- Studies show you don’t have to work up a sweat to keep your cholesterol in check. Walking is no strain, all gain, exercise for your heart.
- Regular activities that burn 2,500 calories a week may cut your heart attack risk in half
- Patients who regularly exercise may greatly improve their chances of avoiding a heart attack
- Exercise is a new lease on life, even for those with a family history of heart disease
Friday, February 29, 2008
Preventing Heart Disease, Heart Attack through Physical Exercise
Thursday, February 28, 2008
What is the need for cardiac CT
Coronary Artery disease (CAD) is the leading cause of death in the industrialized world.
- “Screening” is a widely accepted strategy to combat CAD for early detection of stenosis of the coronary artery lumen.
- Exclusion of stenosis in non- symptomatic high risk patients.
- Prior to major (non-cardiac) Surgery.
- Atypical (unstable) chest pain.
- Refractory chest pain with doubtful coronary origin.
- Non-conclusive stress tests.
- As a substitute to conventional coronary angiography prior to percatareous coronary intervention and in high risk patient like aortic disease.
- Adjuvant to coronary Angio for Plaque characterization ,Complicated coronary intubation., Total coronary occlusion.
- Follow-up in -Percutaneous coronary intervention-Bypass Surgery.
- Evaluation of coronary anomalies.
- Evaluation of chest pain at emergency department.
- Evaluation of lifestyle, dietary or pharmacological interventions on progression /regression of coronary atherosclerosis.
Tuesday, February 26, 2008
Heart-Lung Machines
Gale Encyclopedia of Surgery, (2004)
by Allison J.
Definition
The heart-lung machine is medical equipment that provides cardiopulmonary bypass, or mechanical circulatory support of the heart and lungs. The machine may consist of venous and arterial cannula (tubes), polyvinyl chloride (PVC) or silicone tubing, reservoir (to hold blood), bubbler or membrane oxygenator, cardiotomy (filtered reservoir), heat exchanger(s), arterial line filter, pump(s), flow meter, inline blood gas and electrolyte analyzer, and pressure-monitoring devices. Treatment provides removal of carbon dioxide from the blood, oxygen delivery to the blood, blood flow to the body, and/or temperature maintenance. Pediatric and adult patients both benefit from this technology.
Purpose
In the operating room , the heart-lung machine is used primarily to provide blood flow and respiration for the patient while the heart is stopped. Surgeons are able to perform coronary artery bypass grafting (CABG), open-heart surgery for valve repair or repair of cardiac anomalies, and aortic aneurysm repairs, along with treatment of other cardiac-related diseases.
The heart-lung machine provides the benefit of a motionless heart in an almost bloodless surgical field. Cardioplegia solution is delivered to the heart, resulting in cardiac arrest (heart stoppage).
The heart-lung machine is invaluable
In critical care units and cardiac catheterization laboratories, the heart-lung machine is used to support A heart-lung machine. ( Photograph by Albert Paglialunga. Phototake NYC. Reproduced by permission. ) and maintain blood flow and respiration. The diseased heart or lung(s) is replaced by this technology, providing time for the organ(s) to heal. The heart-lung machine can be used with venoarterial extracorporeal membrane oxygenation (ECMO), which is used primarily in the treatment of lung disease. Cardiopulmonary support is useful during percutaneous transluminal coronary angioplasty (PTCA) and stent procedures performed with cardiac catheterization. Both treatments can be instituted in the critical care unit when severe heart or lung disease is no longer treatable by less-invasive conventional treatments such as pharmaceuticals, intra-aortic balloon pump (IABP), and mechanical ventilation with a respirator.
Use of this treatment in the emergency room is not limited to patients suffering heart or lung failure. In severe cases of hypothermia, a patient's body temperature can be corrected by extracorporeal circulation with the heart-lung machine. Blood is warmed as it passes over the heat exchanger. The warmed blood returns to the body, gradually increasing the patient's body temperature to normal.
Tertiary care facilities are able to support the staffing required to operate and maintain this technology. Level I trauma centers have access to this specialized treatment and equipment. Being that this technology serves both adult and pediatric patients, specialized children's hospitals may provide treatment with the heart-lung machine for venoarterial ECMO.
Description
The pump oxygenator had its first success on May 6, 1953. Continued research and design have allowed the heart-lung machine to become a standard of care in the treatment of heart and lung disease, while supporting other non-conventional treatments.
Foreign surfaces of the heart-lung machine activate blood coagulation, proteins, and platelets, which lead to clot formation. In the heart-lung machine, clot formation would block the flow of blood. As venous and arterial cannulas are inserted, medications are administered to provide anticoagulation of the blood which prevents clot formation and allows blood flow through the heart-lung machine.
Large vessels (veins and arteries) are required for cannulation, to insert the tubes (cannulas) that will carry the blood away from the patient to the heart-lung machine and to return the blood from the heart-lung machine to the patient. Cannulation sites for venous access can include the inferior and superior vena cava, the right atrium (the upper chamber of the heart), the femoral vein (in the groin), or internal jugular vein. Oxygen-rich blood will be returned to the aorta, femoral artery, or carotid artery (in the neck). By removing oxygen-poor blood from the right side of the heart and returning oxygen-rich blood to the left side, heart-lung bypass is achieved.
The standard heart-lung machine typically includes up to five pump assemblies. A centrifugal or roller head pump can be used in the arterial position for extracorporeal circulation of the blood. The four remaining pumps are roller pump in design to provide fluid, gas, and liquid for delivery or removal to the heart chambers and surgical field. Left ventricular blood return is accomplished by roller pump, drawing blood away from the heart. Surgical suction created by the roller pump removes accumulated fluid from the general surgical field. The cardioplegia delivery pump is used to deliver a high potassium solution to the coronary vessels. The potassium arrests the heart so that the surgical field is motionless during surgical procedures. An additional pump is available for emergency backup of the arterial pump in case of mechanical failure.
by Allison J.
Definition
The heart-lung machine is medical equipment that provides cardiopulmonary bypass, or mechanical circulatory support of the heart and lungs. The machine may consist of venous and arterial cannula (tubes), polyvinyl chloride (PVC) or silicone tubing, reservoir (to hold blood), bubbler or membrane oxygenator, cardiotomy (filtered reservoir), heat exchanger(s), arterial line filter, pump(s), flow meter, inline blood gas and electrolyte analyzer, and pressure-monitoring devices. Treatment provides removal of carbon dioxide from the blood, oxygen delivery to the blood, blood flow to the body, and/or temperature maintenance. Pediatric and adult patients both benefit from this technology.
Purpose
In the operating room , the heart-lung machine is used primarily to provide blood flow and respiration for the patient while the heart is stopped. Surgeons are able to perform coronary artery bypass grafting (CABG), open-heart surgery for valve repair or repair of cardiac anomalies, and aortic aneurysm repairs, along with treatment of other cardiac-related diseases.
The heart-lung machine provides the benefit of a motionless heart in an almost bloodless surgical field. Cardioplegia solution is delivered to the heart, resulting in cardiac arrest (heart stoppage).
The heart-lung machine is invaluable
In critical care units and cardiac catheterization laboratories, the heart-lung machine is used to support A heart-lung machine. ( Photograph by Albert Paglialunga. Phototake NYC. Reproduced by permission. ) and maintain blood flow and respiration. The diseased heart or lung(s) is replaced by this technology, providing time for the organ(s) to heal. The heart-lung machine can be used with venoarterial extracorporeal membrane oxygenation (ECMO), which is used primarily in the treatment of lung disease. Cardiopulmonary support is useful during percutaneous transluminal coronary angioplasty (PTCA) and stent procedures performed with cardiac catheterization. Both treatments can be instituted in the critical care unit when severe heart or lung disease is no longer treatable by less-invasive conventional treatments such as pharmaceuticals, intra-aortic balloon pump (IABP), and mechanical ventilation with a respirator.
Use of this treatment in the emergency room is not limited to patients suffering heart or lung failure. In severe cases of hypothermia, a patient's body temperature can be corrected by extracorporeal circulation with the heart-lung machine. Blood is warmed as it passes over the heat exchanger. The warmed blood returns to the body, gradually increasing the patient's body temperature to normal.
Tertiary care facilities are able to support the staffing required to operate and maintain this technology. Level I trauma centers have access to this specialized treatment and equipment. Being that this technology serves both adult and pediatric patients, specialized children's hospitals may provide treatment with the heart-lung machine for venoarterial ECMO.
Description
The pump oxygenator had its first success on May 6, 1953. Continued research and design have allowed the heart-lung machine to become a standard of care in the treatment of heart and lung disease, while supporting other non-conventional treatments.
Foreign surfaces of the heart-lung machine activate blood coagulation, proteins, and platelets, which lead to clot formation. In the heart-lung machine, clot formation would block the flow of blood. As venous and arterial cannulas are inserted, medications are administered to provide anticoagulation of the blood which prevents clot formation and allows blood flow through the heart-lung machine.
Large vessels (veins and arteries) are required for cannulation, to insert the tubes (cannulas) that will carry the blood away from the patient to the heart-lung machine and to return the blood from the heart-lung machine to the patient. Cannulation sites for venous access can include the inferior and superior vena cava, the right atrium (the upper chamber of the heart), the femoral vein (in the groin), or internal jugular vein. Oxygen-rich blood will be returned to the aorta, femoral artery, or carotid artery (in the neck). By removing oxygen-poor blood from the right side of the heart and returning oxygen-rich blood to the left side, heart-lung bypass is achieved.
The standard heart-lung machine typically includes up to five pump assemblies. A centrifugal or roller head pump can be used in the arterial position for extracorporeal circulation of the blood. The four remaining pumps are roller pump in design to provide fluid, gas, and liquid for delivery or removal to the heart chambers and surgical field. Left ventricular blood return is accomplished by roller pump, drawing blood away from the heart. Surgical suction created by the roller pump removes accumulated fluid from the general surgical field. The cardioplegia delivery pump is used to deliver a high potassium solution to the coronary vessels. The potassium arrests the heart so that the surgical field is motionless during surgical procedures. An additional pump is available for emergency backup of the arterial pump in case of mechanical failure.
Monday, February 25, 2008
Nutrition: Diet and Heart Disease
Robert M. Russell, M.D., and Alice H. Lichtenstein, D. Sc.Alice H. Lichtenstein, D. Sc., is an Associate Professor of Nutrition in the School of Nutrition Science and an Associate Professor of Family Medicine, Community Health at Tufts University School of Medicine. Her research investigates the behavior of lipoprotein molecules. particles, predictive factors for changes in blood lipids induced by diet in individuals. Dr. Lichtenstein is on the Editorial Board of the Journal of Nutrition and Atherosclerosis.
Being Thin Is Not Necessarily the Solution
RMR
How important a factor is dietary fat intake in the development of coronary artery disease? Put another way, if a person has a high fat diet but stays relatively thin will their arteries be okay?AHLYou can't tell by looking at someone whether they are of a desirable body weight or overweight, or their risk of developing heart disease. Each person is different.First, you have to know how much fat (lipid) is in your blood (see Table 1 below for more detail). Most physicians do this blood test every time you have a check-up or annual medical exam. The most important factor affecting blood cholesterol levels is how much saturated fat and cholesterol you eat.
Risk Factors Vary with the Individual, but They Do Add Up
RMR
What risk factors affect your blood lipid levels? Alice, you mentioned the various risk factors for coronary artery disease and I wonder if you would list them in order of importance as a review and, secondly, could you review the main sources of saturated fats in our diet and the mechanism whereby saturated fats give rise to elevated cholesterol levels?
AHL
The significant risk factors are hypertension, family history of cardiovascular disease, current cigarette smoker, hypertension, low HDL cholesterol (the good cholesterol) and diabetes. Although not considered independent risk factors, obesity and physical inactivity should also be taken into consideration. No one risk factor is more important than another (see Table 2 below).
Major Sources of Saturated Fat in the Diet
AHL
The American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) have issued recommended guidelines, Step 1 and Step 2 they're called, for the dietary treatment of too much cholesterol Table 3. The patient should be first counseled to follow a Step 1 diet. If a patient is already on a Step 1 diet, or an acceptable response is not achieved, the patient should be advised to follow a Step 2 diet by further decreasing their saturated fat intake to 7% of calories and their cholesterol intake to 200 mg/day. For this strategy to be effective, you'll probably require the help of a registered dietitian. Usually, decreasing the total fat content of the diet is easier to do than decreasing the saturated fat content. In order to decrease effectively the saturated fat content, it is important to know its major sources. These include animal fats such as meat and full fat dairy products and, depending on one's tastes, a few selected plant oils (Table 7). The plant oils, frequently termed tropical oils, include coconut oil, palm oil, palm kernel oil and cocoa butter and contain a fair amount of saturated fat. However, they do not tend to be used in high levels in the United States.For Americans with high blood lipid levels, the focus should be on decreasing full fat dairy products and meat. Many non-fat, reduced-fat and low-fat dairy products are now available. To reduce the intake of saturated fat from meat, buy cuts of meat with the least amount of visible fat; trim meat of excess fat; with poultry, remove the skin before eating; and, of course, cut down on the size portion of meat actually consumed.
The other potential source of animal fat can come from cooking, as discretionary fat is added during food preparation. We recommend that individuals switch from animal fats such as lard or butter to vegetable oils.The other dietary factor which elevates blood cholesterol levels is dietary cholesterol.
Major sources of dietary cholesterol are eggs and animal fats (both dairy and meat). By decreasing the consumption of animal fat, in addition to saturated fat, dietary cholesterol intake should also decrease.
Being Thin Is Not Necessarily the Solution
RMR
How important a factor is dietary fat intake in the development of coronary artery disease? Put another way, if a person has a high fat diet but stays relatively thin will their arteries be okay?AHLYou can't tell by looking at someone whether they are of a desirable body weight or overweight, or their risk of developing heart disease. Each person is different.First, you have to know how much fat (lipid) is in your blood (see Table 1 below for more detail). Most physicians do this blood test every time you have a check-up or annual medical exam. The most important factor affecting blood cholesterol levels is how much saturated fat and cholesterol you eat.
Risk Factors Vary with the Individual, but They Do Add Up
RMR
What risk factors affect your blood lipid levels? Alice, you mentioned the various risk factors for coronary artery disease and I wonder if you would list them in order of importance as a review and, secondly, could you review the main sources of saturated fats in our diet and the mechanism whereby saturated fats give rise to elevated cholesterol levels?
AHL
The significant risk factors are hypertension, family history of cardiovascular disease, current cigarette smoker, hypertension, low HDL cholesterol (the good cholesterol) and diabetes. Although not considered independent risk factors, obesity and physical inactivity should also be taken into consideration. No one risk factor is more important than another (see Table 2 below).
Major Sources of Saturated Fat in the Diet
AHL
The American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) have issued recommended guidelines, Step 1 and Step 2 they're called, for the dietary treatment of too much cholesterol Table 3. The patient should be first counseled to follow a Step 1 diet. If a patient is already on a Step 1 diet, or an acceptable response is not achieved, the patient should be advised to follow a Step 2 diet by further decreasing their saturated fat intake to 7% of calories and their cholesterol intake to 200 mg/day. For this strategy to be effective, you'll probably require the help of a registered dietitian. Usually, decreasing the total fat content of the diet is easier to do than decreasing the saturated fat content. In order to decrease effectively the saturated fat content, it is important to know its major sources. These include animal fats such as meat and full fat dairy products and, depending on one's tastes, a few selected plant oils (Table 7). The plant oils, frequently termed tropical oils, include coconut oil, palm oil, palm kernel oil and cocoa butter and contain a fair amount of saturated fat. However, they do not tend to be used in high levels in the United States.For Americans with high blood lipid levels, the focus should be on decreasing full fat dairy products and meat. Many non-fat, reduced-fat and low-fat dairy products are now available. To reduce the intake of saturated fat from meat, buy cuts of meat with the least amount of visible fat; trim meat of excess fat; with poultry, remove the skin before eating; and, of course, cut down on the size portion of meat actually consumed.
The other potential source of animal fat can come from cooking, as discretionary fat is added during food preparation. We recommend that individuals switch from animal fats such as lard or butter to vegetable oils.The other dietary factor which elevates blood cholesterol levels is dietary cholesterol.
Major sources of dietary cholesterol are eggs and animal fats (both dairy and meat). By decreasing the consumption of animal fat, in addition to saturated fat, dietary cholesterol intake should also decrease.
Heart attack : BBC News Friday, 23 June, 2000
A heart attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle.
This is usually caused by atherosclerosis - hardening of the artery walls. The clot, often caused by rupturing or tearing of plaque in an artery is sometimes called a coronary thrombosis or a coronary occlusion.
If blood supply is cut off for a long time, muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage to the muscle.
A heart attack, also known as myocardial infarction, can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.
An unexpected and abrupt heart attack occuring soon after the onset of symptoms can result in sudden death.
It accounts for about half of all coronary heart disease deaths and can be caused by nearly all types of heart disease.
Three main symptoms of a heart attack:
1. Pressure or pain in the centre of the chest, lasting more than a few minutes or going away and coming back
2. Pain spreading to the shoulders, neck or arms
3. Chest discomfort combined with light-headedness, fainting, sweating, nausea or shortness of breath
Other common warning signs of heart attack include unusual chest, stomach or abdominal pain, nausea or dizziness, shortness of breath or difficulty breathing, unexplained anxiety, weakness or fatigue, palpitations, cold sweat or paleness.
Anybody experiencing these symptoms should call an ambulance immediately, but should not try to drive themselves to hospital, as complications can begin to occur before they get there.
Most people do have time to get to hospital and be treated before collapsing, but they do need to act quickly.
Some people wait for hours or even days before seeking help - they are the ones that get into trouble.
After a heart attack
Diagnosis of a heart attack usually involves a clinical examination, an electrocardiogram, heart rhythm monitoring and blood tests.
Echocardiograms or angiograms will detect the extent of damage to the heart.
Immediately after a heart attack, clot-busting drugs will be used to restore blood flow. Aspirin, to aid blood flow, and beta-blockers, to ease the heart's work rate, may also be used.
In the days or weeks after a heart attack, surgery - either angioplasty or coronary artery bypass surgery - may be performed.
http://news.bbc.co.uk/2/hi/health/medical_notes/g-i/764015.stm
A heart attack, also known as myocardial infarction, can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.
An unexpected and abrupt heart attack occuring soon after the onset of symptoms can result in sudden death.
It accounts for about half of all coronary heart disease deaths and can be caused by nearly all types of heart disease.
Three main symptoms of a heart attack:
1. Pressure or pain in the centre of the chest, lasting more than a few minutes or going away and coming back
2. Pain spreading to the shoulders, neck or arms
3. Chest discomfort combined with light-headedness, fainting, sweating, nausea or shortness of breath
Other common warning signs of heart attack include unusual chest, stomach or abdominal pain, nausea or dizziness, shortness of breath or difficulty breathing, unexplained anxiety, weakness or fatigue, palpitations, cold sweat or paleness.
Anybody experiencing these symptoms should call an ambulance immediately, but should not try to drive themselves to hospital, as complications can begin to occur before they get there.
Most people do have time to get to hospital and be treated before collapsing, but they do need to act quickly.
Some people wait for hours or even days before seeking help - they are the ones that get into trouble.
After a heart attack
Diagnosis of a heart attack usually involves a clinical examination, an electrocardiogram, heart rhythm monitoring and blood tests.
Echocardiograms or angiograms will detect the extent of damage to the heart.
Immediately after a heart attack, clot-busting drugs will be used to restore blood flow. Aspirin, to aid blood flow, and beta-blockers, to ease the heart's work rate, may also be used.
In the days or weeks after a heart attack, surgery - either angioplasty or coronary artery bypass surgery - may be performed.
http://news.bbc.co.uk/2/hi/health/medical_notes/g-i/764015.stm
Sunday, February 24, 2008
Friday, February 22, 2008
Thursday, February 21, 2008
Heart Transplant Surgery
Heart Transplant Surgery
Also called: Cardiac Transplantation, Artificial Heart Transplantation
- Summary- About heart transplants- While waiting- Before the procedure- During the procedure- After the procedure- Benefits and risks- About organ donations- Recent advances- The waiting list- Questions for your doctor
Reviewed By: Larry W. Stephenson, M.D., FACC, FCCP, FACS
Test Your Knowledge
-
Heart Failure Quiz
Quizzes A-Z
Summary
A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased person. Heart transplantation has made great strides over the years. Today, more than 85 percent of heart recipients will live at least another year and more than 70 percent will live another five years. However, patients continue to face a lengthy waiting list to receive a donor heart. Researchers are working to develop equipment to improve the health and comfort for patients waiting for a donor heart and, ideally, to develop a mechanical heart that could permanently solve the shortage problem.
People who receive a heart transplant can expect to spend 10 days to two weeks in the hospital. The medical team will join them in the fight to keep the new heart free from either infection or rejection by the body. After being discharged from the hospital, patients must continue to take their medications and keep their follow-up appointments. There are many changes that come with having a new heart and depression is not uncommon. The support of family and friends during this difficult time is an important part of recovery.
Also called: Cardiac Transplantation, Artificial Heart Transplantation
- Summary- About heart transplants- While waiting- Before the procedure- During the procedure- After the procedure- Benefits and risks- About organ donations- Recent advances- The waiting list- Questions for your doctor
Reviewed By: Larry W. Stephenson, M.D., FACC, FCCP, FACS
Test Your Knowledge
-
Heart Failure Quiz
Quizzes A-Z
Summary
A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased person. Heart transplantation has made great strides over the years. Today, more than 85 percent of heart recipients will live at least another year and more than 70 percent will live another five years. However, patients continue to face a lengthy waiting list to receive a donor heart. Researchers are working to develop equipment to improve the health and comfort for patients waiting for a donor heart and, ideally, to develop a mechanical heart that could permanently solve the shortage problem.
People who receive a heart transplant can expect to spend 10 days to two weeks in the hospital. The medical team will join them in the fight to keep the new heart free from either infection or rejection by the body. After being discharged from the hospital, patients must continue to take their medications and keep their follow-up appointments. There are many changes that come with having a new heart and depression is not uncommon. The support of family and friends during this difficult time is an important part of recovery.
Tetralogy of Fallot / TOF
What is tetralogy of Fallot?
Tetralogy of Fallot / TOF is a cardiac anomaly that refers to a combination of four related heart defects that commonly occur together. The four defects include:
Pulmonary stenosis (narrowing of the pulmonary valve and outflow tract or area below the valve, that creates an obstruction (blockage) of blood flow from the right ventricle to the pulmonary artery
Ventricular septal defect / VSD
Overriding aorta (the aortic valve is enlarged and appears to arise from both the left and right ventricles instead of the left ventricle as occurs in normal hearts)
Right ventricular hypertrophy (thickening of the muscular walls of the right ventricle, which occurs because the right ventricle is pumping at high pressure)
A small percentage of children with tetralogy of Fallot may also have additional ventricular septal defects, an atrial septal defect / ASD or abnormalities in the branching pattern of their coronary arteries. Some patients with tetralogy of Fallot have complete obstruction to flow from the right ventricle, or pulmonary atresia. Tetralogy of Fallot may be associated with chromosomal abnormalities, such as 22q11 deletion syndrome.
The pulmonary stenosis and right ventricular outflow tract obstruction seen with tetralogy of Fallot usually limits blood flow to the lungs. When blood flow to the lungs is restricted, the combination of the ventricular septal defect and overriding aorta allows oxygen-poor blood ("blue") returning to the right atrium and right ventricle to be pumped out the aorta to the body.
This "shunting" of oxygen-poor blood from the right ventricle to the body results in a reduction in the arterial oxygen saturation so that babies appear cyanotic, or blue. The cyanosis occurs because oxygen-poor blood is darker and has a blue color, so that the lips and skin appear blue.
The extent of cyanosis is dependent on the amount of narrowing of the pulmonary valve and right ventricular outflow tract. A narrower outflow tract from the right ventricle is more restrictive to blood flow to the lungs, which in turn lowers the arterial oxygen level since more oxygen-poor blood is shunted from the right ventricle to the aorta.
Tetralogy of Fallot / TOF is a cardiac anomaly that refers to a combination of four related heart defects that commonly occur together. The four defects include:
Pulmonary stenosis (narrowing of the pulmonary valve and outflow tract or area below the valve, that creates an obstruction (blockage) of blood flow from the right ventricle to the pulmonary artery
Ventricular septal defect / VSD
Overriding aorta (the aortic valve is enlarged and appears to arise from both the left and right ventricles instead of the left ventricle as occurs in normal hearts)
Right ventricular hypertrophy (thickening of the muscular walls of the right ventricle, which occurs because the right ventricle is pumping at high pressure)
A small percentage of children with tetralogy of Fallot may also have additional ventricular septal defects, an atrial septal defect / ASD or abnormalities in the branching pattern of their coronary arteries. Some patients with tetralogy of Fallot have complete obstruction to flow from the right ventricle, or pulmonary atresia. Tetralogy of Fallot may be associated with chromosomal abnormalities, such as 22q11 deletion syndrome.
The pulmonary stenosis and right ventricular outflow tract obstruction seen with tetralogy of Fallot usually limits blood flow to the lungs. When blood flow to the lungs is restricted, the combination of the ventricular septal defect and overriding aorta allows oxygen-poor blood ("blue") returning to the right atrium and right ventricle to be pumped out the aorta to the body.
This "shunting" of oxygen-poor blood from the right ventricle to the body results in a reduction in the arterial oxygen saturation so that babies appear cyanotic, or blue. The cyanosis occurs because oxygen-poor blood is darker and has a blue color, so that the lips and skin appear blue.
The extent of cyanosis is dependent on the amount of narrowing of the pulmonary valve and right ventricular outflow tract. A narrower outflow tract from the right ventricle is more restrictive to blood flow to the lungs, which in turn lowers the arterial oxygen level since more oxygen-poor blood is shunted from the right ventricle to the aorta.
What are signs and symptoms of tetralogy of Fallot?
Tetralogy of Fallot is most often diagnosed in the first few weeks of life due to either a loud murmur or cyanosis. Babies with tetralogy of Fallot usually have a patent ductus arteriosus at birth that provides additional blood flow to the lungs, so severe cyanosis is rare early after birth.
As the ductus arteriosus closes, which it typically will in the first days of life, cyanosis can develop or become more severe.
The degree of cyanosis is proportional to lung blood flow and thus depends upon the degree of narrowing of the outflow tract to the pulmonary arteries.
Rapid breathing in response to low oxygen levels and reduced pulmonary blood flow can occur. The heart murmur, which is commonly loud and harsh, is often absent in the first few days of life.
The arterial oxygen saturation of babies with tetralogy of Fallot can suddenly drop markedly. This phenomenon, called a "tetralogy spell," usually results from a sudden increased constriction of the outflow tract to the lungs so that pulmonary blood flow is further restricted. The lips and skin of babies who have a sudden decrease in arterial oxygen level will appear acutely more blue.
Children having a tetralogy spell will initially become extremely irritable in response to the critically low oxygen levels, and they may become sleepy or unresponsive if the severe cyanosis persists. A tetralogy spell can sometimes be treated by comforting the infant and flexing the knees forward and upward. Most often, however, immediate medical attention is necessary.
How is tetralogy of Fallot Diagnosed?
When a newborn baby with significant cyanosis is first seen, they are often placed in supplemental oxygen. The increased oxygen improves the child's oxygen levels in cases of lung disease, but breathing extra oxygen will have little effect on the oxygen levels of a child with tetralogy of Fallot.
Failure to respond to this "hyperoxia test" is often the first clue to suspect a cyanotic cardiac defect. Infants with tetralogy of Fallot can have normal oxygen levels if the pulmonary stenosis is mild (referred to as "pink" tetralogy of Fallot). In these children, the first clue to suggest a cardiac defect is detection of a loud murmur when the infant is examined.
Once congenital heart disease is suspected, echocardiography can rapidly and accurately demonstrate the four related defects characteristic of tetralogy of Fallot.
Cardiac catheterization is occasionally required to evaluate the size and distribution of the pulmonary arteries and to clarify the branching patterns of the coronary arteries. Catheterization can also demonstrate whether patients have pulmonary blood flow supplied by an abnormal blood vessel from the aorta (aortopulmonary collateral).
What are treatment options for tetralogy of Fallot?
Once tetralogy of Fallot is diagnosed, the immediate management focuses on determining whether the child's oxygen levels are in a safe range. If oxygen levels are critically low soon after birth, a prostaglandin infusion is usually initiated to keep the ductus arteriosus open which will provide additional pulmonary blood flow and increase the child's oxygen level. These infants will usually require surgical intervention in the neonatal period. Infants with normal oxygen levels or only mild cyanosis are usually able to go home in the first week of life. Complete repair is usually done electively when the children are about six months of age, as long as the oxygen levels remain adequate. Progressive or sudden decreases in oxygen saturation may prompt earlier corrective repair. Surgical correction of the defect is always necessary. Occasionally, patients will require a surgical palliative procedure prior to the final correction. Corrective repair of tetralogy of Fallot involves closure of the ventricular septal defect with a synthetic Dacron patch so that the blood can flow normally from the left ventricle to the aorta. The narrowing of the pulmonary valve and right ventricular outflow tract is then augmented (enlarged) by a combination of cutting away (resecting) obstructive muscle tissue in the right ventricle and by enlarging the outflow pathway with a patch. In some babies, however, the coronary arteries will branch across the right ventricular outflow tract where the patch would normally be placed. In these babies an incision in this area to place the patch would damage the coronary artery so this cannot safely be done. When this occurs, a hole is made in the front surface of the right ventricle (avoiding the coronary artery) and a conduit (tube) is sewn from the right ventricle to the bifurcation of the pulmonary arteries to provide unobstructed blood flow from the right ventricle to the lungs.
What are the results of treatment for tetralogy of Fallot?
Survival of children with tetralogy of Fallot has improved dramatically over recent decades. In the absence of confounding risk factors, more than 95 percent of infants with tetralogy of Fallot successfully undergo surgery in the first year of life. Surgical repair is more difficult when the pulmonary arteries are critically small or when the lung blood flow is supplied predominantly by aortopulmonary collaterals.Most babies are fairly sick in the first few days after surgery, since the right ventricle is "stiff" from the previous hypertrophy (thickness) and because an incision is made into the muscle of the ventricle, making the muscle temporarily weaker. This right ventricular dysfunction usually improves significantly in the days following surgery. Patients may also have rhythm problems after surgery. An abnormally fast rhythm (called junctional tachycardia) may occur and may require treatment with medication or the use of a temporary pacemaker. This abnormal rhythm is usually temporary and the rhythm generally will return to normal as the right ventricle recovers. Patients are also at risk for slow heart rates after surgery due to heart block. Heart block may be caused by injury to or inflammation of the conduction system in the heart. In many patients, the conduction improves and normal rhythm returns. Rarely, a permanent pacemaker may be necessary. Since a normal circulation is produced by the tetralogy of Fallot repair procedure, long-term cardiac function is usually excellent.However, the repair does usually leave the child with a leaky (insufficient) pulmonary valve. In this situation, after the right ventricle pumps blood out to the pulmonary arteries, some of the blood will flow back into the right ventricle. This creates extra volume in the right ventricle forcing it to work harder and become dilated.In a small percentage of children, this pulmonary insufficiency can lead to diminished function of the right ventricle. Symptoms of fatigue, especially with exercise, may develop. In these cases, replacement of the pulmonary valve is often recommended. Patients who have had repair of tetralogy of Fallot can also redevelop a narrowing at the outflow area or in the branch (left or right) pulmonary arteries, which will cause the right ventricle to pump at abnormally high pressures. If these problems occur, surgical intervention to further widen the outflow tract or pulmonary arteries may be necessary. Narrowing the pulmonary arteries can sometimes be treated without surgery, with balloon dilation of the vessels during cardiac catheterization.
Long-term follow-up with a cardiologist to detect recurrent or new problems as early as possible is essential. Follow-up visits in the cardiology clinic usually consist of a physical examination, periodic echocardiography, and sometimes an exercise stress test or Holter evaluation as a child reaches the teenage and adult years.
Tetralogy of Fallot is most often diagnosed in the first few weeks of life due to either a loud murmur or cyanosis. Babies with tetralogy of Fallot usually have a patent ductus arteriosus at birth that provides additional blood flow to the lungs, so severe cyanosis is rare early after birth.
As the ductus arteriosus closes, which it typically will in the first days of life, cyanosis can develop or become more severe.
The degree of cyanosis is proportional to lung blood flow and thus depends upon the degree of narrowing of the outflow tract to the pulmonary arteries.
Rapid breathing in response to low oxygen levels and reduced pulmonary blood flow can occur. The heart murmur, which is commonly loud and harsh, is often absent in the first few days of life.
The arterial oxygen saturation of babies with tetralogy of Fallot can suddenly drop markedly. This phenomenon, called a "tetralogy spell," usually results from a sudden increased constriction of the outflow tract to the lungs so that pulmonary blood flow is further restricted. The lips and skin of babies who have a sudden decrease in arterial oxygen level will appear acutely more blue.
Children having a tetralogy spell will initially become extremely irritable in response to the critically low oxygen levels, and they may become sleepy or unresponsive if the severe cyanosis persists. A tetralogy spell can sometimes be treated by comforting the infant and flexing the knees forward and upward. Most often, however, immediate medical attention is necessary.
How is tetralogy of Fallot Diagnosed?
When a newborn baby with significant cyanosis is first seen, they are often placed in supplemental oxygen. The increased oxygen improves the child's oxygen levels in cases of lung disease, but breathing extra oxygen will have little effect on the oxygen levels of a child with tetralogy of Fallot.
Failure to respond to this "hyperoxia test" is often the first clue to suspect a cyanotic cardiac defect. Infants with tetralogy of Fallot can have normal oxygen levels if the pulmonary stenosis is mild (referred to as "pink" tetralogy of Fallot). In these children, the first clue to suggest a cardiac defect is detection of a loud murmur when the infant is examined.
Once congenital heart disease is suspected, echocardiography can rapidly and accurately demonstrate the four related defects characteristic of tetralogy of Fallot.
Cardiac catheterization is occasionally required to evaluate the size and distribution of the pulmonary arteries and to clarify the branching patterns of the coronary arteries. Catheterization can also demonstrate whether patients have pulmonary blood flow supplied by an abnormal blood vessel from the aorta (aortopulmonary collateral).
What are treatment options for tetralogy of Fallot?
Once tetralogy of Fallot is diagnosed, the immediate management focuses on determining whether the child's oxygen levels are in a safe range. If oxygen levels are critically low soon after birth, a prostaglandin infusion is usually initiated to keep the ductus arteriosus open which will provide additional pulmonary blood flow and increase the child's oxygen level. These infants will usually require surgical intervention in the neonatal period. Infants with normal oxygen levels or only mild cyanosis are usually able to go home in the first week of life. Complete repair is usually done electively when the children are about six months of age, as long as the oxygen levels remain adequate. Progressive or sudden decreases in oxygen saturation may prompt earlier corrective repair. Surgical correction of the defect is always necessary. Occasionally, patients will require a surgical palliative procedure prior to the final correction. Corrective repair of tetralogy of Fallot involves closure of the ventricular septal defect with a synthetic Dacron patch so that the blood can flow normally from the left ventricle to the aorta. The narrowing of the pulmonary valve and right ventricular outflow tract is then augmented (enlarged) by a combination of cutting away (resecting) obstructive muscle tissue in the right ventricle and by enlarging the outflow pathway with a patch. In some babies, however, the coronary arteries will branch across the right ventricular outflow tract where the patch would normally be placed. In these babies an incision in this area to place the patch would damage the coronary artery so this cannot safely be done. When this occurs, a hole is made in the front surface of the right ventricle (avoiding the coronary artery) and a conduit (tube) is sewn from the right ventricle to the bifurcation of the pulmonary arteries to provide unobstructed blood flow from the right ventricle to the lungs.
What are the results of treatment for tetralogy of Fallot?
Survival of children with tetralogy of Fallot has improved dramatically over recent decades. In the absence of confounding risk factors, more than 95 percent of infants with tetralogy of Fallot successfully undergo surgery in the first year of life. Surgical repair is more difficult when the pulmonary arteries are critically small or when the lung blood flow is supplied predominantly by aortopulmonary collaterals.Most babies are fairly sick in the first few days after surgery, since the right ventricle is "stiff" from the previous hypertrophy (thickness) and because an incision is made into the muscle of the ventricle, making the muscle temporarily weaker. This right ventricular dysfunction usually improves significantly in the days following surgery. Patients may also have rhythm problems after surgery. An abnormally fast rhythm (called junctional tachycardia) may occur and may require treatment with medication or the use of a temporary pacemaker. This abnormal rhythm is usually temporary and the rhythm generally will return to normal as the right ventricle recovers. Patients are also at risk for slow heart rates after surgery due to heart block. Heart block may be caused by injury to or inflammation of the conduction system in the heart. In many patients, the conduction improves and normal rhythm returns. Rarely, a permanent pacemaker may be necessary. Since a normal circulation is produced by the tetralogy of Fallot repair procedure, long-term cardiac function is usually excellent.However, the repair does usually leave the child with a leaky (insufficient) pulmonary valve. In this situation, after the right ventricle pumps blood out to the pulmonary arteries, some of the blood will flow back into the right ventricle. This creates extra volume in the right ventricle forcing it to work harder and become dilated.In a small percentage of children, this pulmonary insufficiency can lead to diminished function of the right ventricle. Symptoms of fatigue, especially with exercise, may develop. In these cases, replacement of the pulmonary valve is often recommended. Patients who have had repair of tetralogy of Fallot can also redevelop a narrowing at the outflow area or in the branch (left or right) pulmonary arteries, which will cause the right ventricle to pump at abnormally high pressures. If these problems occur, surgical intervention to further widen the outflow tract or pulmonary arteries may be necessary. Narrowing the pulmonary arteries can sometimes be treated without surgery, with balloon dilation of the vessels during cardiac catheterization.
Long-term follow-up with a cardiologist to detect recurrent or new problems as early as possible is essential. Follow-up visits in the cardiology clinic usually consist of a physical examination, periodic echocardiography, and sometimes an exercise stress test or Holter evaluation as a child reaches the teenage and adult years.
Congenital Heart Disease
Congenital Heart Disease (CHD)
What is congenital heart
disease (CHD)?
Congenital heart disease (CHD) is malformation of the heart or the large blood
vessels near the heart. "Congenital" speaks only to time, not to causation. It
means "born with" or "present at birth."
Alternative names for CHD
include: congenital heart defect, congenital heart malformation, congenital
cardiovascular disease, congenital cardiovascular defect, and congenital
cardiovascular malformation.
How
common is congenital heart disease?
Congenital heart disease is the most frequent form of major birth defects in
newborns affecting close to 1% of newborn babies (8 per 1,000). This figure is
an underestimate since it does not include some common problems, namely:
Patent ductus arteriosus in
preterm babies (a temporary condition)Bicuspid (two cusps) aortic
valve (the aortic valve usually has three cusps or flaps)
Mitral valve prolapse (drooping of a heart valve)Peripheral pulmonary sten
When is the diagnosis of
congenital heart disease (CHD) usually made?
Although all types of CHD (by definition) are present at birth and therefore
were present before birth, few cases of CHD come to light until birth or
beyond. The diagnosis of CHD is made by one week of age in 40-50% of cases.
And 50-60% of all cases is diagnosed within the newborn period (the first
month of life after birth). The remaining cases are not diagnosed until
after that time.
Why are most cases of CHD
not a problem before birth?
The circulation of blood in the fetus (the fetal circulation) differs from
that after birth. The fetal circulation derives oxygen and nutrients from
the mother through the placenta. The fetal circulation also has important
communications (shunts) between the upper heart chambers and the great blood
vessels near the heart. Consequently, most types of CHD are well tolerated
during fetal life. Even such a severe form of CHD as left heart hypoplasia
(in which the entire left side of the heart is underdeveloped) is
compensated for by the fetal circulation.
The fetal circulation:
The three major features of the fetal circulation are:
The maternal circulation
through the placenta brings oxygen and nutrients to the fetus and
removes carbon dioxide from the fetal circulation.The foramen ovale is a
hole located in the septum (wall) between the two upper heart chambers
(the right and left atria). The foramen allows blood to shunt from the
right atrium to the left atrium.Another shunt, the ductus
arteriosus, allows deoxygenated blood to flow from the pulmonary artery
into the aorta and through it to the body.
The circulation after
birth: The placenta is removed and the lungs have to take over
oxygenating the blood. Major circulatory changes occur after birth.
These changes include:
The maternal circulation
can no longer bring oxygen and remove carbon dioxide from the baby's
circulationThe foramen ovale closes
(or is restricted) and can no longer act as a shunt between the two
atria (the two upper chambers) of the heartThe ductus arteriosus
closes and no longer provides a communication between the pulmonary
artery and aorta
Once these changes occur, the
fetal circulation is a thing of the past and the full impact of various
congenital heart defects is felt. These defects become evident, cause signs
and symptoms and so may be diagnosed. Further changes occur in the
cardiovascular system during infancy and childhood as, for example, in the
pressure relationships between the right and left ventricles. These changes
serve to bring more cases of CHD to light.
What causes congenital
heart defects?
Congenital heart disease can have diverse causes. The causes include
environmental factors (such as chemicals, drugs or infections), certain
maternal diseases, chromosome abnormalities, genetic diseases, and unknown
(idiopathic) factors.
Environmental factors
sometimes are at fault. For example, if a mother catches German
measles (rubella) during pregnancy, the infection can impair the
development of her unborn baby's heart (and other organs). If the mother
consumes alcohol during pregnancy, the fetus can suffer from
fetal alcohol syndrome (FAS) including CHD.
Exposure to certain
medications during pregnancy can also cause CHD. An example is retinoic acid
(brand name Accutane) which is used for
acne.
Other examples are anticonvulsant drugs, specifically the hydantoins (such
as Dilantin) and valproate.
Certain diseases in the
mother can increase the risk of developing CHD in the fetus. The infants of
women with
diabetes mellitus, especially those women under less than optimal blood
glucose control during pregnancy, are at increased risk for CHD. And
women who have the genetic disease
phenylketonuria (PKU) and do not stay on their special diet during
pregnancy tend also to have babies with CHD (and many other problems as
well).
Chromosome disorders can
cause congenital heart disease. (The chromosomes contain the genetic
material, the DNA, with each person normally having 46 chromosomes, 23
chromosomes from each parent). About 3% of all children with CHD have a
detectable chromosome abnormality.
A common chromosome
abnormality causing CHD is Down's syndrome (trisomy 21, that is, an extra
chromosome # 21. About half of children with
Down syndrome have CHD.
Other autosomal (non-sex)
chromosome abnormalities associated with CHD include trisomy 13 (Patau
syndrome) and trisomy 18 (Edwards syndrome). Although less common than Down
syndrome, these trisomies carry an even higher risk of CHD.
A sex chromosome abnormality
with only one X chromosome (45,X) causes
Turner syndrome and a 40% risk of CHD.
Genetic factors can cause CHD.
About 5% of CHD babies have an identifiable genetic disease. Genetic
diseases associated with an increased risk of CHD include Apert syndrome,
Carpenter syndrome, Conradi syndrome, Crouzon syndrome, cutis laxa, Cornelia
de Lange syndrome, Ellis-van Creveld syndrome, Holt-Oram (cardiac-limb)
syndrome, Kartagener syndrome, Meckel-Gruber syndrome,
Noonan syndrome Pallister-Hall syndrome, Rubinstein-Taybi syndrome,
Scimitar syndrome, Smith-Lemli-Opitz syndrome, thrombocytopenia-absent
radius (TAR) syndrome, Treacher Collins syndrome, and Williams syndrome,
etc. (The point here is not for you to learn all the entities just listed
but to know that there are many genes capable of contributing to CHD).
Idiopathic: in the
majority of children with CHD, the cause of the CHD is totally unknown. It
is idiopathic (cause unknown).A number of syndromes of unknown origin are
associated with CHD including:
Alagille syndrome (arteriohepatic
dysplasia)Asplenia syndrome (no
spleen)CHARGE association
(CHARGE is an acronym for Coloboma, Heart, Atresia choanae, Retardation,
Genital anomalies, and Ear anomalies)CHILD association (CHILD
is an acronym for Congenital Hemidysplasia, Ichthyosiform erythroderma,
and Limb Defects)DiGeorge sequence
FAVS spectrum (FAVS is an
acronym for Facio-Auriculo-Vertebral Spectrum)Mullibrey nanism (Mullibrey
is an acronym for MUscle, Liver, BRain, and EYe)Polysplenia syndrome
(multiple spleens)VATER association (VATER
is an acronym for Venticular septal defect or Vertebral defect, Anal,
TracheoEsophageal, and Renal anomalies)
What Are the Signs of Heart Disease?
You know how important your heart
is, so it's no wonder people worry when they hear someone has heart problems.
Heart disease, also called
cardiovascular (say: kar-dee-oh-vas-kyoo-lur) disease, mainly
affects older people and means that there are problems with the heart and blood
vessels.
You might know someone who has
cardiovascular disease because 61 million Americans have some form of it. This
disease includes a variety of problems, including high blood pressure, high
blood cholesterol, hardening of the arteries, chest pain, heart attacks, and
strokes.
What Is Heart Disease?
The
heart is the
center of the cardiovascular system. Through the body's blood vessels, the heart
pumps blood to all of the body's cells. The blood carries oxygen, which the
cells need. Cardiovascular disease is a group of problems that occur when the
heart and blood vessels aren't working the way they should.
Here are some of the problems
that go along with cardiovascular disease:
Arteriosclerosis
(say: ar-teer-ee-oh-skluh-row-sus). Also called hardening of
the arteries, arteriosclerosis means the arteries become thickened and are no
longer as flexible.Atherosclerosis
(say: ah-thuh-row-skluh-row-sus). People with atherosclerosis
have a buildup of cholesterol and fat that makes their arteries narrower so
less blood can flow through. Those deposits are called plaque.Angina (say:
an-jy-nuh). People with angina feel a pain in the chest that
means the heart isn't getting enough blood.Heart attack.
This is when a blood clot or other blockage cuts blood flow to a part of the
heart.Stroke. when
part of the brain doesn't get enough blood due to a clot or a burst blood
vessel.
How Do You Get Heart Disease?
Heart disease is not contagious —
you can't catch it like you can the flu or a cold. Instead, there are certain
things that increase a person's chances of getting cardiovascular disease.
Doctors call these things risk factors.
Some of these risk factors a
person can't do anything about, like being older and having other people in the
family who have had the same problems. But people do have control over some risk
factors — smoking, having high blood pressure, being overweight, and not
exercising can increase the risk of getting cardiovascular disease.
What Are the Signs of Heart
Disease?
Many people do not realize they
have cardiovascular disease until they have chest pain, a heart attack, or
stroke. These kinds of problems often need immediate attention and the person
may need to go to the emergency department of a hospital.
If it's not an emergency and a
doctor suspects the person could have cardiovascular disease, the doctor can do
some tests to find out more about how the heart and blood vessels are working.
These tests include:
Electrocardiogram
(say: eh-lek-tro-kar-dee-uh-gram). This test records the
heart's electrical activity. A doctor puts the patient on a monitor and
watches the machine to see the heart beat and determine if it's normal.Echocardiogram
(say: eh-ko-kar-dee-uh-gram). This test uses sound waves to
diagnose heart problems. These waves are bounced off the parts of the heart,
creating a picture of the heart that is displayed on a monitor.Stress test.
For this test, the person exercises while the doctor checks the
electrocardiogram machine to see how the heart muscle reacts.Catheterization
(say: kah-thuh-tuh-ruh-zay-shun). This test uses a long, thin
tube that is inserted into the patient's body to inject a special dye. It can
locate narrowed areas in arteries due to plaque buildup and find other
problems.Carotid (say:
kuh-rah-tid) artery scan. This test uses sound waves to check
for blockages in the carotid artery, a large blood vessel in the neck that
supplies blood to the brain.
If the doctor finds that a
patient has cardiovascular disease, he or she will talk with the patient about
how stopping smoking, losing weight, eating a healthy diet, and getting exercise
can help. The person also may need to take medicine, have surgery, or both.
There are different surgeries for
the heart and blood vessels. These include:
Angioplasty
(say: an-jee-uh-plas-tee). This opens a blocked vessel by
using a balloon-like device at an artery's narrowest point. The doctor may
also insert a stent, which is a tiny, stainless steel tube that props the
vessel open and makes sure it stays clear.Atherectomy
(say: ah-thuh-rek-tuh-mee). This involves cutting the plaque
out of an artery, so blood can flow freely.Bypass surgery.
This involves taking part of an artery or vein from another part of the body
(like the arm or leg) and using it to channel blood around a blocked area in
an artery.Pacemakers. A
pacemaker is a small electronic device that's put inside the body to regulate
the heartbeat.Valve replacement.
If a heart valve is damaged or isn't working, a surgeon can replace it.Carotid endarterectomy
(say: en-dar-tuh-rek-tuh-me). During this procedure, a
surgeon removes plaque deposits from the carotid artery to prevent a stroke.
If someone you know is getting
one of these operations, you might feel worried. The good news is that these
surgeries can help prevent heart attacks, strokes, and other problems. The
amount of time the person will need to spend in the hospital will vary,
depending on the operation and the person's health. The person may be tired and
worn out after the surgery, but you can help by making a "Get Well" card and
paying a visit.
Can Kids Get Heart Disease?
Kids usually don't have any
symptoms of heart and blood vessel problems. But by starting heart-healthy
habits right now, kids can reduce the chance they will ever need to worry about
cardiovascular disease.
So what should you do? Don't
smoke, for one. And be sure to eat healthy, exercise, and maintain a healthy
weight. Your heart and blood vessels will thank you later!
The role of inflammation in coronary artery disease
The role of inflammation in coronary artery disease
The year 2000 marks the year in which the link between inflammation and coronary artery disease gained widespread recognition among cardiologists.
Several lines of evidence converged last year to suggest that atherosclerosis, unstable angina and heart attacks are all associated with inflammation of the coronary arteries. This evidence includes the following:
- Elevated levels of C-reactive protein (CRP), a protein that appears in the bloodstream during many inflammatory processes, are associated with acute coronary events. (See CRP and fibrinogen – newer risk factors for coronary artery disease.)
- Patients with acute heart attacks who also have elevated white blood cell counts (the white cells are produced in response to inflammation and infection) were found to have poorer outcomes (increased risk of heart failure and death) than patients with normal white blood cell counts.
- Older patients (> 65) who had antibodies to the herpes simplex virus had an increased risk of heart attack and cardiac death.
- DNA to the bacteria Chlamydia pneumoniae was found in a certain type of white blood cell (the CD3+ lymphocytes) in a high proportion of patients with coronary artery disease. The CD3+ lymphocytes are known to accumulate in atherosclerotic plaques.
These observations have sealed the now generally-accepted notion that vascular inflammation is an important component of coronary artery disease, and have opened many brand new lines of research into novel approaches to the prevention and treatment of coronary artery disease.
The efficacy of the statin drugs and aspirin in reducing the incidence of acute coronary events, for instance, may be related, at least in part, to their anti-inflammatory effects in addition to the cholesterol-lowering effect of statins, and the anti-clotting effect of aspirin.
And, seeing the pot of gold at the end of the rainbow, the pharmaceutical industry is now investing tens of millions of dollars in exploiting the new line of evidence that inflammation plays a major role in causing heart attacks. The clinical payoff from this important conceptual advance in coronary artery disease should begin to appear quite soon.
The year 2000 marks the year in which the link between inflammation and coronary artery disease gained widespread recognition among cardiologists.
Several lines of evidence converged last year to suggest that atherosclerosis, unstable angina and heart attacks are all associated with inflammation of the coronary arteries. This evidence includes the following:
- Elevated levels of C-reactive protein (CRP), a protein that appears in the bloodstream during many inflammatory processes, are associated with acute coronary events. (See CRP and fibrinogen – newer risk factors for coronary artery disease.)
- Patients with acute heart attacks who also have elevated white blood cell counts (the white cells are produced in response to inflammation and infection) were found to have poorer outcomes (increased risk of heart failure and death) than patients with normal white blood cell counts.
- Older patients (> 65) who had antibodies to the herpes simplex virus had an increased risk of heart attack and cardiac death.
- DNA to the bacteria Chlamydia pneumoniae was found in a certain type of white blood cell (the CD3+ lymphocytes) in a high proportion of patients with coronary artery disease. The CD3+ lymphocytes are known to accumulate in atherosclerotic plaques.
These observations have sealed the now generally-accepted notion that vascular inflammation is an important component of coronary artery disease, and have opened many brand new lines of research into novel approaches to the prevention and treatment of coronary artery disease.
The efficacy of the statin drugs and aspirin in reducing the incidence of acute coronary events, for instance, may be related, at least in part, to their anti-inflammatory effects in addition to the cholesterol-lowering effect of statins, and the anti-clotting effect of aspirin.
And, seeing the pot of gold at the end of the rainbow, the pharmaceutical industry is now investing tens of millions of dollars in exploiting the new line of evidence that inflammation plays a major role in causing heart attacks. The clinical payoff from this important conceptual advance in coronary artery disease should begin to appear quite soon.
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