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Hepatitis A Vaccine

What is Hepatitis A? Hepatitis A is a liver disease caused by the Hepatitis A virus, which is commonly found in the feces of people with the disease. It can be spread through close personal contact, consuming contaminated food or water, or through other means of exposure to the virus. People with Hepatitis A can easily pass the virus on to others.   What causes Hepatitis A? Hepatitis A is caused by the Hepatitis A virus (HAV), an RNA virus in the picornaviridae family.   Symptoms of Hepatitis A In adults, symptoms typically start with fever, fatigue, loss of appetite, nausea, and abdominal discomfort, followed by jaundice within 2-3 days. Symptoms can range from mild to severe and can last anywhere from 1-2 weeks to several months in severe cases, although these are less common. Most people recover completely without any lingering effects or a return of the illness. In children, the infection is often asymptomatic, with many infected individuals showing mild or no symptoms, and no jaundice. Diagnosis is typically made through liver function tests.   Destroying Hepatitis A virus The following methods are used to properly dispose of feces, urine, and blood: Destroyed by heat at 85°C for 1 minute Formalin (8% for 1 minute at 25°C) Iodine (3 mg/liter for 5 minutes) Chlorine (free residual chlorine 2-2.5 mg/liter for 15 minutes) Seafood with shells such as clams, shrimp, and crabs that come from the sea which is contaminated with this virus should be cooked until it reaches at least 90°C for 4 minutes or use a pressure cooker for 90 minutes.   Who should receive the hepatitis A vaccine? Individuals aged 1 year or older who are planning to travel or work in countries with a high prevalence of hepatitis A virus such as Central America, South America, Asia (except Japan), Africa, and Eastern Europe. Individuals in professions at risk of exposure and transmission of the disease, such as food handlers, individuals who live in close proximity to large groups of people, including childcare facilities and military personnel. Medical personnel who come into contact with hepatitis A virus-infected patients or those who work in laboratories for research on hepatitis A virus. Tourists who are traveling to areas with high disease prevalence, such as Asia (excluding Japan), Central America, South America, the Caribbean, Africa, and Eastern Europe, should receive vaccinations. It is recommended that family members of patients with hepatitis B receive vaccinations at least one month before traveling Other groups that should receive vaccinations include men who have sex with men Individuals who use drugs People with chronic liver disease Those who are being treated for blood clotting disorders.   When should the hepatitis A vaccine be administered? Children aged 2 years and above who have not previously received the vaccine. Individuals at risk may begin to receive the vaccine when they want to be protected against infection. For travelers, the vaccine course should be started at least 1 month before travel, with 2 doses administered at least 6 months apart.   How many doses and when should the hepatitis A vaccine be administered? The vaccine should be given in 2 doses, the first dose and a booster dose 6-18 months later.   Precautions and warnings for receiving the hepatitis A vaccine: Individuals who have had a severe allergic reaction to the vaccine or any of its components should not receive the vaccine. Those who are ill should wait until they have recovered before receiving the vaccine. If pregnant, consult a physician before receiving the vaccine. Caution should be taken in individuals with low platelets or abnormal blood clotting.   Unintended effects of Hepatitis A vaccine Swelling, pain, and soreness at the injection site, headache, loss of appetite, and fatigue, which usually subside within 1-2 days. There may be a risk of severe allergic reactions, which typically occur within 2-3 minutes to 2-3 hours after vaccination, although this is very rare.   When should you see a doctor?   If there are any abnormal symptoms such as high fever or severe allergic reactions, including difficulty breathing, wheezing, hives, pale skin, or rapid heartbeat.   Best regards from the Vaccine Center of Vibhavadi Hospital.

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Hepatitis B Vaccine

Hepatitis B Vaccine What is Hepatitis B? Hepatitis B is a disease caused by the Hepatitis B virus, which can be transmitted through blood and various bodily fluids. The following are ways that the virus can be contracted:   Infected mother to her newborn during childbirth Unprotected sex with an infected person Sharing needles or other injection drug equipment with an infected person Sharing tattoo or piercing equipment with an infected person Sharing personal items such as toothbrushes or razors with an infected person Accidental needle sticks in healthcare settings Contact with blood or bodily fluids contaminated with the Hepatitis B virus through an open wound   In addition, the Hepatitis B virus can cause inflammation and damage to liver cells, and if left untreated, can lead to liver cirrhosis, liver failure, and liver cancer.   Symptoms of Hepatitis B virus infection There are two phases of Hepatitis B virus infection:   • Acute phase: Symptoms usually appear within 1-4 months after infection. They include fever, yellowing of the skin and eyes, pain in the lower right side of the ribcage, nausea, vomiting, loss of appetite, diarrhea, fatigue, rash, joint pain, and muscle pain. In some cases, the destruction of liver cells may lead to severe symptoms, and acute hepatitis may improve within 1-4 weeks and return to normal when the body can eliminate and control the hepatitis virus, which usually takes less than 3 months. However, a small percentage of patients (5-10%) are unable to completely eliminate the virus from their body, leading to chronic hepatitis B infection.   • Chronic phase: Patients can be divided into 2 groups: - Carrier: Patients who have hepatitis B virus in their body but do not have any symptoms. They can still spread the infection to others. Blood tests show normal liver function. - Chronic hepatitis: Patients who have hepatitis B virus in their body and show abnormal liver function test results. Most patients do not have symptoms, but some may experience fatigue or loss of appetite. Chronic infection is common in children infected at birth and can lead to liver cirrhosis, liver cancer, and death.   Who should receive the hepatitis B vaccine?   Children and Adolescents:   All Thai children should receive a series of three hepatitis B vaccine shots. Shot 1: at birth Shot 2: at 1-2 months old Shot 3: at 6-18 months old For infants born to HBsAg-positive mothers (especially if HBeAg is also positive), HBIG (Hepatitis B Immune Globulin) should be given within 12 hours of birth, along with the first vaccine shot. The second shot should be given at 1-2 months old, and the third shot at 6 months old. If combination vaccines for hepatitis B and diphtheria-tetanus-pertussis are used, they can be given at 2, 4, and 6 months old, after the first shot. For children who have never received the vaccine before, those under 11 years old can receive the vaccine at 0, 1, and 6 months old. Those aged 11-15 years old may receive only two shots, at 0 and 4-6 months old, using a vaccine dose of 1.0 mL, similar to that given to adults.   Adult   An adult is a person who has not yet received a vaccine for hepatitis B virus and is at risk of infection, such as: Individuals who have sexual contact with a person who is infected with hepatitis B virus Men who have sex with men Individuals who inject drugs Individuals who have multiple sexual partners Individuals with chronic liver disease or kidney disease Individuals with diabetes who are under 60 years old Medical personnel who come into contact with blood or various body fluids Family members of individuals infected with hepatitis B virus Individuals traveling to countries where hepatitis B virus is endemic Individuals with HIV infection Pregnant women who are at risk can also receive the vaccine.   Who should not receive hepatitis B vaccine:   Individuals who have had a severe allergic reaction to the hepatitis B vaccine or its components that could be life-threatening Individuals who are currently sick should wait until they recover before getting vaccinated You should see a doctor immediately if you experience any of the following adverse events, even though the risk of serious adverse events from the vaccine is very low: Unusual symptoms such as severe allergic reactions, including difficulty breathing, wheezing, high fever, rash, swollen face, or rapid heartbeat.   With best wishes, Vibhavadi Hospital Vaccination Center.

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Meningococcal vaccine

Meningococcal vaccine What are measles and meningococcal disease? Meningococcal disease is caused by a gram-negative spherical bacteria called Neisseria meningitidis, which is of the same type as the genuine pathogen Neisseria gonorrhoeae, but does not cause gonorrhea and is more severe in causing the disease, with a higher mortality rate. The name "black fever” (ไข้กาฬ) comes from the severity of the disease, which can cause death in a short period of time. The name "arched back" (หลังแอ่น) comes from the fact that patients with this disease may experience seizures and stiffness after the acute phase.   The disease-causing bacteria are divided into 5 groups: A, B, C, Y, and W-135. Disease Transmission: This disease is transmitted through airborne droplets from the nose or mouth, or through various secretions from close contact. However, most people who are infected do not show any symptoms. Some individuals may act as carriers and there are few cases where the infection spreads to the brain or bloodstream. In Thailand, there have been sporadic cases of this disease, but no major outbreaks. From previous statistics, the number of deaths from this disease in Thailand does not exceed 10 people per year. Easy contact through close proximity or being in close proximity with a large group, such as students or residents in a dormitory, groups seeking merit, or groups of tourists or travelers entering areas with outbreaks. Therefore, there are recommendations to vaccinate this population group.   The Incubation Period:   The patient begins to show symptoms 2-10 days after infection.   Symptoms: The disease begins with a sudden high fever, severe headache, fatigue, nausea, vomiting, sore throat, joint pain, and muscle aches, especially in the legs and back. Eventually, there may be a rash of dark blood and black spots under the skin. In severe cases, the patient may experience meningitis with accompanying stiffness of the neck. In some cases, the patient may experience seizures, shock, and may even die within 24 hours of the onset of symptoms. Transmission of the disease is easy through close contact, such as in crowded environments like dormitories, groups of people seeking alms, or groups of tourists traveling to areas where the disease is prevalent. Therefore, it is recommended that this vaccine be administered to populations in these groups.   The vaccine for prevention of meningococcal disease The vaccine for prevention of meningococcal disease is used in Thailand and can prevent 4 strains of the disease: A, C, Y, and W-135. However, the most common strain found in Thailand is B, for which there is currently no vaccine. Therefore, there is no general recommendation for Thai people to receive the vaccine for prevention of this disease. The vaccine is only used in cases where people will travel to an area where the disease is endemic, or for people living in an area with an outbreak who know the strain of the infection, or for people who will be traveling to an area with an endemic outbreak, such as the Saharan region in Africa, or countries in Central and East Asia. Those who plan to travel to such areas, such as Thai Muslims who go to seek blessings in Mecca, Saudi Arabia, should receive the vaccine for prevention of meningococcal disease at least 10 days before traveling. The vaccine for prevention of meningococcal disease is divided into two main types:   The polysaccharide vaccine is made from pure extracts of the capsule of the meningococcal bacteria and is extracted from 4 strains: A, C, Y, and W-135. This vaccine is effective and efficient in preventing infection with meningococcal strains A and C in children over 2 years old and in adults. However, it is not very effective in providing immunity against strain C in children under 2 years old and is not effective against strains Y and W-135. The vaccine is therefore not recommended for these strains. The Conjugate vaccine is a new type of meningitis vaccine that can stimulate the immune system for a longer period of time. It is created by combining protein components with polysaccharides from the capsule of the meningitis bacteria serogroups A, C, Y, and W-135. This vaccine is used to prevent meningitis infections in individuals aged 2-55 years old.   Who should receive this vaccine and how many doses should they receive?   The people who should receive this vaccine are divided into four major groups:   Children over 2 years old and adults who are at risk of infection, such as those who travel to or reside in outbreak areas. Students who will continue their studies in the United States or some countries in Europe, especially those who will stay in dormitories, due to previous outbreaks of the disease among students. Therefore, many schools and universities in the United States require students to receive this vaccine before they start studying and submit proof of vaccination. People who seek to perform Hajj and Umrah rituals, which is a requirement of the Saudi Arabian government. Before participating in these rituals, they must receive the meningococcal vaccine and submit proof of vaccination to obtain a visa. It is recommended that they receive the vaccine at least 10 days before traveling and no later than 2 years prior. Tourists/travelers who will go to the countries in the Meningitis belt in Africa, starting from Gambia, Burkina Faso, Senegal, and Guinea to the east as far as Ethiopia or enter areas where the disease is prevalent. Especially, if they will have close contact with people in these areas, they should receive the vaccine before traveling.   The vaccine is administered either subcutaneously with the type of polysaccharide or intramuscularly with the type of conjugate.   It is recommended to postpone receiving the vaccine for Meningococcal disease for those who:   Have experienced a severe reaction to this vaccine or any of its components, or have an allergy to latex, which is a component of the vaccine container. Have a weakened immune system, such as those who have received steroid medication for more than two weeks, cancer patients who have received chemotherapy or radiation therapy, patients with advanced HIV infection or severe immune deficiencies. It is recommended to consult a doctor before receiving the vaccine.   Possible side effects that may occur after receiving the vaccine include: Pain, swelling, redness, and warmth at the injection site, which usually resolve within 2-3 days. If experiencing any of these side effects, applying a cool compress to the affected area and taking an appropriate dose of fever-reducing medication is recommended. If side effects are severe or persistent, seek medical attention immediately and provide a detailed report of symptoms to the doctor.   Best regards from the Vaccination Center,Vibhavadi Hospital.

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Pneumococcal Vaccine

Pneumococcal Vaccine   Pneumococcal Disease Pneumococcus is a disease caused by a bacterial infection called Streptococcus pneumoniae. Although it causes pneumonia, which leads to illness and death worldwide, it is a disease that can be prevented by vaccination. This bacteria can be found everywhere and often lives in the nasal and throat passages of carriers without causing any symptoms. The bacteria spreads to others through coughing or sneezing, which results in the dispersion of respiratory droplets. The bacteria enters the body through contact with contaminated objects, similar to the spread of the common cold and flu.   Symptoms of patients infected with Pneumococcus   If there is a suspicion of the following symptoms, seek medical attention immediately. - Pulmonary edema may have a high fever, cough, rapid breathing, wheezing, and may have symptoms of the flu beforehand or not. - Middle ear infection may have a high fever, earache, dizziness, and fussiness. - Encephalitis may have a sudden high fever, stiff neck, headache, nausea, vomiting, convulsions, or rapid loss of consciousness. Patients may have a high fever with or without other accompanying symptoms, and should seek medical attention promptly.   Treatment of Pneumococcus disease The most important treatment is to provide antimicrobial drugs that can quickly eliminate the Pneumococcus before resistance to penicillin occurs. Antimicrobial drugs can kill the virus within 24 hours, but currently, resistance to penicillin is increasing, requiring doctors to use new drug classes for treatment. The difficulty of treating this disease depends on where the infection occurs, for example, if it infects the brain tissue, it may cause damage to the brain tissue as well. Patients may have residual disabilities in survivors.   The Pneumococcal Polysaccharide Vaccine (PPSV23) The Pneumococcal Polysaccharide Vaccine (PPSV23) is a vaccine that protects against 23 different types of pneumococcal bacteria, including those that often cause severe diseases.   Adults with good health will develop immunity to most or all of the bacteria within 2 to 3 weeks after receiving the vaccine. However, the elderly, children under 2 years of age, and chronically ill patients may not respond to the vaccine as well as they should or may not respond at all.   Who should receive the PPSV23 vaccine? Adults aged 65 years or older People between 2 and 64 years old with chronic health problems such as: Heart disease, lung disease, blood disease, diabetes, chronic alcoholism, liver disease, cerebrospinal fluid leaks or cochlear implants. People between 2 and 64 years old with diseases that weaken the body's ability to fight infection, such as: Chronic renal failure, cancer of the lymphatic system or blood, kidney failure, multiple myeloma, diseases affecting the function of the spleen, HIV/AIDS or other immunocompromising conditions. People between 2 and 64 years old who take medications or receive treatment that weaken the body's ability to fight infection, such as: Long-term use of steroids, radiation therapy, or chemotherapy. Adults aged 19 to 64 who: Smoke cigarettes Have asthma. How many times and when should PPSV23 be administered?             Normally, PPSV23 is given only once, but in some cases a second dose may be necessary. A second dose should be given to individuals aged 65 years or older who received their first dose when they were younger than 65 years and have been vaccinated for more than 5 years. A second dose should be given to individuals aged 2 to 64 years who: have muscle weakness or no muscle, have congenital blood disorders, have been infected with HIV or AIDS, have cancer, have lymphoma, have kidney disease or abnormal kidney function, have undergone organ or bone marrow transplantation, or have received immunosuppressive drugs (such as long-term corticosteroids or androgen therapy). The second dose of vaccine should be administered 5 years after the first dose.   Monitoring for side effects: Vaccines are like any other medication that may cause side effects. For the PPSV23 vaccine, minor side effects may occur such as pain, swelling, or redness at the injection site. There is a small chance (about 1%) of fever or muscle pain. If these symptoms occur, apply a cold compress to the injection site or take appropriate fever-reducing medication. If serious or severe symptoms occur, consult a doctor immediately and provide detailed information about the symptoms.   Taking care of possible side effects Things to observe: - Observe for various abnormal symptoms of severe allergies, such as rash, facial swelling, swollen mouth, swollen throat, difficulty breathing, rapid heartbeat, etc. These symptoms may occur within 2-3 minutes to 1-2 hours after receiving the vaccine.   Things to do:   - If there is a suspicion that the vaccine recipient has a severe allergic reaction, send the patient to the nearest hospital. In the case of using combination vaccines containing diphtheria-tetanus-pertussis and hepatitis B vaccines, it can be given (after the first needle) at 2, 4, and 6 months of age. For children who have never received the vaccine before, for children under 11 years old, the vaccine can be administered in the 0, 1, and 6 months. For children aged 11-15, only 2 doses may be given in the 0 month and 4-6 months, using a 1.0 ml vaccine dose equivalent to an adult. Adults: o Individuals who have not yet received the hepatitis B vaccine and are at risk of contracting the virus, such as: § Individuals who have had sexual contact with someone who has hepatitis B virus § Men who have sex with men § Individuals who inject drugs § Individuals who have had sex with more than one person § Individuals with chronic liver or kidney disease § Individuals with diabetes who are under 60 years old § Medical personnel who come into contact with blood or various secretions § Individuals in families with hepatitis B virus infection § Individuals who travel to countries with hepatitis B virus outbreaks § Individuals with AIDS   o Pregnant women who are at risk can also receive the vaccine.   Who should not receive the hepatitis B vaccine?   Individuals who have had a severe allergic reaction to the hepatitis B vaccine or any of its components, which can be life-threatening. Individuals who are currently sick should wait until they have fully recovered before receiving the vaccine. It is recommended to see a doctor if any of the following undesirable symptoms occur, even though the risk of severe adverse reactions to the vaccine is very low: Unusual symptoms such as severe allergic reactions, difficulty breathing, wheezing, high fever, rash, swelling of the face or mouth, pale skin, or rapid heartbeat.   With best wishes from the Vaccination Center at Vibhavadi Hospital.

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Tdap vaccines for prevention of tetanus, diphtheria and pertussis

Tdap vaccines for prevention of tetanus, diphtheria and pertussis Tetanus, diphtheria, and pertussis are diseases caused by specific bacteria. These diseases can be severe and even life-threatening. Tetanus is caused by a toxin produced by the tetanus bacteria that is commonly found in the environment, such as soil, grass, and animal feces. The bacteria thrive in areas without oxygen and are often associated with a history of injury or puncture wounds, such as stepping on a rusty nail or being bitten by an animal. When the tetanus bacteria enter the body through a wound, it releases toxins that attack the nervous system, causing symptoms such as muscle stiffness, spasms, rigid jaw muscles, difficulty opening the mouth, stiff neck, seizures, and difficulty breathing. The disease can be fatal and has an incubation period of 5 days to 15 weeks, with symptoms appearing between 6-15 days.   Diphtheria is a disease caused by the diphtheria bacterium, which is found in the saliva, mucus, or nasal discharge of infected individuals. This can cause severe inflammation of the throat, leading to breathing difficulties and airway obstruction. In addition, the infection can lead to complications as the diphtheria bacterium releases toxins that can cause heart muscle inflammation and nerve damage. This disease is highly contagious and can be spread through respiratory droplets when infected individuals cough, sneeze, or breathe. The incubation period is typically 1-7 days.   Symptoms of diphtheria include low-grade fever, headache, body aches, mild sore throat, difficulty swallowing, nausea, vomiting, and extreme fatigue. If there is inflammation of the larynx, there may also be coughing, hoarseness, and difficulty breathing.   Pertussis, or whooping cough, is caused by the Bordetella pertussis bacteria, which is only present in the throat of patients in the early stages of the illness. It is spread through coughing or sneezing and can cause inflammation of the respiratory tract, leading to severe coughing fits, difficulty breathing, and in some cases, even cessation of breathing, seizures, and intense coughing that can make it difficult to sleep. The incubation period is typically around 7-14 days.   Symptoms of pertussis can be divided into 3 stages, which are:   The first stage usually lasts for about 7-14 days and is characterized by a mild fever, runny nose, cough, and symptoms similar to those of the common cold. The cough will gradually worsen over time. The second stage is marked by a persistent cough that can cause wheezing and difficulty breathing. When coughing stops, there may be a loud inhaling sound. Infants younger than 6 months may not have this symptom and may also vomit with phlegm. In severe cases, the face may turn green, eyes become red, and the blood vessels in the neck may bulge. Some may even cough to the point of bursting blood vessels in the eyes, causing red spots, swelling, or bleeding under the skin of the eyes. Infants may experience seizures or stop breathing, and their skin may turn green due to lack of oxygen supply to the brain. The persistent cough usually occurs more frequently at night or when exposed to cold air, drinking cold water, smoking, or inhaling dust. This stage may last for about a month, but is usually more severe during the first 2 weeks. The third stage is a recovery phase. The cough gradually subsides, and the individual can eat more easily and gain weight. However, a serious complication of bronchitis is pneumonia, which can be life-threatening in infants. In addition, coughing fits may cause seizures or breathing difficulties due to lack of oxygen in the brain, especially in infants under 2 years of age.   Who should receive vaccines to prevent tetanus, diphtheria, and pertussis? Vaccine for adolescents and adults: Ages 11-18: It is recommended to receive the Tdap vaccine at 11 or 12 years of age. (For children who have not received the DTaP vaccine, it can be given from the age of 7.) Children and adolescents who have not received all doses of the DTaP vaccine by the age of 7 should receive a vaccine that contains both Td and Tdap for all remaining doses.   Ages 19-64: Adults should receive the Td vaccine every 10 years. For adults under 65 who have never received the Tdap vaccine, they should receive a booster with the Tdap vaccine. Adults 65 years and older may receive one Tdap booster. Adults (including pregnant women and adults 65 years and older) who are in close contact with infants younger than 12 months should receive one dose of Tdap to help protect the infant from pertussis. Healthcare personnel who come into direct contact with patients in hospitals or clinics should receive one dose of Tdap.   Ages 65 and older: They may receive one Tdap booster.   Vaccination for prevention in patients after having a wound:               Individuals with a wound or injury may need to receive a Td or Tdap vaccine to prevent tetanus infection. Tdap can be given to individuals who have not previously received this vaccine.   Vaccination for prevention in pregnant women:               Pregnant women who have not received a Tdap vaccine should receive one at 20 weeks of pregnancy and ideally during the third trimester of pregnancy. If given to the mother, it will protect the baby for about 6 months after birth, and the tetanus vaccine will help prevent infection during pregnancy and childbirth. Women who have not received a Tdap vaccine during pregnancy should receive one immediately after giving birth, as their sick baby may have contracted the infection from the mother. Both Tdap and Td vaccines can be given with other vaccines.   Managing possible side effects:               Vaccines can cause severe allergic reactions, which can include rash, swelling of the face, difficulty breathing, or rapid heart rate. The person who receives the vaccine should be taken to a doctor immediately if these symptoms occur. However, severe allergic reactions to vaccines are very rare.               Possible reactions after vaccination may include pain, swelling, and redness at the injection site, which usually go away within 1-2 days. Additionally, fever, vomiting, and muscle aches may occur. If there is pain or swelling at the injection site, applying a cold compress may help. If there are other abnormal symptoms, it is advisable to consult the nearest hospital.   Within 12 hours after birth, the first dose of HBIG vaccine and the first dose of the combined vaccine containing diphtheria-tetanus-pertussis and hepatitis B should be given at separate injection sites. The second dose of the vaccine should be given at 1-2 months of age, and the third dose at 6 months of age. If the combined vaccine containing diphtheria-tetanus-pertussis and hepatitis B is used, it can be given at 2, 4, and 6 months of age, after the first injection. For children who have not received any vaccine before, for children under 11 years of age, the vaccine can be given in months 0, 1, and 6. For children aged 11-15 years old, they can receive only 2 doses of the vaccine in months 0 and 4-6, using a 1.0 ml vaccine dose.   Adults Adults who have never been vaccinated and are at risk of contracting hepatitis B virus, such as: Persons who have had sexual contact with individuals infected with hepatitis B virus Men who have sex with men Persons who inject drugs Persons who have had sexual contact with more than one person Persons with chronic liver or kidney disease Persons with diabetes and under the age of 60 Medical personnel who come into contact with blood or various body fluids Family members of individuals infected with hepatitis B virus Persons who travel to countries with outbreaks of hepatitis B virus Persons infected with HIV/AIDS Pregnant women at risk can also receive the vaccine.   Who should not receive the hepatitis B vaccine?   Individuals who have had a severe allergic reaction to the hepatitis B vaccine or any of its components, which can be life-threatening. Individuals who are currently sick should wait until they have fully recovered before receiving the vaccine. It is recommended to see a doctor if any of the following undesirable symptoms occur, even though the risk of severe adverse reactions to the vaccine is very low: Unusual symptoms such as severe allergic reactions, difficulty breathing, wheezing, high fever, rash, swelling of the face or mouth, pale skin, or rapid heartbeat.   With best wishes from the Vaccination Center at Vibhavadi Hospital.

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Japanese Encephalitis (JE) Vaccine

Japanese Encephalitis (JE) Vaccine What is Japanese Encephalitis?                 Japanese encephalitis (JE) is a disease caused by the Japanese encephalitis virus (JEV), which is transmitted by mosquitoes that are active at night and primarily feed on animals, including several species of milk-producing animals, that serve as hosts for the virus. The incubation period for the disease is 5-15 days, and symptoms include high fever, severe headache, vomiting, convulsions, altered mental status, and can even result in death.                 The majority of people infected with JE do not show any symptoms, with only one in 250 infected individuals exhibiting symptoms. However, children under the age of 10, especially those aged 0-4 years, have a higher mortality and neurological disability rate. JE is prevalent throughout Asia, and while there is no specific treatment for the disease, it can be prevented through vaccination.   Prevention                 Japanese encephalitis (JE) is a disease with a high mortality and disability rate, so prevention is important. It can be done by:   Controlling disease carriers, such as destroying mosquito breeding sites. Taking precautions to avoid mosquito bites. Getting vaccinated against Japanese encephalitis.   In Thailand, there are two types of Japanese Encephalitis (JE) vaccines:   Inactivated vaccine prepared by cultivating the virus causing JE in the brain of newborn mice. There are two strains of the vaccine: Beijing and Nakayama, which have different sizes. The smaller dose is for children under three years old, and the larger dose is for older children. The vaccine is given subcutaneously, with two injections spaced 1-4 weeks apart, and the third injection is given one year after the first vaccine.   The effectiveness of both strains of the vaccine in preventing the disease is about the same. Those who receive two doses of the vaccine will have a high level of immunity for some time, and when they receive all three doses, the vaccine can prevent the disease for 3-5 years. If living in an epidemic area, it is recommended to have a booster shot every 4-5 years, no more than twice, to protect against the disease during the high-risk period.   Vaccines made from live attenuated viruses provide protection against diseases with a percentage of 95-100. They have advantages over vaccines made from inactivated viruses, including longer-lasting immunity and not requiring booster shots. These vaccines are produced by growing a weakened form of the virus in cell cultures, rather than in the brains of mice, which reduces the risk of neurological complications such as sudden inflammation of the brain and spinal cord due to mouse brain tissue contaminating the vaccine.   The Chinese vaccine is prepared in the form of a dry powder by growing a strain of the live attenuated virus SA 14-14-2 in cell cultures. Two doses are given, the first at one year of age and the second one year after the first dose. The vaccine is produced using genetic engineering techniques by inserting genes from the SA14-14-2 strain of Japanese encephalitis virus into the PrM and E genes of the 17D strain of yellow fever virus. This creates a virus with structural proteins similar to Japanese encephalitis virus and non-structural proteins similar to yellow fever virus. The vaccine is given to children aged 9 months or older and can stimulate immunity to a level that can protect against the disease within 28 days of receiving the first dose. To achieve long-term protection, a booster shot is recommended 1-2 years after the first dose, which can maintain immunity at a high level for at least 3 years. The vaccine is given as a single subcutaneous injection to adults aged 18 years or older. In general, the body will produce immunity to a level that can prevent disease after receiving the vaccine for 14 days and not requiring a booster shot within at least 5 years after the first vaccine shot.   Who should receive the Japanese encephalitis vaccine? People living in outbreak areas and tourists who will travel to countries in Asia, including Thailand. If it has been more than 1 month, it is recommended to receive the vaccine at least 10 days before traveling to ensure sufficient immunity to prevent the disease and monitor for possible side effects.   Who should avoid or postpone receiving the Japanese encephalitis vaccine? Those who have a history of allergic reactions to the Japanese encephalitis vaccine in the past. Those who are allergic to gelatin should not receive the inactivated vaccine. Pregnant women. Those who have immunodeficiency due to various causes or are receiving immunosuppressive drugs, or those who have weakened immune systems. Those with chronic illnesses such as liver disease, kidney disease, heart disease, or those who have had seizures within 1 year should seek the advice of a doctor. Those with a high fever or severe infection should postpone vaccination until they recover.   Common side effects: Dead virus vaccine:                Common side effects include pain, swelling, and redness at the injection site, fever, fatigue, headache, muscle aches, nausea, and allergic rash, which can occur immediately or delayed, mostly within 10 days. Live virus vaccine:                Less common side effects than dead virus vaccine and resolve on their own within 2 days. These include pain, swelling, and redness at the injection site, fever, rash, nausea, children crying, loss of appetite, etc.   Caring for side effects that may occur: Things to observe:                Observe for abnormal symptoms of severe allergic reactions such as rash, facial swelling, throat swelling, difficulty breathing, and fast heartbeat. These symptoms can occur within 2-3 minutes to 1-2 hours after receiving the vaccine. Things to do:                If you suspect a severe allergic reaction in the vaccine recipient, send the patient to the nearest hospital.   Best regards, Vibhavadi Hospital Vaccine Center  

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Hyperlipidemia and coronary heart disease

Hyperlipidemia and coronary heart disease   Fat is an important component of the body. It is a component of all types of cells, especially cell walls, and is a reserve energy source stored in the form of fat cells. Abnormally high levels of fat in the body are strongly associated with the development of coronary artery disease. - There are two sources of fat in the body: fat synthesized by the body and fat obtained from food. - Fat obtained from food can be divided into two types: plant-based fat and animal-based fat. - Animal-based fat includes fat obtained from animal-based foods such as meat, animal fat, animal skin (duck skin, chicken skin), animal fat (pork fat, beef fat), egg yolks, brain and animal organs, which contain an important component called "cholesterol". - Plant-based fat, which is mainly composed of "triglycerides", is obtained from foods such as coconut milk, flour, and sweet foods that contain a lot of sugar. This type of fat is also believed to contribute to the development of coronary artery disease, but its importance is less than that of cholesterol.   Regardless of its form, all fat consumed will be broken down by enzymes and bile from the liver in the small intestine. The resulting small fatty acids and lipid components are then absorbed into the bloodstream and processed in the liver to be utilized or stored in the body. These fats come in different forms, such as cholesterol, triglycerides, and phospholipids, which can be classified into two to three types of lipoproteins: high-density lipoprotein (HDL), intermediate-density lipoprotein (IDL), and low-density lipoprotein (LDL).   Approximately 60-70% or two-thirds of the fat present in the blood we examine come from the fats we create. LDL, or low-density lipoprotein, is considered unhealthy because it is deposited in the walls of blood vessels, leading to the hardening of arteries or atherosclerosis. LDL has an important component, cholesterol, which can cause it to seep into damaged or abnormal sections of artery walls, triggering an immune response that results in the accumulation of white blood cells, smooth muscle cells, fibronectin, and other substances. This causes the arterial wall to thicken and form a bump or plaque. If this occurs repeatedly in multiple locations, atherosclerosis may develop, which can lead to constricted or blocked blood vessels, particularly in the heart's arteries.   On the other hand, high-density lipoprotein (HDL) is considered good cholesterol that carries excess cholesterol from the arterial walls back to the liver to be broken down and eliminated from the body. It also has an anti-inflammatory effect, helping to reduce the risk of heart disease.   When will the doctor treat you? If you have high cholesterol, such as greater than 240 mg%, or a total cholesterol value in low-density lipoprotein that is higher than normal, the doctor will examine whether there are risk factors for developing coronary artery disease. If you have risk factors such as having cardiovascular disease in other areas, smoking, diabetes, high blood pressure, a family history of death from heart disease, postmenopausal women, or advanced age, you are considered to have a high risk rate. You or patients in this group should receive full treatment.   Triglycerides are less associated with coronary artery disease than cholesterol, but if they are too high, they need to be treated. If you already have coronary artery disease, you must treat both high cholesterol and high triglycerides.   Treatment Treatment for high blood lipid levels such as LDL cholesterol levels higher than 160-180 mg/dL and triglyceride levels higher than 240 mg/dL, as well as other risk factors for heart disease, involves the following steps:   Patients need to control their diet for about 1-3 months. After 1-3 months, the blood lipids are rechecked. If the levels of bad lipids (LDL cholesterol and triglycerides) are still high, medication to lower blood lipids may be necessary. Currently, there are 4 groups of lipid-lowering medications available in the market: fibric acid derivatives, statins, resin, and ezetimibe. Statins have been proven to significantly reduce the risk of cardiovascular disease mortality in clinical trials. Each group of lipid-lowering drugs has its own advantages and disadvantages, and it is recommended to consult with a doctor before using them. Attempt to lower the total cholesterol level to less than 160 mg/dL and the bad lipids (LDL cholesterol and triglycerides) to less than 130 mg/dL, or reduce them by 30-50% from the previous levels. Diet control and medication use should be continued together.   Principles of dietary control: The food should contain less than 30% fat and cholesterol levels should be between 200-300 mg per %. If the cholesterol level is high: Avoid foods such as egg yolks, animal fats (pork fat, beef fat), animal organs (liver, kidney, heart, lungs, intestines, and brain), various animal oils, red meat (beef, pork), duck skin, chicken skin, duck eggs, squid, and clams. Avoid fried foods and instead choose to grill, roast, boil, or bake. Use vegetable oils that are low in saturated fats such as soybean oil, corn oil, or rice bran oil for cooking. Green leafy vegetables can be eaten without restriction. Lose weight. If the triglyceride level is high: Avoid foods such as coconut milk and sweet desserts. Exercise to lower triglyceride levels. Reduce alcohol and beer consumption. Lose weight. Other things you should know:   Blood lipid level should be checked by fasting for at least 10-12 hours (not 6 hours), including a test for triglycerides along with cholesterol. However, drinking water is allowed.If you want to check only for unhealthy fats (LDL cholesterol), fasting is not necessary. Medications to reduce blood lipids do not reduce belly fat or body weight because belly fat is a different type of fat than the fat in the blood. If there are no risk factors for heart disease, a total cholesterol level below 240 mg/dL and an unhealthy fat level (LDL cholesterol) below 130 mg/dL are acceptable. Fish oil has the ability to reduce triglycerides and increase high-density lipoprotein (HDL) cholesterol, but does not reduce low-density lipoprotein (LDL) cholesterol.   With best regards from Vibhavadi Heart Center.

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What are the types of heart disease?

What are the types of heart disease? There are many types of heart disease, which can be broadly classified as follows: Coronary artery disease Cardiomyopathy - weakened or inflamed heart muscle, or heart muscle damage from a virus Rheumatic heart disease - heart valve damage from rheumatic fever Infective endocarditis - heart valve infection from an infection elsewhere in the body Congenital heart disease - heart defects present at birth Other diseases or conditions related to the heart.   1. Disease of the coronary arteries The cardiac muscles rely on nutrients and oxygen from the coronary arteries to function properly. If the coronary arteries become narrow or blocked, the cardiac muscles will not receive enough nutrients and oxygen, causing heart failure. The heart cannot pump blood to the body efficiently, resulting in symptoms of ischemia.   In cases of coronary artery spasm, symptoms of ischemia usually occur during physical exertion when the heart needs more nutrients and oxygen than normal. The symptoms may go away within a few minutes of rest. However, if the coronary arteries are severely constricted or blocked, the cardiac muscles may die, causing a heart attack. The heart cannot pump blood to the body efficiently, and the cardiac muscles work less effectively, resulting in more severe and longer-lasting symptoms, including heart failure.   Some patients seek medical attention for chest tightness or pressure that mimics indigestion or gastric ulcer. Some patients present with complications such as congestive heart failure, angina, or arrhythmia, and may even die before seeking medical help.   2. Cardiomyopathy or viral myocarditis Cardiomyopathy can occur since birth or develop later in life. The most common type of cardiomyopathy that occurs later in life is cardiomyopathy of unknown cause. Cardiomyopathy of unknown cause can be divided into three types: Thickened heart muscle type Dilated heart muscle type resulting from certain diseases that infiltrate the heart muscle Non-thickened heart muscle type but with a heart that is enlarged and not able to contract normally   The most commonly encountered cardiomyopathy is dilated cardiomyopathy. This disease results from a decrease in the heart muscle's ability to contract, which leads to insufficient blood supply to various organs. The body compensates by enlarging the heart to increase the amount of blood pumped out of the heart. As a result, the patient's heart becomes significantly enlarged, and this condition is known as dilated cardiomyopathy. The main symptoms of this disease are easy fatigue and, in severe cases, swelling and shortness of breath due to heart failure. The cause of this type of cardiomyopathy is unknown, but it can sometimes occur after viral myocarditis or exposure to certain toxins, such as cobalt or cancer medications.   Several types of viruses can cause myocarditis. However, patients with this disease often have a history of fever and upper respiratory symptoms before developing easy fatigue from heart muscle inflammation, which impairs cardiac contraction. Most cases are mild and may not require medical attention, but in rare cases, severe myocarditis can lead to heart failure and even death, requiring immediate medical attention.   3. Rheumatic Heart Disease There are two types of heart valve abnormalities: mitral valve prolapse and mitral valve regurgitation. Some individuals may have both conditions simultaneously. The main cause of these abnormalities in our country is rheumatic fever. Rheumatic fever usually starts in children aged between 5-12 years old after being infected with a bacteria called Streptococcus in the mouth. The body's immune system responds to the bacteria, but the reaction can be too strong, leading to resistance against normal tissues and resulting in rheumatic fever. Symptoms of rheumatic fever include fever, joint pain, joint swelling, skin rash, and the possibility of developing heart inflammation. Chronic heart inflammation can result in heart valve abnormalities (prolapse or regurgitation). Symptoms of heart valve abnormalities can occur from childhood to old age and depend on the severity of the valve's dysfunction. Valve abnormalities can occur in all heart valves, but the most common is mitral valve prolapse, followed by aortic valve prolapse. Mitral valve abnormalities are more common in women of reproductive age. Symptoms of mitral valve prolapse are often a sign of mitral valve regurgitation, which is a condition where blood flows back into the upper heart chamber because it does not flow through the valve properly. This can cause fluid to build up in the lungs, leading to fatigue, dizziness, swelling, and an increased risk of respiratory infections.   The general principle of treatment for mitral valve disease is to use medication to control the function of the heart. However, when the function of the heart deteriorates to the point where the patient begins to experience symptoms of heart failure, surgery must be performed to repair or replace the valve. If the condition is mitral stenosis and medication is not effective, surgery to enlarge or replace the valve must be performed once the valve reaches a point where symptoms appear.   Interestingly, we are currently seeing fewer cases of this disease, possibly due to the widespread use of antibiotics.   4. Infective endocarditis          Most of the time, abnormalities of the heart valves occur first, such as heart valve dysfunction from rheumatic fever. These heart valve abnormalities are caused by inflammation that causes the shape of the heart valves to be distorted. When there is a bacterial infection in the bloodstream for any reason, such as a dental infection (filling, tooth extraction), the bacteria can easily adhere to the abnormal heart valves and spread, causing damage to the heart valves and leading to heart valve inflammation.   Patients usually come to see a doctor with symptoms of fever, chills, signs of infection in the bloodstream, or may present with symptoms of stroke, limb paralysis, from the fragments of disease-causing bacteria that have spread from the inflamed heart valves to various organs, or may present with symptoms of endocarditis, which is blood pooling in the heart muscle or heart valves that can cause damage to the heart muscle or heart valves.   Currently, there are more people who inject drugs into their bloodstream, leading to an increased incidence of right-sided infective endocarditis without preexisting abnormalities. This is due to the use of unsterilized injection equipment, which introduces infectious agents into the bloodstream. These infectious agents have a higher chance of attaching to the heart valve on the right side of the heart.   The treatment for infective endocarditis caused by infection involves hospitalization and high-dose antibiotic therapy administered through the intravenous route initially, followed by oral antibiotics for a period of 4-6 weeks. If symptoms persist or there are other complications, surgical intervention may be required.   5. Congenital heart disease The cause of congenital heart disease is either genetic abnormalities or abnormal development of the heart tissue during fetal growth in the mother's womb. Abnormal growth of the tissue that develops into the heart can lead to incomplete heart structure, which can take on various forms. Some may have leaking heart walls (which can leak between the upper and lower chambers of the heart), while others may have no wall at all (with only one upper or lower chamber of the heart). In addition, some may have congenital heart murmurs or congenital heart valve leakage.   In some cases, the condition is more complex, such as in the case of Tetralogy of Fallot, which consists of several abnormalities, including leaking heart walls, heart murmurs, heart valve leakage, cyanosis, and a constricted pulmonary artery. This can make treatment more difficult.   Symptoms that patients present to physicians with vary depending on the type of congenital heart disease. They range from small size and failure to thrive, to easy respiratory infections or experiencing shortness of breath, to more complex types such as cyanosis and acyanotic types.   The most common congenital heart disease is Ventricular Septal Defect (VSD), where there is a hole in the wall that separates the two lower chambers of the heart. Generally, congenital heart diseases are treated through surgery, but currently, a closure device can be used in VSD cases. This device is inserted through a leg vein and guided to the heart, where it seals the hole by deploying the closure device, similar to heart catheterization. However, the effectiveness of this treatment depends on the size and location of the abnormality.   6. Other diseases or conditions related to the heart include: Rheumatic heart disease Arrhythmia High blood pressure Endocrine disorders such as toxic goiter, pituitary gland tumors, and adrenal gland tumors Malnutrition, such as vitamin B deficiency Diseases of the heart lining, such as pericardial effusion, chronic pericarditis, and constrictive pericarditis Vascular disorders, such as aortic aneurysm and aortic dissection   These diseases can cause abnormal heart conditions, which may be detected by an enlarged heart, rheumatic heart disease, and/or other specific symptoms.   Best regards, Vibhavadi Heart Center Hospital

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Vibhavadi hospital-style treatment for coronary artery disease

Vibhavadi hospital-style treatment for coronary artery disease   The goal of treating acute coronary syndrome (ACS) is to correct the condition of ischemic heart disease, prevent complications from myocardial infarction, and restore heart function to a level close to normal. There are many methods for treating this condition, but here we will attempt to explain it in a way that is easy to understand using the "2-3-4" method, which consists of two principles, three goals, and four treatment methods.   The two principles for treating coronary artery disease with myocardial ischemia are: Reduce the workload of the heart to decrease oxygen demand (resting, medication, stress reduction, and avoiding exertion during symptom episodes). Increase blood flow and oxygen supply to the heart (medication, balloon angioplasty, stent placement, and coronary artery bypass surgery).   The three goals of treating ACS are: Correct the condition of ischemic heart disease by preventing or reducing the number of heart muscle cells that die in order to minimize damage to the functioning of the ventricles, or to avoid any damage at all. Prevent complications such as heart failure or arrhythmias in order to reduce the mortality rate and avoid hospitalization. Restore the heart's function to a level as close to normal as possible.   The four treatment methods for ACS are: Coronary artery bypass grafting involves performing surgery to bypass the blocked coronary arteries with healthy veins or arteries taken from other parts of the body. Percutaneous coronary intervention involves widening the blocked coronary arteries by using a balloon catheter, stent placement, or other techniques. Medical therapy involves the use of medications to lower blood lipid levels, prevent platelet aggregation, and reduce blood pressure. Medications such as ACE inhibitors/ARBs and drugs that dilate coronary arteries may also be used. Risk factors such as smoking, high blood pressure, high cholesterol, and diabetes are addressed through lifestyle modifications and medication therapy.   Explanation of treatment for coronary artery disease The heart muscle works by contracting and relaxing all the time. The heart muscle receives nutrients and oxygen through the red blood vessels of the coronary arteries, which are branches of the main aorta. The pulsation of the coronary artery occurs when the interior walls of the coronary artery are damaged or ruptured, which stimulates the body's mechanism to repair itself. The first thing that happens is the blood clotting mechanism, which causes blood clots to form on the walls of the coronary artery. If the damage is small, the body can repair itself, and the blood vessel's wall cells move to close the wound. This leaves a scar on the interior walls of the coronary artery, called plaque. If there is a lot of plaque, the large coronary artery can become constricted or blocked. When the coronary artery is constricted, the blood and oxygen that nourish the heart decrease, causing chest pain due to the heart muscle lacking blood. The severity of chest pain varies from person to person, but generally, it feels tight and compressed in the middle of the chest and can radiate to the shoulders, back, or left arm. It usually occurs when exerting effort or exercising and goes away when resting. If there is a large blood clot, it can block the entire coronary artery, preventing blood from flowing to the heart muscle, causing severe chest pain suddenly. In cases where the coronary artery is blocked suddenly, the important treatment is to try to open the blocked artery by destroying the blood clot. The blocked blood clot can be dissolved or destroyed in two ways. The first is by performing a procedure called angioplasty to immediately expand the blood vessels using a heart catheterization. The second is by administering medication to dissolve the blood clot. The principle is to try to open the blood vessel as quickly as possible. If this is done within 90 minutes after it is known that the coronary artery is blocked, the heart muscle is less likely to die.   In cases where the coronary artery is narrowed but not completely blocked, we have time to prepare for the best possible treatment. We reduce the need for oxygen by reducing the work of the heart, such as by resting and avoiding getting out of bed, providing medication to reduce the squeezing of the heart, lowering the heart rate, and increasing the amount of blood and oxygen that goes to the heart (oxygen therapy, medication). We assess the risk, examine the heart's function, and perform a heart catheterization to inject contrast dye into the heart's blood vessels to determine the appropriate treatment.   The basic principle of heart catheterization is to insert a needle into the red blood vessel at the ankle or wrist, guide a wire and sheath in, and then insert a catheter about the size of a thin soil probe or dry ink pen (1.5-2 mm) into the blood vessel. The catheter is then pulled up to the area where the coronary artery of the heart is ruptured and the branch comes out. Contrast agent is injected to examine both the left and right coronary arteries to see if there is narrowing. If there is narrowing, the number of positions and the appropriate treatment options are determined, such as balloon angioplasty and stent placement, bypass surgery, or medication treatment. The treatment involves expanding blood vessels by using a balloon and inserting a wire coil is a preferred method of treatment for many patients, but not all are eligible. The method is suitable for cases where the blood vessel has a clear blockage of more than 70%, and the blood vessel is not too twisted or abnormally shaped. It is often used in cases where the heart has 1-2 blocked blood vessels, and if there are 3 blocked vessels, surgery may be a more effective option. If the procedure is done without inserting a stent, there is a 30-40% chance of the blood vessel narrowing again. However, if a bare metal stent is used, the rate of recurrence decreases. If a drug-eluting stent is used, the rate of recurrence is less than 5%. However, no treatment is 100% safe, and potential problems that may arise from this procedure include radiation sensitivity, bleeding at the heart site, kidney failure, arrhythmia, lack of blood flow to certain parts of the heart muscle, blood clots, and tearing of the blood vessel at the stent site, although these are rare. Surgical treatment through bypass surgery is also an option for coronary artery disease. In cases where there are blockages in multiple blood vessels of the heart, especially in cases where the blockages are long, they are often used in cases where there are three blocked blood vessels, especially diffuse blockages throughout the blood vessels that are not suitable for balloon angioplasty, or in cases of blocked blood vessels at the base of the left main coronary artery or when other treatments have failed, or when there are sudden complications from balloon angioplasty of the heart's blood vessels, such as using the saphenous vein in the leg, the internal mammary artery in the chest, or the radial artery in the arm. Generally, the risk of death from surgery is very low, with a hospital mortality rate of 1-2%. However, the risk of death is higher in elderly patients or those with multiple comorbidities.   Treatment with medication for coronary artery disease and myocardial infarction involves five main groups of drugs, which are drugs that lower blood lipid levels, antithrombotic drugs, beta-blockers or drugs with similar effects, vasodilators, and ACE inhibitors/ARBs. The use of medication is a primary method of treatment for individuals who have mild to severe cases of these diseases and cannot be treated effectively through other methods. Medication may be used alone or in combination with other treatment methods. Certain drugs have been proven to reduce mortality rates in individuals with coronary artery disease and myocardial infarction, such as antithrombotic drugs (aspirin, clopidogrel, and two other new drugs), beta-blockers, lipid-lowering drugs, ACE inhibitors/ARBs, and vasodilators such as nitrates. Nitrates, which come in sublingual, oral, and patch forms, dilate the blood vessels that supply the heart and can effectively reduce chest pain. However, it has not been proven that they can reduce mortality rates.   Behavioral modification: Quit smoking campaign to support patients and their relatives to stop smoking, as smoking increases the risk of heart disease by about three times compared to non-smokers.   Blood pressure control: The goal is to maintain blood pressure below 140/90 mmHg. Recommendations for the general population and adults include regular blood pressure measurement at least every 2 years and lifestyle modifications to prevent high blood pressure. These modifications include reducing cholesterol levels in the blood. The goal is to reduce bad cholesterol levels, and recommendations include simple changes such as avoiding fatty foods, animal organs, poultry skin, red meat, fried and stir-fried foods.   Physical activity: The goal is to exercise for 3-6 days a week, for at least 30 minutes a day, with a heart rate of 60-80% of the target heart rate. Recommendations include lifestyle modifications such as walking more and doing more household chores.   Weight management: The goal is to maintain a body mass index (BMI) between 18.5-23.5 kg/m2, which is considered healthy for Thai people. For those who have excess abdominal fat, there is an increased risk of heart disease and diabetes. Recommendations include controlling blood sugar levels to be close to normal.   Summary The objective of treating coronary heart disease with myocardial ischemia and muscle ischemia is to correct the condition of ischemic heart disease, prevent complications from heart muscle death, and restore the function of the heart to a state close to normal. There are four main methods of treating coronary heart disease: balloon angioplasty, coronary artery bypass surgery, medications, and addressing risk factors and making lifestyle changes. Addressing risk factors and making lifestyle changes are particularly important because they can reduce or prevent the recurrence of coronary heart disease. As the saying goes, "prevention is better than cure."   Best regards, Vibhavadi Heart Center

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Symptoms of Heart Disease

Symptoms of Heart Disease There are three main categories of heart disease symptoms that lead patients to consult a doctor:   Chest tightness or pain: This may be a symptom of ischemic heart disease. Fatigue or shortness of breath: These may be symptoms of heart failure. Heart palpitations or fainting: These may be symptoms of arrhythmias. It's important to distinguish these symptoms from those caused by anxiety or stress. It should be understood that some patients may not have any symptoms, some may have vague symptoms, and some may present with complications, such as stroke resulting from a blood clot that has dislodged from the heart. In some cases, patients may not make it to the doctor due to sudden death.   1. Chest tightness or pain due to ischemic heart disease Chest tightness or pain is a significant symptom that leads patients with ischemic heart disease to consult a doctor. Some people describe it as pain, while others describe it as tightness or pressure in the chest, as if something is squeezing or pressing on it. This sensation usually occurs in the center of the chest or slightly to the left. In some cases, it may feel similar to indigestion. The pain may radiate to the base of the neck, the back, the left arm, or the left shoulder. In some cases, the pain in the neck or shoulder may be more intense than the chest pain. This radiating pain is an important diagnostic clue. If the heart's blood supply is not severely compromised, the pain and tightness may be mild and short-lived, occurring only during exertion, such as running, climbing stairs, crossing a bridge, or heavy lifting. The pain usually subsides within 3-5 minutes of rest and typically does not last more than 15-20 minutes. However, if the heart is severely deprived of blood, the pain may last longer than 15-30 minutes, occurring even during light activity or at rest. If the heart muscle dies due to lack of blood, the pain is usually the most severe, lasting longer than 30 minutes, potentially for hours, and persisting even at rest. In this case, even taking medication under the tongue may not relieve the pain, and other symptoms may be present, such as cold sweats, nausea, vomiting, the urge to have a bowel movement or urinate, or feelings of weakness, dizziness, or fainting. Doctors need to differentiate these symptoms from other conditions with similar presentations, such as peptic ulcers, gallbladder inflammation, hepatitis, acid reflux, pleurisy, bronchitis, pneumonia, inflammation or edema of the lungs, pulmonary embolism, inflammation of the chest wall, or inflammation of the chest muscles or nerves, or a ruptured or torn aorta.   2. Easy Fatigue from Congestive Heart Failure Easy fatigue from congestive heart failure is a symptom of fluid accumulation in the lung sacs, which occurs when the heart does not pump efficiently or pumps with high resistance, such as in heart valve stenosis or very high blood pressure. This leads to an increase in pressure in the heart chambers, causing higher pressure in the lungs, pushing blood into the lung sacs (alveoli). This impairs oxygen exchange in the alveoli and results in fatigue. Initially, patients may feel easily fatigued during normal physical activity without any obvious reason. As the condition worsens, even minor exertion causes fatigue, and eventually, patients may experience difficulty lying flat at night due to the blood pooling in the heart and increased pressure in the lung sacs. Patients may need to sit up intermittently to relieve this discomfort.   In addition to these symptoms, a poorly contracting heart can also reduce the blood supply to the brain and muscles, causing weakness, dizziness, and confusion. If fluid accumulation is severe, high pressure in the capillaries of the lungs can push blood into the alveoli, causing frothy sputum mixed with blood, severe shortness of breath, and impaired oxygen exchange in the lung sacs. The reduced blood flow from the heart can lead to a life-threatening situation if not treated promptly.      The right chamber of the heart receives deoxygenated blood from the body and sends it to the lungs for oxygenation. If the pressure in the lungs is high, the pressure in the right chamber also increases, causing elevated pressure in the veins and swelling of the jugular veins in the neck. Fluid and minerals stored in the veins are pushed out, resulting in fluid accumulation in various organs, such as the liver, stomach, and intestines. This can cause an enlarged liver, abdominal discomfort, bloating, loss of appetite, nausea, and vomiting. Fluid accumulation in the arms and legs may lead to swelling at the fingertips and toes or the buttocks and back areas, especially in patients who are mostly bedridden.      Although these symptoms are present, there are several other conditions that can cause easy fatigue or swelling, such as: Lung diseases, like chronic bronchitis or emphysema. Kidney diseases, such as kidney failure or edema caused by protein loss in the kidneys. Liver diseases, like cirrhosis. Severe protein deficiency. Severe anemia.   3. Palpitations or fainting due to irregular heartbeats In cases of irregular heartbeats, rapid or slow arrhythmias may occur, or sometimes a mix of both fast and slow beats, causing a combination of symptoms. If irregular heartbeats occur sporadically or in isolation, which can happen in both the upper and lower heart chambers, these arrhythmias are usually not life-threatening. Common symptoms that lead patients to seek medical attention include heartbeats that feel like they're skipping or pausing. Some patients feel strong, sudden beats as if something is hitting them, or they experience palpitations and uneven heartbeats. If the upper heart chamber has continuous irregular beats for an extended period, called atrial fibrillation, the upper chamber struggles to function. Some patients present with blood clot-related heart attacks or stroke due to blood clots forming in the heart and traveling to the brain. If the lower heart chamber has rapid arrhythmias, it can be life-threatening. Commonly observed symptoms include palpitations, fainting, and low blood pressure. If the rapid beats don't stop, it can be fatal. If the heart beats too slowly, there may not be enough blood supply to the brain, causing dizziness, lightheadedness, blurred vision, fainting, and even seizures.   4. Symptoms in patients with anxiety disorders Symptoms can resemble those of ischemic heart disease or blood clot-related heart attacks, such as chest pain, palpitations, shortness of breath, cold hands and feet, and sweating on fingertips and toes. However, these symptoms often occur in adolescents or young adults and are more common in women than in men. Diagnostic clues include: Chest pain that feels like pinching, stabbing, or sharp. A specific, identifiable point of pain that intensifies when pressed. Chest pain that may occur multiple times a day and last for only seconds. Symptoms not associated with exercise, and exercise may even alleviate symptoms. Despite chest pain, patients can still function. Breathing difficulties are often accompanied by chest pain. Breathing becomes more comfortable with forceful exhalation, and severe cases may resemble asthma.   These symptoms tend to come and go, and are often stress-related. Sometimes, patients are aware of the stress, but most of the time, they're unaware. Close friends or family members can help identify stressors.   Best wishes from Vibhavadi Heart Center, Vibhavadi Hospital

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