Category Archives: Diseases Of The Heart And Blood Vessels
Acute Pericarditis
Acute pericarditis is a generally painful inflammation of the pericardium that develops suddenly due to injury or disease and causes components of blood to spill into the pericardial cavity.
• Acute pericarditis is caused by injury and Infections that cause inflammation of the pericardium.
• Sharp chest pain which changes with movement, and fever, are the usual symptoms.
• The symptoms and a physical examination can help the doctor make a diagnosis, since the chest sounds characteristic to the condition can be easily picked up by a stethoscope.
• Drugs to control inflammation and pain are administered to patients admitted in the hospital.
When extra fluid enters the pericardial space, it is called pericardial effusion and sometimes an effusion may be due to inflammation. When pericarditis is caused by cancer, an injury to the chest or when it develops after a heart surgery, the fluid accumulated is often blood.
Causes
- An infection or any other condition that causes irritation to the pericardium may result in acute pericarditis. The cause of the infection may be bacteria or viruses such as HIV or influenza virus. Protozoa or other parasitic infestations as well as fungal infections also may cause acute pericarditis.
- In India and Africa, pericarditis resulting from tuberculosis (tuberculosis pericarditis) is very common but in the United States, not even 5% of acute pericarditis in the general population is found to be due to tuberculosis.
- However, according to statistics, pericarditis with pericardial effusion is found to be prevalent among AIDS patients in city hospitals; it could be because people who have AIDS are more prone to tuberculosis or aspergillosis which may result in pericarditis.
- Following a heart attack, in 10 to 15% of cases, acute pericarditis occurs within the first two days and in 1 to 3% cases, sub acute pericarditis develops after10 days to 2 months. Heart surgery also may precipitate pericarditis. Other conditions which may inflame the pericardium include rheumatoid arthritis, rheumatic fever, hypothyroidism, kidney failure etc.
Leakage of blood from a bulge in the wall of the aorta (aortic aneurysm), Kaposi sarcoma in AIDS patients, cancers such as leukemia, mesothelioma and sharp or blunt injuries to the chest and radiation therapy are some of the other factors that may precipitate acute pericarditis. - Certain anticoagulant drugs, such as warfarin and heparin, anticonvulsant phenytoin) antibiotic penicillin, antiarrhythmic drug procainamide and a nonsteroidal anti-inflammatory drug phenylbutazone also may cause pericarditis as a side effect.
- Postpericardiotomy syndrome is a type of acute pericarditis which often develops after any surgery which involves the pericardium.
- Subacute pericarditis also results from the same kind of disorders and injuries which cause acute pericarditis. But it is not always possible to determine the exact reason for pericarditis in spite of the many diagnostic tests available.
Symptoms
- The symptoms of acute pericarditis include fever and sharp pain in the chest which may extend to the left shoulder and radiate on to the left arm. The pain often resembles the pain of heart attack, but unlike heart attack, it becomes worse when the patient lies down, or takes a deep breath. The pericardium exerts pressure on the heart, reducing its capacity to function efficiently; and when the pressure is excessive, a life threatening condition called cardiac tamponade may result.
- When tuberculosis is causing pericarditis, it may appear without any symptoms usually associated with a lung infection. On the other hand, fever and symptoms of heart failure, such as fatigue and weakness appear followed by cardiac tamponade.
- When a viral infection causes acute pericarditis, it may be painful but within a few weeks it may disappear without causing any lasting damage.
- After a heart attack, if pericarditis develops after about 10 days and within 2 months, it is often accompanied by a condition called post myocardial infarction syndrome or Dressler syndrome, characterized by joint pain and fever, pleurisy or inflammation of the double walled envelope of the lungs and also pleural effusion, in addition to pericardial effusion.
Diagnosis
- Diagnosis of acute pericarditis is usually possible, based on the description of the characteristic type of pain felt by the patient, and doctors can often confirm it by listening to the sounds picked up by the stethoscope, when placed on the chest. The sounds peculiar to pericarditis is often described either as a crunchy sound, much like the creaking of a leather shoe or as a scratchy sound called pericardial rub, which is like the rustling of dry leaves Doctors often check for these sounds for a few hours to a few days following a heart attack to detect the development of pericarditis.
- An electrocardiogram (ECG) is usually done to assess the abnormalities caused by pericarditis. A chest x-ray and echocardiography can detect pericardial effusion as well as help determine the presence of at least some of the possible causes such as cancer.
- Blood tests can detect some other possible causes of pericarditis such as AIDS, rheumatic fever, leukemia and excess blood urea levels which point to kidney failure.
- When the detection of the cause remains elusive, even after all the above diagnostic tests, a sample of pericardial fluid and sometimes even a bit of pericardial tissue may be extracted and sent for investigations. This test is called pericardiocentesis and it may help identify bacterial infections which can be treated with antibiotics.
Prognosis and Treatment
The prognosis depends on the cause of acute pericarditis. One to three weeks are often required for recovery when pericarditis is due to a viral infection. Recurrences can often slow down and complicate matters. Successful treatment of the cause is the key to treating pericarditis. Prognosis is poor for people with cancer that has spread to the pericardium as their survival beyond a year to 18months is doubtful.
People with pericarditis are usually hospitalized for treatment as well as for diagnostic tests to determine the exact cause. Irrespective of the cause, nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen are given orally for pain relief, and the patient is closely observed for signs of possible problems like cardiac tamponade. When pain is relieved and inflammation is brought under control, the drugs are tapered off. If any drug taken by the patient is causing the pericarditis, it is immediately stopped.
Corticosteroids like prednisone help reduce inflammation while colchicines may prevent recurrence of pericarditis in addition to relieving pain.
Treatment of acute pericarditis often varies according to the cause. A more frequent dialysis regime usually improves pericarditis in people who have kidney failure. Pericardium is often surgically removed in people with cancer who are undergoing radiation therapy and chemotherapy. If pericarditis is caused by a bacterial infection, draining the pus surgically from the pericardium may be as important as treatment with antibiotics.
Percutaneous balloon pericardiotomy is a minimally invasive surgical procedure, usually performed in case of recurring effusions or when the effusions are due to cancer. In this procedure, a catheter fitted with an inflatable balloon is inserted through the skin, and on reaching the pericardium, the balloon is inflated, creating a small window in the pericardium for drainage of fluid.
Subxiphoid pericardiotomy is another procedure which is very effective, especially for effusions caused by bacterial infections. A thin tube is introduced into the pericardial space via a small incision made right below the breast bone and fluid is allowed to drain continuously. It can be done by the patient’s bed, under local anesthesia.
Ibuprofen, often taken along with colchicine may relieve pain and discomfort in case of acute pericarditis due to an injury, viral infection or some other undetected but recurring disorders.
Symptoms of acute pericarditis often go unnoticed, when it develops within the first two days of a heart attack, but analgesics such as aspirin and morphine which are used to treat the heart attack usually bring relief.
When infections are ruled out, the patient may be given corticosteroids, which may help bring down the severity of symptoms.
The pericardium may be surgically removed if treatment with drugs is not effective.
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What is a Pericardial Disease
Pericardial disease affects the double layered, fluid filled envelope of the heart called pericardium.
The function of the pericardium is to protect the heart from injuries and to isolate it from other chest infections. It also helps maintain the position of the heart and prevents it from overfilling. However, if the pericardium is absent congenitally or if it is surgically removed, it does not seem to affect the function of the heart significantly, so it can be considered not essential to maintaining life.
The space between the two layers of the pericardium is filled with just enough pericardial fluid to allow flexibility. When there is fluid accumulation in the pericardial space due to certain disorders, the pericardium expands to accommodate the extra volume. But, if the increase in fluid volume is rapid with not enough time for the pericardium to expand outwards, pressure is inflicted on the heart, making it difficult for the ventricles to expand and fill with blood, causing a condition called pericardial tamponade or cardiac tamponade.
When the pericardium has holes or weak areas, a blood vessel or even a part of the heart may be pushed through a weak spot (hernia) and get trapped. This is a dangerous situation and sudden death may result. It is important to surgically repair such defects in the pericardium whenever detected, and if repair is not possible, the pericardium itself is removed.
Pericarditis or the inflammation of the pericardium is a very common disorder and it can be triggered by injuries to the chest, infections and cancer. When an inflammation develops suddenly, it is called acute pericarditis and an inflammation that slowly develops over several weeks following an injury or illness is termed sub-acute pericarditis. Chronic pericarditis is a prolonged condition lasting more than six months.
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Infective Endocarditis (Acute and Subacute Bacterial Endocarditis)
Infective endocarditis is an infection of the endocardium or the inner lining of the heart, often involving the heart valves.
- Infective endocarditis is the bacterial infection of the heart valves resulting from bacteria that have entered the blood stream from some other sites of infection in the body.
- Acute bacterial endocarditis appears suddenly with symptoms such as high fever, severe fatigue, and rapid heart rate and it quickly damages the heart valves.
- Low grade fever, fast heart rate, marked loss of body weight, and lowered RBC count are symptoms of sub-acute endocarditis. Fatigue and sweating may also be present.
- Heart valve defects and injuries can be diagnosed by echocardiography.
- People who have pre-existing heart valve abnormalities or those who have artificial valves should take antibiotics as a precautionary measure prior to surgery or dental procedures to prevent possible infections that may result in endocarditis.
- Intravenous administration of antibiotics in large doses helps overcome the infection, but the existing damage of the heart valves may need to be surgically corrected.
Infective endocarditis is more prevalent in people above sixty, and in that age group, it affects men eight times more than women. In the general population too, the incidence of this disease in men is twice as that in women.
Endocardium is the inner lining of the heart and though infective endocarditis is a disease due to an infection of the endocardium, it is not always restricted to it. Endocarditis often involves the heart valves and the muscles and blood vessels of the heart too. Infective endocarditis occurs in an acute form as well as a subacute form. Acute infective endocarditis appears suddenly, starting with a high fever, and deteriorates quickly into a life threatening condition whereas the subacute infective endocarditis progresses slowly and steadily over weeks and months, often accompanied by a low grade persistent fever.
Blood is usually free of microorganisms such as bacteria, but due to some injury or infection elsewhere in the body, sometimes bacteria and even some fungi may enter the blood stream. These microorganisms have a tendency to settle on the heart valves and cause infection of the endocardium or the inner lining of the heart. Defective valves and those which are damaged due to some reason, as well as artificial valves are usually more prone to infection, especially subacute bacterial endocarditis. However, aggressive strains of bacteria, when present in large numbers do not spare even healthy valves.
Birth defects, especially abnormal connections that allow leakage of blood across the various chambers of the heart predispose children to infective endocarditis. In older people, damage to the valves resulting from aging or heart disease and calcium deposit formation in the aortic valve or in the mitral valve, are risk factors that increase susceptibility to endocarditis. Rheumatic fever in childhood, when not treated with antibiotics, often precipitates permanent valve damage which in turn becomes susceptible to infections later on.
Dirty needles, syringes, or drug solutions often used by drug abusers may introduce bacteria directly into the blood stream; hence, such people are at a very high risk of contracting endocarditis. Another high risk category is people with artificial valves, especially for a year following the valve replacement surgery. The risk factor varies according to the type of valve implanted; higher risk associated with a mechanical valve compared to a valve of animal origin and an implanted aortic valve compared to a mitral valve.
Causes
When bacteria are introduced into the blood through a cut in the skin or inside the mouth, or through minor infections such as gum disease or gingivitis, the body’s defense mechanism usually destroys them. But, if the bacteria get caught in the heart valves, especially when the valves are defective or damaged, or when artificial valves have replaced them, they colonize the valves, resulting in an infection of the valve which spreads to the lining of the heart (endocardium), resulting in infective endocarditis. Surgical procedures and some dental procedures may introduce bacteria into the blood stream. It may happen during open-heart surgery or when an artificial valve is fitted, but that is rare due to the precautions taken prior to and during such surgery.
When the immune response of the body is compromised, the risk increases, so does, when a large number of bacteria enter the blood stream. A severe infection of the blood called sepsis, which is life threatening in itself, can cause endocarditis even in people who have normal healthy heart valves because of the sheer number of bacteria circulating in the blood.
Infective endocarditis mostly affects the mitral valve and the aortic valve, except when infection results from unhygienic injection of illicit drugs and the use of intravenous lines for very long periods, in which cases the tricuspid valve between the right atrium and the right ventricle is usually affected.
Symptoms and complications
Acute bacterial endocarditis often makes a sudden appearance with a fever in the high range (38.9° to 40°C or 102° to 104°F). Other symptoms include fatigue and a fast heart rate, severe damage to the heart valves.
Subacute bacterial endocarditis which usually has milder symptoms such as a low-grade fever (99° to 101° F [37.2° to 38.3°C]), anemia, weight loss and fatigue, may often remain undiagnosed for several months till the steadily progressing disease causes a block in the arteries or damage to heart valves, which when detected and investigated brings the endocarditis into light.
When blood clots and bacteria accumulate on the valves, they are called vegetations. And when they get disengaged from the site of infection and travel in the blood stream (emboli), they may clog the arteries. A block in the artery supplying the heart muscle can precipitate a heart attack and if an artery supplying the brain is blocked, stroke can result. Emboli can settle in other places and cause infection wherever they settle, usually forming abscesses filled with pus, especially around the valves. Infected heart valves may develop perforations that result in leakage and regurgitation of blood in a short period, affecting the function of the heart. Infections that spread to arteries make the artery walls weak and cause them to rupture, which can be very dangerous, and even fatal, if it happens near the heart or in the brain. Septic shock also may develop, resulting in failure of vital organs like the kidney and liver.
Very small clots (emboli) may travel to various parts of the body and may appear as freckles or red spots in the white part of the eyes and on the skin or as red streaks under the fingernails. Emboli that are larger result in stomach pain, numbness and pain in the limbs or blood in urine. They can also cause stroke or heart attack, if a major artery supplying blood to the brain or heart gets blocked. Enlargement of spleen is a common occurrence. Painful nodules appearing under the skin, pain in the joints, pallor, chills and confusion are also symptoms associated with sub acute bacterial endocarditis.
Whether acute or sub acute, infective endocarditis of an artificial heart valve is more complicated, as the infection, often spreading into the tissue around the valve may loosen the valve. Also, disruption in the electrical conduction system of the heart may result in very slow heartbeat, which may cause fainting and even death.
Diagnosis
Since symptoms of infective endocarditis are not usually specific to that disease, diagnosis can be made only through detailed investigations. When doctors come across fever without any identifiable cause, in a patient having a defective or damaged heart valve or an artificial valve, endocarditis is suspected especially if the patient has also undergone any dental or surgical procedure recently. Since infective endocarditis is a dangerous disease with serious consequences, the patient is immediately hospitalized for further investigations and treatment.
A newly developed heart murmur or a change in the old murmur pattern may point to endocarditis, but echocardiography and blood cultures are the tests employed to make an accurate diagnosis. Echocardiography, which can project images of the heart, can detect accumulations (vegetations) at the heart valves as well as the damage caused to the heart.
If echocardiography done with the probe placed on the patient’s chest (transthoracic echocardiography) is not clear enough, a transesophageal echocardiography may be performed with the ultrasound probe introduced into the esophagus which is situated right behind the heart. This invasive procedure may be costly, but an accurate result may be obtained.
Several blood samples are taken and cultured to identify not only the particular type of bacteria causing the infection but also the most effective antibiotic to fight it. But sometimes, difficulties are encountered in culturing bacteria from the blood samples. If previous antibiotic therapy, which has not been successful in wiping out the infection, has reduced the bacterial count in the blood significantly, it may be very difficult to detect or culture bacteria from blood samples. There are a few disorders such as a tumor in the heart that may display symptoms of endocarditis, making diagnosis difficult.
Prognosis
Prolonged treatment with high doses of antibiotics may be necessary for surviving an episode of infective endocarditis. The outcome usually depends on the age of the patient, the type of infection and its duration and whether the person has an artificial valve implanted. Without treatment, prognosis is poor as infective endocarditis is fatal.
Prevention
When people with congenital heart defects or heart valve defects and those fitted with artificial heart valves undergo dental or surgical procedures, the medical practitioners concerned should be informed of these risk factors so that antibiotics may be given prior to the procedure as a precautionary measure against infective endocarditis. Even though antibiotics given as a precaution may not be very effective in preventing endocarditis and a minor surgical procedure may not pose a high risk of developing the disease, antibiotics are always justified considering the dangerous nature of endocarditis.
Treatment
Intravenous administration of high doses of antibiotics for prolonged periods (usually 2 to 8 weeks) is the first line of treatment, which is started in the hospital immediately on diagnosis, but later on, can be shifted to the patient’s home under the supervision of qualified medical personnel.
Following an episode of infective endocarditis, often corrective measures involving heart surgery may be necessary due to the following reasons:
- Accumulation of bacteria and blood clots (vegetations) should be removed.
- When antibiotics are not successful in getting rid of abscesses, they have to be drained surgically.
- Leaking or damaged heart valves should be repaired.
- In case of irreparable damage to the valves, they have to be replaced with artificial valves.
- Congenital septal defects (abnormal connections between the chambers of the heart) should be corrected.
When the infection involves artificial valves, antibiotics are not sufficient to clear it due to certain reasons. Since antibiotics had definitely been an integral part of treatment during valve replacement surgery, any bacteria that survived it could be a resistant type. Also, artificial materials do not respond to antibiotic treatment as human tissue does, necessitating surgical intervention.
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Sinus Node Dysfunction
Sinus node dysfunction or heart pacemaker dysfunction is the malfunctioning of the primary pacemaker of the heart, namely, the sinus node, resulting in abnormal arrhythmias, especially slow heart rate or bradycardia.
- Sinus node dysfunction may be asymptomatic or symptoms such as palpitations, fatigue and weakness may be present.
- Diagnosis by physical examination is confirmed by electrocardiography (ECG).
- Fitting an artificial pacemaker permanently is usually the ideal solution.
When the sinoatrial node or sinus node, which is the pacemaker or the starting point of the electrical activity of the heart, becomes dysfunctional, it may precipitate a constantly low heartbeat called sinus bradycardia. When the sinus node completely stops functioning, it is called sinus arrest.
Usually, when the sinoatrial node is dysfunctional, a new area takes over its function. This substitute pacemaker, which may be a point in the atrium or in the atrioventricular node, is termed an escape pacemaker. The location of the escape pacemaker can be another area much lower in the electric circuit of the heart or even in the ventricles.
Prevalent in the older age group, sinus node dysfunction may result from hypothyroidism or the usage of certain drugs. But more often, a definite cause cannot be identified, in which cases it is termed as sick sinus syndrome. Bradycardia-tachycardia syndrome, in which episodes of tachycardia or fast heart rhythms such as atrial fibrillation and flutter alternates with episodes of bradycardia or slow rhythms, is considered a version of sick sinus syndrome.
Symptoms and Diagnosis
Often, sinus node dysfunction is asymptomatic. General weakness and fatigue may be symptoms of a slow heart rate that persists over a long period. An extremely low heart rate may result in fainting. A fast heart rate is often perceived by the person as Palpitations which are usually felt when the heart rate is high. After a bout of fast arrhythmia, the pacemaker may be delayed in restarting the heart before reverting to normal rhythm. This delay often results in fainting.
Sinus node dysfunction is usually diagnosed from characteristic symptoms such as slow and irregular pulse, a pulse that does not vary even on exertion, or highly fluctuating pulse irrespective of there being no change in activity. Electrocardiography, especially continuous monitoring with a portable Holter monitor helps confirm the diagnosis.
Treatment
An artificial pacemaker, which helps to increase the heart rate, is permanently attached to prevent a slow heart rhythm. If episodes of fast rhythm also occur, Antiarrhythmic drugs that slow the heart are given.
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Bundle Branch Block
Bundle branch block is a complete or incomplete disruption in the electrical conduction system of the heart, involving the right and left bundle branches of the bundle of His which conduct the impulses to the respective ventricles.
The electrical impulses from the atrioventricular node reaches a group of fibers called the bundle of His which divides into the left bundle branch which transmits the impulses to the left ventricle and the right bundle branch which transmits the current to the right ventricle branch two bundle branches. A block in the electrical circuit can occur in the left or right bundle branch.
Symptoms and Diagnosis
Bundle branch block may be asymptomatic and even healthy people may have a block in the right bundle branch which is not usually dangerous except when it is precipitated by heart damage resulting from a heart attack. Block in the left bundle branch is often more serious since it is usually a sign of coronary artery disease resulting from atherosclerosis or uncontrolled high blood pressure, especially in older people.
Electrocardiography (ECG) can diagnose the type of bundle branch block as each type of block produces a unique pattern that can be easily differentiated.
No treatment is needed for either the left bundle branch block or the right bundle branch block, unless there is a perceived risk of a complete heart block. A pacemaker is often implanted in people to initiate the heart rhythm in the event of a complete block which is dangerous.
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Heart Block
Heart block is either a blockage or delay in the electrical conduction system of the heart, as the electrical impulses originating in the sinoatrial node, travels down the atrioventricular node to the ventricles, via the bundle of his and its branches.
- Heart block may be asymptomatic or may cause symptoms such as bouts of fainting, dizzy feeling and general fatigue.
- Heart block can be diagnosed by electrocardiography.
- Artificial pacemaker is required in severe cases.
Heart block is more prevalent in the older age group. According to the severity of the block in the electrical conduction system, heart block is classified as first degree, second degree and third degree blocks.
- In first-degree heart block, which often does not show any symptoms, the electrical impulses starting in the sinus are all conducted to the ventricles but they are delayed a bit longer as it passes the atrioventricular node. Certain conditions such as an overactive vagus nerve which slows down the heart rate, structural defects of the heart, sarcoidosis and rheumatic diseases of the heart may cause a first-degree heart block. Even some drugs such as verapamil, amiodarone, digoxin, diltiazem and beta-blockers that slow down the electrical conduction may also induce it. Though common among youngsters, teenagers, and athletes who are well-trained, due to lack of symptoms, a first-degree heart block is usually diagnosed by an electrocardiography only.
- In second-degree heart block, only a few electrical impulses get transmitted to the ventricles due to which heart beat may become either slow or irregular or sometimes both.
- In third-degree heart block, the pumping capacity of the heart is greatly compromised, making it a very dangerous situation. The electrical impulses that originate in the sinus (sinoatrial node) in the atria fail to reach the ventricles. In the absence of stimulation from the atria, substitute pacemakers such as the atrioventricular node or the bundle of His or in certain cases the ventricles themselves take over but they are slower than the sinoatrial node. Moreover, they may be irregular and undependable. This causes the ventricles to contact irregularly as well as extremely slowly, sometimes at a rate as low as 30 – 40 beats per minute resulting in fainting bouts and dizziness. If the ventricular rate is above 40 beats a minute, the symptoms may not be severe and generally fatigue may be the only symptom. But since the output of the heart is greatly reduced, third-degree heart blocks require urgent medical attention.
Treatment of Heart Block
Treatment varies depending on the degree of heart block, the first-degree block not requiring any special treatment even if a heart disorder is causing it. While a second degree block may necessitate the installation of pacemaker in some cases, a third degree block invariably requires an artificial pacemaker in almost all cases. Heart block in people who suffered a heart attack may be temporary in nature, and may resolve on its own and heart rate may return to normal, but usually, artificial pacemakers are implanted for life.
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What Is Ventricular Fibrillation
Ventricular fibrillation is a life-threatening condition, when extremely fast irregular heart rhythms caused by disturbances in the electrical system of the heart, incapacitates the ventricles from pumping blood.
• Ventricular fibrillation is a potentially fatal situation requiring immediate medical attention.
• The first symptom is unconsciousness, which may culminate in death, if not revived quickly.
• Diagnosis is by electrocardiography which helps find the reason of the cardiac arrest.
• Immediate CPR or cardiopulmonary resuscitation followed by defibrillation may help re-establish the normal rhythm of the heart and prevent death.
In ventricular fibrillation, the ventricles fail to pump blood as they do not contract normally. They just quiver due to a series of uncoordinated impulses stimulating the ventricles. Ventricular fibrillation can be termed cardiac arrest as the heart stops pumping out blood. In the absence or delay of competent medical intervention, it always results in death.
Coronary artery disease, which impedes the supply of blood to the muscles of the heart, is the most commonly diagnosed reason for ventricular fibrillation. It can also result due to certain other conditions which either directly or indirectly affects the heart such as electrical shock, hypoxemia or low level of oxygen in the blood due to drowning, circulatory shock resulting from abnormally low blood pressure or low blood potassium levels (hypokalemia). Certain antiarrhythmic drugs called sodium channel blockers and potassium blockers may cause disturbances in the electrical system of the heart resulting in ventricular fibrillation.
Symptoms and Diagnosis Of Ventricular Fibrillation
The symptoms of Ventricular fibrillation start with sudden unconsciousness, which quickly deteriorates into seizures resulting from lack of oxygen in the brain causing brain damage, which may not be reversible. Without immediate medical intervention, death occurs within minutes.
When a person suddenly falls unconscious or turns pale and collapses, it is usually assumed to be cardiac arrest.
Extremely low blood pressure that is hard to measure by the blood pressure cuff, absence of pulse, undetectable heartbeat, and dilated pupils point to ventricular fibrillation. Electrocardiography can confirm whether the cardiac arrest is due to ventricular fibrillation.
Treatment Of Ventricular Fibrillation
CPR or cardiopulmonary resuscitation must be administered immediately as ventricular fibrillation is an extremely dangerous condition that can be fatal. Electric shock (cardio version) is applied as soon as possible to revive the heart.
When ventricular fibrillation is accompanied by heart failure or shock, the prognosis is not good since 70% of patients die even after resuscitation and cardioversion. Without such additional risk factors, cardioversion, if given immediately, can reverse ventricular fibrillation in 95 out of hundred cases.
To prevent repeated ventricular fibrillation, those who survive an incidence are often fitted with an implantable automatic defibrillator, which will deliver a shock whenever required. If any reversible or treatable condition is the underlying cause of ventricular fibrillation, it is treated and corrected. Drugs to prevent a recurrence are often prescribed, including antiarrhythmic drugs that control abnormal arrhythmias.
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Ventricular Tachycardia Symptoms And Treatment
Ventricular tachycardia is an abnormally fast heart rhythm, of over 120 beats a minute, originating in the ventricles.
- Palpitations or awareness of heart beats is the major symptom.
- Diagnosis is based on electrocardiography (ECG).
- Selective destruction of a specific area of the ventricle responsible for the condition may be necessary, but using an automatic defibrillator is a viable alternative.
Ventricular tachycardia consists of a series of premature ventricular beats closely following one another. It may be sporadic, and after a brief bout of fast, abnormal beats, the normal heart rhythm may be restored. But if the abnormal rhythm persists for more than half a minute, it is termed as sustained ventricular tachycardia. It is prevalent in people whose ventricles are damaged due to some structural disorder of the heart, as well as in those who have had a heart attack recently. Though, generally, the incidence of ventricular tachycardia is more frequent among older people; even young people, even those without any structural heart defect, occasionally develop this condition.
Ventricular Tachycardia Symptoms and Diagnosis
Palpitations or awareness of heartbeat is the main symptom felt by almost everyone with this condition. Sustained ventricular tachycardia often precipitates a dangerous situation of abnormally low blood pressure due to the inability of the ventricles to fill with blood and pump blood adequately, which can lead to heart failure. Sustained ventricular tachycardia may also deteriorate fast to ventricular fibrillation, culminating in cardiac arrest. Occasionally, ventricular tachycardia may be more or less asymptomatic even at the rate of over 200 beats per minute, making it difficult to recognize this dangerous situation.
Ventricular tachycardia symptoms can be diagnosed by electrocardiography (ECG); this can also help assess the need for treatment. A small portable ECG machine called Holter monitor may be kept connected to the patient for a period of 24 hours to measure and record the heart rhythm.
Treatment
Ventricular tachycardia lasting more than half a minute requires medical intervention even when severe symptoms are not present. Sustained ventricular tachycardia is an emergency situation as it often results in blood pressure getting dangerously lowered due to the impaired pumping action of the heart. Immediate cardioversion may prevent a potentially fatal outcome.
Ventricular tachycardia may also be treated with drugs such as lidocaine and amiodarone, given intravenously to suppress the arrhythmia. Procainamide is another useful drug.
Radiofrequency ablation is a minimally invasive surgical procedure by which, selective destruction of a specific area of the ventricle responsible for the ventricular tachycardia, can be achieved. The procedure involves identifying the offending area with the help of ECG, and then applying high frequency energy to kill the tissue, with the help of an electrode-tipped catheter threaded into the heart via a vein. This is preferred to an open-heart surgery due to the lowered risks and reduced hospital stay involved.
Ventricular tachycardia accompanied by other heart disorders, result in poor pumping activity of the heart. To help counteract it, a small device called automatic defibrillator, (similar to an artificial pacemaker) that can detect an arrhythmia and automatically deliver a shock to correct it, is often implanted by a minimally invasive surgery.
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Ventricular Premature Beat (Premature Ventricular Contraction)
A ventricular premature beat, which is also called premature ventricular contraction, is an abnormal but usually harmless extra beat caused by a rogue electrical impulse starting in the ventricles prior to a normal heartbeat.
- Perception of an occasional strong heart beat or of a sporadic skipped beat is the usual symptom.
- Diagnosis is by electrocardiography and further tests may help rule out other heart defects.
- Stressful situations and mild stimulants like coffee and alcohol are better avoided.
More commonly occurring in older people, ventricular premature beat is generally the result of stress, either physical or emotional or it may be triggered by mild stimulants such as alcohol or coffee or by the use of certain drugs like pseudoephedrine contained in anti-allergic medications.
Heart valve disorders that result in enlargement of ventricles, as well as heart failure, may be reason for this condition. Coronary artery disease, soon after a heart attack especially, also may precipitate this arrhythmia.
Symptoms and Diagnosis
Ventricular premature beats are generally asymptomatic except for a feeling of having skipped a heart beat or an extra strong beat. Since they do not affect the pumping mechanism of the heart, they are usually ignored unless very frequent episodes become disconcerting. Though ventricular premature beats are not dangerous in themselves, frequent episodes, especially in people with pre-existing heart defects, they may be precursors of potentially fatal arrhythmias such as ventricular fibrillation and ventricular tachycardia that call for immediate intervention.
Ventricular premature beats can be diagnosed by electrocardiography (ECG) and further tests can rule out any other underlying heart defects.
Treatment
Usually doctors do not prescribe any drugs for people with ventricular beats if they are otherwise healthy, but often advise them to avoid caffeinated beverages and other mild stimulants such as alcohol and anti-allergic medications, in addition to reducing stress.
Beta-blockers are sometimes prescribed to treat the condition if the symptoms cause extreme discomfort or when there is a possibility of developing ventricular fibrillation or tachycardia. But the side effects of these drugs such as drowsiness often discourage people from taking them. However, if people with this condition, have also had heart attacks, the risk of developing fatal arrhythmias like ventricular fibrillation can be greatly reduced by taking beta blockers. Certain structural defects of the heart and certain patterns in which ventricular premature beats occur can predispose a person to developing more serious and often fatal arrhythmias. Bypass surgery or angioplasty to treat coronary artery disease also may reduce the risk of sudden death due to potentially fatal arrhythmias. Antiarrhythmic drugs can also help but they are associated with a greater risk of developing more dangerous arrhythmias, so doctors prescribe them after careful evaluation only.
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Medical History And Physical Examination For A Heart Patient
Before going for a physical examination a doctor must first Take a full medical history from the patient. The Doctor will ask about the different symptoms that are being experienced by the patient. Symptoms which include shortness of breath, pain in the chest, palpitations and swelling observed in the feet, ankles and legs as well as the abdomen are often determined as symptoms of cardiac disorder. Other general symptoms such as weakness, fever, and feeling of fatigue, lack of appetite and the general experience of discomfort or illness might also suggest cardiac disorder. Doctors can often determine peripheral arterial disease in case the symptoms experienced by the patient include numbness, pain, cramps and the muscles of the leg. Peripheral arterial disease often affects the arteries located in the trunk, legs and arms. However the peripheral arterial disease does not affect the arteries which supply blood to the heart.
After examining the different symptoms experienced by the patient the doctor often asks the patient about infections experienced in the past as well as previous exposure to harmful chemicals and also about the use of tobacco, alcohol and drugs. The doctor might also ask whether any other family member has experienced a cardiac disorder in the past or has experienced any other disorder that affects the blood vessels or the heart.
During performance of the physical examination the doctor will note down the heart rate of the patient as well as overall appearance of the patient which includes checking for paleness, drowsiness and perspiration. Since these symptoms often indicate cardiac disorder. The doctors will also note the general feeling of overall well-being and the general mood of the patient.
During physical examination assessment of the color of the skin is extremely important since pale skin color or skin color that is purplish or bluish often indicates the presence of inadequate blood supply or anemia. The skin colors will tell the doctor that the skin has not been receiving the appropriate amount of oxygen from the blood because of any cardiovascular disorders such as cardiac failure, lung disorders or any other circulatory problem.
During physical examination the doctor must feel for pulse beneath the arms, in the arteries located in the neck, at the wrist, at the right and left elbow, in the abdomen, at the knees, in the groin and also in the feet and ankles to determine whether the blood supply to these parts of the body is adequate and also to determine whether the blood supply is equal on the right as well as on the left side of the body. Similarly the doctor will also check the body temperature and blood pressure of the patient. In case any abnormality is observed by checking the body temperature, blood pressure or blood supply then the patient is suffering from a blood vessel or cardiac disorder.
The veins located in the neck of the patient are inspected by the doctor when the patient is lying down and the trunk of the body is elevated at an angle of 45°. The veins located at the neck of the patient must be inspected since these veins are directly connected to the atrium on the right side of the heart, which receives blood flow from the rest of the body which contains high levels of carbon dioxide and other waste products and low levels of oxygen. Examination of the veins located in the neck of the patient will provide the doctor an indication of the pressure and volume of the blood supply entering the right-hand side atrium of the heart.
During physical examination the doctor also presses the skin over the legs and the ankles. The doctor might also press the skin over the lower back of the patient to check for accumulation of body fluids in the tissues located under the skin.
Often the doctor uses an ophthalmoscope to inspect the blood vessels located in the retina which is a light-sensitive membrane that is located on the inner surface of the back part of the eye. The retina is the only place in the human body where the doctor can directly view the arteries and veins. Abnormalities in the arteries and veins of the retina are clearly visible in case the patient is suffering from diabetes, high levels of blood pressure, bacterial infection in the valves of the heart and arteriosclerosis.
During physical examination the doctor will also observe the movements of the chest during normal breathing to determine whether the movements of the chest and the rate of breathing are normal. Often the doctor will also tap the chest of the patient with the fingers which is commonly known as percussion so that the doctor can determine if the lungs are being filled with air which is normal or if the patient is experiencing any abnormality of the lungs such as the lungs filling up with fluids. Percussion often helps the doctor to determine whether the membrane layers that cover the lungs (pleura) or the sac that envelope the human heart commonly known as the pericardium, contain fluid. This is determined by the doctor with the use of a stethoscope and by listening to sounds of breathing, also by determining whether the airflow is obstructed normal and hence whether the lungs are filled with fluid resulting from cardiac failure.
The doctors often place a hand on the chest of the patient to feel any palpitation of the heart and to determine the position of the heart by checking for the location where the palpitation is the strongest. By feeling the palpitation of the heart the doctor can also determine the size of the heart. Similarly the force and quality of the contractions during the different heartbeats can also be determined by the doctor by feeling the palpitation of the heart. The doctors also look for abnormalities such as disturbed flow of blood in the blood vessels located in the heart chambers. These abnormalities often cause a vibration which is known as a thrill and can be felt between the palms at the fingertips of the doctor that has been placed on the chest of the patient.
The doctor during physical examination also listens to the heart using a stethoscope which is known as auscultation. Using a stethoscope the doctor can listen to the distinctive sounds produced by the closing and opening of the valves of the heart. In case any abnormalities are present, the valves of the heart will create a disturbed blood flow that produce characteristic sounds during heart beat that are known as murmur. The disturbed blood flow usually occurs when the blood moves through valves that are leaking or that have become narrow.
However, not all murmurs indicate cardiac disorder and neither all cardiac disorders will produce murmurs during the heartbeats. For example doctors examining pregnant women will observe murmurs in the heart because during pregnancy the women often experience increased blood flow. Similarly murmurs of the heart which are harmless are also commonly observed in children and infants because the blood flow through the heart of the children and infants is usually rapid because of the small structure of their heart. Often murmurs in the heartbeats are also observe in aged people because as a person ages the walls of the blood vessels, tissues and valves of the heart of the aged percent begins to stiffen which disturbs the normal blood flow and hence the murmurs are produced even if there is no occurrence of a serious cardiac disorder. Hence the doctors often check for clicking sounds and snapping sounds produced by opening of the valves of the heart which are abnormal. The doctors similarly also check for a galloping rhythm which is the sound that resembles the galloping of a horse and is produced due to the extra heart sounds in the patient. The doctors check for the galloping rhythm to determine whether the patient is suffering from cardiac failure.
During physical examination the doctors also place a stethoscope over the veins and arteries of the patient in the different body parts. By doing so the doctors listen to the sound of disturbed blood supply blood is known as bruits. Disturbed blood supply is often caused when the blood vessels begin to narrow. Disturbed blood supply might also occur due to increase in the blood supply to a certain body part as well as due to an abnormal connection that occurs between a vein and an artery, a condition commonly known as arteriovenous fistula.
During physical examination the doctor also checks the abdomen of the patient to determine whether there is an enlargement of the liver since enlargement of the liver often indicates accumulation of blood in the major veins that provide blood supply to the heart. Similarly swelling in the abdominal area might also occur due to accumulation of fluids that might help the doctor determine whether the patient is suffering from cardiac failure. The doctors usually gently press the abdominal area and also check for pulse in the abdominal area which helps the doctor determine the width of the aorta located in the abdominal area.