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Heart disorders (heart disease)

Related Terms
  • Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.

  • A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
  • Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
  • There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
  • The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
  • Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
  • The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
  • Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).

Integrative therapies
  • Unclear or conflicting scientific evidence:
  • Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
  • Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
  • Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
  • Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
  • Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
  • Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
  • Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
  • Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
  • Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
  • Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
  • Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
  • Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
  • Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
  • Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
  • Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
  • Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
  • Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
  • Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
  • Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
  • Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
  • There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
  • Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
  • Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
  • Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
  • Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
  • Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
  • Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
  • Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
  • Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
  • Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
  • Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
  • Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
  • Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
  • Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.

  • In order to prevent wounds from occurring, healthcare providers recommend that individuals: take care when using sharp objects such as knives, scissors, saws, and trimmers; wear shoes or boots on the feet; use helmets when riding a bicycle; use helmets, kneepads, wrist protectors, and elbow pads when using in-line skates or skateboards; and avoid picking up broken pieces of glass and handling razor blades.
  • If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, healthcare providers recommend that the individual be checked for pressure sores every day. Also, look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps: change position at least every two hours to relieve pressure; use items that can help reduce pressure such as pillows, sheepskin, foam padding, and powders from medical supply stores; eat healthy, well-balanced meals; exercise daily, including range-of-motion exercises for immobile patients; and keep skin clean and dry. Incontinent people need to take extra steps to limit moisture.
  • Individuals with diabetes should check their feet daily for blisters, sores, or other wounds in order to prevent serious infection and possibly amputation.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (

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  4. Centers for Disease Control and Prevention. .
  5. Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
  6. Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
  7. de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
  8. Natural Standard: The Authority on Integrative Medicine. .
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Cor pulmonale
  • Cor pulmonale, also called pulmonary heart disease, occurs when the right ventricle of the heart becomes enlarged. If left untreated, the condition may lead to heart failure.
  • Long-term lung diseases, such as emphysema, chronic bronchitis, or cystic fibrosis, cause cor pulmonale. It may also be caused by serious lung infections. These lung diseases increase the blood pressure in the lungs, causing a condition called pulmonary hypertension (high blood pressure). As a result of this increased pressure, the right ventricle of the heart has to work harder to pump blood and it eventually becomes enlarged causing cor pulmonale. Cor pulmonale may also come on suddenly if the patient's pulmonary artery is blocked with a blood clot, a condition called a pulmonary embolism.
  • Symptoms of cor pulmonale are usually similar to the underlying cause, which is typically a lung disease such as emphysema or bronchitis. Symptoms often include frequent coughing, wheezing, weakness, fatigue, difficulty breathing, shortness of breath, and irregular heartbeat. Fluid may build up in the body tissue and cause swelling (edema). Patients may feel weak or experience discomfort in the upper chest.
  • A magnetic resonance imaging (MRI) scan is the standard diagnostic procedure for cor pulmonale. A machine takes pictures of the patient's heart. The pulmonary arteries will be enlarged in patients with cor pulmonale. An electrocardiograph (EKG) may be also performed. During this noninvasive procedure, electrodes are taped to the patient's chest to measure the electrical activity of the heart. Patients with the condition will have frequent premature contractions in the atria or ventricles of the heart because the heart muscle is overworked. A chest X-ray may show an enlarged right pulmonary artery.
  • Even with treatment, many patients with cor pulmonale develop heart failure. This is because cor pulmonale occurs in the later stages of serious lung diseases. In general, a low-salt diet and restricted fluids are recommended for patients who have cor pulmonale or have an increased risk of developing the condition. Antibiotics may be prescribed if a lung infection is causing the condition. Blood thinners (anticoagulants) may be prescribed if a pulmonary embolism caused the condition. Supplemental oxygen may also be used to increase the amount of oxygen in the blood.

Coronary artery disease (cad)
  • Coronary artery disease (CAD), also called coronary heart disease (CHD), occurs when the blood vessels that supply oxygenated blood to the heart muscle gradually become narrowed or blocked by plaque deposits. Plaque is a combination of fatty material, calcium, scar tissue, and proteins.
  • Plaque buildup in the arteries is associated with several risk factors, including high cholesterol, high levels of low-density lipoprotein (LDL or "bad cholesterol") in the blood, low levels of high-density lipoprotein (HDL or "good cholesterol"), high blood pressure, smoking, diabetes mellitus, obesity, age, family history of heart disease, sedentary or inactive lifestyle, stress, and male gender. All of these factors cause the inner lining of the arteries (called the endothelium) to become injured. When the endothelium is injured, the substances that make up plaque cannot flow through the artery. As a result, plaque builds up in the artery.
  • The plaque deposits decrease the space through which blood can flow. As platelets (disc-shaped particles in the blood that aid clotting) come to the area, blood clots form around the plaque, causing the artery to narrow even more.
  • Sometimes the blood clot in the artery breaks apart, and blood supply is restored. In other cases, the blood clot may completely block the blood supply to the heart muscle. This lack of blood flow (called ischemia) can "starve" some of the heart muscle of oxygen and lead to chest pain (angina). A heart attack, also known as a myocardial infarction, results when blood flow is completely blocked. Heart attacks usually happen when a blood clot forms over a plaque that has ruptured.
  • Common symptoms of CAD include chest pain, shortness of breath, irregular or fast heartbeat, weakness or dizziness, nausea, and increased sweating.
  • The standard diagnostic procedure for CAD is a carotid ultrasonography. This procedure evaluates blood flow using a wand-like device, called a transducer. The transducer sends high-frequency sound waves into the neck to determine if there is any narrowing or clotting in the arteries.
  • Drugs used that treat CAD include platelet inhibitors such as aspirin or clogidogrel (Plavix®); beta blockers such as metoprolol (Lopressor® or Toprol®); calcium channel blockers such as amlodipine (Norvasc®) or diltiazem (Cardizem®); angiotensin inhibiting drugs or ACE inhibitors such as lisinopril (Prinivil® or Zestril®) or ramipril (Altace®); statins; or HMG-CoA reductase inhibitors such as atorvastatin (Lipitor®) or lovastatin (Mevacor®).
  • Arteries that are severely blocked may need to be expanded using balloon angioplasty (also called percutaneous transluminal coronary angioplasty or PCTA) and stent placement. This procedure involves using a wire mesh that expands in the blood vessel, allowing more blood to flow normally. A specialized doctor, called a cardiologist, performs these procedures at a hospital. A tube, or catheter, is inserted into a blood vessel. Several types of balloons, stents, and/or catheters are available to treat the plaque inside the vessel. Some of these surgical tools contain anti-clotting medications. The physician chooses the type of procedure based on individual patient needs. Common complications include restinosis (re-narrowing of the artery), bleeding, and infection.
  • Patients with significant CAD may undergo a procedure called coronary artery bypass graft (CABG) surgery. GABG surgery is when one or more blocked blood vessels is bypassed by a graft (transplant of healthy arteries or veins) to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the chest, leg, or arm. The graft goes around the clogged artery to create new pathways for oxygen-rich blood to flow to the heart. Some problems associated with CABG include heart attack, stroke, blood clots, death, and sternal wound infection. Infection is most often associated with obesity, diabetes, or having had a previous CABG. Some patients may develop swelling in the tissue around the heart (a condition called post-pericardiotomy syndrome) a few days to six months after surgery. Symptoms typically include fever and chest pain. The incision in the chest or the graft site may be itchy, sore, numb, or bruised after surgery. Some patients report memory loss or loss of mental clarity after a CABG.

  • Endocarditis occurs when the inner lining of the heart is infected. The infection starts in the bloodstream and spreads to the heart.
  • Bacteria cause most cases of endocarditis, but viruses, fungi, and other microorganisms can also lead to the condition. For instance, dental procedures that have bleeding risks may allow bacteria to enter the bloodstream. Bacteria may also enter the bloodstream during surgical procedures. Other medical conditions, such as skin sores, gum diseases, or intestinal disorders, may also increase a patient's risk of developing a bacterial infection in the blood.
  • Common symptoms of endocarditis include fever, chills, fatigue, weakness, aching muscles and joints, shortness of breath, night sweats, pale complexion, persistent cough, blood in urine, unexplained weight loss, tenderness in the spleen, new heart murmur (abnormal sound of the heart that can be heard with a stethoscope), and swelling in the legs or abdomen. Some patients may develop tender, red spots under the skin of the fingers (called Osler's nodes). Some may also experience tiny purple or red spots on the skin called petechiae. Similar spots may be present in the whites of the eyes or under the fingernails.
  • Several tests, including blood tests, echocardiograms, and a chest X-ray, may be necessary to confirm a diagnosis. Blood tests may reveal low levels of iron in the blood, called anemia. This is because chronic infections often interfere with the production of red blood cells and lead to anemia. Because endocarditis may make it harder for the heart to pump blood, an X-ray may reveal blood and fluid backed up in the lungs. An echocardiogram uses sound waves to produce images of the heart. Patients with endocarditis may have abnormally thick and/or leaky heart valves. Others may have abnormal growths in the heart that contain collections of the disease-causing bacteria.
  • Left untreated, endocarditis can damage the heart valves and permanently damage the lining of the heart. If the heart suffers from permanent damage, it may lead to heart failure, which is fatal, unless the patient undergoes a heart transplant. However, most patients who are diagnosed and treated promptly experience a full recovery.
  • Patients with endocarditis receive intravenous (IV) antibiotics to treat the infection. The type of antibiotic and duration of treatment depends on the type and severity of the infection, as well as the patient's overall health.

High blood pressure
  • Blood pressure is the force of blood pushing against the walls of arteries (blood vessels). Each time the heart beats, it pumps blood through blood vessels, supplying the body's muscles, organs, and tissues with the oxygen and nutrients that they need to function. Throughout the day, an individual's blood pressure rises and falls many times in response to various stimuli. For instance, stress typically increases blood pressure, and patients generally have lower blood pressure during sleep. Elevated blood pressure over a sustained period of time is a condition called hypertension (HTN) or high blood pressure.
  • The cause of 90-95% of the cases of high blood pressure is unknown. Patients who are obese, sensitive to salt, consume excessive amounts of alcohol, do not exercise regularly, smoke, eat poor diets, or experience frequent stress have an increased risk of developing high blood pressure. In addition, individuals may be genetically predisposed to developing high blood pressure. Also, blood pressure tends to increase with age.
  • Hypertension is called the silent killer because an individual can have it for years without knowing it. High blood pressure rarely causes symptoms at first, but it is a risk factor for many other conditions, including kidney disease and CAD, which may lead to heart attack and/or stroke. Although it rarely happens, high blood pressure that has persisted for many months to years occasionally causes symptoms, such as dizziness, ringing in the ears, impaired vision, fatigue, irregular heartbeat, inability of males to achieve or maintain erection (erectile dysfunction), and fainting. Extremely high blood pressure can cause a headache upon awakening or, even more rarely, nosebleed, nausea, or vomiting.
  • Blood pressure is measured with a stethoscope and an inflatable arm cuff with a pressure-measuring gauge called a sphygmomanometer. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first number measures the pressure in the arteries when the heart beats (systolic pressure). The second number measures the pressure in the arteries between beats when the chambers of the heart are filling with blood (diastolic pressure). To get an accurate blood pressure reading, a healthcare professional should evaluate the readings based on the average of two or more blood pressure readings.
  • The latest blood pressure (BP) guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories. Normal blood pressure is below 120/80 mmHg. Patients have pre-hypertension if their systolic pressure is 120-139 and their diastolic pressure is 80-89. Patients have stage 1 hypertension when their systolic pressure is140-159 and their diastolic pressure is 90-99. Patients have stage 2 hypertension when their systolic pressure is 160 or higher and their diastolic pressure is 100 or higher.
  • Treating high blood pressure can help prevent serious and life-threatening complications. Experts recommend using the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Experts also recommend: getting plenty of potassium (e.g. bananas and green leafy vegetables such as spinach), which can help prevent and control high blood pressure; eating less saturated fat (animal fat) and total fat; and limiting the amount of sodium (salt) in the diet. Although 2,400 milligrams of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 milligrams a day will have a more dramatic effect on blood pressure. Consumers should look at the food labels to determine sodium content. If cooking at home, individuals should use less salt or a salt substitute that contains potassium iodide, which does not increase blood pressure.
  • Other lifestyle changes, including bodyweight management, regular exercise, smoking cessation, and stress management, may also help treat high blood pressure.
  • Medications may also be prescribed to reduce blood pressure. Beta-blockers, such as propranolol (Inderal®), metoprolol (Lopressor® or Toprol®), or atenolol (Tenormin®), may reduce the workload on the heart, causing the heart to beat slower and with less force. Angiotensin converting enzyme inhibitors (ACE inhibitors) may be taken to dilate blood vessels and increase oxygen to the heart. Calcium channel blockers (CCBs), such as amlodipine (Norvasc®), felodipine (Plendil®), nicardipine (Cardene® or Carden SR®), and nifedipine (Procardia® or Adalat®), may also be used. These medications affect the transport of calcium into the cells of the heart and blood vessels, causing blood vessels to relax. Alpha blockers, such as doxazosin (Cardura®), prazosin (Minipress®), and terazosin (Hytrin®), may be taken to help dilate the blood vessels. Alpha-beta blockers, such as carvedilol (Coreg®) and labetolol (Normodyne® or Trandate®), may be taken to reduce nerve impulses to blood vessels and slow the heartbeat. This helps reduce the amount of blood that must be pumped through the vessels. Vasodilators, such as hydralazine (Apresoline®), may also be taken. These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Medications should be taken exactly as prescribed. Taking more or less than recommended may have serious effects on the heart.

High cholesterol
  • High cholesterol, or hypercholesterolemia, is a condition in which there are unhealthy high levels of cholesterol in the blood. It is less commonly called dyslipidemia, hyperlipidemia, and lipid disorder.
  • Cholesterol is a soft, waxy, fat-like substance found within the bloodstream and cells of the body. Cholesterol is naturally produced in the body and consumed in the diet. Cholesterol is needed to make membranes for all cells in the body, including those in the brain, nerves, muscles, skin, liver, intestines, and heart. Cholesterol is also converted into steroid hormones, such as the male and female sex hormones (androgens and estrogens) and the adrenal hormones (cortisol, corticosterone, and aldosterone). In the liver, cholesterol is the precursor to bile acids that aid in the digestion of food, especially fats. Cholesterol is also used to make vitamin D.
  • Too much cholesterol in the blood increases a patient's risk of developing heart disease, which may lead to a heart attack, heart failure, stroke, and death. Although eating an unhealthy diet may increase cholesterol, some patients are genetically predisposed to developing high cholesterol.
  • High cholesterol can cause plaque deposits to form in the arteries. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium. When plaque builds up in the arteries, it causes atherosclerosis (hardening of the arteries) or coronary heart disease (CHD). Atherosclerosis can lead to plaque ruptures and blockages in the arteries. If the blood supply to the heart is blocked, a heart attack may occur. If blood supply to the brain is blocked, a stroke may occur.
  • High cholesterol does not lead to specific symptoms unless it is a long-term condition. If patients have high cholesterol for many months to years, they may develop thickening of tendons due to accumulation of cholesterol (xanthoma), yellowish patches around the eyelids (xanthelasma), and white discoloration of the outer edges of the cornea due to cholesterol deposits (arcus senilis). A high level of blood cholesterol causes the arteries to narrow (atherosclerosis) and can slow, or even block, blood flow to the heart. This reduced blood supply prevents the heart from receiving enough oxygen. Left untreated, persistent high blood pressure may cause chest pain (angina), heart attack, transient ischemic attacks (TIAs, or temporary lack of blood flow and oxygen to the brain), lack of oxygen to the brain (called cerebrovascular accidents or stroke), and blocked peripheral arteries (called peripheral artery disease or PAD).
  • Healthcare providers typically take a sample of the patient's blood to measure the patient's total cholesterol levels, lipoprotein levels, and triglyceride levels and diagnose high cholesterol.
  • Healthy total cholesterol levels are less than 200 milligrams per deciliter of blood. If the total cholesterol is less than 200 milligrams per deciliter of blood, the risk of heart attack risk is relatively low, unless there are other risk factors, such as smoking, a previous heart attack, or high blood pressure. Borderline high cholesterol is diagnosed in patients who have 200-239 milligrams of cholesterol per deciliter of blood. High cholesterol is diagnosed when patients have 240 milligrams of cholesterol per deciliter of blood. These patients are twice as likely to develop coronary artery disease as patients who have cholesterol levels lower than 200 milligrams per deciliter of blood.
  • Lipoprotein levels are also measured. A high level of low density lipoprotein (LDL), also called "bad" cholesterol, is a major risk factor for atherosclerosis and coronary artery disease. LDL levels are reported in several categories. An LDL level below 100 milligrams per deciliter of blood is best for people at risk for heart disease. If an individual is at very high risk for heart disease, such as having a previous heart attack, an LDL level less than 70 milligrams per deciliter of blood is optimal. LDL levels can also be near optimal (100-129 milligrams per deciliter of blood), borderline high (130-159 milligrams per deciliter of blood), high (160-189 milligrams per deciliter of blood), and very high (190 or more milligrams per deciliter of blood). When LDL levels are high, the condition is sometimes called hyperlipoproteinemia.
  • HDL ("good") cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 milligrams per deciliter of blood is low and is considered a major risk factor for developing heart disease. HDL levels of 60 milligrams per deciliter of blood or more help to lower the risk for developing heart disease.
  • High levels of triglycerides also indicate an increased risk of heart disease risk. Patients that have levels that are borderline high (150-199 milligrams per deciliter of blood) or high (200 milligrams or more per deciliter of blood) may need treatment.
  • The main goal of cholesterol-lowering treatment is to lower LDL levels enough to reduce the risk of developing heart disease or having a heart attack. There are two main ways to lower cholesterol: therapeutic lifestyle changes (TLC) and drug therapy. TLC includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is more than their target number and goal. Drug treatment with cholesterol-lowering drugs can be used together with TLC treatment to help lower LDL. Prevention of elevated cholesterol with TLC and possibly drug therapy is started if the individual is at risk for high cholesterol level or heart disease, or if the patient has suffered from a heart attack or stroke in the past.

  • Hyperhomocysteinemia is a medical condition that is characterized by high levels of an amino acid, called homocysteine, in the blood. Patients with hyperhomocysteinemia have an increased risk of developing coronary artery disease (CAD). This is because high levels of homocysteine may irritate blood vessels, leading to blockages in arteries.
  • Deficiencies in folic acid (folate), vitamin B6, or vitamin B12 may lead to hyperhomocysteinemia. Patients with kidney failure who are undergoing dialysis also have an increased risk of developing hyperhomocysteinemia. However, researchers have not discovered exactly why this condition may develop in dialysis patients.
  • Hyperhomocysteinemia does not cause any symptoms. Therefore, the American Heart Association recommends regular homocysteine testing in patients who have high risks of developing heart disease.
  • Hyperhomocysteinemia is diagnosed after a blood test, called a homocysteine test. Patients who have 14 or more micromoles of homocysteine per liter of blood are diagnosed with the condition.
  • Patients with hyperhomocysteinemia receive folate, vitamin B6, or vitamin b12 supplements until homocysteine levels are normal.

  • Pericarditis occurs when the sac-like membrane that surrounds the heart (called the pericardium) becomes inflamed.
  • Pericarditis is usually caused by an infection, such as staphylococcus, tuberculosis, or herpes simplex, which spreads to the heart through the blood. It may also occur after a traumatic injury to the heart or after heart surgery. Some patients may develop pericarditis after a severe heart attack. Pericarditis may occur as a result of inflammatory conditions, such as systemic lupus erythematosus or rheumatoid arthritis.
  • Symptoms of pericarditis may include chest pain, shortness of breath, fever, fatigue, dry cough, and swollen legs and/or abdomen.
  • Patients with pericarditis may also have pleural effusions, which occur when the membrane that surrounds the heart fills with fluid.
  • During a physical examination, a healthcare provider listens to the patient's heart. When the sac around the heart is inflamed, it will make a distinct noise when it rubs against the outer layer of the heart. If abnormal sounds are present, a chest X-ray is warranted. Pericarditis is diagnosed after a chest X-ray reveals inflammation around the heart.
  • Treatment of pericarditis depends on the underlying cause. If an infection is causing the inflammation, patients will receive antibiotics. The specific medication and duration of treatment depends on the type and severity of the infection, as well as the patient's overall health.
  • In addition to antibiotics, patients with pleural effusions will also need to have the fluid drained at a hospital. During the procedure, called pericardiocentesis, a healthcare provider administers a local anesthetic to numb the patient's chest. Then, a thin needle is inserted into the pericardium and fluid is removed. This treatment may last several days during the course of the patient's hospitalization.

Copyright © 2011 Natural Standard (

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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