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Saturday, December 8, 2007

Ventricular septal defect (VSD) an overview

What Is Ventricular Septal Defect? Ventricular septal defect (VSD) is a hole (defect) in the wall that separates the lower chambers of the heart. The lower chambers of the heart are called the ventricles (VEN-trih-kuls). The wall between them is called the ventricular septum. In the normal heart, the septum prevents blood from flowing directly from one ventricle to the other. In a heart with a VSD, blood can flow directly between the two ventricles. VSD is a congenital heart defect, which means that it is present at birth. In children with a VSD, blood usually flows through the defect from the left ventricle to the right ventricle. This causes extra blood (called volume overload) in the pulmonary (PULL-mun-ary) arteries and lungs, and in the left atrium and left ventricle.
Effects of VSD Over time, a VSD that does not close—especially a large VSD—can cause:· Congestive heart failure. Infants with large VSDs may develop congestive heart failure. Extra blood flows from the left ventricle through the right ventricle to the lungs and back to the left atrium and on to the left ventricle. This causes the left atrium and left ventricle to handle an increased amount of blood, and the workload on the heart increases. The increased workload on the heart also increases the heart rate and the body's demand for energy. The extra blood flow in the lungs may cause rapid breathing, while also increasing the body's demand for energy.· Growth failure, especially in infancy. Your baby may not be able to eat enough to keep up with his or her body's increased energy demands. Your baby may lose weight or fail to grow and develop as he or she should.· Bacterial endocarditis is an infection of the lining of the heart, valves, or arteries. Endocarditis often occurs following dental and medical procedures.· Irregular heartbeat or rhythm (arrhythmia). The extra blood flowing into the left atrium can cause the atrium to stretch and enlarge. When this occurs, your child can develop a fast heartbeat with symptoms such as dizziness or fainting.· Pulmonary artery hypertension (high blood pressure in the pulmonary arteries). If a moderate or large VSD is not closed, sustained blood flow under higher pressure into the pulmonary arteries causes the arteries to become thickened and stiff. The amount of blood flow to the lungs decreases over time as the resistance to blood flow into the pulmonary arteries increases. However, this causes the right ventricle to work harder. Today, pulmonary artery hypertension rarely develops because most large or moderate VSDs are closed in infancy or early childhood.
Characteristics of VSDVSD is the most common type of congenital heart defect. Infants born with a VSD may have a single hole or more than one hole in the wall that separates the two ventricles. The defect may also occur by itself or with other congenital heart defects.
Types of VSD
Doctors classify VSDs based on the:· Size of the defect.· Location of the defect.· Number of defects.· Presence or absence of a ventricular septal aneurysm—a thin flap of tissue on the septum. It is harmless and can help a VSD close on its own.
VSDs range in size from small to large.· Small VSDs usually allow only a small amount of blood flow between the ventricles. Because of this, they are sometimes called restrictive. Most small VSDs: o Do not cause symptoms in infants and childreno Close on their own, often by school ageo Rarely need surgery or other procedures to close the defect· Moderate (or medium-sized) VSDs are less likely than small defects to close on their own. They may require surgery to close and may cause symptoms during infancy and childhood.· Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle and are sometimes called nonrestrictive. A large VSD is less likely to close completely on its own, but it may get smaller. A large VSD can cause more symptoms in infants and children, and surgery is usually needed to close it.
VSDs are found in different parts of the septum. · Membranous VSDs are located near the heart valves. They can close at any time if a ventricular septal aneurysm is present.· Muscular VSDs are found in the lower part of the septum. They are surrounded by muscle, and most close on their own during early childhood.· Inlet VSDs are located close to where blood enters the heart. They are less common than membranous and muscular VSDs.· Outlet VSDs are found in the part of the ventricle where the blood leaves the heart. This is the rarest type of VSD.
Outlook
Most VSDs close on their own or are so small that they don't need treatment. Some children and adults need surgery or other procedures to close the VSD, especially if it is large. Most children and adults live long and productive lives after their VSD closes or is repaired.
What Causes Ventricular Septal Defect?Doctors do not know what causes ventricular septal defect (VSD). Heredity may play a role. Parents who have congenital heart defects are more likely to have a child with VSD than parents who do not have congenital heart defects. In some cases, VSD may be due to a defect in one or more genes or to chromosomal abnormalities.What Are the Signs and Symptoms of Ventricular Septal Defect?The major signs and symptoms of ventricular septal defect (VSD) are:· Heart murmur· The signs and symptoms of congestive heart failure· Slowed growthMost newborns with VSD do not have heart-related symptoms.
Heart MurmurA heart murmur is an extra or unusual sound heard during your heartbeat. It is usually present in VSD and may be the first and only sign found by your doctor. The heart murmur is often present right after birth in many infants, but it may not appear until the baby is 6 to 8 weeks old. Sometimes the heart murmur is not found until the child is older or much later in life as an adult.
Congestive Heart Failure
A baby with a moderate or large VSD can develop congestive heart failure. These symptoms usually appear during the baby's first 2 months of life. Some older children and adults with VSD also may develop symptoms of congestive heart failure, which include:
· Fatigue or tiring easily· Shortness of breath· Fast breathing· Slow growth and poor weight gain
How Is Ventricular Septal Defect Diagnosed?Ventricular septal defect (VSD) is diagnosed using a medical history, a physical exam, and tests. Your baby's doctor may see symptoms of VSD during a routine checkup. Some parents also notice signs, such as poor feeding, and bring the baby to the doctor.Most cases are diagnosed in infancy and childhood. Babies born with a large VSD may have symptoms of congestive heart failure by the time they are 1–2 months old. They are usually diagnosed at that time. Some cases are not diagnosed until adulthood.
Medical and Family History
Your child's doctor will ask you about:· Family history of congenital heart defects· Your child's symptoms· Your child's feeding and growth
Physical Exam
During the physical exam, the doctor:· Listens to your baby's heart with a stethoscope to hear and evaluate a heart murmur· Looks for signs of congestive heart failure
Tests
Your baby's doctor will order several tests to diagnose VSD. These tests will also help the doctor determine the type and size of the defect.
Echocardiogram (ultrasound)
An echocardiogram or ultrasound study of the heart is the test used most often to diagnose VSD. This test uses sound waves to create a picture of the heart. An echocardiogram shows movement of blood through the heart and problems with how the heart is formed. It is safe and painless.
An echocardiogram shows:· VSD location and size· How much blood is passing through the VSD· Enlargement of the left atrium and left ventricle· Other congenital heart defects
Other tests· Chest x ray. This test takes a picture of the heart and lungs. It can show if the heart is enlarged or if there is fluid in the lungs.· EKG or ECG (electrocardiogram). This test measures the rate and regularity of your child's heartbeat. It provides an estimate of enlargement of the heart chambers and shows abnormal heart rhythms (arrhythmia).· Cardiac catheterization. A thin, flexible tube (catheter) is passed through a blood vessel (artery or vein) to the heart. With the assistance of x rays, the doctor can see the child's blood vessels and heart. During the procedure, the doctor can measure blood pressure in the heart and arteries connected to the heart, and see how much blood is mixing between the two sides of the heart. Cardiac catheterization is rarely used for diagnosis unless the echocardiogram does not provide enough information or if other defects or problems are suspected.
How Is Ventricular Septal Defect Treated?
Goals of Treatment
The goals of ventricular septal defect (VSD) treatment are to:· Monitor the defect to see if it closes or gets smaller· Treat the symptoms of congestive heart failure, if present· Close or repair the VSD if it does not close on its own
Most small VSDs close without treatment. But treatment is needed if your child's VSD:· Is large· Is causing your child to have symptoms· Is moderate and does not close on its own by the time your child is in preschool· Affects the aortic valveTypes of TreatmentThere are several types of treatment for VSD. They include:· Monitoring and observation· Medicines· Extra nutrition· Surgery or a procedure using catheters to close the VSDYour child's doctor will discuss treatment options with you and will consider your family's preferences when making treatment recommendations.
Monitoring and observation
Your baby's doctor may choose to monitor and observe the baby if your child does not have symptoms of congestive heart failure. This means regular checkups and tests to see if the defect closes on it own or gets smaller:
· Weekly for infants with large defects.· Yearly or even less in older children.· A VSD diagnosed during infancy usually closes or gets smaller. Even large defects may close.
MedicinesChildren with small VSDs and no symptoms may not need any medicines. Children and adults who have moderate or large VSDs and develop symptoms of congestive heart failure may need medicine until the defect can be closed. These medicines include:· Diuretics to treat fluid buildup· Digoxin to improve heart function and keep the heartbeat regularAntibiotics to prevent bacterial endocarditis are usually given for a limited time after surgery or a catheter procedure.
Extra nutrition
Some infants with VSDs do not grow and develop or gain weight as they should. These infants usually include those who:· Have large VSDs· Are born prematurely· Tire easily during feeding
Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk that give the baby extra nourishment. In some cases, tube feeding is needed. Food is given through a small tube that is placed through the nose into the stomach. Tube feeding can add to or take the place of bottle feeding.
Surgery
Today, most doctors recommend surgery to close a large VSD by 1 year of age. Doctors also recommend closing a VSD that does not close on its own by the time a child is in preschool. Surgery may be required earlier if:· The child fails to gain weight.· Medicines are required to control the symptoms of congestive heart failure.
The surgical procedure. The surgery to close a VSD is done under general anesthesia so that your child will be asleep and feel no pain. The surgeon makes a cut down the center of the chest to reach the VSD.· The child is placed on a heart/lung bypass machine during surgery.· The heart is stopped, and the heart/lung machine takes over for the heart, pumping red blood throughout the body.· The heart/lung machine also brings oxygen-poor blood back to the machine where it picks up oxygen.· The surgeon uses a special patch or stitches to close the VSD.· The surgeon puts the patch over the VSD and sews it into place.· Once the repair is completed, the heart is restarted.· The child is taken off the heart/lung bypass machine.· The surgeon closes the skin incision.
Within 6–8 weeks, heart tissue will grow over the patch so that it will not need to be replaced as the child grows.After the surgery. After VSD surgery, your child will spend a few days in the intensive care unit or in a regular hospital room. Most children go home about 4 days after the surgery.
While in the hospital, your child will be given medicine to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk to you about:· Limits on activity for your child while he or she recovers· Avoiding blows to the chest while the incision heals· Bathing the child· Followup appointments with your child's doctors· How to give your child medicine at home
Results.
The outcomes from VSD surgery are excellent. Your child should have little pain or discomfort.Complications from VSD surgery, such as bleeding and infection, are rare and short term. After full recovery from surgery, most children are able to participate in normal activities. Children who ate poorly before surgery often start to eat better and gain weight, and they are more active.Living With Ventricular Septal DefectChildren with small ventricular septal defects (VSDs) usually have no problems and do not need long-term treatment or followup. Also, most children and adults who have successful repair or closure of a VSD and have no other congenital heart defects can expect to lead healthy and active lives.
Medical Needs
Sometimes problems and risks remain after surgical closure. They include:· Irregular heart beat (arrhythmia). Serious and frequent arrhythmias require regular followup. The risk for arrhythmia is greater if surgery is done later in life. · Residual or remaining VSD. In some cases, the VSD does not fully close. This is usually due to a leak in the patch. These VSDs tend to be small and do not cause problems. They rarely require another operation. Once catheter-based procedures are readily available, they may be used for this condition.· Bacterial endocarditis. Antibiotic treatment is recommended for 6 months after VSD surgery. Residual VSDs usually require lifelong treatment with antibiotics. The antibiotics are given in a single dose 1 hour before a dental visit or surgical procedure. Antibiotics are used only to prevent infection and not to treat the VSD.· Enlarged left ventricle. Long-term volume overload may lead to increased stress and enlargement of the left ventricle.
Special Needs for ChildrenActivity
There should be no special restrictions on your child once he or she is fully recovered from VSD repair. Regular physical activity is usually allowed. Be sure to check with your child's doctor before allowing your child to participate in any sports.Growth and developmentYour pediatrician or family doctor checks your child for growth and development at each routine checkup. Children with moderate or large VSDs may not grow as quickly as other children. These children usually "catch up" after the VSD is closed. Special Needs for TeenagersTeenagers with VSDs—even if the VSDs have been closed—should continue to have regular checkups. Teenagers or young adults rarely need additional surgery once a VSD closes or is repaired. Your heart doctor (cardiologist) will discuss with you and your teenager the need for any additional heart surgeries. Special Needs for AdultsOver time, some adults—mostly those whose VSD was repaired later in life—may need medicine to help improve heart function or to help stop irregular heartbeats. Your cardiologist decides if you need any medicine. It is important to check with your cardiologist before changing or stopping any medicines.Just like teenagers, adults whose VSDs are closed or repaired usually do not need additional surgery. Sometimes it is necessary to have a pacemaker or defibrillator to help stop or control irregular heartbeats. The cardiologist will discuss with you the need for any additional surgeries.
Key Points·
Ventricular septal defect (VSD) is a hole in the wall of the heart that separates the lower chambers (ventricles). This defect allows blood to flow from one ventricle to the other.· In most cases of VSD, blood flows through the defect from the left ventricle to the right ventricle. This causes extra blood (volume overload) in the pulmonary artery (the blood vessel that carries oxygen-poor blood from the right side of the heart to the lungs) and in the lungs, left atrium, and left ventricle.· Usually a VSD is not found until after a baby is born. Between 4 and 6 out of every 10 VSDs close on their own, often by the time the child is of school age.· Most VSDs are so small that they don't need treatment. But some children and adults need treatment to close the VSD—especially if it is large. Today, large or moderate VSDs are usually closed in infancy or early childhood.· Most children and adults live long and productive lives after their VSD closes or is repaired.· VSDs range in size from small to large. They can occur in different parts of the septum. They also can occur alone or with other congenital heart defects.· A VSD that does not close—especially a large VSD—can lead to congestive heart failure or other serious health conditions.· Doctors do not know what causes VSD. Most cases of VSD develop by chance.· A heart murmur may be the only sign of a VSD. Some cases are not diagnosed until adulthood.· A baby with a moderate or large VSD can develop congestive heart failure. These signs usually appear by the time the baby is 2 months old.· An echocardiogram is the test used most often to diagnose VSD.· Treatments for VSD include monitoring and observation, medicine, extra nutrition, surgery, and procedures using catheters to close the VSD.· Children whose VSDs close on their own usually do not need special followup beyond an initial period. Children and adults without spontaneous or surgical closure need regular followup.

Tetralogy of Fallot an overview

Tetralogy of Fallot is a congenital heart disease that includes 4 specific defects:· Pulmonary valve stenosis (steh-NO-sis) is a narrowing of the pulmonary valve and the area below the valve. This slows the flow of blood from the right side of the heart to the lungs. The heart must pump harder to push blood through the smaller opening to the lungs where the blood picks up oxygen.· Ventricular septal defect (VSD) is a hole in the wall that separates the lower chambers (ventricles) of the heart.· Overriding aorta is a defect in the position of the large artery (aorta) that takes red (oxygen-rich blood) to the body. In a normal heart the aorta attaches to the left lower chamber of the heart (ventricle).
In tetralogy of Fallot, the aorta sits between the left and right ventricles, over the VSD. This causes mixing of red and blue (oxygen-poor) blood.· Right ventricular hypertrophy is the thickening of the right lower chamber of the heart (ventricle). Unlike other muscles in your body, when the heart thickens it does not work well. The heart has to pump harder to move blood through the narrowed pulmonary valve and the area below it.
Tetralogy of Fallot is a serious and complex heart defect that is present at birth. A baby's heart forms shortly after conception. By the end of the second month of pregnancy, the baby's heart is completely formed. It is during this time that tetralogy of Fallot can occur. It causes:· Less blood flow to the lungs· Mixing of red (oxygen-rich) and blue (oxygen-poor) blood inside the heart· Low levels of oxygen in the blood. When oxygen levels are low, the baby's skin, fingertips, or lips have a bluish tint. This is called a "blue baby" or cyanosis (SY-uh-NO-sis).Each year in the United States about 3,000 babies are born with tetralogy of Fallot. It is the congenital heart disease that causes the most cases of cyanosis.
Every infant or child with tetralogy of Fallot needs surgery, usually within the first year of life.· With advances in surgery and treatment many children born with tetralogy of Fallot have successful surgery and live to adulthood.Other Names for Tetralogy of Fallot· TOF· Fallot's
Tetralogy.
What Causes Tetralogy of Fallot?Doctors do not know the cause of most cases of tetralogy of Fallot. Heredity may play a role. In rare cases, more than one child in a family is born with a congenital heart defect like tetralogy of Fallot. Also, parents who have a congenital heart defect may be more likely than other parents to have a child with tetralogy of Fallot.Babies who have other birth defects, such as DiGeorge syndrome or Down syndrome, are also more likely to have tetralogy of Fallot.Other factors that increase the risk of a mother having a child with tetralogy of Fallot are: · Using alcohol or street drugs during pregnancy· Taking medications to control seizures during pregnancy· Having phenylketonuria (fen-el-key-toe-NEW-ree-a, or PKU)· Having viral infections such as German measles during pregnancy.Research continues to find the causes of congenital heart defects.

What Are the Signs and Symptoms of Tetralogy of Fallot?
Common Signs and SymptomsCyanosis is a common sign of tetralogy of Fallot. Cyanosis is the bluish tint of skin, lips, and nail beds caused by low levels of oxygen in the baby's blood. It usually occurs within the first few days to the first 2 weeks of life. The level of oxygen in the blood depends on:· The amount of narrowing of the pulmonary valve and surrounding area. The less narrowing of the pulmonary valve the better. This allows more blood to travel to the lungs to pick up oxygen. Increased narrowing of the pulmonary valve reduces blood flow to the lungs, lowering the amount of oxygen getting to the body.· Whether your baby has a patent ductus arteriosus (PDA) . A PDA is a persistent connection between the aorta and the pulmonary artery. This connection is called the ductus arteriosus and is normally present before birth. In most babies, the vessel closes within a few hours or days after birth. When the PDA stays open, blood mixes between the pulmonary artery and the aorta. More blood is sent back to the lungs to pick up oxygen.
A heart murmur may be the first sign found by your doctor. It is an extra or unusual sound heard during the baby's heartbeat. Most babies with tetralogy of Fallot have a heart murmur. The heart murmur may not be heard until after the baby is a few days old.Other Signs and SymptomsYour baby may have other symptoms, such as:· Rapid breathing· Cool and clammy skin· Pale skin color· Poor feeding because baby tires easily while nursing· Poor weight gain· Fussiness or irritability.Tetralogy "Spells"Some babies with tetralogy of Fallot have what is called a tetralogy "spell." A spell occurs when there is a sudden drop in the oxygen level in the blood. This causes the baby to become very blue. The baby may also:· Have a hard time breathing· Become very tired and limp· Not respond to your voice or touch· Become very fussy· Have a seizure.The cause of these spells is not known. They can happen when the baby is: · Upset · Has a low red blood cell count (anemia) · Has not gotten enough fluids. Babies who have a tetralogy spell need surgery as soon as possible. Each infant is different. Your baby's symptoms depend on the size and severity of the defects and if your baby has any other congenital heart defects.
How is Tetralogy of Fallot Diagnosed?Doctors diagnose tetralogy of Fallot by doing a physical exam of the baby and ordering tests. The signs and symptoms usually appear during the first weeks of life. Your infant's doctor may see them during a routine checkup. Some parents also notice signs of cyanosis or poor feeding and bring the baby to the doctor.If the doctor suspects that there is a problem with your baby's heart, you and your infant will be referred to a specialist who treats heart problems in children. The specialist, a pediatric cardiologist, will take a family and medical history, do a physical examination, and order several tests.Physical ExaminationDuring the physical examination, the doctor:· Listens to your baby's heart. The doctor uses a stethoscope to check for a heart murmur.· Looks for signs such as bluish color of skin and lips and rapid breathing.· Looks at general appearance. Some children with tetralogy of Fallot have a characteristic facial appearance that is associated with DiGeorge syndrome.· Listens to your baby's lungs.TestingAn echocardiogram is the test used most often to diagnose tetralogy of Fallot. This test uses sound waves to create a picture of the heart. An echocardiogram can show abnormal blood flow and problems with how the heart is formed. It is safe and painless.
During pregnancy, if your doctor suspects that your baby has a congenital heart defect, a special test called a fetal echocardiogram can be done. This test uses sound waves to create a picture of the baby's heart while still in the womb. It is usually done during the 5th month of pregnancy. This can help doctors plan treatment for your baby before he or she is born.Your baby may also have a cardiac catheterization if: · The results of the echocardiogram are not clear· The doctor suspects other heart problems.Cardiac catheterization is an invasive procedure. In this test:· A thin flexible tube is placed in the top of the baby's leg or arm and passed through an artery or vein to reach the heart.· Using x-rays, your baby's doctor can see the baby's blood vessels and heart. Your baby's doctor can also:· Measure the pressure inside the heart chambers· Determine how much red and blue blood is mixing between the 2 sides of the heart· See if the coronary arteries are normal.Other tests performed include:· Pulse oximetry .
This test uses a sensor to see how well your baby's lungs are passing oxygen to the blood and to check how much the red (oxygen-rich) blood and blue (oxygen-poor) blood are mixing. The sensor is placed on the baby's finger tip or toe (like a band aid). A small computer unit shows the amount of oxygen in the blood through the skin. This test is painless.· Chest x-ray. A chest x-ray takes a picture of your baby's heart and lungs. It can show if your child's heart is enlarged or if there is any fluid in the baby's lungs.· ECG or EKG (electrocardiogram). This test measures the rate and regularity of your baby's heartbeat.· Blood work to measure blood counts and oxygen levels.· A special blood test to see if your baby has DiGeorge syndrome.
How is Tetralogy of Fallot Treated?
All infants and children with tetralogy of Fallot must have surgery to repair the defects or help improve their symptoms.The goals of treatment are to:· Improve the baby's symptoms· Increase the level of oxygen in the baby's blood· Repair the defects.Most infants have surgery by the time they are 6 months old.Types of SurgeryCorrective SurgeryYour baby needs open-heart surgery to correct tetralogy of Fallot. The surgery includes:· Closing the hole in the inner wall of the heart between the lower chambers (VSD). A patch is used to cover the hole. This stops the mixing of blood between the chambers. The red (oxygen-rich) blood now flows out of the heart only to the body and the blue (oxygen-poor) blood goes to the lungs.· Opening and enlarging the area that blood flows through as it leaves the lower right side of the heart.
The thickened heart muscle is opened or a small amount of heart muscle is removed. This improves the flow of blue blood to the lungs so that it can pick up more oxygen.· Opening or widening the pulmonary valve (between the right ventricle and the pulmonary artery). The valve can be opened using a special instrument, but often a patch is sewn onto the heart to make the narrow area bigger. This increases blood flow out of the heart to the lungs.Your baby's heart doctor and heart surgeon decide the type of surgery needed and when it should happen based on:· The baby's health and weight· Severity of the baby's defects· Severity of the baby's symptoms.Sometimes, teenagers or adults need surgery to correct the right ventricular outflow tract.Temporary or Palliative SurgerySome babies are too weak to have open-heart surgery. They have temporary surgery to:· Reduce cyanosis (improve blood oxygen levels)· Give the baby time to grow and get stronger so the problem can be fixed later.The temporary surgery:· Is not open-heart surgery, but may be open-chest surgery· Does not repair the defect.Instead of open-heart surgery, a small opening can be made between the ribs. The procedure involves:· Placing a tube (called a shunt) between a large artery branching off the aorta and the pulmonary artery. · One end of the tube is sewn to the pulmonary artery and the other end is sewn to an artery branching off the aorta. This creates an additional pathway for blood to travel to the lungs.· This new pathway allows some of the blood in the aorta to flow through the tube into the pulmonary artery where it travels to the lungs to pick up oxygen.· The shunt is removed when your baby's defects are repaired during the corrective surgery.After surgery your baby may need medications to help keep the new blood pathway open.
Treatments
While Waiting for SurgeryYour baby may need other treatments before surgery. These treatments help the baby get stronger. They include:NutritionBabies with tetralogy of Fallot can tire while nursing or feeding. You may need to feed your baby more often. Some babies also need extra nutrition. This is given as a supplement or extra feeding. These feedings usually are formulas that give the baby extra calories. Many babies need extra vitamins or iron. Your pediatrician will decide what your baby needs. Lowering StressLowering your baby's anxiety or stress can help prevent tetralogy "spells" and save the baby's energy. You can try to predict what your baby needs to stop or lessen crying. Try picking up your infant slowly and speaking in a soothing voice to avoid startling or scaring the baby.Tetralogy "Spells"If your baby has a tetralogy spell you should:· Bring the baby's knees up tight against the baby's chest (the knee-chest position)· Attempt to calm the baby.After SurgeryAfter temporary surgery, your baby may need medications to keep the shunt open while you wait for the corrective surgery. These medicines are stopped after the shunt is removed during the corrective surgery.It is rare to need medications after the corrective surgery unless there are other problems. The scar from the surgery usually heals in about 6 weeks. Your surgeon or another member of the hospital staff will tell you when:· You can give your baby a bath· You can pick the baby up under the arms· Your baby should get his/her regular shots (immunizations).Your baby may need to take medicines to prevent a serious respiratory infection called respiratory syncytial virus (RSV). Because of the heart defect your baby may be more prone to get this infection. Your pediatrician or family doctor will decide if your baby needs any medicines to prevent RSV.
General Issues
It is important for your child to have regular medical care. This includes:· Lifetime follow up with a heart specialist· Following up with your child's pediatrician or family doctor for regular exams.Regular testing is usually recommended. These tests include:· Holter monitor· Echocardiogram· Exercise stress test.It is important for anyone with tetralogy of Fallot to have routine dental care to prevent tooth decay, which can lead to infections in the heart. Throughout your child's life, he or she should take antibiotics before any dental procedure, treatment, or cleaning. Talk to your doctor before going to the dentist. You may consider having your child wear a medic alert bracelet or necklace. This tells anyone caring for your child that the child has a congenital heart disease.Some children and adults with tetralogy of Fallot may need to limit certain types of exercise. The limits vary with each child. Discuss with your doctor:· If your child needs to restrict activity or exercise· If your child can play in organized sports, especially contact sports· The need for a note for school or coaches about limiting your child's exercise.Special Needs for ChildrenYour pediatrician or family doctor checks your child for growth and development at each routine checkup. Some children with tetralogy of Fallot do not grow and develop as fast as other children the same age. Most children "catch up" after surgery. However, some babies may need help. Your doctor may have your child tested for learning disabilities or refer you and your child for therapy with a specialist.
Pregnancy and Tetralogy of Fallot
Women with tetralogy of Fallot who want to become pregnant (or who are pregnant) need to:· Talk to their doctor about health risks during pregnancy· Talk to their doctor about medications that can be taken during pregnancy· Consult with specialists who take care of pregnant women with health conditions· Talk to their doctor about any new or worsening symptoms.
Summary·
Tetralogy of Fallot is a congenital heart disease that includes 4 specific defects:o Pulmonary valve stenosis: narrowing of the pulmonary valve and the area below the valve that slows the flow of blood from the right ventricle to the lungso VSD: a hole in the wall that separates the left and right ventricleso Overriding aorta: a defect where the aorta sits between the left and right ventricles, over the VSDo Right ventricular hypertrophy: thickening of the right ventricle. · Tetralogy of Fallot is a serious and complex type of heart defect that is present at birth. It causes:o Reduced blood flow to the lungso Mixing of red (oxygen-rich) and blue (oxygen-poor) blood inside the hearto Low levels of oxygen in the blood. · Cyanosis (bluish tint of skin, lips, and nail beds) is a common sign of tetralogy of Fallot. This happens when oxygen levels in the baby's blood are low.· Most babies with tetralogy of Fallot have a heart murmur (an extra or unusual sound heard during the baby's heartbeat).· Each year in the United States, about 3,000 babies are born with tetralogy of Fallot.· Doctors do not know what causes most cases of tetralogy of Fallot.· Babies who have other birth defects, such as DiGeorge syndrome or Down syndrome, are more likely to have tetralogy of Fallot.· Some babies have a sudden drop in the oxygen level in their blood. This is called a tetralogy "spell." When this happens your baby may:o Have a hard time breathingo Be very tired and limpo Not respond to your voice or toucho Be very fussyo Have a seizure.· If your baby has a tetralogy spell you should:o Put the baby in a knee-chest positiono Attempt to calm the baby · Doctors diagnose tetralogy of Fallot by doing a physical exam of your baby and ordering tests. · An echocardiogram is the test used most often to diagnose tetralogy of Fallot.· All infants and children with tetralogy of Fallot must have surgery to repair the defects or to help improve their symptoms. · Most infants have surgery by about 6 months of age. · With new advances in testing and treatment, most children who have tetralogy of Fallot fixed with surgery grow to adulthood and live healthy and productive lives.

Patent ductus arteriosus an overview

Patent ductus arteriosus (PDA) is a congenital heart disease. A PDA is a persistent connection between the aorta and the pulmonary artery. This connection is called the ductus arteriosus and is normally present before birth. In most babies, the vessel closes within a few hours to days after birth. In some children, this vessel fails to close.The Ductus ArteriosusThe ductus arteriosus is a blood vessel. It connects the aorta and the pulmonary artery. Before birth:· It allows blood to flow through the baby's body without passing through the lungs.· The baby gets oxygen and nutrients from the mother through the placenta and umbilical cord before birth.After birth, as a baby begins to breathe on his or her own: · Air replaces fluid in the baby's lungs.· The pulmonary artery begins to carry oxygen-poor (blue) blood to the lungs to pick up oxygen.· The aorta begins to carry oxygen-rich (red) blood to the body.· The ductus arteriosus is no longer needed, and it usually closes within a few hours to days after birth. Patent Ductus ArteriosusThe ductus arteriosus becomes a PDA if it does not close as it should. Blood can still travel through a PDA.
A PDA can occur in:· Children with otherwise normal hearts· Children born with other types of congenital heart disease. If your baby is born with a PDA but has an otherwise normal heart, the PDA may need to be treated. But if your baby is born with certain other heart defects (in addition to a PDA) that cause inadequate blood flow from the heart to the lungs or the body, the PDA may be needed to maintain blood flow and oxygen levels temporarily. Doctors sometimes use medication to keep the ductus open after birth until corrective surgery for the heart defect(s) can be performed. About 3,000 infants are born with PDA each year in the United States. It is more common in premature infants (babies born too early), but does occur in full-term infants. Premature babies with PDA are more vulnerable to its effects. PDA is twice as common in girls as in boys.Effects of PDAA PDA allows too much blood to pass through your baby's lungs. Some oxygen-rich (red) blood traveling in the aorta out to the body flows through the PDA back to the lungs. This extra blood flowing to the lungs overloads the lungs and the heart. The larger your baby's PDA is, the greater the amount of extra blood that passes through his or her lungs.
A small PDA might not cause any symptoms, while a larger PDA is likely to cause symptoms.PDA can cause congestive heart failure:· The left side of your baby's heart becomes enlarged and weakened from having to work so hard pumping the extra blood that is returning from the lungs.· The lungs become congested with fluid from the extra blood passing through them.In addition to congestive heart failure, PDA can lead to:· Pulmonary vascular disease--damage to the arteries in the lungs due to the extra blood flow. The arteries become stiff and thickened, making it harder for blood to flow through them (pulmonary vascular resistance). This change becomes irreversible over time.· Bacterial endocarditis--an infection of the lining of the heart, valves, or arteries. In the case of PDA, the shunting of blood from the aorta to the lungs irritates the lining of the left pulmonary artery where the PDA connects. This irritation of the artery lining makes it easier for bacteria in the bloodstream to collect and grow there. Fortunately, a number of treatments are available for PDA if the PDA does not close on its own. Treatment often does not require surgery, but can be through medicine or catheter-based. Once a PDA is closed, most children live healthy lives To better understand PDA, go to the section on "How the Heart Works" with an image of a normal heart and a heart with PDA.
How the Heart WorksYour child's heart is a muscle about the size of your child's fist. It works like a pump and beats about 100,000 times a day.The heart has 2 sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.The heart has 4 chambers and 4 valves, and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart, while arteries are the vessels that carry blood away from the heart to the body.
Heart Chambers
The heart has 4 chambers or "rooms"--2 on the left side of the heart and 2 on the right.· The atria (AY-tree-uh) are the 2 upper chambers that collect blood as it comes into the heart.· The ventricles (VEN-trih-kuls) are the 2 lower chambers that pump blood out of the heart to the lungs or other parts of the body. Heart ValvesFour valves control the flow of blood from the atria to the ventricles and from the ventricles into the 2 large arteries connected to the heart.The 4 valves are:· The tricuspid (tri-CUSS-pid) valve in the right side of the heart, between the right atrium and the right ventricle· The pulmonary (PULL-mun-ary) valve in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery that carries blood to the lungs· The mitral (MI-trul) valve in the left side of the heart, between the left atrium and the left ventricle· The aortic (ay-OR-tik) valve in the left side of the heart, between the left ventricle and the entrance to the aorta, the artery that carries blood to the body.Valves are like doors that open and close.
They open to allow blood to flow through to the next chamber or to one of the arteries, and then they shut to keep blood from flowing backwards. When your heart's valves open and close, they make the familiar "lub-DUB" or "lub-DUPP" sounds that your doctor can hear using a stethoscope. · The first sound is made by the tricuspid and mitral valves closing at the beginning of systole (SIS-toe-lee). Systole is when the heart contracts, or squeezes, and pumps blood out of the heart.· The second sound is made by the aortic and pulmonary valves closing at the beginning of diastole (di-AS-toe-lee).
Diastole is when the heart relaxes and fills with blood.ArteriesThe arteries are the major blood vessels connected to your heart.· The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen.· The aorta is the main artery that carries oxygen-rich blood pumped from the left side of the heart out to the body. · The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood to the heart muscle, which must have its own blood supply to function.Veins The veins are major blood vessels connected to your heart.· The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body.· The vena cava is a large vein that carries oxygen-poor blood from the body back to the heart.
What Causes Patent Ductus Arteriosus?The cause of PDA is not known. Heredity may play a role. A defect in one or more genes or a chromosome abnormality could prevent the ductus arteriosus from closing normally after birth. PDA is more common in: · Premature infants (babies born too early)· Infants with genetic abnormalities such as Down syndrome· Infants whose mother had German measles (rubella) during pregnancy.
What Are the Signs and Symptoms of Patent Ductus Arteriosus?A heart murmur may be the only sign that a baby has PDA. A heart murmur is an extra or unusual sound heard during the heartbeat.Some infants may develop symptoms of congestive heart failure. This is due to too much blood flowing through the lungs, which also overworks the heart. Symptoms may include:· Fast breathing, working hard to breathe, or shortness of breath· Poor feeding and poor weight gain· Tiring easily· Sweating with exertion (such as while feeding).
How is Patent Ductus Arteriosus Diagnosed?Your child's doctor will take a family and medical history, do a physical examination, and order several tests to diagnose your child's PDA.Infants born with a large PDA may have symptoms of congestive heart failure within the first few months of life. They are usually diagnosed at that time (even earlier if the baby is premature). Infants with a small PDA may not be diagnosed until they are older. If your child's doctor hears a heart murmur and suspects that it is due to a congenital heart defect, he or she will refer your child to a pediatric cardiologist. A pediatric cardiologist is a doctor who specializes in diagnosing and treating heart problems in children. Physical ExaminationDuring the physical examination, the doctor will: · Listen to your child's heart for a heart murmur· Look for signs of congestive heart failure. TestsSeveral painless tests are used in diagnosing PDA.Echocardiogram. The echocardiogram is the most commonly used test to confirm that there is a PDA. This test uses sound waves to create a picture of the heart. It is used to:· Show movement of blood through the heart· Show how large the PDA is· Check for other congenital heart defects· Show if the chambers of the heart are enlarged.Other TestsChest x-ray. This test takes a picture of the heart and lungs. It can show if the heart is enlarged or if there is fluid in the lungs. In older children, the x-ray is usually normal, so an echocardiogram is needed to show the PDA.Electrocardiogram (EKG or ECG).
This test can:· Measure the rate and regularity of the child's heartbeat· Show abnormal heart rhythms· Show if chambers in the heart are enlarged.
How is Patent Ductus Arteriosus Treated?The goals of treatment are to:· Close the PDA· Prevent the development of complications, including pulmonary vascular disease and bacterial endocarditis· Treat the symptoms of congestive heart failure, if present.Small PDAs often close without treatment. Treatment is needed if your child's PDA: · Is large· Is causing your child to have symptoms· Does not close on its own by the time your child is 12 years old.
Types of TreatmentTreatments for PDA include:· Medications· Extra nutrition · Catheter procedures· Surgery.Your child's doctor will discuss treatment options with you and will consider your family's preferences when making treatment decisions. MedicationsMedications are given to help the PDA close and to treat symptoms of congestive heart failure.· Indomethacin is a drug that helps close a PDA in premature infants. It does not usually work in full-term infants. It works by stimulating the PDA to constrict or tighten, closing the connection.· Medications used to control symptoms of congestive heart failure include:o Digoxin to help the heart pump the extra amount of blood o Diuretics to treat the buildup of fluid in the lungs and body. · Antibiotics are given before dental work and certain procedures or surgery to prevent endocarditis.Extra NutritionBabies who are born prematurely often need extra nutrition (more food and calories) to help them grow. Babies with a large PDA may also need extra food, even if they were not born prematurely. Your doctor may recommend giving your baby high-calorie formula or breast milk. Tube feedings are another way to give your baby extra food. Food is given through a small tube through the nose into the stomach. The tube feedings can add to or take the place of bottle feedings.Catheter ProceduresCatheters are thin, flexible tubes used in cardiac catheterization. Catheter procedures are often used to close PDAs in infants or children who are large enough to have the procedure. Your child's doctor may refer to the procedure as "transcatheter device closure." The procedure is sometimes done on a small PDA to prevent the risk of bacterial endocarditis.
Closure of a PDA using a catheter is often done on an outpatient basis. You will most likely be able to take your child home the same day the procedure is done. During the procedure:· Your child will be sedated or given general anesthesia, so he or she will sleep through the procedure and not feel any discomfort.· The doctor will place a catheter in a large blood vessel in the groin and guide it to your child's heart.· A small metal coil or other blocking device will be placed in the ductus arteriosus to stop blood flow through the vessel.Catheter procedures:· Do not require the child's chest to be opened· Let the child recover quickly.Complications of catheter procedures are rare and short term. They can include bleeding, infection, and movement of the blocking device from where it was placed.SurgerySurgery may be done when:· A premature or full-term infant develops symptoms and is too small to have a catheter procedure· Surgery is planned for a related congenital heart defect. ·
The PDA does not close by the catheter procedureSurgery can be done after 6 months of age in infants who do not show symptoms. Doctors sometime perform surgery on small PDAs to prevent the risk of bacterial endocarditis. The operation is done under general anesthesia so that your child will sleep and not feel any pain. The surgeon will:· Make a small cut between your child's ribs to reach the PDA· Close the PDA with stitches. Complications of the surgery are rare and short term. They can include hoarseness, a paralyzed diaphragm, infection, bleeding, or fluid buildup around the lungs.After SurgeryAfter surgery, your child will spend a few days in the intensive care unit or in a regular hospital room. Most children go home 2 days after surgery. While in the hospital, your child will be given medications to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk to you about:· Limits on activity for your child while he or she recovers· Followup appointments with your child's doctors· How to give your child medications at home.Long-term complications from treatment are rare. They can include narrowing of the aorta, incomplete closure of the ductus, or reopening of the ductus.
Living with Patent Ductus Arteriosus
Most children are healthy and live normal lives after treatment for a PDA. · If your child was not born prematurely, he or she is expected to have normal activity levels, appetite, and growth after PDA treatment, in the absence of other congenital defects. · If your child was born prematurely, the outlook after PDA treatment depends on:o How early he or she was borno Whether he or she has other illnesses or conditions, such as other congenital heart defects.Recovering from Surgery for PDA
When your child goes home after surgery, you can expect that:· Your child will feel fairly comfortable, although he or she may have some pain temporarily.· Your child should begin to eat better and gain weight quickly. · Within a few weeks, your child should be fully recovered and able to participate in normal activities. Medical Care Needs Children with a PDA have an increased risk for bacterial endocarditis. To prevent this infection:· Your doctor will give your child antibiotics before dental work and certain procedures.· It is important to take good care of your child's teeth. He or she should have regular dental care to prevent decay and help reduce the chance of infection.· Once the PDA is closed, your child will not need antibiotics before dental work or surgical procedures.
Summary·
Patent ductus arteriosus (PDA) is a persistent connection between the aorta and the pulmonary artery. This connection is called the ductus arteriosus and is normally present before birth. In most babies, the vessel closes within a few hours to days after birth. The ductus arteriosus becomes a PDA if it does not close as it should.· PDA is more common in premature infants, but it can happen in full-term infants. It is twice as common in girls as in boys. · The cause of PDA is not known. Heredity may play a role. PDA can occur in children with otherwise normal hearts or in children born with other heart defects. · With a PDA, too much blood passes through the lungs, overloading the lungs and heart. The heart must work harder than usual to pump the extra blood. This can cause congestive heart failure, in which the heart enlarges and weakens and fluid (congestion) builds up in the lungs.· PDA can lead to poor growth, damage to the arteries in the lungs due to the extra blood flow, and bacterial endocarditis. · A heart murmur may be the only sign that a baby or child has a PDA. · Some infants may develop symptoms of congestive heart failure, such as fast breathing, poor feeding and poor weight gain, tiring easily, and sweating.· Children with a large PDA are usually diagnosed within the first few months of life. Children with a small PDA may not be diagnosed until they are older. · The echocardiogram is the most commonly used test to confirm that there is a PDA. · A small PDA sometimes closes without treatment. But if a PDA is large or does not close on its own by the time the child is 12 years old, it should be repaired. · Treatments for PDA include medication, extra food, procedures using catheters, and surgery.· After closure of the PDA, most children grow normally and live healthy lives.

Causes of blood pressure

What Causes High Blood Pressure? In many people with high blood pressure, a single specific cause is not known. This is called essential or primary high blood pressure. Research is continuing to find causes. In some people, high blood pressure is the result of another medical problem or medication. When the cause is known, this is called secondary high blood pressure. Who Gets High Blood Pressure? About 65 million American adults--nearly 1 in 3--have high blood pressure. In the U.S., high blood pressure occurs more often in African Americans. Compared to other groups, blacks: Tend to get high blood pressure earlier in life Usually have more severe high blood pressures.
Have a higher death rate from stroke, heart disease, and kidney failure. Many people get high blood pressure as they get older. Over half of all Americans age 60 and older have high blood pressure. This is not a part of healthy aging! There are things you can do to help keep your blood pressure normal, such as eating a healthy diet and getting more exercise. Your chances of getting high blood pressure are also higher if you: Are overweight Are a man over the age of 45 Are a woman over the age of 55 Have a family history of high blood pressure Have a "prehypertension (120-139/80-89)"
Other things that can raise blood pressure include: Eating too much salt Drinking too much alcohol Not eating enough potassium Not exercising Taking certain medicines Stress that is long-lasting Signs and Symptoms of High Blood Pressure High blood pressure is called "the silent killer" because you can have it for years without knowing it. The only way to find out if you have high blood pressure is to have your blood pressure measured. Using a blood pressure cuff and stethoscope or electronic sensor, your doctor or nurse can take your blood pressure and tell you if it is high. Even though high blood pressure usually has no signs or symptoms, it is dangerous if it continues over time. It is important to find out if you have high blood pressure and, if so, to keep it under control.
How Do You Know if You Have High Blood Pressure? Only your doctor can tell you if you have high blood pressure. Most doctors will check your blood pressure several times on different days before deciding that you have high blood pressure. A diagnosis of high blood pressure is given if repeated readings are 140/90 or higher or 130/80 or higher if you have diabetes or chronic kidney disease. Having your blood pressure tested is quick and easy. Your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff, also called a sphygmomanometer(sfig-mo-ma-NOM-e-ter). Blood pressure readings are usually taken when you are sitting or lying down and relaxed.
Below are things you can do before going to get your blood pressure taken: Do not drink coffee or smoke cigarettes 30 minutes before having your blood pressure taken. Wear short sleeves. Go to the bathroom before the reading. Having a full bladder can change your blood pressure reading. Sit for 5 minutes before the test. You should ask the doctor or nurse to tell you the blood pressure reading in numbers. You also can check your blood pressure at home with a home blood pressure measurement device, or monitor.
It is important that you understand how to use the monitor properly. Your doctor, nurse, or pharmacist can help you check the monitor and teach you how to use it correctly. You also may ask for their help in choosing the right blood pressure monitor for you. Blood pressure monitors can be bought at discount chain stores and pharmacies. Below are additional things to do when taking your blood pressure at home: Sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart. Take two readings, at least 2 minutes apart, and average the results. Some people's blood pressure is high only when they visit the doctor's office.
This condition is called "white coat" hypertension. If your doctor suspects this, you may be asked to check and record your blood pressure at home with a home monitor. Another way to check blood pressure away from the doctor's office is by using an ambulatory blood pressure monitor. This device is worn for 24 hours and can take blood pressure every 30 minutes. How Can I Prevent High Blood Pressure? You can take steps to prevent high blood pressure. These steps include: Keeping a healthy weight Being physically active Following a healthy eating plan that emphasizes fruits, vegetables, and low-fat dairy foods. Also see the DASH diet Choosing and preparing foods with less salt and sodium Drinking alcohol in moderation if you drink.
How is High Blood Pressure Treated? Usually, the goal is to keep your blood pressure below 140/90 (130/80 if you have diabetes or chronic kidney disease). Ask your doctor what your blood pressure goal should be. Some people can prevent or control high blood pressure by changing to healthier habits, such as: Eating healthy foods that include fruits, vegetables, and low-fat dairy products Cutting down on salt and sodium in the diet Losing excess weight and staying at a healthy weight Staying physically active (for example, walking 30 minutes a day) Limiting alcohol intake.
Sometimes blood pressure stays too high even when a person makes these kinds of healthy changes. In that case, it is necessary to add medicine to help lower blood pressure. Medicines will control your blood pressure but they cannot cure it. You will need to take high blood pressure medicine for a long time. Blood pressure medicines work in different ways to lower blood pressure. Often, two or more drugs work better than one. Some drugs lower blood pressure by removing extra fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by relaxing and widening blood vessels. Below are the types of medicines used to treat high blood pressure: Diuretics are sometimes called "water pills." They work by helping your kidneys flush excess water and salt from your body.
This reduces the amount of fluid in your blood, and your blood pressure goes down. There are different types of diuretics. They are often used along with other high blood pressure medicines and may be combined with another medicine in one pill. Beta blockers help your heart beat slower and with less force. Your heart pumps less blood through the blood vessels, and your blood pressure goes down. Angiotensin converting enzyme (ACE) inhibitors keep your body from making a hormone called angiotensin II, which normally causes blood vessels to narrow. ACE inhibitors prevents this narrowing so your blood pressure goes down. Angiotensin II Receptor Blockers (ARBS) are newer blood pressure drugs that protect your blood vessels from angiotensin II. As a result, the blood vessels relax and become wider, and your blood pressure goes down. Calcium channel blockers (CCBs) keep calcium from entering the muscle cells of your heart and blood vessels.
This causes blood vessels to relax, and your blood pressure goes down. Alpha blockers reduce nerve impulses that tighten blood vessels, allowing blood to pass more easily and causing blood pressure to go down. Alpha-beta blockers reduce nerve impulses to blood vessels the same way alpha blockers do, but they also slow the heartbeat, as beta blockers do. As a result, blood pressure goes down. Nervous system inhibitors relax blood vessels by controlling nerve impulses from the brain. This causes blood vessels to become wider and blood pressure to go down. Vasodilators open blood vessels by directly relaxing the muscle in the vessel walls, causing blood pressure to go down. It is important that you take your blood pressure medication the same time each day.
The NHLBI Web site, Your Guide to Lowering Your High Blood Pressure, offers tips to help you remember to take your blood pressure medications. Living with High Blood Pressure If you have high blood pressure, it is important that you: Keep track of your blood pressure. Learn to take your own blood pressure at home or have it regularly checked by a health care professional. Write it down each time (with date). Talk to your health care provider about the names and dosages of your blood pressure medicines and how to take them. If you think you're having other problems (side effects) from taking your medicine, talk to your doctor. Another medicine may be better for you, or the problem may not be related to the medicine. Refill your blood pressure medicines before they run out. Take your blood pressure medicines exactly as directed. Keep your followup appointments with your health care provider.
Choose healthier habits--for example, eat a heart healthy diet, exercise regularly, and don't smoke. Ask your doctor or health care provider questions about your treatment and what you need to do to take care of yourself and lower your high blood pressure. Remember, high blood pressure has no symptoms. If you have it, you cannot tell by the way you feel when your blood pressure level is high. Women and High Blood Pressure In some women, blood pressure can increase if they use birth control pills, become pregnant, or take hormone therapy during menopause.
Pregnancy
Many pregnant women with high blood pressure have healthy babies. However, high blood pressure can be dangerous for both the mother and the baby. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. If you are thinking about having a baby and you have high blood pressure, talk first to your doctor or nurse. You can take steps to control your blood pressure before and during pregnancy. Regular prenatal care (health care during pregnancy) is very important for your and your baby's health. Before becoming pregnant: Be sure your blood pressure is under control. Making changes such as limiting the salt and sodium in your diet, exercising regularly, and losing weight if you are overweight can be helpful. Discuss with your doctor how high blood pressure might affect you and your baby during pregnancy, and what you can do to prevent or lessen problems.
If you take medicines for your blood pressure, ask your doctor what you should do about taking them during pregnancy. Women who take ACE inhibitors should talk to their doctor before they become pregnant. While you are pregnant: Be sure to get regular prenatal health care. Don't miss any appointments. Don't drink alcohol or smoke. Talk to your doctor about any over-the-counter or prescribed medicines you are taking or are thinking about taking. Some women develop high blood pressure for the first time in the middle of their pregnancy. In the most serious cases, the mother develops a condition called preeclampsia or "toxemia of pregnancy." This condition can threaten the lives of both the mother and the unborn child. More information about high blood pressure and pregnancy is available at the NHLBI Web site, "Your Guide to Lowering Your High Blood Pressure."Even though high blood pressure during pregnancy can be serious, most women with high blood pressure and those who develop preeclampsia have successful pregnancies.
Getting early and regular prenatal care is the most important thing you can do for you and your baby. Oral Contraceptives (Birth Control Pills) Women taking birth control pills usually have a small increase in both systolic and diastolic blood pressure. If you have high blood pressure and are using birth control pills, get your blood pressure checked regularly and talk to your doctor about a possible rise in blood pressure and what you can do about it. If you have high blood pressure, are age 35 or older, and also smoke, you should not take birth control pills unless you quit smoking. Women age 35 and older who smoke and use birth control pills are more likely to develop heart disease or have a stroke. High blood pressure also raises your chances of stroke and heart disease.
If you are age 35 or older, are healthy, do not smoke, and your high blood pressure is controlled, it may be safe for you to use birth control pills. Ask your doctor if birth control pills are safe for you. Hormone Therapy (HT) for Menopause A recent study indicated that blood pressure does not increase significantly with HT in most women with and without high blood pressure. However, a few women may have a rise in blood pressure due to estrogen therapy. If you start taking HT, you should have your blood pressure checked regularly. Your doctor can help answer your questions. Older Adults and High Blood Pressure.
A common form of high blood pressure in older adults is isolated systolic hypertension (ISH). ISH is high blood pressure, but only the top (systolic) number is high (140 or higher). ISH can be as harmful as high blood pressure in which both numbers are high. ISH is the most common form of high blood pressure for older Americans. About two out of three people over age 60 with high blood pressure have ISH. You may have ISH and feel fine. As with other types of high blood pressure, ISH often causes no symptoms. To find out if you have ISH--or any type of high blood pressure--get your blood pressure checked. If not treated, ISH can cause damage to your arteries and to body organs. ISH is treated the same way as high blood pressure in which both systolic and diastolic pressures are high: by making changes in your health habits and with blood pressure medicines, if needed.
What is normal blood pressure? A blood pressure reading below 120/80 is considered normal. In general, lower is better. If my blood pressure is in the "prehypertension" category, what should I do? You should talk to your doctor or other health care provider about your blood pressure and what you can do to lower it. You may be able to lower your blood pressure by making changes in your diet, losing weight, exercising more often, or drinking less alcohol. You have "prehypertension" blood pressure when your systolic pressure is usually 120 to 139, or your diastolic pressure is usually 80 to 89. Can drinking alcohol raise blood pressure? Drinking too much alcohol can raise blood pressure. If you drink alcohol, limit your drinks to just two a day for men and one a day for women. One drink is 12 ounces of beer, 5 ounces of wine, or 1‡ ounces of 80-proof whiskey.
Do children ever get high blood pressure? Yes. However, high blood pressure is not as common in children as it is in adults. High blood pressure in younger children is often related to another health problem. Children with a family history of high blood pressure or who are overweight are more likely to develop high blood pressure. Is salt and sodium the same thing? The chemical name for salt is sodium chloride, so salt is partly sodium. Salt and other forms of sodium are found in many foods. Most Americans eat too much salt and sodium, and for many, that means higher blood pressure. Eating less salt and sodium in your diet can help lower your high blood pressure. Many snack foods, soups, lunchmeats, and other foods have a lot of sodium in them. Look at food labels to find products that are lower in sodium. The NHLBI Web site, Your Guide to Lowering High Blood Pressure, has tips on how to cut down the salt and sodium in your diet.
How do I know if I'm overweight? Body mass index (BMI) is an easy way to find out if you are overweight or obese. BMI is calculated by relating how much you weigh to how tall you are. It gives an approximation of total body fat. As BMI goes up, so does your chance of getting high blood pressure, heart disease, and other diseases related to being overweight. Overweight is defined as a BMI of 25 to 29.9; obesity is defined as a BMI equal to or more than 30. Use the NHLBI online BMI Calculator to find out if you are overweightSummary You have high blood pressure if your top (systolic) blood pressure number is usually 140 or higher, OR your bottom (diastolic) number is usually 90 or higher. Both numbers are important. Exception: If you have diabetes or chronic kidney disease, you have high blood pressure if your top number is usually 130 or higher, OR your bottom number is usually 80 or higher. High blood pressure usually has no signs or symptoms. Uncontrolled high blood pressure is dangerous and can lead to stroke, heart failure, heart attack, kidney failure, and blindness. Blacks are more likely to have high blood pressure than whites. Over half of adults age 60 and over have high blood pressure. The most common form of high blood pressure in older adults is when only the (systolic) blood pressure number is usually 140 or higher. (You have high blood pressure when one or both numbers are high.) Having your blood pressure checked is quick and easy.
It is important to keep track of your blood pressure and keep it under control. You can help prevent high blood pressure by choosing a healthy way of life. You can control your high blood pressure through healthy habits and taking medicines, if needed.

High Blood Cholesterol an overview

High Blood Cholesterol
Too much cholesterol in the blood, or high blood cholesterol, can be serious. People with high blood cholesterol have a greater chance of getting heart disease. High blood cholesterol on its own does not cause symptoms, so many people are unaware that their cholesterol level is too high. High blood cholesterol, it is important to know more about cholesterol. Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Your body needs some cholesterol to work the right way. Your body makes all the cholesterol it needs. Cholesterol is also found in some of the foods you eat. Your body uses cholesterol to make hormones, vitamin D, and substances that help you digest foods. Blood is watery, and cholesterol is fatty. Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is carried in small packages called lipoproteins. The small packages are made of fat (lipid) on the inside and proteins on the outside.
Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both: Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol. High LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level in your blood, the greater chance you have of getting heart disease. High-density lipoprotein (HDL) cholesterol is sometimes called good cholesterol. HDL carries cholesterol from other parts of your body back to your liver. The liver removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chance of getting heart disease.What Is High Blood Cholesterol? Too much cholesterol in your blood can build up on the walls of your arteries (blood vessels that carry blood from the heart to other parts of the body). This buildup of cholesterol is called plaque.
Over time, plaque can cause narrowing of the arteries. This is called atherosclerosis , or hardening of the arteries. Special arteries, called coronary arteries, bring blood to the heart. Narrowing of your coronary arteries due to plaque can stop or slow down the flow of blood to your heart. When the arteries narrow, the amount of oxygen-rich blood is decreased. This is called coronary artery disease (CAD). Large plaque areas can lead to chest pain called angina. Angina happens when the heart does not receive enough oxygen-rich blood. Angina is a common symptom of CAD. Some plaques have a thin covering and burst (rupture), releasing fat and cholesterol into the bloodstream. The release of fat and cholesterol may cause your blood to clot. A clot can block the flow of blood.
This blockage can cause angina or a heart attack. Lowering your cholesterol level decreases your chance for having a plaque burst and cause a heart attack. Lowering cholesterol may also slow down, reduce, or even stop plaque from building up. Plaque and resulting health problems can also occur in arteries elsewhere in the body. Other Names for High Blood Cholesterol Hypercholesterolemia, and Hyperlipidemia.
What Causes High Blood Cholesterol? A variety of things can affect the cholesterol levels in your blood. Some of these things you can control and others you cannot. You can control:What you eat. Certain foods have types of fat that raise your cholesterol level. Saturated fat raises your low-density lipoprotein (LDL) cholesterol level more than anything else in your diet. Trans fatty acids (trans fats) are made when vegetable oil is hydrogenated to harden it. Trans fatty acids also raise cholesterol levels. Cholesterol is found in foods that come from animal sources, for example, egg yolks, meat, and cheese. Your weight. Being overweight tends to increase your LDL level, lower your high-density lipoprotein (HDL) level, and increase your total cholesterol level. Your activity. Lack of regular exercise can lead to weight gain, which could raise your LDL cholesterol level. Regular exercise can help you lose weight and lower your LDL level. It can also help you raise your HDL level. You cannot control: Heredity.
High blood cholesterol can run in families. An inherited genetic condition (familial hypercholesterolemia) results in very high LDL cholesterol levels. It begins at birth, and may result in a heart attack at an early age. Age and sex. Starting at puberty, men have lower levels of HDL than women. As women and men get older, their LDL cholesterol levels rise. Younger women have lower LDL cholesterol levels than men, but after age 55, women have higher levels than men.
Signs and Symptoms of High Blood Cholesterol? There are usually no signs or symptoms of high blood cholesterol. Many people don't know that their cholesterol level is too high. Everyone age 20 and older should have their cholesterol levels checked at least once every 5 years. You and your doctor can discuss how often you should be tested. How Is High Blood Cholesterol Diagnosed? High blood cholesterol is diagnosed by checking levels of cholesterol in your blood. It is best to have a blood test called a lipoprotein profile to measure your cholesterol levels. Most people will need to not eat or drink anything (fast) for 9 to 12 hours before taking the test. The lipoprotein profile will give information about your: Total cholesterolLow-density lipoprotein (LDL) bad cholesterol: the main source of cholesterol buildup and blockage in the arteries High-density lipoprotein (HDL) good cholesterol: the good cholesterol that helps keep cholesterol from building up in arteries.
Triglycerides: another form of fat in your blood If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. Testing for total and HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. See how your cholesterol numbers.
Triglycerides can also raise your risk for heart disease. If you have levels that are borderline high (150–199 mg/dL) or high (200 mg/dL or more), you may need treatment. Things that can increase triglyceride levels include: >Overweight >Physical inactivity >Cigarette smoking >Excessive alcohol use >Very high carbohydrate diet >Certain diseases and drugs >Genetic disorders
How Is High Blood Cholesterol Treated? The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL) level enough to reduce your risk of having a heart attack or diseases caused by hardening of the arteries. In general, the higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. (A risk factor is a condition that increases your chance of getting a disease.) Some people are at high risk for heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes or a combination of risk factors for heart disease.
Follow the steps below to find out your risk for getting heart disease. Check the list to see how many of the risk factors you have. These are the risk factors that affect your LDL goal: >Cigarette smoking > High blood pressure (140/90 mg/dL or higher), or if you are on blood pressure medicine > Low high-density lipoprotein (HDL) cholesterol (less than 40 mg/dL)> Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65) > Age (men 45 years or older; women 55 years or older) If you have two or more of the risk factors in the list above, use the NHLBI 10-Year Risk Calculator to find your risk score. Risk scores refer to the chance of having a heart attack in the next 10 years, given as a percentage. Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack
After following the above steps, you should have an idea about your risk for getting heart disease or having a heart attack. The higher your risk is, the lower your LDL goal will be. There are two main ways to lower your cholesterol:· Therapeutic Lifestyle Changes (TLC)—includes a cholesterol-lowering diet (called the TLC Diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.· Drug Treatment—if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL. The higher your risk for heart disease, the lower your LDL goal will be. Your doctor will set your LDL goal. Using the following guide, you and your doctor can develop a possible plan for treating your high blood cholesterol. Category I, highest risk, your LDL goal is less than 100 mg/dL.
Lowering Cholesterol With TLC TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main parts of TLC are:· The TLC Diet, which recommends: o Limiting the amount of saturated fat and cholesterol you eat. > Eating only enough calories to achieve or maintain a healthy weight. > Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber. > Adding cholesterol-lowering food, such as margarines that contain plant sterol or stanol esters that lower cholesterol for some people. > Weight management: > Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women). >Physical activity: > Regular physical activity is recommended for everyone. It can help raise HDL levels and lower LDL levels, and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
Cholesterol-Lowering Medicines Along with suggesting that you change the way you eat and exercise regularly, your doctor may prescribe medicines to help lower your cholesterol. Even if you begin drug treatment, you will need to continue TLC. Drug treatment controls but does not "cure" high blood cholesterol. Therefore, you must continue taking your medicine to keep your cholesterol level in the recommended range.The five major types of cholesterol-lowering medicines are: >Statins > Very effective in lowering LDL (bad) cholesterol levels > Safe for most people > Rare side effects to watch for are liver and muscle problems >Bile Acid Sequestrants (seh-KWES-trants) > Help lower LDL cholesterol levels > Sometimes prescribed with statins > Not usually prescribed as the only medicine to lower cholesterol > Nicotinic (Nick-o-TIN-ick) Acid > Lowers LDL cholesterol and triglycerides, and raises HDL (good) cholesterol > Should only be used under a doctor's supervision >Fibrates > Lower triglycerides > May increase HDL (good) cholesterol levels > When used with a statin, may increase the chance of muscle problems > Ezetimibe > Lowers LDL cholesterol > May be used with statins or alone > Acts within the intestine to block cholesterol absorption.
When you are under treatment, you will be checked regularly to:· Make sure your cholesterol level is controlled >Check for other health problems You may take medicines for other health problems. It is important that you take ALL medicines as your doctor prescribes. The combination of medicines may lower your risk for heart disease or heart attack. When trying to lower your cholesterol or keep it low, it is important to remember to follow your treatments for other conditions you may have, such as high blood pressure. Get help with quitting smoking and losing weight if they are risk factors for you. If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.
Key Points in Cholesterol is a fat-like substance that is made in your body. Cholesterol is also in some foods that you eat. Your body needs some cholesterol to work the right way. Your body makes all the cholesterol it needs. > Too much cholesterol in the blood is called high blood cholesterol or hypercholesterolemia. > High blood cholesterol increases the chance of having a heart attack or some other symptom of heart disease, like chest pain (angina). > Lowering cholesterol is important for everyone—young, middle-aged, and older adults, and both men and women. > Eating too much saturated fat and cholesterol raises the level of cholesterol in your blood. > Too much cholesterol in your blood can build up in the walls of arteries. This is called plaque. > There are no signs or symptoms of high blood cholesterol. Many people don't know that their cholesterol level is too high. > High blood cholesterol is diagnosed by checking cholesterol levels in your blood. >A blood test called a lipoprotein profile measures the cholesterol levels in your blood and is the recommended test. >It is important that everyone age 20 and older get their cholesterol checked at least once every 5 years. > Many people are able to lower their cholesterol levels by eating a low saturated fat and low cholesterol diet, exercising, and losing weight if needed. > Some people will need to take medicines prescribed by their doctor to lower their cholesterol in addition to eating a low saturated fat and low cholesterol diet, exercising, and losing weight if needed.

Heart failure an overview

Heart Failure
Heart failure is a condition where the heart cannot pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way that it should. The heart cannot fill with enough blood or pump with enough force or both. Go to the section on How the Heart Works for details. Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left side, the right side, or both sides of the heart. Most cases involve the left side where the heart cannot pump enough oxygen-rich blood to the rest of the body. With right-sided failure, the heart cannot effectively pump blood to the lungs where the blood picks up oxygen. The weakening of the pumping ability of the heart causes: Blood and fluid to "back up" into the lungs The buildup of fluid in the feet, ankles, and legs Tiredness and shortness of breath
Heart failure is a serious condition. About 5 million people in the U. S. have heart failure and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year. How the Heart Works Your heart is a muscle that is about the size of your fist. It works like a pump and it is always pumping blood throughout the body. The average heart beats 100,000 times a day. The heart has a left and right side, separated by a wall of muscle called the septum. Blood vessels called veins bring blood to the heart, while other blood vessels called arteries carry blood away from the heart. Here is what happens: Blood from your body enters the right side of your heart through veins. The blood is dark because it has given all its oxygen to your body. The right side of the heart pumps the blood through the pulmonary artery to your lungs to pick up oxygen. After traveling through the lungs, the blood turns bright red because it is rich in oxygen. The oxygen-rich blood then returns to the left side of your heart and is pumped out to your body through the large artery called the aorta. Heart chambers. The heart has four chambers or "rooms"-two on each side. The upper chambers are called atria and the lower chambers are called ventricles. The atria collect blood as it comes into the heart. As your heart beats, blood is pumped from the atria through valves down into the ventricles. Then, blood is pumped from the ventricles out of the heart through different valves. Heart valves. The heart has four valves that open and close, like doors, to control the flow of blood through the heart in one direction. The four valves are: Tricuspid valve, between the right atrium and the right ventricle Pulmonary valve, between the right ventricle and the entrance to the pulmonary artery Mitral valve, between the left atrium and the left ventricle Aortic valve, between the left ventricle and the entrance to the aorta. Each time your heart beats, it makes the familiar "lub-DUB" sounds. These are the sounds of valves in the heart closing. Arteries. The arteries attached to the heart are: The aorta, the main artery that carries oxygen-rich blood from the left side of the heart to the body The pulmonary artery, which carries blood from the right side of the heart to the lungs to pick up oxygen. The heart also has arteries on its outside surface called the coronary arteries. These important arteries supply the heart muscle itself with the oxygen-rich blood it needs to work normally.
Other Names for Heart Failure
Congestive heart failure or CHF (when the poor pumping function results in symptoms) Left-sided heart failure, Right-sided heart failure, Systolic heart failure, and Diastolic heart failure.
What Causes Heart Failure? Heart failure is caused by other diseases or conditions that damage or overwork the heart muscle. Over time the heart muscle weakens and is not able to pump blood as well as it should. The leading causes of heart failure are: Coronary artery disease (CAD) High blood pressure Diabetes. CAD, including angina and heart attack, is the most common underlying cause of heart failure. Persons who have a heart attack are at high risk of developing heart failure. Most people with heart failure also have high blood pressure and about 1 in 3 has diabetes. Other Causes of Heart Failure Other heart diseases and conditions that can lead to heart failure are: Cardiomyopathy (a disease of the heart muscle) Diseases of the heart valves Abnormal heartbeats or arrhythmias Congenital heart disease (a heart defect or problem you are born with).
Other conditions that may injure the heart muscle and lead to heart failure include: Treatments for cancer such as radiation and certain chemotherapy drugs Thyroid disorders-having either too much or too little thyroid hormone in the body Alcohol abuse HIV/AIDS Cocaine and other illegal drugs use. Who Gets Heart Failure? Heart failure can happen to anyone, but it is more common in: People 65 years of age and older African Americans. Heart failure is very common in persons 65 years of age and older. It is the number one reason for a hospital visit in this group. Blacks are more likely to have heart failure and suffer more severely from it. Blacks are more likely to: Develop symptoms at an earlier age.
Have their heart failure get worse faster ..Have more hospital visits ..Die from heart failure. Men also have a higher rate of heart failure than women. But in actual numbers, more women have heart failure because many more women live into their 70s and 80s when heart failure is common. Children with congenital heart disease can also get heart failure. Congenital heart disease happens when the heart, heart valves, and/or blood vessels near the heart do not develop correctly in babies when they are in the womb. This can weaken the heart muscle and lead to heart failure. Children do not have the same symptoms or get the same treatment for heart failure as adults and will not be discussed here.
What Are the Signs and Symptoms of Heart Failure? The most common signs and symptom are: Shortness of breath or difficulty breathing Feeling tired Swelling in the ankles, feet, legs, and sometimes the abdomen. Shortness of breath and feeling tired are caused by the buildup of fluid in the lungs and around the lung (pleural effusions). When symptoms start, you may feel tired and short of breath after routine physical exertion. Climbing two flights of stairs makes you feel winded. As heart failure progresses, the symptoms get worse. You may begin to feel tired and short of breath after simple activities, like getting dressed or walking across the room. Some people have shortness of breath when lying flat. Fluid buildup in the lungs can also cause a cough. The cough is worse at night and when you are lying down. Excessive fluid in the lungs can cause a life-threatening condition called acute pulmonary edema.
This condition requires emergency treatment. The swelling is from the buildup of fluid in your body (edema). Other signs of fluid buildup are: Weight gain Frequent urination. Limitation on Physical Activity Doctors also classify your symptoms based on how much they limit your daily activity. By class of symptom, your doctor means: Class 1: No limits--ordinary physical activity does not cause undue tiredness or shortness of breath. Class 2: Slight or mild limits--comfortable at rest, but ordinary physical activity results in tiredness or shortness of breath. Class 3: Marked or noticeable limits--comfortable at rest, but less than ordinary physical activity causes tiredness or shortness of breath. Class 4: Severe limits--unable to carry on any physical activity without discomfort. Symptoms are also present at rest. If any physical activity is undertaken, discomfort increases. How is Heart Failure Diagnosed? There is not a specific test to determine if you have heart failure.
A clinical diagnosis of heart failure is usually made when symptoms appear. The symptoms--shortness of breath, tiredness, and fluid buildup--are common in other conditions. Your doctor will determine if you have heart failure by doing a detailed medical history, a physical examination, and several tests. The purpose of these is to: Identify the presence of diseases and conditions that can cause heart failure Rule out other causes of your symptoms Determine the amount of damage to and the pumping capability of your heart. Medical and Family History Your doctor will ask if you or others in your family have or have had any of the diseases and conditions that can cause heart failure. Your doctor will also ask about your symptoms. This includes the types of symptoms, when they occur, how long you have had them, and their severity. The answers will help your doctor determine the limits on your ability to perform daily activities.
Physical Examination Your doctor will: Listen to your heart for abnormal sounds Listen to your lungs for the buildup of fluid Look for swelling in your ankles, feet, legs, and abdomen Look for swelling in the veins in the neck. Tests If you have signs and symptoms of heart failure, your doctor may order the following tests: EKG or ECG (electrocardiogram). This test is used to measure the rate and regularity of your heartbeat. It may show if you have had a heart attack or have thickening of the walls of the pumping chambers of the heart (ventricles). Chest x-ray. A chest x-ray takes a picture of your heart and lungs. It can show if your heart is enlarged, if you have fluid in your lungs, or if you have lung disease. BNP blood test. This new test checks the level of a hormone called BNP (B-type natriuretic peptide) that rises in heart failure. If your doctor suspects heart failure after the history, physical exam, and initial tests (such as tests of kidney function), he/she may refer you to a cardiologist.
A cardiologist is a doctor who specializes in the diagnosis and treatment of heart disease. The cardiologist will do a physical exam and order additional tests. An echocardiogram is the most useful test for diagnosing heart failure. This test uses sound waves to create a picture of the heart. It shows how well the heart is filling with blood and pumping it to the rest of the body. It can also show the areas of your heart muscle that are not contracting normally. Your doctor uses this test to determine the areas of your heart that are damaged and causing it to not work properly. This is very important because more than one area of the heart can be damaged and contribute to heart failure. The cardiologist may order any of the following tests. These tests can help identify the cause of your heart failure: Holter monitor (ambulatory electrocardiography, EKG/ECG). For this test, a small box called a Holter monitor is attached to patches (electrodes) that are placed on your chest. The box may be carried in a pouch around your neck or attached to your belt. The Holter monitor is usually worn for 24 hours and provides a continuous recording of heart rhythm during normal activity.
Cardiac blood pool scan (radionuclide ventriculography or nuclear scan). This test uses a radioactive imaging agent that is injected into a vein to outline chambers of the heart and blood vessels leading to the heart. This will show how well the heart is pumping blood to the rest of the body. Cardiac catheterization. A thin flexible tube is passed through an artery at the top of the leg (groin) or in the arm to reach the coronary arteries. This allows your doctor to study the inside of your arteries to see if there is any blockage. Your doctor can check the pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x-ray. Coronary angiography.
This test is usually performed along with cardiac catheterization. A dye that can be seen by x-ray is injected into the coronary arteries. Your doctor can see the flow of blood to the heart muscle. Dye can also be injected into the chambers of the heart to evaluate the pumping function of your heart. Exercise stress test. EKG and blood pressure readings are taken before, during, and after exercise to see how your heart responds to exercise.
The first EKG and blood pressure reading are done to get a baseline. Readings are then taken while you walk on an exercise treadmill or pedal a stationary bicycle. The test continues until you reach a heart rate set by your doctor. The exercise part of the stress test is stopped if chest pain or a very sharp rise in blood pressure occurs. Monitoring continues for 10 to 15 minutes after exercise or until your heart rate returns to baseline. An echocardiogram or nuclear scan is often included to evaluate the pumping function of your heart. Thyroid functions tests. These are common procedures done to find out how well the thyroid is functioning. They include blood tests, various imaging procedures, and stimulating thyroid function. These tests are very important because both an overactive and an underactive thyroid can be the main or a contributing cause of heart failure.
How is Heart Failure Treated? The goals of treatment are to: Treat the underlying cause of your heart failure Improve your symptoms and quality of life Stop your heart failure from getting worse. Prolong your life span Your doctor will continue to treat the underlying diseases or conditions (such as CAD, high blood pressure, or diabetes) that caused heart failure. The treatment for heart failure includes: Lifestyle changes Medications Specialized care for those in the most advanced stage.
Lifestyle Changes ..There are things that you can do to help with your treatment. Your doctor will recommend that you: Follow a diet low in salt. Salt can cause extra fluid to build up in your body making your heart failure worse. Limit the amount of fluids that you drink. Weigh yourself every day and let your doctor know right away if you have a sudden weight gain. This could mean you have extra fluid building up in your body. Exercise as directed to help build up your fitness level and ability to be more active. Your doctor will also tell you to: Lose weight if you are overweight Quit smoking if you smoke Limit the amount of alcohol that you drink. Medications Your doctor will prescribe medicines to help improve your heart function and symptoms.
The main medicines are: Diuretics (water or fluid pills) to help reduce fluid buildup in your lungs and swelling in your feet and ankles. ACE inhibitors to lower blood pressure and reduce the strain on your heart. These medications also may reduce the risk of a future heart attack. Beta blockers to slow your heart rate and lower your blood pressure to decrease the workload on your heart. Digoxin to make the heart beat stronger and pump more blood. Specialized Care for Severe Disease As the disease progresses, lifestyle changes and regular medications may not be enough to control worsening symptoms. Many people with severe heart failure must be put in the hospital from time to time for treatment. In the hospital, your doctor may prescribe new or special medicines.
You continue to take your regular medicines during this treatment. Your doctor will also order extra oxygen if you continue to have trouble breathing. The extra oxygen can be given in the hospital and at home. Persons with very severe heart failure may be considered for a: Mechanical heart pump Heart transplant. A heart pump is a special device placed inside the body to help pump blood to the rest of the body. There are different kinds of heart pumps. Some stay in the body for a short period of time, while others can stay in the body for a long time. Many people with a heart pump will also be considered for a heart transplant. A heart transplant is surgery to replace the heart of a patient with heart failure with a healthy heart from someone who has recently died. A transplant is indicated in some people when all other treatments fail to control symptoms.
Preventing Heart Failure :The major underlying causes of heart failure are CAD (including angina and heart attack), high blood pressure, and diabetes. The section "What Causes Heart Failure?" lists all the likely causes. Getting treatment and staying in treatment for any underlying condition that you have can greatly reduce your risk. Other things you can do reduce your risk include: Eating a heart-healthy diet low in salt, saturated fat, and cholesterol. The "Prevention" section of the "Your Guide to Lowering High Blood Pressure" Web site provides information and links on heart healthy eating. Quitting smoking if you smoke. Losing weight if you are overweight.
Living with Heart Failure :Heart failure usually cannot be cured and you will likely have to take medication for the rest of your life. It is important that you know that your symptoms may get worse over time. As your symptoms get worse, you may not be able to do many of the things that you did before you had heart failure. Treatment can relieve your symptoms and make it easier to do some of the things that you like to do. Treatment can also reduce the chance that you will have to go to the hospital. For these reasons, it is very important that you follow your treatment plan. You must: Take all of your medications as your doctor prescribed Make all of the lifestyle changes recommended by your doctor Keep all of your doctor's appointments. Common causes of worsening of symptoms that can lead to a crisis or even a hospital visit are: Forgetting to take your medicines ..Not following your diet (such as eating salty foods) ..Drinking excessive amounts of alcohol. If you have trouble following your diet, talk to your doctor.
Your doctor can help arrange for a dietitian to work with you on how to keep to a healthy diet. Alcohol also makes your symptoms worse. If you drink alcohol, don't do so very often and limit yourself to one drink. If you have severe heart failure, you should not drink alcohol. People with heart failure often have other serious conditions that require ongoing treatment. If you have other conditions, it is likely that you are taking medications for those conditions as well as for heart failure. When taking several medications, there is always a chance for side effects and interaction between the medications. Tell your doctor immediately about any problems that you notice with your medications. Also, talk with your doctor before adding any new medicine. This includes over-the-counter medicines and herbal supplements. It is also important that you try to avoid respiratory infections like the flu and pneumonia. Ask your doctor or nurse about getting a flu shot and pneumonia vaccination. It is helpful to have certain information on hand in case you need to go to the hospital or doctor right away. You should plan now to make sure that you have: Phone numbers for the doctor, hospital, and people who can take you to the hospital or doctor Directions to the hospital and doctor's office
List of medications you are taking. Special Needs for Severe Heart Failure In the advanced stages, heart failure is a progressive condition that can generally be expected to get worse and eventually lead to death. If you have severe disease and symptoms at rest, you can expect your condition to worsen. It is important that you and your family discuss what you can expect and your final treatment options with your doctor while you are able to do so. The time may come when you are unable to participate in discussions about your care. Advance directives are documents that tell doctors and hospitals what treatment you want or do not want if you are too ill to speak for yourself. You and your family may decide that you only want treatment to make you comfortable. You, your family, and your doctor may also agree on whether you want treatment if your heart or breathing stops. There are two types of advance directives: A living will provides directions and instructions A medical power of attorney names a person you trust to speak for you when you are unable to make decisions. Advance directives are easy to prepare. You can do it yourself without a lawyer.
The only requirement is that you are at least 18 years old. You may prepare your advance directive by: Simply writing down your wishes Completing a form that your doctor, the hospital, or health department may have Using a special computer software program for legal documents Going to a lawyer Depending on the state where you live, the document may also need to be: Witnessed by 1 or 2 people Notarized As long as you are able to make your own decisions, your advance directives will not be used and you can accept or refuse any medical treatment. But if you become seriously ill, you may not be able to make decisions about your own treatment. Give a copy of your living will and power of attorney to a family member and keep another copy in a safe place. People with severe heart failure are in the hospital often. It is important that you or family a member bring a copy every time you go to the hospital.
Hospice care :As heart failure worsens, the time may come when treatment is no longer working. If you and your doctor agree that your treatments are not working, hospice care may be an option. Hospice is an organization that can comfort and support you and your family. A team of people provides hospice care. This team includes: Doctors Nurses Social Workers Nurse's Aides Chaplain Volunteers. The goals of hospice care are to: Provide comfort rather than cures Give emotional support to you and your family Provide care that supports dying with dignity Provide spiritual support as requested by you and your family. Hospice supports life and views dying as a natural process. Hospice will work with you and your family to provide the services you need.
The Summary of Heart failure is a condition where the heart cannot pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. But it does mean that your heart is not able to pump blood the way that it should. Heart failure is a serious condition that develops over time as the pumping action of the heart grows weaker. Heart failure is caused by other diseases or conditions that damage or overwork the heart muscle. The leading causes of heart failure are CAD, high blood pressure, and diabetes. About 5 million people in the United States have heart failure. Each year 550,000 people are diagnosed with heart failure. It causes or contributes to about 300,000 deaths each year. Heart failure can happen to anyone but is more common in people over 65 years of age, among women, and in African Americans. The most common symptoms of heart failure are shortness of breath, feeling tired, and swelling in the ankles, feet, legs, and sometimes the abdomen. An echocardiogram is the most useful test used to diagnose heart failure. The treatments for heart failure include lifestyle changes, medications, and specialized care for those with severe disease. People with severe heart failure are frequently admitted to the hospital. If you have a disease or condition that makes heart failure more likely, you may be able to prevent it by controlling or treating the disease or condition. Heart failure usually cannot be cured and you will likely have to take medication for the rest of your life. It is important that you know that your symptoms may get worse over time. As your symptoms get worse, you may not be able to do many of the things that you did before you had heart failure. If you have severe disease and symptoms at rest, you can expect your condition to worsen. It is important that you and your family discuss what you can expect and your final treatment options with your doctor while you are able to do so.