Dr. Manohar will be speaking at the Lowell Community Wellness Center.
Wednesday, March 17 at 7 PM
314 S. Hudson Road, Lowell, MI 49331
(the Lowell Community Wellness Center/Gilda’s Place)
Lowell Community Wellness Lecture
March 16th, 2010Ventricular Septal Defect
March 9th, 2010Ventricular septal defect (VSD) is a hole in the wall (called the septum) that separates the right and left ventricles.
When the left ventricle contracts, in addition to sending blood out the aorta, it sends oxygenated blood through the defect to the right ventricle. In the right ventricle, this oxygenated blood mixes with the normal unoxygenated blood coming back from the body and then it is all pumped to the lungs. The result is more blood than normal is pumped to the lungs and, in turn, more blood than normal returns from the lungs to the left atrium and left ventricle. If the hole is more than small, then this increase in blood returning to the left atrium and left ventricle causes these chambers to enlarge and work harder than normal. If the enlargement is significant, then the left ventricle may not function efficiently and blood can back up into the lungs. This may lead to signs of congestive heart failure. In addition, large ventricular septal defects can lead to increased blood pressure in the arteries in the lungs (called pulmonary hypertension) and may eventually lead to damage in the small arteries in the lungs.
What are the warning signs and symptoms of ventricular septal defect?
There are often no obvious signs or symptoms of a ventricular septal defect in a newborn infant. After several days or weeks, the following may appear and suggest the presence of a VSD:
- Abnormal heart murmur
- Labored breathing
- Poor feeding
- Poor growth
How is ventricular septal defect detected?
Often the first sign of a ventricular septal defect is the presence of an abnormal heart murmur. This often leads to the performance of an echocardiogram, which generally will show the precise anatomy of the defect as well as its size and effect on the heart function.
What are the treatment options for ventricular septal defect?
Ventricular septal defects are small and most of these will get even smaller or close by themselves. A medium-sized ventricular septal defect may need to be closed surgically but it is often possible to wait several years to see if the VSD will get smaller on its own. Small VSDs often never need treatment. If the VSD, however, is large enough to cause the left ventricle to be enlarged and there are no signs that the hole is getting any smaller, surgery is generally recommended. Large ventricular septal defects will require surgical closure, the timing of which depends on the degree of symptoms. Symptoms often can be improved by giving the infant medication such as:
- Diuretics, which decrease the amount of fluid retention in the body by increasing urine output
- Digoxin, which helps the heart pump more efficiently
- After-load reducing medicines, which improve the forward flow of blood from the left ventricle to the aorta
If, in spite of medication, the infant is still symptomatic, then surgery will be necessary. If the symptoms are improved but the hole is large, then a short period of observation is possible to see if there are any signs that the hole is getting smaller. Recently, some ventricular septal defects have been closed in the cardiac catheterization laboratory with devices that are undergoing research. The vast majority still require surgical closure, however.
Tetralogy of Fallot
March 9th, 2010Tetralogy of fallot is a name given to a complex of four cardiac malformations when they appear together.
The above mentioned cardiac malformations are: ventricular septal defect, pulmonary stenosis, right ventricular hypertophy, and overriding aorta. For practical purposes, however, the signs and symptoms of tetralogy of fallot depend on the ventricular septal defect and the degree of pulmonary stenosis. The VSD is a large hole in the wall between the ventricles. Pulmonary stenosis is a narrowing in the outlet from the right ventricle to the pulmonary artery. With more severe degrees of pulmonary stenosis, the right ventricle delivers less and less blood to the arteries to the lungs for oxygenation. With increasing degrees of pulmonary stenosis, more and more of this blue blood (lacking oxygen) is directed away from the lungs, through the ventricle septal defect, and back to the left ventricle and out to the body. Thus, as the pulmonary stenosis becomes increasingly narrowed, the patient becomes more blue.
What are the warning signs and symptoms of tetralogy of fallot?
The most common warning signs and symptoms of tetralogy appear in a newborn or young infant and include bluish coloring around the mouth, lips, tongue, and fingertips (called cyanosis) and presence of a heart murmur.
Occasionally, early on, the degree of pulmonary stenosis will be very mild and the symptoms will be that of a ventricular septal defect, including labored breathing, poor feeding, and poor weight gain.
How is tetralogy of fallot detected?
Usually tetralogy patients are initially referred for evaluation because of a heart murmur or cyanosis. This leads to performing an echocardiogram and the diagnosis of tetralogy is documented. Occasionally, a cardiac catheterization with angiography is needed prior to surgery to obtain more detailed anatomical information.
What are the treatment options for tetralogy of fallot?
Patients with tetralogy of fallot generally undergo surgery in infancy. Most often a complete repair is performed with patch closure of the ventricular septal defect and widening of the outflow from the right ventricle to the pulmonary artery. Occasionally, it is too dangerous to perform open-heart surgery on a particular infant and a temporizing surgery is performed called a shunt, which allows more blood to flow to the lungs. The open-heart repair is then deferred until the patient gets bigger. Sometimes, infants will have periods of inconsolable crying accompanied by a severe increase in cyanosis (called “Tet Spells”) requiring immediate notification to the child’s physician.
Sudden Cardiac Death
March 9th, 2010Heart attack survivors and others may be at risk of sudden cardiac death (SCD).
A heart attack can damage heart tissue causing your heart to misbehave electrically. Abnormal and dangerously fast electrical signals, or arrhythmias, limit your heart’s ability to pump blood to the body and brain. This can also occur for no known reason.
Risk Factors
Most patients have no obvious symptoms of SCD so it is important to be familiar with the possible risk factors. Risk factors may include:
- Previous heart attack: A heart attack is a mechanical problem with the plumbing of your heart. A blockage in one of the arteries nourishing your heart prevents blood and oxygen from reaching your heart muscle, therefore part of your heart tissue dies.
- Impaired pumping function of the heart muscle: The pumping function of your heart or “ejection fraction” after a heart attack may be impaired. This is due to scarring of the tissue of your heart due to the heart attack.
- Rapid heart rhythms: You could experience a very brief period of short bursts of fast heartbeats called non-sustained ventricular tachycardia (VT). These rapid heartbeats may or may not be noticeable to you. Non-sustained VT is often the precursor to SCD.
- Family history of heart arrhythmias.
Early identification is key. If you are at risk it is important to talk to your doctor.
Diagnosis
If you have had a heart attack, your doctor may perform one or more of the tests below to make a diagnosis.
- Echocardiogram – The echocardiogram will determine your heart’s pumping function or “ejection fraction”. During this test, ultrasound waves are bounced off your heart muscle to provide a moving image. Based on the results of this test your doctor will determine if further testing is needed.
- Holter monitoring – A holter monitor is an external monitor that is worn on a 24-hour outpatient basis. The monitor records your heart’s electrical activity including any episodes of arrhythmia. Your doctor will analyze the recording to see if there are any abnormal rhythms, either rapid or slow or irregular.
- Electrophysiology (EP) testing – EP testing is commonly conducted in an electrophysiology lab. Wires will be threaded from your groin up into your heart. Then, an electrical stimulus will be delivered through the wires in an attempt to excite your heart into a fast rhythm. If your heart is stimulated into VT, medications will be administered intravenously to try and suppress the arrhythmia. While you are on the medications, the stimulus will be delivered again to see if your heart can still be induced into VT.
Stroke
March 9th, 2010A stroke occurs when the flow of oxygenated blood to the brain is suddenly interrupted.
A stroke can be categorized in one of two ways: 1) ischemic stroke which is caused by the buildup of fatty deposits (plaque) in a brain artery or by a blood clot which blocks blood flow in a brain artery and 2) hemorrhagic stroke which is caused by a sudden rupture of an artery that leads to the brain. When blood flow to the brain ceases, the brain receives no oxygen. This can cause temporary or permanent brain damage, and with time, can result in death.
What are the warning signs and symptoms of a stroke?
A stroke can have several different symptoms. Do not ignore them- every second counts. When treated early, your chance of survival increases and the likelihood of permanent brain damage decrease.
Be aware of the following symptoms and signs of stroke:
- Difficulty feeling or moving on one side of the body
- Slurring or trouble speaking
- Brief episode of a weakness of an arm or leg
- Momentary loss of vision
- Darkening of the vision in one eye
- A shade or curtain coming down over one eye
- Dizziness or confusion
- Faint (syncope) or feeling faint
Do not ignore the warning signs of a stroke. If you or someone you know is experiencing any of the above symptoms, immediately call 9-1-1 to get to emergency hospital care as quickly as possible.
How is a stroke detected?
A stroke is usually detected too late. That is, when a patient reaches the emergency room. However, if you experience early symptoms of a stroke, there are imaging tests that can determine if you are having a stroke or need treatment to prevent one.
Stroke is a progressive disease caused by several cardiovascular risk factors. These include family history of stroke, old age, diabetes, smoking, high blood pressure, high cholesterol, overweight, lack of exercise, and stress. We invite you to take a simple and free risk assessment to evaluate your own risk factors.
If you are at risk for stroke (e.g. have multiple risk factors), talk to your physician. He or she can perform imaging tests to detect cardiovascular disease early and prevent a stroke. These imaging studies include:
- Carotid Duplex Scan (ultrasound)
- Computed Topography (CT) Scan
- Magnetic Resonance Imaging (MRI)
What are the treatment options for a stroke?
The best medicine for treatment of stroke is prevention. This means making lifestyle changes to reduce your cardiovascular risk factors. A stroke occurs when fatty deposits (plaque) build up inside the arteries leading to your brain. This is called peripheral vascular disease, and is progressive–meaning the plaque accumulates over time. But if you modify your risk factors that contribute to peripheral vascular disease (and coronary artery disease as well), you can maintain, and in some cases, reverse the effects of the disease.
Should you or someone you know have a stroke, a treatment plan will be developed specific to the severity of your condition. Your doctor will monitor your health carefully to prevent further brain damage. Then your doctor may recommend therapy to deal with consequences of stroke. This may include physical, speech and occupational therapy.
Peripheral Vascular Disease
March 9th, 2010Peripheral vascular disease, or peripheral artery disease, is caused by the same atherosclerotic plaque that causes coronary artery disease.
Frequently, atherosclerosis is not confined to one artery but may involve arteries in other areas as well. Some of the more commonly affected peripheral areas are the arteries in the legs, arms, kidneys and neck. Some patients may have both coronary artery disease and peripheral vascular disease.
What are the symptoms of peripheral vascular disease?
As the internal lining of the artery thickens from the atherosclerotic plaque, the blood vessel becomes increasingly constricted and blood flow diminishes. Therefore, the symptoms you experience depend on what artery is affected and how severely the blood flow is reduced.
Some of the symptoms you may experience in the affected areas are:
- Claudication (dull, cramping pain in hips, thighs or calf muscle)
- Buttock pain
- Numbness or tingling in leg, foot or toes
- Changes in skin color (pale, bluish or reddish discoloration)
- Changes in skin temperature, coolness
- Impotence
- Infection/sores that do not heal
- Ulceration or gangrene
- Uncontrolled hypertension (high blood pressure)
- Renal failure
Risk Factors
Clinical studies have identified factors that increase the risk of peripheral vascular disease. Some of these factors cannot be changed while others can be managed to greatly reduce your risk of the disease. They are as follows:
- Diabetes: PVD is not uncommon among those individuals with diabetes. This correlation is due to complications of the disease which may cause damage to the large and small blood vessels of the legs and feet.
- Smoking: The risk of PVD dramatically increases in smokers. When a person stops smoking, regardless of how much he or she may have smoked in the past, their risk of Peripheral Vascular Disease rapidly declines.
Any of the following risk factors may also increase your chance of developing peripheral vascular disease:
- Obesity (being overweight)
- High blood pressure
- A family history of the disease
- Lack of exercise
- Coronary artery disease
- Age greater than 65
- Dyslipidemia (abnormal cholesterol)
Diagnosis
If your doctor suspects that you have peripheral vascular disease or if you have symptoms of the disease, several tests are performed to diagnosis it. Such diagnostic tests include:
- Ankle Brachial Index (ABI)
- Ultrasound Doppler Test
- Angiogram
Treatment
Many treatments can be used to improve blood flow through the peripheral arteries. The latest interventions for treating peripheral vascular disease can bring relief and are more cost effective than surgery. Most procedures require no more than an overnight hospital stay, and patients enjoy an early return to most normal activities. Techniques available to you include:
- Angioplasty and Stents
- Atherectomy – a minimally invasive intervention procedure that involves the excision and removal of blockages by catheters with miniature cutting systems.
Each of these techniques treats the build-up of plaque by removing it, compressing it, or displacing it. During these procedures, the physician will periodically inject a contrast dye and take x-ray pictures to determine whether or not the artery is sufficiently open. If the blockage is extremely long or has become very hard and calcified with time, it may be resistant to any of these interventions. In these cases, surgery may be required to bypass the problem area.
Non-invasive interventions may also be used to treat PVD. These interventions include:
- Exercise – exercise may improve arterial blood flow to the affected limb. Exercise is not recommended for people with severe rest pain, venous ulcers, or gangrene. Consult your doctor before beginning an exercise program.
- Positioning – It is recommended that people do not cross their legs, which may interfere with blood flow. Some people manage swelling by elevating their feet at rest. You should elevate your feet but not above the heart level. Extreme elevation slows arterial blood flow to the feet. Again, talk with your doctor about positioning.
- Promoting vasodilation (increasing the diameter of blood vessels) – vasodilation can be achieved by providing warmth to the affected extremity and preventing long periods of exposure to cold. It is recommended that people maintain a warm environment at home and wear socks or insulated shoes at all times. Never apply direct heat to the limb, such as with the use of a heating pad ore extremely hot water to reduce the risk of burns.
- Stop smoking – Smoking causes vasoconstriction (decreases the diameter of blood vessels), which can interfere with adequate blood flow to the limbs. Emotional stress, exposure to cold temperatures, and caffeine can all cause vasoconstriction.
- Medications – Prescribed medications are often given to patients with chronic peripheral vascular disease. Anti-platelet medications (such as Aspirin and Plavix) may be prescribed. Other medications may be prescribed depending on the patient’s condition.
- Controlling hypertension – Controlling high blood pressure can improve blood flow through the blood vessels and reduce the constriction of blood vessels.
What is the difference between peripheral vascular disease and peripheral artery disease?
Peripheral artery disease is a type of peripheral vascular disease. People with peripheral vascular disease have problems that alter blood flow through both the arteries and veins. Those people with peripheral artery disease have problems only with blood flow through the arteries.
Patent Foramen Ovale
March 9th, 2010A condition from infancy, patent foramen ovale often goes undiagnosed through adulthood.
When a baby/fetus is developing in the uterus, a small, flap-like opening forms in the wall (septum) between the right and left upper chambers of the heart (right atrium and left atrium). This opening occurs naturally before birth and usually closes within days of being born. In about one out of five people, however, this opening persists throughout life and is called patent foramen ovale (PA-tunt fo-RA-mun o-VA-le), or PFO. The opening that occurs in patent foramen ovale may allow blood to flow from the heart’s right atrium to the left atrium and vice versa.
Most people with patent foramen ovale don’t know they have the condition. That’s because patent foramen ovale usually doesn’t cause any signs or symptoms. Most people with patent foramen ovale don’t need treatment, although closing the opening with a device is an option and may be helpful in patients with prior stroke or difficult to control headaches.
Patent Ductus Arteriosus
March 9th, 2010Patent ductus arteriosus (PDA) is a condition found in infants that occurs when the ductus arteriosus does not close after birth.
The ductus arteriousus is an artery that is present in the fetus to connect the pulmonary artery to the aorta. This vessel is necessary to divert blood flow away from the lungs because the lungs are collapsed prior to birth. When the infant is born and begins to breathe, there is a stimulus which causes the ductus arteriousus to close. If the ductus arterious remains open (patent), blood will flow from the aorta to the pulmonary artery and out to the lungs, causing an excess of pulmonary blood flow.
What are the warning signs and symptoms of patent ductus arteriosus?
If a PDA is small, there are generally no symptoms. If the PDA is large, however, there will be a significant excess in blood flow to the lungs, causing the heart to have to pump more blood. This can lead to signs of congestive heart failure, including labored breathing, difficulty feeding, and poor growth.
How is patent ductus arteriosus detected?
The first sign is often the presence of a heart murmur. The diagnosis is documented with an echocardiogram.
What are the treatment options for patent ductus arteriosus?
For many years, the only treatment option for patent ductus arteriosus was surgical closure. More recently, it has been possible to close certain types of PDA during a cardiac catheterization. The catheter is threaded through the ductus. Either a metallic coil or an expandable metallic device is then passed through the catheter and out the end of the catheter until it is positioned within the ductus. This will then obstruct flow through the ductus and the ductus will no longer be patent. Some ductuses, however, are of a certain size and shape that surgery is still necessary.
Mitral Valve Prolapse
March 9th, 2010Mitral valve prolapse (MVP) is a common heart disorder in which the valve leaflet or leaflets bulge upward into the left atrium.
Mitral valve prolapse affects approximately 2 percent of adults in the United States. The mitral valve is the third of four valves in the heart and is located between the left upper and left lower chamber of the heart (the left ventricle and left atrium respectively). Mitral valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.
In most people, mitral valve prolapse is harmless and doesn’t require treatment or changes in lifestyle. In some people with mitral valve prolapse, however, the progression of the disease requires treatment. This may be as simple as medication and healthy lifestyles or, if needed, surgical evaluation and surgery.
Hypertension
March 9th, 2010Blood pressure, is the pressure of the blood against the walls of the artery. When this pressure is high, it is eferred to as hypertension.
The higher your blood pressure, the harder your heart must work to pump blood to the rest of your body. Without proper treatment, high blood pressure can lead to many cardiovascular problems, including dilated pumping chamber and valvular defects.
Two measurements are taken to determine your blood pressure:
- Systolic: The systolic number reflects the pressure against the arterial walls immediately after the heart pumps. This is the top number in the reading. For example, if your blood pressure is 120/80 (described as 120 over 80), the systolic measurement is 120.
- Diastolic: The diastolic number represents the pressure against the arterial walls when your heart is at rest briefly, between heart beats. This is the bottom number in the reading. Using the same example, if your blood pressure is 120 over 80, the diastolic measurement is 80.
Goal blood pressure for most people is 110-120/70-80 mmHg.
What are the warning signs and symptoms of high blood pressure?
In most cases, high blood pressure does not cause any symptoms. Many people assume that it is related to high levels of stress, tension, and nervousness, but the truth is you can be a very relaxed, easy-going person and still have high blood pressure.
The best way to know if you are hypertensive is to have your blood pressure checked by your health care provider. This should be done routinely. High blood pressure can develop over time and many treatment options are available to manage the disease. Prompt treatment can reduce your risk of stroke, heart attack, kidney failure, and congestive heart failure.
How is high blood pressure detected?
High blood pressure is detected using a blood pressure monitoring device called a sphygmomanometer. Blood pressure varies constantly so if your doctor detects high blood pressure on one occasion, he or she will usually take another couple of readings to ensure the measurement is accurate. You may be asked by your doctor to purchase a home B/P monitoring device.
What are the treatment options for high blood pressure?
Your doctor will discuss with you a variety of ways to control and/or lower your blood pressure. As with all cardiovascular risk factors, lifestyle changes are sensible, effective ways to reduce your chances of developing cardiovascular disease. To reduce blood pressure in particular, it is essential to:
- Exercise regularly
- Stop smoking
- Eat a well-balanced diet low in salt, fat and cholesterol
- Manage stress levels
- Control your weight
- Reduce caffeine and other stimulants
In some cases, lifestyle changes will not achieve the required results. In this situation, your doctor may discuss medications and/or procedures that can help to reduce your blood pressure.
Medications
- Adrenergic Receptive Blockers (Alpha and/or Beta blockers) help regulate the heart beat and decrease oxygen demand, lower B/P, protect against heart attack and heart failure
- Diuretics remove excess fluid from the body
- Calcium channel blockers decrease heart contractility and spasms, dilates arteries, help to treat high B/P and Angina
- Angiotensin Converting Enzyme (ACE) Inhibitors dilate blood vessels to increase blood flow, guard against arteriosclerosis (plaque in the arteries), help strengthen heart muscles, lower B/P
- Angiotensin II Receptor Blockers dilate blood vessels to increase blood flow
- Central Nervous System (CNS) Active Agents reduce nerve activity which can cause B/P to rise