Archive
Hot Topics of the Day are picked by experts to capture the latest information and publications on public health genomics and precision health for various diseases and health topics. Sources include published scientific literature, reviews, blogs and popular press articles.
Addressing Health Disparities—The Case for Variant Transthyretin Cardiac Amyloidosis Grows Stronger
(Posted: May 14, 2024 3PM)
From the article: "There has been a transformational change in understanding heart failure due to transthyretin cardiac amyloidosis (ATTR-CA). Previously considered a rare condition, the widespread adaptation of nuclear imaging to establish the diagnosis has led to the recognition that ATTR-CA is commonly encountered in clinical practice. Additionally, the advent of effective disease-modifying therapies that reduce morbidity and mortality among affected patients has afforded hope to those newly diagnosed. Because these disease-modifying therapies are more effective when administered early in the course of the illness, before significant end-organ dysfunction has occurred, it is vital to facilitate early diagnosis. "
What to Know About PREVENT, the AHA's New Cardiovascular Disease Risk Calculator.
Howard Larkin et al. JAMA 2023 12
(Posted: Jan 02, 2024 10AM)
From the article: "After 10 years, the American Heart Association (AHA) has updated its cardiovascular disease risk calculator for all adults aged 30 to 79 years without known cardiovascular disease. The Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator is based on newer data from a larger, more diverse sample than the existing tool, the commonly used Pooled Cohort Equations (PCEs), released in 2013 for non-Black Hispanic and White adults aged 40 to 79 years. The PREVENT equations also take into account other health conditions, such as kidney and metabolic diseases, for determining the 10- and 30-year chances of both atherosclerotic cardiovascular disease and heart failure. "
Organ aging signatures in the plasma proteome track health and disease.
Hamilton Se-Hwee Oh et al. Nature 2023 12 (7990) 164-172
(Posted: Dec 12, 2023 10AM)
From the abstract: "Using machine learning models, we analysed aging in 11 major organs and estimated organ age reproducibly in five independent cohorts encompassing 5,676 adults across the human lifespan. We discovered nearly 20% of the population show strongly accelerated age in one organ and 1.7% are multi-organ agers. Accelerated organ aging confers 20–50% higher mortality risk, and organ-specific diseases relate to faster aging of those organs. We find individuals with accelerated heart aging have a 250% increased heart failure risk and accelerated brain and vascular aging predict Alzheimer’s disease (AD) progression. "
Prediction of atrial fibrillation from at-home single-lead ECG signals without arrhythmias
M Gadaleta et al, NPJ Digital Medicine, December 12, 2023
(Posted: Dec 12, 2023 9AM)
From the abstract: "Early identification of atrial fibrillation (AF) can reduce the risk of stroke, heart failure, and other serious cardiovascular outcomes. However, paroxysmal AF may not be detected even after a two-week continuous monitoring period. We developed a model to quantify the risk of near-term AF in a two-week period, based on AF-free ECG intervals of up to 24?h from 459,889 patch-based ambulatory single-lead ECG (modified lead II) recordings of up to 14 days "
AI detects eye disease and risk of Parkinson's from retinal images.
Mariana Lenharo et al. Nature 2023 9
(Posted: Sep 14, 2023 8AM)
From the article: " Scientists have developed an artificial intelligence (AI) tool capable of diagnosing and predicting the risk of developing multiple health conditions — from ocular diseases to heart failure to Parkinson’s disease — all on the basis of people’s retinal images. AI tools have been trained to detect disease using retinal images before, but what makes the new tool — called RETFound — special is that it was developed using a method known as self-supervised learning. That means that the researchers did not have to analyse each of the 1.6 million retinal images used for training and label them as ‘normal’ or ‘not normal’, for instance. "
Association of Longer Leukocyte Telomere Length With Cardiac Size, Function, and Heart Failure
N Aung et al, JAMA Cardiology, July 26, 2023
(Posted: Jul 26, 2023 0PM)
Is leukocyte telomere length (LTL) associated with alterations in cardiovascular structure and function? In this cross-sectional study including 40 459 UK Biobank participants, longer LTL was associated with higher left ventricular mass, larger ventricular and atrial sizes, and higher stroke volumes. Mendelian randomization analysis demonstrated a potential causal genetic association between LTL and left ventricular mass, ventricular size, and left ventricular stroke volume, and longer LTL was associated with a lower risk of incident heart failure after accounting for potential confounders.
Transthyretin Cardiac Amyloidosis: Underrecognized in the Underrepresented.
Douglas J Leedy et al. J Am Heart Assoc 2023 7 e030802
(Posted: Jul 25, 2023 8AM)
Over the past decade, transthyretin cardiac amyloidosis (ATTR-CM) has rapidly emerged as an increasingly diagnosed cause of heart failure (HF) among older adults, predominantly those with HF with preserved ejection fraction. Although still frequently classified as a rare disease, there is mounting evidence that ATTR-CM is not as “rare” as it has been historically described. Because of the development of effective disease-modifying therapies, such as transthyretin stabilizers, early and accurate identification of ATTR-CM is essential.
Clinical Penetrance of the Transthyretin V122I Variant in Older Black Patients With Heart Failure: The SCAN-MP (Screening for Cardiac Amyloidosis With Nuclear Imaging in Minority Populations) Study.
Avni Madhani et al. J Am Heart Assoc 2023 7 e028973
(Posted: Jul 25, 2023 8AM)
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed cause of heart failure (HF) among patients =60?years of age. Although the V122I (valine to isoleucine substitution at position 122 of the transthyretin protein) variant associated with hereditary ATTR-CM is present in 3.4% of self-identified Black individuals in the United States (or 1.5?million people), the phenotypic penetrance is not known. In this study, among older Black individuals with HF and increased left ventricular wall thickness, of those with ATTR-CM, 63% had wild-type, and of those with V122I, the phenotypic penetrance of ATTR-CM was 39% (95% CI, 17–64), suggesting that genotype alone is insufficient for diagnosis.
EMQN: Recommendations for genetic testing in inherited cardiomyopathies and arrhythmias
JB Hayesmoore et al. EJHG July 13, 2023
(Posted: Jul 14, 2023 1PM)
Inherited cardiomyopathies and arrhythmias (ICAs) are a prevalent and clinically heterogeneous group of genetic disorders that are associated with increased risk of sudden cardiac death and heart failure. Making a genetic diagnosis can inform the management of patients and their at-risk relatives and, as such, molecular genetic testing is now considered an integral component of the clinical care pathway. However, ICAs are characterised by high genetic and allelic heterogeneity, incomplete / age-related penetrance, and variable expressivity.
Advancing heart failure research using machine learning
MA Mohammad, The Lancet Digital Health, June 2023
(Posted: May 25, 2023 8AM)
Machine learning has demonstrated significant potential in various medical research fields and has the potential to uncover intricate associations and the ability to identify subtypes of heart failure beyond those that are currently recognised, improve risk prediction, and ultimately pave the way for personalised medicine.
Validation of a Polygenic Score for Beta-Blocker Survival Benefit in Patients With Heart Failure Using the United Kingdom Biobank.
David E Lanfear et al. Circulation. Genomic and precision medicine 2023 3 e003835
(Posted: Mar 04, 2023 9AM)
Approaches to Genetic Screening in Cardiomyopathies: Practical Guidance for Clinicians.
Amy R Kontorovich et al. JACC. Heart failure 2023 2 (2) 133-142
(Posted: Mar 01, 2023 0PM)
Patients and families benefit when the genetic etiology of cardiomyopathy is elucidated through a multidisciplinary approach including genetic counseling and judicious use of genetic testing. The yield of genetic testing is optimized when performed on a proband with a clear phenotype, and interrogates genes that are validated in association with that specific form of cardiomyopathy. Variants of uncertain significance are frequently uncovered and should not be overinterpreted.
The role of aldehyde dehydrogenase 2 in cardiovascular disease.
Jian Zhang et al. Nature reviews. Cardiology 2023 2
(Posted: Feb 26, 2023 8AM)
Aldehyde dehydrogenase 2 (ALDH2) is a mitochondrial enzyme involved in the detoxification of alcohol-derived acetaldehyde and endogenous aldehydes. The inactivating ALDH2 rs671 polymorphism, present in up to 8% of the global population and in up to 50% of the East Asian population, is associated with increased risk of cardiovascular conditions such as coronary artery disease, alcohol-induced cardiac dysfunction, pulmonary arterial hypertension, heart failure and drug-induced cardiotoxicity.
Association of Hypertensive Disorders of Pregnancy With Future Cardiovascular Disease.
Bilal Rayes et al. JAMA network open 2023 2 (2) e230034
(Posted: Feb 18, 2023 8AM)
Is there evidence for an association between hypertensive disorders of pregnancy (HDPs) and long-term risk of cardiovascular disease? In this large genome-wide genetic association study using mendelian randomization, HDPs were associated with higher risk of coronary artery disease and ischemic stroke but not heart failure or atrial fibrillation. Mediation analysis revealed a partial attenuation of the association between HDPs and coronary artery disease after adjustment for systolic blood pressure and type 2 diabetes. These results support the consideration of HDPs as potential risk factors for cardiovascular disease.
CRISPR gene-editing therapies for hypertrophic cardiomyopathy.
Alanna Strong et al. Nature medicine 2023 2
(Posted: Feb 17, 2023 6AM)
Hypertrophic cardiomyopathy (HCM) is a primary cardiac disorder characterized by abnormal heart muscle thickening and caused by heterozygous pathogenic variants in genes encoding sarcomeric proteins. HCM often presents during young adulthood and can progress to heart failure, arrhythmia and sudden cardiac death. Pre-symptomatic gene editing in preclinical models of hypertrophic cardiomyopathy shows therapeutic promise; clinical studies are now needed to assess safety and efficacy in humans.
Acute respiratory distress syndrome after SARS-CoV-2 infection on young adult population: International observational federated study based on electronic health records through the 4CE consortium
B Moal et al, PLOS ONE, Jan 4, 2023
(Posted: Jan 05, 2023 5AM)
Among the 75,377 hospitalized patients with positive SARS-CoV-2 PCR, 1001 young adults presented with ARDS (7.8% of young hospitalized adults). Their mortality rate at 90 days was 16.2% and they presented with a similar complication rate for infection than older adults with ARDS. Peptic ulcer disease, paralysis, obesity, congestive heart failure, valvular disease, diabetes, chronic pulmonary disease and liver disease were associated with a higher risk of ARDS. We described a high prevalence of obesity (53%), hypertension (38%- although not significantly associated with ARDS), and diabetes (32%).
Genomics and phenomics of body mass index reveals a complex disease network.
Huang Jie et al. Nature communications 2022 12 (1) 7973
(Posted: Jan 02, 2023 0PM)
Using a BMI genetic risk score including 2446 variants, 316 diagnoses are associated in the Million Veteran Program, with 96.5% showing increased risk. A co-morbidity network analysis reveals seven disease communities containing multiple interconnected diseases associated with BMI as well as extensive connections across communities. Mendelian randomization analysis confirms phenotypes across many organ systems, including conditions of the circulatory (heart failure, ischemic heart disease, atrial fibrillation), genitourinary (chronic renal failure), respiratory (respiratory failure, asthma), musculoskeletal and dermatologic systems.
Association of PCSK9 Loss-of-Function Variants With Risk of Heart Failure.
Trudsø Linea C et al. JAMA cardiology 2022 12
(Posted: Dec 23, 2022 6PM)
Deep learning-based age estimation from chest X-rays indicates cardiovascular prognosis.
Ieki Hirotaka et al. Communications medicine 2022 12 (1) 159
(Posted: Dec 12, 2022 9AM)
In recent years, there has been considerable research on the use of artificial intelligence to estimate age and disease status from medical images. However, age estimation from chest X-ray (CXR) images has not been well studied and the clinical significance of estimated age has not been fully determined. To address this, we trained a deep neural network (DNN) model using more than 100,000 CXRs to estimate the patients' age solely from CXRs. We applied our DNN to CXRs of 1562 consecutive hospitalized heart failure patients, and 3586 patients admitted to the intensive care unit with cardiovascular disease.
International electronic health record-derived post-acute sequelae profiles of COVID-19 patients
HG Zhang et al, NPJ Digital Medicine, June 29, 2022
(Posted: Jun 29, 2022 7PM)
We leveraged electronic health record (EHR) data from 277 international hospitals representing 414,602 patients with COVID-19, 2.3 million control patients without COVID-19 in the inpatient and outpatient settings, and over 221 million diagnosis codes to systematically identify new-onset conditions enriched among patients with COVID-19 during the post-acute period. Compared to inpatient controls, inpatient COVID-19 cases were at significant risk for angina pectoris (RR 1.30, 95% CI 1.09–1.55), heart failure (RR 1.22, 95% CI 1.10–1.35), cognitive dysfunctions (RR 1.18, 95% CI 1.07–1.31), and fatigue (RR 1.18, 95% CI 1.07–1.30). Relative to outpatient controls, outpatient COVID-19 cases were at risk for pulmonary embolism (RR 2.10, 95% CI 1.58–2.76), venous embolism (RR 1.34, 95% CI 1.17–1.54), atrial fibrillation (RR 1.30, 95% CI 1.13–1.50), type 2 diabetes (RR 1.26, 95% CI 1.16–1.36) and vitamin D deficiency (RR 1.19, 95% CI 1.09–1.30).
Mendelian Randomization: Principles and its usage in Lp(a) research.
Lamina Claudia et al. Atherosclerosis 2022 5 36-41
(Posted: Jun 07, 2022 10AM)
Mendelian Randomization (MR) methods can be used to establish a causal link between a biomarker and a disease. Lp(a) is primarily genetically determined by KIV-repeats, apo(a) isoforms, single SNPs and SNP-scores. Lp(a) was the first phenotype for which a causal relationship with cardiovascular diseases was shown using the idea of MR. Lp(a) is causally related to CHD, MI, stroke, peripheral vascular disease, heart failure and aortic valve stenosis. It was estimated that Lp(a) would have to be reduced by 65–100 mg/dL to reduce CVD risk by about 22% over 5 years.
Association of Pathogenic DNA Variants Predisposing to Cardiomyopathy With Cardiovascular Disease Outcomes and All-Cause Mortality.
Patel Aniruddh P et al. JAMA cardiology 2022 5
(Posted: May 13, 2022 8AM)
In this genetic association study of 9667 participants in the US (Atherosclerosis in Risk Communities [ARIC]) and 49?744 participants in the UK (UK Biobank), a pathogenic or likely pathogenic variant for inherited cardiomyopathy was identified in 0.61% of ARIC participants and 0.73% of UK Biobank participants. These individuals were at 1.7- to 2.1-fold increased risk of heart failure, 2.1- to 2.9-fold increased risk of atrial fibrillation, and 1.5- to 1.7-fold increased risk of all-cause mortality, and they were not reliably identified by imaging. These results suggest that 0.7% of participants harbor a pathogenic variant related to inherited cardiomyopathy and are at increased risk of cardiovascular morbidity and all-cause mortality.
Heart Failure, Precision Medicine, and Incremental Equity- The Case of Hereditary Amyloid Cardiomyopathy
MR Echols et al, JAMA, April 4, 2022
(Posted: Apr 05, 2022 11AM)
An important consideration is whether a genome-guided precision approach could have beneficial effects on health equity among patients with heart failure. It is well established that poor heart failure outcomes occur disproportionately among Black individuals. Furthermore, as with other major health disparities, even though huge investments in research and development have produced greater mechanistic insight and an ever-widening therapeutic armamentarium, thereby improving outcomes for patients with heart failure in general, they have not produced a substantial reduction in race-related disparities
Association of Transthyretin Val122Ile Variant With Incident Heart Failure Among Black Individuals
V Parcha et al, JAMA, April 4, 2022
(Posted: Apr 05, 2022 11AM)
In this retrospective cohort study that included 7514 Black participants in the US with a median 11.1 years of follow-up, the incidence of heart failure was 15.6 per 1000 person-years among Val122Ile variant carriers compared with 7.2 per 1000 person-years among noncarriers, with an adjusted hazard ratio of 2.43.
Microbiome and metabolome features of the cardiometabolic disease spectrum
S Fromentin et al, Nature Medicine, February 17, 2022
(Posted: Feb 18, 2022 8AM)
We recruited 1,241 middle-aged Europeans, including healthy individuals, individuals with dysmetabolic morbidities (obesity and type 2 diabetes) but lacking overt IHD diagnosis and individuals with ischemic heart disease at three distinct clinical stages—acute coronary syndrome, chronic IHD and IHD with heart failure—and characterized their phenome, gut metagenome and serum and urine metabolome. We found that about 75% of microbiome and metabolome features that distinguish individuals with IHD from healthy individuals.
Identifying Dilated Cardiomyopathy Through Family-Based Screening
KG Aragam, JAMA, February 1, 2022
(Posted: Feb 01, 2022 4PM)
What might be done to mitigate the onset of DCM in first-degree relatives? Existing trial data support a role for evidence-based neurohormonal agents (such as angiotensin-converting enzyme inhibitors) to prevent the progression of asymptomatic left ventricular systolic dysfunction to overt and symptomatic clinical heart failure. A new study suggests the utility of family-based clinical screening for DCM to more readily identify the individuals with preclinical disease who might benefit from the early initiation of neurohormonal therapies.
Imputation of missing values for electronic health record laboratory data
J Li et al, NPJ Digital Medicine, October 11,2021
(Posted: Oct 11, 2021 7AM)
We assess the utility of imputation in two real-world EHR-derived cohorts of ischemic stroke from Geisinger and of heart failure from Sutter Health. Overall, the pattern of missingness in EHR laboratory variables was not at random and was highly associated with patients’ comorbidity data; and the multi-level imputation algorithm showed smaller imputation error than the cross-sectional method.
Towards precision medicine in heart failure
CS Weldy et al, Nat Rev Cardiol, June 9, 2021
(Posted: Jun 11, 2021 7AM)
We summarize the biology of heart failure (HF), emphasizing the causal relationships between genetic contributors and traditional structure-based remodelling outcomes, and highlight the mechanisms of action of traditional and novel therapeutics. We discuss the latest advances in our understanding of both the Mendelian genetics of cardiomyopathy and the complex genetics of the clinical syndrome presenting as HF.
Association of the V122I Transthyretin Amyloidosis Genetic Variant With Cardiac Structure and Function in Middle-aged Black Adults - Coronary Artery Risk Development in Young Adults (CARDIA) Study
A Sinha et al, JAMA Cardiology, December 23, 2020
(Posted: Dec 24, 2020 7AM)
In this population-based cohort study of 875 Black adults, there was a significant association of the TTR V122I variant with worse left ventricular structure and cardiac mechanics at a mean age of 54 years. Earlier screening with echocardiography may inform use of novel therapies and intensification of risk factor modification to prevent heart failure.
Genetic Contribution to Common Heart Failure—Not So Rare?
EM McNally et al, JAMA Cardiology, December 15, 2020
(Posted: Dec 17, 2020 8AM)
Dilated cardiomyopathy and hypertrophic cardiomyopathy underlie heart failure (HF) and often run in families. For these families, genetic testing provides risk stratification, which is especially important because some genes carry higher risk of arrhythmias, and the testing allows family members to be monitored and treated for early-phase disease. Genetic testing identifies the defective gene in 30% to 50% of families.
Assessing the Role of Rare Genetic Variation in Patients With Heart Failure.
Povysil Gundula et al. JAMA cardiology 2020 Dec
(Posted: Dec 17, 2020 8AM)
In this analysis of 5942 patients with heart failure and 13 156 controls using whole-exome sequencing, a significant enrichment of rare protein-truncating variants in the TTN gene and in general an increased burden of mendelian cardiomyopathy variants was demonstrated in patients with heart failure compared with controls.
Factors Associated with Disease Severity and Mortality among Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis
V Chidambaram et al, MEDRXIV, August 13, 2020
(Posted: Aug 13, 2020 7AM)
109 articles were included. The risks of mortality or severe diseases were higher in patients with increasing age, male gender, dyspnea, diabetes, hypertension, congestive heart failure, hilar lymphadenopathy, bilateral lung involvement and reticular pattern.
Artificial intelligence for the diagnosis of heart failure
DJ Choi et al, NPJ Digital Medicine, April 8, 2020
(Posted: Apr 09, 2020 7AM)
Improving risk prediction in heart failure using machine learning
ED Adler et al, European Journal Heart Failure, November 2019
(Posted: Nov 18, 2019 9AM)
Microbes and genes in heart failure
S Epelman, Science Magazine, November 2019
(Posted: Nov 16, 2019 7AM)
A new study shows that a confluence of factors—including genetic predisposition, production of a commensal gut microbial autoantigen, and systemic inflammation—together trigger the generation of autoreactive CD4+ T cells that cause autoimmune myocarditis and cardiac dysfunction in animals and patients.
Digital endpoints library can aid clinical trials for new medicines
J Goldsack et al, Stat News, November 6, 2019
(Posted: Nov 09, 2019 8AM)
Digital endpoints can use sensors to capture existing measures in a new way, say using a smartphone microphone to measure cough instead of relying on a patient to record episodes of coughing in a diary. Continuous assessment of the quantity and intensity of activity, measured using a wearable sensor, can be a clinically important digital endpoint for heart failure.
Clinical utility of exome sequencing in infantile heart failure
A Ritter et al, Genetics in Medicine, September 16, 2019
(Posted: Sep 17, 2019 7AM)
Dilated cardiomyopathy was the predominant cardiac diagnosis, seen in 60% of patients. A molecular diagnosis was identified in 66.7% of patients (10/15). Of those diagnoses, 70% would not have been detected using multigene next-generation sequencing panels.
Heart Failure in the Era of Precision Medicine: A Scientific Statement From the American Heart Association.
Cresci Sharon et al. Circulation. Genomic and precision medicine 2019 Sep HCG0000000000000058
(Posted: Sep 13, 2019 10AM)
The goals of this scientific statement are to provide a comprehensive overview of the current state of these omics as they relate to the development and progression of heart failure and to consider the current and potential future applications of these data for precision medicine with respect to prevention, diagnosis, and therapy.
How Immunotherapy Might Be Used to Treat Heart Failure- Modified immune cells may be trained not just to attack cancer, but any cells in the body that cause disease
G Kolata, NY Times, September 11, 2019
(Posted: Sep 12, 2019 7AM)
Prevalence and clinical importance of titin truncating variants in adults without known congestive heart failure
JP Pirruccello et al, MedRXIV, August 2019
(Posted: Aug 23, 2019 8AM)
Cross-sectional studies of various forms of dilated cardiomyopathy have noted a truncating mutation in the gene encoding titin ('TTNtv') in 7-30% of patients, but the clinical importance of identifying a TTNtv in an asymptomatic adult is largely unknown.
A Review of Randomized Controlled Trials Utilizing Telemedicine for Improving Heart Failure Readmission: Can a Realist Approach Bridge the Translational Divide?
Garcia, MG. et. al. Clinical Medicine Insights: Cardiology, July 10, 2019
(Posted: Jul 15, 2019 1PM)
Genome-wide studies of heart failure and endophenotypes: lessons learned and future directions.
van der Ende Maaike Yldau et al. Cardiovascular research 2018 Jul (9) 1209-1225
(Posted: Jul 13, 2018 0PM)
Is Heart Failure Inherited? Beyond the Cardiomyopathies, Genetics Do Matter
CJ O'Donnell et al, JAMA Cardiology, July 11, 2018
(Posted: Jul 13, 2018 0PM)
A Swedish Nationwide Adoption Study of the Heritability of Heart Failure
MP Lindgren et al, JAMA Cardiology, July 11, 2018
(Posted: Jul 13, 2018 0PM)
Hypertrophic Cardiomyopathy: Clinical Update.
Geske Jeffrey B et al. JACC. Heart failure 2018 Apr
(Posted: Apr 18, 2018 10AM)
Genetic Evaluation of Cardiomyopathy - a Heart Failure Society of America Practice Guideline.
Hershberger Ray E et al. Journal of cardiac failure 2018 Mar
(Posted: Mar 27, 2018 1PM)
Genetic Testing for Cardiomyopathies in Clinical Practice.
Ingles Jodie et al. Heart failure clinics 2018 Apr 14(2) 129-137
(Posted: Mar 14, 2018 10AM)
Genetic determinants of heart failure: facts and numbers.
Czepluch Frauke S et al. ESC heart failure 2018 Feb
(Posted: Feb 21, 2018 10AM)
Gene Therapy for Atrial Fibrillation in Heart Failure.
Arora R et al. Clinical pharmacology and therapeutics 2017 Aug (2) 200-202
(Posted: Sep 24, 2017 6AM)
Genetics and genomics of dilated cardiomyopathy and systolic heart failure
U Tayal et al, Genome Medicine, February 2017
(Posted: Feb 26, 2017 9AM)
Evolving Approaches to Genetic Evaluation of Specific Cardiomyopathies.
Teo Loon Yee Louis et al. Current heart failure reports 2015 Oct
(Posted: Jan 06, 2016 7PM)
The Genetic Challenges and Opportunities in Advanced Heart Failure.
Hannah-Shmouni Fady et al. The Canadian journal of cardiology 2015 Nov (11) 1338-50
(Posted: Jan 06, 2016 7PM)
The Importance of NLRP3 Inflammasome in Heart Failure.
Butts Brittany et al. J. Card. Fail. 2015 May 14.
(Posted: Jul 01, 2015 2PM)
Aplastic Anemia
From NHLBI health topic site
(Posted: Jan 11, 2014 11AM)
What Is
Aplastic anemia (a-PLAS-tik uh-NEE-me-uh) is a blood disorder in which the body's bone marrow doesn't make enough new blood cells. Bone marrow is a sponge-like tissue inside the bones. It makes stem cells that develop into red blood cells, white blood cells, and platelets (PLATE-lets).
Red blood cells carry oxygen to all parts of your body. They also carry carbon dioxide (a waste product) to your lungs to be exhaled. White blood cells help your body fight infections. Platelets are blood cell fragments that stick together to seal small cuts or breaks on blood vessel walls and stop bleeding.
It's normal for blood cells to die. The lifespan of red blood cells is about 120 days. White blood cells live less than a day. Platelets live about 6 days. As a result, your bone marrow must constantly make new blood cells.
If your bone marrow can't make enough new blood cells, many health problems can occur. These problems include irregular heartbeats called arrhythmias (ah-RITH-me-ahs), an enlarged heart, heart failure, infections, and bleeding. Severe aplastic anemia can even cause death.
Overview
Aplastic anemia is a type of anemia. The term "anemia" usually refers to a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). This iron-rich protein helps carry oxygen to your body.
In people who have aplastic anemia, the body doesn't make enough red blood cells, white blood cells, and platelets. This is because the bone marrow's stem cells are damaged. (Aplastic anemia also is called bone marrow failure.)
Many diseases, conditions, and factors can damage the stem cells. These conditions can be acquired or inherited. "Acquired" means you aren't born with the condition, but you develop it. "Inherited" means your parents passed the gene for the condition on to you.
In many people who have aplastic anemia, the cause is unknown.
Outlook
Aplastic anemia is a rare but serious disorder. It can develop suddenly or slowly. The disorder tends to get worse over time, unless its cause is found and treated. Treatments for aplastic anemia include blood transfusions, blood and marrow stem cell transplants, and medicines.
With prompt and proper care, many people who have aplastic anemia can be successfully treated. Blood and marrow stem cell transplants may offer a cure for some people who have aplastic anemia.
Hemochromatosis
From NHLBI health topic site
(Posted: Jan 11, 2014 11AM)
What Is
Hemochromatosis (HE-mo-kro-ma-TO-sis) is a disease in which too much iron builds up in your body (iron overload). Iron is a mineral found in many foods.
Too much iron is toxic to your body. It can poison your organs and cause organ failure. In hemochromatosis, iron can build up in most of your body's organs, but especially in the liver, heart, and pancreas.
Too much iron in the liver can cause an enlarged liver, liver failure, liver cancer, or cirrhosis (sir-RO-sis). Cirrhosis is scarring of the liver, which causes the organ to not work well.
Too much iron in the heart can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs) and heart failure. Too much iron in the pancreas can lead to diabetes.
If hemochromatosis isn't treated, it may even cause death.
Overview
The two types of hemochromatosis are primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron you absorb from food. Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload.
Most people who have primary hemochromatosis inherit it from their parents. If you inherit two hemochromatosis genes?one from each parent?you're at risk for iron overload and signs and symptoms of the disease. The two faulty genes cause your body to absorb more iron than usual from the foods you eat.
Hemochromatosis is one of the most common genetic disorders in the United States. However, not everyone who has hemochromatosis has signs or symptoms of the disease.
Estimates of how many people develop signs and symptoms vary greatly. Some estimates suggest that as many as half of all people who have the disease don't have signs or symptoms.
The severity of hemochromatosis also varies. Some people don't have complications, even with high levels of iron in their bodies. Others have severe complications or die from the disease.
Certain factors can affect the severity of the disease. For example, a high intake of vitamin C can make hemochromatosis worse. This is because vitamin C helps your body absorb iron from food.
Alcohol use can worsen liver damage and cirrhosis caused by hemochromatosis. Conditions such as hepatitis also can further damage or weaken the liver.
Outlook
The outlook for people who have hemochromatosis largely depends on how much organ damage they have at the time of diagnosis. Early diagnosis and treatment of the disease are important.
Treatment may help prevent, delay, or sometimes reverse complications of the disease. Treatment also may lead to better quality of life.
For people who are diagnosed and treated early, a normal lifespan is possible. If left untreated, hemochromatosis can lead to severe organ damage and even death.
?Acquired hemochromatosis
?Classical hemochromatosis
?Genetic hemochromatosis
?Genetic iron poisoning
?Hereditary hemochromatosis
?Iron overload disease
?Primary hemochromatosis
?Secondary hemochromatosis
Hemolytic Anemia
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
Hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) is a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over.
Red blood cells are disc-shaped and look like doughnuts without holes in the center. These cells carry oxygen to your body. They also remove carbon dioxide (a waste product) from your body.
Red blood cells are made in the bone marrow?a sponge-like tissue inside the bones. They live for about 120 days in the bloodstream and then die.
White blood cells and platelets (PLATE-lets) also are made in the bone marrow. White blood cells help fight infections. Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding.
When blood cells die, the body's bone marrow makes more blood cells to replace them. However, in hemolytic anemia, the bone marrow can't make red blood cells fast enough to meet the body's needs.
Hemolytic anemia can lead to many health problems, such as fatigue (tiredness), pain, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), an enlarged heart, and heart failure.
Overview
Hemolytic anemia is a type of anemia. The term "anemia" usually refers to a condition in which the blood has a lower than normal number of red blood cells.
Anemia also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that carries oxygen from the lungs to the rest of the body.
Anemia has three main causes: blood loss, lack of red blood cell production, or high rates of red blood cell destruction.
Hemolytic anemia is caused by high rates of red blood cell destruction. Many diseases, conditions, and factors can cause the body to destroy its red blood cells.
These causes can be inherited or acquired. "Inherited" means your parents passed the gene(s) for the condition on to you. "Acquired" means you aren't born with the condition, but you develop it. Sometimes the cause of hemolytic anemia isn't known.
Outlook
There are many types of hemolytic anemia. Treatment and outlook depend on what type you have and how severe it is. The condition can develop suddenly or slowly. Symptoms can range from mild to severe.
Hemolytic anemia often can be successfully treated or controlled. Mild hemolytic anemia may need no treatment at all. Severe hemolytic anemia requires prompt and proper treatment, or it may be fatal.
Inherited forms of hemolytic anemia are lifelong conditions that may require ongoing treatment. Acquired forms of hemolytic anemia may go away if the cause of the condition is found and corrected.
Other Names
Alloimmune hemolytic anemia
?Autoimmune hemolytic anemia (AIHA)
?Drug-induced hemolytic anemia
?Glucose-6-phosphate dehydrogenase (G6PD) deficiency
?Hereditary elliptocytosis
?Hereditary ovalocytosis
?Hereditary spherocytosis
?Immune hemolytic anemia
?Microangiopathic hemolytic anemia
?Paroxysmal nocturnal hemoglobinuria (PNH)
?Pyruvate kinase deficiency
?Sickle cell anemia
?Thalassemias
Polycythemia Vera
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Polycythemia vera (POL-e-si-THEE-me-ah VAY-rah or VE-rah), or PV, is a rare blood disease in which your body makes too many red blood cells.
The extra red blood cells make your blood thicker than normal. As a result, blood clots can form more easily. These clots can block blood flow through your arteries and veins, which can cause a heart attack or stroke.
Thicker blood also doesn't flow as quickly to your body as normal blood. Slowed blood flow prevents your organs from getting enough oxygen, which can cause serious problems, such as angina (an-JI-nuh or AN-juh-nuh) and heart failure. (Angina is chest pain or discomfort.)
Overview
Red blood cells carry oxygen to all parts of your body. They also remove carbon dioxide (a waste product) from your body's cells and carry it to the lungs to be exhaled.
Red blood cells are made in your bone marrow?a sponge-like tissue inside the bones. White blood cells and platelets (PLATE-lets) also are made in your bone marrow. White blood cells help fight infection. Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding.
If you have PV, your bone marrow makes too many red blood cells. It also can make too many white blood cells and platelets.
A mutation, or change, in the body's JAK2 gene is the major cause of PV. This gene makes a protein that helps the body produce blood cells. What causes the change in the JAK2 gene isn't known. PV generally isn't inherited?that is, passed from parents to children through genes.
PV develops slowly and may not cause symptoms for years. The disease often is found during routine blood tests done for other reasons.
When signs and symptoms are present, they're the result of the thick blood that occurs with PV. This thickness slows the flow of oxygen-rich blood to all parts of your body. Without enough oxygen, many parts of your body won't work normally.
For example, slower blood flow deprives your arms, legs, lungs, and eyes of the oxygen they need. This can cause headaches, dizziness, itching, and vision problems, such as blurred or double vision.
Outlook
PV is a serious, chronic (ongoing) disease that can be fatal if not diagnosed and treated. PV has no cure, but treatments can help control the disease and its complications.
PV is treated with procedures, medicines, and other methods. You may need one or more treatments to manage the disease.
Other Names
?Cryptogenic (KRIP-to-JEN-ik) polycythemia
?Erythremia (ER-ih-THRE-me-ah)
?Erythrocytosis (eh-RITH-ro-si-TO-sis) megalosplenica (MEG-ah-lo-SPLE-ne-kah)
?Myelopathic (MY-e-lo-PATH-ik) polycythemia
?Myeloproliferative (MY-e-lo-pro-LIF-er-ah-tiv) disorder
?Osler disease
?Polycythemia rubra vera
?Polycythemia with chronic cyanosis (SI-ah-NO-sis)
?Primary polycythemia
?Splenomegalic (SPLE-no-me-GA-lic) polycythemia
?Vaquez disease
Atrial Fibrillation
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
Atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
AF occurs if rapid, disorganized electrical signals cause the heart's two upper chambers?called the atria (AY-tree-uh)?to fibrillate. The term "fibrillate" means to contract very fast and irregularly.
In AF, blood pools in the atria. It isn't pumped completely into the heart's two lower chambers, called the ventricles (VEN-trih-kuls). As a result, the heart's upper and lower chambers don't work together as they should.
People who have AF may not feel symptoms. However, even when AF isn't noticed, it can increase the risk of stroke. In some people, AF can cause chest pain or heart failure, especially if the heart rhythm is very rapid.
AF may happen rarely or every now and then, or it may become an ongoing or long-term heart problem that lasts for years.
Understanding the Heart's Electrical System
To understand AF, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat.
With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.
Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium. In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to 100 times a minute. (This rate may be slower in very fit athletes.)
From the SA node, the electrical signal travels through the right and left atria. It causes the atria to contract and pump blood into the ventricles.
The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down slightly, allowing the ventricles time to finish filling with blood.
The electrical signal then leaves the AV node and travels to the ventricles. It causes the ventricles to contract and pump blood to the lungs and the rest of the body. The ventricles then relax, and the heartbeat process starts all over again in the SA node.
For more information about the heart's electrical system and detailed animations, go to the Diseases and Conditions Index How the Heart Works article.
Understanding the Electrical Problem in Atrial Fibrillation
In AF, the heart's electrical signals don't begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don't travel normally. They may spread throughout the atria in a rapid, disorganized way. This can cause the atria to fibrillate.
The faulty signals flood the AV node with electrical impulses. As a result, the ventricles also begin to beat very fast. However, the AV node can't send the signals to the ventricles as fast as they arrive. So, even though the ventricles are beating faster than normal, they aren't beating as fast as the atria.
Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AF, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.
If this happens, blood isn't pumped into the ventricles as well as it should be. Also, the amount of blood pumped out of the ventricles to the body is based on the random atrial beats.
The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.
Most of the symptoms of AF are related to how fast the heart is beating. If medicines or age slow the heart rate, the symptoms are minimized.
AF may be brief, with symptoms that come and go and end on their own. Or, the condition may be ongoing and require treatment. Sometimes AF is permanent, and medicines or other treatments can't restore a normal heart rhythm.
Outlook
People who have AF can live normal, active lives. For some people, treatment can restore normal heart rhythms.
For people who have permanent AF, treatment can help control symptoms and prevent complications. Treatment may include medicines, medical procedures, and lifestyle changes.
Other Names
?A fib
?Auricular fibrillation
Cardiac Rehabilitation
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Cardiac rehabilitation, also called cardiac rehab, is a medically supervised program for people who have had a heart attack, heart failure, heart valve surgery, coronary artery bypass grafting, or percutaneous coronary intervention.
Overview
Cardiac rehab involves adopting heart-healthy lifestyle changes to address risk factors for cardiovascular disease. To help you adopt lifestyle changes, this program includes exercise training, education on heart-healthy living, and counseling to reduce stress and help you return to an active life. Cardiac rehab can improve your health and quality of life, reduce the need for medicines to treat heart or chest pain, decrease the chance you will go back to a hospital or emergency room for a heart problem, prevent future heart problems, and even help you live longer.
Cardiac rehab is provided in an outpatient clinic or in a hospital rehab center. The cardiac rehab team includes doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and mental health specialists. Sometimes a case manager will help track your care. Your cardiac rehab team will design a program to meet your needs. Before starting your program, the rehab team will take your medical history, do a physical exam, and perform tests. Possible tests include an electrocardiogram (EKG), cardiac imaging tests, and a treadmill or stationary bike exercise test. You also may have tests to measure your cholesterol and blood sugar levels. During cardiac rehab, you will learn to exercise safely and increase your physical activity. The length of time that you spend in cardiac rehab depends on your condition. Medicare and most insurance plans cover a standard cardiac rehab program that includes 36 supervised sessions over 12 weeks.
The heart-healthy lifestyle changes in cardiac rehab have few risks. Very rarely, physical activity during rehab can cause serious problems, such as injuries to your muscles and bones, or possibly life-threatening heart rhythm problems. If serious problems occur during the supervised sessions, the rehab team will immediately stop the physical activity, administer appropriate treatment, and contact your doctor.
Cardiomyopathy
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
Cardiomyopathy refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms, and treatments.
In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue.
As cardiomyopathy worsens, the heart becomes weaker. It's less able to pump blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or irregular heartbeats called arrhythmias. In turn, heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen.
The weakening of the heart also can cause other complications, such as heart valve problems.
Overview
The types of cardiomyopathy are:
?Hypertrophic cardiomyopathy
?Dilated cardiomyopathy
?Restrictive cardiomyopathy
?Arrhythmogenic right ventricular dysplasia
?Unclassified cardiomyopathy
Cardiomyopathy can be acquired or inherited. "Acquired" means you aren't born with the disease, but you develop it due to another disease, condition, or factor. "Inherited" means your parents passed the gene for the disease on to you. Many times, the cause of cardiomyopathy isn't known.
Cardiomyopathy can affect people of all ages. However, people in certain age groups are more likely to have certain types of cardiomyopathy. This article focuses on cardiomyopathy in adults.
Outlook
Some people who have cardiomyopathy have no signs or symptoms and need no treatment. For other people, the disease develops quickly, symptoms are severe, and serious complications occur.
Treatments for cardiomyopathy include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure. These treatments can control symptoms, reduce complications, and stop the disease from getting worse.
Other Names
Other Names for Dilated Cardiomyopathy
?Alcoholic cardiomyopathy. This term is used when overuse of alcohol causes the disease.
?Congestive cardiomyopathy.
?Diabetic cardiomyopathy.
?Familial dilated cardiomyopathy.
?Idiopathic cardiomyopathy.
?Ischemic cardiomyopathy. This term is used when coronary heart disease (also called coronary artery disease) or heart attack causes the disease.
?Peripartum cardiomyopathy. This term is used when the disease develops in a woman shortly before or after she gives birth.
?Primary cardiomyopathy.
Other Names for Hypertrophic Cardiomyopathy
?Asymmetric septal hypertrophy
?Familial hypertrophic cardiomyopathy
?Hypertrophic nonobstructive cardiomyopathy
?Hypertrophic obstructive cardiomyopathy
?Idiopathic hypertrophic subaortic stenosis
Other Names for Restrictive Cardiomyopathy
?Idiopathic restrictive cardiomyopathy
?Infiltrative cardiomyopathy
Other Names for Arrhythmogenic Right Ventricular Dysplasia
?Arrhythmogenic right ventricular cardiomyopathy
?Right ventricular cardiomyopathy
?Right ventricular dysplasia
Cardioversion
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Cardioversion is a procedure that uses external electric shocks to restore a normal heart rhythm.
Overview
Cardioversion is called defibrillation when it is done in an emergency to prevent death due to potentially fatal ventricular arrhythmias that can result in sudden cardiac arrest. Alternatively, your doctor can schedule cardioversion as a way to treat arrhythmias in the upper chambers of your heart called atrial fibrillation. If untreated, atrial fibrillation can increase your risk for stroke and heart failure.
Scheduled cardioversion procedures may be done in a hospital or other health care facility by cardiologists, or doctors who specialize in the heart. While the procedure takes only a few minutes, it requires that you arrive a few hours before the procedure. To prepare, you will be given anesthesia through an intravenous (IV) line in your arm to make you fall asleep, and you will have electrodes placed on your chest and possibly your back. These electrodes will be attached to the cardioversion machine. The machine will record your heart?s electrical activity and send the shocks to your heart. When ready, the doctor will send one or more brief, low-energy shocks to your heart to restore a normal rhythm. You will not feel any pain from the shocks.
You will need to stay for a few hours after your procedure. During this time, your health care team will monitor your heart rhythm and blood pressure closely and watch for complications. You will need a ride home because of the medicines or anesthesia you received. You may have some redness or soreness where the electrodes were placed. You also may have slight bruising where the IV line was inserted in your arm.
Although uncommon, cardioversion has some risks. It can cause or worsen life-threatening arrhythmias that will need to be treated. This procedure can cause blood clots to break away and travel from the heart to other tissues or organs and cause a stroke or other problems. Taking anticlotting medicines before and after cardioversion can reduce this risk.
Coronary Heart Disease
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Coronary Artery Disease
What Is
Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
Atherosclerosis
Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. The buildup of plaque limits the flow of oxygen-rich blood through the artery. The inset image shows a cross-section of the plaque-narrowed artery.
Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. The buildup of plaque limits the flow of oxygen-rich blood through the artery. The inset image shows a cross-section of the plaque-narrowed artery.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.
Overview
If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur.
Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn?t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death.
Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can't pump enough blood to meet your body?s needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.
Outlook
Lifestyle changes, medicines, and medical procedures can help prevent or treat coronary heart disease. These treatments may reduce the risk of related health problems.
Other Names
?Atherosclerosis
?Coronary artery disease
?Hardening of the arteries
?Heart disease
?Ischemic (is-KE-mik) heart disease
?Narrowing of the arteries
Diabetic Heart Disease
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
The term "diabetic heart disease" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes:
?Are at higher risk for heart disease
?Have additional causes of heart disease
?May develop heart disease at a younger age
?May have more severe heart disease
What Is Diabetes?
Diabetes is a disease in which the body's blood glucose (sugar) level is too high. Normally, the body breaks down food into glucose and carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.
The two main types of diabetes are type 1 and type 2. In type 1 diabetes, the body doesn't make enough insulin. This causes the body's blood sugar level to rise.
In type 2 diabetes, the body's cells don't use insulin properly (a condition called insulin resistance). At first, the body reacts by making more insulin. Over time, though, the body can't make enough insulin to control its blood sugar level.
For more information about diabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' Introduction to Diabetes Web page.
What Heart Diseases Are Involved in Diabetic Heart Disease?
DHD may include coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy (KAR-de-o-mi-OP-ah-thee).
Coronary Heart Disease
In CHD, a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.
CHD can lead to chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh), irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart attack, or even death.
Heart Failure
Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. The term ?heart failure? doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
If you have heart failure, you may tire easily and have to limit your activities. CHD can lead to heart failure by weakening the heart muscle over time.
Diabetic Cardiomyopathy
Diabetic cardiomyopathy is a disease that damages the structure and function of the heart. This disease can lead to heart failure and arrhythmias, even in people who have diabetes but don't have CHD.
Overview
People who have type 1 or type 2 diabetes can develop DHD. The higher a person's blood sugar level is, the higher his or her risk of DHD.
Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease, just like smoking, high blood pressure, and high blood cholesterol. In fact, people who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks.
Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Although research is ongoing, it's clear that diabetes and other conditions?such as overweight and obesity and metabolic syndrome?interact to cause harmful physical changes to the heart.
Third, diabetes raises the risk of earlier and more severe heart problems. Also, people who have DHD tend to have less success with some heart disease treatments, such as coronary artery bypass grafting and percutaneous coronary intervention, also known as coronary angioplasty.
Outlook
If you have diabetes, you can lower your risk of DHD. Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors.
Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity can lower your blood pressure, help control your blood sugar level and your weight, and reduce stress.
It's also very important to follow your treatment plan for diabetes and see your doctor for ongoing care.
If you already have DHD, follow your treatment plan as your doctors advises. This may help you avoid or delay serious problems, such as a heart attack or heart failure.
Electrocardiogram
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as ECG, EKG
An electrocardiogram, also called an ECG or EKG, is a simple, painless test that detects and records your heart?s electrical activity.
Overview
An EKG can show how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart. You may have an EKG as part of a routine exam to screen for heart disease. This test also is used to detect and study heart problems such as heart attacks, arrhythmia or irregular heartbeat, and heart failure. Results from this test also may suggest other heart disorders.
An EKG may be recorded in a doctor?s office, an outpatient facility, in a hospital before major surgery, or as part of stress testing. For the test, you will lie still on a table. A nurse or technician will attach up to 12 electrodes to the skin on your chest, arms, and legs. Your skin may need to be shaved to help the electrodes stick. The electrodes are connected by wires to a machine that records your heart?s electrical activity on graph paper or on a computer. After the test, the electrodes will be removed.
An EKG has no serious risks. EKGs don?t give off electrical charges such as shocks. You may develop a slight rash where the electrodes were attached to your skin. This rash usually goes away on its own without treatment.
Heart Disease in Women
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
How Does Heart Disease Affect Women?
In the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)?the most common type of heart disease?is the #1 killer of both men and women in the United States.
Other types of heart disease, such as coronary microvascular disease (MVD) and broken heart syndrome, also pose a risk for women. These disorders, which mainly affect women, are not as well understood as CHD. However, research is ongoing to learn more about coronary MVD and broken heart syndrome.
This article focuses on CHD and its complications. However, it also includes general information about coronary MVD and broken heart syndrome.
Coronary Heart Disease
CHD is a disease in which plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis).
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque can harden or rupture (break open).
Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
Heart With Muscle Damage and a Blocked Artery
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture.
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture.
Plaque also can develop within the walls of the coronary arteries. Tests that show the insides of the coronary arteries may look normal in people who have this pattern of plaque. Studies are under way to see whether this type of plaque buildup occurs more often in women than in men and why.
In addition to angina and heart attack, CHD can cause other serious heart problems. The disease may lead to heart failure, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), and sudden cardiac arrest (SCA).
Coronary Microvascular Disease
Coronary MVD is heart disease that affects the heart's tiny arteries. This disease is also called cardiac syndrome X or nonobstructive CHD. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased.
Coronary Microvascular Disease
Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD.
Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B shows a large coronary artery with plaque buildup.
Women are more likely than men to have coronary MVD. Many researchers think that a drop in estrogen levels during menopause combined with other heart disease risk factors causes coronary MVD.
Although death rates from heart disease have dropped in the last 30 years, they haven't dropped as much in women as in men. This may be the result of coronary MVD.
Standard tests for CHD are not designed to detect coronary MVD. Thus, test results for women who have coronary MVD may show that they are at low risk for heart disease.
Research is ongoing to learn more about coronary MVD and its causes.
Broken Heart Syndrome
Women are also more likely than men to have a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to severe (but often short-term) heart muscle failure.
Broken heart syndrome is also called stress-induced cardiomyopathy (KAR-de-o-mi-OP-ah-thee) or takotsubo cardiomyopathy.
Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms and test results. However, there's no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.
Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have previously been healthy.
Outlook
Women tend to have CHD about 10 years later than men. However, CHD remains the #1 killer of women in the United States.
The good news is that you can control many CHD risk factors. CHD risk factors are conditions or habits that raise your risk for CHD and heart attack. These risk factors also can increase the chance that existing CHD will worsen.
Lifestyle changes, medicines, and medical or surgical procedures can help women lower their risk for CHD. Thus, early and ongoing CHD prevention is important.
Other Names
?Arrhythmia
?Broken heart syndrome, which also is called stress-induced cardiomyopathy or takotsubo cardiomyopathy
?Coronary heart disease, which also is called coronary artery disease
?Coronary microvascular disease, which also is called cardiac syndrome X or nonobstructive coronary heart disease
?Heart failure
?Sudden cardiac arrest
Heart Failure
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Congestive heart failure
What Is
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. In some cases, the heart can't fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems.
The term "heart failure" doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
Overview
Heart failure develops over time as the heart's pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.
Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if the heart can't pump enough oxygen-rich blood to the rest of the body.
Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness).
The leading causes of heart failure are diseases that damage the heart. Examples include coronary heart disease (CHD), high blood pressure, and diabetes.
Outlook
Heart failure is a very common condition. About 5.7 million people in the United States have heart failure. Both children and adults can have the condition, although the symptoms and treatments differ. The Health Topic focuses on heart failure in adults.
Currently, heart failure has no cure. However, treatments?such as medicines and lifestyle changes?can help people who have the condition live longer and more active lives. Researchers continue to study new ways to treat heart failure and its complications.
Other Names
?Congestive heart failure.
?Left-side heart failure. This is when the heart can't pump enough oxygen-rich blood to the body.
?Right-side heart failure. This is when the heart can't fill with enough blood.
?Cor pulmonale. This term refers to right-side heart failure caused by high blood pressure in the pulmonary arteries and right ventricle (lower right heart chamber).
Heart Transplant
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Heart transplant is surgery that removes a diseased heart and replaces it with a healthy heart from a deceased donor to improve your quality of life and increase your lifespan.
Overview
Most heart transplants are done on patients who have end-stage heart failure, a condition in which your heart is severely damaged or weakened, and on people who have failed other treatment options. End-stage heart failure may be caused by conditions such as coronary heart disease, viral infections, or hereditary conditions. In rare instances, heart transplant may be performed at the same time as lung transplant in patients who have severe heart and lung disease.
You may be eligible for heart transplant surgery if you have severe heart disease that does not respond to other treatments. If you are otherwise healthy enough for surgery, you will be placed on the National Organ Procurement and Transplantation Network?s waiting list. This national network handles the organ-sharing process for the United States. If a match is found, you will need to have your heart transplant surgery right away.
Heart transplant surgery will be done in a hospital. You will have general anesthesia and will not be awake during the surgery. You will receive medicine through an intravenous (IV) line in your arm. A breathing tube connected to a ventilator will help you breathe. A surgeon will open your chest, connect your heart?s arteries and veins to a heart-lung bypass machine, and remove your diseased heart. The body?s arteries and veins will be taken off the bypass machine and reconnected to the healthy donor heart. The heart transplant is complete after the surgeon closes your chest.
After the surgery, you will recover in the hospital?s intensive care unit (ICU) and stay in the hospital for up to three weeks. During your recovery, you may start a cardiac rehabilitation program. Before leaving the hospital, you will learn how to keep track of your overall health; monitor your weight, blood pressure, pulse, and temperature; and learn the signs of heart transplant rejection and infection. For the first three months after leaving the hospital, you will return often for tests to check for infection or rejection of your new heart, to test your heart function, and to make sure that you are recovering well.
Practicing good hygiene, obtaining routine vaccines, and making healthy lifestyle choices are very important after a heart transplant to reduce your risk of infection. Regular dental care is also important. Your doctor or dentist may prescribe antibiotics before any dental work to prevent infection. Following your doctor?s advice will help you recover and stay as healthy as possible.
Heart transplant has some serious risks. Primary graft dysfunction happens when the donor heart fails and cannot function. This is the most frequent cause of death for the first month after transplant. Your immune system also may reject your new heart. Rejection is most likely to occur within six months after the transplant. You will need to take medicines for the rest of your life to suppress your immune system and help prevent your body from rejecting your new heart. These medicines weaken your immune system and increase your chance for infection. Their long-term use also can increase your risk for cancer, cause diabetes and osteoporosis, and damage your kidneys. Cardiac allograft vasculopathy is a common and serious complication of heart transplant. Cardiac allograft vasculopathy is an aggressive form of atherosclerosis that over months or a few years can quickly block the heart?s arteries and cause the donor heart to fail. Over time, your new heart may fail due to the same reasons that caused your original heart to fail. Some patients who have a heart transplant that fails may be eligible for another transplant.
Despite these risks, heart transplant has a good success rate that has improved over many decades of research. Recent survival rates are about 85 percent at one year after surgery, with survival rates decreasing by about three to four percent each additional year after surgery because of serious complications. Mechanical circulatory support, possibly from left ventricular assist devices, may be an alternative to heart transplant. But more research is needed to determine long-term survival rates for these new devices.
Heart Valve Disease
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
Heart valve disease occurs if one or more of your heart valves don't work well. The heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves.
These valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through your heart's four chambers and to the rest of your body.
Healthy Heart Cross-Section
Figure 1 shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs into the heart and then out to the body.
Figure 1 shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs into the heart and then out to the body.
Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or to let blood leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood.
Overview
How the Heart Valves Work
At the start of each heartbeat, blood returning from the body and lungs fills the atria (the heart's two upper chambers). The mitral and tricuspid valves are located at the bottom of these chambers. As the blood builds up in the atria, these valves open to allow blood to flow into the ventricles (the heart's two lower chambers).
After a brief delay, as the ventricles begin to contract, the mitral and tricuspid valves shut tightly. This prevents blood from flowing back into the atria.
As the ventricles contract, they pump blood through the pulmonary and aortic valves. The pulmonary valve opens to allow blood to flow from the right ventricle into the pulmonary artery. This artery carries blood to the lungs to get oxygen.
At the same time, the aortic valve opens to allow blood to flow from the left ventricle into the aorta. The aorta carries oxygen-rich blood to the body. As the ventricles relax, the pulmonary and aortic valves shut tightly. This prevents blood from flowing back into the ventricles.
For more information about how the heart pumps blood and detailed animations, go to the Health Topics How the Heart Works article.
Heart Valve Problems
Heart valves can have three basic kinds of problems: regurgitation, stenosis, and atresia.
Regurgitation, or backflow, occurs if a valve doesn't close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or into an artery.
In the United States, backflow most often is due to prolapse. "Prolapse" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve.
Stenosis occurs if the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening. As a result, not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.
Atresia occurs if a heart valve lacks an opening for blood to pass through.
Some people are born with heart valve disease, while others acquire it later in life. Heart valve disease that develops before birth is called congenital heart valve disease. Congenital heart valve disease can occur alone or with other congenital heart defects.
Congenital heart valve disease often involves pulmonary or aortic valves that don't form properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly.
Acquired heart valve disease usually involves aortic or mitral valves. Although the valves are normal at first, problems develop over time.
Both congenital and acquired heart valve disease can cause stenosis or backflow.
Outlook
Many people have heart valve defects or disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems.
For other people, heart valve disease slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots, or death due to sudden cardiac arrest (SCA).
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can relieve many of its symptoms and complications.
These treatments also can lower your risk of developing a life-threatening condition, such as stroke or SCA. Eventually, you may need to have your faulty heart valve repaired or replaced.
Some types of congenital heart valve disease are so severe that the valve is repaired or replaced during infancy, childhood, or even before birth. Other types may not cause problems until middle-age or older, if at all.
Other Names
?Aortic regurgitation
?Aortic stenosis
?Aortic sclerosis
?Aortic valve disease
?Bicuspid aortic valve
?Congenital heart defect
?Congenital valve disease
?Mitral regurgitation
?Mitral stenosis
?Mitral valve disease
?Mitral valve prolapse
?Pulmonic regurgitation
?Pulmonic stenosis
?Pulmonic valve disease
?Tricuspid regurgitation
?Tricuspid stenosis
?Tricuspid valve disease
Implantable Cardioverter Defibrillators
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is an Implantable Cardioverter Defibrillator?
An implantable cardioverter defibrillator (ICD) is a small device that's placed in the chest or abdomen. Doctors use the device to help treat irregular heartbeats called arrhythmias (ah-RITH-me-ahs).
An ICD uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA).
SCA is a condition in which the heart suddenly stops beating. If the heart stops beating, blood stops flowing to the brain and other vital organs. SCA usually causes death if it's not treated within minutes.
Understanding the Heart's Electrical System
Your heart has its own internal electrical system that controls the rate and rhythm of your heartbeat. With each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.
Each electrical signal normally begins in a group of cells called the sinus node or sinoatrial (SA) node. As a signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity.
First, the heart's two upper chambers, the atria (AY-tree-uh), contract. This contraction pumps blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat.
For more information about the heart's electrical system (including detailed animations), go to the Health Topics How the Heart Works article.
Overview
A problem with any part of the heart's electrical system can cause an arrhythmia. Most arrhythmias are harmless, but some can be serious.
ICDs use electrical pulses or shocks to treat life-threatening arrhythmias that occur in the ventricles (the heart's lower chambers).
When ventricular arrhythmias occur, the heart can't pump blood well. You can pass out within seconds and die within minutes if not treated.
To prevent death, the arrhythmia must be treated right away with an electric shock to the heart. This treatment is called defibrillation (de-fib-ri-LA-shun).
An ICD has wires with electrodes on the ends that connect to your heart chambers. The ICD will monitor your heart rhythm. If the device detects an irregular rhythm in your ventricles, it will use low-energy electrical pulses to restore a normal rhythm.
If the low-energy pulses don't restore your normal heart rhythm, the ICD will switch to high-energy pulses for defibrillation. The device also will switch to high-energy pulses if your ventricles start to quiver rather than contract strongly. The high-energy pulses last only a fraction of a second, but they can be painful.
Doctors also treat arrhythmias with another device called a pacemaker. An ICD is similar to a pacemaker, but has some differences.
Pacemakers give off only low-energy electrical pulses. They're often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of your heart. Most new ICDs can act as both pacemakers and defibrillators.
Comparison of an Implantable Cardioverter Defibrillator and a Pacemaker
The image compares an ICD with a pacemaker. Figure A shows the location and general size of an ICD in the upper chest. The wires with electrodes on the ends are inserted into the heart through a vein in the upper chest. Figure B shows the location and general size of a pacemaker in the upper chest. The wires with electrodes on the ends are inserted into the heart through a vein in the upper chest.
The image compares an ICD with a pacemaker. Figure A shows the location and general size of an ICD in the upper chest. The wires with electrodes on the ends are inserted into the heart through a vein in the upper chest. Figure B shows the location and general size of a pacemaker in the upper chest. The wires with electrodes on the ends are inserted into the heart through a vein in the upper chest.
People who have heart failure may need a special device called a cardiac resynchronization therapy (CRT) device. The CRT device is able to pace both ventricles at the same time. This allows them to work together and do a better job pumping blood out of the heart. CRT devices that have a defibrillator are called
CRT-D.
Heart Attack
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Myocardial infarction
What Is
A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can?t get oxygen. If blood flow isn?t restored quickly, the section of heart muscle begins to die.
Heart attack treatment works best when it?s given right after symptoms occur. If you think you or someone else is having a heart attack, even if you?re not sure, call 9?1?1 right away.
Overview
Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Heart With Muscle Damage and a Blocked Artery
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.
A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.
Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias.
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.
Don't Wait--Get Help Quickly
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's given right after symptoms occur.
Many people aren't sure what's wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:
?Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
?Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
?Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.
Other possible symptoms of a heart attack include:
?Breaking out in a cold sweat
?Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
?Nausea (feeling sick to the stomach) and vomiting
?Light-headedness or sudden dizziness
?Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)
Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.
Quick Action Can Save Your Life: Call 9?1?1
If you think you or someone else may be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9?1?1 for emergency medical care. Acting fast can save your life.
Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment.
Other Names
?Myocardial infarction (MI)
?Acute myocardial infarction (AMI)
?Acute coronary syndrome
?Coronary thrombosis
?Coronary occlusion
Pacemakers
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is a Pacemaker
A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.
Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
A heartbeat that's too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that's too slow is called bradycardia (bray-de-KAR-de-ah).
During an arrhythmia, the heart may not be able to pump enough blood to the body. This can cause symptoms such as fatigue (tiredness), shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death.
A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting. A pacemaker also can help a person who has abnormal heart rhythms resume a more active lifestyle.
Understanding the Heart's Electrical System
Your heart has its own internal electrical system that controls the rate and rhythm of your heartbeat. With each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.
Each electrical signal normally begins in a group of cells called the sinus node or sinoatrial (SA) node. As the signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity.
First, the heart's two upper chambers, the atria (AY-tree-uh), contract. This contraction pumps blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat.
For more information about the heart's electrical system and detailed animations, go to the Health Topics How the Heart Works article.
Overview
Faulty electrical signaling in the heart causes arrhythmias. Pacemakers use low-energy electrical pulses to overcome this faulty electrical signaling. Pacemakers can:
?Speed up a slow heart rhythm.
?Help control an abnormal or fast heart rhythm.
?Make sure the ventricles contract normally if the atria are quivering instead of beating with a normal rhythm (a condition called atrial fibrillation).
?Coordinate electrical signaling between the upper and lower chambers of the heart.
?Coordinate electrical signaling between the ventricles. Pacemakers that do this are called cardiac resynchronization therapy (CRT) devices. CRT devices are used to treat heart failure.
?Prevent dangerous arrhythmias caused by a disorder called long QT syndrome.
Pacemakers also can monitor and record your heart's electrical activity and heart rhythm. Newer pacemakers can monitor your blood temperature, breathing rate, and other factors. They also can adjust your heart rate to changes in your activity.
Pacemakers can be temporary or permanent. Temporary pacemakers are used to treat short-term heart problems, such as a slow heartbeat that's caused by a heart attack, heart surgery, or an overdose of medicine.
Temporary pacemakers also are used during emergencies. They might be used until your doctor can implant a permanent pacemaker or until a temporary condition goes away. If you have a temporary pacemaker, you'll stay in a hospital as long as the device is in place.
Permanent pacemakers are used to control long-term heart rhythm problems. This article mainly discusses permanent pacemakers, unless stated otherwise.
Doctors also treat arrhythmias with another device called an implantable cardioverter defibrillator (ICD). An ICD is similar to a pacemaker. However, besides using low-energy electrical pulses, an ICD also can use high-energy pulses to treat life-threatening arrhythmias.
Heart Palpitations
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Palpitations are feelings that your heart is skipping a beat, fluttering, pounding, or beating too hard or too fast.
Overview
You may feel palpitations in your chest, throat, or neck during activity or when you are sitting still or lying down. Strong emotions, physical activity, some medicines, caffeine, alcohol, nicotine, or illegal drugs may cause palpitations. Medical conditions such as thyroid disease, low blood sugar, anemia, and low blood pressure also may cause palpitations. Heart palpitations may be a sign or symptom of arrhythmia, an irregular heartbeat, or other heart conditions such as heart attack, heart failure, heart valve disease, or cardiomyopathy.
Although palpitations are very common and usually harmless, they can be frightening when they happen and may cause anxiety. Most go away on their own. To prevent palpitations, you can try to avoid things that trigger them, such as stress, alcohol, or caffeine. You also may prevent palpitations by treating any other medical condition that may be causing them.
Palpitations may be a sign of more serious heart problems. You should seek medical attention immediately if you have palpitations and feel dizzy or confused, have trouble breathing, think you may faint, or have pain or tightness in your chest. Your doctor will perform a physical exam and possibly other tests. These tests may include an electrocardiogram (EKG), a stress test, or the use of a Holter or event monitor to study your heart?s activity. Treatment for palpitations will depend on the cause.
Percutaneous Coronary Intervention
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Coronary Angioplasty
Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a nonsurgical procedure that improves blood flow to your heart.
Overview
PCI requires cardiac catheterization, which is the insertion of a catheter tube and injection of contrast dye, usually iodine-based, into your coronary arteries. Doctors use PCI to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic plaque. PCI may be used to relieve symptoms of coronary heart disease or to reduce heart damage during or after a heart attack.
A cardiologist, or doctor who specializes in the heart, will perform PCI in a hospital cardiac catheterization laboratory. You will stay awake, but you will be given medicine to relax you. Before your procedure, you will receive medicines through an intravenous (IV) line in your arm to prevent blood clots. Your doctor will clean and numb an area on the wrist or groin where your doctor will make a small hole and insert the catheter into your blood vessel. Live x rays will help your doctor guide the catheter into your heart to inject special contrast dye that will highlight the blockage. To open a blocked artery, your doctor will insert another catheter over a guidewire and inflate a balloon at the tip of that catheter. Your doctor may put a small mesh tube called a stent in your artery to help keep the artery open.
After PCI, your doctor will remove the catheters and close and bandage the opening on your wrist or groin. You may develop a bruise and soreness where the catheters were inserted. It also is common to have discomfort or bleeding where the catheters were inserted. You will recover in a special unit of the hospital for a few hours or overnight. You will get instructions on how much activity you can do and what medicines to take. You will need a ride home because of the medicines or anesthesia you received. Your doctor will check your progress during a follow-up visit. If a stent is implanted, you will have to take special anticlotting medicines exactly as prescribed, usually for at least three to 12 months.
Serious complications from PCI don?t occur often, but they can happen. These complications may include bleeding, blood vessel damage, a treatable allergic reaction to the contrast dye, the need for emergency coronary artery bypass grafting during the procedure, arrhythmias, damaged arteries, kidney damage, heart attack, stroke, or blood clots. Sometimes chest pain can occur during PCI because the balloon briefly blocks blood supply to the heart. Restenosis, or tissue regrowth in the treated portion of the artery, may occur in the following months and cause the artery to become narrow or blocked again. The risk of complications is higher if you are older, have chronic kidney disease, are experiencing heart failure at the time of the procedure, or have extensive heart disease and multiple blockages in your coronary arteries.
Smoking and Your Heart
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
How Does Smoking Affect the Heart and Blood Vessels?
Cigarette smoking causes about 1 in every 5 deaths in the United States each year. It's the main preventable cause of death and illness in the United States.
Smoking harms nearly every organ in the body, including the heart, blood vessels, lungs, eyes, mouth, reproductive organs, bones, bladder, and digestive organs. This article focuses on how smoking affects the heart and blood vessels.
Other Health Topics articles, such as COPD (chronic obstructive pulmonary disease), Bronchitis, and Cough, discuss how smoking affects the lungs.
Overview
Smoking and Your Heart and Blood Vessels
The chemicals in tobacco smoke harm your blood cells. They also can damage the function of your heart and the structure and function of your blood vessels. This damage increases your risk of atherosclerosis.
Atherosclerosis is a disease in which a waxy substance called plaque builds up in the arteries. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
Coronary heart disease (CHD) occurs if plaque builds up in the coronary (heart) arteries. Over time, CHD can lead to chest pain, heart attack, heart failure, arrhythmias, or even death.
Smoking is a major risk factor for heart disease. When combined with other risk factors?such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity?smoking further raises the risk of heart disease.
Smoking also is a major risk factor for peripheral artery disease (P.A.D.). P.A.D. is a condition in which plaque builds up in the arteries that carry blood to the head, organs, and limbs. People who have P.A.D. are at increased risk for heart disease, heart attack, and stroke.
Smoking and Atherosclerosis
The image shows how smoking can affect arteries in the heart and legs. Figure A shows the location of coronary heart disease and peripheral artery disease. Figure B shows a detailed view of a leg artery with atherosclerosis?plaque buildup that's partially blocking blood flow. Figure C shows a detailed view of a coronary (heart) artery with atherosclerosis.
The image shows how smoking can affect arteries in the heart and legs. Figure A shows the location of coronary heart disease and peripheral artery disease. Figure B shows a detailed view of a leg artery with atherosclerosis?plaque buildup that's partially blocking blood flow. Figure C shows a detailed view of a coronary (heart) artery with atherosclerosis.
Any amount of smoking, even light smoking or occasional smoking, damages the heart and blood vessels. For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.
Secondhand smoke also can harm the heart and blood vessels. Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that's breathed out by a person who is smoking.
Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. Secondhand smoke can damage the hearts and blood vessels of people who don't smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults' risk of heart attack and death.
Secondhand smoke also raises children and teens' risk of future CHD because it:
?Lowers HDL cholesterol (sometimes called "good" cholesterol)
?Raises blood pressure
?Damages heart tissues
The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome (RDS) and children who have conditions such as asthma.
Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.
However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk for heart disease.
Benefits of Quitting Smoking and Avoiding Secondhand Smoke
One of the best ways to reduce your risk of heart disease is to avoid tobacco smoke. Don't ever start smoking. If you already smoke, quit. No matter how much or how long you've smoked, quitting will benefit you.
Also, try to avoid secondhand smoke. Don't go to places where smoking is allowed. Ask friends and family members who smoke not to do it in the house and car.
Quitting smoking will reduce your risk of developing and dying from heart disease. Over time, quitting also will lower your risk of atherosclerosis and blood clots.
If you smoke and already have heart disease, quitting smoking will reduce your risk of sudden cardiac death, a second heart attack, and death from other chronic diseases.
Researchers have studied communities that have banned smoking at worksites and in public places. The number of heart attacks in these communities dropped quite a bit. Researchers think these results are due to a decrease in active smoking and reduced exposure to secondhand smoke.
Outlook
Smoking or exposure to secondhand smoke damages the heart and blood vessels in many ways. Smoking also is a major risk factor for developing heart disease or dying from it.
Quitting smoking and avoiding secondhand smoke can help reverse heart and blood vessel damage and reduce heart disease risk.
Quitting smoking is possible, but it can be hard. Millions of people have quit smoking successfully and remained nonsmokers. A variety of strategies, programs, and medicines are available to help you quit smoking.
Not smoking is an important part of a heart-healthy lifestyle. A heart-healthy lifestyle also includes heart-healthy eating, aiming for a healthy weight, managing stress, and physical activity.
Stress Testing
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is Stress Testing?
Stress testing provides information about how your heart works during physical stress. Some heart problems are easier to diagnose when your heart is working hard and beating fast.
During stress testing, you exercise (walk or run on a treadmill or pedal a stationary bike) to make your heart work hard and beat fast. Tests are done on your heart while you exercise.
You might have arthritis or another medical problem that prevents you from exercising during a stress test. If so, your doctor may give you medicine to make your heart work hard, as it would during exercise. This is called a pharmacological (FAR-ma-ko-LOJ-ih-kal) stress test.
Overview
Doctors usually use stress testing to help diagnose coronary heart disease (CHD). They also use stress testing to find out the severity of CHD.
CHD is a disease in which a waxy substance called plaque (plak) builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can mostly or completely block blood flow through an artery. This can lead to chest pain called angina (an-JI-nuh or AN-juh-nuh) or a heart attack.
You may not have any signs or symptoms of CHD when your heart is at rest. But when your heart has to work harder during exercise, it needs more blood and oxygen. Narrow arteries can't supply enough blood for your heart to work well. As a result, signs and symptoms of CHD may occur only during exercise.
A stress test can detect the following problems, which may suggest that your heart isn't getting enough blood during exercise:
?Abnormal changes in your heart rate or blood pressure
?Symptoms such as shortness of breath or chest pain, especially if they occur at low levels of exercise
?Abnormal changes in your heart's rhythm or electrical activity
During a stress test, if you can't exercise for as long as what is considered normal for someone your age, it may be a sign that not enough blood is flowing to your heart. However, other factors besides CHD can prevent you from exercising long enough (for example, lung disease, anemia, or poor general fitness).
Doctors also may use stress testing to assess other problems, such as heart valve disease or heart failure.
Total Artificial Heart
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
A total artificial heart (TAH) is a pump that is surgically installed to provide circulation and replace heart ventricles that are diseased or damaged. The ventricles pump blood out of the heart to the lungs and other parts of the body. Machines outside the body control the implanted pumps, helping blood flow to and from the heart.
A doctor may recommend a TAH if you have heart failure caused by ventricles that no longer pump blood well enough, and you need long-term support. TAH surgery may be an alternative treatment in certain patients who are unable to receive a heart transplant.
As with any surgery, TAH surgery can lead to serious complications such as blood clots or infection. You may have to stay in the hospital to prevent or manage these complications. In some cases, people with a TAH can leave the hospital to wait for a heart transplant.
Explore this Health Topic to learn more about TAH surgery, life with a TAH, and where to find more information.
Ventricular Assist Device
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Heart Pump
A ventricular assist device (VAD) is a mechanical pump that supports heart function and blood flow in people who have weakened hearts.
Overview
These devices can support the function of the left, right, or both heart ventricles. Ventricles are the lower chambers of your heart. The VAD includes tubes to carry blood out of your heart and to your blood vessels, a power source, and a control unit to monitor device function. The device may be used to support your heart until it recovers, to support your heart while you are waiting for a heart transplant, or to help your heart work better if you are not eligible for a heart transplant.
Surgery is required to connect the VAD to your heart. The surgery will be performed in a hospital. You will have general anesthesia and will not be awake or feel pain during the surgery. You will receive anticlotting medicine through an intravenous (IV) line in your arm. A breathing tube connected to a ventilator will help you breathe. A surgeon will open your chest and connect your heart?s arteries and veins to a heart-lung bypass machine. Your surgeon will place the pump in the upper part of your belly wall and connect the pump to your heart with a tube. Another tube will connect the pump to one of your major arteries. The VAD will be connected to the control unit and power source outside your body. When the heart-lung machine is switched off, the VAD will support blood flow and take over your heart?s pumping function.
After your surgery, you will recover in the intensive care unit (ICU) and may stay in the hospital for two to eight weeks. Hospital staff will help you to increase your activity gradually to gain strength. You may start a cardiac rehabilitation program. Your medical team will watch closely for signs of infection. To prevent infection, it is important to practice good hygiene, obtain routine vaccines, and properly clean and care for your device and the hole in your abdomen. You will be given instructions on what to do if the device gives a warning that it is not working correctly. If you are on the waiting list for a heart transplant, you will stay in close contact with the transplant center.
Getting a VAD involves serious risks such as blood clots and bleeding from the surgery or caused by the anticlotting medicines. Other risks include infection, device malfunction, and right-sided heart failure if a left VAD was used. Because blood tends to clot more when coming in contact with the VAD, you likely will need to take anticlotting medicines for as long as you have the device. It is important to take your medicines exactly as your doctor prescribes to prevent clots.
Bronchiectasis
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Bronchiectasis (brong-ke-EK-ta-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. The airways are tubes that carry air in and out of your lungs.
Bronchiectasis usually is the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria, and other small particles.
In bronchiectasis, your airways slowly lose their ability to clear out mucus. When mucus can't be cleared, it builds up and creates an environment in which bacteria can grow. This leads to repeated, serious lung infections.
Each infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.
Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis (at-eh-LEK-tah-sis), and heart failure.
Bronchiectasis
Figure A shows a cross-section of the lungs with normal airways and with widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis.
Figure A shows a cross-section of the lungs with normal airways and with widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis.
Overview
Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs.
The initial lung damage that leads to bronchiectasis often begins in childhood. However, symptoms may not occur until months or even years after you start having repeated lung infections.
In the United States, common childhood infections?such as whooping cough and measles?used to cause many cases of bronchiectasis. However, these causes are now less common because of vaccines and antibiotics.
Now bronchiectasis usually is due to a medical condition that injures the airway walls or prevents the airways from clearing mucus. Examples of such conditions include cystic fibrosis and primary ciliary (SIL-e-ar-e) dyskinesia (dis-kih-NE-ze-ah), or PCD.
Bronchiectasis that affects only one part of the lung may be caused by a blockage rather than a medical condition.
Bronchiectasis can be congenital (kon-JEN-ih-tal) or acquired. Congenital bronchiectasis affects infants and children. It's the result of a problem with how the lungs form in a fetus.
Acquired bronchiectasis occurs as a result of another condition or factor. This type of bronchiectasis can affect adults and older children. Acquired bronchiectasis is more common than the congenital type.
Outlook
Currently, bronchiectasis has no cure. However, with proper care, most people who have it can enjoy a good quality of life.
Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor starts treating bronchiectasis and any underlying conditions, the better your chances of preventing further lung damage.
Other Names
?Acquired bronchiectasis
?Congenital bronchiectasis
Pleurisy and Other Pleural Disorders
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Hemothorax, Pleural Effusion, Pneumothorax
What Is
Pleurisy (PLUR-ih-se) is a condition in which the pleura is inflamed. The pleura is a membrane that consists of two large, thin layers of tissue. One layer wraps around the outside of your lungs. The other layer lines the inside of your chest cavity.
Between the layers of tissue is a very thin space called the pleural space. Normally this space is filled with a small amount of fluid?about 4 teaspoons full. The fluid helps the two layers of the pleura glide smoothly past each other as you breathe in and out.
Pleurisy occurs if the two layers of the pleura become irritated and inflamed. Instead of gliding smoothly past each other, they rub together every time you breathe in. The rubbing can cause sharp pain.
Many conditions can cause pleurisy, including viral infections.
Other Pleural Disorders
Pneumothorax
Air or gas can build up in the pleural space. When this happens, it's called a pneumothorax (noo-mo-THOR-aks). A lung disease or acute lung injury can cause a pneumothorax.
Some lung procedures also can cause a pneumothorax. Examples include lung surgery, drainage of fluid with a needle, bronchoscopy (bron-KOS-ko-pee), and mechanical ventilation.
Sometimes the cause of a pneumothorax isn't known.
The most common symptoms of a pneumothorax are sudden pain in one side of the lung and shortness of breath. The air or gas in the pleural space also can put pressure on the lung and cause it to collapse.
Pleurisy and Pneumothorax
Figure A shows the location of the lungs, airways, pleura, and diaphragm (a muscle that helps you breathe). The inset image shows a detailed view of the two pleural layers and pleural space. Figure B shows lungs with pleurisy and a pneumothorax. The inset image shows a detailed view of an infected lung with thickened and inflamed pleural layers.
Figure A shows the location of the lungs, airways, pleura, and diaphragm (a muscle that helps you breathe). The inset image shows a detailed view of the two pleural layers and pleural space. Figure B shows lungs with pleurisy and a pneumothorax. The inset image shows a detailed view of an infected lung with thickened and inflamed pleural layers.
A small pneumothorax may go away without treatment. A large pneumothorax may require a procedure to remove air or gas from the pleural space.
A very large pneumothorax can interfere with blood flow through your chest and cause your blood pressure to drop. This is called a tension pneumothorax.
Pleural Effusion
In some cases of pleurisy, excess fluid builds up in the pleural space. This is called a pleural effusion. A lot of extra fluid can push the pleura against your lung until the lung, or part of it, collapses. This can make it hard for you to breathe.
Sometimes the extra fluid gets infected and turns into an abscess. When this happens, it's called an empyema (em-pi-E-ma).
You can develop a pleural effusion even if you don't have pleurisy. For example, pneumonia, (nu-MO-ne-ah), heart failure, cancer, or pulmonary embolism (PULL-mun-ary EM-bo-lizm) can lead to a pleural effusion.
Hemothorax
Blood also can build up in the pleural space. This condition is called a hemothorax (he-mo-THOR-aks). An injury to your chest, chest or heart surgery, or lung or pleural cancer can cause a hemothorax.
A hemothorax can put pressure on the lung and cause it to collapse. A hemothorax also can cause shock. In shock, not enough blood and oxygen reach your body's vital organs.
Outlook
Pleurisy and other pleural disorders can be serious, depending on their causes. If the condition that caused the pleurisy or other pleural disorder isn't too serious and is diagnosed and treated early, you usually can expect a full recovery.
Other Names
?Pleurisy also is called pleuritis and pleuritic chest pain.
?Pleural effusion also is called fluid in the chest and pleural fluid.
?Pneumothorax also is called air around the lung and air outside the lung.
Idiopathic Pulmonary Fibrosis
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
Pulmonary fibrosis (PULL-mun-ary fi-BRO-sis) is a disease in which tissue deep in your lungs becomes thick and stiff, or scarred, over time. The formation of scar tissue is called fibrosis.
As the lung tissue thickens, your lungs can't properly move oxygen into your bloodstream. As a result, your brain and other organs don't get the oxygen they need. (For more information, go to the "How the Lungs Work" section of this article.)
Sometimes doctors can find out what's causing fibrosis. But in most cases, they can't find a cause. They call these cases idiopathic (id-ee-o-PATH-ick) pulmonary fibrosis (IPF).
IPF is a serious disease that usually affects middle-aged and older adults. IPF varies from person to person. In some people, fibrosis happens quickly. In others, the process is much slower. In some people, the disease stays the same for years.
IPF has no cure yet. Many people live only about 3 to 5 years after diagnosis. The most common cause of death related to IPF is respiratory failure. Other causes of death include pulmonary hypertension (HI-per-TEN-shun), heart failure, pulmonary embolism (EM-bo-lizm), pneumonia (nu-MO-ne-ah), and lung cancer.
Genetics may play a role in causing IPF. If more than one member of your family has IPF, the disease is called familial IPF.
Research has helped doctors learn more about IPF. As a result, they can more quickly diagnose the disease now than in the past. Also, researchers are studying several medicines that may slow the progress of IPF. These efforts may improve the lifespan and quality of life for people who have the disease.
Other Names
?Idiopathic diffuse interstitial pulmonary fibrosis
?Pulmonary fibrosis of unknown cause
?Pulmonary fibrosis
?Cryptogenic fibrosing alveolitis
?Usual interstitial pneumonitis
?Diffuse fibrosing alveolitis
Pneumonia
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Pneumonia is a bacterial, viral, or fungal infection of one or both sides of the lungs that causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus. Symptoms can be mild or severe and may include a cough with phlegm (a slimy substance), fever, chills, and trouble breathing. Many factors affect how serious pneumonia is, such as the type of germ causing the lung infection, your age, and your overall health. Pneumonia tends to be more serious for children under the age of five, adults over the age of 65, people with certain conditions such as heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), or people who have weak immune systems due to HIV/AIDS, chemotherapy (a treatment for cancer), or organ or blood and marrow stem cell transplant procedures.
To diagnose pneumonia, your doctor will review your medical history, perform a physical exam, and order diagnostic tests. This information can help your doctor determine what type of pneumonia you have. If your doctor suspects you got your infection while in a hospital, you may be diagnosed with hospital-acquired pneumonia. If you have been on a ventilator to help you breathe, you may have ventilator-associated pneumonia. The most common form of pneumonia is community-acquired pneumonia, which is when you get an infection outside of a hospital.
Treatment depends on whether bacteria, viruses, or fungi are causing your pneumonia. If bacteria are causing your pneumonia, you usually are treated at home with oral antibiotics. Most people respond quickly to treatment. If your symptoms worsen you should see a doctor right away. If you have severe symptoms or underlying health problems, you may need to be treated in a hospital. It may take several weeks to recover from pneumonia.
Explore this Health Topic to learn more about pneumonia, our role in research and clinical trials to improve health, and where to find more information.
Pulmonary Hypertension
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
What Is
Pulmonary hypertension (PULL-mun-ary HI-per-TEN-shun), or PH, is increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen.
PH causes symptoms such as shortness of breath during routine activity (for example, climbing two flights of stairs), tiredness, chest pain, and a racing heartbeat. As the condition worsens, its symptoms may limit all physical activity.
Overview
To understand PH, it helps to understand how your heart and lungs work. Your heart has two sides, separated by an inner wall called the septum.
Each side of your heart has an upper and lower chamber. The lower right chamber of your heart, the right ventricle (VEN-trih-kul), pumps blood to your pulmonary arteries. The blood then travels to your lungs, where it picks up oxygen.
The upper left chamber of your heart, the left atrium (AY-tree-um), receives the oxygen-rich blood from your lungs. The blood is then pumped into the lower left chamber of your heart, the left ventricle. From the left ventricle, the blood is pumped to the rest of your body through an artery called the aorta.
For more information about the heart and lungs, go to the Diseases and Conditions Index How the Heart Works and How the Lungs Work articles.
PH begins with inflammation and changes in the cells that line your pulmonary arteries. Other factors also can affect the pulmonary arteries and cause PH. For example, the condition may develop if:
?The walls of the arteries tighten.
?The walls of the arteries are stiff at birth or become stiff from an overgrowth of cells.
?Blood clots form in the arteries.
These changes make it hard for your heart to push blood through your pulmonary arteries and into your lungs. As a result, the pressure in your arteries rises. Also, because your heart is working harder than normal, your right ventricle becomes strained and weak.
Your heart may become so weak that it can't pump enough blood to your lungs. This causes heart failure. Heart failure is the most common cause of death in people who have PH.
PH is divided into five groups based on its causes. In all groups, the average pressure in the pulmonary arteries is higher than 25 mmHg at rest or 30 mmHg during physical activity. The pressure in normal pulmonary arteries is 8?20 mmHg at rest. (The mmHg is millimeters of mercury?the units used to measure blood pressure.)
Other diseases or conditions, such as heart and lung diseases or blood clots, usually cause PH. Some people inherit the condition (that is, their parents pass the genes for PH on to them). In some cases, the cause isn't known.
Outlook
PH has no cure. However, research for new treatments is ongoing. The earlier PH is treated, the easier it is to control.
Treatments include medicines, procedures, and other therapies. These treatments can relieve PH symptoms and slow the progress of the disease. Lifestyle changes also can help control symptoms.
Other Names
Group 1 pulmonary arterial hypertension (PAH) that occurs without a known cause often is called primary PAH or idiopathic (id-ee-o-PATH-ick) PAH.
Group 1 PAH that occurs with a known cause often is called associated PAH. For example, PAH that occurs in a person who has scleroderma might be called "PAH occurring in association with scleroderma," or simply "scleroderma-associated PAH."
Groups 2?5 pulmonary hypertension (PH) sometimes are called secondary PH.
Thoracentesis
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall to remove excess fluid from the pleural space to help you breathe easier.
Overview
Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier. It may be done to determine the cause of your pleural effusion. Some conditions such as heart failure, lung infections, and tumors can cause pleural effusions.
Thoracentesis is performed in a doctor?s office or hospital. The procedure usually takes 10 to 15 minutes, unless you have a lot of fluid in your pleural space. For the procedure, most patients sit quietly on the edge of a chair or bed with their head and arms resting on a table. Your doctor may use ultrasound to determine the best location to insert the needle. After cleaning the skin around the area where the needle will be inserted, your doctor will inject numbing medicine. A needle is inserted between your ribs into the pleural space. You may feel some discomfort or pressure when the needle is inserted. As your doctor draws out excess fluid from around your lungs, you may feel like coughing or have chest pain. The needle will be removed, and a small bandage will be applied to the site.
After the procedure, your blood pressure and breathing will be monitored to make sure you do not have complications. The fluid that was removed from your chest will be sent for laboratory testing to determine the cause of your pleural effusion and to help plan your treatment. Your doctor may order a chest x ray to check for lung problems.
The risks of thoracentesis include a pneumothorax or collapsed lung, pain, bleeding, bruising, or infection. Liver or spleen injuries are rare complications.
Sleep Studies
From NHLBI health topic site
(Posted: Jan 01, 2014 0AM)
Also known as Polysomnography
Sleep studies are painless, noninvasive tests that measure how well you sleep and how your body responds to sleep problems.
Overview
The more common sleep studies monitor and record data about your body during a full night of sleep. Other types of sleep studies include multiple sleep latency and daytime maintenance of wakefulness tests. Multiple sleep latency tests measure how quickly you fall asleep during a series of daytime naps and use sensors to record your brain activity and eye movements. A daytime maintenance of wakefulness test measures your ability to stay awake and alert.
Sleep studies can help your doctor diagnose sleep-related breathing disorders such as sleep apnea, sleep-related seizure disorders, sleep-related movement disorders, and sleep disorders that cause extreme daytime tiredness such as narcolepsy. Doctors also may use sleep studies to help diagnose or rule out restless legs syndrome.
Your doctor will determine whether you must have your sleep study at a sleep center or if you can do it at home with a portable diagnostic device. If your sleep study will be done at a sleep center, you will sleep in a bed at the sleep center for the duration of the study. Removable sensors will be placed on your scalp, face, eyelids, chest, limbs, and a finger. These sensors record your brain waves, heart rate, breathing effort and rate, oxygen levels, and muscle movements before, during, and after sleep. There is a small risk of irritation from the sensors, but this will go away after they are removed.
Your doctor will review your sleep study test results and develop a treatment plan for any diagnosed sleep disorder. Untreated sleep disorders can raise your risk for heart failure, high blood pressure, stroke, diabetes, and depression. Sleep disorders also have been linked to an increased risk for injury and car accidents.
Disclaimer: Articles listed in Hot Topics of the Day are selected by Public Health Genomics Branch to provide current awareness of the scientific literature and news. Inclusion in the update does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article's methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.
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