FAQ - epistaxis
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The doctor suspects mild congestive heart failure. Explain how this can develop from hypertension?

Ms. S. J., aged 48 years, has essential hypertension, diagnosed 4 years ago. She has not been taking her medication during the past 6 months because she has been feeling fine. Now she has a new job and has been too busy to enjoy her usual swimming and golf. She has decided to have a checkup because she is feeling tired and dyspneic and has had several bouts of dizziness, blurred vision and epistaxis (nosebleeds) lately. On examination, her blood pressure is found to be 190/120, some rales are present in the lungs, and the retinas of her eyes show some sclerosis and several arteriolar ruptures. The physician orders rest and medication to lower the blood pressure, as well as an appointment with a nutritionist and urinary tests to check kidney function.

Congestive heart failure is basically when the ventricles are failing to pump blood adequately. Prolonged and untreated hypertension can cause ventricular hypertrophy (enlarging of the muscle in the ventricles), thus reducing the the size of the actual chamber. The ventricles are then no longer able to fill enough to keep up with preload, since blood coming into the heart stays the same, but ability to pump it out reduces, blood backs up into the lungs causing pulmonary hypertension and congestion in left ventricular failure, and blood backs up into the periphery in right ventricular failure causing peripheral edema.  (+ info)

It is absurd that I had two nosebleeds after I cried. Why these happens?

I had nasal surgery last Jan. 29, '08. After 3 weeks of recuperating, I had a terrible nosebleeds. It happenned after I cried when I read my Mom's email to me. When I got up from sitting position, I noticed drops of blood from my left nostril then it drips like a faucet. There was a considerable amount of blood that came out. I was alarmed which made me to visit ER. It was cauterized then. It went well and I resumed my normal activities but after 2 weeks I had a terrible nosebleed again. It happened the same very reason.. crying. I had a teary eyes when I watch the "Bridge to Terabithia". That incident made my nose bleed again. Im just wondering how come I am having epistaxis after being emotional or crying. I will ask my ENT doctor tomorrow what could be reasons.. why I am having this. If anyone of you experiencing from this.. feel free to reply. I will wait. Thanks.

My son has thin membranes and when he is physically active or too inactive his nose bleads. He's a good kid annd rarely gets in trouble so there isn't much reason for him to cry often as he's pretty happy but I suppose if you are crying then it may irritate the membranes with extra blood flow. I'm not sure.  (+ info)

Side-effects of marijuana...?

in comparison, here's a list of possible marijuana side-effects I found online, along with possible side-effects of a variety of popular pharmaceuticals

four questions follow:

without looking at the answers, which side-effects do you think are attributable to marijuana?

which side-effects do you think sound worst?


serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal, increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events. Abdominal pain, Diarrhea, Dispepsia, Flatulence, Nausea, Back pain, Peripheral, edema, Injury-accidental, Dizziness, Headache, Insomnia, Respiratory Pharyngitis, Rhinitis, Sinusitis, Upper respiratory tract infection, Rash.

anaphylactic reaction (including laryngeal edema), asthenia, face edema, pain
AUDITORY: sudden decrease or loss of hearing, tinnitus
CARDIOVASCULAR: angina pectoris, chest pain, hypertension, hypotension, myocardial ischemia, myocardial infarction, palpitation, postural hypotension, syncope, tachycardia
DIGESTIVE: abdominal pain, abnormal liver function tests, diarrhea, dry mouth, dysphagia, esophagitis, gastritis, gastroesophageal reflux, GGTP increased, vomiting
MUSCULOSKELETAL: arthralgia, back pain, myalgia, neck pain
NERVOUS: hypertonia, hypesthesia, insomnia, paresthesia, somnolence, vertigo
RESPIRATORY: dyspnea, epistaxis, pharyngitis
SKIN AND APPENDAGES:photosensitivity reaction, pruritus, rash, sweating
OPHTHALMOLOGIC: abnormal vision, blurred vision, chromatopsia, changes in color vision, conjunctivitis (increased redness of the eye), dim vision, eye pain, glaucoma, photophobia, watery eyes
UROGENITAL: abnormal ejaculation, priapism (including prolonged or painful erections)

Trouble remembering things, Sleepiness, Anxiety, Paranoia, Altered time perception, Dry mouth, Nausea, Headache, Tremor, Decreased coordination, Increased heart rate, Altered pulmonary status, Altered body temperature, Reduced muscle strength, Decreased cerebral blood flow, Increased food consumption, Anxiety and panic, Paranoia, Confusion, Aggressiveness, Hallucinations, Sedation, Altered libido, Possible suicidal ideation, Depersonalization, Derealization, Poor sense of time, Worsened short-term memory, Addictive behaviors, Amotivational syndrome

arrhythmias, sinus tachycardia, prolongation of the conduction time leading to myocardial infarction and stroke, drowsiness, dry mouth, fatigue, headache, abdominal pain, acid regurgitation, constipation, diarrhea, dizziness, nausea, irritability, mental acuity decreased, nervousness, upper respiratory infection, and pharyngitis. Syncope; malaise.

Cardiovascular: Tachycardia; arrhythmia; vasodilatation; palpitation; hypotension.

Digestive: Vomiting; anorexia; diarrhea; gastrointestinal pain; gastritis; thirst; flatulence; edema of the tongue; abnormal liver function and rare reports of hepatitis, jaundice and cholestasis.

Hypersensitivity: Anaphylaxis; angioedema; pruritus; facial edema; urticaria; rash.

Musculoskeletal: Local weakness.

Nervous System and Psychiatric: Seizures, ataxia; vertigo; dysarthria; tremors; hypertonia; convulsions; muscle twitching; disorientation; insomnia; depressed mood; abnormal sensations; anxiety; agitation; psychosis, abnormal thinking and dreaming; hallucinations; excitement; paresthesia; diplopia. Sweating, ageusia; tinnitus, urinary frequency and/or retention. Chest pain; edema. Hypertension; myocardial infarction; heart block; stroke. Paralytic ileus, tongue discoloration; stomatitis; parotid swelling. Inappropriate ADH syndrome. Purpura; bone marrow depression; leukopenia; eosinophilia; thrombocytopenia. Elevation and lowering of blood sugar levels; weight gain or loss. Myalgia. Decreased or increased libido; abnormal gait; delusions; aggressive behavior; paranoia; peripheral neuropathy; Bell's palsy; alteration in EEG patterns; extrapyramidal symptoms. Dyspnea. Photosensitization; alopecia. Impaired urination; dilatation of urinary tract; impotence; testicular swelling; gynecomastia; breast enlargement; galactorrhea.

Drowsiness; dry mouth; stomach pain ; tiredness; trouble sleeping. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); dark urine; fainting; fast or irregular heartbeat; mental or mood changes; persistent fatigue; seizures; severe dizziness; unusual bruising or bleeding; yellowing of eyes or skin. headache, fatigue, and somnolence. dry mouth and nausea or vomiting. Pharyngitis, dyspepsia, and increased appetite. liver function abnormalities, acute hepatitis. wheezing, coughing, bronchitis, sinusitis

1) C

2) A  (+ info)

I Just Saw an Ad for Claritin, Again. Claiming it was "Non-Drowsy", Again, True?

Less Drowsy Perhaps:


Drowsiness and/or sedation is a frequent adverse reaction to most H1-blockers, however, H1-blockers vary in their ability to produce drowsiness, and this side effect does not correlate with peripheral antihistamine potency.[23592] Somnolence was reported in 8% of patients taking loratadine vs. 6% taking placebo. Fatigue is also experienced in about 4% of patients taking loratadine. Patients should be warned about undertaking hazardous tasks while taking loratadine, although the risk of sedation is relatively low. Anticholinergic side effects are minimal with loratadine compared to most other H-blockers; however, some patients experience xerostomia (3%). Headache (12%) is the most common adverse reaction experienced by patients taking loratadine.

In children >= 6 years old, adverse events were similar to those reported in adult populations and similar to placebo; the rate of discontinuation due to side effects was < 1%. Side effects occurring in >= 2% of those aged 6—12 years included nervousness (restlessness), wheezing, fatigue, hyperkinesia, abdominal pain, conjunctivitis, dysphonia, malaise, and respiratory tract infection. In children 2—5 years, the following adverse events were reported in 2—3% taking loratadine and more frequently than with placebo: diarrhea, epistaxis, pharyngitis, influenza-like symptoms, fatigue, stomatitis, tooth disorder (unspecified), earache, viral infection, and rash (unspecified).

Drowsiness, headache, and sinus tachycardia have occurred when the maximum recommended dose of loratadine has been exceeded (doses of 40—180 mg). In a human study in which doses 4 times the clinical dose were administered for up to 90 days, loratadine did not cause clinically significant changes on the QT interval. The manufacturer reports that in a single, rising-dose study in which doses up to 160 mg (16 times the clinical dose) were studied, loratadine did not cause any clinically significant changes on the QTc interval.

Specific information regarding non-causally associated, less common side effects and post-marketing adverse reactions may be found in the manufacturers' current prescribing information for loratadine.
Thanks Sareli7, How Nice for you, but you Are Not Everybody. I Personally Like Fexofenidine (Sp?).
Thanks miss medic, So In Fact Deceptive. I Think Allegra-D is Fexofenidine + Pseudoephidrine (Sp?).


I used Claritin.......I wound up falling asleep at traffic lights.

So, CAN it make you drowsy?....YES.....but, I guess most people do not have a problem.

Zyrtec made me feel like I got run over by a truck---I just felt SO TIRED....yet I did not fall asleep at traffic lights, I just had NO ENERGY.

Allegra (the Fexofenidine) you mention---I would have LOVED to be able to really try that, but, I had a SEVERE allergic reaction to it---I had taken it, and my eyes swelled up, I was wheezing, sneezing, itching with hives, and my paramedic partner kept asking me if I was ok....did I need some benedryl or epi?.....I was like---no, I just have some allergies, I took some Allegra, it will kick in any minute now...ANY minute......*(this was back when it was brand new and only a 12 hour dose---NOT the Allegra-D....just plain Allegra).....well, 12 hours later, suddenly, I am feeling a bit better, but, time for my next scheduled dose, so, I take the next one...and BAM!! even worse....figured out what my allergy was!!---lol!

Popped some benedryl and MUCH better!

Funny thing with how tired the Claritan and Zyrtec make me--I have NO PROBLEM taking Benedryl 50 mg every 4 hours and driving/thinking/ect.....it does NOT make me tired at all.....

So, I would say, I am probably NOT the typical kind of reaction.

*Yes, you are Correct about the ALLEGRA D being "fexofenadine + Sudafed Original formula" (didn't check on the spelling either---lol--it is late at night). (ps--the formula I was on was just the ORIGINAL allegra when it first came out, NON-decongestant added, and it was a 12 hour version).  (+ info)

What is the ICD-9-CM codes for?

1.unstable angina secondary to coronary artery disease.
2.Atherosclerotic heart disease with new-onset angina.
3.Spontaneous epistaxis secondary to uncontrolled hypertension.
4.Femoral-popliteal occlusive disease, right leg.

it's a coding exercise the teacher give us the class
well i found some in the book that my teacher lend us
but it gives us only half the word such as "unstable"
since that didn't work she told us a site we can look it up on and so far no luck..

help anyone ...it's due Monday but omg it's hard

1)413.1 ,2) 440 ,3) 21 to 21 .09 and 784.7 ,4) 453.4  (+ info)

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