Heart Disease - Cardiomyopathy : Diagnosis, Prevention dan Treatment

HOW IS CARDIOMYOPATHY DIAGNOSED?

Based on your medical and family histories, a physical exam, and the results from tests and procedures.

  a)    Specialists Involved

ü  Often, a cardiologist or pediatric cardiologist diagnose and treats cardiomyopathy.A cardiologist specializes in diagnosing and treating heart diseases.A pediatric cardiologist is a cardiologist who treats children.

  b)    Medical and Family Histories

ü  Your doctor will want to learn about your medical history.They want to know what signs and symptoms you have and how long you have had them.

ü  They also want to know whether anyone in your family has had cardiomyopathy, heart failure, or sudden cardiac arrest.

  c)    Physical Exam

ü  Your doctor will use a stethoscope to listen to your heart and lungs for sounds that may suggest cardiomyopathy. This sounds may even suggest a certain type of the disease.

ü  Swelling of the ankles, feet, legs, abdomen, or veins in your neck suggests fluid buildup, a sign of heart failure.

ü  Doctor may notice signs and symptoms of cardiomyopathy during a routine exam.

  d)    Diagnostic Tests

ü  Doctor may recommend one or more of the following tests to diagnose cardiomyopathy:-

·         Blood test. A small amount of blood is taken from your body. It is often drawn from a vein in your arm using a needle. This procedure is quick and easy. Blood tests give information about your heart and help rule out other conditions.

·         Chest X-ray. Takes pictures of the organs and structures inside the chest, such as heart, lungs, and blood vessels. This test can show whether the heart is enlarged and show whether fluid is building up in the lungs.

·         EKG (Electrocardiogram).A simple test that records the hearts’s electrical activity. The test show how fast the heart is beating and its rhythm. This test is used to detect and study many heart problems.

·         Holter and Event Monitors. A small, portable devices. Record heart’s electrical activity while doing normal daily activities. Record heart’s electrical activity for a full 24-or48 hour period.

·         Echocardiography. Is a test that uses sound waves to create a moving picture of heart. The pictures shows how well the heart is working and its size and shape. There a several types of echo, stress echo that show whether you have decreased blood flow to heart and transesophageal echo (TEE) which provide a view of the back of the heart.

·         Stress Test. These tests may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.

  e)    Diagnostic Procedures

ü  These procedures may include cardiac catheterization, coronary angiography, or myocardial biopsy.

·         Cardiac Catheterization. Checks the pressure and blood flow in heart’s chambers. The procedure need to collect blood samples and look at the heart’s arteries using x-ray imaging.

·         Coronary Angiography. Often is done with cardiac catheterization. During the procedure, dye that can be seen on an x-ray is injected into coronary arteries. This is to study the blood flow through heart and blood vessels. Dye also may be injected into the heart chambers to study the pumping function of the heart.

·         Myocardial Biopsy. Doctor removes a piece of the heart muscle. This can be done during cardiac catheterization. The heart muscle is studied under a microscope to see wether changes in cells have occurred.

  f)    Genetic Testing

ü  Some types of cardiomyopathy run in families. Thus, doctor may suggest genetic testing to look for the disease in the parents, brothers and sisters, or other family members.

ü  Genetic testing can show how the disease runs in families. It also can find out the chances of parents passing the genes for the disease on to their children.

ü  This also may useful  if  doctor thinks you have cardiomyopathy, but you do not yet have signs and symptoms.

HOW CAN CARDIOMYOPATHY

BE PREVENTED?

The inherited types of cardiomyopathy can not be prevent but several steps needed to lower the risk for diseases or conditions that may lead to or complicate cardiomyopathy.

Doctor may advice you to make heart-healthy lifestyle changes such as :-

         ü  Avoiding the use of alcohol and illegal drugs

         ü  Getting enough sleep and rest

         ü  Heart-healthy eating

         ü  Physical activity

         ü  Quitting smoking

         ü  Managing stress

The cardiomyopathy may be due to an underlying disease or condition. Treat the conditions early enough to prevent cardiomyopathy complications.

HOW IS CARDIOMYOPATHY

TREATED?

People who have cardiomyopathy but no signs and symptoms may not need treatment. Sometimes, dilated cardiomyopathy that comes on suddenly may go away on its own. For other people who have cardiomyopathy, treatment is need. Treatment depends on the type of cardiomyopathy you have, the severity of the symptoms and complications, and age and overall health. 

The main goals of treating this disease include :

·         Controlling signs and symptoms so that the patient can live as normally as possible

·         Managing any conditions that cause or contribute to the disease

·         Reducing complications and the risk of sudden cardiac arrest

·         Stopping the disease from getting worse

Treatments may include :

·         Heart-healthy lifestyle changes

·         Medicines

·         Nonsurgical procedure

·         Surgery and implanted devices

  a)    Heart-Healthy Lifestyle Changes

·         Heart-healthy eating

·         Aiming for a healthy weight

·         Managing stress

·         Physical activity

·         Quitting smoking

  b)    Medicines

·         Balance electrolytes in the body

·         Keep heart beating with a normal rhytm

·         Lower blood pressure

·         Prevent blood clots from forming

·         Reduce inflammation

·         Remove excess sodium from the body

·         Slow heart rate

  c)    Surgery and Implanted Devices

·         Septal Myetomy. Open-heart surgery is used to treat people who have hypertrophic cardiomyopathy and severe symptoms.This is used for younger patients and for people whose medicines are not working well.

·         Surgically Implanted Devices.

·         Heart Transplant. A surgeon replaces a person’s diseased heart with a healthy heart from a deceased donor.

  d)    Nonsurgical Procedure

·         Alcohol septal ablation to treat cardiomyopathy.

·    The doctor injects ethanol through a tube into the small artery that supplies blood to the thickened area of heart muscle.

·        The alcohols kills cells and the thickened tissue shrinks to a more normal size.

·  This procedure allows blood to flow freely through the ventricles, which improves symptoms.

Heart Disease - Cardiomyopathy : Type, Causes and Symptoms

WHAT IS CARDIOMYOPATHY?

·         Diseases of the heart muscle.

·         Heart muscle becomes enlarged, thick, or rigid.

·         In rare cases, the muscle tissue in the heart is replaced with scar tissue.

·         Worsens; the heart becomes weaker. It’s less able to pump blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or irregular heartbeats called arrhythmias.

·         Heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen.

·         The weakening of the heart also can cause other complications such as heart vaive problems.

The types of cardiomyopathy are :

·         Hypertrophic cardiomyopathy

·         Dilated cardiomyopathy

·         Restrictive cardiomyopathy

·         Arrhythmogenic right ventricular dysplasia

·         Unclassified cardiomyopathy

These disease can be acquired or inherited. In the other words, ”acquired” means you are not born with this disease, but  you develop it due to another disease, condition, or factor. “Inherited” means your parents paseed the gene for the disease on to you.Many times the cause of cardiomyopathy is not known.

Cardiomyopathy can affect people of all ages. However, people in certain age groups are more likely to have certain types of cardiomyopathy.

WHAT ARE THE CAUSES OF CARDIOMYOPATHY?

Many times, the cause of cardiomyopathy is not known. This often is the case when the disease occurs in children.

1.    Hypertrophic Cardiomyopathy

·         Usually inherited.

·         Caused by a mutation or change in some of the genes in heart muscle proteins.

·         Can develop over time because of high blood pressure, aging, or other diseases such as diabetes or thyroid disease.

·         Sometimes the cause of the disease is not known.

2.    Dilated Cardiomyopathy

·         Often is not known the causes.

·         One-third inherit it from their parents.

·         Certain diseases, conditions, and substances also can cause the diasease, such as :-

Ø  Alcohol, especially if you also have a poor diet

Ø  Certain toxins, such as poisons and heavy metals

Ø  Complications during the last months of pregnancy

Ø  Coronory heart disease, heart attack, high blood pressure, diabetes, thyroid disease, viral hepatitis, and HIV

Ø  Illegal drugs, such as cocaine and amphetamines, and some medicines used to treat cancer

Ø  Infections, especially viral infections that inflame the heart muscle

3.    Restrictive Cardiomyopathy

·         Certain diseases, conditions, and factors can cause restrictive cardiomyopathy,including :-

Ø  Amyloidosis

Ø  Connective tissue disorders

Ø  Hemochromatosis

Ø  Sarcoidosis

Ø  Some cancer treatments, such as radiation and chemotherapy

4.    Arrhythmogenic Right Ventricular Dysplasia

·         Researchers think that arrhythmogenic right ventricular dysplasia is an inherited disease.

WHAT ARE THE SYMPTOMS OF

CARDIOMYOPATHY?

Some people with this disease have no signs or symptoms and need no treatment.For other people, cardiomyopathy develops quickly, symptoms are severe, and serious complications occur.

As cardiomyopathy worsens and the heart weakens, sign and symptoms of heart failure usually occur.These signs and symptoms include :

·         Shortness of breath or trouble breathing, especially with physical exertion

·         Fatigue (tiredness)

·         Swelling in the ankles, feets, legs, abdomen, and veins in the neck

Others signs and symptoms may include :

·         Dizziness

·         Light-headedness

·         Fainting during physical activity

·         Arrhythmias

·         Chest pain

·         Heart murmurs

CONGENITAL HEART DISEASE

CONGENITAL HEART DISEASE

Congenital heart disease is a general term for a range of birth defects that affect the normal workings of the heart.The term "congenital" means the condition is present at birth . Congenital heart disease is one of the most common types of birth defect, affecting up to 9 in every 1,000 babies born in the UK.

CAUSES OF CONGENITAL HEART DISEASE

Congenital heart disease is caused when something disrupts the normal development of the heart. It occurs when something affect the heart’s development during about the fifth week of pregnancy. This is when the heart is developing from a simple tube like structure into a shape more like a fully formed heart. In most cases, no obvious cause of congenital heart disease is identified. However some things are known to increase the rate of the condition.  

                                   

1.     Genetic conditions (Down syndrome)

                                           

                                                                                                

Several genetic health conditions that a baby inherits from one or both parents can cause congenital heart disease. It's also recognised that certain types of congenital heart disease run in families.

Down's syndrome is the most widely-known genetic condition that can cause congenital heart disease. Children with Down's syndrome are born with a range of disabilities as the result of a genetic abnormality. About half of all children with Down's syndrome have congenital heart disease. In 90% of cases, this is a type of septal defect . Other genetic conditions associated with congenital heart disease include:

• Turner syndrome  A genetic disorder that only affects females and it's estimated that 25% of children with Turner syndrome will be born with congenital heart disease, which is usually a type of valve or artery narrowing problem.
• Noonan syndrome - A genetic disorder that can cause a wide range of potential symptoms and around 80% of children with Noonan syndrome will be born with congenital heart disease, and in about half of all cases, this will be pulmonary stenosis.

2.     Women with diabetes.

Women with diabetes are five times more likely to give birth to a baby with congenital heart disease than women who don't have diabetes. It's estimated that 3-6% of women with diabetes who become pregnant will give birth to a baby with a heart defect. The side where it is occur most commonly, transposition of the great arteries.

·         This increased risk only applies to type 1 diabetes and type 2 diabetes. It doesn't apply to gestational diabetes, which can develop during pregnancy and usually disappears once the baby is born.

       3. Rubella       

·         Rubella (German measles) is an infectious condition caused by a virus. It isn't usually a serious infection for adults or children, but it can have a devastating effect on an unborn baby if a mother develops a rubella infection during the first 8 to 10 weeks of pregnancy.

A rubella infection can cause multiple birth defects, including congenital heart disease. All women of childbearing age should be vaccinated against rubella. The vaccine is now given as part of the routine childhood vaccination schedule. Contact your GP for advice if you're not sure whether you've been vaccinated against rubella.

SYMPTOMS OF CONGENITAL HEART DISEASE

Congenital heart disease can have a range of symptoms, because the condition refers to several different types of heart defect . General signs of congenital heart disease can include:

• excessive sweating
• extreme tiredness and fatigue
• poor feeding
• rapid heartbeat
• rapid breathing
• shortness of breath
• chest pain
• a blue tinge to the skin (cyanosis)
• clubbed fingernails

In more severe cases, these problems may develop shortly after birth. However, symptoms sometimes don't develop until the teenage years or early adulthood.

TYPES OF CONGINETAL HEART DISEASE 


There are many types of congenital heart disease and they sometimes occur in combination. Some of the more common defects include :

 

SEPTAL DEFECTS  -  where there’s a hole between two of the heart chambers 

COARCTATION OF AORTA   – where the main large artery of the body called the aorta , is narrower than normal 

PULMONARY VALVE STENOSIS  – where the pulmonary valve which controls the flow of blood out of the lower right chamber of the heart to the lungs , is narrower than normal 

TRANSPOSITION OF GREAT ARTERIES  – where the pulmonary and aortic valves and the arteries they are connected to have swapped positions .

EBSTEINS ANOMALLY  – where the valve on the right side of the heart ,which separates the right atrium and right ventricles , doesn’t develop properly

PATENT DUCTUS ATRIOSEOUS  – where this connection doesn’t close after birth as it’s supposed to . 

VENTRICULAR SEPTAL DEFECTS – extra blood flows throught the hole from the left to the right ventricle due  to the pressure difference between them . 

HYPOPLASTIC LEFT HEART SYNDROME  – where the left of the heart doesn’t develop properly and is too small 

 
DIAGNOSIS  : Doctors may find some problems before a baby is born. Other problems may be found in infants, kids, or adults. The doctor listens to your heartbeat to check your health. If she hears an unusual sound or heart murmur, she might order more tests, such as :

Echocardiogram : A type of ultrasound that takes pictures of your heart. There are different kinds, so ask your doctor what you can expect.

Cardiac catheterization : A doctor guides a very thin, flexible tube (called a catheter) through a blood vessel in your arm or leg to reach your heart. She puts dye through the catheter and then uses X-ray videos to see inside your heart.

Chest X-ray : These can reveal signs of heart failure.

Electrocardiogram (ECG or EKG) : This measures the heart’s electrical activity.

MRI : You get a scan that lets doctors see the heart’s structure .

  COMPLICATIONS 

Children and adults with congenital heart disease can also develop a range of further problems, such as :

• problems with growth and development
• repeated respiratory tract infections (RTIs)– infections of the sinuses, throat, airways or lungs
• heart infection (endocarditis)
• pulmonary hypertension – raised blood pressure within the blood vessels that supply the lungs (pulmonary arteries)
• heart failure– where the heart is unable to efficiently pump enough blood around the body

TREATMENT : Treatment for congenital heart disease depends on the specific defect you or your child has.

Mild heart defects don't usually need to be treated, although it's likely that you'll have regular check-ups to monitor your health.

   
  More severe heart defects usually require surgery and long-term monitoring of the heart throughout adult life by a congenital heart disease specialist.

     
  In some cases, medications may be used to relieve symptoms or stabilise the condition before and, or after surgery. 

      These may include diuretics to remove fluid from the body and make breathing easier, and digoxin to slow down the heartbeat and increase the strength at which the heart   pumps.
                                                                                           

                                                                                                     
PREVENTATION  :  As so little is known about the causes of congenital heart disease, there's no guaranteed way of avoiding having a baby with the condition. However, if you're pregnant, the following advice can help reduce the risk :

• Ensure you are vaccinated against rubella and flu.
• Avoid drinking alcohol or taking drugs.
• Take 400 micrograms of folic acid supplement a day during the first trimester (first 12 weeks) of your pregnancy – this lowers your risk of giving birth to a child with congenital heart disease, as well as several other types of birth defect.
• Check with your GP or pharmacist before you take any medication during pregnancy, including herbal remedies and medication that's available over the counter.
• Avoid contact with people who are known to have an infection.
• If you have diabetes, make sure it's controlled.

Avoid exposure to organic solvents, such as those used in dry cleaning, paint thinners and nail polish remover.

CONCLUSION 

 Congenital heart disease patients with or without invansive therapeutic interventions are at increased risk of development and other psychiatric disorders , which seem to develop earlier than in patients with diabetes mellitus or asthma . The medical literature tells us that the most effective ways to reduce the risk of heart disease , cancer , stroke , diabetes , Alzheimer's and many more problems are through healthy diet and exercise . Our body are evolved to move , yet we now use the energy in oil instead of muscle to do our work .