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What is lupus?

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Lupus is a long-term autoimmune condition that hyperactivates the body’s immune system and destroys normal, healthy tissue. Symptoms involve swelling, inflammation and damage to joints, skin, kidneys, blood, heart, and lungs.

Due of its complex nature, people often call lupus the “1,000-face disease.”

In the United States, people record approximately 16,000 new cases of lupus per year, and up to 1,5 million people, according to the Lupus Foundation of America, may be living with this illness.

The Foundation claims lupus especially affects women, and is most likely to occur between the ages of 15 and 44.

Lupus gained public attention in 2015 following the announcement by the singer Selena Gomez that she was diagnosed in her late teens and sought treatment for the disease.

Lupus is not contagious. A individual can not have it transferred to another individual sexually or in any other way.

Nevertheless, women with lupus can, in rare cases, give birth to children who develop a type of lupus. This is called lupus neonatal.

Types

There are various types of lupus. This article will concentrate specifically on systemic lupus erythematosus (SLE), include discoid, drug-induced, and neonatal lupus are another forms.

Systemic lupus erythematosus

Malar rash is a major symptom of lupus. Image credit: Doktorinternet, 2013.
Malar rash is a major symptom of lupus. Image credit: Doktorinternet, 2013.

SLE is the most well recognized form of lupus. It is a state of systemicity. This means it is having an effect all over the body. Symptoms may be mild to severe.

It is more extreme than other forms of lupus, such as discoid lupus, as it can affect any organ or organ system in the body. This may cause skin, joints, lungs, kidneys, blood, pulse, or a combination of these inflammations.

This state is usually cyclical. The person should have no symptoms in moments of remission. The illness becomes active during a flare-up, and symptoms appear.

Discoid lupus erythematosus

Symptoms affect only the skin in discoid lupus erythematosus (DLE) — or cutaneous lupus —; There’s a rash on your nose, neck and scalp.

The areas raised can become thick and scaly and can result in scarring. The rash can last from several days to several years, and can recur.

DLE will not affect the internal organs but, according to the Lupus Foundation of America, about 10 percent of people with DLE will tend to develop SLE. However, it is not clear if these individuals already had SLE and displayed only clinical symptoms on the skin, or if there is improvement from DLE or SLE.

Subacute cutaneous lupus erythematosus

Subacute cutaneous lupus erythematosus refers to skin lesions that occur on sun-exposed areas of the body. None of the lesions cause scarring.

Drug-induced lupus

Symptoms arise in around 10 percent of people with SLE due to a reaction to some prescription drugs. Some 80 medications can cause the condition according to the Genetics Home Reference.

They are some of the drugs people are using to control epilepsy and high blood pressure. Some thyroid medications, antibiotics, antifungals, and oral contraceptive pills also come in.

Drugs that are commonly associated with this form of lupus are:

  • Hydralazine, a hypertension medication
  • Procainamide, a heart arrhythmia medication
  • Isoniazid, an antibiotic used to treat tuberculosis (TB)

Drug-induced lupus typically goes away after the person stops taking the medication.

Neonatal lupus

The majority of babies born with SLE are healthy. Yet only 1% of women with lupus-related autoantibodies may have a baby with neonatal lupus.

The woman may have SLE, a condition of Sjögren, or no signs of disease at all.

Sjögren’s syndrome is another autoimmune disease often associated in lupus. Main signs include a dry mouth and dry eyes.

Babies with neonatal lupus at birth can experience skin rash, liver problems and low blood counts. About 10 percent would have anemia.

The lesions usually go away after a few weeks. However, some infants have a congenital heart block, in which the heart cannot regulate a normal and rhythmic pumping action. The infant may need a pacemaker. This can be a life-threatening condition.

To women with SLE or other associated autoimmune disorders it is essential to be under the care of a doctor during pregnancy.

Causes

Lupus is an autoimmune condition, but the exact cause is unclear.

What goes wrong?

The immune system defends the body and kill antigens including viruses, bacteria, and germs.

This does so by producing proteins known as antibodies. These antibodies are formed by white blood cells, or lymphocytesB.

The immune system can not distinguish between harmful substances, or antigens, and healthy tissue when a person has an autoimmune disorder such as lupus.

As a consequence, anticorps are guided toward both healthy tissue and antigens by the immune system. This causes damage to swelling, pain and tissue.

An antinuclear antibody (ANA) is the most common form of autoantibody that develops in humans with lupus. The ANA interacts with parts of the nucleus of the cell, the cell’s command center.

Such autoantibodies circulate in the blood but some of the cells of the body have walls that are sufficiently permeable to let certain autoantibodies pass through.

The autoantibodies will then target the DNA in those cells’ nucleus. Therefore lupus affects certain organs more than others.

Why does the immune system go wrong?

The development of SLE is possibly affected by various genetic factors.

Within the body certain genes help the immune system function. Changes in certain genes may stop the immune system from functioning properly in people with SLE.

According to Genetics Home Guide, one potential explanation relates to cell death, a normal cycle that happens when the body renews its cells.

Some scientists claim that the body is not getting rid of cells which have died due to genetic factors.

These remaining dead cells that release substances which cause malfunction in the immune system.

Risk factors: Hormones, genes, and environment

A variety of factors may cause lupus to grow in response. They may be hormonal, genetic, environmental, or a combination of them.

1) Hormones

Hormones are chemical substances which are produced by the body. We monitor and regulate the operation of different cells or organs.

The following risk factors may be explained by hormonal activity:

Sex: The U.S. National Institutes of Health states that females are 9 times more likely to develop lupus than males.

Age: Signs and diagnosis frequently arise during childbearing years, between the ages of 15 and 45. Nonetheless, according to Genetics Home Reference, 20 percent of cases occur after the age of 50 years.

As 9 out of 10 lupus cases affect females, researchers have looked at a possible connection between lupus and estrogen. All men and women are consuming estrogen but women are producing more.

In a study published in 2016, scientists observed that oestrogen in mice susceptible to lupus can affect immune function and induce lupus antibodies.

This can explain why women are more likely to get affected by autoimmune diseases than men.

In 2010 researchers who published a study in the journal Rheumatology on self-reported flares found that women with lupus experience more intense menstrual pain and fatigue. This indicates flares at this time might be more probable.

There’s no data to prove that lupus is caused by estrogen. If there is a correlation, lupus severity may be controlled by estrogen-based treatment. Nonetheless, it needs more work before physicians can recommend it as a therapy.

2) Genetic factors

Studies have not shown that lupus is caused by any particular genetic factor although it is more severe in some families.

Genetic factors may be the reason why the following are risk factors for lupus:

Race: people of any ethnicity that develop lupus, but in people of color it is two to three times more common compared to white people. This is also more common in women from Hispanic, Asian and Native American countries.

History of the family: A person who has a first or second degree relative with lupus will have a greater chance of developing it.

Scientists have established some genes that could lead to lupus development but there is insufficient evidence to prove they cause the disease.

In identical twin studies, one twin may develop lupus while the other does not, even though they grow together and have the same exposures to the environment.

According to a report published in Seminars on Arthritis and Rheumatism in 2017, if one member of a twin pair has lupus, the other has a 25 percent risk of developing the disorder. Identical twins have a greater risk of each developing the disease.

Lupus may occur in people who have no family history of the disease, but other autoimmune disorders may occur within the family. Examples of this include thyroiditis, hemolytic anemia and purpura thrombocytopenia idiopathic.

Some have suggested changes to the x-chromosomes may affect the risk.

3) Environment

Environmental agents — such as chemicals or viruses — can help to cause lupus in people who are genetically susceptible already.

Possible environmental causes include:

Smoking: an increase in the number of cases may be attributed to increased exposure to cigarettes in recent decades.

Sunlight exposure: Many say this may be a cause.

Medication: Around 10 percent of cases may be drug-related, according to Genetics Home Reference

Viral infections: These may trigger symptoms in people who are prone to SLE.

Lupus is not infectious, and can not be sexually transmitted by a human.

Gut microbiota

Scientists have recently looked into gut microbiota as a potential factor in lupus growth.

Scientists who published research in Applied and Environmental Microbiology in 2018 noted that in both people and mice with lupus, unique changes in the gut microbiota function.

They are demanding more reserch in this field.

Are children at risk?

Lupus is rare in children under the age of 15 unless the mother of their birth has it. In this case, a child may have problems with the heart, liver, or skin associated with lupus.

Children with neonatal lupus may have a greater risk of developing another autoimmune disorder later in life.

Symptoms

The lupus signs arise at flare-up periods. Individuals normally experience recovery periods between flare-ups, where there are little to no symptoms.

Lupus has a wide range of symptoms, including:

  • fatigue
  • a loss of appetite and weight loss
  • pain or swelling in joints and muscles
  • swelling in the legs or around the eyes
  • swollen glands, or lymph nodes
  • skin rashes, due to bleeding under the skin
  • mouth ulcers
  • sensitivity to the sun
  • fever
  • headaches
  • chest pain upon deep breathing
  • unusual hair loss
  • pale or purple fingers or toes from cold or stress (Raynaud’s phenomenon)
  • arthritis
Lupus affects people in different ways. Symptoms may be found in many areas of the body.
Lupus affects people in different ways. Symptoms can occur in many parts of the body.

Effect on other body systems

Lupus can also affect the following systems:

Kidneys: Kidney inflammation (nephritis) will make it harder for the body to efficiently absorb waste products and other toxins. Around 1 in 3 people suffering from lupus will have kidney problems.

Lungs: Some people develop pleuritis, an inflammation of the chest cavity lining that causes pain in the chest, particularly at breathing. May develop pneumonia.

Central nervous system: Occasionally, lupus may affect the brain or the central nervous system. Symptoms include headaches, dizziness, fatigue, memory loss, problems with vision, seizures, strokes or behavioral changes.

Blood vessels: Vasculitis, or blood vessel inflammation, can occur. This can have an effect on circulation.

Blood: Lupus can cause anemia, leukopenia (a decrease in the number of white blood cells) or thrombocytopenia (a decrease in the number of platelets in the blood that help to clot).

Heart: When the heart is compromised by inflammation it can lead to myocarditis and endocarditis. It can also affect the membrane surrounding the heart which causes pericarditis. It can result in chest pain or other symptoms. Endocarditis can damage heart valves and cause thickening and development of the valve surface. This can lead to growths which can trigger heart murmurings.

Other complications

Having lupus increases the risk of a number of health problems.:

Infection: Infection gets more likely as the immune system is compromised by both lupus and its treatments. Popular infections include urinary tract infection, respiratory infections, yeast infection, salmonella, herpes, and shingles.

Bone tissue death: This happens when blood flow to a bone is small. Minor breaks in the bone may grow. The bone could ultimately collapse. The hip joint is most often affected by this.

Pregnancy complications: People with lupus are at elevated risk of loss of pregnancy, premature delivery and preeclampsia, a disorder that requires high blood pressure. Doctors also suggest stopping the pregnancy until the lupus has been under control for at least 6 months to reduce the likelihood of such complications.

video


The following video explains how lupus causes symptoms.

Classification: 11 symptoms

When validate a diagnosis, the American College of Rheumatology makes use of a common classification system.

When a person meets 4 out of 11 requirements, a doctor may find the likelihood of having lupus.

The 11 parameters are those of:

  1. Malar rash: A butterfly-shaped rash appears across the cheeks and nose.
  2. Discoid rash: Raised red patches develop.
  3. Photosensitivity: A skin rash appears after exposure to sunlight.
  4. Oral or nose ulcers: These are usually painless.
  5. Non-erosive arthritis: This does not destroy the bones around the joints, but there is tenderness, swelling, or effusion in 2 or more peripheral joints.
  6. Pericarditis or pleuritis: Inflammation affects the lining around the heart (pericarditis) or lungs (pleuritis).
  7. Kidney disorder: Tests show high levels of protein or cellular casts in the urine if a person has a kidney problem.
  8. Neurologic disorder: The person has seizures, psychosis, or problems with thinking and reasoning.
  9. Hematologic (blood) disorder: Hemolytic anemia is present, with a low white blood-cell count or low platelet count.
  10. Immunologic disorder: Tests show that there are antibodies to double-stranded DNA (dsDNA), antibodies to Sm, or antibodies to cardiolipin.
  11. Positive ANA: The test for ANA is positive, and the person has not used any drugs that might induce it.

Even this system, however, sometimes fails early and mild cases.

Underdiagnosis can occur because lupus signs and symptoms are not similar to each other.

On the other hand, some blood tests may lead to overdiagnosis, because people without lupus can have the same antibodies as those with the disease.

Diagnosis

A blood test can help to diagnose lupus.
A blood test can help to diagnose lupus.

Diagnosis can be complicated due to the varied symptoms which can resemble symptoms from other diseases.

The doctor will inquire about the symptoms, conduct a physical examination and take a medical history of both personal and family. We will also consider the above 11 conditions.

The doctor can order blood tests, as well as other laboratory research.

Biomarkers

Biomarkers are antibodies, proteins, genetics, and other factors that may show a doctor what’s going on in the body, or how the body responds to treatment.

Symptoms are useful because they can show that a person has a disease even without symptoms.

Lupus affects people in different ways. This makes identifying accurate biomarkers difficult.

A combination of blood tests and other studies will also help a doctor confirm a diagnosis.

Blood tests

Blood tests can indicate whether certain biomarkers are present, and biomarkers can provide details on which, if any, a person has autoimmune disease.

1) Antinuclear antibody

In the ANA study, nearly 95 percent of people with lupus would have a positive result. Many people test positive for ANA, however, but don’t have lupus. Other tests must confirm the diagnosis.

2) Antiphospholipid antibodies

Antiphospholipid antibodies (APLs) are a type of phospholipid-directed antibody. In up to 50 percent of people with lupus, APLs are present. Individuals without a lupus can have APLs, too.

A person with APLs may have an increased risk of blood clots, stroke, and lung hypertension. There is also an increased risk of complications of pregnancy including a loss of pregnancy.

3) Anti-DNA antibody test

About 70 percent of people with lupus have an antibody called the anti-DNA antibody. In a flare-up the result is more likely to be optimistic.

4) Anti-dsDNA antibody

The anti-double-stranded DNA antibody (anti-dsDNA) is a particular form of ANA antibody that occurs in around 30 percent of lupus people. Fewer than 1 per cent of lupus-free people have this antibody.

If the test is positive, a person may have a more severe form of lupus, such as lupus nephritis, or lupus in the kidneys.

5) Anti-Smith antibody

Around 20 percent of people with lupus have an antibody to Sm, a ribonucleoprotein that is present in the nucleus of a cell.

It is present in less than 1 per cent of lupus-free people and is rare in those with other rheumatic diseases. A individual with anti-sm antibodies is likely to get lupus for this purpose. It is typically not present with lupus in the kidneys.

6) Anti-U1RNP antibody

Around 25 percent of people with lupus have anti-U1RNP antibodies, and fewer than 1 percent of people without lupus have them.

This antibody may be present in people with the syndrome of Raynaud, and Jaccoud’s arthropathy, a hand deformity due to arthritis.

7) Anti-Ro/SSA and anti-La/SSB antibodies

For people with lupus, between 30 and 40 percent have anti-Ro / SSA and anti-La / SSB antibodies. They also occur with Sjögren’s primary syndrome and in people with lupus who test ANA negative.

In around 15 per cent of people without lupus, they are present in small quantities and can occur with certain rheumatic disorders, such as rheumatoid arthritis.

If a mother has anti-Ro and anti-La antibodies, the risk of a baby born to her developing neonatal lupus is greater.

A person with lupus who wants to become pregnant has these antibodies undergoing testing.

8) Anti-histone antibodies

Antibodies to histones are proteins that play a role in the structure of DNA. People with drug-induced lupus usually have them, and people with SLE may have them. However, they do not necessarily confirm a diagnosis of lupus.

Serum (blood) complement test

Histone antibodies are proteins which play a role in DNA structure. Those with drug-induced lupus generally have them, and can have them for those with SLE. They may not automatically however validate a lupus diagnosis.

Serum (blood) complement test

serum complement test measures the levels of proteins that the body consumes when inflammation takes place.

If a person has low complement levels, this suggests that inflammation is present in the body and that SLE is active.

Urine tests

Urine tests can help to diagnose and monitor the effects of lupus on the kidneys.

The presence of protein, red blood cells, white blood cells, and cellular casts can all help to show how well the kidneys are working.

For some tests, only one sample is necessary. For others, the person may need to collect samples over 24 hours.

Tissue biopsies

The doctor may also require biopsies to test for any injury or inflammation, usually of the skin or kidneys.

Imaging tests

X-rays and other imaging tests can help doctors see the organs affected by lupus.

Monitoring tests

Ongoing tests can show how lupus continues to affect a person or how well their body is responding to treatment.

Treatment and home remedies

There is currently no cure for lupus, but people can manage their symptoms and flares with lifestyle changes and medication.

Treatment aims to:

  • prevent or manage flares
  • reduce the risk of organ damage

Medication can help to:

  • reduce pain and swelling
  • regulate the activity of the immune system
  • balance hormones
  • reduce or prevent joint and organ damage
  • manage blood pressure
  • reduce the risk of infection
  • control cholesterol

The precise diagnosis will depend on how personally the lupus affects. Flares may occur without care, which could have life-threatening consequences.

Alternative and home therapies

Exercise can help to reduce pain and relieve stress.
Exercise can help to reduce pain and relieve stress.

Apart from medication, the following may help to relieve pain or reduce the risk of a flare:

  • applying heat and cold
  • participating in relaxation or meditation activities, including yoga and tai chi
  • doing regular exercise when possible
  • avoiding exposure to the sun
  • avoid stress, as far as possible

Many people use the thunder-god-vine replacement. The National Center for Complementary and Integrative Health (NCCIH), however, warns that this may be dangerous. Until using it, it is crucial that you speak to a doctor.

Outlook In the past, people who had a lupus diagnosis would usually not survive for longer than five years.

Nevertheless, care now, according to the National Institutes of Health, will dramatically improve a person’s life span.

Effective therapy also allows lupus treatment possible, so that an full, healthy life can be lived by a person.

As scientists know more about genetics, physicians hope to be able to recognize lupus at an earlier stage one day. It would promote avoidance of accidents before they occur.

Often people want to enter a clinical trial, because this can include access to new medicines. For more information on clinical trials please click here.

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Cardiovascular / Cardiology

Symptoms, causes, and treatment of transient ischemic attack (TIA)

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A transient ischemic attack (TIA), also known as a ministroke, happens when the brain’s blood supply is interrupted for a short period of time.

Although the diminished blood flow normally only lasts 5 minutes, a TIA is still a medical emergency. It could be a precursor to a massive stroke.

Because the symptoms of a TIA resolve fast, many people do not seek medical care. However, according to the Centers for Disease Control and Prevention (CDC), more than one-third of people who don’t get treatment for a TIA will have a severe stroke within a year.

According to statistics, 20% of persons who have a TIA will have a stroke within three months, and half of these will happen within two days of the TIA.

Knowing the signs and symptoms of a TIA and seeking care as soon as possible can help you avoid a more serious and perhaps life-threatening incident.

In this article, you’ll learn more about what a TIA entails and what to do if one arises.

What is a TIA?

transient ischemic attack (TIA)

A transient ischemic attack (TIA) has symptoms that are similar to those of a stroke, but it causes only a few minutes. The decreased blood flow normally only lasts a few seconds, but the symptoms can last for several minutes. They can last for a few hours on rare occasions.

TIAs occur when a blood clot stops blood flow to the brain cells for a brief period of time, preventing oxygen from reaching the cells. The symptoms usually go away when the clot breaks up or moves on. These events do not stay long enough to cause brain cells permanently.

People should not dismiss a TIA since it could be an indication of a big stroke, according to the American Stroke Association.

According to statistics, TIAs afflict about 2% of the population in the United States.

Causes

When the supply of oxygen to the brain is interrupted, a TIA ensues. This could be as a result of:

  • atherosclerosis, in which fatty deposits cause the arteries to become harder, thicker, narrower, and less flexible
  • blood clots due to heart disease, cardiovascular disease, or an irregular heart rhythm
  • blood clots due to a blood condition, such as sickle cell disease
  • an embolism or blood clot that has traveled from elsewhere in the body
  • an air bubble in the bloodstream

Symptoms

The symptoms of a TIA are determined by which area of the brain isn’t getting enough blood.

The acronym FAST (facial, arms, speech, time) might help people recall the symptoms to look for, just as it can with a severe stroke:

  • F = face: The eye or mouth may droop on one side, and the person may be unable to smile properly.
  • A = arms: Arm weakness or numbness might make it hard to raise one or both arms or keep them raised.
  • S = speech: The person’s speech may be slurred and garbled.
  • T = time: Someone should call the emergency services at once if a person has one or more of these symptoms.

The person may also have:

  • numbness or weakness, especially on one side of the body
  • sudden confusion
  • difficulty understanding what others are talking about
  • vision problems
  • dizziness
  • problems with coordination
  • difficulty walking
  • a very bad headache
  • a loss of consciousness, in some cases

TIA symptoms are only present for a short time. They can last anywhere from a few minutes to several hours, and they normally go away after 24 hours.

However, if anyone experiences symptoms that could signal a TIA, they should seek medical care right away because a massive stroke could result.

The same variables that cause temporary blood flow insufficiency in a TIA can cause a stroke, which can result in irreversible brain damage owing to a longer-lasting blood flow deficit.

Conditions with symptoms that are similar

A TIA’s symptoms can be similar to those of other diseases, such as:

Even if the symptoms of the TIA have subsided, getting an accurate diagnosis can assist a person get the proper treatment to help minimise the risk of a future stroke.

  • having a family history of stroke or TIA
  • being 55 years or above
  • being assigned male at birth
  • being Black or Hispanic, compared with being non-Hispanic white
  • having high blood pressure
  • having cardiovascular disease
  • smoking tobacco
  • having diabetes
  • getting low levels of exercise
  • having high cholesterol levels
  • eating a diet that is high in unhealthy fats and salt
  • having high homocysteine levels
  • having overweight or obesity
  • having a type of heartbeat known as atrial fibrillation

Treatment

Treatment options will be determined by the cause of the TIA. The parts that follow will go over some of the possibilities.

Medications

A doctor may recommend medicine to reduce the risk of a second blood clot and catastrophic stroke.

The treatment options will vary depending on the cause of the TIA, however they usually include:

  • anti-platelet drugs to prevent clotting, such as include aspirin, ticlopidine (Ticlid), and clopidogrel (Plavix)
  • anticoagulants such as warfarin (Coumadin) and heparin, which also help prevent clotting
  • medications to manage high blood pressure, or hypertension
  • drugs to help manage cholesterol levels
  • medications to manage heart disease and regulate irregular heart rhythms

All of these medications can cause side effects and may interact with other medications.

As a result, people should tell their doctor about any other prescriptions they’re taking, including over-the-counter drugs, supplements, and herbal therapies.

If a person has negative side effects while taking a medication, they should consult a doctor. It’s possible that another option exists.

Surgery

A doctor may propose surgery to remove a blockage or a portion of a damaged artery in some instances.

Preventive actions and lifestyle changes

A risk of lifestyle changes can help minimise your chances of having a TIA or stroke. These are some of them:

  • avoiding or quitting smoking
  • avoiding exposure to secondhand tobacco smoke
  • eating a nutritious and varied diet, with plenty of fresh fruits and vegetables
  • managing one’s intake of salt and unhealthy fats
  • getting regular exercise
  • avoiding the use of recreational drugs
  • managing body weight, if appropriate
  • following any treatment plan for heart disease, diabetes, or other conditions

Before making any major lifestyle changes, such as beginning a new workout plan, it is best to consult with a healthcare practitioner to determine the best course of action.

Diagnosis

Anyone who has signs or symptoms of a TIA should seek medical help right away to figure out why it happened and how to avoid a recurrence or a more serious occurrence.

Symptoms can fade fast, and by the time the person sees a doctor, they may be gone. A witness who was present at the time, on the other hand, may be able to assist the individual in explaining the situation to the doctor.

The doctor will likely:

  • ask what happened and ask about any ongoing symptoms
  • ask how long the symptoms lasted for and how they affected the person
  • consider the individual’s personal and family medical history
  • carry out a neurological examination, which may include memory and coordination tests

If the doctor suspects the patient suffered a TIA, he or she may be referred to a neurologist for further evaluation.

The following are some examples of possible tests:

  • blood tests to check blood pressure, cholesterol levels, and clotting ability
  • an electrocardiogram to measure the electrical activity and rhythms of the heart
  • an echocardiogram to check the pumping action of the heart
  • a chest X-ray to help rule out other conditions
  • CT scan to reveal any signs of an aneurysm, bleeding, or changes to blood vessels in the brain
  • an MRI scan to help identify damage to the brain

The doctor may also request that the patient wear a Holter monitor for a few days or weeks in order to track their heart rhythms over time.

Conclusion

The symptoms of a TIA can last anywhere from a few minutes to several hours. However, it is critical to seek medical help because a TIA can be a symptom of a massive stroke.

A TIA is marked by weakness and numbness on one side of the body, facial drooping on one side, and difficulty speaking. If you or someone you know is experiencing these symptoms, call 911 right away.

Following a TIA, lifestyle changes and the use of medicine to lower the risk of future blood clots are two choices for treatment.

Sources:

  • http://stroke.ahajournals.org/content/strokeaha/45/7/2160.full.pdf
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832890/
  • https://www.nhs.uk/conditions/transient-ischaemic-attack-tia/
  • https://www.medicalnewstoday.com/articles/164038
  • https://www.ncbi.nlm.nih.gov/books/NBK459143/
  • https://www.nhlbi.nih.gov/health-topics/stroke
  • https://www.stroke.org/en/about-stroke/stroke-symptoms
  • https://www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack
  • https://www.cdc.gov/stroke/types_of_stroke.htm

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Cardiovascular / Cardiology

What is an echocardiogram?

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An echocardiogram is an ultrasound image of the heart. It can help doctors diagnose a range of heart problems.

Doctors use echocardiograms to help them diagnose heart problems, such as damaged cardiac tissue, chamber enlargement, stiffening of the heart muscle, blood clots in the heart, fluid around the heart, and damaged or poorly functioning heart valves.

In this article, we explain how doctors use echocardiograms, what to expect during the test, and how to interpret the results.

What is it?

echocardiogram

Ultrasound waves are used in echocardiography to create a picture of the heart, which is referred to as an echocardiogram (echo).

It is a minimally invasive medical technique that emits no radiation and has few negative effects.

A doctor can see the following things during an echocardiogram:

  • any blood clots in the heart
  • areas of damaged or weak cardiac muscle tissue
  • the size and thickness of the chambers
  • how the valves of the heart are functioning
  • problems affecting the pericardium, which is the fluid-filled sac around the heart
  • causes of a stroke
  • the direction of blood flow through the heart

Doctors frequently utilize echocardiography to assess a person’s overall heart health, particularly following a heart attack or stroke.

What is the procedure?

Echocardiograms are simple, noninvasive procedures that require little preparation.

We’ll go over what to expect before, during, and after an echocardiography in the sections below.

Preparation

The person does not need to prepare if the echocardiogram is taken from the outside of the body by a healthcare expert.

A doctor will advise people who are getting a transesophageal echocardiography to avoid eating or drinking anything for at least 6 hours before the procedure. Following the local anesthetic wears off, people can resume eating and drinking 1–2 hours after the echocardiography.

During the test

The transthoracic (external) echocardiography will be performed by a sonographer. Sonographers are medical practitioners who specialize in producing images and movies for diagnostic purposes utilizing ultrasound instruments.

The person getting the echocardiography will take off their clothes from the waist up throughout the procedure. If they want to be covered during the exam, they can wear a hospital gown.

The sonographer will then urge the patient to lie on their back or left side on a table. They may inject a saline solution or dye into the veins of the patient to make the heart seem more distinct on an echocardiogram.

The type of echocardiography determines the procedure. Consider the following example:

Transthoracic echocardiogram

The sonographer will apply a gel to the chest if a doctor has ordered a transthoracic echocardiogram. After that, the sonographer will move the transducer across the chest to obtain various images of the heart.

The sonographer may ask someone to change positions or take or hold a deep breath throughout the examination. To gain a better view of the heart, they could press the transducer into the chest.

Transesophageal echocardiogram

If a clinician wants more detailed or sharper images of the heart than a transthoracic echocardiogram can provide, they may perform a transesophageal echocardiogram.

The person may be given a small sedative to help relax the muscles in their throat and a topical anesthetic to block the gag reflex during a transesophageal echocardiogram.

A doctor will guide a small transducer on the end of a long tube down the throat and esophagus until it reaches the back of the heart once the sedative and local anesthetic have taken effect.

As the doctor moves the transducer around the esophagus, the sonographer will record images of the heart. After swallowing the probe, the user should not feel the transducer or tube in their esophagus.

After the test

After a transthoracic echocardiography, most people can resume their normal activities.

After a transesophageal echocardiography, people may be required to stay at the hospital or healthcare center for a few hours. They may have a sore throat at first, but it should go away within a day or two.

If you were given a sedative prior to the exam, you should not drive for many hours afterward.

What does it diagnose?

Echocardiograms allow doctors to see the size, structure, and activity of different parts of the heart.

This allows them to identify heart abnormalities, assess the need for additional tests, decide their next actions, and monitor changes and improvements.

Doctors may use this approach to examine for signs or symptoms that could indicate the following:

  • Heart attack: The test can look for anomalies in the heart muscle tissue’s blood supply, as well as wall irregularities and blood flow, all of which can signal a heart attack.
  • Blood clots (thrombus) or tumors: In a study published in 2021, echo was proven to be a viable alternative to cardiac magnetic resonance in detecting thrombosis. According to a 2020 study, it is also an important noninvasive method for detecting heart masses such as malignancies.
  • Atherosclerosis and coronary artery disease (CAD): While an echo cannot detect artery blockages, narrowing and obstructed arteries can impair the heart’s ability to pump blood and disrupt the heart’s wall motion. This is more noticeable during times of stress, making a stress echo a useful diagnostic tool.
  • Aortic aneurysm and aortic dissection: An echo can detect a wide, weaker aorta, as well as unruptured aneurysms and their size, as well as fibrosis and thrombus formation in the vessel.
  • Cardiomyopathy: The test can determine the size and function of the heart and link it to factors such as wall thickness, weak heart muscle, leaky heart valves, heart failure, and high blood pressure.
  • Pulmonary hypertension: The test can measure heart pressure, which can indicate the presence of pulmonary hypertension and aid doctors in determining the following steps in the diagnosis.
  • Congenital heart disease: In newborns and early children, the test can detect congenital cardiac problems such as septal defects and holes.
  • Heart valve disease: The test checks for leakage, constriction, infection, and blockage in heart valves, as well as irregular cardiac blood flow.
  • Problems with the pericardium: The test can determine whether the pericardium (the sac that surrounds the heart) is inflamed (pericarditis) or has become filled with fluid or blood (pericardial effusion).
  • Heart failure: It can detect cardiac muscle that is weak, stiff, or thickened, which can be a symptom of heart failure.

Doctors frequently utilize the test to determine the cause of an abnormal electrical heart test, known as an electrocardiogram (EKG).

The method is also used to track how effectively the heart responds to various heart treatments, such as heart failure, drugs, prosthetic valves, and pacemakers.

If a doctor suspects a patient has cardiac abnormalities, an echocardiography will be ordered. The following are signs and symptoms that could suggest a cardiac condition:

Types of echocardiogram

Different types of echocardiograms are available, all of which use high-frequency sound waves. The following are some of the most frequent types.

The most common form of echocardiography is the transthoracic echocardiogram.

An ultrasound wand called a transducer is placed on the outside of the chest, near the heart, for this test. Sound waves are sent through the chest and into the heart via the device.

Sound waves move more easily when a gel is applied to the chest. These waves bounce off the heart and appear on a screen as images of the heart’s architecture.

Transesophageal echocardiogram

A thinner transducer attached to the end of a lengthy tube is used in a transesophageal echocardiogram. The tube will be swallowed and inserted into the esophagus, which connects the mouth to the stomach and runs behind the heart.

Because it gives a “close up” view of the heart, this type of echocardiography produces more detailed images of the heart than the typical transthoracic echocardiogram.

Doppler ultrasound

Doppler ultrasounds are used by doctors to check blood flow. They accomplish this by producing sound waves at specified frequencies and observing how the waves bounce off and return to the transducer.

Color doppler ultrasounds can be used by doctors to map the direction and velocity of blood flow in the heart. The blood flowing toward the transducer shows red, while the blood flowing away appears blue. It can also tell you how bad the blockages are.

A doppler ultrasound can detect issues with valves or holes in the heart’s walls, as well as let doctors examine how blood flows through it.

3D echocardiogram

A detailed 3D image of the heart is created through a 3D echocardiography. 3D echocardiograms can be used by doctors to:

  • plan heart valve or structural interventional surgery
  • image complex structures within the heart
  • assess valve functionality in people who have heart failure
  • assess the function of the heart in 3D
  • diagnose heart problems in infants and children

Stress echocardiogram

A doctor can order an echocardiogram as part of a stress test. A stress test involves physical exercise, such as walking, jogging on a treadmill, or riding a bike.

During the test, the doctor will keep track of your heart rate, blood pressure, and electrical activity in your heart.

Before and after the activity, a sonographer will do a transthoracic echocardiogram.

Stress tests are used by doctors to diagnose:

Point-of-care (POC) echocardiogram

A POC echocardiogram is a type of echocardiogram that can be performed at a patient’s bedside by a clinician. These can assist a doctor in answering specific inquiries about possible differential diagnoses.

Limited and focused POC echo are the two types of POC echo.

A limited echocardiogram aids a clinician in determining the cause and repercussions of a heart injury. A focused echo is used by a doctor to assist narrow down the list of other possible diagnoses or to answer a specific query.

With each heartbeat, a POC echocardiogram can determine how well the left or right ventricles pump blood.

Fetal echocardiogram

A fetal echocardiogram allows doctors to see the heart of an unborn baby. This check is normally done between 18 and 22 weeks of pregnancy. Because echocardiograms do not involve radiation, they are safe for both the mother and the infant.

Interpreting the results

The echocardiographic images will be sent to the doctor who requested the test by the sonographer after the exam. The doctor will examine the photos for indicators of cardiac disease, such as:

  • abnormal chamber size
  • poorly functioning valves
  • chamber size
  • masses in the heart, such as blood clots or tumors
  • damaged heart muscle tissue
  • pumping function of the heart
  • thick or thin ventricle walls

What can it miss?

Echocardiograms are very useful in detecting structural heart abnormalities. They may, however, not be the ideal way to check the coronary arteries.

Blockages can cause the structure of the heart. Changes in cardiac function, weak muscles, or thinner heart walls are frequently detected by doctors, prompting them to order additional tests such as a coronary angiogram.

Echocardiograms cannot detect conduction disorders or electrical difficulties that impact the heart’s rhythm, but they can measure the effects of these abnormalities on the heart.

Echocardiogram vs. electrocardiogram

An echocardiogram should not be confused with an electrocardiogram, or EKG, which is another diagnostic procedure. The electrical impulses or waves that flow through cardiac muscle tissue are measured by an EKG.

The electrical activity in the heart causes the heart muscle tissues to contract and relax, resulting in the rhythmic heartbeat that a stethoscope can detect.

Electrodes are placed on the skin of the chest, arms, or legs by a qualified technician, nurse, or doctor. These electrodes capture electrical activity and transfer it to a computer, which translates it into a graph that a doctor may see.

Are there any side effects?

An echocardiogram has a very minimal risk of problems or side effects. When the sonographer guides the tube down the throat during a transesophageal electrocardiogram, the person’s gag reflex may be triggered. After the exam, some people may experience a sore throat.

A significant consequence, such as injury to the throat, vocal cords, or esophagus, can occur very rarely as a result of the transesophageal echocardiogram.

Some people may have an adverse reaction to local anesthetics, sedatives, contrast dyes, or saline used during the exam. Only use contrast dyes if absolutely essential when pregnant.

The following are some of the potential negative effects of contrast dyes:

During a stress test, some people may experience changes in blood pressure or a reduction in oxygen delivery to the heart. In the event that a person has any issues during the assessment, a stress test will be performed in a fully equipped medical facility.

When a person is given sedatives, the stomach contents have a risk of entering the lungs. To avoid this, the patient will be asked to come to the surgery on an empty stomach.

Conclusion

Doctors utilize echocardiography to diagnose heart-related issues. A doctor will assess how well a person’s heart pumps blood during the test.

Doctors can also use echocardiography to check for indicators of cardiac disease such weak heart muscle, blood clots inside the heart, or malfunctioning heart valves.

An echocardiogram may be ordered by a clinician if a patient exhibits symptoms of heart disease, such as:

  • heart murmurs
  • irregular heartbeat
  • shortness of breath
  • abnormal blood pressure
  • leg swelling

The test has a low risk of serious problems or side effects in general. However, some people may have discomfort, and other people may be allergic to the contrast material or anesthesia.

Sources:

  • https://link.springer.com/article/10.1007/s00392-020-01741-7
  • https://www.nhlbi.nih.gov/health-topics/echocardiography
  • https://www.medicalnewstoday.com/articles/326727
  • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4593021/
  • https://www.ahajournals.org/doi/10.1161/JAHA.120.017684
  • https://www.sciencedirect.com/science/article/abs/pii/S1443950620314487
  • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4960283/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326059/
  • https://www.nhlbi.nih.gov/health-topics/stress-test
  • https://www.sciencedirect.com/science/article/pii/S2666087320300910
  • https://onlinelibrary.wiley.com/doi/full/10.1002/ajum.12128
  • https://www.science.org/doi/full/10.1126/sciadv.abi9283
  • https://www.ncbi.nlm.nih.gov/books/NBK395556/

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Cardiovascular / Cardiology

What to know about cerebrovascular disease

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Cerebrovascular disease is a term that encompasses a variety of ailments, diseases, and disorders that affect the brain’s blood arteries and blood flow.

If the brain cells are deprived of oxygen due to a blockage, malformation, or hemorrhage, brain injury can occur.

Cerebrovascular disease can be caused by a number of causes, including atherosclerosis, in which the arteries narrow; thrombosis, or embolic arterial blood clot, in which a blood clot forms in a brain artery; and cerebral venous thrombosis, in which a blood clot forms in a brain vein.

Stroke, transient ischemic attack (TIA), aneurysm, and vascular malformation are all examples of cerebrovascular disorders.

Cerebrovascular disease is the sixth leading cause of mortality in the United States. In 2017, it resulted in 44.9 deaths per 100,000 people, totaling 146,383 deaths.

People can, however, take actions to lower their risk of acquiring cerebrovascular disease. We’ll go through the symptoms, kinds, and treatments for these major health issues, as well as how to avoid them, in this post.

Causes

doctor giving advice to her patient

Cerebrovascular disease can be caused by a number of factors.

If a blood artery in the brain is damaged, it will be unable to provide enough or any blood to the brain region it serves. The absence of blood obstructs the supply of necessary oxygen to brain cells, which causes them to die.

Damage to the brain is irreversible. Emergency assistance is critical in reducing the likelihood of long-term brain damage and increasing a person’s chances of life.

Cerebrovascular disease is mostly caused by atherosclerosis. This happens when high cholesterol levels combine with inflammation in the brain’s arteries, causing cholesterol to form a thick, waxy plaque that narrows or blocks blood flow.

This plaque can restrict or totally block blood flow to the brain, resulting in a cerebrovascular event such as a stroke or transient ischemic attack (TIA).

Types

Cerebrovascular disease includes stroke, transient ischemic attack, and subarachnoid hemorrhage.

Aneurysms and hemorrhages can be dangerous to one’s health. A blockage can occur when blood clots develop in the brain or migrate there from other parts of the body.

Cerebrovascular disease comes in a variety of forms, including:

Ischemic stroke: A blood clot or atherosclerotic plaque stops a blood artery that provides blood to the brain, resulting in a stroke. A clot, or thrombus, can develop in an already narrowed artery.

A stroke happens when the brain cells die due to a lack of blood flow.

Embolism: The most frequent form of ischemic stroke is an embolic stroke. When a clot from elsewhere in the body breaks off and goes to the brain, it blocks a smaller artery.

Arrhythmias, or irregular heart people, increase the risk of embolism.

Ischemic stroke can be caused by a rupture in the lining of the carotid artery in the neck. The rip allows blood to travel between the carotid artery’s layers, narrowing it and limiting blood flow to the brain.

Hemorrhagic stroke: When a blood artery in a portion of the brain becomes weak and breaks open, blood leaks into the brain.

The leaking blood puts pressure on the brain tissue, causing edema and brain tissue damage. Nearby parts of the brain may also lose their supply of oxygen-rich blood as a result of the hemorrhage.

Cerebral aneurysm or subarachnoid hemorrhage: These can be caused by structural issues with the brain’s blood arteries. An aneurysm is a weakened area of the artery wall that can burst and cause bleeding.

When a blood artery ruptures and bleeds between two membranes covering the brain, it is known as a subarachnoid hemorrhage.

The leakage of blood has the potential to harm brain cells.

Learn more about a thrombus, which can lead to an embolism, in this article.

Symptoms

The symptoms of cerebrovascular disease vary depending on where the blockage is located and how it affects brain tissue.

Different events may have different consequences, however the following are frequent symptoms:

  • losing vision on one side
  • loss of balance
  • becoming unconscious
  • paralysis of one side of the body, or hemiplegia
  • weakness on one side, also known as hemiparesis
  • a severe and sudden headache
  • confusion
  • difficulty communicating, including slurred speech

Response to an emergency

The American Stroke Association promotes public awareness of the F.A.S.T. acronym as a tool for detecting and responding to stroke warning signs:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 911

If somebody displays symptoms of a cerebrovascular stroke, they should get medical help right away since it can have long-term consequences including cognitive damage and paralysis.

Risk factors

The most frequent form of cerebrovascular incident is a stroke.

Stroke risk rises with age, especially if a person or a close family has already experienced a cerebrovascular event. Between the ages of 55 and 85, this risk doubles every ten years.

A stroke, on the other hand, can strike at any age, including infancy.

Stroke and other kinds of cerebrovascular disease are caused by a number of factors, including:

A person’s chances of developing a cerebral aneurysm are increased by the same circumstances. People who have a congenital abnormality or have had head trauma, on the other hand, may be at a higher risk of developing a cerebral aneurysm.

Cerebral venous thrombosis, a blood clot affecting a vein in the brain, can also be increased by pregnancy.

Other cerebrovascular disease risk factors include:

  • a vein of Galen malformation, an arterial disorder that develops in a fetus during pregnancy
  • venous angiomas, which affect around 2% of the U.S. population and rarely bleed or cause symptoms
  • Moyamoya disease, a progressive condition that can lead to a blockage of the cerebral arteries and their major branches

Certain medications and medical conditions can cause blood to clot more easily, increasing the risk of ischemic stroke.

In people who currently have atherosclerosis or carotid artery disease, hormone replacement treatment (HRT) may raise the risk of a heart attack.

Find out what strokes are and how to spot them.

Treatment

A cerebrovascular episode need immediate medical attention. Because a person must get stroke drugs within a specified time frame from the beginning of symptoms, rapid assessment and treatment are critical.

In the event of an acute stroke, the emergency team may deliver tissue plasminogen activator (tPA), a drug that dissolves the blood clot.

A brain hemorrhage requires the attention of a neurosurgeon. They may do surgery to relieve the increased pressure caused by a bleed.

A carotid endarterectomy is a procedure that includes cutting a hole in the carotid artery and removing plaque. This re-establishes blood flow. The artery is then repaired with stitches or a graft by the surgeon.

Carotid angioplasty and stenting, which includes a surgeon putting a balloon-tipped catheter into the artery, may be necessary for some people. The balloon will subsequently be inflated to reopen the artery.

The surgeon next inserts a thin metal mesh tube, known as a stent, into the carotid artery to increase blood flow in the previously occluded artery. After the treatment, the stent keeps the artery from collapsing or shutting up.

Rehabilitation

People may endure temporary or permanent incapacity as a result of a cerebrovascular accident, which can cause lasting brain damage.

As a result, they may need a variety of supportive and rehabilitative therapies in order to maintain as much function as feasible.

These might include the following:

  • Occupational therapy: This can assist a person in gaining access to resources that will enable them return to employment and daily life.
  • Psychological therapy: Physical disabilities might result in unforeseen emotional demands that need extensive retraining. If a person feels overwhelmed following a cerebrovascular incident, they may benefit from seeing a psychiatrist, psychologist, or counselor.
  • Physical therapy: This seeks to improve limb function, mobility, and flexibility.
  • Speech therapy: After a stroke or a cerebrovascular episode, this may help people speak more effectively and restore speech.

Find out all about physical therapy here.

Reducing the risk of stroke

Blood platelet inhibitors like Dipyridamole, Ticlopidine, and Clopidogrel can help prevent strokes before they happen. These can help prevent stroke in people who have had a stroke before or who have a high risk of developing one

Doctors used to suggest that people take aspirin every day to lower their risk of heart attack or stroke. Current guidelines, on the other hand, recommend that people take aspirin only if they are at high risk of a cardiovascular event and have a low risk of bleeding.

This is due to the fact that aspirin raises the risk of bleeding.

Statins are drugs that are prescribed by doctors to lower and control high cholesterol levels and reduce the risk of ischemic stroke and heart attack.

Diagnosis

Any cerebrovascular incident is a medical emergency, and anybody who notices the symptoms should call 911 for assistance. The importance of early detection in preventing brain injury cannot be overstated.

A doctor will inquire about the patient’s medical history and look for particular neurological, motor, and sensory problems, such as:

  • abnormal eye movements
  • muscle weakness
  • changes in vision or visual fields
  • decreased sensation
  • reduced or altered reflexes

A vascular abnormality, such as a blood clot or a blood artery defect, can be detected using a cerebral angiography, vertebral angiogram, or carotid angiogram. Injecting dye into the arteries reveals any clots and allows CT or MRI imaging to show their size and form.

Because it can distinguish between blood, bone, and brain tissue, a CAT scan can aid in the diagnosis and detection of hemorrhagic strokes. However, especially in the early phases of an ischemic stroke, it does not always detect damage.

Even early-stage strokes can be detected with an MRI scan.

A cardiac arrhythmia, which is a risk factor for embolic strokes, can be detected by an electrocardiogram (EKG or ECG).

Prevention

healthy foods
Adopting a healthy diet can aid in the preservation of vascular health.

The following are some methods for lowering the risk of cerebrovascular disease:

  • getting at least 150 minutes of moderate to vigorous physical activity every week is recommended
  • maintaining a healthy body weight by consuming a balanced diet that promotes vascular health, such as the DASH diet, as recommended by the National Heart, Lung, and Blood Institute
  • stop smoking
  • managing blood cholesterol and blood pressure with diet and medications if necessary

People who have heart arrhythmia should talk to their doctor about whether or not they should take a blood thinner to avoid strokes.

Although stroke and other cerebrovascular events can result in death, full or partial recovery is possible with prompt medical intervention. To lower the risk of a stroke, people with cerebrovascular disease should follow healthy lifestyle advice and their doctor’s instructions.

Conclusion

The outlook is determined by the sort of occurrence, its intensity, and the speed with which a person receives care.

Cerebrovascular disease can kill someone or leave you disabled for a long time. Some people, on the other hand, will fully recover.

The greatest approaches to enhance a person’s outlook with cerebrovascular disease are prompt treatment and a lifestyle that decreases the chance of stroke.

Sources:

  • http://www.onlinejacc.org/content/accj/early/2019/03/07/j.jacc.2019.03.010.full.pdf
  • https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
  • https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Preventing-Stroke#Risk%20Factors
  • https://www.nhlbi.nih.gov/health-topics/carotid-endarterectomy
  • https://www.medicalnewstoday.com/articles/184601
  • https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Cerebrovascular-Disease
  • https://www.cdc.gov/nchs/fastats/stroke.htm
  • https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
  • https://www.strokeassociation.org/en/about-stroke/stroke-symptoms
  • https://www.strokeassociation.org/en/about-stroke/treatment#.WBMLG5MrJTY

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