Diagnosing Heart Problems

There are numerous tests available to diagnose problems affecting the heart. These range from noninvasive screenings to more involved procedures that may include the use of high-tech imaging equipment. If you are experiencing symptoms such as chest pain, shortness of breath, or irregular heartbeats, your physician may recommend diagnostic tests to assess the health of your heart.

“Common testing for exploring these symptoms includes electrocardiogram, echocardiogram, or a stress test,” says Joy Gelbman, MD, a cardiologist at the Weill Cornell Greenberg Center. Other tests that may be employed, depending on the patient’s signs and symptoms, include heart rhythm monitors, cardiac MRI tests, cardiac computerized tomography (CT) scans, and electrophysiology tests—for electrical issues such as irregular heart rhythms.

Signs, Symptoms and Family History

If you do not have heart disease symptoms but have a family history of heart disease, you are a likely candidate for a heart health evaluation. “Having a first-degree relative with early onset of cardiovascular disease, such as heart attack, arrhythmias, or sudden unexplained death, might warrant additional testing,” explains Dr. Gelbman. Even in the absence of symptoms or a family history of heart disease, your doctor might recommend further evaluation. “For example, testing might be warranted based on what is found on your physical exam, such as a heart murmur, elevated blood pressure, or swollen legs,” says Dr. Gelbman.

Guide to Common Heart Tests

Here is a guide to some common tests that are frequently ordered when your heart health is being evaluated:

Electrocardiogram (ECG). An ECG is a quick and painless test that checks your heart’s electrical system and heart rhythm. This test will be ordered if you have risk factors for an enlarged heart such as high blood pressure, or symptoms of heart disease such as chest pain, shortness of breath, palpitations, or an irregular heartbeat.

Echocardiogram. This exam uses sound waves to create detailed images of the heart in motion. An echocardiogram can help determine if a valve is narrowed or leaking. “An echocardiogram tells us if the heart is strong, or stiff, and if the valves are working normally,” explains Dr. Gelbman.

Stress tests. These tests involve walking on a treadmill or riding a stationary bike, while the heart is monitored. Exercise stress tests help reveal how the heart responds to physical activity and whether heart disease symptoms occur during exertion. For patients who are not physically fit enough to participate in an exercise stress test, there are alternatives. “We can administer an intravenous medication stress test that shows how blood flows through the heart, or a CT scan that looks at the coronary arteries and assess for blockages,” Dr. Gelbman explains.

Cardiac catheterization. This test can show blockages in the heart’s arteries. Under sedation, in a surgical setting, a long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on x-ray images taken during the test.

Consistent Follow-up

“It is important to have regular followup with your doctor since some cardiac risk markers such as high blood pressure, high cholesterol, and elevated blood sugar do not always cause symptoms,” says Dr. Gelbman. Many of the major risk factors for heart disease can be modified and controlled with lifestyle changes such as a heart-healthy diet and exercise.

Your doctor will decide which tests are important both to diagnose what you have and to rule out certain diseases. Diagnosis is the first critical step in planning a treatment strategy. “Your doctor will work with you to figure out if your symptoms are cardiac in nature,” says Dr. Gelbman, “and if they are, they will help to identify the appropriate treatment strategies.”

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Cardiac Arrest vs. Heart Attack

Although some people may use the terms heart attack and cardiac arrest interchangeably, these conditions are not the same. Cardiac arrest occurs due to an electric malfunction in the heart. In contrast, a heart attack is akin to a plumbing problem and results from blockages in the coronary arteries. If those blockages aren’t opened, part of the heart normally nourished by that blood supply starts to die.

Symptoms of a heart attack can be mild and start slowly, or they can be intense and abrupt. The heart, however, keeps on beating. And that’s the key difference between these two conditions—during cardiac arrest, the heart stops beating suddenly and often without any warning. According to the American Heart Association (AHA), immediate action using CPR can double or even triple the chances of survival after cardiac arrest.

“During cardiac arrest, the electrical signals that direct your heart to pump blood unexpectedly malfunction. This causes a disruption in your heart’s ability to provide blood to your body. Suddenly, your entire body including your lungs and your brain, is devoid of all the oxygen and nutrients it needs to survive,” explains Marwah Shahid, MD, cardiology fellow at UCLA Medical Center. “If someone is in cardiac arrest outside of the hospital, it is very unlikely that they will survive without CPR. By doing CPR we are mimicking the function of the heart, which is pumping the nutrient-rich blood to our vital organs.”

Immediate Action Matters

Every second counts when the heart stops beating. With each passing minute, a person’s chance of survival goes down by about 10%. While calling 911 is, of course, a vital part of the protocol in an emergency, it can take a while for first responders to arrive on the scene. Therefore, the actions of bystanders can make the difference between life and death, as well as how much disability a person can incur if they do survive cardiac arrest. The longer a person is with limited or no blood flow to the brain, the greater and more widespread the risk of brain damage. That’s why immediate action to try to restart the heart is so very important.

Myths About CPR

There are several reasons why people might be reluctant to perform CPR, especially on a stranger. Below are the most common misunderstandings.

• Fear of being sued. Every state has Good Samaritan laws designed to protect bystanders who perform CPR or give other assistance to someone who is injured or otherwise in danger. The law applies to someone performing CPR, using a defibrillator/AED (automated external defibrillator), or simply giving chest compressions in an attempt to restart/restore a person’s normal heart rhythm. Defibrillators send an electric shock to the heart to try to restore its normal rhythm. AEDs are portable defibrillators installed in many public places. Though AEDs are not difficult to use (most have voice prompts), training is very helpful. You can learn how to use one in a CPR class.
• Mouth-to-mouth reluctance. Part of the classic CPR process includes giving mouth-to-mouth resuscitation, which can make people reluctant to do/learn CPR, especially after the COVID-19 pandemic. However, statistics show that about 70% of cardiac arrests occur at home, so chances are high that you will know the person needing CPR. Also know that hands-only (chest compression only) can still be effective in the first few minutes after cardiac arrest. Even if you haven’t taken a CPR class, doing chest compressions can help. Call 911 and while you are waiting for first responders, put your phone on speaker mode and the 911 operator can talk you through the process. Become acquainted with the process by viewing the AHA’s hands-only CPR video, which you can find online here: https://tinyurl.com/AHAhands-OnlyCPR.
• Doing more harm than good. Emergencies are stressful by nature. Nonmedical professionals might be quite nervous that they may not perform CPR correctly and therefore cause more harm than good. But according to Dr. Shahid, the most harmful thing you can do is doing nothing at all. “Almost 90% of people who have an out-of-hospital cardiac arrest will die, and immediate CPR can double or triple their chance of survival,” she stresses. “As a cardiology fellow at UCLA who has witnessed cardiac arrest countless times, the victims that are most likely to survive are those who had immediate CPR at the time of their cardiac arrest.”

Risk Factors for Cardiac Arrest

Cardiac arrests can happen to anyone: professional athletes, young children, and older adults. In most cases, physicians may not know what triggered the event. In adults, the most common causes are ventricular fibrillation or ventricular tachycardia, which are types of arrhythmias (abnormal electrical signals in the heart). To diagnose an arrhythmia, your doctor will ask you about any symptoms, lifestyle habits, and other risk factors of arrhythmias. Your doctor will also do a physical exam, which may include these steps:

• checking for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure

• taking your pulse to find out how fast your heart is beating

• assessing the rate and rhythm of your heartbeat

• listening to your heart for a heart murmur

• testing for signs of other diseases, such as thyroid disease, which could be causing arrhythmias.

Other risk factors for cardiac arrest include a blockage in one of the arteries of the heart and problems with the heart muscle.

More than half of cardiac arrests occur in people who didn’t know they had a heart problem. Cardiac arrest can sometimes be prevented by treating arrythmias and preventing the progression of heart disease with medications or advanced therapies. In younger people, an unfortunate but common cause of cardiac arrest is drug overdose. In children, the most common cause is choking. CPR and First Aid classes can provide you with the skills to act quickly and potentially save a life.

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“Women can sometimes have more severe A-fib symptoms if the condition is left untreated,” explains Joy Gelbman, MD, a cardiologist at Weill Cornell Medicine. “Without treatment, A-fib can lead to heart failure, stroke, and other cardiovascular complications.”

What Is A-fib?

Your heart rate is controlled by an electrical signal that travels through your heart along a certain pathway and stimulates the upper chambers (atria) and lower chambers (ventricles) to contract in harmony. But with A-fib, the heart’s electrical activity becomes chaotic, and the atria beat very rapidly in an irregular rhythm. Because of these irregularities, the atrial beat is no longer effective in pumping blood to the ventricles. Instead, blood may pool in the atria, raising the risk of blood clots. A blood clot that dislodges can block circulation in an artery that carries blood to the brain, potentially causing a stroke. In fact, having A-fib increases the risk of stroke by a factor of five.

Abnormalities in the heart’s structure can cause A-fib. Other causes of A-fib include damage to the heart caused by a heart attack, hypertension, aging, or some other medical condition such as thyroid disease.

Women Are at Higher Risk

It’s unclear why women with A-fib have increased rates of heart disease and stroke, but experts think it may have something to do with the fact that women are older and tend to have multiple medical issues when they are diagnosed with A-fib. Where stroke is concerned, there is evidence that women with A-fib are 50 percent less likely than men to be prescribed anticlotting drugs.

Women also tend to have different risk factors precipitating A-fib. For example, high systolic blood pressure (the top number in a blood pressure reading) is a significant risk factor for A-fib among women, while men who have a higher body mass index, diabetes, a heart murmur, or a history of heart attack are more likely to develop A-fib than women with these risk factors.

Symptoms and Diagnosis

“The most common symptoms of A-fib are palpitations, which manifest as a feeling of skipping or racing heartbeat, shortness of breath, and chest discomfort,” Dr. Gelbman explains. “A-fib also can cause weakness or lightheadedness.” However, some people with A-fib have no symptoms.

An electrocardiogram (ECG or EKG) monitors the heart’s electrical activity; your doctor will order this test if he or she suspects you have A-fib. However, if your heart is not in A-fib during the screening, the test won’t detect it. You may have to wear a Holter monitor, which continuously records your heart’s electrical activity, for a day or two, or have a small implantable monitor placed under your skin.

Other possible tests include a stress test, which evaluates heart function during physical activity, and echocardiography, which uses sound waves to create moving images of the heart’s valves and chambers.

Treatment Options

The first-line treatment for A-fib is medication. Some drugs help control heart rate, while others help the heart maintain a normal rhythm. You’ll also be given a blood-thinning medication to help prevent blood clots (see What You Should Know).

If your A-fib does not respond to drug treatment, more invasive therapies will be considered. “There is a procedure called a cardioversion, which is essentially a ‘shock’ to the heart that resets it to a normal rhythm,” Dr. Gelbman explains. “If symptoms persist and are bothersome, another procedure, called ablation, can be done.”

Ablation involves having a catheter with a special tip inserted through a vein and threaded to the heart, where it is used to burn (ablate) the area of tissue that is disrupting the heart’s electrical signal. Ideally, this enables the signal to travel along the proper pathway, but some patients need more than one ablation procedure to achieve a normal, stable heart rhythm.

Lifestyle Changes Can Help

A healthy lifestyle can help prevent A-fib and contribute to an improved outcome if ablation is performed.

“Eat healthfully, exercise regularly, and maintain a healthy weight,” advises Dr. Gelbman. “Limiting caffeine and alcohol also can be helpful, since these sometimes trigger A-fib. And take steps to reduce your stress level.”

Dr. Gelbman adds that if you have sleep apnea, it should be treated, since untreated sleep apnea can sometimes lead to heart arrhythmias. Also, follow your doctor’s instructions to control other stroke risk factors, such as high blood pressure and diabetes.

The post An Irregular Heartbeat May Be a Sign of Atrial Fibrillation appeared first on University Health News.

A: Hiccups occur due to involuntary spasms of the diaphragm, a sheet of muscle that separates the chest from the abdominal cavity. Your diaphragm moves down when you inhale, creating a vacuum that pulls air into the lungs, and moves up when you exhale, helping to expel air from your lungs. Hiccups are triggered by something, such as a drink nearly “going down the wrong way,” carbonated drinks, alcohol, a large meal, excitement, or stress. For reasons that are unclear, triggers such as these cause the brain to signal the diaphragm to move down, pulling air in so quickly that your vocal cords suddenly close, resulting in the “hic” sound.
    It is unusual for hiccups to be a symptom of a more serious condition, but in rare cases they may occur if something irritates or damages the nerves connected to the diaphragm (such as a hiatal hernia, or enlarged thyroid gland). They also may be related to gastroesophageal reflux disease, diabetes, kidney disease, central nervous system damage after trauma (such as a stroke or traumatic brain injury), and anesthesia.
    Hiccups typically go away without treatment (holding your breath for a few seconds, sipping cold water, or breathing into a paper bag may help). If an underlying illness is causing the hiccups, treating the illness may help. If an attack of hiccups won’t resolve, mention the problem to your doctor since he or she may want to investigate further.
Rosanne M. Leipzig, MD, PhD
Geriatric Medicine

Q: Can you tell me more about quinoa and how I can use it in meals? 

A: Quinoa (pronounced keen-wah) resembles grains in its raw and cooked state, but it’s actually a seed. One cup of cooked quinoa contains about 5 grams (g) of fiber, and also is rich in protein, providing about 8 g. That’s about the same as an ounce of meat or cheese, but minus their harmful saturated fat. Moreover, quinoa is a “complete” protein, meaning that it contains all of the essential amino acids the body needs in the correct proportions. Besides these health benefits, quinoa is a better source of iron than red meat, and also provides folate, potassium, and magnesium. Try substituting quinoa for your morning oatmeal and top it with fruit, dried fruit, or cinnamon, and use it in place of pasta, rice, or potatoes for dinner.
Fran C. Grossman, RD, MS, CDE, CDN
Nutrition

Q: During my annual physical, my doctor detected a heart murmur. I had an echocardiogram and have been diagnosed with tricuspid valve insufficiency. Should I worry? My doctor recommends monitoring again in a couple of years.

A: The tricuspid valve is one of the four valves that ensure forward blood flow through the heart. Deoxygenated blood enters the right atrium (one of the upper chambers of the heart), which pumps it through the tricuspid valve into the right ventricle (one of the lower chambers). The right ventricle pumps the blood through the pulmonary valve into the lungs. Oxygenated blood from the lungs enters the left atrium and is pumped through the mitral valve into the left ventricle, which pumps the blood out to the body through the aortic valve.
    One or more of the heart valves can be affected by conditions that affect forward blood flow. Tricuspid valve insufficiency (also known as regurgitation) occurs when the valve doesn’t close properly after blood flows from the right atrium to the right ventricle. This enables some blood to flow back into the atrium (creating the “whooshing” sound we term a heart murmur).
    Mild tricuspid valve insufficiency is common and doesn’t usually cause any symptoms. Higher amounts of insufficiency may prompt further testing to see if there is a condition in the lungs or other heart valves contributing to the problem. The fact your doctor recommends monitoring suggests that the condition is mild. But do alert your doctor if you experience fatigue, shortness of breath with exertion, declining exercise capacity, swelling in your abdomen and/or legs, or a racing heartbeat.
Bruce Darrow, MD, PhD
Cardiology

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Restricted Bloodflow Your heart valves are situated at the exit of each of the four chambers of the heart, and maintain forward blood flow through the heart. But if any of these valves don’t open fully, blood has to flow through a narrower opening. This is what occurs in stenosis, which can affect any of the four heart valves.

“In the elderly, stenosis is frequently caused by a buildup of calcium in the valve,” explains Mount Sinai cardiologist Bruce Darrow, MD, PhD. “Calcium is present in the blood and as it flows through the aortic valve it can deposit on the valve’s three cusps.” He adds that some people are born with valves that have only two cusps (bicuspid aortic valves). “These individuals tend to develop stenosis between ages 40 and 70,” he notes. “Another possible underlying cause is rheumatic fever, which can cause scarring of the heart valves. While rheumatic fever is now rare in the United States, elderly adults who had the condition in childhood may go on to develop aortic valve stenosis because the scarring can increase calcium buildup in the valve.”

If you have aortic stenosis, your left ventricle (one of the two larger chambers at the bottom of the heart) has to work harder to pump blood into the aorta, which is the main artery transporting oxygenated blood from the heart to the body. The increased workload causes the left ventricle to thicken and enlarge so that it can pump blood with more force. “While this initially compensates for the narrowed valve opening, having to work harder than it should gradually weakens the heart and reduces blood flow to the major organs,” Dr. Darrow explains.

Mild-to-moderate aortic valve stenosis is usually asymptomatic, but as your heart weakens you may notice you feel more fatigued than usual. Other signs include shortness of breath or feeling faint upon exertion, heart palpitations (manifesting as a racing heartbeat or fluttering/skipping sensation), and angina (a sensation of pressure in the heart). If untreated, aortic valve stenosis can lead to heart failure, heart attack, and sudden cardiac death.

Conservative Treatments Many people are asymptomatic when diagnosed with aortic valve stenosis—the condition typically is picked up during a routine physical if your doctor detects a heart murmur (a whooshing sound that may occur as blood passes through a faulty heart valve). Imaging tests may be ordered to confirm the diagnosis and gauge the severity of your condition.

Although aortic valve stenosis is not usually the result of an unhealthy lifestyle, Dr. Darrow says that if you aren’t experiencing symptoms your doctor likely will recommend lifestyle strategies to maintain your heart health, such as eating a diet rich in fruits, vegetables, whole grains and healthy fats, and getting plenty of exercise to help you maintain a normal weight. Medications that may be beneficial include angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics. “ACE inhibitors can help slow ventricular enlargement, while beta-blockers help slow the heart rate,” Dr. Darrow says. “Diuretics can help lower the heart’s workload by reducing the amount of fluid in the body.”

Should You Have Surgery? Surgery to replace a failing aortic valve typically is recommended only when stenosis begins to cause severe symptoms. However, a small study published in the New England Journal of Medicine, Jan. 9, suggested that putting off aortic valve replacement until symptoms manifest may not be the best treatment approach. The study included 145 asymptomatic people with severe aortic stenosis who were randomized to receive either conservative treatment or surgery. During an eight-year follow-up, deaths from any cause occurred in five participants in the early surgery group compared to 15 in the conservative treatment group. The cumulative incidence of sudden death was greater in the conservative treatment group than the early surgery group (10 percent versus 4 percent after four years, and 32 percent versus 10 percent at eight years).

Dr. Darrow says that when deciding whether to proceed with valve replacement surgery, you and your physician must weigh the risks of surgery with those of watchful waiting. “While the latter may seem like the best option for people who are asymptomatic, aortic valve stenosis is a progressive condition that can cause irreversible damage to the heart,” he observes. “That said, this trial did not include adults age 80 and older—the participants also had few co-existing conditions and low operative risk. Operating earlier may not be the best choice for frail elderly people with asymptomatic stenosis.”

What’s Involved in Valve Replacement? Valve replacement surgery involves transplanting a mechanical or biological valve in place of the failing valve. Mechanical valves are more durable and last longer, but are associated with a greater risk for blood clots, so recipients have to take anticoagulant medications for the rest of their life. Biological valves are made from animal tissue or other non-metallic materials, or may be taken from a donated heart. “A biological replacement valve is less likely to raise the risk of blood clots, but it won’t last as long as a mechanical valve,” Dr. Darrow says. “For this reason, biological valves are more likely to be recommended for older people.”

Two methods of replacement are available: surgical aortic valve replacement (SAVR), or transcatheter aortic valve replacement (TAVR).

• SAVR This is an open-surgery procedure that requires a six-to-eight inch incision down the center of the sternum (breastbone), which is then separated so the surgeon can access the heart. During the procedure, your heart will be stopped temporarily, and you’ll be placed on a heart-lung bypass machine that will oxygenate your blood and pump it to your organs. After the old heart valve is removed, a new valve will be stitched into place and checked for leaks. If all is well you’ll be taken off the bypass machine, your sternum will be repaired, and your incision will be closed.

Dr. Darrow notes that valves replaced using SAVR may last for up to two decades. “However, the surgery is considered high risk for people whose left ventricle is failing, and for those who have had a previous heart attack,” he adds. “The recovery time is also typically several weeks.”

• TAVR is a minimally invasive procedure that is performed through a small incision in the femoral artery. A balloon catheter with a collapsible aortic valve at the tip is inserted through the incision and guided into the heart. Once the replacement valve is in position within the existing valve, the balloon is expanded to open the replacement valve. The balloon is then deflated and the catheter is withdrawn.

Recovery after TAVR is typically faster and easier, but some research suggests the procedure may come with a risk of post-operative stroke. “It also is not always suitable for people with a bicuspid aortic valve, since these are shaped differently from normal aortic valves and may not structurally support the implanted valve,” Dr. Darrow says.

If you are considering aortic valve replacement, have a discussion with your doctor about what surgical method would be safest and most effective for you—and keep in mind that beyond the valve replacement method used, your recovery and continuing wellbeing depend on following healthy lifestyle approaches that protect your heart health as well as mitigate other conditions you may have.

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“Women can sometimes have more severe AFib symptoms if the condition is left untreated,” explains Joy Gelbman, MD, a cardiologist at Weill Cornell Medicine. “Without treatment, AFib can lead to heart failure, stroke, and other cardiovascular complications.”

What Is AFib?

Your heart rate is controlled by an electrical signal that travels through your heart along a certain pathway and stimulates the upper chambers (atria) and lower chambers (ventricles) to contract in harmony. But with AFib, the heart’s electrical activity becomes chaotic, and the atria beat very rapidly in an irregular rhythm. Because of these irregularities, the atrial beat is no longer effective in pumping blood to the ventricles. Instead, blood may pool in the atria, raising the risk of blood clots. A blood clot that dislodges can block circulation in an artery and potentially cause a stroke.

Abnormalities in the heart’s structure can cause AFib. Other causes of AFib include damage to the heart caused by a heart attack, hypertension, aging, or some other medical condition such as thyroid disease.

Women Are at Higher Risk

It’s unclear why women with AFib have increased rates of heart disease and stroke, but experts think it may have something to do with the fact that women are older and tend to have multiple medical issues when they are diagnosed with AFib. Where stroke is concerned, there is evidence that women with AFib are 50 percent less likely than men to be prescribed anti-clotting drugs.

Women also tend to have different risk factors precipitating AFib. For example, high systolic blood pressure (the top number in a blood pressure reading) is a significant risk factor for AFib among women, while men who have a higher body mass index, diabetes, a heart murmur, or a history of heart attack are more likely to develop AFib than women with these risk factors.

Symptoms and Diagnosis

“The most common symptoms of AFib are palpitations, which manifest as a feeling of skipping or racing in the heartbeat, shortness of breath, and chest discomfort,” Dr. Gelbman explains. “AFib also can cause weakness or lightheadedness.” However, some people with AFib have no symptoms.

An electrocardiogram (EKG) monitors the heart’s electrical activity; your doctor will order this test if he or she suspects you have AFib. However, if your heart is not in AFib during the screening, an EKG won’t detect it. You may have to wear a Holter monitor, which records your heart’s electrical activity, for a day or two, or have a small implantable monitor placed under your skin to detect your AFib.

Other possible tests include a stress test, which evaluates heart function during physical activity, and echocardiography, which uses sound waves to create moving images of the heart’s valves and chambers.

Treatment Options

The first-line treatment for AFib is medication. Some drugs help control heart rate, while others help the heart maintain a normal rhythm. You’ll also be given a blood-thinning medication to help prevent blood clots (see What You Should Know).

If your AFib does not respond to drug treatment, more invasive therapies will be considered. “There is a procedure called a cardioversion, which is essentially a ‘shock’ to the heart that resets it to a normal rhythm,” Dr. Gelbman explains. “If symptoms persist and are bothersome, another procedure, called ablation, can be done.”

Ablation involves having a catheter with a special tip inserted through a vein and threaded to the heart, where it is used to burn (ablate) the area of tissue that is disrupting the heart’s electrical signal. Ideally, this enables the signal to travel along the proper pathway, but some patients need more than one ablation procedure to achieve a normal, stable heart rhythm.

Lifestyle Changes Can Help

A healthy lifestyle can help prevent AFib and improve the outcome of ablation.

“Eat healthfully, exercise regularly, and maintain a healthy weight,” advises Dr. Gelbman. “Limiting caffeine and alcohol also can be helpful, since these sometimes trigger AFib. And take steps to reduce your stress level.”

Dr. Gelbman adds that if you have sleep apnea, it should be treated, since untreated sleep apnea can sometimes lead to heart arrhythmias. Also, follow your doctor’s instructions to control other stroke risk factors, such as high blood pressure and diabetes.

The post Racing and Skipping Heartbeats Are Signs of Atrial Fibrillation appeared first on University Health News.

MR can advance very slowly, and symptoms may be quite mild at first. Because of this, some people may think their symptoms, such as fatigue, are just a normal part of aging, and they don’t investigate further. It’s also possible to have a failing valve, experience sudden symptoms, and then discover a major valve problem.

Once the valve is disordered, it cannot repair itself. Merely having a disordered valve does not automatically mean it will advance to heart failure, but it could. Symptom severity and the degree of dysfunction determine if, when, and how to treat MR. So, it’s important to know what to look for and when to see your doctor.

“Patients with new or progressive shortness of breath should be evaluated,” says cardiologist Boris Arbit, MD, Assistant Professor, Department of Medicine, Division of Cardiology. “For example, if you could walk 3 miles last year and now you have difficulty breathing just walking around the block, this may be a sign of problems with a heart valve. Additional symptoms include chest pain or dizziness, and it’s prudent to see a doctor if you are experiencing these.”

Like other structures and systems in the body, heart valves can become less efficient through time. Infection, diseases, birth defects, trauma, heart attacks, and radiation treatments can all affect valve function. With mild heart valve cases, a watch and wait approach could work, but more advanced cases may require surgery, says Dr. Arbit.

Function and Dysfunction

The heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves. The one-way valves keep blood flowing in the right direction through leaflets, which are thin, strong, and flexible structures that open and close with each heartbeat. Regurgitation (blood backflow/leakage) occurs when leaflets don’t close properly. Stenosis (hardening) is when the leaflets stiffen and don’t open enough, narrowing the hole through which the blood must pass.

The mitral valve is located in the left ventricle and its structure is like that of a parachute. The leaflets are attached to and supported by a ring of tough, fibrous tissue called the annulus, which helps maintain the shape of the valve. The strings (chordae tendineae) anchor the mitral valve to the wall of theleft ventricle. A torn leaflet, slackened annulus, or disconnected chordae tendinea can cause leakage. For example, leaflets can’t join together when the annulus is loose. A rupture of the chordae tendineae or torn leaflet can result in what’s called prolapse (a common mitral valve leakage problem). It means that leaflet tissues flip-flop or bulge back into the upper heart chamber, creating a gap that forces some blood to flow back into the left atrium. The good news is it that each of these structures may be surgically reparable.

Diagnosing Heart Valve Problems

A heart murmur is indicative of valve dysfunction, and the distinctive sound can be heard through a stethoscope in your primary care doctor’s office. A heart murmur does not necessarily mean there is a major heart problem. But in many cases, it warrants further evaluation by a heart specialist. Echocardiography is an ultrasound procedure and is the main test for diagnosing heart valve disease. It reveals the size and shape of heart valves and chambers, how well the heart is pumping blood, and whether the valve has narrowed or if blood backflows. Depending on the outcome, further tests may be needed.

Treatment Options

Currently, no medicines can cure heart valve disease. Lifestyle changes and medicines can relieve some symptoms and reduce complications, including life-threatening strokes or sudden cardiac arrest.

Medicines include diuretics, which remove extra fluid from the tissues and bloodstream, antiarrhythmics to control heart rhythm, vasodilators that widen blood vessels to allow blood to flow more easily, beta blockers that reduce work on the heart by making it beat less forcefully and more slowly, and anticoagulants (blood thinners) that reduce how quickly blood clots.

Eventually, some people may need to repair or replace a faulty heart valve. Repair is preferred over replacement whenever possible to preserve natural structures and minimize the need for ongoing blood thinners. Compared to other heart valves, mitral valves usually can be repaired. Surgery is the gold standard. There is also a less invasive option called transcatheter valve therapy, which uses clips or other devices to repair valves by reshaping it and/or repairing the valve structures. Recovery is easier with this procedure, but it may not treat MR as well as surgical methods. But, it can be a viable option for people who are at high risk for surgery.

Prevention

According to Dr. Arbit, most of the time MR cannot be prevented, but it depends upon the cause. Decreasing your risk of heart failure and other cardiovascular problems are ways to potentially reduce the chance of severe valve failure. Stress management and heart-healthy lifestyles go a long way toward keeping the mind and body in the best shape possible. And if you do need invasive treatment, being in good health speeds recovery. The advice is nothing new but remains profoundly effective. Nourish your body with whole foods and minimize overly-processed food, limit alcohol consumption, strengthen your heart through cardiovascular exercise (that which makes you sweat and increases your heart rate), and keep stress at bay. Following these recommendations enables you to better control the quality of your life. Your doctor can provide specifics on diet and exercise relative to your current health condition.

The post This Leaky Heart Valve Disorder Affects Millions appeared first on University Health News.

Surgical risk, the risk of dying or suffering severe complications as a result of open-heart surgery, is the key factor in the excitement about these findings. TAVR is a well-established procedure that has been used in patients at high risk (>8%) for many years and in patients with intermediate surgical risk (4-8%) since 2017. But until now, there has been insufficient research to recommend its use in low-risk (<4%) patients.

What Is TAVR?

Instead of using open-heart surgery to replace a blocked aortic valve, a cardiologist using TAVR makes a small incision, usually in the groin, and guides a catheter through the blood vessels and across the aortic valve. The technique is similar to most routine heart catheterizations. The cardiologist then passes a new valve that is folded within a large stent through the catheter until it is inside the blocked aortic valve.

Some valves expand by themselves as the catheter sheath is pulled back off the stented valve, while others are expanded by a balloon in the stent. In both cases, the new valve pushes the defective valve’s cusps out of the way and removes the blockage that the aortic stenosis had been creating. The biggest advantage to TAVR is that there is no need to put the patient on a heart-lung machine to replace the heart valve.

Study 1: Self-Expanding Valves. The first study, CoreValve Low Risk, looked at three kinds of self-expanding stented valves. The researchers randomly assigned 725 patients (mean age 74) with severe symptomatic aortic stenosis to the TAVR treatment group and another 678 patients to an open-heart surgery group. Two years later, death from any cause and overall rates of stroke were the same for both groups, leading the researchers to determine that TAVR is noninferior to surgery in low-risk patients. Noninferiority means that a new treatment performs no worse than an existing treatment.

There were a few important differences between the groups. Patients in the TAVR group experienced lower rates of disabling stroke, bleeding complications, acute kidney injury, and atrial fibrillation, but slightly higher rates of leakage around the new valve at 30 days and a slightly greater need for a permanent pacemaker.

Study 2: Balloon-Expanded Valve. The second study, PARTNER 3, looked at a stented valve that expands with the use of a balloon in 500 patients. Another 500 patients served as a control group. The researchers reported that the rate of death, stroke, or rehospitalization at one year was significantly lower with TAVR than with surgery, and that rates of atrial fibrillation were lower at 30 days. The researchers did not find any significant increases in new permanent pacemaker insertions or leakage around the valve.

The Durability Question. TAVR valves are made differently from traditional valves so they can fit through the catheter, which leaves one important unanswered question: How long will those valves last? The patients who tend to fall into the low-risk category are those who are younger and who will need a valve longer.

Preliminary studies suggest that the durability of TAVR valves is similar to surgically placed valves five years after implantation, but that’s where the data end. Surgical bioprosthetic valves tend to degenerate after about 10 to 15 years, and TAVR valves haven’t been around that long. Both CoreValve Low Risk and PARTNER 3 will continue for several more years and will shed more light on TAVR valves’ durability.

A New Standard. In the meantime, experts predict that, based on these study findings, the U.S. Food and Drug Administration will probably approve a low-risk indication for TAVR later this year. The TAVR valve would then likely be the preferred valve for all aortic stenosis patients, regardless of surgical risk. DM

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“Women can sometimes have more severe AFib symptoms if the condition is left untreated,” explains Joy Gelbman, MD, a cardiologist at Weill Cornell Medicine. “Without treatment, AFib can lead to heart failure, stroke, and other cardiovascular complications.”

What Is AFib?

Your heart rate is controlled by an electrical signal that—ideally—spreads through your heart along a certain pathway and stimulates the upper chambers (atria) and lower chambers (ventricles) to contract in harmony. But, in AFib, the heart’s electrical activity becomes chaotic, and the atria beat very rapidly in an irregular rhythm that is out of sync with the ventricles. Because of these irregularities, the atrial beat is no longer effective when it comes to pumping blood to the ventricles. Instead, blood may pool in the atria, raising the risk of blood clots. A blood clot that dislodges can block circulation in an artery and potentially cause a stroke.

Abnormalities in the heart’s structure, as well as damage to the heart caused by a heart attack, hypertension, aging, or other conditions, may cause AFib.

Women’s Risk Factors

Women also tend to have different risk factors precipitating AFib. For example, high systolic blood pressure (the top number in a blood pressure reading) is a significant risk factor (other than age) for AFib among women, while men who have a higher body mass index, diabetes, a heart murmur, and/or a history of heart attack are more likely to develop AFib than women with the same risk factors.

Symptoms

AFib has a variety of symptoms, notes Dr. Gelbman. “The most common are palpitations, which manifest as a feeling of skipping or racing heartbeat, shortness of breath, and chest discomfort,” she explains. “AFib also can cause weakness or lightheadedness.” However, some people with AFib have no symptoms, and the condition is often picked up as an incidental finding on an electrocardiogram (EKG).

An EKG monitors the heart’s electrical activity and is used to detect AFib if your doctor suspects you have the condition. However, if your heart is not in AFib during the screening, an EKG won’t detect it. You may have to wear a Holter monitor, which records your heart’s electrical activity for a day or two. Sometimes, you may wear the monitor for up to one month, or have a small implantable monitor placed under your skin to detect your AFib. There also are smartwatches and smartphone “apps” that can help with AFib detection.

Other possible tests include a stress test, which evaluates heart function during physical activity, and echocardiography, which uses sound waves to create moving images of the heart’s valves and chambers.

Treatment Options

The first-line treatment for AFib is medication. Some drugs help control heart rate, while others help the heart maintain a normal rhythm (see What You Should Know for more information). You’ll also be given a blood-thinning medication to help prevent clots—options include warfarin (Coumadin) and newer drugs, such as dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). If your doctor diagnoses AFib but does not prescribe a blood thinner, be sure to ask why you are not being given the drugs.

If your AFib does not respond to drug treatment, more invasive therapies will be considered. “There is a procedure called a cardioversion, which is essentially a ‘shock’ to the heart that resets it to a normal rhythm,” Dr. Gelbman explains. “If symptoms persist and are bothersome, another procedure, called ablation, can be done to more permanently address AFib.”

Ablation involves having a catheter with a special tip threaded to the heart, where it is used to burn or freeze the area of tissue disrupting your heart’s electrical signal. Ideally, this enables the signal to travel along the proper pathway, but you may need more than one ablation procedure to achieve a successful outcome.

Lifestyle Changes Are Vital

Maintaining a healthy lifestyle can help prevent AFib as well as improve the outcome of catheter ablation.

“Eat healthfully, exercise regularly, and maintain a healthy weight,” advises Dr. Gelbman. “Limiting caffeine and alcohol also can be helpful, since they sometimes trigger AFib. And, take steps to reduce your stress level.” Also, get treatment if you have sleep apnea, since untreated sleep apnea can sometimes lead to heart arrhythmias.

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Speaking the same language as your doctor can be very helpful, says Erica Jones, MD, a cardiologist at NewYork-Presbyterian/Weill Cornell.

“Knowing some medical lingo makes it easier to follow your physician,” Dr. Jones says. “Having said that, if your doctor says something you don’t understand, always ask for clarification rather than just letting a conversation continue.”

Instructions for taking medications are particularly important. For example, blood pressure medications called alpha-blockers can make patients dizzy when they stand up, so the drug should be taken at night. “If the patient doesn’t understand that, he or she may take the medication in the morning and put themselves at risk of falling,” Dr. Jones explains.

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