Cardiomyopathy

Doctors refer to a whole group of diseases as cardiomyopathies in which the heart muscle, the myocardium, is affected. The colloquial term is a heart muscle disease.

The word cardiomyopathy is derived from Greek. “Cardio” stands for heart, “myo” for muscle, and “pathie” for sick. Cardiomyopathy is a collective term for various heart diseases. A common feature of these diseases are changes in the heart muscle (myocardium), which are associated with a decline in cardiac output.

Cardiomyopathies are almost always very serious diseases which, without appropriate therapy, lead to heart failure or heart failure.

Forms Of Cardiomyopathy

There are a number of cardiomyopathies. First of all, medical professionals differentiate between primary and secondary cardiomyopathies. Primary cardiomyopathies are caused by a disease or congenital malformation of the heart muscle. If other diseases affect the myocardium, doctors speak of secondary cardiomyopathies. In addition to the pure forms, there are also mixed forms.

Furthermore, medical professionals divide cardiomyopathies into four main types.

    • dilated cardiomyopathy
    • hypertrophic cardiomyopathy
    • restrictive cardiomyopathy
    • arrhythmogenic right ventricular cardiomyopathy (ARVC).

There are also other sub-forms such as

    • Non-compaction cardiomyopathy
    • Broken Heart Syndrome (Tako Tsubo Cardiomyopathy, Broken Heart Syndrome)
    • hypertensive cardiomyopathy (damage to the heart muscle caused by high blood pressure)

Frequency

By far the most common form is hypertrophic cardiomyopathy. There are around 200 cases for every 100,000 inhabitants (prevalence). The number of new cases per 100,000 inhabitants per year (annual incidence) is 19.

The second most common form is dilated cardiomyopathy, with a prevalence of 40 cases per 100,000 population and an annual incidence of 6 new cases.

Cardiomyopathies affect people of all ages. However, there are frequency peaks between 20 and 50 years on average for all forms. In men, the incidence is about twice as high as in women.

Symptoms

The common symptom of all cardiomyopathies is a more or less restricted beating and pumping power of the heart. Heart failure often occurs as the disease progresses. In the case of some heart muscle diseases, the symptoms resemble the symptoms of cardiac insufficiency at the onset of cardiomyopathy.

Complications

Cardiomyopathies are often very slow to develop and therefore often go unnoticed for many years. Without timely diagnosis and suitable therapy, the cardiac output – and with it the oxygen supply to the body – continues to decline.

The human heart is a very finely tuned system. When a component like the heart muscle itself changes, it has a variety of possible effects. An example: In the case of an emerging cardiac insufficiency, the heart compensates for the decreasing impact force by increasing the frequency and strength of the impact. This increases the mass of the heart muscle. If the heart muscle becomes too thick (heart muscle hypertrophy), mobility is restricted on the one hand. In addition, the blood flow in the heart changes. This can promote blood clots, which in turn can trigger a pulmonary embolism.

The extremely sensitive heart valves are also endangered by myocardial growth. Any heart valve defects increase the risk of heart failure or heart failure even more.

Sometimes the heart expands as a result of the additional stress caused by cardiomyopathies, doctors speak of dilation. Then the heart chambers literally wear out. As a result, the heart’s pumping power and ejection performance drop drastically.

But cardiomyopathies also disrupt the heart’s excitation lines. This is a possible cause of cardiac arrhythmias, which can lead to ventricular fibrillation and sudden cardiac death.

Cardiomyopathy

Causes

Many primary cardiomyopathies are congenital. This does not necessarily mean that the heart muscle changes exist from birth. They can also only develop over the years. Most common, however, are primary cardiomyopathies with no apparent cause. In this case, medical professionals speak of idiopathic cardiomyopathies.

There are also acquired primary heart muscle diseases and secondary cardiomyopathies.

Acquired primary cardiomyopathies result from other diseases or are sometimes the result of pregnancy. Examples of such causes are:

    • Viral infections, such as a badly healed cold or flu, can lead to viral myocarditis. Infections with the mump pathogen during childbirth sometimes cause restrictive cardiomyopathy in children for years afterward.
    • Bacterial infections such as repeated inflammation of the inner lining of the heart also cause cardiomyopathies. Typical bacterial pathogens that cause myocardial disease are meningococci, streptococci, and diphtheria bacteria.
    • Fungi and parasites such as candida infections or toxoplasmosis
    • Tumor diseases
    • autoimmune connective tissue diseases such as scleroderma or sarcoid
    • Damage to the heart muscle due to deposits of foreign substances or metabolic products such as amyloidosis or hemochromatosis (iron storage disease)
    • Alcohol and drug abuse (toxic cardiomyopathy)
    • increased stress from pregnancy or competitive sport
    • Postmenopause or increased emotional stress (stress cardiomyopathy or, colloquially, broken heart syndrome).

Many other causes are conceivable, depending on the type of cardiomyopathy.

Secondary cardiomyopathies are mostly caused by other conditions. These can be congenital or acquired. Cause here are, for example, toxic substances, storage diseases, endocrine functional disorders, neurological and neuromuscular changes, autoimmune processes, drugs (especially chemotherapeutic agents), or malnutrition.

Examination

General practitioners, cardiologists, or internists usually suspect cardiomyopathy on the basis of declining physical performance. In pronounced cases, shortness of breath, blue discoloration of the skin (cyanosis), or water retention in the legs (edema) speak for themselves.

The diagnosis of cardiomyopathy is initially confirmed by an electrocardiogram (EKG, recording of heart activity), an X-ray of the chest, and an ultrasound examination of the heart (echocardiography). If the initial suspicion is confirmed, a cardiac catheter examination usually follows. During this procedure, a small piece of myocardial tissue is secured (biopsy) in order to better determine the exact type of cardiomyopathy.

Imaging methods such as computer and magnetic resonance tomography, stress tests, and rhythm diagnostics provide additional insights.

Treatment

Once the cause of the cardiomyopathy can be identified, the first step in therapy is to eliminate the causes. Often, however, therapy for heart muscle disease is limited to relieving symptoms and stopping the progression of cardiomyopathy.

Medical therapy

One of the most important goals of drug therapy for cardiomyopathies is to prevent the development or progression of cardiac insufficiency. For this purpose, drugs are used that relieve and strengthen the heart. It is not uncommon for several active ingredients to be combined.

Beta Blockers

The most commonly used active ingredients for the symptomatic therapy of heart failure come from the group of beta-blockers. Beta-blockers block activating hormones like adrenaline and northern adrenaline. Among other things, this causes the heart’s resting frequency to normalize and the blood vessels to expand. This lowers blood pressure, improves blood circulation and oxygen supply, and relieves the heart. They also reduce the excitability of the heart muscle.

Many used beta-blockers are bisoprolol and metoprolol.

Beta Blockers

ACE inhibitors block the action of the angiotensin-converting enzyme (ACE). This enzyme plays a key role in regulating blood pressure and water balance. ACE inhibitors such as benazepril, captopril, ramipril or zofenopril relieve the heart by widening blood vessels and thus lowering high blood pressure. At the same time, they help promote water excretion. This reduces the blood volume and the heart is relieved.

The excretion-promoting effect of ACE inhibitors is in many cases insufficient to relieve the heart of blood volume and to flush out edema caused by cardiac insufficiency. This task is carried out by the so-called water tablets (diuretics) such as hydrochlorothiazide, spironolactone and furosemide.

Antiarrhythmics

Antiarrhythmics are agents that normalize the heartbeat. As a rule, the aim is to slow down an accelerated heartbeat (tachycardia). Active ingredients such as ajmaline, flecainide, or phenytoin achieve this effect, among other things, by blocking the flow of sodium ions into the cells.

Other antiarrhythmics include potassium channel blockers such as amiodarone and sotalol and calcium channel blockers such as diltiazem and verapramil.

Anticoagulants

Anticoagulants such as Phenprocoumon or Eliquis, Pradaxa, and Xarelto are used in cardiomyopathies to prevent blood clots from forming in the heart. This is because these clots pose a significant risk. They can trigger pulmonary embolisms, for example.

Operative Therapy

If drug therapy for cardiomyopathies does not relieve the symptoms, surgery is another option. For example, damaged heart valves are replaced, parts of the heart muscle are removed or pacemakers are implanted.

The heart transplant remains the last possibility and the only causal therapy option.

Forecast

The prognosis for the course and life expectancy of cardiomyopathies depends on the type and extent of the heart muscle damage and the general state of health. In mild forms of blood pressure-related (hypertrophic) cardiomyopathy, for example, those affected have a normal life expectancy if the high blood pressure is consistently treated.

Dilated and restrictive cardiomyopathies, on the other hand, are often recognized very late and can then often hardly be treated effectively. Up to 80 percent of those affected die within 5 years of diagnosis.

Prevention

Cardiomyopathies are very often the result of cardiovascular disease. To reduce the risk of these diseases, you should lead a heart-healthy lifestyle. Above all, exercise keeps the circulation and the heart fit.

A fresh and varied diet provides the body with all the necessary nutrients and also helps to avoid obesity.

Lung and heart health are closely related. Quitting smoking is, therefore, a cornerstone in the prevention and accompanying treatment of heart muscle disorders. Regular consumption of alcohol is also harmful to the heart.

Finally, the prevention of cardiomyopathies also includes having favorable diseases (see causes) treated consistently.

Risk Groups: Who Is Most At Risk From Covid-19?

Risk Groups: Old People, Men, Smokers And People With Chronic Diseases

The new lung disease COVID-19 is mild for most people, and the SARS-CoV-2 infection sometimes even goes unnoticed. However, very severe courses with a fatal outcome are also possible. It is not currently possible to say exactly who is most likely to be affected by these severe courses in individual cases. However, some risk groups can be clearly identified.

High-risk group of people with chronic diseases

The risk of a complicated course of COVID-19 is particularly high in people with chronic diseases. In the case of lung diseases such as asthma or COPD, the explanation for this is obvious: In people with diseases of the respiratory tract, healthy lung function is already impaired and the lungs are therefore particularly vulnerable.

The high-risk groups also include people with diseases that at first glance have little to do with the lungs or breathing. These are mainly people with heart failure, high blood pressure, diabetes, cancer, liver disease, or chronic kidney disease.

Why do the chronically ill belong to the high-risk group?

The chronically ill belong to the high-risk groups primarily because they are usually already burdened by the underlying disease. In the event of an infection with SARS-CoV-2 or a COVID-19 illness, the physical resources are not fully available to them as with a healthy person. In addition, some common chronic diseases indirectly affect healthy lung function. Heart failure, for example, increases the risk of pulmonary hypertension. Atherosclerosis promotes circulatory disorders, which in turn can put a strain on the cardiovascular system.

According to the Robert Koch Institute, according to the current state of research, young people with chronic diseases also belong to the high-risk group of people with an increased risk of severe disease progression.

Risk Increases With Combinations Of Risk Factors

A particularly susceptible high-risk group is made up of people who have a combination of risk factors. According to the RKI, this applies, for example, to older people with an underlying disease compared to one of the risk factors (age or underlying disease). Old and young people with several underlying diseases are particularly hard hit.

Risk From Covid-19

High-risk group of people with sick or suppressed immune systems

People whose immune systems are not functioning or not functioning adequately are particularly at risk from COVID-19. This does not mean people with general immune deficiencies, but people with serious diseases of the immune system such as HIV, primary immunodeficiencies, or secondary immunodeficiencies.

Primary and secondary immunodeficiencies

Primary immunodeficiencies are congenital disorders of the immune system. Medicine now knows more than 300 different clinical pictures, many of which are among the rare diseases.

  • Secondary immunodeficiencies are permanent disorders of the immune system that are only acquired in the course of life. Common causes of such immune deficiencies are, for example, cancer, side effects of drugs, or metabolic disorders such as diabetes.

High-Risk Group Of People Taking Immunosuppressive Drugs

Another high-risk group is people in whom the immune system is suppressed or weakened by drugs. So-called immunosuppressants such as glucocorticoids (in colloquial language cortisone) are used, among other things, after transplants or for autoimmune diseases. Chronic asthma, inflammatory bowel disease, or rheumatic diseases are other areas of application for drugs that suppress the immune system.

The Risk Increases For Everyone Aged 50 And Over And For Smokers

SARS-CoV-2 does not only infect high-risk groups. According to the Robert Koch Institute, the risk of a severe course of COVID-19 increases from the age of 50 and increases steadily thereafter. This is mainly due to the fact that the immune system becomes weaker over the years and is less able to fight pathogens such as viruses. There is also the possibility that the disease is recognized late in people with a weakened immune system. Why is that?

Fever is the classic symptom of infection. However, fever is not caused by pathogens such as SARS-CoV-2 but is a result of the reaction of the immune system. If the immune system is weak, a fever may be low or it may not occur. This increases the likelihood that infections such as COVID-19 will be discovered late and may have advanced.

Male mortality is nearly twice that of women

According to the RKI, the risk of infection with SARS-CoV-2 is about the same for women and men at 49 to 51 percent at the current state of knowledge (beginning of April). On the other hand, mortality seems to be significantly higher in men than in women. Of the 732 deaths with corona infection (as of April 1), 65 percent were men. An evaluation of the COVID-19 cases in China had previously also come to the conclusion that the mortality rate for men is almost twice as high as that for women.

The reasons for the higher mortality are not yet known. The virologist Alexander Kekulé names the overall poorer health of older men (compared to women of the same age) as a possible cause.

Even Young And Healthy People Shouldn’t Think They Are Safe

So far, it is not known how the individual risk of COVID-19 disease can be reliably assessed. After numbers at the beginning of the pandemic had suggested that young and healthy adults might have a rather small risk of severe disease, the number of those affected is now increasing in this group as well. According to the US Centers for Disease Control (CDC) as of mid-March, a fifth of COVID-19 patients admitted to the hospital were between 20 and 44 years old. According to the study, almost half required intensive care treatment. Young, healthy people must therefore under no circumstances feel safe.

Pulmonary Emphysema

Pulmonary emphysema is primarily the end-stage of lung diseases such as chronic bronchitis or COPD. Read more about symptoms, causes, and treatment.

Synonyms

Emphysema pulmonum, pulmonary emphysema, pulmonary hyperinflation, pulmonary distension

Definition

Pulmonary emphysema is a serious, progressive, and incurable disease of the lungs. Medical professionals also refer to it as pulmonary emphysema. The colloquial language is particularly familiar with the disease terms lung flatulence or lung overinflation. With pulmonary emphysema, lung function continues to decrease. This creates progressive shortness of breath. The associated lack of oxygen not only severely restricts physical performance. There are also secondary reactions that place a heavy strain on the heart, among other things. A typical consequence of emphysema is, for example, the cor pulmonale, a common form of right heart failure.

Alpha-1 Antitrypsin Deficiency

In addition to the acquired form of emphysema, there is also a congenital variant. Alpha-1-antitrypsin deficiency is one of the rare diseases with 2.5 new cases per 10,000 inhabitants per year. In this disease, the congenital deficiency of the protein alpha-1-antitrypsin triggers chronic inflammatory processes in the lungs.

Frequency

According to experts, the frequency of emphysema is growing worryingly. Exact figures are not available because emphysema and COPD are not always properly recorded separately. But it is assumed that there are around a million cases in Germany. The vast majority of emphysema occurs in smokers over the age of 50.

Symptoms

A characteristic symptom of emphysema is increasing shortness of breath (dyspnoea). As a rule, the shortness of breath initially only occurs during physical exertion. As the disease progresses, there is difficulty breathing even when the body is at rest.

Advanced emphysema causes chronic oxygen deficiency, which can be recognized by the blue color of the lips and fingers (cyanosis). Another visible symptom of emphysema is a barrel-like enlargement of the upper body, the so-called barrel chest. Doctors speak of the barrel chest. The barrel breast is created because the lung tissue continues to inflate.

Causes

By far the most common cause of emphysema is chronic lung diseases such as chronic bronchitis. If the bronchial passages are permanently inflamed, narrowed, and cause shortness of breath, coughing, and increased sputum, this chronic bronchitis is one of the chronic obstructive pulmonary diseases that are described in more detail under COPD. Chronic bronchitis and COPD are also precursors of lung cancer. The most common cause of all these diseases smoking.

Pulmonary Emphysema

How Do The Symptoms Of Chronic Bronchitis Arise

In healthy people, the air you breathe reaches the alveoli via the bronchi. Gas exchange takes place in these alveoli. During the gas exchange, the elastic alveoli absorb the oxygen from the inhaled air and then release carbon dioxide from the blood with the exhaled air. That requires a certain elasticity. In the case of emphysema, this elasticity is gradually lost as a result of inflammatory processes. The alveoli become increasingly inelastic and are no longer able to completely release the exhaled air. As a result, less fresh inhaled air can be taken in. This causes the alveoli to expand and ultimately lose their function entirely. Sometimes the small alveoli transform into large emphysema bubbles.

The approximately 300 million alveoli of a healthy person have a surface area the size of a football field. With emphysema of the lungs, this area for gas exchange sometimes shrinks to the size of a towel.

Treatment

Pulmonary emphysema cannot be cured. Treatment can only relieve symptoms. The most important thing is to prevent the disease from progressing, or at least to slow it down. To do this, it is imperative to stop smoking.

Drug Therapy For Emphysema

The symptoms of not too advanced pulmonary emphysema can be alleviated by drug therapy. The aim of this therapy is to widen the bronchi (bronchodilation) and to stop the inflammatory processes in the lungs. So-called beta-2 sympathomimetics are often inhaled for this purpose. Active substances in this group are salbutamol, salmeterol, or reproterol. Anticholinergics like ipratropium or inhaled glucocorticoids like budesonide, beclometasone, or fluticasone have even stronger anti-inflammatory properties.

In the case of congenital alpha-1-antitrypsin deficiency, the protein can be given in the form of medication (infusions) and thus prevent the development of pulmonary emphysema. Unfortunately, the therapy is very costly and not as promising as one initially hoped it would be.

In the case of very advanced pulmonary emphysema, selected emphysema patients (younger than 60 years, high therapeutic motivation, no additional complications) only have a lung transplant as the last chance. The possibilities of artificial ventilation are very limited due to the characteristics of the disease.

Zinc to Protect Against Respiratory Infections

Sore throat, runny nose, cough, exhaustion, etc. – Colds are among the most common reasons for sick leave. During the current coronavirus pandemic, there is also fear of serious respiratory infections in COVID-19. An adequate supply of zinc can help prevent and alleviate respiratory diseases.

The immune system is a miracle of nature and protects us against innumerable harmful influences every day. To do this, the organism needs important vital substances to defend itself against viruses, bacteria, free radicals, and the like. An essential trace element that our immune system needs is zinc. However, once the stores are empty, the immune system can no longer perform its tasks properly. The result: You become more susceptible to infections and, above all, are more prone to respiratory infections.

Virus Diseases Particularly Affect People With Weak Immune Defenses

In the colder months of the year, virus infections such as colds and flu are high season. Accordingly, our immune system is also working at full speed. Newer strains of viruses, such as the Sars-CoV-2 coronavirus and now also its mutated variants, also put our immune system to a tough test. Because an infection with this multi-organ virus, which mainly affects the respiratory tract, can have serious consequences, especially for people with weak immune defenses or chronic pre-existing diseases (such as cardiovascular diseases, lung diseases or diabetes) as well as for seniors and severe COVID 19 gradients entail.

Zinc Protects Against Virus Diseases

A sufficient supply of the vital trace element zinc can protect against virus diseases. How this works has been shown for various types of viruses. A sufficient supply of zinc prevents, for example, rhinoviruses – the typical pathogens of colds – from sticking to our nasal mucosa1. Cold viruses cannot penetrate our bodies and spread. Even with the currently rampant SARS-CoV-2 coronavirus, zinc can prevent viruses from penetrating body cells and inhibit the virus from multiplying2. In the case of coronaviruses, zinc not only shows antivirus effects but can also slow down the excessive inflammatory reaction in COVID-19 and strengthens the airways. There is ample evidence that adequate zinc supplies are beneficial for the prevention and treatment of COVID-192. Current studies also show that an adequate zinc supply can protect against severe COVID-19 courses. The zinc levels of COVID-19 patients are significantly lower compared to healthy volunteers. In an Indian study, COVID-19 patients with a zinc deficiency had a more than the 5-fold increased risk of complications and showed an increased mortality rate3.

Zinc To Protect Against Respiratory Infections

Versatile Effects Of Zinc

The trace element zinc, which is necessary for humans, plays an important role in the defense against pathogens. A zinc deficiency affects the immune system, increases the susceptibility to infectious diseases, delays recovery, and leads to a worse course of infections. In the case of infections, a zinc deficit increases the symptoms, which can lead to excessive inflammation and additional tissue damage. In addition to other immune cells, zinc primarily affects the function of the large phagocytes4,5. The large phagocytes (so-called macrophages) belong to the white blood cells and play an essential role in the elimination of microorganisms such as bacteria etc.

A Polish study indicates that zinc has anti-oxidative as well as anti-inflammatory effects6. In addition to standard therapy, the consumption of zinc is said to be able to reduce the mortality rate from pneumonia7.

Zinc Reduces The Duration Of The Cold

Around two to four times a year, adults in this country are affected by colds. Usually, the disease will be over in about a week. Fresh air, rest, sufficient humidity in the rooms, and hydration in the form of mineral water and tea as well as enough sleep generally promote recovery. This also applies to a diet rich in vital substances. Hot spices such as ginger, chili, curry, horseradish, and mustard not only heat things up, they also have an antimicrobial effect. Freshly cooked chicken soup is also helpful.

Zinc is currently recommended again and again for flu-like infections. Because by adding zinc you can shorten the duration of colds by around 33 percent. Patients with a cold should use zinc within 24 hours of the onset of symptoms8.

Strengthen The Immune System With The Right Substances

There are many remedies for colds. Since most colds are caused by viruses, but antibiotics only work against bacteria, they are usually not suitable. With the so-called CRP rapid test, the doctor can determine within a few minutes whether viruses or bacteria are responsible for the disease and accordingly initiate the right treatment and select the right drug. A few drops of blood and a few minutes waiting time are sufficient for the rapid test. The rapid test can prevent patients suffering from a virus disease from receiving antibiotics unnecessarily.

Zinc is the basic element for a healthy immune system, as it has a positive effect on the body’s own production of important defense cells (T cells). Since it is an essential trace element, the body cannot produce zinc itself and is dependent on it to be supplied through food. This is certainly one reason why zinc deficiency is relatively widespread. The results of the National Consumption Study II show that up to 44 percent of adults in Germany are undersupplied with zinc 10.

 

Everything About A Cough

Talk about everything about a cough the possible causes and treatment, cough is less of a disease in its own right than a symptom of respiratory disease. It occurs, for example, when we have choked. However, coughing can also indicate serious medical conditions such as heart failure or reflux disease.

Definition

Who does not know the nights disturbed by a cold-related cough or the pain of a dry cough or dry cough? The bronchi are burning and you are short of breath. After a coughing fit, we sometimes feel like we have sprinted 100 meters. If the cough then loosens a little and produces sputum, this is often perceived as a relief.

Cough is not an independent disease in the medical sense, but a symptom. As a rule, a cough is triggered by illness. The most common are respiratory infections such as bronchitis, colds, or the flu. Allergies, asthma, or smoker’s cough are other common causes of coughs. Heart failure or drug side effects such as the ACE inhibitor cough are also causes of cough.

Symptoms

Doctors classify the symptom of cough into categories. First of all, a distinction is made according to the duration:

    • According to the medical definition, acute cough lasts up to 8 weeks.
    • Subacute cough is a classification that is sometimes used for coughs lasting between 3 and 8 weeks.
    • Chronic cough is the name given to a cough that lasts longer than 8 weeks.

In addition to this distinction based on duration, there is a division into productive and unproductive or dry cough:

    • Productive coughing is accompanied by increased secretion and expectoration.
    • Unproductive (dry cough) is also known as a dry cough. Mucus does not form with this form of cough. Therefore, unproductive cough is dry, so it remains without expectoration.

Everything About A Cough

Symptoms Of Productive Cough

A productive cough is characterized by the fact that the cough removes sputum from the airways or lungs. Often a productive cough begins with a dry cough. After usually 1 to 3 days, often accompanied by a sore throat, there is an increased production of mucus. This bronchial mucus is transported out of the airways or the lungs as sputum via the cough reflex.

Symptoms Of Unproductive Cough

An unproductive cough feels hard and painful, often burning. It does not produce sputum. Coughing fits that can last for minutes are also typical of dry coughs. Coughing attacks are said to occur more frequently at night and thus deprive the sick of sleep. Oftentimes, a dry cough is accompanied by allergy symptoms. Heartburn can also occur along with a dry cough.

More Symptoms Of Cough

The frequency and sound of coughing attacks are further characteristics that can sometimes even be used to determine the cause. Barking cough in small children, for example, suggests pseudo croup. An attack-like cough with a high repetition frequency like a staccato is typical of whooping cough (pertussis). A morning cough, often with copious expectoration, is particularly common among smokers.

Causes

The Cough Reflex

The cause of cough is the cough reflex. This is an innate protective mechanism of the body. The cough reflex has the task of protecting the respiratory tract from damaging influences and of removing secretions such as mucus and foreign bodies such as dust or swallowed items.

The cough reflex is triggered by receptors in the mucous membranes of the larynx, the trachea, and the larger bronchi. They react to mechanical stimuli such as those caused by secretions (mucus), foreign bodies (smoke, dust, swallowed things) or other stimuli (inflammation, gases). These stimuli reach a certain brain region, the medulla oblongata, via the vagus nerve (nervus vagus or 10th cranial nerve).

The medulla oblongata houses the respiratory center and is located in the brain stem. These nerve fibers are activated, which cause a sudden contraction of the diaphragm and the muscles of the abdominal wall and intercostal. In addition, the glottis is narrowed and extreme pressure builds up under the closed larynx.

When the lid of the larynx opens, exhalation occurs suddenly. With this impulse, foreign bodies or secretions are thrown out of the windpipe like an explosion. When coughing, enormous forces act on the larynx muscles. With strong coughing attacks, the air flows through the larynx at speeds up to the sound limit.

Causes Of Productive Cough

A productive cough is most often a symptom of a respiratory infection. These are, for example, the flu or cold, which in turn are accompanied by fever, runny nose, and a more or less pronounced feeling of illness. If the underlying disease is not healed properly or if there are constant new infections, the cough can become chronic; doctors speak of chronic bronchitis.

Causes Dry Cough

Dry cough is usually a reaction to a variety of harmful stimuli. These include smoke, dust, gases or chemical vapors. A very common typical example is the smoker’s cough.

Other causes of dry cough are severe respiratory diseases such as whooping cough, tuberculosis or lung cancer (bronchial carcinoma) as well as pulmonary embolism or emphysema. Allergic asthma or other allergies can also trigger a dry cough.

Other Causes Of Cough

Medicines can also trigger a cough. For example, this is a common side effect of some drugs for high blood pressure, such as ACE inhibitors.

Irritation from stomach acid when stomach contents flow back into the esophagus (reflux disease) also leads to coughing. This is often accompanied by heartburn and acid regurgitation.

Examination

Diagnosing cough is easy based on the symptoms. To find out the exact cause, your doctor will first ask you in detail. This is followed by a physical examination, during which mainly the breathing sounds are listened to.

In the case of a productive cough, the color and texture of the sputum indicate the possible cause:

    • Clear whitish sputum: mostly caused by viral upper respiratory infections such as colds or flu
    • Yellowish or green sputum: indication of a possible additional bacterial infection in viral respiratory diseases
    • The bloody build-up is an indication of serious lung diseases such as pneumonia, pulmonary embolism, or lung cancer. In addition, the sputum is sometimes bloody if the blood vessels in the airways or the lungs have been damaged by swallowed objects or other injuries. Bloody sputum is usually a medical emergency and should be investigated immediately.
    • Brown or black sputum: especially common in smokers, often signs of advanced lung damage from chronic bronchitis or COPD.

At times, complex diagnostics may be necessary to find the cause of the cough. These more extensive examinations are usually carried out by specialists. As a rule, your family doctor will refer you to a pulmonologist (pulmonologist) for this purpose. For heart-related coughs, cardiologists are the specialists of choice. In the case of gastrointestinal diseases as the cause, the path leads to the gastroenterologist and in the case of allergies to the allergologist.

Treatment

Treatment for cough is based on the cause. If a cough is not triggered by a serious underlying disease, home remedies are usually well suited to relieve the excruciating urge to cough. If the cough does not improve within a few days, the first thing you should do is see a family doctor so that the cause of the cough can be found. Only then can meaningful treatment be initiated.

There are a number of medications your doctor can use to treat coughs. If necessary, he will treat infection or inflammation as the cause of the cough, for example with antibiotics. If ACE inhibitors are responsible for the cough, he will change the medication. In the event of a cough accompanied by heartburn and acid regurgitation, the doctor will order a gastroscopy and then treat the gastric acid reflux.

Do not take coughing lightly. This is especially true if the cough:

    • lasts longer than 2 weeks (for infants, toddlers, or children: longer than 3 days)
    • is accompanied by fever or severe malaise
    • occurs new and without a traceable harmless cause
    • with bloody, brown, or black obstruction
    • is accompanied by a high fever and/or extreme fatigue.

More information about treatment and self-help, as well as home remedies for coughs:

    • bronchitis
    • COPD
    • cough

Prevention

Coughing as a result of respiratory infections can hardly be prevented in a targeted manner. Basically, it is advisable to strengthen the immune system. A varied diet rich in vitamins and exercise in the fresh air strengthens the immune system and therefore helps prevent coughs. Smokers should give up smoking, especially if they have a smoker’s cough.

Pulmonary Edema

Pulmonary edema is usually accompanied by significant breathing problems and can easily lead to a life-threatening emergency. Read more about early warning signs, symptoms, causes and treatment, and what to do in an emergency.

Synonyms

pulmonary edema, water lung, congestive lung

Definition

With pulmonary edema, fluid collects in the lungs. Doctors speak of pulmonary edema. Colloquially, pulmonary edema is also referred to as water in the lungs. Strictly speaking, these are liquid components of the blood that are pressed into the lung tissue from the finest blood vessels in the lungs, the lung capillaries. The function of the lungs is restricted by the free fluid.

In pulmonary edema, depending on the localization of the fluid, a distinction is made between two forms that can quickly merge without therapy:

    • Interstitial pulmonary edema: fluid accumulation in the connective tissue support structure or in the tissue between the cells, the interstitium
    • Intraalveolar pulmonary edema: accumulation of fluid within the finest alveoli.

Pulmonary congestion is a less pronounced preliminary stage of pulmonary edema. Especially in people with left heart failure and kidney failure, pulmonary congestion occurs as a chronic form of pulmonary edema.

Pulmonary edema usually causes clearly noticeable symptoms such as accelerated shallow breathing, rattling breath sounds, coughing, and shortness of breath. If left untreated, pulmonary edema can be life-threatening. If you have symptoms, you should seek medical help immediately. If the symptoms are severe, the emergency doctor should be called.

The most common causes of pulmonary edema are heart disease (cardiac pulmonary edema). Other causes include kidney disease (renal pulmonary edema), poisoning (toxic pulmonary edema), or a lack of oxygen at high altitudes (high altitude pulmonary edema). Sunstroke (cerebral pulmonary edema) can also lead to pulmonary edema under unfavorable circumstances. See the Causes section below for details.

With timely medical help, the life-threatening acute symptoms of pulmonary edema can in most cases be managed well with oxygen treatment and drug therapy. The long-term healing prospects depend primarily on whether the triggering circumstances can be eliminated.

Pulmonary Edema

Frequency

The exact frequency of pulmonary edema is not recorded. From medical practice, however, it can be said that it is a common complication of heart diseases, for example, especially heart failure (heart failure). The prevalence (incidence) of heart failure is given in the literature to be up to 2 percent. The frequency increases sharply from the age of 60.

According to the German Heart Foundation, up to 3 million men and women in Germany are affected by heart failure. Around 450,000 people are hospitalized for cardiac insufficiency each year. Almost 10 percent do not survive.

Symptoms

The symptoms of pulmonary edema differ according to four degrees of severity.

Stage I: interstitial pulmonary edema

Doctors refer to stage I as interstitial pulmonary edema. Interstitial means that the fluid collects in the connective tissue of the lungs or between the cells of the lung tissue. At this stage, pulmonary edema is mainly noticeable as breathing difficulties. Most of the time, breathing is much faster and shallower. Typically, these symptoms of pulmonary edema subside when the person concerned is elevated or standing. Further symptoms of interstitial pulmonary edema are cough and a noticeable restlessness.

Stage II: Alveolar pulmonary edema

In stage II, the fluid from the lung tissue first penetrates into the alveoli. This is why doctors speak of alveolar pulmonary edema. Later, the fluid also collects in the small bronchi (bronchioles). Typical symptoms of this pulmonary edema stage are increasing shortness of breath and intensifying cough, which is sometimes accompanied by whitish-foamy sputum. Breathing sounds can be heard (so-called wheezing), the pulse is racing (tachycardia), the patients are pale and are afraid of suffocating. At the latest in stage of alveolar pulmonary edema, urgent medical help is required.

Stage III: Increased foaming

In the third stage, the breathing difficulties continue to worsen. More and more fluid collects in the bronchi. A visible symptom is increased foam formation, which is coughed up as whitish sputum. The breathing noises sound more and more rattling. A threatening lack of oxygen (hypoxemia) can occur. Signs of this are bluish discoloration of the lips and fingers (cyanosis).

Stage IV: Respiratory arrest (asphyxia)

Doctors refer to the life-threatening end-stage of pulmonary edema as asphyxia or respiratory failure. If those affected are not immediately supplied with oxygen, there is a risk of death from cardiac arrest.

Causes

Pulmonary edema can have very different causes. By far the most common cause is heart disease. In second place are kidney diseases. Other causes, such as lack of oxygen at high altitudes or other illnesses, are rare causes of pulmonary edema. More about the individual groups below.

Cardiac Pulmonary Edema

Many people are unaware that the heart and lungs are closely connected by cardiopulmonary circulation. Very simply, the circuit looks like this: The oxygen-poor blood from the body reaches the lungs via the right ventricle. There it flows through the pulmonary capillaries along the alveoli. The blood releases carbon dioxide and absorbs vital oxygen. The freshly enriched blood then returns from the lungs to the heart and from the left ventricle back into the body.

The left ventricle is therefore responsible for the blood being pumped from the lungs into the body. If the left ventricle can no longer do this, the blood backs up into the pulmonary circulation. In addition, the right ventricle releases more and more blood into the lungs, as a result of which the pressure in the large and small blood vessels of the lungs continues to rise. Doctors speak of increasing hydrostatic pressure in the pulmonary veins and pulmonary capillaries. This pressure causes fluid from the blood to be forced through the walls of the blood vessels into the interstitial lung tissue, alveoli, and bronchioles.

Left heart failure (left heart failure) is the most common cause of cardiac pulmonary edema. In principle, however, pulmonary edema also occurs as a result of other severe cardiovascular diseases. These are above all:

    • high blood pressure
    • Heart attack
    • Heart valve defects, especially aortic valve stenosis and mitral valve stenosis
    • Myocarditis
    • Arrhythmia
    • Coronary heart disease (CHD)

Non-Cardiac Pulmonary Edema

If the cause of pulmonary edema is not in the heart, doctors speak of non-cardiac pulmonary edema. There are many possible triggers here.

    • Kidney weakness and pulmonary edema: The kidneys play a decisive role in regulating the fluid balance in the body. With kidney weakness, less fluid is usually excreted. This also promotes pulmonary edema. In addition, kidney diseases sometimes excrete more proteins that should remain in the blood. Because these proteins make a significant contribution to binding the fluid in the blood vessels. Without these proteins, fluid can more easily escape from the blood vessels into the tissue: edema develops. Acute kidney failure is a life-threatening emergency that requires the fastest possible therapy. Lung edema can also result from chronic kidney weakness.
    • Toxic pulmonary edema is caused by toxins or irritants. Typical for this form are, for example, the inhalation of irritant gases, nitric oxide, heroin or gastric fluid.
    • Allergic pulmonary edema is based on a particularly severe form of an allergic reaction, anaphylactic shock.
    • The causes of high altitude pulmonary edema have not yet been clearly clarified. It sometimes arises in people who quickly ascend to great heights in the mountains. It occurs mainly at altitudes of more than 4,000 meters. About 7 percent of mountaineers are affected.
    • So-called cerebral or neurogenic pulmonary edema is very rare. These pulmonary edema arise, for example, as a result of severe brain injuries or brain infections (encephalitis). Epilepsy can also be associated with cerebral pulmonary edema. In addition, in particular rare cases, severe forms of sunstroke lead to pulmonary edema.

Examination

For doctors or paramedics, the suspected diagnosis of pulmonary edema usually arises from the obvious breathing symptoms. The eavesdropping examination with the stethoscope (auscultation) and imaging examinations create clarity. A simple X-ray examination is sufficient to detect the pulmonary edema itself. When looking for the cause of the pulmonary edema, very different diagnostic methods are used, depending on the initial suspicion. These include ultrasound examinations of the heart (echocardiography) and laboratory tests of blood and urine.

Treatment

The treatment of pulmonary edema is divided into immediate measures to alleviate breathing difficulties, drug therapy, and combating the triggering circumstances.

Immediate measures for pulmonary edema

Whether medical professionals, paramedics, or first aiders: If pulmonary edema is suspected, those affected should be positioned with the upper body upright. It is best for the patient to sit on a chair. Sitting or lying up has several positive effects:

  • The respiratory muscles can relax and thus better support breathing.
  • The pressure in the blood vessels in the lungs decreases because less blood normally gets to the chest when the legs are low.
  • A firm holds while sitting usually helps reduce the agitation and anxiety typical of pulmonary edema.

In the event of a respiratory arrest or pronounced lack of oxygen (recognizable by blue lips or fingers paired with a lack of breathing), cardiopulmonary massage and resuscitation by first aiders can save lives. Paramedics or doctors can compensate for a lack of oxygen by ventilating with oxygen through a nasogastric tube. If necessary, doctors give a sedative against feelings of fear and restlessness.

In the case of severe pulmonary edema obviously caused by cardiac disease, medication to relieve the heart, such as nitroglycerine, catecholamines to improve expectoration such as dobutamine, diuretic agents such as furosemide, and anxiety-relieving opiates such as morphine are usually administered intravenously in the ambulance. In the case of toxic or allergic pulmonary edema, in particular, anti-inflammatory drugs from the active ingredient group of glucocorticoids such as prednisolone and dexamethasone are injected.

Cause-specific treatment of pulmonary edema

Cause-specific treatment of pulmonary edema usually takes place after admission to the hospital. These include, for example, the treatment of cardiovascular diseases or kidney weakness.

Forecast

A general prognosis for pulmonary edema is not possible. Basically, the earlier professional treatment begins, the better the prospects. There are no official figures on the chances of survival. However, the statistics for cardiac insufficiency offer a clue. Of the approx. 450,000 heart failure patients treated in German hospitals each year, one in ten dies on average.

Prevention

Breathing difficulties of unknown cause should always be examined by a doctor as early as possible. In particular, people with cardiovascular diseases, high blood pressure, lung diseases or kidney diseases should strictly adhere to the treatment recommendations – and if the symptoms change, see a doctor immediately to prevent pulmonary edema.

Pulmonary Fibrosis

There are more than 200 forms of pulmonary fibrosis, many of which are rare diseases. More about the causes, symptoms, and treatment of this pathological stiffening of the lung tissue.

Synonyms: interstitial lung disease, pneumoconiosis, idiopathic interstitial pneumonia

Definition

Pulmonary fibrosis is not an independent disease, but rather a change in the lung tissue and the surrounding blood vessels, which is accompanied by an increasing loss of function of the lungs. This loss of function occurs because more and more lung tissue changes like connective tissue and the alveoli are, so to speak, suffocated. At the same time, the lungs lose their elasticity more and more to inflate when you breathe in. As a result, pulmonary fibrosis causes chronic shortness of breath with a lack of oxygen, which is ultimately fatal. The course of the disease can sometimes be slowed down. Lung fibrosis is not curable so far.

Frequency

There is no precise information on the frequency of pulmonary fibrosis in Germany. By far the most common form of the disease in this country is idiopathic pulmonary fibrosis. According to estimates by experts, the incidence rate for IPF is up to 10 cases per 100,000 population per year.

Many diseases related to pulmonary fibrosis are so rare that they are classified as rare diseases (orphan diseases).

Symptoms

Pulmonary fibrosis often goes unnoticed for many years because the lungs can compensate for the loss of functioning alveoli and bronchi for a long time. At the beginning of the symptomatic course, there are breathing difficulties, which are primarily noticeable during physical exertion. Later, symptoms such as shortness of breath and shortness of breath occur even at rest. As a rule, the symptoms continue to worsen. Coughing and accelerated shallow breathing are other signs of pulmonary fibrosis. The lack of oxygen usually severely restricts physical performance. Typical visible signs of advanced pulmonary fibrosis are blue lips and fingers. This cyanosis is a result of the lack of oxygen. This also applies to the so-called drumstick fingers (piston-shaped finger ends) and conspicuously curved fingernails (watch glass nails).

Pulmonary Fibrosis

Causes

There are more than 200 causes of pulmonary fibrosis or so-called fibrosing lung diseases. What all forms have in common is that the connective tissue between the alveoli and the surrounding pulmonary blood vessels and bronchi continues to multiply. Doctors refer to these tissues as the interstitium.

As a result of an inflammatory process, the interstitium becomes increasingly hard and scarred. This has two consequences: on the one hand, the alveoli are as it was suffocated, on the other hand, the lungs are less and less able to inflate when inhaling. This means that less oxygen reaches the lungs. And this reduced volume of oxygen can also be absorbed and released by the alveoli less and less.

How it relates to the inflammatory process has not yet been clearly clarified. Recent studies suggest that the inflammatory response begins on the surface of the alveoli.

In addition to inflammation, drugs can also promote pulmonary fibrosis. In particular, the active ingredients amiodarone, bleomycin, and busulfan are suspected of causing changes in the lungs of the connective tissue. Other causes of pulmonary fibrosis are inhalation of fibers such as asbestos and dust particles such as quartz dust, allergic reactions, and radiation therapy.

Treatment

Pulmonary fibrosis is incurable. Lung tissue that is lost once cannot be reactivated. Pulmonary fibrosis is fatal if left untreated. With a timely start of treatment, the course of the drug therapy can be slowed down. Above all, anti-inflammatory drugs based on cortisone are used. Other typical active ingredients in the treatment of pulmonary fibrosis are immunosuppressants such as azathioprine and cyclophosphamide.

Advanced pulmonary fibrosis often requires long-term oxygen therapy. The last option is a lung transplant.

How Does A Corona Test Actually Work?

Who will determine if I need to be tested? Where can I get tested? How does the corona test work? And how meaningful are the results? Under what conditions are testing at all?

For the official test for infection with the SARS-CoV-2 coronavirus, two conditions must generally be met. On the one hand, there must be symptoms (from a mild cold to signs of pneumonia) that justify the suspicion of an infection. On the other hand, there must have been contact with a verifiably infected person within 14 days of the onset of symptoms.

Tests are also possible in people with previous illnesses (see also risk groups: Who is most at risk from COVID-19?) Or if respiratory problems (and/or fever) worsen. The decision about this is ultimately made by the attending physician.

It is also possible to test who comes into contact, professionally or on a voluntary basis, with people who are at high risk of a serious disease course with COVID-19.

Until recently, the combination of cold symptoms and staying in an official corona risk area was considered a sufficient requirement for the test. Since April 10th, however, the Robert Koch Institute has no longer identified any risk areas due to the worldwide spread of SARS-CoV-2. The RKI recommends that returnees to Germany go into voluntary quarantine for 14 days.

Where can I do a corona test?

Official corona tests are mainly done in hospitals or specially set up test centers. Sometimes doctors in private practice also offer the corona test. Health authorities also carry out the test on-site, especially for the elderly and/or people with restricted mobility.

If you suspect a corona infection, you should not go to the doctor, but first, inquire by phone. Nationwide, you can call the medical on-call service. The employees can best explain to you how the corona test organization is regulated in your place of residence.

How Does A Corona Test Actually Work

What is done with the corona test to detect SARS-CoV-2?

In the corona test for the detection of SARS-CoV-2, a swab is taken from the mouth, nose, and throat with a cotton swab. Occasionally sputum is saved as a sample.

These samples are then examined in a laboratory. In the meantime (April 10th) these samples can also be evaluated in many hospitals.

How are the coronaviruses detected in the smear?

The common corona test is a so-called PCR test. PCR stands for a polymerase chain reaction, i.e. polymerase chain reaction. PCR tests are considered to be the safest method for detecting viruses such as SARS-CoV-2. Polymerases are very specific proteins that are involved in the construction of the genetic code, DNA. The test can detect even the tiniest amounts of the Coronavirus genetic material.

How safe is the result of the corona test procedure?

The test results are not entirely certain. There can be both false positives and false negatives. Therefore, a first positive test is checked by a second test.

False-negative results are usually checked if the symptoms or the circumstances of possible infection (return from severely affected countries, contact with sick people, or high-risk groups) give a cause.

Sometimes samples are taken incorrectly, damaged during transport, or incorrectly processed in the laboratory.

Are corona rapid tests from the Internet recommended?

The corona rapid tests, which are mainly offered on the Internet, are generally not a PCR test for the detection of viral genetic material, but rather tests that are intended to detect antibodies against SARS-CoV-2 in the blood. Reliable antibody tests play a major role in the therapy of corona because they demonstrate immunity to SARS-CoV-2.

For private use, corona antibody rapid tests from the Internet are not a recommended alternative.

The rapid tests available to date are not fully developed and very likely often give false results – false positive as well as a false negative. Such test results are worthless and do not provide any security. In addition, one can assume that by no means all of the corona rapid tests offered on the Internet come from reputable providers.

How Dangerous Is Covid-19 For Children?

How Dangerous Is Covid-19 For Children?. According to the Robert Koch Institute, corona infections in children are mostly mild or unnoticed. At the same time, however, the experts agree that there is so far too little data to make a scientifically tenable statement about the COVID-19 risk in children. The reason for this is simple: Parents understandably do not bring their children to the doctor or hospital if things go slightly or unnoticed. Therefore, children are rarely tested. The proportion of patients who tested positive has so far been around 2 percent for children and adolescents and 6 percent for young adults up to the age of 20 (see sources, section 2). However, it is not currently possible to say with certainty whether this corresponds to the actual prevalence.

More frequent severe courses in children with previous illnesses

So it is currently not possible to answer with final certainty whether COVID-19 is actually almost always mild in children. But there is much to be said for it. Nevertheless, there are also difficult courses for children. According to the RKI, infants and toddlers are treated as inpatients for COVID-19 more often than other children and adolescents. Children with pre-existing conditions such as cardiovascular diseases or diabetes make up around a quarter of the children admitted to the hospital and half of all children who had to be treated in an intensive care unit because of COVID-19. According to the German Society for Pediatric Infectious Diseases (22), there was only one death associated with COVID-19 in this patient group in Germany until May 18.

Why is COVID-19 often symptom-free or mild in children?

This question cannot be answered at the moment, as the relevant research has not yet been possible. Experts suspect that the child’s immune system, which is not fully developed, enables a broader non-specific defense system than the “ready-made” immune system of adults. Another possibility would be that the child’s cells offer the virus fewer docking options because the corresponding binding sites (receptors) for the virus are not yet developed or are less strongly developed in the child’s cells.

Are children infected more easily than adults?

According to the current state of research, it looks like children are actually less likely to become infected with Sars-CoV-2 than adults. As with many other questions about corona infections, this question cannot currently be answered conclusively.

According to the RKI, studies come to very different results. In the majority of studies, however, the infection rate in children is significantly lower than that of adults. A study from China puts the infection rate in children under 15 years of age at a third of the risk for people between the ages of 15 and 64. The study “Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China” was published by Science at the end of April.

How Dangerous Is Covid-19 For Children

How contagious are children to other children or adults?

The study situation is currently not clear on this question either. Germany’s leading virologist Christian Drosten published an evaluation of the laboratory tests at the Berline Charité at the end of April. According to this, the viral load of infected children is essentially as great as that of adults. Therefore, it could be possible that children are just as contagious as adults, Drosten concludes. At the same time, he admits that the number of children recorded in this analysis is very small. In his podcast, Drosten says “You should actually have ten times as many children, but we don’t have that many”.

Study in Baden-Württemberg: Children are not drivers of infections

The state of Baden-Württemberg had 2,500 children aged up to 10 years and one parent each tested for corona infections and antibodies. The complete results of this investigation by the university hospitals in Heidelberg, Freiburg, and Tübingen are not yet available. According to the state government, however, the interim results show that children are significantly less contagious and infectious than adults. The difference is significant, said Prime Minister Winfried Kretschmann (Greens) during a press conference on May 26th. And further: “We can rule out that children are drivers of the infection process”. These are reliable interim results with a stable trend “.

Professional societies: Children do not play a prominent role in the spread

In their joint statement “Children and adolescents in the COVID-19 pandemic”, 4 medical societies had previously assessed the study situation. They come to the conclusion that the risk of infection in children is significantly lower than that of adults. Accordingly, children do not play a prominent role in the spread of COVID-19. Rather, the infection in the family usually occurs through infected adults.

Do parents need to be concerned about the number of cases of Atypical Kawasaki Syndrome?

In the past few weeks, reports of severe inflammation in children with COVID-19 have created great concern among many parents. Accordingly, especially in the USA, Italy, Spain, France, and Switzerland, a noticeable number of children showed severe symptoms that resemble Kawasaki syndrome.

The German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Cardiology and Congenital Heart Defects (DGPK) point out in a joint statement that the reported cases do not always correspond to the typical clinical picture of Kawasaki syndrome. Therefore, in their opinion, the experts speak of an excessive inflammatory reaction with inflammation of the blood vessels (vasculitis). Such hyper inflammation syndromes were already well known before COVID-19. There is currently no evidence that infections with Sars-CoV-2 are the trigger for the corresponding symptoms.

At the same time, the experts point out that hyper inflammation syndromes can be treated “very well with cortisone or other immunosuppressants and immunoglobulins”. Therefore, there is no reason for parents to be concerned about the number of cases of atypical Kawasaki syndrome.

New evidence of a lower risk of infection for and by children

Update from June 17th

The University Hospitals of Freiburg, Heidelberg, Tübingen, and Ulm have now presented the first results of the study commissioned by the State of Baden-Württemberg on the risk of infection in children. According to the medical director of the children’s clinic at Ulm University Hospital, children are not to be seen as drivers of the wave of corona infections. However, the cause is still unknown, said Klaus-Michael Debatin on June 16 at a press conference. It may be because children have fewer binding sites (ACE receptors) to which the virus can dock. But it is also possible that the child’s immune system successfully combats SARS-CoV-2 in the nasopharynx.

For the study, the doctors tested around 2,500 children under 10 years of age and one parent each for SARS-CoV-2 and COVID-19 antibodies from April 22 to May 15. Of the 5,000 participants, only one parent-child pair was infected during the survey period. Antibodies could be detected in 64 people – 45 adults and 19 children.

Low number of infections in the families studied

The scientists summarize: “The preliminary analysis of the study shows that the most important results are that only a small number of infections occurred in the families examined and that children apparently not only contract COVID-19 less, which has been known for a long time, but also less often be infected by the SARS-CoV-2 virus. ”

The scientists point out that they could make statements about whether children infected their parents or parents infected their children. The study also did not examine how infectious children are in principle. Like many other studies in connection with Corona, the study has not yet been reviewed by experts.

Symptoms And Course Of Covid-19 Pneumonia

Symptoms of atypical pneumonia tend to develop slowly

Infections with the new coronavirus SARS-CoV-2 are so dangerous because they cause atypical pneumonia in up to 20 percent of cases. Doctors call this form of pneumonia atypical because it is not – as is usually the case – caused by an infection with bacteria. Pneumonia caused by bacteria is known as typical pneumonia. The most common culprits are bacteria such as pneumococci and Haemophilus influenza B (HiB).

Atypical pneumonia such as COVID-19 usually develops more slowly than typical pneumonia. In COVID-19 pneumonia, both lungs are usually affected. As a result of the infection, the lungs swell, and fluid collects. The cause: In the fight against viruses, defense cells of the body’s immune system (lymphocytes) produce certain proteins (cytokines) that trigger an inflammatory reaction in the lung tissue. Fluid flows into the alveoli. The combination of inflamed cells and fluid entry into the vesicles means that less oxygen enters the blood. At the same time, less used carbon dioxide is released from the blood through the lungs and breath. Shortness of breath, paleness, and other symptoms are the result. If this process continues untreated, it leads to a slow and excruciating death from suffocation.

Course Of Covid-19 Pneumonia

Sepsis As A Life-Threatening Complication Of Covid-19

A life-threatening complication of COVID-19 pneumonia is sepsis, which is also known colloquially as blood poisoning. Sepsis is a very dangerous condition. In the course of blood poisoning, more and more vital organs fail. Such multi-organ failure is fatal if left untreated. Even with maximum intensive care medicine, around 40 percent of those affected do not survive sepsis.

Lung Damage Possibly Even After A Mild Course

Mild infections with SARS-CoV-2 may also cause permanent lung damage. A small study by the Princess Margaret Hospital in Hong Kong is often quoted in the media, in which the lung capacity of the patients was restricted after healing and the lungs were damaged – possibly by lung fibroids. So far, however, it is not clear whether the lung function impairments were caused by COVID-19 pneumonia or, for example, did not exist before the corona infection.