Swelling of the foot, ankle and leg can be severe enough to leave an indentation, or "pit," when you press on the area.
This post is an overview on calcium channel blockers, in this first part we will discuss their classification, mechanism of action as well as clinical indications. Phenilalkylamines: verapamil is the only drug in this group, it binds to the V binding site. Dihydropyridines: the prototype agent in this group is nifedipine, a first generation dihydropyridine that binds to the N binding site. Calcium channel antagonists block the inward movement of calcium by binding to the L-type calcium channels in the heart and in smooth muscle of the peripheral vasculature. Dihydropiridines have minimal effect on cardiac conduction or heart rate, while they have potent actions as arteriolar vasodilators. On the other hand, verapamil and diltiazem slow AV conduction and decrease SA node automaticity, they also decrease heart rate. CCB’s  effectiveness in the treatment of hypertension is  related to a decrease in peripheral resistance accompanied by increases in cardiac index.
CCB are also useful in the treatment of hypertensive patients with comorbidities such as: asthma, diabetes, angina, ond or peripheral vascular disease. Calcium channel blockers act as coronary vasodilators, producing variable and dose-dependent reductions in myocardial oxygen demand, contractility, and arterial pressure. In the presence of heart failure, the use of calcium channel blockers can cause further worsening of heart failure as a result of their negative inotropic effect.
Verapamil and diltiazem are class IV antiarrhythmics, according to Vaughan and Williams’ classification of antiarrhythmic drugs. Calcium channel blockers act as coronary vasodilators, producing variable and dose-dependent reductions in myocardial oxygen demand, contractility, and arterial pressure.
In the presence of heart failure, the use of calcium channel blockers can cause further worsening of heart failure as a result of their negative inotropic effect.
Scleroderma also called as systemic sclerosis is a type of autoimmune disorder affecting the connective tissues of the body. Very often scleroderma is localized since it affects the skin leaving the other parts but in rare cases it will affect vital organs like heart, lungs and kidneys.
Sometimes it involves constriction of blood vessels on the hands and feet causing pain, numbness and color changes and these symptoms are named as Raynaud’s phenomenon.
Liner scleroderma is seen in children and is marked by the presence of streaks of hard skin on arms and legs but it affects only one side of the body. Treatment for scleroderma is difficult since there is no medicine available to stop the collagen production in excess. For GERD and digestive tract issues suitable drugs are prescribed for controlling gastric problem.


In case of severe symptoms causing ulcers and sores particular area is amputated by surgery.
Kawasaki disease (mucocutaneous lymph node syndrome) is a rare childhood disease that causes inflammation in the walls of small-sized and medium sized arteries. There is no single test for Kawasaki disease and in order to diagnose it, you must look for symptoms. This swelling (edema) is the result of excess fluid in your tissues — often caused by congestive heart failure or blockage in a leg vein. Diltiazem is used in the treatment of variant angina because of its coronary antispasmodic properties.
These combined pharmacologic effects are advantageous and make these agents as effective as beta blockers in the treatment of angina pectoris. These combined pharmacologic effects are advantageous and make these agents as effective as beta blockers in the treatment of angina pectoris. The origin of the word “scleroderma” comes from Greek in which the word ‘sclero’ means hardening and ‘derma’ means skin.
It is visible as thick patches on the skin more concentrated on the areas of fingers, hands and face. This condition happens when the person becomes stressed due to emotion or exposed to cold weather for long duration. In the morphea type of scleroderma it causes round shaped patches on the skin marked with purple border. Systemic scleroderma is serious since it affects the internal organs like lungs, heart and even the blood vessels of the body. Collagen is a protein that is naturally produced by the tissues of the body but when it is produced in excess of quantity it accumulates in the body tissues causing hardness on the skin. African Americans, Choctaw Americans living in Oklahoma are more prone to develop this disease than others. Similarly people who are exposed to dust of silica, and those working in mines and quarries are more likely to develop hardening of skin. It can cause complications on the lungs lading to pulmonary fibrosis thus reducing the ability of breathing. Often localized scleroderma does not require any treatment and will resolve within few years. Drugs for managing blood pressure are given if the disease causes dilation of blood vessels. It is most often seen in children under the age of 5 of Asian descent (primarily Japanese of Korean). We offer learning materials for Internal Medicine, Family Medicine, and Physician Assistant certification and re-certification exams.


They also decrease cardiac contractility (negative inotropic effect) ,automaticity at the SA node and conduction at the AV node.
They are indicated when beta blockers are contraindicated, poorly tolerated, or ineffective.
Their ability to inhibit the AV node is employed in the management of supraventricular tachyarrhythmias, such as: atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardia. They are indicated when beta blockers are contraindicated, poorly tolerated, or ineffective.
Unlike other skin diseases, scleroderma is not contagious but it reduces the self esteem of the person due to its ugly appearance. This disease can affect the esophagus area present near the stomach making it difficult to absorb the nutrients properly. Often it is seen only on one part of the body like face or hands but sometimes it can appear throughout the body.
It is believed to be triggered by autoimmune disorder in which the body’s own immune system will induce collagen production in large amounts.
It can cause circulatory complications when it affects the blood flow causing ulcers and sores on the fingers.
Medicines are prescribed for suppressing the immune system that can reduce the overproduction of collagen.
The criteria defined for diagnosis is that the child must have fever for greater than 5 days and must show four of the following five symptoms. The intensity of sclerosis differs from one person to the other and the disease is not progressive in nature. The disease becomes serious and complicated if it affects the internal organs or blood vessels of the body. In rare cases it will increase protein level in the body thus affecting the kidney function. Occupational therapy is given for improving the functional ability of fingers and hands that gets hardened. The progressive disease can make the small sac that surrounds the heart to become swollen thus making the person prone to heart failure. It can affect the digestive tract causing digestive problems and can also affect the gums causing dental problems.



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