Tag Archives: Heart Disease

Pericarditis

Definition:
The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart. It shields the heart from infection or malignancy and contains the heart in the chest wall. It also prevents the heart from over-expanding when blood volume increases, which keeps the heart functioning efficiently.
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Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart). A characteristic chest pain is often present.

It can be caused by a variety of causes including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the precardium (for i.e. Mycobacterium tuberculosis), post-infarct pericarditis (pericarditis due to heart attack), or Dressler’s pericarditis.

If you could see and touch it, the membrane around the heart would look red and swollen, like the skin around a cut that becomes inflamed. Sometimes excess fluid develops in the space between the pericardial layers and causes a pericardial effusion (buildup of excess fluid around the heart).

Classification:
Pericarditis can be classified according to the composition of the inflammatory exudate or in other words the composition of the fluid that accumulates around the heart.

Types include:

*serous
*purulent
*fibrinous
*caseous
*hemorrhagic
*Post infarction

Acute vs. chronic:
Depending on the time of presentation and duration, pericarditis is divided into “acute” and “chronic” forms. Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or even as a result of a heart attack (myocardial infarction). Chronic pericarditis however is less common, a form of which is constrictive pericarditis.

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The following is the clinical classification of acute vs. chronic:
Clinically: Acute (<6 weeks), Subacute (6 weeks to 6 months) and Chronic (>6 months)

 

Symptoms:
Acute pericarditis usually lasts less than a few weeks. Chronic pericarditis usually lasts six months or longer.

If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.

The pain of acute pericarditis may travel into your left shoulder and neck. It often intensifies when you lie down or inhale deeply. Coughing, taking a deep breath or swallowing food also may make the pain worse. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.

Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart (pericardial effusion). The most common symptom of chronic pericarditis is chest pain.

Depending on the type, signs and symptoms of pericarditis may include some or all of the following:

*Sharp, piercing chest pain over the center or left side of your chest, which is worse when taking a deep breath and relieved by sitting forwards – many people think they’re having a heart attack

*Shortness of breath when reclining

*Low-grade fever

*An overall sense of weakness, fatigue or feeling sick

*Dry cough and fatigue

*Fever

*Abdominal or leg swelling

*Pain in the shoulders and neck

Causes:
Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. In pericarditis, the sac becomes inflamed and the resulting friction from the inflamed sac leads to chest pain.

In some cases the amount of fluid contained in the pericardial sac may increase, causing a pericardial effusion.

The cause of pericarditis is often hard to determine. In most cases doctors are either unable to determine a cause (idiopathic) or suspect a viral infection.

Pericarditis can also develop shortly after a major heart attack, due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery because of antibody formation. This delayed pericarditis is known as Dressler’s syndrome. Many experts believe Dressler’s syndrome is due to an autoimmune response, a mistaken inflammatory response by the body to its own tissues — in this case, the heart and pericardium.

Other causes of pericarditis include:

*Systemic inflammatory disorders. These may include lupus and rheumatoid arthritis.

*Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.

*Other health disorders. These may include kidney failure, AIDS, tuberculosis and cancer.

*Certain medications. Some medications can cause pericarditis, although this is unusual.

Complication:
Constrictive pericarditis is a severe form of chronic pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. The thick, rigid pericardium constricts the heart’s normal movement so that it cannot expand normally as it fills with blood. As a result, the heart chambers don’t fill up with enough blood. The blood then backs up behind the heart, causing symptoms of heart failure, including shortness of breath, swelling of the legs and feet, water retention and disturbances in the heart’s normal rhythm. These symptoms should improve when the constrictive pericarditis is treated.

Constrictive pericarditis often can be treated with a diuretic, such as furosemide, to treat the fluid retention. If you develop a heart rhythm problem, you may need to take a medication to treat the irregular rhythm for as long as the constrictive pericarditis lasts or until your heart rhythm returns to normal. When none of these treatments is effective, pericardiectomy may be needed to surgically remove the stiffened pericardium.

Pericardial Effusion
When an excess of fluid builds up in the space between the pericardium, it can cause a condition known as pericardial effusion. Rapid fluid accumulation in the pericardium can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function. Cardiac tamponade resulting from a pericardial effusion can be life-threatening and is a medical emergency requiring emergent drainage of the fluid with a catheter.

 

 

Diagnosis:
The classic sign of pericarditis is a friction rub auscultated on the cardiovascular examination usually on the lower left sternal border. Other physical signs include a patient in distress, positional chest pain, diaphoresis (excessive sweating), and possibility of heart failure in form of precardial tamponade causing pulsus paradoxus, and the Beck’s triad of hypotension (due to decreased cardiac output), distant (muffled) heart sounds, and JVD (jugular vein distention).

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

•Crackles in the lungs
•Decreased breath sounds
•Other signs of fluid in the space around the lungs (pleural effusion)

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If fluid has built up in the pericardial sac, it may show on:

•Chest MRI scan
•Chest x-ray
•ECG
•Echocardiogram
•Heart MRI or heart CT scan
•Radionuclide scanning
These tests show:

•Enlargement of the heart
•Signs of inflammation
•Scarring and contracture of the pericardium (constrictive pericarditis)
Other findings vary depending on the cause of pericarditis.

To rule out heart attack, the health care provider may order serial cardiac marker levels (CPK-MB and troponin I). Other laboratory tests may include:

•Blood culture
•CBC
•C-reactive protein
•Erythrocyte sedimentation rate (ESR)
•HIV serology
•Pericardiocentesis, with chemical analysis and pericardial fluid culture
•Tuberculin skin test

Treatment:
The cause of pericarditis must be identified, if possible.

Medications include:

•Analgesics for pain
•Antibiotics for bacterial pericarditis
•Antifungal medications for fungal pericarditis
•Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
•Corticosteroids such as prednisone (in some patients)
•Colchicine
If the buildup of fluid in the pericardium makes the heart function poorly or produces cardiac tamponade, it is necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or minor surgery.

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended.

Prognosis:
Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by significant fluid buildup around the heart and poor heart function.

The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months. However, pericarditis may come back.

Prevention:
Many cases are not preventable.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm
http://www.mayoclinic.com/health/pericarditis/DS00505
http://en.wikipedia.org/wiki/Pericarditis
http://my.clevelandclinic.org/heart/disorders/other/pericarditis.aspx

http://www.nlm.nih.gov/medlineplus/ency/imagepages/18080.htm

http://fromyourdoctor.com/topic.do?title=Pericarditis&t=8158

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Lifestyle for a Healthy Heart

Heart disease may be inherited, but often it’s the result of lifestyle. Changing eating, exercise and smoking habits can play a significant part in prevention.

The following risk factors can cause heart disease. While there are some you can do little or nothing about, there are others that are worth addressing to make sure you keep a healthy heart:
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Age
Four out of five people who die from coronary heart disease are aged 65 or older.

Gender
Men are more at risk of heart disease than women and have heart attacks earlier in life. However, death rates from heart disease and stroke for women are twice as high as those for all forms of cancer.

The risk for women increases as they approach menopause and continues to rise as they get older, possibly because of the loss of oestrogen, the natural hormone.

Family history
Children of parents with heart disease are more likely to suffer from the disease themselves. Some races, such as Afro-Caribbeans, are more prone to coronary heart disease and stroke than others.

Smoking
Smokers are twice as likely to suffer heart attacks as non-smokers and are more likely to die as a result. Smoking is also linked to increased risk of stroke.

The nicotine and carbon monoxide in tobacco smoke damages the cardiovascular system. Passive smoking may also be a danger.

Women who smoke and take the oral contraceptive pill are at high risk of heart disease and stroke.

Alcohol
Drinking an average of more than one drink a day for women or more than two drinks a day for men increases the risk of heart disease and stroke because of the effect on blood pressure, weight and levels of triglycerides, a type of fat carried in the blood.

Binge drinking is particularly dangerous.

Drug abuse
The use of certain drugs, particularly cocaine and those taken intravenously, has been linked to heart disease and stroke.

Cocaine can cause abnormal heartbeat, which can be fatal, while heroin and opiates can cause lung failure. Injecting drugs can cause an infection of the heart or blood vessels.

Cholesterol
The higher the blood cholesterol level, the higher the risk of coronary heart disease, particularly if it’s combined with any of the other risk factors.

Diet is one cause of high cholesterol; others are age, gender and family history.

Blood pressure
High blood pressure increases the heart’s workload, causing it to enlarge and weaken over time. When combined with obesity, smoking, high cholesterol or diabetes, the risk increases several times.

High blood pressure can be a problem in women who are pregnant or are taking high-dose types of oral contraceptive pill.

Physical inactivity
Failure to exercise is a cause of coronary heart disease as physical activity helps control cholesterol levels, diabetes and, in some cases, can help lower blood pressure.

Obesity
People who are overweight are more likely to develop heart disease and stroke, even if they have none of the other risk factors. Excess weight causes extra strain on the heart, influences blood pressure, cholesterol and levels of other blood fats – including triglycerides – and increases the risk of developing diabetes.

 

Diabetes
The condition seriously increases the risk of developing cardiovascular disease, even if glucose levels are under control. More than 80 per cent of people with diabetes die of some form of heart or blood vessel disease.

Previous medical history
People who have had a previous heart attack or stroke are more likely than others to suffer further events.

Stress
Some links have been made between stress and coronary artery disease. This could be because it encourages people to eat more, start smoking or smoke more than they would otherwise have done.

Source:BBC Health

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Bigger the Belly, the Bigger the Risk

Although obesity has long been known to be a risk factor for heart disease, several studies have found that a high body mass index is actually associated with a lower risk of dying from heart ailments. However, according to a new analysis, the apparent paradox may be explained by the simple fact that BMI is a very flawed measurement.
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The study revealed that waist size provides a far more accurate way to predict a heart patient’s chances of dying at an early age from a heart attack or other causes.

CNN reports:
“As in previous studies, a high BMI was associated with a lower risk of death. But researchers found that heart patients with a high ratio of waist-to-hip circumference or a large waist size — greater than 35 inches for women, or 40 inches for men — were 70 percent more likely to die during the study period than those with smaller waists. The combination of a large waist and a high BMI upped the risk of death even more.”

Resources:
*CNN May 2, 2011

*Wall Street Journal May 3 2011 *

*Journal of the American College of Cardiology May 10, 2011; 57(19):1877-86

Posted By Dr. Mercola | May 20 2011

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Heart Murmurs in Babies

Definition
The heart has four separate chambers, and four one-way valves attaching them. The two lower chambers pump, and they’re called ventricles. The two upper chambers accept incoming blood, and they’re called atria.

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Blood that’s low in oxygen comes from the body into the right atrium, then goes through a valve into the right ventricle, and over to the lungs to get more oxygen. That oxygen-rich blood returns to the heart through the left atrium, then across a valve into the left ventricle. From there it’s pumped through the aorta, which is a large blood vessel, and on to smaller blood vessels throughout the body.

A heart murmur is the term used when an extra swishing sound is heard besides the normal heartbeat, which is the sound of the valves opening and closing. A doctor can hear these sounds with a stethoscope, but a child needs to sit very quietly for that to happen, because his heart is near his chest wall, and outside sounds can get picked up. You might be asked to hold your baby in your lap while the doctor listens, or calm him down; if he’s crying, it’s almost impossible to hear a murmur.

Parents often panic when they are told their baby has been diagnosed with a heart murmur, yet do not realize that heart murmurs are actually common in babies and that, in general, they resolve themselves without affecting the baby’s overall health.Murmurs are very common during childhood and the vast majority are not a sign of disease or anything to worry about. It is extremely important for parents to understand which type of murmur their child has been diagnosed with, if it requires further evaluation and treatment options available if the result is a serious heart defect.

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Symptoms:
There may be no other symptoms – a murmur is generally diagnosed by the sound heard through the stethoscope.

These murmurs usually get resolved by the time the child become adult. The defective heart murmur may need to be tested to find out the real cause of it. The child with innocent murmur can live as healthy life as any other child of healthy heart. Pathological heart murmurs is a defect in the heart with a hole which may be there in the two chambers of the heart. The chest pain, rapid heart beat, bluish color or fingertips, shortness of breath, fainting, fatigue with exertion and signs of congestive heart failure are some of serious symptoms of this disease.

However, if the murmur is due to disease – ie, it isn’t harmless or ‘innocent’ – the child may be cyanosed (blue, especially around the lips), short of breath (especially on feeding), off their feeds, failing to thrive (poor growth) or have frequent chest infections.

Causes:
The majority of heart murmurs are the result of the fast rate at which children’s hearts beat or normal variations in the structure of the heart. Some factors, such as fever or excitement, make these innocent murmurs more likely because they increase the speed at which the heart pumps.

The common cause of baby’s heart murmur is congenital heart disease which may occur when blood vessels or valves attached to the heart don’t get developed even before the child is born. Some children may get birth with heart defects. One in hundred children may be found with this type of birth disorder.

. Some serious heart defects may be due to some illnesses like rheumatic fever, heart disease, heart attacks. It is due to heart defects in structural disorder of a baby’s heart. The defects may be of valve abnormalities, cardiomyopathy and septal which produce murmur. Cardiomyopathy is usually a heart disorder of muscle which can result in defective functioning of the heart.

However, a heart murmur is also the most common sign of congenital heart defects caused by abnormal development of the heart tissues. This may be atrial or ventricular septal defects – a hole in the heart or an abnormal hole between two heart chambers. Sometimes the connections between vessels from the heart don’t close after birth as they should, resulting in patent ductus arteriosus.

Other abnormalities of the heart valves and still rarer problems can also cause a murmur.

Heart murmurs may also be caused by heart failure and infection involving the heart.

Diagnosis:
Although parents often fear the worse, not all heart murmurs are serious. They’re graded on scale from 1 to 6, where 1 is almost inaudible and 6 is quite loud. When your baby’s doctor hears it, he’ll note where in the heart it occurs, at what point in the heartbeat cycle, what type of sound it makes, and whether the noise changes when your child moves. If further evaluation is required, your child will be referred to a pediatric cardiologist.

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Sometimes a heart murmur will be heard at one appointment, when it wasn’t noticed at the last one. This could be because heart murmurs are better heard when children are in certain positions or have a different heart rate. It could also mean it’s due to a heart problem that’s recently developed, or one that’s been there since birth but hasn’t been severe enough to make a detectable murmur.

It can be difficult to tell an innocent murmur from a suspicious one. If a child has an unusual murmur but seems well, the doctor may suggest the child comes back for review in a few weeks or months.

Tests including a chest x-ray, electrocardiogram and echocardiogram may be recommended to examine the structure of the heart and check for abnormalities. If heart disease is suspected, more extensive tests may be needed.

Treatment :
The treatment of innocent murmur is not required at all. Congenital heart defects may be diagnosed after conducting laboratory tests. The parents should consult pediatric cardiologist after confirming the tests. The doctor will provide the suitable treatment to regulate the proper blood flow to the heart.

Some medications may solve the problem but in case of severity, the surgery can be conducted to treat the ailment. The mitral valve prolapsed may not require any treatment but only periodic checkups can be sufficient to be conducted. The doctor can prescribe some anti-biotic but medications should never be self prescribed which pose some serious problems.

The surgery may be conducted in serious types of cases. The anti-clotting medication, medications to put control on irregular heartbeat, palpitations and to open the blood vessels

Alternative treatment:
If a heart murmur requires surgical treatment, there are no alternative treatments, although there are alternative therapies that are helpful for pre- and post-surgical support of the patient. If the heart murmur is innocent, heart activity can be supported using the herb hawthorn (Crataegus laevigata or C. oxyacantha) or coenzyme Q10. These remedies improve heart contractility and the heart’s ability to use oxygen. If the murmur is valvular in origin, herbs that act like antibiotics as well as options that build resistance to infection in the valve areas may be considered.

Prognosis
Most children with innocent heart murmurs grow out of them by the time they reach adulthood. Severe causes of heart murmurs may progress to severe symptoms and death.

Prevention:
Heart murmurs in infants or babies can not be prevented but the blood pressure may be treated before the heart murmur gets developed. It is also advised to prevent rheumatic fever in the children to prevent heart murmurs. The regular check ups may be conducted to get to know the defects in advance to treat the ailment.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

 

Sources:
http://www.ehow.com/about_5280475_heart-murmur-babies.html
http://health.stateuniversity.com/pages/696/Heart-Murmurs.html
http://www.livestrong.com/article/22104-heart-murmur-babies/
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/heart/heartmurmurs2.shtml

Heart Murmur in Infants or Newborn Babies

http://fromyourdoctor.com/topic.do?title=Heart+How+it+Works&t=7986

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Mediterranean Diet Improves Heart Risk Factors

Eating a “Mediterranean diet” could prevent or even reverse metabolic syndrome, a cluster of risk factors for heart disease and diabetes. Scientists believe that a Mediterranean-style diet has antioxidant and anti-inflammatory effects on your body.

A review of 35 clinical trials found that faithfully eating a Mediterranean diet can improve traits such as belly fat, high blood pressure, low levels of “good” HDL cholesterol, elevated blood fat levels, and high blood sugar.

Reuters reports:
“For instance, those who stuck with the Mediterranean diet as compared to eating their regular foods or a low-fat diet trimmed their waistlines by about 0.43 cm (0.16 inches) on average.  They also showed slashed their blood pressure by 2.35 points on the top reading, and their fasting blood sugar by 3.89 milligrams per deciliter.”

Resources:
Reuters March 7, 2011
Journal of the American College of Cardiology March 15, 2011;57(11):1299-313

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