Problems with the cardiovascular system are common — more than 64 million Americans have some type of cardiac problem. But cardiovascular problems don't just affect older people — many heart and circulatory system problems affect children and teens, too. Heart and circulatory problems are grouped into two categories: congenital, which means the problems were present at birth, and acquired, which means that the problems developed some time during infancy, childhood, adolescence, or adulthood. A unique electrical conduction system in the heart causes it to beat in its regular rhythm. The sinoatrial or SA node, a small area of tissue in the wall of the right atrium, sends out an electrical signal to start the contracting of the heart muscle. This node is called the pacemaker of the heart because it sets the rate of the heartbeat and causes the rest of the heart to contract in its rhythm.
These electrical impulses cause the atria to contract first, and then travel down to the atrioventricular or AV node, which acts as a kind of relay station. From here the electrical signal travels through the right and left ventricles, causing them to contract and forcing blood out into the major arteries. In the systemic circulation, blood travels out of the left ventricle, to the aorta, to every organ and tissue in the body, and then back to the right atrium. The arteries, capillaries, and veins of the systemic circulatory system are the channels through which this long journey takes place. Once in the arteries, blood flows to smaller arterioles and then to capillaries. While in the capillaries, the bloodstream delivers oxygen and nutrients to the body's cells and picks up waste materials. Blood then goes back through the capillaries into venules, and then to larger veins until it reaches the vena cavae.
Blood from the head and arms returns to the heart through the superior vena cava, and blood from the lower parts of the body returns through the inferior vena cava. Both vena cavae deliver this oxygen-depleted blood into the right atrium. From here the blood exits to fill the right ventricle, ready to be pumped into the pulmonary circulation for more oxygen. In the pulmonary circulation, blood low in oxygen but high in carbon dioxide is pumped out the right ventricle into the pulmonary artery, which branches off in two directions. The right branch goes to the right lung, and vice versa. In the lungs, the branches divide further into capillaries. Blood flows more slowly through these tiny vessels, allowing time for gases to be exchanged between the capillary walls and the millions of alveoli, the tiny air sacs in the lungs. During the process called oxygenation, oxygen is taken up by the bloodstream. Oxygen locks onto a molecule called hemoglobin in the red blood cells. The newly oxygenated blood leaves the lungs through the pulmonary veins and heads back to the heart. It enters the heart in the left atrium, then fills the left ventricle so it can be pumped into the systemic circulation.
Congenital heart defects. Congenital heart defects are abnormalities in the heart's structure that are present at birth. Approximately 8 out of every 1,000 newborns have congenital heart defects ranging from mild to severe. These defects occur while the fetus is developing in the mother's uterus and it's not usually known why they occur. Some congenital heart defects are caused by genetic disorders, but most are not. What all congenital heart defects have in common, however, is that they involve abnormal or incomplete development of the heart. A common sign of a congenital heart defect is a heart murmur — an abnormal sound (like a blowing or whooshing sound) that's heard when listening to the heart. Usually a heart murmur is detected by a doctor who's listening to the heart with a stethoscope during a routine exam. Murmurs are very common in children and can be caused by congenital heart defects or other heart conditions.
Wednesday, March 4, 2009
CIRCULATORY SYSTEM IN THE HEART
The heart has four chambers that are enclosed by thick, muscular walls. It lies between the lungs and just to the left of the middle of the chest cavity. The bottom part of the heart is divided into two chambers called the right and left ventricles, which pump blood out of the heart. A wall called the interventricular septum divides the ventricles. The upper part of the heart is made up of the other two chambers of the heart, the right and left atria. The right and left atria receive the blood entering the heart. A wall called the interatrial septum divides the right and left atria, which are separated from the ventricles by the atrioventricular valves. The tricuspid valve separates the right atrium from the right ventricle, and the mitral valve separates the left atrium and the left ventricle.Two other cardiac valves separate the ventricles and the large blood vessels that carry blood leaving the heart. These are the pulmonic valve, which separates the right ventricle from the pulmonary artery leading to the lungs, and the aortic aortic valve, which separates the left ventricle from the aorta, the body's largest blood vessel.
Two other cardiac valves separate the ventricles and the large blood vessels that carry blood leaving the heart. These are the pulmonic valve, which separates the right ventricle from the pulmonary artery leading to the lungs, and the aortic valve, which separates the left ventricle from the aorta, the body's largest blood vessel.Arteries carry blood away from the heart. They are the thickest blood vessels, with muscular walls that contract to keep the blood moving away from the heart and through the body. In the systemic circulation, oxygen-rich blood is pumped from the heart into the aorta. This huge artery curves up and back from the left ventricle, then heads down in front of the spinal column into the abdomen. Two coronary arteries branch off at the beginning of the aorta and divide into a network of smaller arteries that provide oxygen and nourishment to the muscles of the heart. Unlike the aorta, the body's other main artery, the pulmonary artery, carries oxygen-poor blood. From the right ventricle, the pulmonary artery divides into right and left branches, on the way to the lungs where blood picks up oxygen.
Veins carry blood back to the heart. They're not as muscular as arteries, but they contain valves that prevent blood from flowing backward. Veins have the same three layers that arteries do, but are thinner and less flexible. The two largest veins are the superior and inferior vena cavae. The terms superior and inferior don't mean that one vein is better than the other, but that they're located above and below the heart. A network of tiny capillaries connects the arteries and veins. Though tiny, the capillaries are one of the most important parts of the circulatory system because it's through them that nutrients and oxygen are delivered to the cells. In addition, waste products such as carbon dioxide are also removed by the capillaries. The circulatory system works closely with other systems in our bodies. It supplies oxygen and nutrients to our bodies by working with the respiratory system. At the same time, the circulatory system helps carry waste and carbon dioxide out of the body.
Two other cardiac valves separate the ventricles and the large blood vessels that carry blood leaving the heart. These are the pulmonic valve, which separates the right ventricle from the pulmonary artery leading to the lungs, and the aortic valve, which separates the left ventricle from the aorta, the body's largest blood vessel.Arteries carry blood away from the heart. They are the thickest blood vessels, with muscular walls that contract to keep the blood moving away from the heart and through the body. In the systemic circulation, oxygen-rich blood is pumped from the heart into the aorta. This huge artery curves up and back from the left ventricle, then heads down in front of the spinal column into the abdomen. Two coronary arteries branch off at the beginning of the aorta and divide into a network of smaller arteries that provide oxygen and nourishment to the muscles of the heart. Unlike the aorta, the body's other main artery, the pulmonary artery, carries oxygen-poor blood. From the right ventricle, the pulmonary artery divides into right and left branches, on the way to the lungs where blood picks up oxygen.
Veins carry blood back to the heart. They're not as muscular as arteries, but they contain valves that prevent blood from flowing backward. Veins have the same three layers that arteries do, but are thinner and less flexible. The two largest veins are the superior and inferior vena cavae. The terms superior and inferior don't mean that one vein is better than the other, but that they're located above and below the heart. A network of tiny capillaries connects the arteries and veins. Though tiny, the capillaries are one of the most important parts of the circulatory system because it's through them that nutrients and oxygen are delivered to the cells. In addition, waste products such as carbon dioxide are also removed by the capillaries. The circulatory system works closely with other systems in our bodies. It supplies oxygen and nutrients to our bodies by working with the respiratory system. At the same time, the circulatory system helps carry waste and carbon dioxide out of the body.
HEART RELATED ILLNESS RECOGNIZING AND TREATING
Heat-related illnesses, such as heat exhaustion and heat stroke, can be problems for people enjoying outdoor activities in the hot summer months. A heat-related illness occurs when the body is not able to regulate (control) its temperature. If left untreated, a heat illness can lead to serious complications, even death. If detected and treated early, however, most serious problems stemming from heat-related illnesses can be avoided. The body’s main center for heat regulation is the hypothalamus, a part of the brain that secretes substances that control metabolism (the chemical processes occurring in the body). Normal body temperature is balanced through heat production and heat loss. As a person is exposed to high heat and humidity, the body temperature rises. Most of the body’s methods for heat loss depend on the environmental, or outside, temperature being lower than the body’s temperature. When the outside temperature is high, the main source of heat loss is evaporation, when perspiration on the skin changes from liquid to vapor. If humidity if high, however, sweat cannot evaporate easily.
Heat cramps are muscle pains or spasms that may occur with strenuous activity. They usually affect the muscles of the abdomen, arms or legs. Heat cramps usually affect people who sweat a lot during strenuous activity. They also may be a symptom of heat exhaustion. Heat exhaustion is a heat-related illness that can develop after spending a long time in high temperatures and not drinking enough fluids. Elderly people, people with high blood pressure, and people working or exercising in a hot environment are most at risk for heat exhaustion. Heat stroke is a more severe heat-related illness. It results from the total failure of the body’s heat regulation system. This occurs when the body’s temperature rises rapidly, the sweating system fails and the body cannot cool down. Heat stroke is a medical emergency. It can cause permanent disability or even death.
Heat stroke is a medical emergency. If you suspect heat stroke, have someone call for immediate medical help while you try to reduce the person’s temperature. Try the following cooling methods are Stop any activity and take the person to a cool place, such as a shaded area or air-conditioned room. Have the person lie down with the feet slightly elevated. Place the person in a cool bath or shower. Spray the person with cool water from a hose, or sponge the person with cool water. Wrap the person in a cool, damp sheet and fan the person vigorously. Apply ice packs to the groin and armpits.Give the person something cool and non-alcoholic to drink.
Carefully monitor the temperature and humidity outdoors, and plan your activities accordingly. Try to schedule outdoor activities during cooler parts of the day. Stay in the shade as much as possible. Be sure to drink plenty of fluids to be sure you are taking in more than you are losing through sweat. Mist yourself with a spray bottle to keep yourself cool. Wear lightweight loose-fitting and light-colored clothing. Light-colored clothing absorbs less heat than dark clothing. Protect yourself from the sun by wearing a hat and sunglasses, and using an umbrella. If participating in sports, be sure to re-hydrate between multiple-session practices or at halftime during games. Illness related is eliminated by Dehydration, Wearing heavy equipment, such as pads and helmets, when practicing sports outdoors, Obesity, Alcohol use, Drug use, Some medications and supplements, Not being acclimated to hot weather, Illness/fever .
Heat cramps are muscle pains or spasms that may occur with strenuous activity. They usually affect the muscles of the abdomen, arms or legs. Heat cramps usually affect people who sweat a lot during strenuous activity. They also may be a symptom of heat exhaustion. Heat exhaustion is a heat-related illness that can develop after spending a long time in high temperatures and not drinking enough fluids. Elderly people, people with high blood pressure, and people working or exercising in a hot environment are most at risk for heat exhaustion. Heat stroke is a more severe heat-related illness. It results from the total failure of the body’s heat regulation system. This occurs when the body’s temperature rises rapidly, the sweating system fails and the body cannot cool down. Heat stroke is a medical emergency. It can cause permanent disability or even death.
Heat stroke is a medical emergency. If you suspect heat stroke, have someone call for immediate medical help while you try to reduce the person’s temperature. Try the following cooling methods are Stop any activity and take the person to a cool place, such as a shaded area or air-conditioned room. Have the person lie down with the feet slightly elevated. Place the person in a cool bath or shower. Spray the person with cool water from a hose, or sponge the person with cool water. Wrap the person in a cool, damp sheet and fan the person vigorously. Apply ice packs to the groin and armpits.Give the person something cool and non-alcoholic to drink.
Carefully monitor the temperature and humidity outdoors, and plan your activities accordingly. Try to schedule outdoor activities during cooler parts of the day. Stay in the shade as much as possible. Be sure to drink plenty of fluids to be sure you are taking in more than you are losing through sweat. Mist yourself with a spray bottle to keep yourself cool. Wear lightweight loose-fitting and light-colored clothing. Light-colored clothing absorbs less heat than dark clothing. Protect yourself from the sun by wearing a hat and sunglasses, and using an umbrella. If participating in sports, be sure to re-hydrate between multiple-session practices or at halftime during games. Illness related is eliminated by Dehydration, Wearing heavy equipment, such as pads and helmets, when practicing sports outdoors, Obesity, Alcohol use, Drug use, Some medications and supplements, Not being acclimated to hot weather, Illness/fever .
HEART BLOCKS
The heart’s rhythm is coordinated by its own electrical system. With each heartbeat, the electrical impulse begins at the sinus (or sinoatrial, SA) node, also called the heart’s natural pacemaker. The SA node is a cluster of specialized cells, located in the right atrium. The SA node produces the electrical impulses that set the rate and rhythm of your heartbeat. The impulse spreads through the walls of the right and left atria, causing them to contract, forcing blood into the ventricles. The impulse then reaches the atrioventricular (AV) node, which acts as an electrical bridge allowing impulses to travel from the atria to the ventricles. There is a short delay before the impulse travels on to the ventricles. From the AV node, the impulse travels through a pathway of fibers called the HIS-Purkinje system. This network sends the impulse into the muscular walls of the ventricles and causes them to contract. This contraction forces blood out of the heart to the lungs and body.
You can tell how fast your heart is beating by feeling your pulse. You can feel your pulse on your wrist or neck. Place the tips of your index and middle fingers on the inner wrist of your other arm, just below the base of your thumb. Or, place the tips of your index and middle fingers on your lower neck, on either side of your windpipe. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may need to move your fingers around slightly up or down until you feel the pulsing. Your heart rate, or pulse, is the number of beats felt in one minute. You can count the number of beats in 10 seconds and multiply by 6 to determine your heart rate in beats per minute. A normal heart rate, at rest, is 50 to 100 beats per minute. The normal heart rhythm (also called normal sinus rhythm) shows the electrical activity in the heart is following the normal pathway, the rhythm is regular and the node is normal (about 50 to 100 beats per minute).
Premature ventricular contractions (PVCs) - are early, extra beats beginning in the lower chambers of the heart (ventricles). PVCs are common. Most of the time they cause no symptoms and require no treatment. In some people, they can be related to stress, too much caffeine or nicotine, or exercise. But sometimes, PVCs can be caused by heart disease or an electrolyte imbalance. If you have a lot of PVCs and/or arrhythmia symptoms associated with them (see the symptoms listed on page 8), you should be evaluated by a cardiologist. Ventricular tachycardia (V-tach) - a rapid rhythm originating from the lower chambers of the heart. This rapid rate prevents the heart from filling adequately with blood, and less blood is pumped through the body. This can be a more serious arrhythmia, especially in people with heart disease, and may be associated with more symptoms. A cardiologist should evaluate this arrhythmia condition.
Long QT - the QT interval is the area on the electrocardiogram (ECG or EKG) that represents the time it takes for the heart muscle to contract and then recover, or for the electrical impulse to fire and then recharge. When the QT interval is longer than normal, it increases the risk for “torsades de pointes,” a life-threatening form of ventricular tachycardia. Arrhythmias may have many causes, including coronary artery disease, changes in the heart muscle (heart failure or cardiomyopathy), valve disease, electrolyte imbalances in your blood (such as sodium or potassium), injury from a heart attack or the healing process after heart surgery. A fast or slow heart rate does not always mean your heart rhythm is abnormal. Fast or slow heart rates are also related to anxiety, activity, medications or other normal causes.
You can tell how fast your heart is beating by feeling your pulse. You can feel your pulse on your wrist or neck. Place the tips of your index and middle fingers on the inner wrist of your other arm, just below the base of your thumb. Or, place the tips of your index and middle fingers on your lower neck, on either side of your windpipe. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may need to move your fingers around slightly up or down until you feel the pulsing. Your heart rate, or pulse, is the number of beats felt in one minute. You can count the number of beats in 10 seconds and multiply by 6 to determine your heart rate in beats per minute. A normal heart rate, at rest, is 50 to 100 beats per minute. The normal heart rhythm (also called normal sinus rhythm) shows the electrical activity in the heart is following the normal pathway, the rhythm is regular and the node is normal (about 50 to 100 beats per minute).
Premature ventricular contractions (PVCs) - are early, extra beats beginning in the lower chambers of the heart (ventricles). PVCs are common. Most of the time they cause no symptoms and require no treatment. In some people, they can be related to stress, too much caffeine or nicotine, or exercise. But sometimes, PVCs can be caused by heart disease or an electrolyte imbalance. If you have a lot of PVCs and/or arrhythmia symptoms associated with them (see the symptoms listed on page 8), you should be evaluated by a cardiologist. Ventricular tachycardia (V-tach) - a rapid rhythm originating from the lower chambers of the heart. This rapid rate prevents the heart from filling adequately with blood, and less blood is pumped through the body. This can be a more serious arrhythmia, especially in people with heart disease, and may be associated with more symptoms. A cardiologist should evaluate this arrhythmia condition.
Long QT - the QT interval is the area on the electrocardiogram (ECG or EKG) that represents the time it takes for the heart muscle to contract and then recover, or for the electrical impulse to fire and then recharge. When the QT interval is longer than normal, it increases the risk for “torsades de pointes,” a life-threatening form of ventricular tachycardia. Arrhythmias may have many causes, including coronary artery disease, changes in the heart muscle (heart failure or cardiomyopathy), valve disease, electrolyte imbalances in your blood (such as sodium or potassium), injury from a heart attack or the healing process after heart surgery. A fast or slow heart rate does not always mean your heart rhythm is abnormal. Fast or slow heart rates are also related to anxiety, activity, medications or other normal causes.
HAY FEVER CAUSED BY HEART DISEASE
Just about everyone knows what hay fever is - the seasonal itching, sneezing, and runny nose caused by the type of pollen that happens to be in the air at the time. But what most people don’t know is that hay fever is just one manifestation of a more basic condition called allergic rhinitis. Whenever a stuffy nose, dark circles under the eyes, or post-nasal drip persists as a chronic condition, allergic rhinitis could be the cause. In fact, this condition affects approximately 10% of the U.S. population (roughly 30 million people) and is the most common allergic disorder in the country. No one knows why some people suffer from allergies and others do not. Some evidence suggests that allergies could be a hereditary trait. Other evidence links allergic rhinitis to asthma and eczema. People who suffer from these diseases are more likely to develop allergic rhinitis, too. Allergic rhinitis is an allergic reaction of the upper respiratory system to a substance called an allergen, which is anything that causes an allergy. These reactions will occur either seasonally or perennially.
Trees tend to be the cause of symptoms in the spring. Grasses tend to be the culprits in the summer, and ragweed and other weeds tend to be the problem in the fall. Fungi are suspect over a much longer period because they release their spores from late March until November. Weather influences the severity of allergy symptoms because it affects the daily pollen count. Pollen counts tend to be at their highest on warm, dry, and breezy mornings and at their lowest on rainy, cool days. Generally, the severity of your allergic reaction will correspond to the rise and fall of the pollen count. As the name suggests, perennial rhinitis occurs all year round. Its cause is allergens whose production is not tied to any seasonal cycle. Common examples are dust mites, animal dander, and molds. These allergens can aggregate in pillows, down-filled clothing and bedding, draperies, upholstery, thick carpeting, and shower curtains. Symptoms will be steady if you come into contact with the allergen daily, but they can come and go if your contact with it is only intermittent. It also is possible for a sustained reaction to a perennial allergen to mask a seasonal allergy.
The symptoms of allergic rhinitis are the result of your immune system protecting itself from what it perceives as an invading substance. Most evidence suggests that genetics determine whether your body will mount this kind of defense. This allergic response begins with the production of allergic (IgE) antibodies. The job of these antibodies is to find molecules of the offending substance in the bloodstream and tissues and to escort them to the body’s mast cells for destruction. As the mast cells destroy the allergens, a chemical called histamine is released into the bloodstream and certain mucous membranes (specifically, the lining of the nose or eyes). Histamine inflames the sinuses and eyelids, making them red and swollen. It also triggers the sneezing reflex. The swelling is designed to block more of the allergens from entering the body, and sneezing is a method of expelling them. Histamine also causes itching and permits fluids to enter the nasal tissue, resulting in congestion and a runny nose.
Effective drug therapies include antihistamines, topical nasal steroids, and certain decongestants, many of which are available over the counter. Antihistamines are effective at treating allergic rhinitis because they block the actions of the histamine produced by the allergic reaction. Most of the older generation that are available over the counter, however, can cause drowsiness. For this reason, do not take them when you plan on driving a car, operating heavy equipment, drinking alcohol, or taking other drugs that also cause drowsiness. The newer antihistamines do not cause drowsiness in most cases. Loratidine (Claritin) is one antihistamine that is available over-the-counter. Others, such as fexofenadine (Allegra) and cetirizine (Zyrtec) are available. The other major effective drug therapy for allergic rhinitis is nasal steroids. These medications relieve symptoms because they counteract the inflammation caused by the allergic reaction. Prescription nasal steroids include such drugs as fluticasone (Flovent), mometasone (Nasonex), budesonide (Rhinocort), and beclomethasone (Vanceril).
Allergen immunotherapy, commonly known as allergy shots, is a technique designed to increase your tolerance to the substances that cause allergy symptoms. It desensitizes you to your allergens, allowing you to tolerate the offending agents. Physicians usually recommend it for people who either do not get good results with medications or do not tolerate them. During the treatments, an allergen is injected periodically into your body in increasingly larger amounts until an effective dose, called the maintenance dose, is reached. The maintenance dose is given at intervals over three to five years to induce a tolerance to the allergen. In most cases, immunotherapy is very effective at reducing or preventing the development of allergy symptoms whenever you come into contact with the allergen. It usually reduces and often eliminates the need for medications. The effects are long-term for most people who complete an adequate course of allergen immunotherapy.
Trees tend to be the cause of symptoms in the spring. Grasses tend to be the culprits in the summer, and ragweed and other weeds tend to be the problem in the fall. Fungi are suspect over a much longer period because they release their spores from late March until November. Weather influences the severity of allergy symptoms because it affects the daily pollen count. Pollen counts tend to be at their highest on warm, dry, and breezy mornings and at their lowest on rainy, cool days. Generally, the severity of your allergic reaction will correspond to the rise and fall of the pollen count. As the name suggests, perennial rhinitis occurs all year round. Its cause is allergens whose production is not tied to any seasonal cycle. Common examples are dust mites, animal dander, and molds. These allergens can aggregate in pillows, down-filled clothing and bedding, draperies, upholstery, thick carpeting, and shower curtains. Symptoms will be steady if you come into contact with the allergen daily, but they can come and go if your contact with it is only intermittent. It also is possible for a sustained reaction to a perennial allergen to mask a seasonal allergy.
The symptoms of allergic rhinitis are the result of your immune system protecting itself from what it perceives as an invading substance. Most evidence suggests that genetics determine whether your body will mount this kind of defense. This allergic response begins with the production of allergic (IgE) antibodies. The job of these antibodies is to find molecules of the offending substance in the bloodstream and tissues and to escort them to the body’s mast cells for destruction. As the mast cells destroy the allergens, a chemical called histamine is released into the bloodstream and certain mucous membranes (specifically, the lining of the nose or eyes). Histamine inflames the sinuses and eyelids, making them red and swollen. It also triggers the sneezing reflex. The swelling is designed to block more of the allergens from entering the body, and sneezing is a method of expelling them. Histamine also causes itching and permits fluids to enter the nasal tissue, resulting in congestion and a runny nose.
Effective drug therapies include antihistamines, topical nasal steroids, and certain decongestants, many of which are available over the counter. Antihistamines are effective at treating allergic rhinitis because they block the actions of the histamine produced by the allergic reaction. Most of the older generation that are available over the counter, however, can cause drowsiness. For this reason, do not take them when you plan on driving a car, operating heavy equipment, drinking alcohol, or taking other drugs that also cause drowsiness. The newer antihistamines do not cause drowsiness in most cases. Loratidine (Claritin) is one antihistamine that is available over-the-counter. Others, such as fexofenadine (Allegra) and cetirizine (Zyrtec) are available. The other major effective drug therapy for allergic rhinitis is nasal steroids. These medications relieve symptoms because they counteract the inflammation caused by the allergic reaction. Prescription nasal steroids include such drugs as fluticasone (Flovent), mometasone (Nasonex), budesonide (Rhinocort), and beclomethasone (Vanceril).
Allergen immunotherapy, commonly known as allergy shots, is a technique designed to increase your tolerance to the substances that cause allergy symptoms. It desensitizes you to your allergens, allowing you to tolerate the offending agents. Physicians usually recommend it for people who either do not get good results with medications or do not tolerate them. During the treatments, an allergen is injected periodically into your body in increasingly larger amounts until an effective dose, called the maintenance dose, is reached. The maintenance dose is given at intervals over three to five years to induce a tolerance to the allergen. In most cases, immunotherapy is very effective at reducing or preventing the development of allergy symptoms whenever you come into contact with the allergen. It usually reduces and often eliminates the need for medications. The effects are long-term for most people who complete an adequate course of allergen immunotherapy.
ANAPHYLAXIS IN THE HEART
Anaphylaxis is a severe, life-threatening allergic response. The immune system creates specific immunoglobulin E (IgE) antibodies towards a substance that is normally harmless. The body becomes sensitized to this substance, but when the person is exposed to it again, the IgE antibodies recognize this substance and activate immune cells to release large amounts of inflammatory substances, including histamine. These substances can cause the symptoms of anaphylaxis, which may include swelling, hives, lowered blood pressure, shortness of breath, wheezing, difficulty swallowing, and loss of consciousness. In severe cases, a person will go into anaphylactic shock. Blood pressure drops severely and swelling occurs in the bronchial tissues, causing symptoms of choking and loss of consciousness. If anaphylactic shock isn't treated immediately, it can be fatal.
Food allergy is a recognized cause of anaphylaxis--especially peanuts, tree nuts (for example, walnuts, hazelnuts, Brazil nuts, cashews, etc.), shellfish (for example, shrimp, lobster, etc.), cow’s milk, egg, wheat, and soy. Venom allergies (for example, allergy to bee or wasp stings) are also recognized causes of anaphylaxis. Some substances can cause reactions, called anaphylactoid reactions, that are similar to and just as serious as anaphylaxis, but do not involve IgE antibodies. Acetylsalicylic acid (aspirin), other nonsteroidal anti-inflammatory drugs, and intravenous radiocontrast dye given for CT scans are recognized causes of these reactions. Pollens and other inhaled allergens (allergy-causing substances) rarely cause anaphylaxis. Anaphylaxis is diagnosed based on its symptoms. People with a history of allergic reactions may have a greater risk for developing a severe reaction in the future.
Anaphylaxis is diagnosed based on its symptoms. People with a history of allergic reactions may have a greater risk for developing a severe reaction in the future. Skin testing and RAST blood tests may help confirm the substances that cause severe allergic reactions. If anaphylactic reactions are suspected, testing should be performed under the guidance of a medical professional with training and experience in selecting appropriate tests. The only effective treatment for acute anaphylaxis is epinephrine (adrenaline) by injection. Epinephrine works quickly to reverse anaphylactic symptoms. Epinephrine can be given through an self-delivered injection device. The most common injection site is the thigh. If you are near someone who is going into anaphylactic shock, call for professional medical help immediately.
CPR and other lifesaving measures may be required. If breathing is compromised, medical professionals may have to place a tube through the nose or mouth into the airway (endotracheal intubation) or even perform emergency surgery to place a tube directly into the trachea (tracheostomy). In addition to epinephrine, treatment for shock includes intravenous fluids and medications that support the actions of the heart and circulatory system. After a person in shock is stabilized, medications such as antihistamines and corticosteroids may be given to further reduce symptoms. If you are allergic to bee stings or any substances that cause anaphylaxis, you should always be prepared. Carry an epinephrine injection kit with you at all times. Also, if you have any drug allergies, you should always inform your health care provider before undergoing any type of treatment, including dental care. It is also a good idea to either wear jewelry or carry a card that identifies your allergy. In cases of emergency, it could save your life.
Food allergy is a recognized cause of anaphylaxis--especially peanuts, tree nuts (for example, walnuts, hazelnuts, Brazil nuts, cashews, etc.), shellfish (for example, shrimp, lobster, etc.), cow’s milk, egg, wheat, and soy. Venom allergies (for example, allergy to bee or wasp stings) are also recognized causes of anaphylaxis. Some substances can cause reactions, called anaphylactoid reactions, that are similar to and just as serious as anaphylaxis, but do not involve IgE antibodies. Acetylsalicylic acid (aspirin), other nonsteroidal anti-inflammatory drugs, and intravenous radiocontrast dye given for CT scans are recognized causes of these reactions. Pollens and other inhaled allergens (allergy-causing substances) rarely cause anaphylaxis. Anaphylaxis is diagnosed based on its symptoms. People with a history of allergic reactions may have a greater risk for developing a severe reaction in the future.
Anaphylaxis is diagnosed based on its symptoms. People with a history of allergic reactions may have a greater risk for developing a severe reaction in the future. Skin testing and RAST blood tests may help confirm the substances that cause severe allergic reactions. If anaphylactic reactions are suspected, testing should be performed under the guidance of a medical professional with training and experience in selecting appropriate tests. The only effective treatment for acute anaphylaxis is epinephrine (adrenaline) by injection. Epinephrine works quickly to reverse anaphylactic symptoms. Epinephrine can be given through an self-delivered injection device. The most common injection site is the thigh. If you are near someone who is going into anaphylactic shock, call for professional medical help immediately.
CPR and other lifesaving measures may be required. If breathing is compromised, medical professionals may have to place a tube through the nose or mouth into the airway (endotracheal intubation) or even perform emergency surgery to place a tube directly into the trachea (tracheostomy). In addition to epinephrine, treatment for shock includes intravenous fluids and medications that support the actions of the heart and circulatory system. After a person in shock is stabilized, medications such as antihistamines and corticosteroids may be given to further reduce symptoms. If you are allergic to bee stings or any substances that cause anaphylaxis, you should always be prepared. Carry an epinephrine injection kit with you at all times. Also, if you have any drug allergies, you should always inform your health care provider before undergoing any type of treatment, including dental care. It is also a good idea to either wear jewelry or carry a card that identifies your allergy. In cases of emergency, it could save your life.
SPASMODIC DYSPHONIA IN THE HEART
Spasmodic dysphonia (or laryngeal dystonia) is a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two or they may experience sufficient difficulty to interfere with communication. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality. There are three different types of spasmodic dysphonia. The three types of spasmodic dysphonia are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia. In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing.
In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing. Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has features of both adductor and abductor spasmodic dysphonia. Spasmodic dysphonia can affect anyone. The first signs of this disorder are found most often in individuals between 30 and 50 years of age. More women appear to be affected by spasmodic dysphonia than are men.
The cause of spasmodic dysphonia is unknown. Because the voice can sound normal or near normal at times, spasmodic dysphonia was once thought to be psychogenic, that is, originating in the affected person¹s mind rather than from a physical cause. While psychogenic forms of spasmodic dysphonia exist, research has revealed increasing evidence that most cases of spasmodic dysphonia are in fact neurogenic or having to do with the nervous system (brain and nerves). Spasmodic dysphonia may co-occur with other movement disorders such as blepharospasm (excessive eye blinking and involuntary forced eye closure), tardive dyskinesia (involuntary and repetitious movement of muscles of the face, body, arms and legs), oromandibular dystonia (involuntary movements of the jaw muscles, lips and tongue), torticollis (involuntary movements of the neck muscles), or tremor (rhythmic, quivering muscle movements).In some cases, spasmodic dysphonia may run in families and is thought to be inherited. Research has identified a possible gene on chromosome 9 that may contribute to the spasmodic dysphonia that is common to certain families. In some individuals the voice symptoms begin following an upper respiratory infection, injury to the larynx, a long period of voice use, or stress.
The diagnosis of spasmodic dysphonia is usually made based on identifying the way the symptoms developed as well as by careful examination of the individual. Most people are evaluated by a team that usually includes an otolaryngologist (a physician who specializes in ear, nose and throat disorders), a speech-language pathologist (a professional trained to diagnose and treat speech, language and voice disorders) and a neurologist (a physician who specializes in nervous system disorders). The otolaryngologist examines the vocal folds to look for other possible causes for the voice disorder. Fiberoptic nasolaryngoscopy, a method whereby a small lighted tube is passed through the nose and into the throat, is a helpful tool that allows the otolaryngologist to evaluate vocal cord movement during speech. The speech-language pathologist evaluates the patient's voice and voice quality. The neurologist evaluates the patient for signs of other muscle movement disorders.There is presently no cure for spasmodic dysphonia. Current treatments only help reduce the symptoms of this voice disorder. Voice therapy may reduce some symptoms, especially in mild cases.
In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing. Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has features of both adductor and abductor spasmodic dysphonia. Spasmodic dysphonia can affect anyone. The first signs of this disorder are found most often in individuals between 30 and 50 years of age. More women appear to be affected by spasmodic dysphonia than are men.
The cause of spasmodic dysphonia is unknown. Because the voice can sound normal or near normal at times, spasmodic dysphonia was once thought to be psychogenic, that is, originating in the affected person¹s mind rather than from a physical cause. While psychogenic forms of spasmodic dysphonia exist, research has revealed increasing evidence that most cases of spasmodic dysphonia are in fact neurogenic or having to do with the nervous system (brain and nerves). Spasmodic dysphonia may co-occur with other movement disorders such as blepharospasm (excessive eye blinking and involuntary forced eye closure), tardive dyskinesia (involuntary and repetitious movement of muscles of the face, body, arms and legs), oromandibular dystonia (involuntary movements of the jaw muscles, lips and tongue), torticollis (involuntary movements of the neck muscles), or tremor (rhythmic, quivering muscle movements).In some cases, spasmodic dysphonia may run in families and is thought to be inherited. Research has identified a possible gene on chromosome 9 that may contribute to the spasmodic dysphonia that is common to certain families. In some individuals the voice symptoms begin following an upper respiratory infection, injury to the larynx, a long period of voice use, or stress.
The diagnosis of spasmodic dysphonia is usually made based on identifying the way the symptoms developed as well as by careful examination of the individual. Most people are evaluated by a team that usually includes an otolaryngologist (a physician who specializes in ear, nose and throat disorders), a speech-language pathologist (a professional trained to diagnose and treat speech, language and voice disorders) and a neurologist (a physician who specializes in nervous system disorders). The otolaryngologist examines the vocal folds to look for other possible causes for the voice disorder. Fiberoptic nasolaryngoscopy, a method whereby a small lighted tube is passed through the nose and into the throat, is a helpful tool that allows the otolaryngologist to evaluate vocal cord movement during speech. The speech-language pathologist evaluates the patient's voice and voice quality. The neurologist evaluates the patient for signs of other muscle movement disorders.There is presently no cure for spasmodic dysphonia. Current treatments only help reduce the symptoms of this voice disorder. Voice therapy may reduce some symptoms, especially in mild cases.
PAIN IN THE ABDOMINAL
Chronic abdominal pain poses a significant challenge to most clinicians. While a careful review of a patient's medical history, a thorough physical examination, and appropriate studies usually help provide an accurate diagnosis and treatment plan for acute (short-term or sudden onset) pain, the same cannot be said for chronic (prolonged or long-term) pain. In fact, some therapies appropriate for acute pain, such as analgesics (pain medications), rest, and surgery, may only worsen chronic pain. The first step in managing chronic abdominal pain is determining the nature, causes, and development of any abnormal condition, and the mechanism of pain. For optimal management, pain must be assessed from biological, social, cognitive, emotional, and behavioral perspectives. Many factors, listed below, may increase suffering and disability in chronic pain. It is important to recognize these factors because most can be treated.
Anxious feelings are common and often occur in every one of us, but they may cause emotional and physical distress. Physical symptoms of anxiety include increased muscle tension, which can worsen symptoms of irritable bowel disease (a group of inflammatory diseases of the gastrointestinal tract that includes Crohn's disease and ulcerative colitis). Combinations of behavioral therapy, other treatment methods, and/or medication have proven highly effective in reducing the symptoms of anxiety. The percentage of patients who have chronic pain and experience depression range from 30 to 80 percent. Recognizing depression is important because pain can be a symptom of depression, and depression makes pain worse. Patients with intractable pain and symptoms of depression may be treated with antidepressant medications.
Common reinforcers for chronic pain include avoidance of responsibilities at home or work, financial compensation related to disability, and increased attention from family and friends. In treating patients, it is necessary to explore several issues, such as the use of pain medication, work performance, absenteeism, and financial compensation to identify factors that may encourage a patient to accept the role of being sick. Educating patients and families must be a major focus of treatment to correct misinformation about chronic pain, to minimize enabling behaviors, and to ultimately reward the patient for making an effort to reduce pain and become well. Antidepressant medications also may play a role in treatment, especially for patients who have mood disorders.
Biofeedback and stress management techniques also are beneficial for patients experiencing anxiety. Biofeedback is a technique that helps a person become more aware of and learn to deal with the body's response to pain. This alternative therapy emphasizes relaxation and stress-reduction techniques. When standard treatments are not successful, patients with chronic pain should undergo an evaluation and treatment from a multidisciplinary team of specialists. The goals of treatment should include a reduction in pain and suffering and a return to normal life. Chemical dependence, including narcotics, tranquilizer addictions, and alcoholism, are important contributors to chronic pain. Not only does chemical dependence increase pain symptoms, but it also can produce cravings, muscle spasms, and other symptoms that are experienced as pain. Drug use impairs a person's inability to cope with life's demands, making the sick role more acceptable.
Anxious feelings are common and often occur in every one of us, but they may cause emotional and physical distress. Physical symptoms of anxiety include increased muscle tension, which can worsen symptoms of irritable bowel disease (a group of inflammatory diseases of the gastrointestinal tract that includes Crohn's disease and ulcerative colitis). Combinations of behavioral therapy, other treatment methods, and/or medication have proven highly effective in reducing the symptoms of anxiety. The percentage of patients who have chronic pain and experience depression range from 30 to 80 percent. Recognizing depression is important because pain can be a symptom of depression, and depression makes pain worse. Patients with intractable pain and symptoms of depression may be treated with antidepressant medications.
Common reinforcers for chronic pain include avoidance of responsibilities at home or work, financial compensation related to disability, and increased attention from family and friends. In treating patients, it is necessary to explore several issues, such as the use of pain medication, work performance, absenteeism, and financial compensation to identify factors that may encourage a patient to accept the role of being sick. Educating patients and families must be a major focus of treatment to correct misinformation about chronic pain, to minimize enabling behaviors, and to ultimately reward the patient for making an effort to reduce pain and become well. Antidepressant medications also may play a role in treatment, especially for patients who have mood disorders.
Biofeedback and stress management techniques also are beneficial for patients experiencing anxiety. Biofeedback is a technique that helps a person become more aware of and learn to deal with the body's response to pain. This alternative therapy emphasizes relaxation and stress-reduction techniques. When standard treatments are not successful, patients with chronic pain should undergo an evaluation and treatment from a multidisciplinary team of specialists. The goals of treatment should include a reduction in pain and suffering and a return to normal life. Chemical dependence, including narcotics, tranquilizer addictions, and alcoholism, are important contributors to chronic pain. Not only does chemical dependence increase pain symptoms, but it also can produce cravings, muscle spasms, and other symptoms that are experienced as pain. Drug use impairs a person's inability to cope with life's demands, making the sick role more acceptable.
ABDOMINAL AORTIC ANEURYSM IN THE HEART
An abdominal aortic aneurysm is an enlargement of the lower part of the aorta that extends through the abdominal area (at times, the upper portion of the aorta in the chest can be enlarged). The aorta is the main blood vessel that carries blood from the heart to the rest of the body. Since arteries are elastic and are filled with blood under high pressure, the wall of the artery may become weakened and distended like a balloon. The analogy of a bubble in a garden hose would be appropriate in describing an aneurysm. Aneurysms are usually discovered before they produce symptoms, such as back pain, but like the weakened hose, they may rupture if they become too large. Since a ruptured aneurysm is extremely dangerous, causing life-threatening bleeding, aneurysms are best corrected by an operation before this happens.
Arteriosclerosis (also called atherosclerosis). This occurs when the normal lining of the arteries deteriorates, the walls of the arteries thicken, and deposits of fat and plaque block the flow of blood through the arteries. High blood pressure (hypertension). This speeds up damage to blood vessel walls. Disease, such as diabetes, high cholesterol. Injury. Infection. Congenital defects, such as an inherited weakness in the blood vessel wall, example Marfan's syndrome. Heredity. Smoking. Most aneurysms occur in the abdomen. Abdominal aortic aneurysms occur most frequently in people over age 60 and most commonly at a point in the aorta just below the level of the kidneys. Men are more commonly affected by aneurysms than women. Most abdominal aneurysms are diagnosed during a routine physical examination or on X-rays when being tested for other health concerns. Once an aneurysm is suspected, the following imaging tests may be used to determine size, location of the aneurysm.
"Endovascular " means "inside or within a blood vessel" -- and that is exactly how a small fabric tube that has metal stents attached to the fabric, called a stent-graft, is introduced into your body and moved into place. First, small incisions are made in each groin to get to arteries that carry blood from the aorta. The surgeon then moves the stent-graft up through these arteries until it is opened inside the diseased portion of aorta. The stent-graft reinforces the weakened part of the vessel from the inside and creates a new channel through which the blood flows, eliminating the risk of rupture. This procedure usually takes 1 to 3 hours and patients typically leave the hospital in 1 to 2 days. Return to normal activity ranges from 2 to 6 weeks. Like any medical procedure, endovascular repair has a risk of complications. It also involves regular routine follow-up visits with your doctor to evaluate the stent-graft. These regular follow-ups are extremely important and will require CT.
This involves the surgeon making an incision to access the abdominal aortic aneurysm. The diseased portion of the aorta is replaced with a graft that acts as a replacement blood vessel. Open surgical repair is a proven procedure that has a good track record and acceptable risks. But it also involves a long recovery period. Average hospital stay ranges from 5 to 8 days. The time until return to normal activity ranges from 6 weeks to 3 months. As with any operation, open surgical repair has a risk of complications. You will want to discuss them thoroughly with your doctor. Very large or symtomatic aneurysms require immediate treatment. There are two types of surgical treatments for large aneurysms. A ruptured aneurysm usually produces sudden, severe pain and other symptoms such as loss of consciousness or shock, depending on the location of the aneurysm and the amount of bleeding.
Arteriosclerosis (also called atherosclerosis). This occurs when the normal lining of the arteries deteriorates, the walls of the arteries thicken, and deposits of fat and plaque block the flow of blood through the arteries. High blood pressure (hypertension). This speeds up damage to blood vessel walls. Disease, such as diabetes, high cholesterol. Injury. Infection. Congenital defects, such as an inherited weakness in the blood vessel wall, example Marfan's syndrome. Heredity. Smoking. Most aneurysms occur in the abdomen. Abdominal aortic aneurysms occur most frequently in people over age 60 and most commonly at a point in the aorta just below the level of the kidneys. Men are more commonly affected by aneurysms than women. Most abdominal aneurysms are diagnosed during a routine physical examination or on X-rays when being tested for other health concerns. Once an aneurysm is suspected, the following imaging tests may be used to determine size, location of the aneurysm.
"Endovascular " means "inside or within a blood vessel" -- and that is exactly how a small fabric tube that has metal stents attached to the fabric, called a stent-graft, is introduced into your body and moved into place. First, small incisions are made in each groin to get to arteries that carry blood from the aorta. The surgeon then moves the stent-graft up through these arteries until it is opened inside the diseased portion of aorta. The stent-graft reinforces the weakened part of the vessel from the inside and creates a new channel through which the blood flows, eliminating the risk of rupture. This procedure usually takes 1 to 3 hours and patients typically leave the hospital in 1 to 2 days. Return to normal activity ranges from 2 to 6 weeks. Like any medical procedure, endovascular repair has a risk of complications. It also involves regular routine follow-up visits with your doctor to evaluate the stent-graft. These regular follow-ups are extremely important and will require CT.
This involves the surgeon making an incision to access the abdominal aortic aneurysm. The diseased portion of the aorta is replaced with a graft that acts as a replacement blood vessel. Open surgical repair is a proven procedure that has a good track record and acceptable risks. But it also involves a long recovery period. Average hospital stay ranges from 5 to 8 days. The time until return to normal activity ranges from 6 weeks to 3 months. As with any operation, open surgical repair has a risk of complications. You will want to discuss them thoroughly with your doctor. Very large or symtomatic aneurysms require immediate treatment. There are two types of surgical treatments for large aneurysms. A ruptured aneurysm usually produces sudden, severe pain and other symptoms such as loss of consciousness or shock, depending on the location of the aneurysm and the amount of bleeding.
HHEART DISEASE IN CONGENITAL AND PEDIATRIC
Today, Cleveland Clinic Children's Hospital includes a team of internationally renowned pediatric congenital heart disease specialists and surgeons among its staff of more than 150 pediatricians and pediatric specialists. According to the American Heart Association, about 40,000 children are born with heart defects in the United States each year. Cleveland Clinic Children's Hospital's Center for Pediatric and Congenital Heart Diseases has an outstanding reputation for successfully handling the most complex cases of heart disease in children, and serves as a worldwide referral and second opinion center for patients of all ages with pediatric congenital heart disease (CHD). Cleveland Clinic Children's Hospital pediatric heart surgeons, cardiologists and anesthesiologists are among the most highly trained and experienced in the world.
Cleveland Clinic Children's Hospital pediatric heart surgeons, cardiologists and anesthesiologists are among the most highly trained and experienced in the world. In addition, our team consists of the referring physician, the patient's family, specially trained cardiac nurses, allied health professionals, social workers and child life specialists. In 2006, our Heart Center registered more than 13,700 outpatient visits. For some instances of pediatric congenital heart disease in children, Cleveland Clinic Children's Hospital specialists may recommend medication. If intervention is needed, our pediatric cardiologists can repair certain heart defects in the cardiac catheterization laboratory using coils, stents and implantable devices. These defects may be repaired through small incisions in the groin, thus eliminating the need for open-heart surgery. In 2006, our cardiologists performed 418 heart-related catheterizations.
Our cardiac surgeons manage all forms of heart disease in children, including heart and heart/lung transplants not performed elsewhere, and routinely perform complex surgeries such as Repair of Tetralogy of Fallot Transposition of Great Arteries and The Norwood Procedure. Our success rates, including those for repairing heart defects in newborns, are excellent, and our complication and mortality rates are low. Adults with complex congenital heart defects require expert care. Ours is one of the few heart centers in Ohio dedicated to the lifelong care of patients with congenital heart defects, including those over 18. Each year, our heart center assesses more than 400 adults with congenital heart defects. Since 1993, we have performed more than 500 surgeries on adult patients with a mortality rate of 0.9%. Our Heart Center's cardiac surgeons developed and perfected the double-switch operation for complex transposition of the great arteries
Our cardiologists pioneered the research that led to the development of devices to close holes between the chambers of the heart. Our physician investigators are sponsored by corporate and government organizations with the goal of advancing treatment for patients with congenital heart defects. Because heart defects are relatively rare, it is crucial to choose a multispecialty medical center with a highly skilled and experienced medical team. At Cleveland Clinic, our physicians can diagnose heart disease in children and determine management strategies before they are even born. Complicated and high-risk pregnancies are expertly managed within our Level III perinatal center, and critically ill newborns receive the highest level of care available in our Level III neonatal intensive care unit.
Cleveland Clinic Children's Hospital pediatric heart surgeons, cardiologists and anesthesiologists are among the most highly trained and experienced in the world. In addition, our team consists of the referring physician, the patient's family, specially trained cardiac nurses, allied health professionals, social workers and child life specialists. In 2006, our Heart Center registered more than 13,700 outpatient visits. For some instances of pediatric congenital heart disease in children, Cleveland Clinic Children's Hospital specialists may recommend medication. If intervention is needed, our pediatric cardiologists can repair certain heart defects in the cardiac catheterization laboratory using coils, stents and implantable devices. These defects may be repaired through small incisions in the groin, thus eliminating the need for open-heart surgery. In 2006, our cardiologists performed 418 heart-related catheterizations.
Our cardiac surgeons manage all forms of heart disease in children, including heart and heart/lung transplants not performed elsewhere, and routinely perform complex surgeries such as Repair of Tetralogy of Fallot Transposition of Great Arteries and The Norwood Procedure. Our success rates, including those for repairing heart defects in newborns, are excellent, and our complication and mortality rates are low. Adults with complex congenital heart defects require expert care. Ours is one of the few heart centers in Ohio dedicated to the lifelong care of patients with congenital heart defects, including those over 18. Each year, our heart center assesses more than 400 adults with congenital heart defects. Since 1993, we have performed more than 500 surgeries on adult patients with a mortality rate of 0.9%. Our Heart Center's cardiac surgeons developed and perfected the double-switch operation for complex transposition of the great arteries
Our cardiologists pioneered the research that led to the development of devices to close holes between the chambers of the heart. Our physician investigators are sponsored by corporate and government organizations with the goal of advancing treatment for patients with congenital heart defects. Because heart defects are relatively rare, it is crucial to choose a multispecialty medical center with a highly skilled and experienced medical team. At Cleveland Clinic, our physicians can diagnose heart disease in children and determine management strategies before they are even born. Complicated and high-risk pregnancies are expertly managed within our Level III perinatal center, and critically ill newborns receive the highest level of care available in our Level III neonatal intensive care unit.
VASCULAR HEART DISEASE
Vascular disease is mainly caused by hardening of the arteries (atherosclerosis) due to a thickening of the artery lining from fatty deposits or plaques (atheroma). The arteries are blood vessels that supply blood, oxygen and nutrients to the body from the heart. Narrow, hardened arteries make it more difficult for blood to flow through and reach the tissue in question. Those parts of the body most affected by this disease suffer the consequences of an inadequate blood supply: poor function, tissue damage and, in worst cases, death. There are different symptoms, depending on where the vascular disease is. It most commonly affects the arteries of the heart, brain and legs.
The heart - cardiovascular disease is a mild degree of atherosclerosis does not cause any symptoms. More severe cases of coronary atherosclerosis may be associated with chest pain on exertion that settles within a few minutes of rest (angina). If any of the arteries supplying the heart (coronary arteries) get completely blocked (coronary thrombosis), the part of the heart muscle that's deprived of blood dies, causing a heart attack (myocardial infarction). If you have risk factors for cardiovascular disease, be aware of heavy or tight chest pain, sometimes also experienced in the throat or left arm. Pain of this nature, not settling within 20 minutes, should be assessed urgently by a doctor or paramedic is made arranged for patient. The brain - cerebrovascular disease is a narrowed arteries in the brain can become blocked by clots (cerebral thrombosis). Clots can form in the main carotid arteries in the neck that supply blood to brain or in smaller cerebral arteries.
Alternatively, smaller diseased arteries may rupture and bleed into the brain (cerebral haemorrhage). Both of these events damage the brain and are collectively referred to as strokes (cerebrovascular accidents or CVAs). Atherosclerosis can cause cramping pain in the leg muscles on exertion that settles after a few minutes' rest (intermittent claudication). In the early stages of the condition, the pain usually occurs in the calves with a particular walking distance or effort, but settles again after 5 to 10 minutes' rest. The pain is a result of the leg muscles not getting enough blood to cater for the physical effort needed. More advanced atherosclerosis may cause constant pain at rest, ulceration of the lower leg and even gangrene in the toes and feet. More advanced atherosclerosis may cause constant pain at rest, ulceration of the lower leg and even gangrene in the toes and feet.
Diagnosis is made on the basis of your medical history and symptoms.
If there is diagnostic doubt or difficulty with treatment, then referral to a specialist for further assessment will help in the management of the condition.
Additional tests may be done in the hospital, such as Doppler ultrasound imaging tests or angiography, when dye is injected to make the arteries visible on X-rays.
If there are symptoms of atherosclerosis in the brain or legs, your GP can refer you to a hospital-based specialist for further investigation is made for patient.
This may include scans of the brain (CT or MRI scans) and angiograms for a better understanding of blood flow in the limbs. Atherosclerosis affects many people. It can start at the age of 20 and increases with advancing age.
The heart - cardiovascular disease is a mild degree of atherosclerosis does not cause any symptoms. More severe cases of coronary atherosclerosis may be associated with chest pain on exertion that settles within a few minutes of rest (angina). If any of the arteries supplying the heart (coronary arteries) get completely blocked (coronary thrombosis), the part of the heart muscle that's deprived of blood dies, causing a heart attack (myocardial infarction). If you have risk factors for cardiovascular disease, be aware of heavy or tight chest pain, sometimes also experienced in the throat or left arm. Pain of this nature, not settling within 20 minutes, should be assessed urgently by a doctor or paramedic is made arranged for patient. The brain - cerebrovascular disease is a narrowed arteries in the brain can become blocked by clots (cerebral thrombosis). Clots can form in the main carotid arteries in the neck that supply blood to brain or in smaller cerebral arteries.
Alternatively, smaller diseased arteries may rupture and bleed into the brain (cerebral haemorrhage). Both of these events damage the brain and are collectively referred to as strokes (cerebrovascular accidents or CVAs). Atherosclerosis can cause cramping pain in the leg muscles on exertion that settles after a few minutes' rest (intermittent claudication). In the early stages of the condition, the pain usually occurs in the calves with a particular walking distance or effort, but settles again after 5 to 10 minutes' rest. The pain is a result of the leg muscles not getting enough blood to cater for the physical effort needed. More advanced atherosclerosis may cause constant pain at rest, ulceration of the lower leg and even gangrene in the toes and feet. More advanced atherosclerosis may cause constant pain at rest, ulceration of the lower leg and even gangrene in the toes and feet.
Diagnosis is made on the basis of your medical history and symptoms.
If there is diagnostic doubt or difficulty with treatment, then referral to a specialist for further assessment will help in the management of the condition.
Additional tests may be done in the hospital, such as Doppler ultrasound imaging tests or angiography, when dye is injected to make the arteries visible on X-rays.
If there are symptoms of atherosclerosis in the brain or legs, your GP can refer you to a hospital-based specialist for further investigation is made for patient.
This may include scans of the brain (CT or MRI scans) and angiograms for a better understanding of blood flow in the limbs. Atherosclerosis affects many people. It can start at the age of 20 and increases with advancing age.
Monday, March 2, 2009
TREATMENT FOR THE HEART DISEASE
Treatment disease depends on the severity of symptoms and the extent of the condition. Treatment options include lifestyle changes, medication, and surgery(e.g., angioplasty, coronary artery bypass). In mild cases, lifestyle changes may help to control the underlying cause of heart disease (e.g., high blood pressure, diabetes, high cholesterol). These changes may include the following: Diet modifications, Regular exercise, Smoking cessation, Weight loss. Diet modifications can help patients maintain an appropriate weight for their frame and build. Physicians recommend eating a well-balanced, low-fat, low-cholesterol diet that includes several servings of fruits and vegetables daily. Vitamin supplements that may help prevent heart disease may also be recommended. Regular exercise is important. Short, frequent sessions of exercise are preferable to a complete sedentary lifestyle. Before beginning any exercise program, please consult with your physician.
Medications that may be used to treat heart disease include the following: HMG-CoA reductase inhibitors (statins) to lower cholesterol (e.g., Lipitor, Lescol, Crestor, Zocor), Blood pressure medications (e.g., ACE inhibitors, angiotensin-receptor blockers [ARBs], beta blockers, calcium channel blockers, diuretics), Medications that reduce the risk for blood clots (e.g., antiplatelets [aspirin, ticlopidine, clopidogrel]), Nitrates (e.g., nitroglycerin) to dilate the coronary arteries and improve blood flow to the heart Coronary angioplasty, also called percutaneous transluminal coronary angioplasty (PTCA), or angioplasty, is an invasive procedure performed to reduce or eliminate blockages in coronary arteries. The goal of PTCA is to restore blood flow to blood-deprived heart tissue, reduce the need for medication, and eliminate or reduce the number of episodes of angina (chest pain).
Opening a blockage, or a plaque, in a coronary artery typically involves the use of an angioplasty balloon. When the blockage is calcified or so dense that a balloon cannot be placed, other devices are used. Plaque can be cut out, ablated with a laser, or bored out using a surgical drill bit. Often, a stent (small tube) is implanted after angioplasty to keep the artery open and prevent regrowth of plaque (restenosis). The arteries are accessed through a needle puncture made in the groin (femoral artery) or arm (brachial artery). In most cases, the femoral artery is used. More than one blockage may be treated during a single session, depending on the location of the blockages and the patient's condition. The procedure can take 30 minutes to several hours, depending on the number of blockages being treated.
Coronary atherectomy (also called "rotorooter") is another procedure that can be used to remove plaque and open up arteries. Atherectomy can be performed by conventional surgical incision or through a catheter inserted into the artery (similar to angioplasty). Balloon angioplasty or stent implantation may be performed following atherectomy. Coronary brachytherapy is a relatively new treatment that may be used in patients who develop restenosis after undergoing coronary stenting. It involves delivering radiation to the coronary arteries. The long-term effects of this procedure are unknown. The use of coronary brachytherapy as a first-line treatment is being studied.Coronary artery bypass is performed to reroute blood flow around blocked coronary arteries. In this procedure, the surgeon uses a piece of artificial vessel or removes a segment of a healthy blood vessel from another part of the body (e.g., a vein in the leg) and uses the segment to create a new path to the heart (called a graft). One or more grafts may be performed, depending on the number of blockage.
Medications that may be used to treat heart disease include the following: HMG-CoA reductase inhibitors (statins) to lower cholesterol (e.g., Lipitor, Lescol, Crestor, Zocor), Blood pressure medications (e.g., ACE inhibitors, angiotensin-receptor blockers [ARBs], beta blockers, calcium channel blockers, diuretics), Medications that reduce the risk for blood clots (e.g., antiplatelets [aspirin, ticlopidine, clopidogrel]), Nitrates (e.g., nitroglycerin) to dilate the coronary arteries and improve blood flow to the heart Coronary angioplasty, also called percutaneous transluminal coronary angioplasty (PTCA), or angioplasty, is an invasive procedure performed to reduce or eliminate blockages in coronary arteries. The goal of PTCA is to restore blood flow to blood-deprived heart tissue, reduce the need for medication, and eliminate or reduce the number of episodes of angina (chest pain).
Opening a blockage, or a plaque, in a coronary artery typically involves the use of an angioplasty balloon. When the blockage is calcified or so dense that a balloon cannot be placed, other devices are used. Plaque can be cut out, ablated with a laser, or bored out using a surgical drill bit. Often, a stent (small tube) is implanted after angioplasty to keep the artery open and prevent regrowth of plaque (restenosis). The arteries are accessed through a needle puncture made in the groin (femoral artery) or arm (brachial artery). In most cases, the femoral artery is used. More than one blockage may be treated during a single session, depending on the location of the blockages and the patient's condition. The procedure can take 30 minutes to several hours, depending on the number of blockages being treated.
Coronary atherectomy (also called "rotorooter") is another procedure that can be used to remove plaque and open up arteries. Atherectomy can be performed by conventional surgical incision or through a catheter inserted into the artery (similar to angioplasty). Balloon angioplasty or stent implantation may be performed following atherectomy. Coronary brachytherapy is a relatively new treatment that may be used in patients who develop restenosis after undergoing coronary stenting. It involves delivering radiation to the coronary arteries. The long-term effects of this procedure are unknown. The use of coronary brachytherapy as a first-line treatment is being studied.Coronary artery bypass is performed to reroute blood flow around blocked coronary arteries. In this procedure, the surgeon uses a piece of artificial vessel or removes a segment of a healthy blood vessel from another part of the body (e.g., a vein in the leg) and uses the segment to create a new path to the heart (called a graft). One or more grafts may be performed, depending on the number of blockage.
DIAGNOSIS IN HEART DISEASE
Diagnosis because heart attack is a process that actually occurs over several hours, diagnosis must be made as quickly as possible to minimize permanent damage. Diagnosis involves physical examination, medical history (including history of symptoms related by the patient or a bystander), and diagnostic tests (e.g., blood tests, chest x-ray, electrocardiogram, echocardiogram). Blood tests include the following: Complete blood count (CBC), Chemistry and electrolytes, Clotting function (coagulation), Enzyme levels (elevated levels of certain enzymes are released into the bloodstream during heart attack) Chest x-ray may be performed to detect abnormalities in the size and shape of the heart and to detect the accumulation of fluid in the lungs, which may indicate decreased blood flow. During an echocardiogram, a microphone-like device (transducer) is used to transmit and receive ultrasonic waves that travel through the chest wall to the heart and are reflected back to the transducer.
An electrocardiogram (ECG or EKG) is a noninvasive test used to measure electrical activity in the heart. Electrical sensors (called leads) are attached to predetermined positions on the arms, legs, and chest to record electrical activity and help diagnose heart attack. ECG is not conclusive and the test is repeated in most cases. Echocardiogram (cardiac echo) is an ultrasound examination of the heart that produces detailed images of the organ. It can be used to detect abnormalities in the structure of the heart and blood clots that may cause additional damage. Echocardiogram also is used to measure the strength of the heart (called ejection fraction), which is an important factor in determining treatment.
Normally, approximately 60% of the blood in the left ventricle is ejected each time the heart beats (contracts). Patients with ejection fractions of approximately 40–45% have mildly depressed ejection fractions, which may indicate a relatively minor heart attack; patients with ejection fractions of about 30–40% have moderately depressed ejection fractions, which may indicate moderate or severe heart attack; and patients with ejection fractions in the 10–25% range have severely depressed ejection fractions, which may indicate a massive heart attack, several mild heart attacks, or other heart conditions. During an echocardiogram, a microphone-like device (transducer) is used to transmit and receive ultrasonic waves that travel through the chest wall to the heart and are reflected back to the transducer.
Cardiac catheterization involves passing a catheter (i.e., a thin flexible tube) through an artery or a vein to the heart, and into a coronary artery. This procedure produces angiograms (i.e., x-ray images) of the coronary arteries and the left ventricle, the heart's main pumping chamber, and also can be used to measure pressures in the pulmonary artery and to monitor heart function, usually in critically ill patients (called right heart catheterization).In most cases, cardiac catheterization is recommended when a partial or complete arterial blockage is suspected. It is used to evaluate how well the heart is functioning and to obtain information about blockages. Cardiac catheterization is performed in a hospital. Usually, the procedure takes 2 to 3 hours to perform and patients are required to remain immobile for 4 to 6 hours following cardiac catheterization.
An electrocardiogram (ECG or EKG) is a noninvasive test used to measure electrical activity in the heart. Electrical sensors (called leads) are attached to predetermined positions on the arms, legs, and chest to record electrical activity and help diagnose heart attack. ECG is not conclusive and the test is repeated in most cases. Echocardiogram (cardiac echo) is an ultrasound examination of the heart that produces detailed images of the organ. It can be used to detect abnormalities in the structure of the heart and blood clots that may cause additional damage. Echocardiogram also is used to measure the strength of the heart (called ejection fraction), which is an important factor in determining treatment.
Normally, approximately 60% of the blood in the left ventricle is ejected each time the heart beats (contracts). Patients with ejection fractions of approximately 40–45% have mildly depressed ejection fractions, which may indicate a relatively minor heart attack; patients with ejection fractions of about 30–40% have moderately depressed ejection fractions, which may indicate moderate or severe heart attack; and patients with ejection fractions in the 10–25% range have severely depressed ejection fractions, which may indicate a massive heart attack, several mild heart attacks, or other heart conditions. During an echocardiogram, a microphone-like device (transducer) is used to transmit and receive ultrasonic waves that travel through the chest wall to the heart and are reflected back to the transducer.
Cardiac catheterization involves passing a catheter (i.e., a thin flexible tube) through an artery or a vein to the heart, and into a coronary artery. This procedure produces angiograms (i.e., x-ray images) of the coronary arteries and the left ventricle, the heart's main pumping chamber, and also can be used to measure pressures in the pulmonary artery and to monitor heart function, usually in critically ill patients (called right heart catheterization).In most cases, cardiac catheterization is recommended when a partial or complete arterial blockage is suspected. It is used to evaluate how well the heart is functioning and to obtain information about blockages. Cardiac catheterization is performed in a hospital. Usually, the procedure takes 2 to 3 hours to perform and patients are required to remain immobile for 4 to 6 hours following cardiac catheterization.
SYMPTOMS IN THE HEART DISEASE
Heart disease can be asymptomatic (i.e., cause no noticeable symptoms) or may cause symptoms that vary from mild to severe. Signs of cardiovascular disease include chest pain (angina), shortness of breath, and heart attack. Typical chest pain occurs in the center of the chest, is often described as a "heavy" or "tight" feeling, and often occurs with exertion or stress. This type of chest pain may be relieved by rest or by taking nitroglycerin (medication that acts quickly to open blood vessels). Atypical chest pain can occur in the left or right side of the chest, in the abdomen, in the back, in the arm, or in the jaw. This type of pain usually is sharp, is unrelated to exertion or stress, and is more common in women. Shortness of breath (dyspnea) may occur as a result of congestive heart failure (CHF), caused by reduced blood and oxygen flow to the heart over time. In addition to shortness of breath, congestive heart failure also may cause abnormal fluid retention that results in swelling (edema) in the feet and legs.
The heart is a complex, highly specialized, muscular organ in the chest that maintains the circulation of blood throughout the body. Heart attack, or acute myocardial infarction, is the death of heart tissue caused by a complete blockage in one of the arteries that supply blood to the heart (coronary arteries), resulting in an interruption in the blood supply to the heart. When heart tissue is deprived of blood-borne oxygen for longer than 30 minutes (called ischemia), it begins to die. Ischemia causes electrical instability within the chambers of the heart, preventing the heart from adequately pumping blood throughout the body (called ventricular fibrillation). Permanent brain damage and death can occur when the brain is deprived of blood flow for longer than 5 minutes.
In most cases, blockage occurs as a result of coronary heart disease (CHD), also called atherosclerosis, a condition in which plaques (deposits of cholesterol and fatty material) build up in the arteries and partially or completely block blood flow. When the surface of a plaque tears or ruptures, a blood clot (thrombus) can form and completely block the flow of blood in the artery. Sudden cardiac arrest (SCA), also called sudden cardiac death, occurs when the heart develops an abnormal rhythm (arrhythmia; e.g., ventricular fibrillation) that causes it to stop beating suddenly. In as many as 95% of cases, a person who experiences SCA dies, usually within minutes.
Incidence and Prevalence according to the American Heart Association, coronary heart disease (CHD) is the leading cause of death in the United States; and, in adults, heart attacks cause 1 out of every 5 deaths. According to the National Institutes of Health (NIH) more than 1.2 million heart attacks occur each year in the United States and about 460,000 of these are fatal. Approximately 300,000 people die annually from heart attacks before they can receive medical treatment. In some cases, heart attack is caused by a severe spasm (contraction) in a coronary artery. During a spasm, the artery narrows and blood flow to an area of the heart decreases or stops. The cause of spasms is unknown, and one can occur in normal arteries as well as those partially blocked by atherosclerosis.
The heart is a complex, highly specialized, muscular organ in the chest that maintains the circulation of blood throughout the body. Heart attack, or acute myocardial infarction, is the death of heart tissue caused by a complete blockage in one of the arteries that supply blood to the heart (coronary arteries), resulting in an interruption in the blood supply to the heart. When heart tissue is deprived of blood-borne oxygen for longer than 30 minutes (called ischemia), it begins to die. Ischemia causes electrical instability within the chambers of the heart, preventing the heart from adequately pumping blood throughout the body (called ventricular fibrillation). Permanent brain damage and death can occur when the brain is deprived of blood flow for longer than 5 minutes.
In most cases, blockage occurs as a result of coronary heart disease (CHD), also called atherosclerosis, a condition in which plaques (deposits of cholesterol and fatty material) build up in the arteries and partially or completely block blood flow. When the surface of a plaque tears or ruptures, a blood clot (thrombus) can form and completely block the flow of blood in the artery. Sudden cardiac arrest (SCA), also called sudden cardiac death, occurs when the heart develops an abnormal rhythm (arrhythmia; e.g., ventricular fibrillation) that causes it to stop beating suddenly. In as many as 95% of cases, a person who experiences SCA dies, usually within minutes.
Incidence and Prevalence according to the American Heart Association, coronary heart disease (CHD) is the leading cause of death in the United States; and, in adults, heart attacks cause 1 out of every 5 deaths. According to the National Institutes of Health (NIH) more than 1.2 million heart attacks occur each year in the United States and about 460,000 of these are fatal. Approximately 300,000 people die annually from heart attacks before they can receive medical treatment. In some cases, heart attack is caused by a severe spasm (contraction) in a coronary artery. During a spasm, the artery narrows and blood flow to an area of the heart decreases or stops. The cause of spasms is unknown, and one can occur in normal arteries as well as those partially blocked by atherosclerosis.
RISK FACTOR IN THE HEART DISEASE
Risk Factors and Causes risk factors for cardiovascular disease include unmodifiable factors (i.e., factors that cannot be changed) and modifiable factors (i.e., risk factors that may be controlled or reduced by lifestyle choices and medications). Unmodifiable risk factors include the following like Age (older than 65 years old), Family history of heart disease (especially before age 50), Male gender, Menopause in women (Prior to menopause, women have a lower risk than men, but after menopause, the risk is approximately the same in women as it is in men.) The Framingham Heart Study has shown that having a sibling (i.e., brother or sister) with heart disease is a strong risk factor for the condition. It is unclear whether this increased risk (as high as 45%) is due to genetic factors or to similar childhood lifestyles.
The first heart transplants and artificial hearts. A team of South African surgeons headed by Christiaan Barnard performed the first human heart transplant in 1967. The patient lived 18 days and died of a lung infection. Norman Shumway pioneered in heart transplants in the United States. He and his surgical team performed the first U.S. heart transplant on an adult patient in 1968. Shumway refined transplant techniques and performed more transplants than any other surgeon. In the late 1960's and early 1970's, doctors performed many heart transplants. But most patients died within a year, mainly because the body rejected the new organ. Doctors almost stopped doing heart transplants. Then in the 1980's, they began using a drug called cyclosporine to fight rejection. Cyclosporine greatly increased the survival rate among transplant patients. The shortage of donor hearts has become the chief obstacle to successful heart transplants today.
Development of heart surgery. An American cardiologist named James B. Herrick made the first diagnosis of a heart attack in 1912. In 1938, Robert E. Gross, an American surgeon, performed the first successful repair of a congenital heart defect. Gross sewed the hole in the artery of a child suffering from patent ductus arteriosus. In 1944, Helen Brooke Taussig and Alfred Blalock, two American physicians, developed an operation to help correct abnormal circulation of blue babies. In 1952, American surgeon Charles Hufnagel operated on a beating heart and implanted the first artificial heart valve. In 1953, another American surgeon, John H. Gibbon, and his associates successfully used a heart-lung machine they developed, which enabled doctors to stop the heart while the device pumped and oxygenated the blood. Doctors could then repair defects that could not be corrected while the heart beat.
Invention of new medical instruments. During the 1800's, many inventions expanded doctors' knowledge of the heart and helped in their diagnosis and treatment of heart problems. In 1816, a French physician named Rene Laennec invented the stethoscope, which enabled doctors to listen to sounds of the heart and other organs. In 1880, Samuel Siegfried von Basch, a Viennese physician, developed the sphygmomanometer, an instrument to measure blood pressure without breaking the skin. Russian physician Nikolai Korotkoff used a stethoscope in 1905 to take the pulse while measuring blood pressure, thus recording systolic and diastolic blood pressure. Doctors still use this technique. In 1903, Willem Einthoven, a Dutch physiologist, invented the string galvanometer, a device to measure minute electrical currents generated by the activity of the heart, and so developed the basis of the electrocardiograph. By the 1920's, the electrocardiograph had become the chief diagnostic tool in cardiology.
The first heart transplants and artificial hearts. A team of South African surgeons headed by Christiaan Barnard performed the first human heart transplant in 1967. The patient lived 18 days and died of a lung infection. Norman Shumway pioneered in heart transplants in the United States. He and his surgical team performed the first U.S. heart transplant on an adult patient in 1968. Shumway refined transplant techniques and performed more transplants than any other surgeon. In the late 1960's and early 1970's, doctors performed many heart transplants. But most patients died within a year, mainly because the body rejected the new organ. Doctors almost stopped doing heart transplants. Then in the 1980's, they began using a drug called cyclosporine to fight rejection. Cyclosporine greatly increased the survival rate among transplant patients. The shortage of donor hearts has become the chief obstacle to successful heart transplants today.
Development of heart surgery. An American cardiologist named James B. Herrick made the first diagnosis of a heart attack in 1912. In 1938, Robert E. Gross, an American surgeon, performed the first successful repair of a congenital heart defect. Gross sewed the hole in the artery of a child suffering from patent ductus arteriosus. In 1944, Helen Brooke Taussig and Alfred Blalock, two American physicians, developed an operation to help correct abnormal circulation of blue babies. In 1952, American surgeon Charles Hufnagel operated on a beating heart and implanted the first artificial heart valve. In 1953, another American surgeon, John H. Gibbon, and his associates successfully used a heart-lung machine they developed, which enabled doctors to stop the heart while the device pumped and oxygenated the blood. Doctors could then repair defects that could not be corrected while the heart beat.
Invention of new medical instruments. During the 1800's, many inventions expanded doctors' knowledge of the heart and helped in their diagnosis and treatment of heart problems. In 1816, a French physician named Rene Laennec invented the stethoscope, which enabled doctors to listen to sounds of the heart and other organs. In 1880, Samuel Siegfried von Basch, a Viennese physician, developed the sphygmomanometer, an instrument to measure blood pressure without breaking the skin. Russian physician Nikolai Korotkoff used a stethoscope in 1905 to take the pulse while measuring blood pressure, thus recording systolic and diastolic blood pressure. Doctors still use this technique. In 1903, Willem Einthoven, a Dutch physiologist, invented the string galvanometer, a device to measure minute electrical currents generated by the activity of the heart, and so developed the basis of the electrocardiograph. By the 1920's, the electrocardiograph had become the chief diagnostic tool in cardiology.
OVERVIEW IN HEART DISEASE
The term "heart disease" can be used to describe any disorder of the cardiovascular system (i.e., the heart and blood vessels) that affects the heart's ability to function normally. Heart disease is also called cardiovascular disease, coronary heart disease (CHD), and coronary artery disease. Heart disease is a major cause for heart attack (myocardial infarction), congestive heart failure, angina pectoris, stroke, sudden cardiac arrest (SCA), and ischemia (reduced blood flow).The most common type of heart disease is atherosclerosis, which results from progressive narrowing of the blood vessels that supply oxygen and blood to the heart (coronary arteries). It develops when deposits (plaques) build up on the inner lining (endothelium) of the artery walls.
The heart is the muscular organ in the chest that maintains the circulation of blood throughout the body. Blood that has traveled through the body returns to the heart and is pumped into the lungs, where it absorbs oxygen. Oxygen-rich blood returns from the lungs, enters the heart, and then is pumped through the aortic valve into the main artery of the body (aorta) and smaller arteries that travel to the head, arms, abdomen, and legs. These arteries supply oxygen-rich blood to the organs and tissues of the body, which require oxygen to function. The coronary arteries supply oxygen-rich blood to the tissues of the heart. Meanwhile, prevention of heart disease has centered on eliminating controllable risk factors. High blood pressure, high blood cholesterol, and cigarette smoking are major causes of CAD.
Incidence and Prevalence Cardiovascular disease is the leading cause of death in both men and women in the United States, and is a major cause of death throughout the world. According to the Centers for Disease Control and Prevention (CDC), approximately 61 million people in the United States have heart disease. The American Heart Association reports that approximately 870,000 people died from the condition in 2004. Heart disease contributes to approximately 40% of all deaths. According to the American Heart Association, cardiovascular disease accounts for more deaths in women per year in the United States than the next six causes of death combined. In February 2007, new guidelines for preventing heart disease in women were established. These guidelines, which are based on individual cardiovascular health, emphasize lifestyle modifications, such as smoking cessation, physical activity, a heart-healthy diet, and weight control, for all women.
In 1982, an American surgical team headed by William DeVries implanted the first permanent artificial heart in a human patient. Robert Jarvik, an American physician, designed the device. The patient, Barney Clark, suffered from many medical complications and died 112 days later. A number of other patients received the Jarvik heart, but none of them survived two years. In 1990, the U.S. Food and Drug Administration withdrew approval of the Jarvik device. Another model, similar to the Jarvik, is used as a temporary replacement heart at a few medical centers in the United States. Progress in treatment and prevention occurred about the same time as the dramatic advances in heart surgery. In the late 1960's, researchers developed beta-blockers. These drugs help in reducing high blood pressure, preventing angina, and controlling certain arrhythmias. Calcium blockers, which work like beta-blockers, appeared in the 1970's
The heart is the muscular organ in the chest that maintains the circulation of blood throughout the body. Blood that has traveled through the body returns to the heart and is pumped into the lungs, where it absorbs oxygen. Oxygen-rich blood returns from the lungs, enters the heart, and then is pumped through the aortic valve into the main artery of the body (aorta) and smaller arteries that travel to the head, arms, abdomen, and legs. These arteries supply oxygen-rich blood to the organs and tissues of the body, which require oxygen to function. The coronary arteries supply oxygen-rich blood to the tissues of the heart. Meanwhile, prevention of heart disease has centered on eliminating controllable risk factors. High blood pressure, high blood cholesterol, and cigarette smoking are major causes of CAD.
Incidence and Prevalence Cardiovascular disease is the leading cause of death in both men and women in the United States, and is a major cause of death throughout the world. According to the Centers for Disease Control and Prevention (CDC), approximately 61 million people in the United States have heart disease. The American Heart Association reports that approximately 870,000 people died from the condition in 2004. Heart disease contributes to approximately 40% of all deaths. According to the American Heart Association, cardiovascular disease accounts for more deaths in women per year in the United States than the next six causes of death combined. In February 2007, new guidelines for preventing heart disease in women were established. These guidelines, which are based on individual cardiovascular health, emphasize lifestyle modifications, such as smoking cessation, physical activity, a heart-healthy diet, and weight control, for all women.
In 1982, an American surgical team headed by William DeVries implanted the first permanent artificial heart in a human patient. Robert Jarvik, an American physician, designed the device. The patient, Barney Clark, suffered from many medical complications and died 112 days later. A number of other patients received the Jarvik heart, but none of them survived two years. In 1990, the U.S. Food and Drug Administration withdrew approval of the Jarvik device. Another model, similar to the Jarvik, is used as a temporary replacement heart at a few medical centers in the United States. Progress in treatment and prevention occurred about the same time as the dramatic advances in heart surgery. In the late 1960's, researchers developed beta-blockers. These drugs help in reducing high blood pressure, preventing angina, and controlling certain arrhythmias. Calcium blockers, which work like beta-blockers, appeared in the 1970's
Sunday, March 1, 2009
HISTORY IN HEART RESEARCH
Early beliefs about the heart. In ancient times, many people believed that the heart had special importance. For example, the Chinese thought that each emotion originated in a certain organ and that happiness dwelt in the heart. Chinese physicians diagnosed many illnesses and prescribed treatment by taking the pulse at the wrist. The ancient Egyptians considered the heart to be the source of intelligence and emotion. The ancient Greeks learned from battlefield injuries and animal sacrifices that the heart was a beating organ. In the A.D. 100's, the Greek physician Galen developed the first medical theories based on scientific experiments. Galen observed the heartbeat and realized that the heart put blood in motion. But he thought that the heart's right ventricle forced blood into the left ventricle through holes in the septum. Galen also believed that the liver converted food into blood, which then flowed through the body and was used up.
Discovery of circulation. Doctors accepted Galen's theories--in spite of the many errors--until the 1500's. In the mid-1500's, a Flemish-born physician named Andreas Vesalius described veins and arteries. He also showed that no holes exist between the heart's chambers. Also in the 1500's, Michael Servetus, a Spanish physician and theologian, reasoned that blood flows between the heart and lungs. But his studies were not publicized because of his unpopular religious beliefs. The theory of blood circulation was first published in 1628, by William Harvey, an English physician. His work became the basis of modern research on the heart and blood vessels. Harvey showed that the heart works like a pump. He described how blood flows from the heart to the lungs, back to the heart, out to the body, and back to the heart. Harvey believed that small blood vessels called capillaries connect arteries and veins. The idea of capillaries had been proposed in the 1500's by an Italian anatomist named Andrea Cesalpino.
Marcello Malpighi, an Italian physician, proved their existence in 1661. In the early 1700's, Stephen Hales, an English clergyman and scientist, became the first person to measure blood pressure. He placed a glass tube in a horse's artery after breaking through the animal's skin. Hales published the result of this experiment in 1733. Invention of new medical instruments. During the 1800's, many inventions expanded doctors' knowledge of the heart and helped in their diagnosis and treatment of heart problems. In 1816, a French physician named Rene Laennec invented the stethoscope, which enabled doctors to listen to sounds of the heart and other organs. In 1880, Samuel Siegfried von Basch, a Viennese physician, developed the sphygmomanometer, an instrument to measure blood pressure without breaking the skin. Russian physician Nikolai Korotkoff used a stethoscope in 1905 to take the pulse while measuring blood pressure, thus recording systolic and diastolic blood pressure.
Doctors still use this technique. In 1903, Willem Einthoven, a Dutch physiologist, invented the string galvanometer, a device to measure minute electrical currents generated by the activity of the heart, and so developed the basis of the electrocardiograph. By the 1920's, the electrocardiograph had become the chief diagnostic tool in cardiology. Development of heart surgery. An American cardiologist named James B. Herrick made the first diagnosis of a heart attack in 1912. In 1938, Robert E. Gross, an American surgeon, performed the first successful repair of a congenital heart defect. Gross sewed the hole in the artery of a child suffering from patent ductus arteriosus. In 1944, Helen Brooke Taussig and Alfred Blalock, two American physicians, developed an operation to help correct abnormal circulation of blue babies. In 1952, American surgeon Charles Hufnagel operated on a beating heart and implanted the first artificial heart valve.
Discovery of circulation. Doctors accepted Galen's theories--in spite of the many errors--until the 1500's. In the mid-1500's, a Flemish-born physician named Andreas Vesalius described veins and arteries. He also showed that no holes exist between the heart's chambers. Also in the 1500's, Michael Servetus, a Spanish physician and theologian, reasoned that blood flows between the heart and lungs. But his studies were not publicized because of his unpopular religious beliefs. The theory of blood circulation was first published in 1628, by William Harvey, an English physician. His work became the basis of modern research on the heart and blood vessels. Harvey showed that the heart works like a pump. He described how blood flows from the heart to the lungs, back to the heart, out to the body, and back to the heart. Harvey believed that small blood vessels called capillaries connect arteries and veins. The idea of capillaries had been proposed in the 1500's by an Italian anatomist named Andrea Cesalpino.
Marcello Malpighi, an Italian physician, proved their existence in 1661. In the early 1700's, Stephen Hales, an English clergyman and scientist, became the first person to measure blood pressure. He placed a glass tube in a horse's artery after breaking through the animal's skin. Hales published the result of this experiment in 1733. Invention of new medical instruments. During the 1800's, many inventions expanded doctors' knowledge of the heart and helped in their diagnosis and treatment of heart problems. In 1816, a French physician named Rene Laennec invented the stethoscope, which enabled doctors to listen to sounds of the heart and other organs. In 1880, Samuel Siegfried von Basch, a Viennese physician, developed the sphygmomanometer, an instrument to measure blood pressure without breaking the skin. Russian physician Nikolai Korotkoff used a stethoscope in 1905 to take the pulse while measuring blood pressure, thus recording systolic and diastolic blood pressure.
Doctors still use this technique. In 1903, Willem Einthoven, a Dutch physiologist, invented the string galvanometer, a device to measure minute electrical currents generated by the activity of the heart, and so developed the basis of the electrocardiograph. By the 1920's, the electrocardiograph had become the chief diagnostic tool in cardiology. Development of heart surgery. An American cardiologist named James B. Herrick made the first diagnosis of a heart attack in 1912. In 1938, Robert E. Gross, an American surgeon, performed the first successful repair of a congenital heart defect. Gross sewed the hole in the artery of a child suffering from patent ductus arteriosus. In 1944, Helen Brooke Taussig and Alfred Blalock, two American physicians, developed an operation to help correct abnormal circulation of blue babies. In 1952, American surgeon Charles Hufnagel operated on a beating heart and implanted the first artificial heart valve.
HEART ATTACKS ARE DANGEROUS
Almost all heart attacks occur when a blood clot suddenly and completely blocks a coronary artery. The condition is called a coronary thrombosis, or simply a coronary. The heart muscle supplied by the blocked artery becomes damaged because it receives too little oxygen. Unless blood flow returns within minutes, muscle damage increases. The heart cells begin to die after four to six hours without blood. The damage can affect the heart's ability to pump and cause the death of the victim. The body reacts to a heart attack with its own defenses. Substances in the blood can dissolve clots and permit blood to flow freely again. If the clot is dissolved within four to six hours of the attack, the heart suffers less damage.The machine removes carbon dioxide from the blood and delivers oxygenated blood to the body tissues. A coronary bypass can ease symptoms of angina and prolong the lives of patients with more severe CAD. But it does not stop atherosclerosis.
Symptoms. Before having a heart attack, many people suffer from angina, feel dizzy, have indigestion, or experience other symptoms. Some people have no warning signs. Most heart attacks cause severe pain. Victims describe the pain as a dull, crushing ache in the chest, but it may extend into the neck, jaw, arms, or back. The pain may last from a few minutes to several hours. A person who has chest pain and suspects it may mean a heart attack should seek medical help immediately. Some victims may stop breathing, and their heart may stop beating. A first-aid technique called cardiopulmonary resuscitation (CPR) can maintain a person's breathing and circulation until medical help arrives and the victim is taken to a hospital. But cardiopulmonary resuscitation should be performed only by someone trained in the technique. A mild heart attack may force a person to lead a less active life. A severe attack may make the heart unable to supply the body with enough blood even at rest and so cause a person's death. Disease may also strike other parts of the heart with equally destructive effects.
Diagnosis and treatment. Soon after a heart attack victim reaches the hospital, doctors use an ECG to make sure the patient actually had a heart attack and not chest pain resulting from some other disorder. Injured heart muscle causes abnormal ECG waves. Doctors also use certain blood tests to detect a heart attack. But the tests are not useful until six hours after the attack. If a victim still has pain, doctors may administer a painkilling drug, such as morphine. They also use drugs to dissolve clots in the blocked artery. If the drugs fail to dissolve the clots, doctors may perform emergency angioplasty or bypass surgery. After being hospitalized, heart attack patients are monitored for complications in the intensive care unit. Two major complications are heart failure and arrhythmia. Heart failure occurs if the heart does not pump enough blood because of extensive damage to the heart muscle. In most cases, heart failure can be successfully treated. In arrhythmia, the heart's electrical system produces an abnormal rhythm. One kind of arrhythmia, ventricular fibrillation, occurs when electrical signals in the ventricles fire randomly.
Ineffective heart rhythm and sudden death may result from ventricular fibrillation. Arrhythmias can be readily treated under medical care. The death rate among heart attack victims who do not get medical care is more than 20 percent. Some of them die before reaching a doctor. Other victims ignore their symptoms. The death rate among hospitalized patients ranges from 5 to 10 percent. Heart attack patients with repeated chest pain, arrhythmias, or heart failure have a greater risk of another attack than do patients without those problems. Plaques can completely block an artery and stop the blood flow. In addition, they can narrow an artery and so reduce blood flow enough to form a thrombus (blood clot). Plaques often crack, releasing substances that also can lead to blood clots. If a blood clot blocks a coronary artery, it causes a heart attack. A blood clot that occurs in an artery in the brain causes a stroke.
Symptoms. Before having a heart attack, many people suffer from angina, feel dizzy, have indigestion, or experience other symptoms. Some people have no warning signs. Most heart attacks cause severe pain. Victims describe the pain as a dull, crushing ache in the chest, but it may extend into the neck, jaw, arms, or back. The pain may last from a few minutes to several hours. A person who has chest pain and suspects it may mean a heart attack should seek medical help immediately. Some victims may stop breathing, and their heart may stop beating. A first-aid technique called cardiopulmonary resuscitation (CPR) can maintain a person's breathing and circulation until medical help arrives and the victim is taken to a hospital. But cardiopulmonary resuscitation should be performed only by someone trained in the technique. A mild heart attack may force a person to lead a less active life. A severe attack may make the heart unable to supply the body with enough blood even at rest and so cause a person's death. Disease may also strike other parts of the heart with equally destructive effects.
Diagnosis and treatment. Soon after a heart attack victim reaches the hospital, doctors use an ECG to make sure the patient actually had a heart attack and not chest pain resulting from some other disorder. Injured heart muscle causes abnormal ECG waves. Doctors also use certain blood tests to detect a heart attack. But the tests are not useful until six hours after the attack. If a victim still has pain, doctors may administer a painkilling drug, such as morphine. They also use drugs to dissolve clots in the blocked artery. If the drugs fail to dissolve the clots, doctors may perform emergency angioplasty or bypass surgery. After being hospitalized, heart attack patients are monitored for complications in the intensive care unit. Two major complications are heart failure and arrhythmia. Heart failure occurs if the heart does not pump enough blood because of extensive damage to the heart muscle. In most cases, heart failure can be successfully treated. In arrhythmia, the heart's electrical system produces an abnormal rhythm. One kind of arrhythmia, ventricular fibrillation, occurs when electrical signals in the ventricles fire randomly.
Ineffective heart rhythm and sudden death may result from ventricular fibrillation. Arrhythmias can be readily treated under medical care. The death rate among heart attack victims who do not get medical care is more than 20 percent. Some of them die before reaching a doctor. Other victims ignore their symptoms. The death rate among hospitalized patients ranges from 5 to 10 percent. Heart attack patients with repeated chest pain, arrhythmias, or heart failure have a greater risk of another attack than do patients without those problems. Plaques can completely block an artery and stop the blood flow. In addition, they can narrow an artery and so reduce blood flow enough to form a thrombus (blood clot). Plaques often crack, releasing substances that also can lead to blood clots. If a blood clot blocks a coronary artery, it causes a heart attack. A blood clot that occurs in an artery in the brain causes a stroke.
DIAGNOSIS AND SYMPTOMS
Coronary atherosclerosis usually takes many years to develop. Doctors have found coronary artery plaques in young soldiers killed in battle. But symptoms seldom occur until age 50 or later. In some cases, the first symptom is a heart attack or sudden death. However, a typical early symptom may be pain in the chest from exercising or some other activity that makes the heart work harder than usual. Doctors call such pain angina pectoris, or simply angina. The narrowed coronary arteries supply the heart with less oxygen, which may cause pain when the heart must work harder. After the exercising or other activity is stopped, the pain usually disappears. However, angina may worsen if left untreated. Patients may then suffer from frequent attacks, even when resting.
Physicians diagnose coronary artery disease by first listening to their patients tell of their general physical condition and past illnesses. They note any history of angina or heart attack and the presence of any risk factors. Physical examination may reveal other risk factors, such as high blood pressure or heart damage. Doctors use an instrument called an electrocardiograph to detect heart damage or disturbances of the heart rhythm. The instrument produces a record called an electrocardiogram (ECG), which displays the electrical activity of the heart muscle. The impulses are printed on moving paper that shows the heart's electrical activity as a series of wavy lines. Major waves represent contraction of the ventricles. Minor waves represent relaxation of the ventricles and contraction and relaxation of the atria. Most ECG's are taken with the patient lying down. But many physicians take a patient's ECG during exercise. Such a stress ECG shows whether a patient's heart--even if the patient has no chest pain--receives enough oxygen during vigorous exercise.
Doctors also use a method called radionuclide imaging to detect CAD. A doctor injects a radioactive element into a patient's bloodstream. The doctor can view the element on a screen as it spreads into the heart muscle. Areas that do not receive blood appear blank on the image. Doctors generally use radionuclide imaging with a stress ECG. If the usual diagnostic techniques leave doubt, physicians may perform cardiac catheterization followed by coronary angiography. They insert a long, flexible tube called a catheter through a large blood vessel, usually an artery in the area where the thigh and abdomen meet. They push the catheter up to where the coronary arteries begin and inject dye. The inside of the arteries can then be viewed and recorded on X-ray film called an angiogram. The test clearly shows the condition of the coronary arteries. Coronary angiography presents a small risk of injury or even death. Doctors therefore perform it only in difficult diagnostic cases.
If drugs fail to control coronary artery disease, doctors consider other techniques to correct the problem. In the easiest technique, coronary angioplasty or simply angioplasty, doctors insert a catheter with a deflated balloon attached into the narrowed area of the coronary artery. They then inflate the balloon, which pushes the blockage aside and enlarges the artery. Angioplasty works in about 85 per cent of patients at first. But in about a third of those patients, blockage returns within three months. For some patients, various methods may prolong the benefits of angioplasty. For example, intense beams of light from devices called lasers burn away new plaque deposits. Or the placement of tiny metal props in the artery may keep it open. Should catheter methods fail, most cardiologists suggest coronary artery bypass graft surgery. In bypass surgery, doctors first remove a short piece of a blood vessel, usually a vein from the patient's leg or from an artery in the chest.
Physicians diagnose coronary artery disease by first listening to their patients tell of their general physical condition and past illnesses. They note any history of angina or heart attack and the presence of any risk factors. Physical examination may reveal other risk factors, such as high blood pressure or heart damage. Doctors use an instrument called an electrocardiograph to detect heart damage or disturbances of the heart rhythm. The instrument produces a record called an electrocardiogram (ECG), which displays the electrical activity of the heart muscle. The impulses are printed on moving paper that shows the heart's electrical activity as a series of wavy lines. Major waves represent contraction of the ventricles. Minor waves represent relaxation of the ventricles and contraction and relaxation of the atria. Most ECG's are taken with the patient lying down. But many physicians take a patient's ECG during exercise. Such a stress ECG shows whether a patient's heart--even if the patient has no chest pain--receives enough oxygen during vigorous exercise.
Doctors also use a method called radionuclide imaging to detect CAD. A doctor injects a radioactive element into a patient's bloodstream. The doctor can view the element on a screen as it spreads into the heart muscle. Areas that do not receive blood appear blank on the image. Doctors generally use radionuclide imaging with a stress ECG. If the usual diagnostic techniques leave doubt, physicians may perform cardiac catheterization followed by coronary angiography. They insert a long, flexible tube called a catheter through a large blood vessel, usually an artery in the area where the thigh and abdomen meet. They push the catheter up to where the coronary arteries begin and inject dye. The inside of the arteries can then be viewed and recorded on X-ray film called an angiogram. The test clearly shows the condition of the coronary arteries. Coronary angiography presents a small risk of injury or even death. Doctors therefore perform it only in difficult diagnostic cases.
If drugs fail to control coronary artery disease, doctors consider other techniques to correct the problem. In the easiest technique, coronary angioplasty or simply angioplasty, doctors insert a catheter with a deflated balloon attached into the narrowed area of the coronary artery. They then inflate the balloon, which pushes the blockage aside and enlarges the artery. Angioplasty works in about 85 per cent of patients at first. But in about a third of those patients, blockage returns within three months. For some patients, various methods may prolong the benefits of angioplasty. For example, intense beams of light from devices called lasers burn away new plaque deposits. Or the placement of tiny metal props in the artery may keep it open. Should catheter methods fail, most cardiologists suggest coronary artery bypass graft surgery. In bypass surgery, doctors first remove a short piece of a blood vessel, usually a vein from the patient's leg or from an artery in the chest.
Subscribe to:
Posts (Atom)