Tag Archives: Heart Disease

Heart Disease: Symptoms & Types Of Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure.

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The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices, heart surgery or, in severe cases, a heart transplant — depends on the type of cardiomyopathy and how serious it is.

Types

  1. Dilated cardiomyopathy
  2. Hypertrophic cardiomyopathy

Symptoms

There might be no signs or symptoms in the early stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including:

  • Breathlessness with activity or even at rest
  • Swelling of the legs, ankles and feet
  • Bloating of the abdomen due to fluid buildup
  • Cough while lying down
  • Difficulty lying flat to sleep
  • Fatigue
  • Heartbeats that feel rapid, pounding or fluttering
  • Chest discomfort or pressure
  • Dizziness, lightheadedness and fainting

Signs and symptoms tend to get worse unless treated. In some people, the condition worsens quickly; in others, it might not worsen for a long time.

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Diet: Consuming Olive Oil Daily Lowers Heart Risks

Consuming just a half-tablespoon or more of olive oil a day is linked to a lower risk of dying from heart disease and other chronic health conditions, new research suggests.

photo of a hand holding a bottle of olive oil and drizzling it on a dish of quinoa

The study included more than 92,000 women and men from the Nurses’ Health Study and the Health Professionals Follow-up Study, who filled out diet questionnaires every four years for 28 years. Olive oil intake was calculated from how much they reported using in salad dressings, on bread and other food, and in baking or frying.

Compared with participants who rarely or never consumed olive oil, those who consumed the most (about a half-tablespoon or more daily) had a 19% lower risk of dying from heart disease during the study. Researchers also noted lower death rates over all among people who substituted olive oil for a similar amount of margarine, butter, mayonnaise, or dairy fat. The findings, published Jan.18, 2022, in the Journal of the American College of Cardiology, lend further support for choosing olive oil — a key component of the heart-friendly Mediterranean diet.

Read more at Harvard Health

Infographic: Acute Heart Failure (Nature Reviews)

Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome.

Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities.

As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.

COMMENTARY:

High frequency sound (ultrasound) bounces off of tissues, like an echo,  and allows an electronic look at the heart. Doppler echocardiography is the doctors method of choice for evaluating a heart failure. One of the most important numbers determined by this method is the EJECTION FRACTION, which is a measure of heart efficiency. If the ejection fraction is low, let’s say below 45%, the heart is pumping out only 45% of its volume with each stroke, which means it must work harder to produce the same amount of circulation. The normal is about 60%.

This is the basis of SYSTOLIC Heart failure.

The test can also tell about blood coming into the heart; the early part of the blood entering is usually 80% of the total. If it drops, let’s say below 50%, it means the heart is stiff and resists blood coming in, which is the basis of DIASTOLIC heart failure.

FACES Is an acronym-mnemonic for the symptoms of heart failure. F is for FATIGUE.

A is for ACTIVITY LIMITATION. C is for CONGESTION in the lungs.  E is for EDEMA, or swelling, usually of the ankles and legs. S is for SHORTNESS of BREATH.

If you want to remember a bit about heart failure, think about echoes and faces. If your Doctor orders an ultrasound with Doppler, be sure to ask about your ejection fraction and percent of blood that enters early, before the “atrial kick”. Being informed is always a good thing.

To be honest, I have never encountered a person who was given a Doppler echocardiogram and could tell me what his ejection fraction was, but I am eternally hopeful.

—Dr. C.

COVID-19: HEART DISEASE RISKS RISE AFTER INFECTION

In December 2020, a week before cardiologist Stuart Katz was scheduled to receive his first COVID-19 vaccine, he came down with a fever. He spent the next two weeks wracked with a cough, body aches and chills. After months of helping others to weather the pandemic, Katz, who works at New York University, was having his own first-hand experience of COVID-19.

On Christmas Day, Katz’s acute illness finally subsided. But many symptoms lingered, including some related to the organ he’s built his career around: the heart. Walking up two flights of stairs would leave him breathless, with his heart racing at 120 beats per minute. Over the next several months, he began to feel better, and he’s now back to his normal routine of walking and cycling. But reports about COVID-19’s effects on the cardiovascular system have made him concerned about his long-term health. “I say to myself, ‘Well, is it really over?’” Katz says.

In one study1 this year, researchers used records from the US Department of Veterans Affairs (VA) to estimate how often COVID-19 leads to cardiovascular problems. They found that people who had had the disease faced substantially increased risks for 20 cardiovascular conditions — including potentially catastrophic problems such as heart attacks and strokes — in the year after infection with the coronavirus SARS-CoV-2. Researchers say that these complications can happen even in people who seem to have completely recovered from a mild infection.

Some smaller studies have mirrored these findings, but others find lower rates of complications. With millions or perhaps even billions of people having been infected with SARS-CoV-2, clinicians are wondering whether the pandemic will be followed by a cardiovascular aftershock. Meanwhile, researchers are trying to understand who is most at risk of these heart-related problems, how long the risk persists and what causes these symptoms.

COMMENTARY:

 The heart and Covid are connected from a variety of angles.

Obese people with high blood fats, diabetes, the metabolic syndrome tend to have atherosclerosis and heart problems, making them more susceptible to severe Covid and long Covid. Covid loves to involve the lining of blood vessels and the heart, the endothelium, where the number of ACE receptors are high.

The respiratory tract and lung are a particular target for Covid, and reduced oxygen from lung involvement can compromise the hard-working heart.

 Heart cells, cardio myocytes, can be directly infected with the virus. Even Covid vaccines can rarely produce myocarditis, raising the possibility that there is some antigenic similarity between the virus and heart cells, similar to the beta hemolytic streptococcus and the heart which sets up rheumatic fever. 

If this similarity is real, the tendency of Covid to compromise the immune system and produce a cytokine storm in severe cases could therefore specifically involve the heart.

The nature article indicates several different varieties of heart problems and is a recommended read. From my personal standpoint, arrhythmias were mentioned, and I already have trouble with a couple of different types, AF and NSVT.

To make definite statements about the likelihood of heart involvement in Covid is problematic. The patients reported on were infected with an earlier strain of Covid, and the present one, BA.5, seems to be milder, and  may not be as hard on the heart as previous strains. Many more people are now immunized, and the most susceptible patients may have passed away. There are medications to take, such as remdesivir, and even select immune globulins, such as an immuno-suppressed friend of mine was given when he contracted Covid recently.

The bottom line for me is that I am 90 years old and have no desire to let Covid have a crack at me, so I avoid big gatherings, and wear a mask whenever I am exposed.

—Dr. C.

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Women’s Heart Disease: Three Steps To Lower Risk

Heart attack symptoms for women

The most common heart attack symptom in women is the same as in men — some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes.

But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe heart attack pain as pressure or tightness. And it’s possible to have a heart attack without chest pain.

Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

  • Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort
  • Shortness of breath
  • Pain in one or both arms
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue
  • Heartburn (indigestion)

These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.

Mammograms: How They Can Reveal Heart Disease

The routine mammograms women receive to check for breast cancer may also offer clues to their risk for heart disease, new research suggests.

White spots or lines visible on mammograms indicate a buildup of calcium in breast arteries. This breast arterial calcification is different from coronary artery calcification, which is known to be a marker for higher cardiovascular risk. For the study, researchers followed 5,059 postmenopausal women (ages 60 to 79) for six and a half years. They found that those with breast arterial calcification were 51% more likely to develop heart disease or have a stroke than those without calcification. The study was published March 15, 2022, in Circulation: Cardiovascular Imaging.

Heart Disease: Molecular Mapping To Predict Risk

Vulnerability to heart disease can be projected before symptoms occur, Mayo Clinic discovered in preclinical research. This proof-of-concept study revealed that heart muscle changes indicate who is vulnerable to disease later in life. These changes can be detected from blood samples through comprehensive protein and metabolite profiling. This exploratory mapping, conducted in the Marriott Family Comprehensive Cardiac Regenerative Program within Mayo Clinic’s Center for Regenerative Medicine, is published in Scientific Reports.

“The team implemented state-of-the-art technologies to predict who is vulnerable and who is protected from heart disease,” says Andre Terzic, M.D., Ph.D., a Mayo Clinic cardiologist and the senior author. “In this era of post-genomic medicine, the acquired foundational knowledge provides guidance for development of curative solutions targeted to correct the disease-causing maladaptation.” Dr. Terzic is the Marriott Family Director, Comprehensive Cardiac Regenerative Medicine, for the Center for Regenerative Medicine and the Marriott Family Professor of Cardiovascular Research.

Technology: AI Offers Window On Heart Health

AI can pick up on subtle clues from a person’s physiological state such as their heart rate, the time differences between each heartbeat or the electrical signals their heart produces in order to identify irregularities that point to medical conditions.

“Being able to detect atrial fibrillation just by wearing a wristwatch all the time, that kind of relatively simple technology could actually have a massive impact,” explained consultant cardiologist Tim Fairbairn, cardiovascular imaging lead at Liverpool Heart and Chest Hospital in the UK.

Clinical: Yale Women’s Heart Health Program

The Women’s Heart and Vascular Program provides state-of-the-art cardiac care for women with heart disease, as well as expert screening of women at risk for heart disease.

Heart disease remains the number one killer of American women and there is a great need for specialized care directed at women’s cardiac needs. The Women’s Heart and Vascular Program is dedicated to screening, educating and treating women at risk for, or with established heart disease.

Under the direction of Lisa A. Freed, MD, FACC, the Women’s Heart and Vascular Program incorporates not only her expertise in cardiology, but also collaborates with experts in diabetes, menopause, nutrition, exercise physiology, and smoking cessation. In addition, Dr. Freed consults with experts in sleep apnea and mental health professionals for intervention with co-existing depression and anxiety.

The program also focuses on clinical research in collaboration with Yale’s Women’s Health Research Center in order to advance the care of women with heart disease. 

2021 HEART RESEARCH: TOP FINDINGS OF CARDIOLOGISTS

Coronary artery bypass graft (CABG) was supported as superior to fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for three-vessel coronary artery disease (CAD). PCI failed to meet noninferiority criteria at 1-year follow-up in a study comparing outcomes between FFR-guided PCI using contemporary stents and CABG. This adds to existing evidence showing superior outcomes with CABG in patients with the most-complex CAD.

The sodium–glucose transporter-2 (SGLT-2) inhibitor empagliflozin was found to be beneficial in heart failure with preserved ejection fraction. Empagliflozin is the first medication shown to improve outcomes in this population. It’s unknown if this is a class effect of all SGLT-2 inhibitors, but this could be a game changer.

Poor-quality carbohydrates were linked to cardiovascular mortality, around the world. Consumption of higher-glycemic-index carbohydrates was associated with higher rates of cardiovascular disease and mortality in countries all around the world. These data are particularly important because lower-income countries often have diets high in refined carbohydrates, which may worsen cardiovascular disparities.

New guidelines for managing valvular heart disease were released. These new guidelines add or elevate several recommendations for transcatheter therapy, and they lower thresholds for intervention in some conditions.

The editors of Circulation: Cardiovascular Quality and Outcomes addressed racial-ethnic disparities. The editors affirmed that structural racism is a public health crisis and that the scientific publishing community can play a role in addressing it.

Tricuspid annuloplasty for moderate regurgitation during mitral-valve surgery was of unclear benefit. Annuloplasty was associated with less progression of moderate tricuspid regurgitation but more pacemakers at 2 years. Unfortunately, this mixed outcome does not clearly inform the decision on performing annuloplasty at the time of surgery, and longer-term follow-up is needed.

Immediate angiography was not beneficial in out-of-hospital cardiac arrest without ST elevation. Patients with out-of-hospital cardiac arrest who did not have ST elevation on their initial ECG did not benefit from immediate angiography. Although a potential coronary culprit was identified in about 40% of patients, neurologic injury was by far the most frequent cause of death, negating any benefit from coronary revascularization.

Many statin side effects are related to the “nocebo” effect. A creative study enrolled 60 people with statin intolerance and gave them 12 randomly ordered 1-month treatment periods: 4 periods of no medication, 4 of placebo, and 4 of statin. Symptom intensity did not differ between placebo and statin periods and, interestingly, some even had more symptoms on placebo. This demonstrates that some cases of “statin intolerance” may be related to the “nocebo” effect.

Shorter duration of dual antiplatelet therapy following PCI/stent placement was found to be acceptable in patients with high bleeding risk. A large, randomized trial found that 1 month of dual antiplatelet therapy provided similar clinical outcomes and a lower bleeding risk than 3-to-6-month regimens for this challenging patient subset.

De-escalation” of dual antiplatelet therapy for patients undergoing PCI for acute myocardial infarction (MI). This industry-funded study evaluated patients who had received 1 month of aspirin plus ticagrelor after acute MI and stent placement and “de-escalated” half to aspirin plus clopidogrel. At 1 year, there was significantly less bleeding in the de-escalation group and a nonsignificant trend toward fewer ischemic events as well.