Learn About Your Heart...
Made Simple

By Nicolas Shammas, MD

A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics

Statistics about Heart and Blood Vessel Diseases in the United States
Structure and Function of the Heart and Blood Vessels
Diseases of the Blood Vessels of the Heart
Surgical Therapies for the Cardiovascular Patient
Peripheral Vascular Disease
Diseases of the Blood Vessels of the Head and Neck
Strokes: How to Survive Them and How to Prevent Them
Valvular Heart Disease
Heart Rhythms: How to Recognize Them and Treat Them
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test

Click below to view larger images

Figure 1.

Figure 2.

You are placed on antibiotics, you go on to get your tooth fixed, and after the treatment, a repeat echocardiogram shows that your mitral valve has been damaged to the point of not being able to stop the blood from back leaking. Even though you have been placed on medications to improve your breathing, you are limited. You report more ankle swelling, your wedding ring was so tight the jeweler cut it off to enlarge it, and you have stopped wearing your watch for the same reason.

Your doctors send you to see a cardiac surgeon. "Do I need surgery? What will you do to me? Will I die? Do I really need something done? What if I don't do anything?" you ask. The natural history of valvular malfunction is that it leads to congestive heart failure. This condition begins with the heart muscle becoming thick, like a body builder lifting weights (still reversible), then proceeds with the heart becoming thick and enlarged (still reversible in part), to the heart finally becoming thin and enlarged with poor function (not reversible) leading to death. Your doctor informs you that although you have congestive heart failure, it is in an early form that your valve is indeed quite damaged and will need to be replaced, but you will feel better afterward. Death from surgery has steadily decreased in the last decade.You learn that there are 2 potential types of valves that can be used, a mechanical valve that requires anticoagulation with warfarin, and a tissue valve that requires only aspirin. Because of your age,you have either option available.As before, antibiotics will be required before any procedure.

You decide that proceeding with the operation is in your best interest, but your curiosity leads you to learn more. You find out that many times the valves in the mitral position can be repaired, and the valves in the aortic position are most often replaced. The whole field of valvular surgery has only been around for about 50 years, and many things are constantly being learned. You learn that your condition is common but that degeneration of the valve tissue is an even more common condition for valve failure and the need for surgery. Younger patients will more likely need mechanical valves, which are in fact made from ceramic discs mounted in a cylinder. These valves require warfarin, a blood thinner, which keeps them functioning well. They require more constant monitoring because of the warfarin.

You are ready. Your surgery is scheduled, and you receive a tissue valve as expected. Afterward, your cardiac rehabilitation gets you up and running, and you are amazed at how much better you feel.

How does surgery help in fixing disorders of the electrical system of the heart?

You get a call from your grandmother. "Grandpa has been hospitalized. His heart rate became dangerously high, he could not breathe, and his lungs filled up with fluid." Your grandmother's voice breaks. "I am worried," she says. "The doctor said he has atrial fibrillation, congestive heart failure, coronary artery disease, pulmonary hypertension, and aortic stenosis. I just don't understand this mumbo jumbo. I am worried he is going to die. Will he? Can you help? Would you explain what this all means? No one seems to be talking English around here. I just want him to get better and come home."

You sit down with your grandmother, who suddenly looks very old, and you remember the many times she comforted you, explained things to you, and made you feel like everything was going to be all right. So you sit next to her and you begin. You say that atrial fibrillation is a condition when 2 of the 4 chambers of the heart beat randomly. Because of this, the heart has to work harder and is less efficient. It is like a car that runs rough and needs a tune-up. What probably happened was that the aortic valve became damaged and caused the heart to overwork. This overwork led to congestive heart failure.The atrial fibrillation was caused by a combination of things that included pulmonary hypertension, which means that the blood pressure on the right side of the heart is elevated. Your grandfather gets better, but he will need surgery. The doctor is advising coronary bypass surgery, valvular surgery, and atrial fibrillation surgery. It's time to sit down with your grandmother again.

Most of the rhythm of the heart can be managed by the use of drugs or pacemakers. There is a condition, however, called atrial fibrillation, which arises when the 2 chambers of the heart that receive the blood from the body on the right and the lungs on the left beat randomly and in doing so affect the efficiency of the cardiac cycle. The cause of atrial fibrillation is complex. When it does occur, many times medications will help improve the condition, either by controlling the rate of beating or by actually converting the rhythm back to normal.

When this does not work, however, there is a procedure available that is performed alone or in conjunction with other cardiac procedures. The most common operation is called the Maze procedure. It is performed by creating scar on the atrial chambers that allow the electrical current of the heart to run in only certain ways. It is like creating a set of highways for that current to follow, thus preventing it from getting lost at other sites. The importance in controlling atrial fibrillation is that besides decreasing the efficiency of the cardiac cycle (how the blood moves through the heart), atrial fibrillation increases the risk of strokes, because it allows blood to form pools with little active movement. When blood sits around, it gels up and forms clots, which when placed in the circulation can cause stroke if they go to the brain and cause other damage when they end up in other organs. Most people with atrial fibrillation are placed on warfarin if possible to decrease the likelihood of these occurrences. Not all patients, however, benefit from the surgical intervention or the medical treatment.The majority of them do,and thus, the procedure is being offered more commonly these days.

Your grandpa goes on to have the surgery and he progresses well. Post-operatively he progresses slowly, and after the hospital and a short stay in rehab, he transitions home. He and your grandmother spend several more good years together.

Although surgery continues to be important for many patients, new, less invasive techniques are being developed to fix heart problems that currently are fixed surgically.Valve repair or even replacing valves non-surgically is currently under investigation. Catheter-based bypass surgery is also being developed. Most electrical conduction abnormalities in the heart can now be fixed with special catheters and devices. Repair of aneurysms in certain patients can now be treated with special coated stents called endografts.

New therapies continue to evolve to replace invasive surgeries, but at present, surgery remains an important tool to fix advanced cardiac problems.

© 2007 HMP Communications | All Rights Reserved | 83 General Warren Blvd, Malvern, PA 19355