More causes, diagnostics, and treatments for heart valves.
Today in lecture I covered four of the five heart valve defects on my list. But there were many aspects of valve defects I didn't have time to go into. If you find the topic intriguing, you can pursue it in the comments. Here are some ideas; pick one and do some research and tell us what you've learned.
option: learn more about one of the diagnostics used by doctors to check for defects.
option: learn about one other cause of heart damage, like Fen-Phen or Chagas disease.
option: find a new sort of valve repair or replacement treatment option
Be sure to explain what you've found in your own words, and tell us why it is interesting to you, and provide a good reference. Be sure you are not discussing something covered in an earlier comment.
48 comments:
Fen-Phen is a diet drug which was very popular in the 1990s. Research has shown that it can cause heart disease in people with no previous heart conditions or problems.
The drug Fen-Phen is made up of the drugs fenfluramine (appetite suppressant) and phentermine (stimulant). FDA approves the drugs separately, but not as a combination. The combination of these drugs led to leaky valves in the hearts of women in particular. The heart valves of these patients deteriorated and forced the heart to work harder. Most patients needed surgery to either replace or repair the affected heart valves. If this problem was not treated, it could lead to heart failure. The drug Fen-Phen is also have said to cause primary pulmonary hypertension in which the blood pressure is very high in the arteries that supply the heart.
After learning of the problems of this drug, the FDA removed it in 1997. It was a very popular drug, taken by over 15 million people a year. The following link is to a CNN article that explains this issue very well and was the source for my information regarding it. (http://www.cnn.com/HEALTH/9707/08/
fen.phen.pm/)
Cardiac Catheterization
this is a way for doctors to check for heart defects.
It is a type of procedure in which the doctor threads a small plastic tube called a catheter, through a blood vessel in the body(ex.leg or arm) to an artery in the heart. A special dye is injected through this catheter which fills your heart's arteries. These arteries now become visible only through the use of an X-ray.
This type of test can measure blood pressure within the heart and how see much oxygen is in the blood. It's also able to observe the pumping ability of the heart muscle. This test is often used to treat congenital heart defects. Blockages of the arteries can also be seen. you are awake through this procedure.
http://www.nhlbi.nih.gov/health/dci/Diseases/cath/cath_what.html
http://www.americanheart.org/presenter.jhtml?identifier=4491
Chagas disease is caused by the parasite Trypanosoma cruzi, which is transmitted to animals and people by insect vectors that are found only the Americas (usually Latin America). People can become infected through parasites in feces, consumption of uncooked food, congenital transmission (from a pregnant woman to her baby), blood transfusion, or organ transplantation.
Symptoms include cardiac complications (enlarged heart-cardiomyopathy), heart failure, altered heart rate or rhythm, and cardiac arrest.
Treatment includes antiparasitic treatement (to kill the parasite), or symptomatic treatment (ex: pacemakers, medications for irregular heartbeats).
http://www.cdc.gov/chagas/factsheet.html
An electrocardiogram, also abbreviated as ECG, is a pain free test that measures the electrical activity of the heartbeat. An ECG will show the timing of the top and lower chambers. With each heartbeat, a wave (or an electrical impulse) travels through the heart, causing the muscle to contract. The upper chambers (the right and left atria) make up the first wave, called the "P wave", which is then followed by a flat line when the electrical wave goes into the lower chambers. These bottom ventricles, or chambers, make up the next wave, called the "QRS complex". The last wave, the "T wave" then shows electrical recovery top a resting state for the ventricles. This procedure allows doctors to determine how long the electrical wave takes to pass through the heart and by measuring the amount of electrical activity passing through, a cardiologist can determine if parts of the heart are too large or overworked.
For the electrocardiogram from Michelle Lim; I forgot to post my link:
http://www.americanheart.org/presenter.jhtml?identifier=3005172
Researchers found that in a great majority of diseased heart valves bone was present. A team looked at 228 valves which were removed from patients who underwent valve replacement surgery and they found that in 30 of those valves hard-bone tissue, which is identical to that of a living human skeleton, was present. What this apparently does is open up the door for some more research to be done to find out how the bone got there and also perhaps lead to the development of therapies to prevent or treat heart-valve disease. I found this interesting because I guess the heart valve is probably one of the last places I would expect to see bone growing. I also made me wonder why it would be growing there in the first place.
http://www.biology-online.org/articles/hard_hearts_discovery_bone.html
I found a site http://www.congenitalheartdefects.com/ which gaves a list of all congenital heart defects: http://www.congenitalheartdefects.com/typesofCHD.html
it also includes a description of these conditions. For example, the "Tricuspid Atresia" is where the tricuspid valve doesn't even exist and so there can't be any blood flow between the right atrium and the right ventricle, which we know is a vital step in getting oxygenated blood to the body. People with this defect have underdeveloped atria and has to have another defect: either the atrial septal defect (having an opening in the wall between the atria) or the ventricular septal defect (having a small opening in the wall between the two ventricles, in order to live. Children born with this condition usually get pulmonary artery banding or surgical shunting procedure to either increase the blood flow to their lungs or decrease the bloodflow to their lungs. Another option is to get the Fontan procedure, in which a connection is created between the right atrium and pulmonary artery and the atrial defect is also closed. This is a condition that happens in about 2 out of 10,000 live births and makes up about 1 to 2 percent of congenital heart disease, occuring equally commonly in both genders.
There are several cardiac tests used by doctors to diagnose mitral valve stenosis and identify the cause or seriousness of the problem. One of the common tests includes the Transesophageal Echocardiogram or the TEE. This test takes a close look at your heart by inserting a transducer (which is attached to an end of a tube) down your esophagus (from your throat to your stomach). Once the transducer is put behind the heart, it bounces off sound waves within the heart to reveal the cardiac structures. The TEE is mainly useful for patients with trouble obtaining regular images through the standard echo procedure. It is also preferred because the Intraoperative TEE is useful during valve reconstruction surgery where the echo image can instantly give the surgeon information about the structures’ repair. Unfortunately, the TEE is known to carry more risk the regular echocardiogram due to discomforts such as gagging, but the TEE has been proved to be useful and safe when used with enough sedation and careful attention after the procedure. I found this particular test interesting because I know of a family member that had to go through with it. Despite minimal discomfort due to a sore throat, the surgery went well and like the article said, revealed a clear diagnosis (the sound waves don’t have to bounce through the lungs and chest like in a regular echo). More information on TEE can be found in the following website: http://heartdisease.about.com/cs/echocardiograms/a/tee.htm
Researchers from the University of Groningen have found that anti-cancer drugs such as Anthracyclines damage the heart and continue to harm the heart over time. Researchers conducted follow up for children and young adults who had bone tumors treating them with anthracyclines such as doxorubicin. About 1/4 of them had systolic dysfunction. About 1/2 of them had another defect known as diastolic dysfunction. The defects worsen over a couple of follow ups.
This hurts the heart and decreases the strength of the heart.
I know doctors are trying to help by providing drugs to help out with diseases such as cancer, but if they continue to give such drugs to patients, they might be in a greater risk than the cancer itself. The heart is a vital organ for our body and we all need it to live.
http://www.naturalnews.com/019713.html
I found on this website some information about other causes of heart damage. http://www.npr.org/templates/story/story.php?storyId=6718704
I find it really interesting that a medication for Parkinson's disease could be the cause of heart damage and eventually lead to heart failure. The drugs are pergolide and cabergoline. They're derived from a fungus called ergot. Like many other heart damages, if a damage in the heart occurs from this medication, the patient will need to get a valve replacement to fix a leaky valve. The reported damage that this medication causes have been said to be the same as the diet drug fen phen. So I guess this means that if a person is taking medication for Parkinson's disease, they many also encounter heart damage. :/
On the website http://www.nhlbi.nih.gov/health/dci/Diseases/chd/chd_diagnosis.html, there were lists of tests that can be used to diagnose causes of heart defects and I chose to further research the Pulse Oximetry test. This is also a non-invasive method that involves placing a sensor over either the earlobe or finger of the patient to detect how much oxygen is in their blood. Once the sensor is in place, both red and infrared lights are passed through the body and the rates of absorbance of the two lights are recorded. A ratio between the absorbances of the two lights are calculated and the measure of oxygenation in the blood can now be configured. Although this is most commonly used to monitor patients that have just undergone anesthesia or also on newborns, it is used to asses a patients blood flow, and this of course relates to heart defects. If a patient undergoes a pulse oximetry and finds that their blood flow is inadequate, this will help convince them to look further into a possible heart defect, therefore this is an accurate way to determine if a patient may or may not have a heart defect. I think this is a very interesting way to test for defects because it is non-invasive and seems fairly simple and painless to sit through. Just a simple thing that could potentially save your life.
I didn't register with blogger before so I'm posting again to make sure it works...
On the website http://www.nhlbi.nih.gov/health/dci/Diseases/chd/chd_diagnosis.html, there were lists of tests that can be used to diagnose causes of heart defects and I chose to further research the Pulse Oximetry test. This is also a non-invasive method that involves placing a sensor over either the earlobe or finger of the patient to detect how much oxygen is in their blood. Once the sensor is in place, both red and infrared lights are passed through the body and the rates of absorbance of the two lights are recorded. A ratio between the absorbances of the two lights are calculated and the measure of oxygenation in the blood can now be configured. Although this is most commonly used to monitor patients that have just undergone anesthesia or also on newborns, it is used to asses a patients blood flow, and this of course relates to heart defects. If a patient undergoes a pulse oximetry and finds that their blood flow is inadequate, this will help convince them to look further into a possible heart defect, therefore this is an accurate way to determine if a patient may or may not have a heart defect. I think this is a very interesting way to test for defects because it is non-invasive and seems fairly simple and painless to sit through. Just a simple thing that could potentially save your life.
I found this article very interesting because it gave you different options of different diagnostic tests that can recognize mitral valve stenosis. One of the diagnostic tests that are used often are chest x rays. I always hear about them on medical TV shows and even pertaining to my own life with my grandparents. Chest x rays are what they sound like they are an x ray of the chest, which takes pictures of the heart and the lungs. I don't think people realize the differences in choices to treat or diagnose mitral valve stenosis. There are both benefits and mild risks with a chest x ray. Some benefits are that x rays usually have no side affects, unless you are pregnant. They are often inexpensive and are at most medical places, clinics, doctors offices, and hospitals. Last of all they are quick and simple, which helps with diagnosing it faster. Although there is also the risk of cancer from radiation. If you are interested in how helpful a chest x ray is, or how it works, the equipment that is used etc, here is the link: http://www.radiologyinfo.org/en/info.cfm?pg=chestrad&bhcp=1
I wanted to show other facts about Chagas disease because I found it interesting. The alternate name for this disease is American trypanosomiasis and mostly found in Latin America. Caused by an insect called Trypanosoma cruzi, this insect causes a sleeping sickness. Many Latinos are infected because they live in huts where these parasites are common. A blood transfusion takes place between the human and the insect, thus leading to the two stages of the disease. A person would ordinarily go through an acute and chronic stage. Enlarged and swelling of different locations of the body will occur once the disease has hit hard; sometimes the disease will lead to death through a heart disease. Luckily, it is said that it takes around 20 years for the heart disease to fully take effect so treatment has a high chance. Once noticed of this disease, treatments such as Benznidazole will help the process. Although this is more focused in Latin America, the disease has hit about 500,000 people in the United States due to immigration.
http://www.nlm.nih.gov/medlineplus/ency/article/001372.htm
Holter monitor is also called an ambulatory electrocardiography. It is a portable device that continuously monitors the activity of the heart for 24 hours or more. It is often useful for observing occasional cardiac arrhythmias which may not be possible in a shorter period of time.
Holter monitor requires that 3 to 8 electrodes be attached to the chest of a person, the number of electrodes varying with the model of the Holter monitory. These electrodes are connected to another electrical device which is small enough to be attached to the belt. This form of technology has improved significantly, from using audio cassettes to slowly record the data to putting data onto digital flash memory devices. This data is put into a computer and it analyzes the the input, displaying results such as average heart rate, minimum and maximum heart rate, and counting ECG complexes.
Holter monitoring also requires that the person keep a precise diary of daily activity which can help simplify the process and enables the doctors to pinpoint problem which might be unreasonably difficult to identify otherwise.
For anyone who is interested in the technicalities and the process of how the Holter Monitory is attached, how many minutes it takes to attach, and other such questions, you can visit the following website:
http://www.heartsite.com/html/holter.html
We've only discuused one kind of treatment for a valve repair which was called the vulvuloplasty. Another valve repair would be called the Annuloplasty. It is a technique used to provide support for the valve, and reinforce other repair techniques. This only occurs when the annulus becomes too big, which causes the blood to stay in the atrium. In order to fix this, the surgeons need to have the leaflets meet again when the valve closes.
In most cases, a ring is used to fix the problem. Sutures, which are stitch fibers are sewn around the ring to create a smaller opening. This would allow the leaflets to actually touch when the valve closes. This ring is scientifically called the annuloplasty ring. For the most part, it provides support for the damaged valve.
I found this interesting because fixing valves is almost like fixing a car. The body is so mechanical that there are so many intricacies involved. It is fascinating how one small valve can cause such a disaster like a small problem in a car's engine that can lead to greater difficulties if not fixed. I found my article on:
http://www.sjm.com/procedures/procedure.aspx?name=Heart+Valve+Repair
Very interesting!
I wasn't really interested in the actual diseases themselves but more on how we can cure them or assist hearts in functioning normally. Implantable Cardioverter Defibrillators, or ICDs, are devices that monitor heart rhythms and deliver shocks if dangerous rhythms are detected. Many record the heart's electrical patterns whenever an abnormal heartbeat occurs, allowing doctors to review the patterns. New monitoring devices allow ICDs to transmit basic information to physicians. Many of the diseases discussed in class all cause abnormal heart beats, rhythums and functions which could be easily fixed by this device. according to the article found at
http://www.americanheart.org/presenter.jhtml?identifier=11227
there have been over 26,000 ICD heart procedures, which indicates their effectiveness.
One of the causes of heart failure is Coronary Artery Disease, also known as CAD. CAD is caused by the build up of cholesterol and fatty deposits (or plaque) in the arteries of the heart. Because coronary arteries supply oxygen-rich blood to the heart, it is really important that these arteries are functioning properly.
When atherosclerosis (the condition where arteries are blocked by plaque) happens, the oxygenated blood cannot reach the heart, causing angina, or heart attack.
This disease progresses gradually, and becomes very serious as a person reaches an old age. However, it can also develop in younger people. Although both men and women can develop this disease, coronary artery disease is more common in men.
Treatment to coronary artery disease depends on the patient’s symptoms and diagnostic results. For some people, this disease can be easily treated with simple lifestyle changes and medications (with observations). Some of the medications used to treat this disease are cholesterol-lowering medications (to prevent further blocking of the arteries with plaque), and nitroglycerin, which opens the narrowed blood vessels and improve blood flows.
However, for some people with serious cases, surgery may be needed. One of the surgical procedures is called coronary artery bypass surgery. The bypass surgery, also known as coronary artery bypass grafting (CABG), involves creating another route to the heart with a new blood vessel.
http://www.mayoclinic.org/coronary-artery-disease/
http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html
Mitral Regurgitation can result in Ischemic heart disease. Ischemia is a the lack of oxygenated blood supply in an organ. In the heart, the muscle doesn't get enough oxygen-rich blood because f the narrowed or blocked coronary arteries. It often results in angina or chest pains, which can be an early warning of a heart attack.
To repair a stenotic mitral valve, one can use mitral commisurotomy if started from birth or damage
by rheumatic fever. To repair a regurgitant mitral valve by closing the open cleft with sutures. Since mitral valve disease may be from chordal apparatus, the strings that support the heart to function normally of by the "floppy valve" syndrome where the components of the valve are enlarged and elongated. To undergo these types of surgerys prophylactic antibiotics are to be given to fight against infection as well.
The source I used to find this information was
http://www.cts.usc.edu/mitralvalverepair.html
It was very useful in informing me about surgerys and different heart diseases i was previously unaware of.
TEE or transesophageal echocardiogram is used to diagnosed heart disease.
Transesophageal echocardiogram is an alternate way to performing an echocardiogram. A probe containing a n ultrasound at the tip which is passed through the esophagas. The patient is first sedated so that when the tube enters the esophagas. The patient is given a spray to numb their mouth and throat so that they will not feel any discomfort. Next the patient must swallow the tube because the tube goes down the same esophagas as swallowed food. Although the patient is sedated it is very difficult for the tube to go down when the patient is gagging on the tube. Finally the tube arrives at the position behind the heart. This allows for the doctor to look in several different angles and search for things like blood pressure, heart rate or even breathing.
http://www.stanfordhospital.com/healthlib/greystone/heartcenter/heartprocedures/transesophagealechocardiogram
One of the the diagnostics or standards used to check the severity of heart failure is called the New York Heart Association Functional Classification (NYHA Classification). This type of classification places patients in one of four categories based on how much they are limited during daily physical activity. The classifications are based upon breathing levels and or pain. The four levels can be found on this website:
http://www.abouthf.org/questions_stages.htm
A similar classification scale is the Canadian Cardiovascular Society Angina Grading Scale which classifies the severity of angina or chest pains due to the lack of oxygen supply to the heart muscle.
Even though the NYHA Classification is one of the most commonly used methods in the diagnosis of severity of heart failure, this site states there are limitations to this type of classification.
http://heart.bmj.com/cgi/content/full/93/4/476
It concludes that the NYHA Classification method is a poor method mainly because different doctors apply it differently. Making the classification to vary upon doctors and those suggest that there should be specific questions asked about the patient regarding daily life and exercise to fully classify a patient.
The main type of treatment for valve disease is replacement or repair. The site that I have found features many different aortic and mitral valves that the company manufactures in both adult and pediatric sizes. An interesting thing about this company is that they also offer three different types of valve repair. The three types they offer are: AnnuloFlex Annuloplasty System, AnnuloFlo Annuloplasty System, and CardioFix Pericardium with PhotoFix Technology. The most interesting thing about the site is they offer pictures of all of the different valves and pictures of the materials used for the valve repair procedure.
The pictures can be found here:
http://www.carbomedics.com/professional_products_top.asp?from=us
A distinct way that doctors use to check for heart defects is through Holter monitoring.
Holter monitering is also called a ambulatory electrocardiography device. It is a portable device that continuously monitors the electrical activity of the heart for 24 hours straight. Its extended recording capabilities are useful for observing occasional cardiac "arrhythmias" that would be difficult to identify within a short time period. For some patients with more transient symptoms, a cardiac even monitor will be worn for a month or even more.
similar to the electrocardiography (ECG), the Holter monitor records electrical signals from the heart through the electrodes attached to the chest. . These electrodes are connected to a small piece of equipment that is attached to the patient's belt, and is responsible for keeping a log of the heart's electrical activity throughout the recording period.
http://www.heartsite.com/html/holter.html
here is a website, demonstrating and showing an in depth analysis on the Holter monitor and provides detailed photos and descriptions.
A method used to diagnose heart defects is the Chest X-ray. This is an X-ray image of the chest that allows doctors to check the size and shape of the heart to determine whether a chamber of the heart is abnormal. The X-ray also helps a doctor check the condition of the lungs and it helps the doctor to determine if thier is blood back up in the lungs. The Chest X-ray can also help to find the cause behind common symptons such as excessive coughing, shortness of breath, and chest pain. A bizzare and interesting use for a Chest X-ray is that it helps to find find foreign objects, such as coins or other small pieces of metal, in the tube to the stomach (esophagus), the airway, and the lungs. However, a chest X-ray may not be able to see food, nuts, or wood fiber.
The Chest X-ray is not usually done on people who are pregnant because the radiation could do harm to unborn baby. But even so, very little damage is done so precautions can be taken.
A radiologist usually takes the X-rays. Two X-ray views of the chest are usually taken. One view is taken from the back and the other view is taken from the side of the body. Other views may be needed depending on what the doctor is looking for. But in emergency situations, only one picture is taken and that is from the front of the chest so that the doctor can get a quick view of the chest.
http://www.webmd.com/heart-disease/chest-x-ray
The link above gives more information about Chest X-rays. It explains the effects, when it is taken, how it feels, etc.
Fen-phen
Fen-Phen is a drug that helps people lose weight. It is made up of two drugs fenfluramine and phentermine. What this drug does is to block hunger by blocking the hungry receptors in the brain.
This drug can cause diseases related to the 4 main valves of the heart.
Aortic Stenosis - regurgitation of the blood which causes decreased efficiency and increased left ventricular volume of the heart.
Mitral Stenosis - When the mitral valve becomes more narrow and causes regurgitation the left atrium.
Tricuspid Stenosis - The narrwoing of the Tricuspid valve of the heart.
Mitral Stenosis and Tricuspid can cause rheumatic fever.
I learned that there were many problems with this drug. In 1997 FDA required this drug to be labeled with heart warnings. In 2004 Fen-Phen was no longer available because of the health risks.
http://en.wikipedia.org/wiki/Fen-phen
http://www.ashcraftandgerel.com/fenphen.html
In class we learned about the balloon vulvuloplasty technique of heart repair. If you will remember, this is the technique in which the valve is stretched by a balloon-like device that is threaded from the leg, into the right atrium, and then into the left aftrium by poking a hole through the right atrium. Another valve repair technique is a commissurotomy. Opposite to a vulvuloplasty, a commissurotomy narrows the valve.
Below is an interesting website I found that covers a wide range of topics regarding valve repairs and replacements:
http://www.texasheartinstitute.org/hic/topics/proced/vsurg.cfm
An electrocardiogram, also known as ECG, is used by doctors to help them see if anything is wrong with the heart of the patient. It measures the electrical activity that the heart contains in great detail. It helps doctors see if the patient has heart disease.
This machine was actually first brought into the medical field by Willem Einthoven in 1893.
The way this diagnostic tool works is by attaching these clear sticky patches on your skin all over your body where heart pulses can be sensed with wires attached. It can give information about the rhythm of the heart.
in this link..it includes the advantages of getting this procedure and the risks that come with it... http://www.med.umich.edu/1libr/aha/aha_elecgram_car.htm
An echocardiogram is a diagnostic test that used ultrasound to produce a moving image of the heart. It is done by the help of ultrasound waves. A transducer creates and beams the ultrasound rays, when these rays hit a solid object, or an object of a different density, they reflect back to the transducer, thus creating an image of the object keeping in mind the amount of time the beam took to travel to and fro from the transducer. The reflection of the beam suggests the shape, size, movement and density of the heart.
The echocardiogram can make two-dimensional images of the different chambers of the heart, valves, and the blood vessels that exit from the left and right ventricle. They test the size and the movement of the heart’s structures. The Doppler Effect tests the blood flow of the heart.
http://www.heartsite.com/html/echocardiogram.html
A new valve replacement/ repair is Biological valves. Biological valves.
According to http://www.mayoclinic.org/heart-valve-surgery/treatment.html:
They are made from xenograft which is animal tissue or they are taken from an allograft which is human tissue of a donated heart. Even tissue from the same patient can be used for valve replacement called a Ross procedure.
Biological valves are not as long lasting as mechanical valves meaning that they may need to be replaced. Patients with these type of valves usually do not need to take blood-thinning medication.
Biological patients are usually seen in elderly patients.
The choice to have this procedure should be made by the doctor and patient while taking into account: age, other medical conditions, patient's preferences with regard to medications and possible need for another operation, lifestyle, and potential pregnancy in women.
Another cause of heart damages is from carbon monoxide. Researchers have found that carbon monoxide could cause direct damage to the heart muscle. The heart's pumping capacity gets reduced because there's lack of oxygen, which causes a permanent cardiac function damage. This can lead to serious heart damage which is irreversible. Results show that the heart damage by carbon monoxide can have long lasting effects even after the carbon monoxide is not in the blood anymore. This shows how critical carbon monoxide poisoning really is. This is interesting to me because it is something I never learned before, and I also want to know more about what causes heart damages/failures. Carbon monoxide is known as the "invisible killer," and every year it affects 15,000 emergency visits to the hospital and 500 unintentional deaths.
http://www.eurekalert.org/pub_releases/2008-01/l-cmm012908.php
One of the latest and innovative forms of heart defect diagnosis is the employment of virtual reality. Dutch doctors are using virtual reality to create three-dimensional holograms of the heart to help them find the heart defect. The Erasmus Medical Center in Rotterdam of the Netherlands is one of the first centers to install an I-Space virtual reality system. This 4-walled system allows observers to observe pathological heart valve problems with accuracy.
I personally find this method to be efficient and perhaps a useful training tool. But only a few centers actually have and use this I-Space system since the costs aren't exactly cheap. Thus this form of diagnosis may be useful but not probable as a massively used system.
The article about this method can be found here:
http://blogs.zdnet.com/emergingtech/?p=118
Many of the heart diseases we discussed in class were congenital, so it raises the question of if it can be diagnosed before birth. With today's technology, most parents are able to know the status of the child's bodily systems during normal ultrasounds. However, if family history or other signs direct to a high risk of a certain problem, the doctors can issue a fetal echocardiography. It is an ultrasound test normally used for examining the chest cavity, but it can safely be used on the abdomen of the the pregnant woman. With the results, doctors and family members can prepare to help the child with any surgical or medical procedure if need be. (It would probably give a peace of mind to the parents as well.)
http://www.childrenshospital.org/clinicalservices/Site1032/mainpageS1032P0.html
[Sorry I keep reposting! I don't get how to use this...]
Many of the heart diseases we discussed in class were congenital, so it raises the question of if it can be diagnosed before birth. With today's technology, most parents are able to know the status of the child's bodily systems during normal ultrasounds. However, if family history or other signs direct to a high risk of a certain problem, the doctors can issue a fetal echocardiography. It is an ultrasound test normally used for examining the chest cavity, but it can safely be used on the abdomen of the the pregnant woman. With the results, doctors and family members can prepare to help the child with any surgical or medical procedure if need be. (It would probably give a peace of mind to the parents as well.)
http://www.childrenshospital.org/clinicalservices/Site1032/mainpageS1032P0.html
The Chagas disease is an infection that is transmitted by an assassin bug, kissing bug, or reduviid bug. In order for a bite to be contagious, the insect itself must be infected. Contamination occurs when the infected insect releases feces onto human skin. If the feces finds its way into the body via: eye, wound, or mouth, the disease can become dangerous. Chagas disease is more often seen in poor rural areas. Though the early stages of chagas are not considered to be dangerous, it is later on that the symptoms can become severe. In the intermediate-chronic stage, 10-20 years after infection, chagas can cause an enlarged heart, altered heart rates, heart failure, or even cardiac arrest.
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/chagas_disease.jsp
According to researchers at Northwestern University, heart valve disease is caused by an inflammatory process likely triggered by high cholesterol that stimulates certain cells to reprogram into bone cells in the aortic valve and cartilage cells in the mitral valve.
The study demonstrated that the early use of statins lead to a significant reduction in heart valve diseases in laboratory rats. Therefore, the use of statins in humans should be considered in patients with early aortic sclerosis.
http://www.sciencedaily.com/releases/2006/04/060411225344.htm
Valvuloplasty is an excellent option in certain circumstances to treat stenotic or stiff heart valves. Stanford University is a leader in the procedure of valvuloplasty, in which a catheter is inserted from a vessel in the groin through the aorta and into the heart. The catheter is advanced to the valve to be opened, a large balloon at the tip of the catheter is inflated until the leaflets (flaps) of the valve are opened. This procedure can be performed under general or local anesthesia.
Other related procedures that may be used to assess and treat the heart include resting and exercise electrocardiogram (ECG or EKG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest x-ray, computed tomography (CT scan) of the chest, coronary artery bypass graft surgery, valve repair/replacement surgery, echocardiography, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and ultrafast CT scan.
http://www.stanfordhospital.com/healthlib/greystone/heartcenter/heartprocedures/valvuloplasty
Chagas Disease
Chagas Disease is named after a Brizilian physician carlos Chagas in 1909. The common way of getting infected with this disease is through vectorborne transmission by the insect called triatomine bugs. These bugs suck the blood and transmit a parasite known as Trypanosoma cruzi into the human body. Some people develop cardiac complications which can enlarge the heart, cause heart failure and irregular heart rhythm, and cardiac arrest. Currently, there are two treatments for Chagas Disease, antiparasitic and symptomatic. It says that some people go through years and decades without noticing any symptoms of this disease until it is too late to be cured. What worries me is that a tiny bug bite may seem like nothing, but can damage and alter the way a healthy heart functions.
http://www.cdc.gov/chagas/factsheet.html#intro
The average age for valve replacement surgery is rising, as is the life expectency. An interesting viewpoint on the subject of valvular heart disease can be found on the website:
http://www.onevalveforlife.com/ovflcontenttmp.aspx?section=2&page=1
Something that I found very interesting was the relationship between the thyroid gland and how this can lead to heart failure. Thyroid disease is one of the many diseases that may increase the effects of the heart especially when the thyroid gland is overactive or also known as hyperthyroidism. With an overactive thyroid this may produce system of palpitations, heart pain, or heart failure. Similar symptoms may occur with an under active thyroid (hypothyroidism). Symptoms of heart disease are more likely to occur in patients who have heart disease from other cause. Permanent changes in the heart are unusual in patients with normal healthy hearts, unless the thyroid disease is severe and left untreated for an extended period.
I thought this connection between the thyroid gland the heart was interesting because we think of the thyroid gland with the function dealing with metabolism. The thyroid gland releases a hormone, thyroxin which stimulate the heart to work faster or slower.
For further information look at this link:
http://www.thyroid.ca/Articles/EngE6A.html
Besides Fen-Phen which is a diet drug can cause heart disease, the treatment with the Parkinson's disease drugs Permax (pergolide) and Dostinex (cabergoline) can also cause cardiac-valve dysfunction. Permax and Dostinex are popular drugs designed to treat the neurological condition Parkinson’s disease. The National Institute of Neurological Disorders and Stroke believes that over 500,000 Americans will face this disease of the central nervous system every day. There are a number of options to treat this disease, but many doctors chose to use Permax and Dostinex.
Unfortunately, according to the New England Journal of Medicine (NEJM) articles, two studies discovered that these drugs could cause heart damage, such as pulmonary fibrosis, cardiac valvulopathy, leaky heart valves, etc. Researchers in Italy found that almost 25% of Parkinson’s patients that used these drugs to treat their disease suffered moderate to severe heart-valve damage. Additionally, scientists and doctors in Germany found out that Permax and Dostinex were five to seven times more likely cause leaky heart valves than those that took less dangerous drugs. The serious effect of increased risk is resulting in calls for the use of these drugs to be discontinued for the treatment of Parkinson's disease.
http://www.drug-injury.com/druginjurycom/2007/01/two_parkinsons_.html
I also found some information on the Mayo Clinic, which concluded that "Cabergoline should be discontinued if valvular disease is detected and neo other cause identified."
Cardiomyopathy is a heart disease in which the heart becomes inflamed and doesn’t work like it normally should. This disorder is classified as either primary or secondary cardiomyopathy. Primary cardiomyopathy can usually not be linked to specific causes.
Secondary cardiomyopathy, however, is usually due to specific causes. It is usually due to problems in other organs as well. Three main types of cardiomyopathy are dilated, hypertrophic and restrictive cardiomyopathy. Dilated cardiomyopathy is the most common one in which the heart cavity is enlarged and stretched. Blood flows more slowly through an enlarged heart, so blood clots may form. The heart is weak and doesn't pump normally, and most patients develop heart failure. Hypertrophic cardiomyopathy is when muscle mass of the left ventricle enlarges or "hypertrophies”. Restrictive cardiomyopathy is the least common one in which heart muscle of the ventricles becomes highly rigid which makes it harder for ventricles, the most important chambers of the heart, to fill with blood.
Since, cardiomyopathy results in a significantly enlarged heart, the mitral and tricuspid valves may not be able to close properly, resulting in murmurs. I found this article interesting because I could draw the connection that cardiomyopathy can cause the valve problems we learnt about in class.
More information can be found at: http://www.americanheart.org/presenter.jhtml?identifier=4468
Fen-phen was an anti-obesity medication which consisted of two drugs which were fenfluramine and phentermine. There had been several reports regarding valvular heart disease and pulmonary hypertension primarily in women who had been trying to get treated with the diest medication Fen-phen. When these reports came jeapordizing the health of people, the FDA requested a withdrawal of it from the market. Based off of certain findings by doctors who had done echocardiograms on patients, they were able to figure out that people without any health problems came back with abnormal echocardiograms.
This topic is interesting to me because even when a person is 100% healthy, taking certain drugs can jeapordize a persons health.
http://en.wikipedia.org/wiki/Fen-phen
Chagas’ disease is a contagious disease which can be found in Northern South America, Central America and Mexico. The protozoan parasite (Trypanosoma cruzi) enters the human by broken skin. The disease can be transmitted where there are poor-quality of houses. The parasites appear at night and suck human blood. The disease usually can be seen children. They get fever; if the disease is near the eye, the eyelid becomes swollen. Fever and swollen lymph nodes would become severe and those can lead someone to death especially in young children. Parasites attack human organs and cause heart and intestinal damage.
The reason I chose this disease is because it happens in Northern South America which is close to where I live. Moreover, I was surprised how those small parasites can cause that much damage to human; not only does it transmit the disease but also kill human as well. It is important to keep houses clean and well-protected from parasites especially in rural areas. I found this information from this website.
http://www.who.int/tdr/diseases/chagas/diseaseinfo.htm
http://yourtotalhealth.ivillage.com/valvular-regurgitation.html
Vulvular regurgitation is basically a condition in which blood leaks in the wrong direction because one or more of the heart's valves are not closing properly. It may occur in any of the four parts of the heart: the aortic valve, the mitral valve, the tricuspid valve, or the pulmonic valve.
One of the diagnostics used by doctors to detect for this disease is the electrocardiogram. The elctrocardiogram is a test that uses sound waves to help the doctor to see the structures and functions of the heart. A motion image of the patient’s beating heart is played on a video screen, where the doctor can study and measure the heart’s thickness, size and function. The image also reveals the motion pattern and structure of the four heart valves, revealing any potential leakage (regurgitation). During this test, a color flow Doppler ultrasound is required to assess the severity of the regurgitation.
I find this site useful in terms of its explanations of the disease, what are its symptons, how to identify it, and how to treat it. I find this site to be really applicacble in terms of studying the diseases in depth and gain a better understanding of human physiology.
Mitral valve repair can be carried out with many different procedures, but there was one that stood out in my eyes. Triangular Resection Mitral Valve Repair seems truly interesting. During Triangular Resection a surgeon removes the ruptured area of the cord by making a small cut with a scalpel. Then, it is sewn back together and the repair is now complete.
I found this interesting because of how surgeons can actually perform this type of procedure. Just imagine opening up a patient's chest and fixing a mitral valve. It is absolutely astonishing what can be accomplished. Another astonishing fact that I found interesting was how a surgeon can operate on the heart and the patient can still live after the operation is complete. Medical marvels have come a long way and it is saving lives everyday.
http://www.clevelandclinic.org/heartcenter/pub/guide/disease/valve/mvrepair.htm
Transesophageal echocardiogram (TEE) caught my attention because I did not think it was possible to look at the mitral valve through the esophageal throat. I learned that from this website, http://www.heartsite.com/html/tee.html, the esophageal is located behind the heart. It allows physicians to see the left atrium for better diagnosis. Transophageal echocardiogram is one of the preferred diagnoses because the heart can be examined at different angles. The procedure makes me cringe because the patient has to swallow the tube. To make this swallowing procedure comfortable for the patient, the throat has to be numbed for it to relax and not to gag on the tube. The positive outlook of this procedure is that it is safe and causes minor bleeding and sore throat. From the same website, TEE is said to help detect blood clots, tumors, and valve problems. TEE is also used in heart surgery to repair congenital heart defects. Again, TEE allows better visual for doctors to perform surgical procedures.
I cannot find any new facts about TEE, every website that I have searched discussed the same criteria points; what is a Transesophageal Echocardiogram? How is it done? How do I prepare for it? What happens after the test? If you are interested, you can check this website out for more details. http://www.med.umich.edu/1libr/chheart/noninv04.htm
I found an article on a new procedure that is meant to improve valve repair/replacement surgery called the Least Invasive Valve "LiV" technique. It allows the surgery to be performed without having to open the chest of the patient. The study shows that 45% of those at high risk for the surgery showed a reduction in operational mortality. It can also provide patients with a quicker recovery period.
I think this method would be great for those who maybe older or weaker than the average person and can't recover as fast from open heart surgery.
http://www.news-medical.net/?id=35154
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