You may have been wondering what are my options for treating arrhythmia that does not include all of these medications with side effects and costly procedures. Well I found a few natural treatments that may be of help, but please keep in mind they are not often enough to fully treat the arrhythmia. Please consult with your doctor about diagnosis and treatments. These things listed below may not be your complete solution but they will definitely not make it worse...it will certainly make you a healthier individual that leads a better lifestyle than one that could make your condition worse.
1. QUIT SMOKING
Clearly smoking is not good for your lungs or any other part of your respiratory system. So what would make you think it is good for your heart? Smoking can further complicate heart problems, so stopping as soon as possible is advisable. Even if you don't have a heart problem, please stop for your own health!
2. Avoid Alcohol
Alcohol can cause arrhythmias after one single drink simply because it depresses the central nervous system, keeping it from operating properly. (And no, drinking more than one will not make the arrhythmia go away nor will it make you feel better!) It is clearly never a smart move if you make the body stressed about anything you can avoid.
3. Relaxation
Have you ever taken a deep breath and suddenly felt your body relax just a little bit? Just the simple act of breathing deeply somehow puts the body at ease, right? Taking a deeper breath brings in more oxygen, which is delivered to the rest of the organs, calming the body. This helps combat stress and mental tensions as well, which will certainly make you feel better and is at least good for the sanity. (The bonus is that it is good for your health as well.)
4. Exercise!
By now, you probably feel like I'm a broken record that is just preaching away...But maybe you admit that any frustration/annoyance displaying on your face is because you know all of the above is true, right? Ok then, onward we go! Any excess weight is obviously weight that must be carried around every step of the way. This excess weight makes the heart have to work harder to get blood to all of the bigger (and no, not better) parts of the body. Now you don't have to look like a super model to be healthier than whatever your current state is. Not only can exercise help you lose weight, but it helps combat stress and releases endorphins in the body that are great for cardiac health. Surely any more sanity that can be gained from the daily stress of life would be warmly welcomed! Try simple exercises such as yoga, aerobics, fitness ball, cycling, dancing or walking on a daily basis to improve the overall health of your heart. I have found that having a partner (husband, wife, boyfriend, girlfriend, neighbor, parent, child, anyone!) in exercise keeps you entertained and motivated! You will have no idea how true this is until you have done a fitness class (or any exercise) with someone and then without someone. The difference is phenomenal-just make sure you don't spend more time talking than exercising!
5. Natural Herbs/Supplements
a. Omega-3 Fatty Acids
I know, these things are all over the news. What is so magical about something that has the word Fat and Acid in it? After extensive research into Omega-3 Fatty acids it has been determined that it strengthens the heart muscles and helps PREVENT arrhythmias!! Omega-3 Fatty Acid tablets can be found Over the Counter at most grocery stores and drug stores/pharmacy chains. It can also be found in foods (fish): such as sardines, salmon and mackerel. Consider adding these to your diet for a healthier heart!
b. Garlic
Whether you want to keep the vampires away or have a healthier heart, neither one hurts! Garlic has a ton of antioxidants (yes, the cool word that boosts your immunity--also found in blueberries and other yuumier tasting foods) and sulfur compounds that are great for overall heart health. Similar to Omega-3 Fatty Acids, garlic can be taken as a tablet or thrown in the mixture of your diet...but I'm pretty sure I know which one is less appealing. Don't forget to brush your teeth too...this won't help your heart but could be the deal breaker between getting a date with someone that makes your heart flutter or not. =)
c. Dilguard
Dilguard is a supplement that strengthens the heart muscles and provides immunity support as well. This herbal remedy is available as a vegetable capsule and should be taken on a regular basis in order to improve your cardiac health. Dilguard Plus capsules reduces platelet aggregation, lowers LDL (bad cholesterol) and maintain HDL (good cholesterol) levels.
6. QUIT STRESSING OUT
Quit stressing out about all of the things mentioned above that you may or may not be doing and just in general, quit stressing out as much as humanly possible. Stress alone may not be the cause of an arrhythmia but stress does lead to elevated blood pressure levels and cholesterol levels....which as we well know leads to heart problem later down the road. Stress triggers your "fight-or-flight" response, sending hormones flying and heart rates racing. The rate of blood flow increases, which increases blood pressure. Your body automatically releases fatty acids into the blood stream, which increases your cholesterol levels. Under chronic stress, the continued release of cortisol (hormone released from adrenal glands) seems to have some effect on where fat is deposited in the body, most often in the abdomen (again read #4 above-more weight=harder for the heart)! All of these things I just mentioned can lead to serious heart problems if the patient does not cut back on whatever it is that stresses them out! Remember those deep breaths I talked about earlier...they really help make you feel better, even if it's only temporary! We all know stress isn't going away any time soon and we also know it negatively affects our health...so really try to avoid it if at all possible. Whether it is financial, time-management, too much on your plate, loneliness, whatever...try to find someone or something that helps!
As mentioned above, none of these solutions are enough to make you completely, 100% healthy. If it were and we all followed all of these tips, we would not even need to have this discussion! Combining all of the above along with any additional treatments, medications or procedures that your doctor recommends will certainly improve your cardiac health. Don't try them all at once...this may overload you with more than you can handle. Maybe try adding one of these to the roster every week. Piling them all up at once may make you stressed out...which of course is not the goal!
If you have ever seen Bad Boys with Will Smith...Woosa...
Tuesday, August 24, 2010
Wednesday, August 18, 2010
Anticoagulants/Anti-Platelets as a Treatment for Patients with Heart Problems
Anticoagulant=blood thinner that makes it more difficult for the blood to clot (coagulate). They do not dissolve existing blood clots but prevent new clots from forming and from existing clots from getting larger.
Also known as blood thinners (although they really do not thin your blood), many patients with heart problems are prescribed anticoagulant medications. These are prescribed for people that are at increased risks for strokes because the most common stroke is caused by blood clots obstructing blood flow to the brain. For our purposes, anticoagulants are prescribed for others that are at increased risk for blood clots, such as those with an artificial heart valve or those with atrial fibrillation.
Three of the most commonly prescribed anticoagulants are Aspirin, Coumadin (generic: Warfarin Sodium) and Plavix. All of these drugs interfere with your body's natural ability to clot blood, which can be very dangerous in situations of large losses of blood (causes abnormal bleeding!). Therefore it is VERY important that these medications be taken exactly as prescribed!
Aspirin
Aspirin has an antiplatelet effect, which makes your blood platelets less likely to stick together and form clots. Aspirin is less likely to cause abnormal bleeding and is usually added in addition to a prescription anticoagulant.
Coumadin (Warfarin)
Warfarin is an anticoagulant that is more effective at preventing clot-caused strokes than Aspirin. Most people over age 60 with an atrial fibrillation will be prescribed a blood thinner. It has been shown that patients that have been taking Warfarin for a long period of time have reduced their chances of having a stroke by 70 percent or more! While the side effect of abnormal bleeding is a dangerous side effect, having a stroke is even more dangerous. It is important that it is taken exactly as prescribed. If a patient misses a dose, the patient should NOT take another one later to catch up. Always be sure to tell a new doctor, dentist, etc that you are taking Warfarin, especially when a new medication is being prescribed that may interfere or a procedure that causes bleeding.
Plavix
Anyone that has had one clot-related event (heart attack, stroke or heart-related chest pain) may be up to 9 times as likely to have another clot-related event. Plavix is the most researched (and one of, if not the most expensive) anti-platelet medicine. Many people take cholesterol and blood pressure medicines to help lower their risk of a heart attack or stroke. While reducing high blood pressure and cholesterol is extremely important, it’s also important to know that blood pressure and cholesterol medications do not directly address the formation of clots, which are the cause of most heart attacks and strokes. Therefore, blood pressure and cholesterol medications are NOT always ENOUGH to treat and prevent patients from having a clot-related event. Plavix addresses this important issue and is currently the #1 prescribed anti-platelet medication. The patient should not stop taking Plavix unless he or she consults their doctor first. Suddenly stopping Plavix can increase your risk of heart attack or stroke. People with stomach ulcers or conditions that cause bleeding should not use Plavix. Also patients that take any medication for heartburn or acid reflux (like Nexium or Prilosec) should not take Plavix.
While anticoagulants are not a direct treatment for arrhythmias, they are important in treating or preventing blood clots that may lead to a heart attack. Patients with atrial fibrillation are at increased risks for forming a blood clot in the upper chambers of their heart that can lead to a heart attack or stroke. Therefore, AF patients are commonly prescribed for anti-platelets. It is important to take these medications as prescribed because of the abnormal bleeding that can occur during surgeries or open wounds. But it is also important to remember that the abnormal bleeding is not as dangerous as the stroke or heart attack that can result from not taking these medications.
Also known as blood thinners (although they really do not thin your blood), many patients with heart problems are prescribed anticoagulant medications. These are prescribed for people that are at increased risks for strokes because the most common stroke is caused by blood clots obstructing blood flow to the brain. For our purposes, anticoagulants are prescribed for others that are at increased risk for blood clots, such as those with an artificial heart valve or those with atrial fibrillation.
Three of the most commonly prescribed anticoagulants are Aspirin, Coumadin (generic: Warfarin Sodium) and Plavix. All of these drugs interfere with your body's natural ability to clot blood, which can be very dangerous in situations of large losses of blood (causes abnormal bleeding!). Therefore it is VERY important that these medications be taken exactly as prescribed!
Aspirin
Aspirin has an antiplatelet effect, which makes your blood platelets less likely to stick together and form clots. Aspirin is less likely to cause abnormal bleeding and is usually added in addition to a prescription anticoagulant.
Coumadin (Warfarin)
Warfarin is an anticoagulant that is more effective at preventing clot-caused strokes than Aspirin. Most people over age 60 with an atrial fibrillation will be prescribed a blood thinner. It has been shown that patients that have been taking Warfarin for a long period of time have reduced their chances of having a stroke by 70 percent or more! While the side effect of abnormal bleeding is a dangerous side effect, having a stroke is even more dangerous. It is important that it is taken exactly as prescribed. If a patient misses a dose, the patient should NOT take another one later to catch up. Always be sure to tell a new doctor, dentist, etc that you are taking Warfarin, especially when a new medication is being prescribed that may interfere or a procedure that causes bleeding.
Plavix
Anyone that has had one clot-related event (heart attack, stroke or heart-related chest pain) may be up to 9 times as likely to have another clot-related event. Plavix is the most researched (and one of, if not the most expensive) anti-platelet medicine. Many people take cholesterol and blood pressure medicines to help lower their risk of a heart attack or stroke. While reducing high blood pressure and cholesterol is extremely important, it’s also important to know that blood pressure and cholesterol medications do not directly address the formation of clots, which are the cause of most heart attacks and strokes. Therefore, blood pressure and cholesterol medications are NOT always ENOUGH to treat and prevent patients from having a clot-related event. Plavix addresses this important issue and is currently the #1 prescribed anti-platelet medication. The patient should not stop taking Plavix unless he or she consults their doctor first. Suddenly stopping Plavix can increase your risk of heart attack or stroke. People with stomach ulcers or conditions that cause bleeding should not use Plavix. Also patients that take any medication for heartburn or acid reflux (like Nexium or Prilosec) should not take Plavix.
While anticoagulants are not a direct treatment for arrhythmias, they are important in treating or preventing blood clots that may lead to a heart attack. Patients with atrial fibrillation are at increased risks for forming a blood clot in the upper chambers of their heart that can lead to a heart attack or stroke. Therefore, AF patients are commonly prescribed for anti-platelets. It is important to take these medications as prescribed because of the abnormal bleeding that can occur during surgeries or open wounds. But it is also important to remember that the abnormal bleeding is not as dangerous as the stroke or heart attack that can result from not taking these medications.
Wednesday, August 11, 2010
Congenital Heart Defects & Diseases
Continuing along the same lines of the fetal circulation transforming into post-natal circulation brings us to the topic congenital heart defects. Congenital heart defect means it is a problem with the structure of the heart and is present at birth. It is the most common type of defect at birth. The problem with the structure arises from the fetal circulation not correctly transitioning to a normal post-natal circulation.
The majority of the structural defects arise from a valve not shutting completely or at all. There are a variety of defects that can occur:
1. Atrial Septal Defect (ASD) also known as Patent Foramen Ovale
Remember the foramen ovale that connects the right atria and the left atria...while inside the mother, this should remain open to shunt blood away from the lungs. But after birth, this valve should shut. If the valve does not shut, blood can move from the left atria (oxygenated blood) to the right atria (deoxygenated blood), which causes too much pressure to build up in the lungs or from the right atria to the left atria. With a large shunt (large hole between the atria), a person will be significantly short of breath because blood can reverse directions. A small shunt may not even be discovered until later in life and generally does not cause any major problems. By itself, an ASD could have no symptoms but patients are at an increased risk for atrial fibrillation, heart failure, pulmonary hypertension, and stroke. Treatment is usually not necessary if the defect is minor; if the defect is large, a simple procedure done via a catheter can fix it.
2. Ventral Septal Defect (VSD)
During pregnancy, a fetus' heart does not have two separate ventricles. As the fetus grows, a ventral wall between the right and left ventricle will form to separate them. However, if the wall does not completely form, a hole remains and is called a ventral septal defect. A baby may have no symptoms but can be seen by an EKG; it also may close by itself. If the defect is too large, too much blood will be pumped to the lungs (from the left ventricle to the right and then to the lungs) and can lead to heart failure. If the defect is large, symptoms may arise, such as: shortness of breath, fast or hard breathing, paleness and fast heart rate. VSD is one of the most common congenital heart defects and often occurs with other heart defects. Treatment is usually not necessary if the defect is minor; if the defect is large, a simple procedure done via a catheter can fix it.
3. Coarctation of the Aorta
Coarctation means narrowing...thus coarctation of the aorta means narrowing of the aorta! This makes it difficult for blood and nutrients to pass to the rest of the body. It can be seen with other congenital heart defects and is more common in those with genetic disorders. There may be no symptoms but there may be symptoms of shortness of breath, chest pain, poor growth, nosebleed and dizziness. Coarctation of the aorta can be cured with surgery and the patient may need to be prescribed blood pressure medications.
4. Patent Ductus Arteriosus
Remember the ductus arteriosus artery that connects the pulmonary artery to the aorta in a fetus to shunt blood away from the lungs? Patent means open...patent ductus arteriosus means the ductus arteriosus has not closed completely after birth. The condition leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart. PDA affects girls more than boys and is common in premature infants and those born with other congenital heart defects. The usual goal of treating PDA is to close the valve. The exception is when other heart defects are present and the PDA is keeping the patient alive. Medications, catheter procedure or surgery are among the options to repair the PDA.
5. Pulmonary Atresia
Atresia means closed or blocked. Pulmonary atresia occurs when the pulmonary valve (from the right ventricle to the lung) does not form properly; thus, blood cannot flow to the lungs to become oxygenated. Someone with pulmonary atresia may also have a weak tricuspid valve (valve between the right atria and right ventricle) and may occur with VSD. Prostaglandins are usually given to move blood into the lungs to become oxygenated by keeping the ductus arteriosus open. Other treatments include heart catheterization or open heart surgery.
As you may have noticed, most of the congenital heart defects occur from valves that are inappropriately opened or closed or even the wrong size. I will list some of the diseases that may be commonly heard of and what exactly they entail:
1. Cyanotic Heart Disease
This is a congenital heart defect that results in low blood oxygen levels. Any abnormal blood flow through the heart can cause the blood to not be oxygenated to the appropriate level. This can cause the child's skin to appear blue on the lips, fingers and toes! Medications are often administered or may need surgery to repair the defect causing the oxygen levels to be low.
2. Dextrocardia
Strangley enough, someone's heart can be tilted incorrectly! The heart is pointed toward the right side of the chest rather than the left. Most types of dextrocardia also occur with other abdomen or heart problems. In a rare case, the heart and other organs can mirror what they normally look like. In this case, no treatment is needed. In addition, the abdominal and chest organs in babies with dextrocardia may be abnormal and may not work correctly. If heart defects are present along with dextrocardia, surgery and medications may be necessary.
3. Hypoplastic Left Heart Syndrome
Hypoplastic Left Heart Syndrome occurs when the left heart (ventricle, mitral valve, aortic valve and aorta) do not develop completely. This is very rare and occurs in males more often than females. It causes the ventricle and aorta to be smaller than normal, which leads to the heart being unable to send enough blood to the rest of the body and overloads the right ventricle by forcing it to fulfill the duties of supplying the lungs and the rest of the body with blood. This eventually leads the right heart into heart failure. If it is known that the baby has hypoplastic heart syndrome before birth, medication will be given to keep the ductus arteriosus open in order for the baby to stay alive. If the ductus arteriosus is allowed to close, the patient could quickly die. The baby may seem normal when born but could have symptoms of blue skin, cold extremities, lethargy, poor pulse or rapid breathing. A ventilator may be necessary to help the baby breathe and will soon need surgeries to fix the hypoplastic left heart syndrome.
4. Transposition of the Great Vessels
A congenital heart defect in which the two major vessels that carry blood away from the heart (the aorta and pulmonary artery) are switched....a major problem. In transposition of the great vessels, the blood goes to the lungs, picks up oxygen, and then goes right back to the lungs without going to the body. Blood from the body returns to the heart and goes back to the body without ever picking up oxygen in the lungs. The patient will most likely be blue, feed poorly, be short of breath and have clubbing of the fingers or toes. The infant will immediately receive prostaglandins, which keep the ductus arteriosus open, allowing some mixing of the oxygenated and deoxygenated blood. A cardiac catheterization and a surgery called arterial switch procedure will be needed to permanently correct the problem. This must be done within the first week of the baby's life.
5. Tricuspid Atresia
The tricuspid heart valve is the valve between the right atria and ventricle. Atresia means blocked or closed. In tricuspid atresia, the tricuspid heart valve is missing or is not completely developed. While rare, 20% of the patients with this condition will have other heart problems. Blood ultimately cannot enter the lungs to pick up oxygen; thus, the infant's skin will be blue (cyanotic). Being extremely short of breath, the baby will need to be put on a ventilator to help it breathe and prostaglandin is used to maintain circulation of blood to the lungs. This condition always requires surgery within the first few days of life. Three surgeries may be necessary, two of which are called the Glenn shunt and Fontan procedure.
6. Tetralogy of Fallot
Tetra=4....4 related defects of the heart and its major blood vessels:
a. VSD (hole between left and right ventricle)
b. Narrowing of the pulmonary outflow tract (the valve and artery that connect the heart with the lungs)
c. Overriding aorta that is shifter over the right ventricle and VSD, instead of only coming out from the left ventricle
d. Thickened muscular wall of the right ventricle (hypertrophy=larger than normal)
Cyanosis (blue skin), difficulty feeding, failure to gain weight, passing out, clubbing of fingers, and poor development are all symptoms of tetralogy of fallot. Surgery is always required to correct the heart's 4 defects, and usually multiple surgeries. Most cases can be corrected with surgery and the patient can live an active, healthy life.
Clearly, medications and surgeries are the answers to correcting the majority of the congential heart defects. And even more obvious, the tranformation of the heart from fetal circulation to post-natal circulation is of utmost importance for a normal, heart-healthy baby.
The majority of the structural defects arise from a valve not shutting completely or at all. There are a variety of defects that can occur:
1. Atrial Septal Defect (ASD) also known as Patent Foramen Ovale
Remember the foramen ovale that connects the right atria and the left atria...while inside the mother, this should remain open to shunt blood away from the lungs. But after birth, this valve should shut. If the valve does not shut, blood can move from the left atria (oxygenated blood) to the right atria (deoxygenated blood), which causes too much pressure to build up in the lungs or from the right atria to the left atria. With a large shunt (large hole between the atria), a person will be significantly short of breath because blood can reverse directions. A small shunt may not even be discovered until later in life and generally does not cause any major problems. By itself, an ASD could have no symptoms but patients are at an increased risk for atrial fibrillation, heart failure, pulmonary hypertension, and stroke. Treatment is usually not necessary if the defect is minor; if the defect is large, a simple procedure done via a catheter can fix it.
2. Ventral Septal Defect (VSD)
During pregnancy, a fetus' heart does not have two separate ventricles. As the fetus grows, a ventral wall between the right and left ventricle will form to separate them. However, if the wall does not completely form, a hole remains and is called a ventral septal defect. A baby may have no symptoms but can be seen by an EKG; it also may close by itself. If the defect is too large, too much blood will be pumped to the lungs (from the left ventricle to the right and then to the lungs) and can lead to heart failure. If the defect is large, symptoms may arise, such as: shortness of breath, fast or hard breathing, paleness and fast heart rate. VSD is one of the most common congenital heart defects and often occurs with other heart defects. Treatment is usually not necessary if the defect is minor; if the defect is large, a simple procedure done via a catheter can fix it.
3. Coarctation of the Aorta
Coarctation means narrowing...thus coarctation of the aorta means narrowing of the aorta! This makes it difficult for blood and nutrients to pass to the rest of the body. It can be seen with other congenital heart defects and is more common in those with genetic disorders. There may be no symptoms but there may be symptoms of shortness of breath, chest pain, poor growth, nosebleed and dizziness. Coarctation of the aorta can be cured with surgery and the patient may need to be prescribed blood pressure medications.
4. Patent Ductus Arteriosus
Remember the ductus arteriosus artery that connects the pulmonary artery to the aorta in a fetus to shunt blood away from the lungs? Patent means open...patent ductus arteriosus means the ductus arteriosus has not closed completely after birth. The condition leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart. PDA affects girls more than boys and is common in premature infants and those born with other congenital heart defects. The usual goal of treating PDA is to close the valve. The exception is when other heart defects are present and the PDA is keeping the patient alive. Medications, catheter procedure or surgery are among the options to repair the PDA.
5. Pulmonary Atresia
Atresia means closed or blocked. Pulmonary atresia occurs when the pulmonary valve (from the right ventricle to the lung) does not form properly; thus, blood cannot flow to the lungs to become oxygenated. Someone with pulmonary atresia may also have a weak tricuspid valve (valve between the right atria and right ventricle) and may occur with VSD. Prostaglandins are usually given to move blood into the lungs to become oxygenated by keeping the ductus arteriosus open. Other treatments include heart catheterization or open heart surgery.
As you may have noticed, most of the congenital heart defects occur from valves that are inappropriately opened or closed or even the wrong size. I will list some of the diseases that may be commonly heard of and what exactly they entail:
1. Cyanotic Heart Disease
This is a congenital heart defect that results in low blood oxygen levels. Any abnormal blood flow through the heart can cause the blood to not be oxygenated to the appropriate level. This can cause the child's skin to appear blue on the lips, fingers and toes! Medications are often administered or may need surgery to repair the defect causing the oxygen levels to be low.
2. Dextrocardia
Strangley enough, someone's heart can be tilted incorrectly! The heart is pointed toward the right side of the chest rather than the left. Most types of dextrocardia also occur with other abdomen or heart problems. In a rare case, the heart and other organs can mirror what they normally look like. In this case, no treatment is needed. In addition, the abdominal and chest organs in babies with dextrocardia may be abnormal and may not work correctly. If heart defects are present along with dextrocardia, surgery and medications may be necessary.
3. Hypoplastic Left Heart Syndrome
Hypoplastic Left Heart Syndrome occurs when the left heart (ventricle, mitral valve, aortic valve and aorta) do not develop completely. This is very rare and occurs in males more often than females. It causes the ventricle and aorta to be smaller than normal, which leads to the heart being unable to send enough blood to the rest of the body and overloads the right ventricle by forcing it to fulfill the duties of supplying the lungs and the rest of the body with blood. This eventually leads the right heart into heart failure. If it is known that the baby has hypoplastic heart syndrome before birth, medication will be given to keep the ductus arteriosus open in order for the baby to stay alive. If the ductus arteriosus is allowed to close, the patient could quickly die. The baby may seem normal when born but could have symptoms of blue skin, cold extremities, lethargy, poor pulse or rapid breathing. A ventilator may be necessary to help the baby breathe and will soon need surgeries to fix the hypoplastic left heart syndrome.
4. Transposition of the Great Vessels
A congenital heart defect in which the two major vessels that carry blood away from the heart (the aorta and pulmonary artery) are switched....a major problem. In transposition of the great vessels, the blood goes to the lungs, picks up oxygen, and then goes right back to the lungs without going to the body. Blood from the body returns to the heart and goes back to the body without ever picking up oxygen in the lungs. The patient will most likely be blue, feed poorly, be short of breath and have clubbing of the fingers or toes. The infant will immediately receive prostaglandins, which keep the ductus arteriosus open, allowing some mixing of the oxygenated and deoxygenated blood. A cardiac catheterization and a surgery called arterial switch procedure will be needed to permanently correct the problem. This must be done within the first week of the baby's life.
5. Tricuspid Atresia
The tricuspid heart valve is the valve between the right atria and ventricle. Atresia means blocked or closed. In tricuspid atresia, the tricuspid heart valve is missing or is not completely developed. While rare, 20% of the patients with this condition will have other heart problems. Blood ultimately cannot enter the lungs to pick up oxygen; thus, the infant's skin will be blue (cyanotic). Being extremely short of breath, the baby will need to be put on a ventilator to help it breathe and prostaglandin is used to maintain circulation of blood to the lungs. This condition always requires surgery within the first few days of life. Three surgeries may be necessary, two of which are called the Glenn shunt and Fontan procedure.
6. Tetralogy of Fallot
Tetra=4....4 related defects of the heart and its major blood vessels:
a. VSD (hole between left and right ventricle)
b. Narrowing of the pulmonary outflow tract (the valve and artery that connect the heart with the lungs)
c. Overriding aorta that is shifter over the right ventricle and VSD, instead of only coming out from the left ventricle
d. Thickened muscular wall of the right ventricle (hypertrophy=larger than normal)
Cyanosis (blue skin), difficulty feeding, failure to gain weight, passing out, clubbing of fingers, and poor development are all symptoms of tetralogy of fallot. Surgery is always required to correct the heart's 4 defects, and usually multiple surgeries. Most cases can be corrected with surgery and the patient can live an active, healthy life.
Clearly, medications and surgeries are the answers to correcting the majority of the congential heart defects. And even more obvious, the tranformation of the heart from fetal circulation to post-natal circulation is of utmost importance for a normal, heart-healthy baby.
Friday, August 6, 2010
Fetal Circulation
Not everyone knows this but it's important in understanding infant arrhythmias and congenital heart defects: Fetal circulation is very different!! As a matter of fact, it seems as if everything is backwards. For now, I will discuss the circulation and later I will discuss the defects that can arise if fetal circulation does not make all of the proper changes to the normal postnatal circulation.
Normal Circulation/Flow of Blood Through the Heart
In a normal post-natal heart, blood flows in this order starting with deoxygenated blood:
Vena Cava (from the body and carries carbon dioxide)-->Right Atrium-->Triscuspid Valve-->Right Ventricle-->Pulmonary Arteries (carrying deoxygenated blood)-->Lungs-->Pulmonary Veins (carrying oxygenated blood)-->Left Atrium-->Mitral/Bicuspid Valve-->Left Ventricle-->Aorta (pumped to the rest of the body)
Below is a diagram of blood circulation in a normal heart: blue means deoxygenated blood and red is oxygenated blood.
Pressure in a normal post-natal heart is higher in the left heart (left atria and ventricle) than the right heart. The left heart is also larger, stronger and thicker than the right heart. This is due to the fact that the left heart must pump blood to the entire body and against gravity! The right heart simply has to pump blood into the lungs directly below it.
Fetal Circulation Similarities
1. The fetus has all of the same parts (2 atria, 2 ventricles, valves, arteries and veins) but as mentioned above may be different sizes.
2. The fetus receives deoxygenated blood into the right atrium.
Fetal Circulation Differences
1. The first and foremost important thing to recognize is that a fetus does not have mature lungs until approximately 36-37 weeks gestation. But the blood still needs to receive oxygen from somewhere...
2. Umbilical Vein
This is the somewhere that the oxygenated blood comes from. While veins typically carry deoxygenated blood from the body back to the heart to be oxygenated by the lungs, pulmonary veins and umbilical veins are different!! Again, fetal circulation is different! The UMBILICAL VEIN carries OXYGENATED blood from the mother's heart TO the PLACENTA.
3. Umbilical Arteries
Yes, plural. There are two arteries; as a matter of fact, when a baby is born this is one of the first things the doctor checks after cutting the umbilical cord. The doctor makes sure there are two arteries and one vein. Normally arteries carry oxygenated blood away from the heart to the body and pick up carbon dioxide to bring back to the lungs. BUT again, pulmonary arteries and umbilical arteries are different! The UMBILICAL ARTERIES bring DEOXYGENATED blood FROM the PLACENTA to the mother.
4. Foramen Ovale
Because the fetus does not have mature lungs to be able to exchange gases itself, blood that normally goes to the lungs must be shunted away from them in the fetus. The first of these shunts is the foramen ovale: this shunts blood from the right atrium to the left atrium (at the top of the heart) bypassing the right ventricle and the lungs. As opposed to the post-natal heart, the fetus' right heart has higher pressure than the left heart (DIFFERENT in yet another way)! This pressure differential pushes blood from the higher pressure heart to the lower pressure heart to avoid the lungs. The foramen ovale normally closes within 3 months of birth.
5. Ductus Arteriosus
The second cardiac shunt in the fetus is the ductus arteriosus. Any blood that has gotten to the right ventricle and not gone through the foramen ovale is shunted from the pulmonary arteries (normally carries deoxygenated blood to the lungs to become oxygenated) to the aorta (pumped to the rest of the body). Again, this bypasses the lungs. The ductus arteriosus typically closes once breathing regulates in the newborn baby.
6. Ductus Venosus
The ductus venosus is another shunt that is present in the fetus that is not present after birth. This does not directly involve blood flow in the heart but sends approximately 80% of the blood from the umbilical vein to the inferior vena cava (vein that carries blood from lower extremities back to the heart). The ductus venosus therefore bypasses the fetal liver. Within minutes of birth, the ductus venosus does not work but it will take 3-7 days for it to completely close.
As a general overview, everything above is basically how the fetal heart differs from that of a healthy, normal person after birth. As mentioned above, I will discuss how congenital heart defects and arrhythmias can be present at birth if something in the regular developmental cycle goes wrong.
Normal Circulation/Flow of Blood Through the Heart
In a normal post-natal heart, blood flows in this order starting with deoxygenated blood:
Vena Cava (from the body and carries carbon dioxide)-->Right Atrium-->Triscuspid Valve-->Right Ventricle-->Pulmonary Arteries (carrying deoxygenated blood)-->Lungs-->Pulmonary Veins (carrying oxygenated blood)-->Left Atrium-->Mitral/Bicuspid Valve-->Left Ventricle-->Aorta (pumped to the rest of the body)
Below is a diagram of blood circulation in a normal heart: blue means deoxygenated blood and red is oxygenated blood.
Pressure in a normal post-natal heart is higher in the left heart (left atria and ventricle) than the right heart. The left heart is also larger, stronger and thicker than the right heart. This is due to the fact that the left heart must pump blood to the entire body and against gravity! The right heart simply has to pump blood into the lungs directly below it.
Fetal Circulation Similarities
1. The fetus has all of the same parts (2 atria, 2 ventricles, valves, arteries and veins) but as mentioned above may be different sizes.
2. The fetus receives deoxygenated blood into the right atrium.
Fetal Circulation Differences
1. The first and foremost important thing to recognize is that a fetus does not have mature lungs until approximately 36-37 weeks gestation. But the blood still needs to receive oxygen from somewhere...
2. Umbilical Vein
This is the somewhere that the oxygenated blood comes from. While veins typically carry deoxygenated blood from the body back to the heart to be oxygenated by the lungs, pulmonary veins and umbilical veins are different!! Again, fetal circulation is different! The UMBILICAL VEIN carries OXYGENATED blood from the mother's heart TO the PLACENTA.
3. Umbilical Arteries
Yes, plural. There are two arteries; as a matter of fact, when a baby is born this is one of the first things the doctor checks after cutting the umbilical cord. The doctor makes sure there are two arteries and one vein. Normally arteries carry oxygenated blood away from the heart to the body and pick up carbon dioxide to bring back to the lungs. BUT again, pulmonary arteries and umbilical arteries are different! The UMBILICAL ARTERIES bring DEOXYGENATED blood FROM the PLACENTA to the mother.
4. Foramen Ovale
Because the fetus does not have mature lungs to be able to exchange gases itself, blood that normally goes to the lungs must be shunted away from them in the fetus. The first of these shunts is the foramen ovale: this shunts blood from the right atrium to the left atrium (at the top of the heart) bypassing the right ventricle and the lungs. As opposed to the post-natal heart, the fetus' right heart has higher pressure than the left heart (DIFFERENT in yet another way)! This pressure differential pushes blood from the higher pressure heart to the lower pressure heart to avoid the lungs. The foramen ovale normally closes within 3 months of birth.
5. Ductus Arteriosus
The second cardiac shunt in the fetus is the ductus arteriosus. Any blood that has gotten to the right ventricle and not gone through the foramen ovale is shunted from the pulmonary arteries (normally carries deoxygenated blood to the lungs to become oxygenated) to the aorta (pumped to the rest of the body). Again, this bypasses the lungs. The ductus arteriosus typically closes once breathing regulates in the newborn baby.
6. Ductus Venosus
The ductus venosus is another shunt that is present in the fetus that is not present after birth. This does not directly involve blood flow in the heart but sends approximately 80% of the blood from the umbilical vein to the inferior vena cava (vein that carries blood from lower extremities back to the heart). The ductus venosus therefore bypasses the fetal liver. Within minutes of birth, the ductus venosus does not work but it will take 3-7 days for it to completely close.
As a general overview, everything above is basically how the fetal heart differs from that of a healthy, normal person after birth. As mentioned above, I will discuss how congenital heart defects and arrhythmias can be present at birth if something in the regular developmental cycle goes wrong.
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