deep breath, yawning, coughing which is usually described as pleuritic. If the effusion causes inflammation of the diaphragm the pain may be referred to the shoulder or the upper abdomen. As the pleural effusion increases in size, the pain may increase or disappear altogether due to the separation of inflamed pleural surfaces.

Shortness of breath: As the effusion grows larger with more fluid, the harder it is for the lung to expand and the more difficult it is for the patient to breathe resulting in shortness of breath.

Other Symptoms: Other symptoms are generally attributable to the underlying disease process.

Diagnosis of Pleural Effusion -

Patient s Detailed History and Clinical Examination are the mainstays of diagnosing pleural effusion and it s the underlying cause. Following investigative modalities are generally opted for working out the final diagnosis before instituting appropriate therapy.

Chest X-ray: X-ray will help indicate the presence of fluid. 
Chest Ultrasound(USG): will help in confirming the presence of the fluid and it s localization which in turn can guide the physician about its quantity and its capability.
CT Scan: CT scan of the chest may at times be required to ascertain the underlying cause or to know about any other co-morbid conditions.
Thoracentesis: Thoracentesis is a procedure used to sample the fluid from the pleural effusion. Using a long thin needle, fluid can be removed and sent for testing to confirm the diagnosis.
This can be just for diagnostic purposes or can even be used as a therapeutic procedure.
Chemical analysis of the fluid will help determine the type of pleural effusion.
Treatment of Pleural Effusion -

Treatment of underlying Disease: The treatment of a pleural effusion usually requires that the underlying illness or disease is treated and controlled to prevent the accumulation of the pleural fluid. Like anti-TB therapy for Tubercular etiology or treatment of Cancer in malignant pleural effusion, etc.

Thoracentesis: As discussed earlier Thoracentesis can be used as a therapeutic procedure to remove excess fluid and help lung expand and function properly.

Tube thoracostomy: Thoracostomy or chest tube insertion may be done to drain and treat fluids which cannot be removed by needle aspirations, e.g. empyemas (pus collections).

Pleurodesis: Some pleural effusions reoccur multiple times; sclerosing agents that induce scarring such as talc or tetracycline was used to prevent a recurrence.

Decortication: If sclerosing agents fail, surgery may be required, called Decortication.

Pleural Effusion - What Is It?

Hemothorax is a serious and possibly a life-threatening condition in which blood collects between the lungs and the chest wall due to a traumatic injury or some other factor. It can be caused due to an extrapleural or an intrapleural injury. An extrapleural injury damages the chest wall on the outside while an intrapleural injury damages the chest wall on the inside.
Sometimes, Hemothorax is accompanied by excess air in the pleural cavity, known as pneumothorax. If they both occur at the same time, the condition is said to be hemopneumothorax. When blood accumulation is as large as nearly one liter, it has the potential to lead to shock and is referred to as Massive Hemothorax, which can be fatal.

Causes-
Hemothorax can be caused by a number of factors discussed as follows:
  Traumatic injury in an accident or sports causes the pleural lining of the lungs or chest to rupture. It causes blood to spill over into the pleural cavity, and it finds no way to drain itself out. Chest and lungs are so sensitive that even the smallest of injuries (or seemingly small) have the potential to cause Hemothorax.
  Tuberculosis and other lung infections can cause Hemothorax.
  Pulmonary embolism refers to a blood clot in the lungs that can cause Hemothorax.
  Lung or pleural cancer also have the potential to cause grave disease.
  Defective blood clotting as in hemophilia in which blood lacks clotting factors can cause Hemothorax.
  Tissue necrosis in the lungs or pulmonary infarction is a lung tissue dysfunction which can cause Hemothorax.
  Tearing of pulmonary blood vessels due to an invasive surgical procedure also has the potential of causing Hemothorax.
  Patients who have undergone major surgeries like lung transplant and open- heart surgery are very likely to get Hemothorax.


Symptoms-
There are many symptoms associated with Hemothorax like low blood pressure, rapid rate of heart, cold and pale skin color, chest pain while breathing, tense and shallow
breathing, difficulty in breathing, anxiety, and restlessness.


Diagnosis-
  Physical examination includes listening to the sounds of abnormal breathing and to the sounds of liquid in the chest.
  An X-Ray image reveals the presence of liquid in the pleural cavity.
  A full Computed Tomography Scan can reveal the occurrence as well as the cause of Hemothorax.
  An ultrasound provides good insight into the situation of the lungs and the pleural cavity.
  Sometimes, a sample of the pleural fluid is extracted for test and diagnosis.


Treatment-
The procedure is performed under anesthesia. A catheter or a needle is inserted into the chest through ribs for removing air and blood from the pleural cavity. If the lung collapses, it is expanded using the chest tube, which is left attached to a closed system. This ensures the escape of air and fluid from the pleural cavity and prevents additional air from entering the pleural space. This section is hence left in a water seal or hooked up to suction.
If the injury is small, chest drainage might be sufficient depending upon the case. However, if there is a major injury, it might require stopping bleeding at its source through a surgery.


Take Away-
Hemothorax can cause a collapsed lung that might progress to lead to respiratory failure. If left untreated, Hemothorax can cause infection in pleura, lung or pleural fluid in the chest cavity. Hemothorax can cause scarring of the lung tissue and pleural membranes. Retained Hemothorax occurs when blood stays in the pleural cavity for too long. It might clot and get difficult to remove through the catheter. It might also cause the buildup of pus in the surrounding region leading to an infection. Retained Hemothorax is treated by draining the fluid differently or through a video-assisted surgical procedure. Before opting for any treatment or surgery, one should always consult a doctor.

Chest Injuries And Hemothorax - Know How Serious It Can Be!

Lifestyle changes and unhealthy habits take a toll on one s physical and mental health resulting in many diseases. One such disease that is growing common is the stroke that occurs due to a sudden interruption of blood supply to the brain. As with any lifestyle disease, the chances of having a stroke can be reduced as well. Knowing the risk factors and taking appropriate measures can prevent you from a stroke attack. 

Read on to know the seven effective ways to prevent you from a stroke.

Opt for a healthy lifestyle: While smoking leads to an increased risk of suffering from a stroke, excessive consumption of alcohol not only triggers irregular heartbeats, but also high blood pressure, which can be a solid reason behind having a stroke. Therefore, leading a healthy lifestyle free from smoking and alcohol can help in preventing strokes.
Manage conditions: Whether it is diabetes or any other kind of illness which directly or indirectly give rise to the risk of having a stroke, dealing with one's underlying conditions is important. In case one is diagnosed with such a condition that can be responsible for a stroke, he or she must make it a point to keep that condition under control.
Lose weight: Obesity is often known to increase the complexities associated with a stroke such as diabetes and high blood pressure. Therefore, for those who are overweight, losing a few pounds can be really helpful in preventing the chances of having a stroke.
Keep blood pressure in check: High blood pressure often causes a stroke, if not controlled. It is referred to as the biggest contributor in causing a stroke by many. Lowering the high blood pressure or bringing it to normal levels can indeed be a great way of preventing a stroke.
Exercise regularly: Exercise not only contributes to lowering the blood pressure, but also helps to maintain body weight while ensuring the overall fitness of the body. Some light hand exercises or regular walking combined with proper diet can do wonders in preventing a stroke.
Have a proper sleep at night: Spending sleepless nights may increase the risk of stroke. Therefore, one must make it a point to maintain the necessary amount of sleep at night that can help in reducing stress and anxiety, while decreasing the chance of heart diseases as well as a stroke.
Never ignore the palpitations: Ignoring the palpitations is the last thing one can want to do, if he or she is willing to prevent the chances of suffering a stroke. Feelings of lightheadedness or shortness of breath, chest pain and abnormal heart beats can be warning signs for a stroke. Therefore, you must pay proper attention to these and deal with appropriate medications.
An otherwise healthy person can stay away from stroke by continuing a healthy lifestyle and following the tips mentioned above. However, if you have suffered a stroke earlier, then it becomes imperative to follow these tips along with supervised medical care.

Stroke - Can You Prevent It From Happening?

Your heart is the most important and vital organ of all and regulates the flow of heart to all parts of the body. Thus, the valves and the arteries which take the blood to your heart are also an important component in ensuring that the circulation is constant. Thus, any hindrance to this process will put a lot of pressure on your heart and lead to more serious problems in the long run. Coronary artery disease is one such problem and can seriously put the health of your heart at risk.

What is coronary heart disease?
Coronary arteries are very important blood vessels, which carry nutrients, blood and oxygen to your heart. If the level of bad cholesterol is high in your blood, it will start leaving deposits on the walls of the arteries which are commonly known as plaque. This plaque will start building up over time causing blockage of the arteries and disrupting proper blood flow. Excessive build up of the plaque may then rupture the lining of the plaque. This will then induce blood clotting and further prevent the normal flow of blood.

Symptoms
Primary symptoms may include

Shortness of breath: This may occur while you are exercising or performing activities which are mildly exerting.
Heart beats very hard and fast: Your heart may beat very hard and fast, especially when doing everyday activities such as climbing stairs or walking for a prolonged distance.
Angina or chest pain: You may experience pain in your chest as if someone was pressing against it with a lot of force. Angina is also triggered due to stressful activities or even emotional stress. It usually occurs on the left or the middle of the chest and may even be felt in the back, arms, and neck.
Heart attack: Heart attacks are the most common and the most serious complications of coronary heart disease. You would feel extreme pain, akin to crushing on your chest, shoulder, or arm. It may even be accompanied by jaw pain, and sweatiness.
Treatment
Non invasive forms of treatment are always preferable rather than invasive surgeries or procedures to treat coronary heart disease, especially where the risk of serious complications such as heart attack are still on the lower side. Some of the treatments used for coronary heart disease are as follows:

Making lifestyle changes: Quit smoking, reduce alcohol consumption along with consumption of regulated diet will automatically start cleaning plaque that has built up within the arteries. Losing weight also tends to help.
Medications: Special medications can take care of cases wherein the deposits are still lesser and the plaque buildup can be removed without the requirement of extensive surgery. Anti-cholesterol medications are one example of this.
Surgical procedures: These are usually employed when the blockage is severe and cannot be corrected by the conventional methods mentioned above. Some of the procedures are angioplasty, stent replacement, as well as coronary artery bypass surgery.

Coronary Artery Disease -  Know the Primary Signs!

How many of us have heard about Extracorporeal Membrane Oxygenation (ECMO) before Tamil Nadu, Chief Minister late J Jayalalithaa was put on it for recovery? Hardly a handful. Patients who are placed on the device have 50-50 chance of survival and while it could not help the late Chief Minister, her condition put a spotlight on ECMO.

What is ECMO?
ECMO is a life support device that is put in place when a patient's heart and lungs stop functioning completely post a cardiac arrest. When the patient does not respond to Cardio Pulmonary Resuscitation (CPR), the patient is put on ECMO.

Function of ECMO
The core function of the device is to separate carbon dioxide from the blood and add oxygen into it. It takes the load off from heart and lungs, providing critical time to the body organs for its treatment and recovery.
Patients are only put on ECMO, if there is a chance that the condition can be reversed.

How does ECMO work?
The device drains blood from a vein, which is attached to an oxygenator machine. The machine then removes carbon dioxide from the blood and adds oxygen to it. Depending upon the condition of the patient, the warm blood is either pumped into the body with the help of the machine or is transferred back into the body through an artery.

How long a patient can be on ECMO?
After seven days of being put on ECMO,there are chances of patient getting an infection.
In case the patient contracts an infection, it is recommended to take the patient off ECMO support.

All About ECMO - Extracorporeal Membrane Oxygenation 

Arrhythmia is a disorder which is characterized by improper and irregular heartbeats; be it too slow or too fast. This problem occurs when the electrical impulses that are used to regulate your heartbeat don t work in the correct manner. Your heart may beat irregularly, too slow or too fast.

Symptoms
Although this disorder does not yield many symptoms, a few noticeable symptoms of arrhythmia are slow heartbeat, or a racing heartbeat, chest pain, breathing difficulties and dizziness. Arrhythmia can lead to inefficient pumping by the heart, leading to bouts of fainting. A severe symptom of this disorder is ventricular fibrillation, wherein the ventricles tend to quiver instead of transporting blood. This symptom can cut off blood supply to the vital organs, which may lead to death.

Causes

Coronary artery disease: In this disease, arteries of the heart can get blocked, leading to irregular heart beat and impaired heart functioning.
A heart attack: An ongoing heart attack usually leads to irregular heartbeats.
High blood pressure: High blood pressure problems make you more vulnerable to this condition.
Impaired functioning of the thyroid glands: An overactive or underactive thyroid gland can lead to heart arrhythmia.
Excessive smoking and alcohol consumption: These habits can cause problems with the blood vessels in the body, thus increasing risks of this particular condition as well as other cardio-vascular diseases.
Stress: Too much stress can lead to high blood pressure; that is again linked to heart arrhythmia.
Treatment
Mild symptoms of arrhythmia do not require treatment. However, complications resulting from it warrant treatment. The various treatment options for this condition are:

Pacemaker: A pacemaker is a device that is used to regulate your heart rhythms. It is placed in the body by a surgical procedure and an insulated wire is put, connecting the heart to the pacemaker. In case of an irregular heartbeat, the pacemaker sends out impulses to correct the improper heartbeat.
Implantable cardioverter-defibrillator: This device is used to prevent a dangerous symptom of heart arrhythmia, a symptom wherein the ventricle quivers. It is similar to a pacemaker as it is also placed near the collarbone. In case it detects an abnormal rhythm, it sends out shocks to reset the heart rhythm.
Maze procedure: This is a surgical procedure wherein incisions are made on the upper heart tissue to create a scar tissue. Scar tissues act as insulators to prevent stray impulses.
Alternative therapies: Alternative procedures such as yoga and meditation can help remedy the disorder.

Is Your Heart Missing a Beat Regularly - Could it be Arrhythmia?

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