Heart rhythm disorders, or arrhythmias, are not something to be ignored.
Arrhythmias may cause the heart to beat too slowly (less than 60 beats per minute is bradycardia) or too fast (greater than 100 beats per minute is tachycardia). Arrhythmias may occur from the upper two chambers of the heart, called atrial arrhythmias or supraventricular arrhythmias or may originate from the lower chambers of the heart, called the ventricles. Some arrhythmias are benign, and have little, if any, clinical significance. Other arrhythmias are malignant, and may be life-threatening. A given arrhythmia may have different clinical significance in different individuals, primarily depending upon whether or not the individual has structural heart disease or, most importantly, diminished cardiac performance (congestive heart failure).
What are the warning signs and symptoms of heart rhythm disorders?
An individual’s response to any particular arrhythmia may vary. Individuals may have no symptoms whatsoever, or may present with sudden, catastrophic collapse followed by loss of consciousness or sudden death. In between these two extremes, is an entire gamut of symptoms including insignificant palpitations to marked fluttering in one’s chest associated with shortness of breath, chest pain, sweating, and lightheadedness. These are important symptoms to recognize and should not be ignored. These should be discussed with your physician to help determine their significance
How are heart rhythm disorders detected?
Your doctor has several ways of evaluating heart rhythm disorders. The electrocardiogram (ECG) is a common, noninvasive, quickly performed test that allows your physician to assess exactly what rhythm your heart is in. This test, however, does not provide any information as to what heart rhythm you may have had at any time in the past, particularly associated with one or more symptoms. To help evaluate rhythm disturbances that may occur while you are not at the doctor’s office, you may have a 24 hour ambulatory electrocardiographic monitoring test (24 hour holter monitor recording) or a long term ECG analysis called an event monitor which may allow for recording of abnormal heart rhythms for 14 days or 1 month. Other adjunctive tests that may be helpful include treadmill testing, or electrophysiology testing, which is an invasive procedure involving placement of catheters into the vascular system.
What are the treatment options for heart rhythm disorders?
Treatment options depend entirely on the severity of the heart rhythm problem. Many heart rhythm problems do not require any treatment at all, other than reassurance. Other heart rhythm problems may be easily treated with various anti-arrhythmic medications. Some rapid heart rhythm problems may be treated with catheter ablation or implantation of a pacemaker-type device known as an implantable cardioversion defibrillator. Finally, and rarely, one may require an open-heart surgical procedure to eliminate the source of heart rhythm problems.
Acute myocardial infarction, or heart attack, is a complete blockage of blood flow in a coronary artery.
When a complete blockage in a coronary artery occurs, oxygen-rich blood is prevented from reaching part of the heart muscle. Usually a blood clot or piece of plaque (fatty deposits called atherosclerosis) causes the blockage in the heart artery. When blood cannot reach this part of the heart muscle, the muscle may become permanently damaged. The faster you get to a hospital for treatment, the less damage to your heart. If you wait too long, the condition can be fatal.
More than one million Americans have a heart attack each year. Better treatment options and community awareness have decreased mortality rates over the years. Yet, lack of recognition or a disregard for the warning signs of a heart attack is still a major contributor to death. In the event of a heart attack, every second counts.
What are the warning signs and symptoms of a heart attack?
The warning signs and symptoms of a heart attack are gender-specific, meaning men and women have very different feelings and experiences when a heart attack is occurring.
Men typically experience the following common warning signs of a heart attack: moderate to severe chest pain, dizziness, shortness of breath, nausea, radiating pain in the arms and chest.
Despite the fact that chest pain is often a key warning sign of a heart attack, some women who have a heart attack experience their pain in other areas. A woman’s pain may be in the back, arm, neck, shoulder, and/or throat. Also, women will typically have more “non-pain” symptoms than men. These include vomiting, nausea, fatigue and shortness of breath.
It is also surprisingly common for people to experience no symptoms at all. This is especially true of diabetics and those over the age of 75. We recommend that these individuals visit their family physician and/or cardiologist on a regular basis to continually monitor their health.
Do not ignore the warning signs of a heart attack. If you or someone you know is experiencing any of the above symptoms, immediately call 9-1-1 because it is quite possibly signaling the onset of a heart attack.
How is a heart attack evaluated?
A heart attack is evaluated using several different methods, but most often your doctor will order a simple test called an electrocardiogram (EKG). This test monitors the electrical activity within the heart and can aid your doctor in determining if your condition is angina or if you are actually having a heart attack. The doctor may also order blood tests that can determine if there is damage to the heart muscle.
Other possible tests your doctor may order to evaluate a possible Heart Attack are:
Laboratory testing, i.e. heart enzymes
EKG
Nuclear Test
Echocardiogram
Coronary (heart) Angiography
If your doctor determines that you are having a heart attack (or have already had one), he or she will quickly stabilize the condition in several ways.
What are the treatment options for a heart attack?
If you are experiencing the symptoms of a heart attack, e.g. chest pain, shortness of breath, etc., call 9-1-1 immediately. Delaying your arrival at the hospital can increase your risk of dying. Do not drive yourself or someone else having a heart attack.
Take one regular strength (preferably non-coated) aspirin or 4 baby aspirin, and chew the aspirin(s) to increase absorption into your system. The aspirin works to thin the blood, allowing more oxygen-rich blood to get through the narrowed artery to your heart. Aspirin has proven to reduce fatality by about 25% in heart attack victims.
If someone you know is having a heart attack, call 9-1-1 and have them chew and swallow an aspirin. If they are unconscious, first call 9-1-1, and then begin mouth-to-mouth resuscitation (CPR) to provide oxygen to the brain, heart, and the rest of the body. If you are unfamiliar with how to perform CPR, the emergency personnel on the phone line can assist you until help arrives.
Upon arrival to the hospital, if you have not already taken an aspirin, a doctor may instruct you to chew an aspirin right then. An electrocardiogram (EKG) will be done immediately to determine if a heart attack is occurring, or has already happened. If the diagnosis is a heart attack, the doctor will promptly begin treatment to open the blockage, and get much needed oxygen-rich blood to your heart.
Procedures
There are a variety of procedures that can treat and stabilize the lining of the coronary arteries. These procedures include:
Acute Angioplasty
Balloon Angioplasty
Coronary Stenting
Coronary Artery Bypass Surgery
Thrombolytic Therapy
Medications
Several medications are available if you are suffering a heart attack. Here are some possibilities:
Anticoagulants (blood thinners) such as aspirin
Nitroglycerin which dilate the blood vessels to increase blood flow
Adrenergic Receptive Blockers (Beta blockers) help regulate the heart beat and decrease oxygen demand, lower B/P, protect against Heart Attack and heart failure
Angiotensin Converting Enzyme (ACE) Inhibitors dilate blood vessels to increase blood flow, guard against arteriosclerosis (plaque in the arteries), help strengthen heart muscles, lower blood pressure (B/P)
Calcium channel blockers decrease heart contractility and spasms, dilate arteries, help to treat high B/P and angina
Statins to lower cholesterol
Prevention
If you have been diagnosed with a heart attack, it is extremely important to make lifestyle changes that reduce the risk factors which have contributed to your heart disease. Making such changes can maintain, and in many cases, reverse the damage done to your heart. Changing your lifestyle to reduce your risk factors is one of the most important steps you can take to improve your overall cardiovascular condition.
Diabetes, a disease in which the amount of glucose (sugar) in the blood is too high, has an effect on cardiovascular health.
If you have diabetes, your pancreas, the organ in your body responsible for producing insulin, is defective in producing or adequately utilizing insulin…or both, which leads to elevated blood sugar levels.
Insulin is vital for converting sugars into fuel so your body can function properly. When these sugars are not turned into energy, your body responds by creating more glucose from stored fats. Over time, these sugars accumulate in the bloodstream. If the condition is left untreated, it can cause very serious complications such as kidney, eye, and nerve damage and heart and vascular disease.
The two main types of diabetes are:
Type I (also called juvenile diabetes) develops in children and young adults. In Type I Diabetes, the body does not produce enough or any insulin. Cells in the pancreas responsible for this function have been destroyed.
Type II (also called adult-onset diabetes) is the most common form of diabetes, affecting roughly 16 million Americans. In Type II Diabetes, the body cannot produce enough insulin, or the insulin produced is ignored by the body. This condition develops in usually older, overweight people.
There is no cure for diabetes, but many treatments are available for diabetics which enable them to lead long and healthy lives. It is important to follow your doctor’s treatment plan precisely, as this can add many “quality” years to your life.
What are the warning signs and symptoms of diabetes?
The warning signs of diabetes, both Type I and Type II, are similar. The main difference is that Type I Diabetes usually develops much more quickly. It is important to be aware of the symptoms of diabetes because early detection and treatment is the best way to avoid permanent complications.
If you have any of the symptoms below, contact your Primary Care Physician immediately:
Sweet, fruity breath (also called “acetone breath”)
Increased thirst
Fatigue
Weight loss
Excessive trips to the bathroom to urinate, especially at night
Blurred vision
How is diabetes detected?
Diabetes is diagnosed by a blood test. Your doctor will order a lipid profile, which examines your cholesterol and your glucose levels. If your glucose levels are high, it is an indicator that you may have diabetes. Diabetes can also be diagnosed by a simple urine test which shows the presence of glucose in the urine.
What are the treatment options for diabetes?
The key is to keep your sugar levels within your target range by maintaining a healthy lifestyle and by using insulin injections. Your physician will determine your target range.
Type I diabetics must be treated with insulin injections because the body is unable to produce insulin on its own. Two to four insulin injections are required daily.
For all diabetics, lifestyle changes are a must. This includes stopping smoking, exercising regularly, eating a balanced diet (low in carbohydrates, fat and sugars), and maintaining a healthy weight, cholesterol level and blood pressure level. It is important that all people lead a healthy lifestyle. However, it is especially important if you are a diabetic. Why? Because all of these risk factors compound the severity of diabetes.
Coronary artery disease is a result of plaque buildup within the artery walls.
A gradual build-up of fat (cholesterol) in the coronary ateries causes them to become blocked or narrowed. This build-up is called “atherosclerotic plaque” or simply “plaque.” When this occurs, the arteries cannot deliver sufficient blood to the heart. This condition is referred to as coronary artery disease (CAD).
What are the warning signs and symptoms of coronary artery disease? Angina pectoris (also referred to as chest pain) is a warning sign of coronary artery disease. Do not ignore this symptom, as it is often a sign of an impending heart attack. If you or someone you know is experiencing angina, call
9-1-1 at once to get to an emergency room immediately.
It is important to understand that men and women experience angina differently. These differences are described below:
Men typically experience the following common warning signs of a heart attack: severe to moderate chest pain, dizziness, shortness of breath, nausea, radiating pain in the arms and chest.
Women may have symptoms that differ greatly from men. While chest pain is often a key warning sign of a heart attack, some women who have a heart attack do not experience chest pain. A woman’s pain may be in the back, arm, neck, shoulder, and/or throat. Also, women will typically have more “non-pain” symptoms than men. These include vomiting, nausea, fatigue and shortness of breath.
It is also surprisingly common for people to experience no symptoms at all. Additionally, some people experience persistent flu-like symptoms. This is especially true of diabetics and those over the age of 75. We recommend that these individuals visit their family physician and/or cardiologist on a regular basis to continually monitor their health.
How is coronary artery disease detected? Usually doctors suspect that you have cardiovascular disease based on your cardiovascular risk factors. During a physical exam, your doctor will evaluate many of these risks, which include diabetes, high blood pressure, high blood cholesterol, previous family history, history of smoking, etc…
We invite you to take our free online cardiovascular risk assessment at any time to evaluate your cardiovascular health. It only takes about ten minutes, and your results are generated immediately. Please print and bring these results to your next physician visit.
In addition to evaluating your risk factors, noninvasive imaging techniques are available to detect coronary artery disease at its earliest stage. Young or old, it is extremely important to be aware of coronary artery disease. It is a progressive disease that can lead to death or heart failure. There are many treatment options which can slow the progression or, in some cases, reverse the effects of the disease.
The non-invasive and catheterization techniques available to detect coronary artery disease are listed below:
• Electrocardiography (EKG)
• Treadmill
• Stress Testing
• Echocardiography (Ultrasound)
• Nuclear Studies
• Computer Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Diagnostic Cardiac Catheterization
What are the treatment options for coronary artery disease? The safest, simplest treatment for coronary artery disease is lifestyle change. Evaluate your modifiable cardiovascular risks–high blood pressure, high blood cholesterol, smoking, exercise, diet, weight, etc.–and work to reduce the damaging effects of each risk factor. If you smoke, stop smoking; if you do not exercise, develop an exercise regimen; if you have high blood pressure, devise a plan with your physician to reduce your blood pressure level; and so on.
As coronary artery disease progresses, medications, interventional catheterizations, or cardiovascular surgery may be required. Your doctor will work with you to devise a plan that is best suited for you.
Medications Thousands of medications are available to treat coronary artery disease. The most common medications prescribed are blood pressure lowering medications, cholesterol lowering drugs, and anticoagulants (blood thinning) medications.
Procedures
To rid the arteries of atherosclerosis (plaque buildup), which prevents oxygen-rich blood from reaching the heart muscle, it is often necessary to treat plaque with invasive surgical techniques. Depending upon the degree of coronary artery disease, plaque build-up can be treated with catheter interventions or with surgery. These procedures are:
• Balloon Angioplasty
• Coronary Stenting
• Brachytherapy
• Drug-Eluting Stenting
• Intracoronary Ultrasound
• Atherectomy
If needed, your doctor may refer you to a cardiovascular surgeon for coronary artery bypass surgery (CABG). This is more invasive than any of the procedures listed above, but it is extremely safe and reliable.
Congestive Heart Failure (CHF) is one of the most prevalent diagnoses today.
Congestive heart failure is a combination of heart dysfunction along with symptoms of heart failure such as shortness of breath or leg swelling. The heart dysfunction can be systolic, in which the ejection fraction is low and heart muscle strength is weakened. Or it can be diastolic heart dysfunction, in which the heart filling and relaxation is impaired because of heart muscle stiffness.
The goal of treating heart failure is to improve quality of life and life expectancy, prevent unnecessary emergency room visits and hospital admissions, and promote use of heart strengthening medications.
What are the warning signs and symptoms of heart failure?
Symptoms of heart failure may get worse over time. The most common symptoms include:
Shortness of breath-this may get worse over time.
Fatigue-this happens because your muscles aren’t getting enough oxygen from your blood.
Palpitations-this is a feeling that your heart is racing or that your heartbeat is irregular.
Chronic cough-this is due to the fluid buildup in the lungs.
Fluid retention-especially in the legs and feet.
Other symptoms can include heart palpitations (feeling that your heart is racing or that your heartbeat is irregular). Some people also have nausea and lack of appetite, dizziness, fainting spells, or difficulty concentrating.
Heart failure severity is described by the New York Heart Failure Class System:
Class I- has heart failure but does not yet have heart failure symptoms
Class II-has symptoms with mid-level exercise
Class III-has symptoms with low-level exercise
Class IV-has symptoms even when at rest.
How is heart failure detected?
Heart failure can be diagnosed in a variety of different ways. Your doctor will decide which tests are appropriate for you.
What are the treatment options for heart failure?
People suffering from heart failure can almost always be helped by changes in lifestyle. For instance, it is important that people with heart failure eat low-fat foods and especially low-salt (low-sodium) foods. Your doctor may also recommend cardiac rehabilitation as part of your treatment, which will show you the best exercises to do, suggest new eating habits, order medications to reduce your symptoms, and help you regain or learn new lifestyle and coping skills.
Also, check with your doctor about pain relievers you may need for aches and pains. Heart failure patients should avoid one type of pain reliever: non-steroidal anti-inflammatory medications. This includes medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve), among others. Ask your doctor or nurse which pain relievers you can take.
Other types of treatment may depend on your test results. Your doctor may ask you to report worsening symptoms, blood pressure readings, and/or your weight on a regular (sometimes daily) basis. If you report changes in those areas, your doctor can act accordingly to change your treatment.
Pacemaker Therapy
Some types of heart failure can be improved by pacemakers which enhance the timing and vigor of the way the heart beats. Some can correct lethal arrhythmias which are more common in heart failure. These and other devices are being used more commonly in the treatment of heart failure.
Coarctation of the aorta is a constriction in the aorta causing obstruction to blood flow.
The narrowing most often is located just after the aorta gives its branches to the head and arms as it curves down to supply the lower body. The left ventricle of the heart has to work harder to force blood past the narrowed area. This may cause the left ventricle to weaken and may cause an elevation of blood pressure before the narrowed area.
What are the warning signs and symptoms of coarctation of the aorta?
Coarctation of the aorta generally presents in one of two ways. An infant, often in the second week of life, may not tolerate the obstruction and may develop signs of significant congestive heart failure including labored breathing, poor feeding, and decreased urination. Some infants, however, tolerate the obstruction very well and their hearts rapidly compensate. The diagnosis is then often made later in life, either in childhood or adulthood, and the person may be referred to a specialist because of the presence of a heart murmur or elevated blood pressure in the upper extremities.
How is coarctation of the aorta detected?
Coarctation of the aorta may be suspected because of the following: a heart murmur, elevated blood pressure in the upper extremities with lower blood pressure in the lower extremities, and/or absent pulses in the lower extremities.
The following tests can confirm the presence of the coarctation:
Echocardiography, MRI Scan, CT scan, Cardiac Catheterization
What are the treatment options for coarctation of the aorta?
The treatment of coarctation of the aorta for many years has been surgical repair. This is still the treatment of choice in many infants. In older children and adults, a newer non-surgical approach can be offered. A catheter is threaded from the artery in the groin up to the area of narrowing. The catheter has a balloon on the end of it and when the narrowed area is straddled, the balloon is inflated to expand the area. Sometimes a metallic stent is placed over the balloon. When the balloon is inflated, the stent enlarges along with the balloon to open up the narrowed area. The balloon is then deflated and removed; the metal stent retains its enlarged shape and keeps the artery open.
Angina Pectoris, more commonly known as chest pain, is a sign that the heart needs more oxygen.
Angina can be caused by an insufficient supply of blood and oxygen to the heart muscle. The body responds to this oxygen deprivation with pain (many people refer to the pain as tightness or pressure) in the chest, arms, shoulders, neck and/or jaw. Some people also experience shortness of breath, fatigue, sweating, dizziness and/or vomiting. It is most frequently caused by narrowing of the coronary arteries. The narrowing is due to buildup of fatty deposits (plaque or Atherosclerosis) within the artery walls.
Remember, you may not have chest pain as your heart disease equivalent. If you have symptoms that are not readily explained, always think about heart disease. It is the number one disease that affects Americans. Do not ignore your warning signs, as they may be an indicator of an impending cardiac event. Angina usually lasts several minutes. If your angina lasts more than 5 minutes, don’t delay in getting help. Dial 9-1-1 right away. Do not drive yourself to the hospital.
There are two types of angina:
Stable angina typically occurs when you exercise or feel stress, so it is somewhat predictable, and it feels the same way each time. Stable angina usually disappears when you rest and/or take your medication.
Unstable angina is less predictable and may occur even when you rest. It can occur more frequently, feel more severe, and/or last longer than stable angina. Your doctor may be more concerned about unstable angina, since it can mean there is a blocked artery in your heart. In some people, unstable angina can be a sign of a heart attack.
What is the cause?
Angina is most often caused by plaque buildup in the coronary arteries (heart arteries). Plaque is made up of fatty substances, like cholesterol, in your blood. The plaque builds up slowly, over a number of years. In time, plaque can harden and narrow the coronary arteries. Eventually the plaque can slow or block blood flow to the heart, cut off the oxygen supply, and cause angina.
Atherosclerosis is the general medical term for plaque buildup that clogs arteries. Coronary artery disease (CAD) is the medical term for atherosclerosis in the coronary arteries in particular. Angina, therefore, often results from atherosclerosis and from CAD.
Of course, chest pain is not always caused by reduced oxygen supply to the heart. Sometimes, chest pain is not related to heart vessel blockages at all. It could instead be related to valvular heart disease, other structural heart disease, or a lung condition.
How is chest pain evaluated?
If you have angina, your doctor may suggest one or more tests to find out the underlying cause. The test results can also help your doctor choose the best treatment(s) for you.
What are the treatment options for angina?
There are a variety of treatment options for angina which are targeted according to the cause of the pain. They include:
Procedure(s) that open narrowed arteries (for example, Angioplasty) and Coronary Artery Bypass Surgery
Medication(s) (such as Nitroglycerin, Beta Blockers, Calcium Channel Blockers) and ACE Inhibitors
Lifestyle changes to reduce your risk factors (e.g. smoking cessation, exercise, diet, etc).
Changing your lifestyle to reduce your risk factors is one of the most important steps you can take to improve your overall cardiovascular condition.
Heart disease is the #1 killer of men AND women. How can it be prevented and can it be reversed?
In this video, Dr. Prerana Manohar of the Heart and Wellness Institute and other panelists discuss the answers to these questions.
About 85-90% of heart disease is preventable. Many things a person does in the course of a day affects the heart- what is eaten, habits formed (from exercise to smoking), quality of sleep, the environment, and stress. These heart health factors can be controlled and making changes in the necessary areas can certainly prevent and even reverse heart disease and the underlying symptoms.
Experts agree diet plays a very important role in heart, health. “Diet” in this case, simply means what is eaten, not restricting calories. Issues such as high blood pressure, high cholesterol, and diabetes all increase a person’s risk of heart disease. Blood pressure, cholesterol, diabetes, and other food related health issues will be controlled if healthy diet choices are made and the risk of heart disease as a result will be diminished.
Exercise is also very important in having a healthy heart. Dr. Manohar recommends a half hour of exercise every day, even if it is just a brisk walk. And if that’s not feasible, at least a half hour four to five times a week is recommended. For every half hour of exercise done, the risk of heart disease is lowered by 10%.
The quality of sleep a person gets is also an important factor in preventing heart disease. Repeated low oxygen levels, as seen with sleep apnea, have a significant effect on the heart and can even lead to congestive heart failure.
Not only do smoking and second hand smoke have a detrimental effect on the heart, but recent studies have shown a correlation between smog and pollution and the occurrence of coronary artery disease. This is why it is important to NOT smoke, to try and stay away from second hand smoke, and to protect the environment.
Dr. Manohar suggests preventing heart disease and reducing risk by meeting with one’s primary care physician to assess risk and make a plan of action. This should include eating right, exercising regularly, getting good quality sleep, and getting rid of bad habits. Then, the risk factors, plan of action, and actions taken should be reassessed regularly. This action plan and regular assessment will contribute to a healthier heart.
With some lifestyle changes and continuous healthy choices, heart disease risk CAN be reduced and even reversed.
Thrombosis is the presence of a blood clot within an artery or vein.
This blood clot has the potential to break away from an artery or vein and either partially or completely block the flow of blood to a particular area of the body. Depending upon the area of blockage, this can result in a variety of debilitating or fatal conditions, including stroke and heart attack.
How does a blood clot occur?
When the flow of blood slows down, usually due to inactivity, illness, or injury, the blood may collect in a small pool. If this pool of blood hardens or coagulates, a blood clot forms. Thrombus formation can also occur from a condition known as endothelial dysfunction. This causes a disruption in the integrity of the inner walls of blood vessels, and is usually associated with high blood pressure and/or diabetes.
How is a Blood Clot detected?
Blood clots are difficult to detect, as they often do not cause any symptoms. Doctors will often look for a blood clot following a surgical procedure (especially a knee or hip replacement surgery). If your doctor suspects that you may have a blood clot, he or she will order any of the following tests to make the diagnosis:
Doppler Ultrasound
Angiography
Computed Topography (CT) Scan, especially if they suspect a clot in the lungs
Ventilation-Perfusion Scan (Nuclear lung scan) if clot is suspected
What are the treatment options for a blood clot?
To treat thrombosis, your physician may prescribe medications or perform specific procedures. Much of the treatment depends upon the severity of the blood clot.
Medications
There are three types of medications your doctor may prescribe:
Anti-Coagulants weaken blood clots and prevent them from expanding in size
Thrombolytic agents dissolve blood clots, and are generally prescribed for larger, more dangerous clots; the most common thrombolytics are TPA (Tissue Plasminogen Activator) and TNK (a newer version of TPA)
Antiplatelet Agents are preventive drugs, and work to avoid new clot formation
Various therapies and procedures can also destroy Blood Clots. These are described below.
Intravenous (IV) Therapy
Thrombolytic Therapy: Thrombolytic agents, such as streptokinase or TPA, can be given intravenously (IV) to dissolve larger clots in the blood vessels. Thrombolytic therapy requires hospitalization to 1) administer the IV drug and 2) monitor patients for complications usually related to excessive bleeding.
Procedures
Patients who cannot tolerate anti-coagulant medications due to allergies or excessive bleeding, or who develop a pulmonary embolism, may require a minimally invasive procedure such as filters or thrombectomy (embolectomy) to destroy blood clots.
An atrial septal defect (ASD) is a hole in the wall (called the septum) that separates the right and left atria.
This hole allows a portion of the blood coming back from the lungs to pass from the left atrium to the right atrium, and then back to the lungs, without passing to the body. The proportion of the blood coming back from the lungs that passes through the hole depends on the size of the hole. If the hole is large enough, then the blood passing through the hole will cause the right atrium and right ventricle to be enlarged, and the excess blood flow to the lungs could cause damage to the small arteries in the lungs.
What are the warning signs and symptoms of atrial septal defect? There usually are no obvious signs or symptoms of an atrial septal defect in a newborn or a child. Occasionally, growth will be slow or there may be more frequent pulmonary infections. A long-standing enlargement of the right heart may cause abnormal heart rhythms in adults.
How is atrial septal defect detected? An abnormal heart murmur is usually the first clue to the presence of congenital heart disease. Often an echocardiogram will be obtained which documents the presence of the atrial septal defect. It is important to precisely determine the location and size of the hole using surface and transesophageal echocardiography.
What are the treatment options for atrial septal defect? A small atrial septal defect generally does not cause complications in childhood and no treatment is required. If found in infancy, many of these small atrial septal defects will close on their own over time.
If the atrial septal defect is large enough to cause cardiac enlargement, and has not gotten any smaller after several years of age, then closure of the atrial septal defect is warranted. For many years, the mainstay of treatment was open-heart surgery, either by simply stitching the hole closed or by sewing a patch over the hole to close it. The patch is generally obtained from the wall of the sac surrounding the heart.
A newer, non-surgical approach to atrial septal defect closure has been developed and is becoming widely used. In this procedure, a catheter is threaded from a vein in the groin, up through the venous system to the right atrium, and then across the hole. An umbrella-like device is then threaded through the catheter and placed in a position that straddles the hole to seal it. The catheter itself is then removed.
