What is this condition?

Dilated cardiomyopathy is caused by extensively damaged heart muscle fibers. This disorder interferes with the heart’s metabolism and greatly enlarges all four chambers of the heart, giving the heart a globular shape and causing it to contract poorly .

Dilated cardiomyopathy leads to intractable congestive heart failure, irregular heart rhythm, and emboli (blood clots or other material that is carried in the bloodstream). Because this disease usually isn’t diagnosed until it’s in the advanced stages, the prognosis is generally poor.

What causes it?

The cause of most cardiomyopathies is unknown. Dilated cardiomyopathy may occur as a primary heart disease or it may result from viruses, endocrine and electrolyte disorders, or nutritional deficiencies. Other causes include muscle disorders (myasthenia gravis, progressive muscular dystrophy, myotonic dystrophy), infiltrative disorders (hemochromatosis, amyloidosis, sarcoidosis), and some­times pregnancy.

Cardiomyopathy may also be a complication of alcoholism. The condition may improve somewhat with abstinence but recurs when the person resumes drinking.

What are its symptoms?

In dilated cardiomyopathy, the heart ejects blood less efficiently than normal. Consequently, a large volume of blood remains in the left ventricle after its contraction, causing shortness of breath, fatigue, an irritating dry cough at night, swelling, liver engorgement, and swelling of the neck veins.

How is it diagnosed?

No single test confirms dilated cardiomyopathy. Diagnosis requires elimination of other possible causes of congestive heart failure and irregular heart rhythms. Tests include the following:

• Electrocardiography and angiography rule out ischemic heart disease; the electrocardiogram may also show an enlarged heart .

• Chest X-ray demonstrates an enlarged heart, lung congestion, or pleural effusion.

How is it treated?

Therapeutic goals include correcting the underlying causes and improving the heart’s pumping ability with drugs, oxygen, and a sodium-restricted diet. Other options may include bed rest and steroids.

When these treatments fail, therapy may require a heart transplant for carefully selected people. Another option for selected individuals is cardiomyoplasty, a surgical procedure in which the latissimus dorsi muscle is wrapped around the ventricles. This helps the ventricle to effectively pump blood. A cardiomyostimulator delivers bursts of electrical impulses to contract the muscle

What is this condition?

The dominant effect of this disease is the loss of oxygen and nutrients to the heart because of diminished blood flow through the heart’s arteries. This disease is near epidemic in the Western world.

Coronary artery disease occurs more often in men than in women, in whites, and in middle-aged and elderly people. In the past, it rarely affected premenopausal women, bur that’s no longer the case - perhaps because many women now take oral contraceptives, smoke cigarettes, and are employed in stressful jobs that used to be held exclusively by men.

What causes it?

Axherosclerosis is the usual cause of coronary artery disease. In atherosclerosis, fatty and fibrous plaques narrow the interior channel of the heart’s arteries. They reduce the volume of blood that can flow through the arteries, thereby damaging the heart. Plaque formation also predisposes a person to thrombosis (blood clot formation), which can provoke a heart attack.

Atherosclerosis usually develops in high-flow, high-pressure arteries, such as those in the heart, brain, and kidneys, and in the aorta. It has been linked to many risk factors: family history, high blood pressure, obesity, smoking, diabetes, stress, sedentary lifestyle, and high cholesterol and triglyceride levels.

Uncommon causes of reduced coronary artery blood flow include dissecting aneurysms, infectious vasculitis, syphilis, and congenital defects in the coronary vascular system. Coronary artery spasms may also impede blood flow.

What are its symptoms?

The classic symptom of coronary artery disease is angina, which results from inadequate flow of oxygen to the heart. Angina is described as a burning, squeezing, or tight feeling in the chest that may radiate to the left arm, neck, jaw, or shoulder blade. Typically, the person clenches his or her fist over the chest or rubs the left arm when describing the pain, which may be accompanied by nausea, vomiting, fainting, sweating, and cool arms and legs.

Anginal episodes most often follow physical exertion bur may also follow emotional excitement, exposure to cold, or a large meal. Severe and prolonged anginal pain generally suggests a heart attack.

How is it diagnosed?

The person’s history - including the frequency and duration of angina and the presence of associated risk factors - is crucial in evaluating coronary artery disease. Diagnostic test results include the following:

• Electrocardiogram during angina shows heart damage and, possibly, an irregular heart rhythm. It tends to be normal when the person is pain-free.
• Treadmill or bicycle stress test may provoke chest pain and signs of heart damage.
• Coronary angiography reveals coronary artery narrowing or block­age.
• Myocardial perfUsion imaging (with thallium-20l or Cardiolite) during treadmill exercise detects damaged areas of the heart, seen as “cold spots.”

How is it treated?

The goal of treatment is to either reduce the heart’s oxygen demand or increase its oxygen supply. Drug therapy consists primarily of nitrates such as nitroglycerin (given beneath the tongue, orally, through the skin in patch form, or topically in ointment form), Isordil (given beneath the tongue or orally), beta blockers (given orally), or calcium channel blockers (given orally).

Blocked coronary arteries may necessitate coronary artery bypass surgery and the use of vein grafts. In people with only partial block­age of the coronary arteries, the doctor may perform angioplasty, a procedure in which a catheter is used to compress fatty deposits and relieve blockages. Laser angioplasty, a newer procedure, corrects the blockage by melting fatty deposits.

Because coronary artery disease is so widespread, prevention is very important. Dietary restrictions aimed at reducing intake of calories (in obesity) and of salt, fats, and cholesterol serve to minimize the risk, especially when supplemented with regular exercise. Stopping smoking and reducing stress are also beneficial.

Other preventive actions include controlling high blood pressure, reducing triglyceride levels, and taking 2.5 grains of aspirin daily (to reduce the threat of blood clots).

What can a person with coronary artery disease do?

• Be sure to follow the prescribed drug therapy, exercise program, and diet.
• Get regular, moderate exercise.
• Enroll in a self-help program to stop smoking .

What do Doctors call this Condition - Pericarditis

What is this Condition?

In this disease, the pericardium - the sac that envelops, supports, and protects the heart - becomes inflamed. It occurs in both acute and chronic forms. Acute inflammation may be marked by the build­up of fluid that may contain pus or blood. In chronic constrictive inflammation, the pericardium becomes thickened and fibrous, restricting heart motion. The prognosis depends on the underlying cause but is generally good in acute inflammation.

What Causes it?

Common causes of this disease include:

• bacterial, fungal, or viral infection

• cancers (primary or spread from the lungs, breasts, or other organs)

• high-dose radiation to the chest

• uremia (an excess of waste products in the blood produced by the metabolism of protein)

• hypersensitivity or autoimmune disease, such as acute rheumatic fever (most common cause of inflammation of the sac around the heart in children), lupus, and rheumatoid arthritis

• injury to the pericardial sac, which may result from a heart attack (which later causes an autoimmune reaction in the pericardium), trauma, or surgery that leaves the pericardium intact but causes blood to leak into the pericardial cavity

• such drugs as Apresoline and Pronestyl.

What are its Symptoms?

Acute inflammation of the sac around the heart typically produces a sharp and often sudden pain that usually starts over the sternum and radiates to the neck, shoulders, back, and arms. However, unlike the pain of a heart attack, pericardial pain often increases with deep inspiration and decreases when the person sits up and leans forward.

A major complication of this disorder is pericardial effusion.

How is it Diagnosed?

Because inflammation of the sac around the heart often exists with other conditions, its diagnosis depends on typical signs and symptoms and elimination of other possible causes. When listening with a stethoscope, the doctor may hear a grating sound as the heart moves, called a pericardial friction rub. In addition, if acute inflammation has caused accumulation of fluid in the pericardial sac, the doctor may note changes in sounds produced by the heart - increased cardiac dullness, diminished or absent apical impulse, and distant heart sounds.

Diagnostic test results, such as white blood cell count and measurement of cardiac enzymes, may help to confirm inflammation and identifY its cause. Open surgical drainage or cardiocentesis may be performed to obtain a culture of pericardial fluid. Culturing may help to identifY a causative organism in bacterial or fungal inflammation. An electrocardiogram may show changes in heart rate and rhythm brought on by acute inflammation.

How is it Treated?

The goal of treatment is to relieve symptoms and manage underlying systemic disease. When this condition is caused by a heart attack or follows heart surgery, treatment consists of bed rest as long as fever and pain persist and nonsteroidal anti-inflammatory drugs, such as aspirin and Indocin, to relieve pain and reduce inflammation. If these drugs fail to relieve symptoms, corticosteroids may be used.

Antibiotics, surgical drainage, or both may be needed to treat infectious inflammation of the sac around the heart. If cardiac tamponade (increased pressure on the heart muscle from fluid buildup) develops, the doctor may perform emergency pericardiocentesis.

Recurrent inflammation of the sac around the heart may require partial pericardiectomy, which creates a “window” that allows fluid to drain. In constrictive inflammation, total pericardiectomy (removal of the sac around the heart) may be necessary to permit adequate filling and contraction of the heart.