Heart Disease: Overview, Causes, Risk Factors, Treatment, Prevention
New heart valve replacement technologies offer hope for high-risk patients
A significant number of people with heart disease will benefit from less invasive transcatheter heart valve replacements in future, finds a review of updated practices in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj080064.pdf
The most effective treatment for aortic stenosis, a common heart condition that shows with angina, loss of consciousness due to lack of blood flow, congestive heart failure, or sudden death, is valve replacement. However, large cohorts of people are never referred for this surgery because they are deemed too high-risk even though the prognosis is grim without the treatment.
New technologies such as stent-based transcatheter valve replacement can now be performed on high-risk patients without the need for sternotomy (an incision through the sternum), a heart-lung bypass machine or stopping the heart. Patients can also recover in a step-down unit compared with monitoring and treatment in an intensive care unit.
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Big hearts may mean trouble in cross-country skiers
Like many other top athletes, Harald Sjoelshagen, a 66-year-old Norwegian, has an enlarged heart. When doctors noticed it in the early 1960s, he was already training hard, skiing or running almost every day. He didn’t need to worry, they told him, because he showed no sign of underlying disease.
So for the next 45 years, he strapped on his Fischer cross-country skis almost every March to compete in Norway’s Birkebeiner ski marathon, slightly longer than the 31 miles facing contestants on Sunday in this year’s Winter Olympics.
Then in 2004, researchers studying heart health in veteran Birkebeiner skiers told Sjoelshagen he had a heart-rhythm disturbance called atrial fibrillation, which can cause fatigue and strokes.
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Does happiness make for a healthy heart?
People who are usually happy and enthusiastic are less likely to develop heart disease than those who tend to be glum, scientists said on Thursday, and boosting positive emotions could help cut heart health risks.
U.S. researchers said their observational study was the first to show an independent relationship between positive emotions and coronary heart disease, but stressed that more work was needed before any treatment recommendations could be made.
“We desperately need rigorous clinical trials in this area. If the trials support our findings, then these results will be incredibly important in describing specifically what clinicians and/or patients could do to improve health,” Karina Davidson of Columbia University Medical Center wrote in the study in the European Heart Journal.
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Heart Conditions Can Threaten Pediatric Patients
While heart disease is traditionally associated with adults, pediatric patients face a number of cardiac conditions that can impact their health.
“The most common pediatric cardiac condition is a congenital heart defect - a structural problem in the heart that can range from small holes between heart chambers to the absence of entire chambers or valves in the heart,” said Robert Mangano, M.D., Director, Pediatric Cardiology, Geisinger Health System.
According to the American Heart Association, approximately 36,000 babies are born each year with congenital heart defects.
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Gene tests fail to predict women’s heart risks
Gene tests that combined over 100 genetic mutations proved ineffective at predicting a woman’s risk of a heart attack or stroke, U.S. researchers said on Tuesday.
They said high cholesterol, high blood pressure and a family history of heart disease were the strongest predictors of a woman’s heart disease risk.
Many variations of genes have been identified that are associated with a higher risk of heart disease, but combining them into a risk prediction score did not help researchers find which women in a study of 19,000 participants would eventually develop the disease.
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Heart Failure Worse When Right Ventricle Goes Bad
New research from the University of Alabama at Birmingham (UAB) suggests that the ability of right side of the heart to pump blood may be an indication of the risk of death to heart-failure patients whose condition is caused by low function by the left side of their heart.
The ability of the two chambers of the heart, the left and right ventricles, to pump blood is described as ejection fraction. Healthy individuals typically have ejection fractions between 50 and 65 percent in both chambers.
In findings reported in January in Circulation, a journal of the American Heart Association, researchers at UAB say that low right-ventricular ejection fraction (RVEF) increased the risk of death in patients with systolic heart failure — heart failure associated with low left-ventricular ejection fraction.
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Heart patients worry about health costs
The monthly mortgage payment is the heaviest expense facing the average U.S. family but for heart patient Frank Amend, an engineer from North Carolina, the biggest cost is healthcare.
That’s why Amend and tens of thousands of patients with similar conditions find themselves at the center of debate over how to reform the $2.5 trillion U.S. healthcare sector - and whether the country can afford it.
Amend, 48, has insurance through his employer but since suffering a heart attack in 2003, his monthly out-of-pocket costs for premiums and medications have grown to consume as much as 20 percent of his wages, and he has become a strong advocate for broad healthcare overhaul.
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C-reactive Protein: Not a Routine Test for Heart Disease
For women concerned about heart disease, routine testing of high-sensitivity C-reactive protein (hs-CRP) is controversial, says Thomas Behrenbeck, M.D., Ph.D., a Mayo Clinic cardiologist, in an interview in the February issue of Mayo Clinic Women’s HealthSource.
CRP is a marker for inflammation within the body and has been promoted as a screening test for coronary artery disease. Inflammation can play an important role in atherosclerosis, the process in which fatty deposits build up in coronary arteries. Interest in hs-CRP originated when studies found that patients with unstable angina or chest pain had high levels of this marker. Researchers found that hs-CRP could be used to predict who would go on to have a heart attack. But other studies have shown that hs-CRP isn’t a predictor of heart attack risk in people without symptoms of heart disease.
“If hs-CRP is elevated, it is worrisome because it tells you there is inflammation in the body,” says Dr. Behrenbeck. “But it doesn’t mean the inflammation is related to coronary artery disease.”
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Study examines course and treatment of unexplained chest pain
Fewer than half of individuals who have “non-specific” chest pain (not explained by a well-known condition) experience relief from symptoms following standard medical care, according to a report in the February 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, one-tenth of those with persistent chest pain undergo potentially unnecessary diagnostic testing.
More than half of patients with chest pain are classified as not having an underlying heart condition, according to background information in the article. Some have another well-established medical condition, such as upper respiratory tract infection, but for many no pathophysiologic cause can be found. Such non-specific chest pain “is a frequent phenomenon in primary care,” the authors write. “However, knowledge about the course and outcome of this condition is sparse.”
Julia Anna Glombiewski, Ph.D., of Philipps-University of Marburg, Germany, and colleagues studied 807 patients (average age 57.6 years) with non-specific chest pain who visited 74 German primary care offices in 2005 and 2006. The clinicians recorded their preliminary diagnoses, along with any investigations and treatments related to their patients’ chest pain. Patients were contacted by phone six weeks and then six months after the initial consultation.
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Optimism about heart risks may be a good thing
Men who believe they are at low risk of a heart attack may in fact live longer than those with a more pessimistic outlook, a new study suggests.
Researchers found that of more than 2,800 adults followed for 15 years, men who thought they were at lower-than-average risk of a heart attack were 70 percent less likely than other men to die of heart disease or stroke—even with their objective risks taken into account. This relationship was not seen among women though.
The findings, published in the Annals of Family Medicine, suggest that a dose of optimism may be helpful in controlling heart disease risk. An awareness of one’s heart disease risk factors can certainly be a good thing. But problems may arise when people become fearful about their odds of suffering a heart attack, according to lead researcher Dr. Robert E. Gramling, of the University of Rochester in New York.
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