CONGENITAL CYANOTIC HEART DISEASE

CYANOTIC CONGENITAL HEART DISEASE

                                     CYANOTIC CONGENITAL HEART DISEASE
                                 

Cyanotic congenital heart disease (CCHD) is a condition present at birth. CYANOTIC CONGENITAL HEART DISEASE causes low levels of oxygen in the blood. A common symptom is a bluish tint to the skin, called cyanosis.
Several birth defects can cause this type of heart disease, including:
issues with the heart valves, which are the flaps in the heart that make sure the blood flows through in the right direction
an interruption in the aorta, which is the largest artery in the body
abnormalities in the large blood vessels leading to or from the heart
In many cases, if only one defect is present, there’s no cyanosis. Often more than one defect is present in CCHD.
Doctors use imaging tests to confirm the presence of defects that lead to CCHD. These include chest X-rays and echocardiograms. Medication can help relieve symptoms of cyanosis. Ultimately, most infants need to have surgery to correct the defects causing the disease. The success of the surgery depends on the severity of the defects.
RISK FACTOR FOR CONGENITAL CYANOTIC HEART DISEASE
In many cases, an infant will be born with this disease in association with a genetic factor. An infant is more at risk for CCHD when there’s a family history of congenital heart diseases. Certain genetic syndromes can be accompanied by defects that cause CCHD. These include:
Down syndrome
Turner syndrome
Marfan’s syndrome
Noonan syndrome
In some instances, outside factors can cause this disease. If a pregnant woman is exposed to toxic chemicals or certain drugs, her infant may have a higher risk of developing heart defects. Infections during pregnancy are also a factor. Poorly controlled gestational diabetes can also lead to a higher risk of the infant developing CCHD.
Defects that cause cyanotic congenital heart disease
Many physical defects in the heart can cause CCHD. Some infants may be born with several defects. Common causes can include:

 Cyanotic Heart Disease. Acyanotic Heart Disease. Decreased pulmonary flow: Tetralogy of Fallot. Tricuspid atresia. Other univentricular heart with pulmonary stenosis. Increased pulmonary flow: Transposition of great arteries. Total anomalous pulmonary venous return. Left – Right shunt lesions: Ventricular septal defect. Atrial Septal Defect. Atrio-ventricular Septal Defect. Patent Ductus Arteriosus. Obstructive lesions: Aortic stenosis. Pulmonary valve stenosis. Coarctation of Aorta.
TETRALOGY OF FALLOT (TOF) TETRALOGY OF FALLOT

TOF is the most common cause of CCHD. It’s a combination of four different defects. TOF includes:
A hole between the right and left ventricles of the heart
A narrow pulmonary valve
A thickening of the right ventricle muscles
A misplaced aortic valve
The defects lead to blood with and without oxygen getting mixed together and pumped throughout the body.
TRANSPOSITION OF GRAET ARTERIES (TGA)
In infants with TGA, the pulmonary and aortic valves have switched positions with their arteries. This results in low-oxygen blood getting pumped out to the rest of the body through the aorta. This blood should actually go to the lungs through the pulmonary artery.
TRICUSPID ATRESIA
In this type of defect, the tricuspid heart valve has developed abnormally or is missing entirely. This causes disruption to the normal flow of blood. Low-oxygen blood is pumped out to the body as a result.
TOTAL ANOMOLUS PULMONARY VENOUS CONNECTION (TAPVC)
TAPVC occurs when veins that bring high-oxygen blood from the lungs to the heart are connected to the right atrium. The veins should be connected to the left atrium. This defect may also be accompanied by a blockage in these veins between the lungs and the heart.
SYMPTOMS
The classic symptom of CCHD is cyanosis, or the blue coloring of the skin. This often occurs in the lips, toes, or fingers. Another common symptom is difficulty breathing, especially after physical activity.
Some children also experience spells during which their oxygen levels are very low. As a result, they get anxious, exhibit blue skin, and may hyperventilate.
Other symptoms of CCHD depend on the exact physical defect:
SYMPTOMS OF TOF
Low birth weight
Cyanosis
Poor feeding
Clubbed, or rounded, large fingers
Delayed growth
Rapid breathing
SYMPTOMS OF TGA
Rapid heartbeat
Rapid breathing
Slow weight gain
Heavy sweating
SYMPTOMS OF TRICUSPID ATRESIA
Cyanosis
Tiredness
Shortness of breath
Difficulty feeding
Heavy sweating
Slow growth
Chronic respiratory infections
SYMPTOMS TAPVC WITHOUT A BLOCKAGE
Shortness of breath
Chronic respiratory infections
Slow growth
TAPVC WITH BLOCKAGE
Cyanosis
Rapid heartbeat
Rapid breathing
Breathing difficulty, becoming very severe with time
DIAGNOSIS
Symptoms such as cyanosis, rapid heartbeat, and abnormal heart sounds can lead your child’s doctor to suspect heart defects are present. The observation of symptoms isn’t enough to make a diagnosis, though. To understand which defects are present, your child’s doctor will use tests to confirm a diagnosis.
A chest X-ray can show the outline of the heart and the location of several of the arteries and veins. To get another image of the heart, your child’s doctor may order an echocardiogram. This is an ultrasound of the heart. This test gives more details than an X-ray image.
A cardiac catheterization is a more invasive test that’s often needed to investigate the interior of the heart. This test involves moving a small tube, or a catheter, into the heart from the groin or the arm
.
TRETMENT OF CYANOTIC CONGENITAL HEART DISEASE
Treatment for CCHD may or may not be necessary depending on the severity of symptoms. In many cases, surgery to correct the physical defects in the heart is eventually necessary.
When the defect is very dangerous, the surgery may need to be performed soon after birth. In other instances, the surgery can be delayed until the child is older. Sometimes, more than one surgery is needed.
If surgery is delayed, a child may be given medications to treat the disease. Medications can help:
Eliminate extra fluids from the body
Get the heart pumping better
Keep blood vessels open
Regulate abnormal heart rhythms
OUTLOOK FOR CYANOTIC CONGENITAL HEART DISEASE
The outlook for children with CCHD varies based on the severity of the underlying defects. In mild cases, the child may be able to live a normal lifestyle with minimal medications or other treatments.
More severe cases will need surgery. Your child’s doctor will work with you toward the best treatment for your child. They can discuss your child’s particular outlook with you and if any further procedures are needed.

CONGENITAL HEART DISEASE

DEFINATION
Congenital heart disease, or a congenital heart defect, is a heart abnormality present at birth. The problem can affect:

• The heart walls
• The heart valves
• The blood vessels
  There are numerous types of congenital heart defects. They can range from simple conditions that don’t cause symptoms to complex problems that cause severe, life-threatening symptoms.

According to the Centers for Disease Control and Prevention, there are currently 1 million adults and 1 million children in the United States living with congenital heart defects. Treatments and follow-up care for defects have improved drastically over the past few decades, so nearly all children with heart defects survive into adulthood. Some need continuous care for their heart defect throughout their lives. However, many go on to have active and productive lives despite their condition.

TYPES OF CONGENOITAL HEART DISEASE
Though there are many different types of congenital heart defects, they can be divided into three main categories:
In heart valve defects, the valves inside the heart that direct blood flow may close up or leak. This interferes with the heart’s ability to pump blood correctly.
In heart wall defects, the natural walls that exist between the left and right sides and the upper and lower chambers of the heart may not develop correctly, causing blood to back up into the heart or to build up in places where it doesn’t belong. The defect puts pressure on the heart to work harder, which may result in high blood pressure.
In blood vessel defects, the arteries and veins that carry blood to the heart and back out to the body may not function correctly. This can reduce or block blood flow, leading to various health complications.
Cyanotic and Acyanotic Congenital Heart Disease
Many doctors classify congenital heart disease as either cyanotic congenital heart disease or acyanotic congenital heart disease. In both types, the heart isn’t pumping blood as efficiently as it should. The main difference is that cyanotic congenital heart disease causes low levels of oxygen in the blood, and acyanotic congenital heart disease doesn’t. Babies with reduced oxygen levels may experience breathlessness and a bluish tint to their skin. Babies who have enough oxygen in their blood don’t display these symptoms, but they may still develop complications later in life, such as high blood pressure.
SYMPTOMS OF CONGENITAL HEART DISEASE

 
A congenital heart defect is often detected during a pregnancy ultrasound. If your doctor hears an abnormal heartbeat, for instance, they may further investigate the issue by performing certain tests. These may include an echocardiogram, a chest X-ray, or an MRI scan. If a diagnosis is made, your doctor will make sure the appropriate specialists are available during delivery.
In some cases, the symptoms of a congenital heart defect may not appear until shortly after birth. Newborns with heart defects may experience:

• Bluish lips, skin, fingers, and toes
• Breathlessness or trouble breathing
• Feeding difficulties
• Low birth weight
• Chest pain
• Delayed growth
• In other cases, the symptoms of a congenital heart defect may not appear until many years after birth. Once symptoms do develop, they may include:
• Abnormal heart rhythms
• Dizziness
• Trouble breathing
• Fainting
• Swelling
• Fatigue

CAUSES OF CONGENITALL HEART DISEASE
Congenital heart disease occurs as a result of an early developmental problem in the heart’s structure. The defect typically interferes with the normal flow of blood through the heart, which may affect breathing. Although researchers aren’t exactly sure why the heart fails to develop correctly, suspected causes include the following:

• The heart defect may run in families.
• Taking certain prescription drugs during pregnancy puts a child at a higher risk for a heart defect.
• Using alcohol or illegal drugs during pregnancy can increase a child’s risk of having a heart defect.
• Mothers who had a viral infection during the first trimester of pregnancy are more likely to give birth to a child with a heart defect.
• Increased blood sugar levels, such as occurs with diabetes, may affect childhood development.

TREATMENT
The treatment for a congenital heart defect depends on the type and severity of the defect. Some babies have mild heart defects that heal on their own with time. Others may have severe defects that require extensive treatment. In these cases, treatment may include the following:
MEDICATION
There are various medications that can help the heart work more efficiently. Some can also be used to prevent blood clots from forming or to control an irregular heartbeat.
IMPLANTABLE HEART DEVICE
Some of the complications associated with congenital heart defects can be prevented with the use of certain devices, including pacemakers and implantable cardioverter defibrillators (ICDs). A pacemaker can help regulate an abnormal heart rate, and an ICD may correct life-threatening irregular heartbeats.
CATHETER PROCEDURE
Catheterization techniques allow doctors to repair certain congenital heart defects without surgically opening the chest and heart. During these procedures, the doctor will insert a thin tube into a vein in the leg and guide it up to the heart. Once the catheter is in the correct position, the doctor will use small tools threaded through the catheter to correct the defect.
OPEN-HEART SURGERY
This type of surgery may be needed if catheter procedures aren't enough to repair a congenital heart defect. A surgeon may perform open-heart surgery to close holes in the heart, repair heart valves, or widen blood vessels.
HEART TRANSPLANT
In the rare cases in which a congenital heart defect is too complex to fix, a heart transplant may be needed. During this procedure, the child's heart is replaced with a healthy heart from a donor.
CONGENITAL HEART DISEASE IN ADULTS
Depending on the defect, diagnosis and treatment may begin shortly after birth, during childhood, or in adulthood. Some defects don’t cause any symptoms until the child becomes an adult, so diagnosis and treatment may be delayed. In these cases, the symptoms of a newly discovered congenital heart defect may include:

• Shortness of breath
• Chest pain
• A reduced ability to exercise
• Being easily fatigued
• The treatment for congenital heart disease in adults can also vary depending on the severity of the heart defect. Some people may only need to monitor their condition closely, and others may require medications and surgeries.

In some cases, defects that may have been treated in childhood can present problems again in adulthood. The original repair may no longer be effective or the initial defect may have become worse over time. Scar tissue that developed around the original repair may also end up causing problems, such as heart arrhythmias.
Regardless of your situation, it’s important to continue seeing your doctor for follow-up care. Treatment may not cure your condition, but it can help you maintain an active, productive life. It will also reduce your risk for serious complications, such as heart infections, heart failure, and stroke.
PREVENTION OF CONGENITAL HEART DISEASE
Women who are pregnant or plan on becoming pregnant can take certain precautions to lower their risk of giving birth to a baby with a congenital heart defect:

• If you’re planning on becoming pregnant, talk to your doctor about any prescription or over-the-counter medications you’re taking.
• If you have diabetes, make sure your blood sugar levels are under control before becoming pregnant. It’s also important to work with your doctor to manage the disease while pregnant.
• If you weren’t vaccinated against rubella, or German measles, avoid exposure to the disease and speak with your doctor about prevention options.
• If you have a family history of congenital heart defects, ask your doctor about genetic screening. Certain genes may contribute to abnormal heart development.
• Avoid drinking alcohol and using illegal drugs during pregnancy.

CONGESTIVE HEART FAILURE

DEFINATION

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.
Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.
ANATOMY
You have four heart chambers. The upper half of your heart has two atria, and the lower half of your heart has two ventricles. The ventricles pump blood to your body’s organs and tissues, and the atria receive blood from your body as it circulates back from the rest of your body.
CHF develops when your ventricles can’t pump enough blood volume to the body. Eventually, blood and other fluids can back up inside your:
Lungs
Abdomen
Liver
Lower body
CHF can be life-threatening. If you suspect you or someone near you has CHF, seek immediate medical treatment.
TYPES OF CHF
Results of these tests help doctors determine the cause of your signs and symptoms and develop a program to treat your heart. To determine the most appropriate treatment for your condition, doctors may classify heart failure using two systems:
New York Heart Association classification. This symptom-based scale classifies heart failure in four categories. In Class I heart failure, you don't have any symptoms. In Class II heart failure, you can perform everyday activities without difficulty but become winded or fatigued when you exert yourself. With Class III, you'll have trouble completing everyday activities, and Class IV is the most severe, and you're short of breath even at rest.
American College of Cardiology/American Heart Association guidelines. This stage-based classification system uses letters A to D. The system includes a category for people who are at risk of developing heart failure.
For example, a person who has several risk factors for heart failure but no signs or symptoms of heart failure is Stage A. A person who has heart disease but no signs or symptoms of heart failure is Stage B. Someone who has heart disease and is experiencing or has experienced signs or symptoms of heart failure is Stage C. A person with advanced heart failure requiring specialized treatments is Stage D.
Doctors use this classification system to identify your risk factors and begin early, more aggressive treatment to help prevent or delay heart failure.
These scoring systems are not independent of each other.



CAUSES OF CHF

                                                                RISK FACTORS
      CHF may result from other health conditions that directly affect your cardiovascular system. This is why it’s important to get annual checkups to lower your risk for heart health problems, including high blood pressure (hypertension), coronary artery disease, and valve conditions

• HYPERTENSION
  When your blood pressure is higher than normal, it may lead to CHF. Hypertension has many different causes. Among them is the narrowing of your arteries, which makes it harder for your blood to flow through them.
• CORONARY ARTERY DISEASE
  Cholesterol and other types of fatty substances can block the coronary arteries, which are the small arteries that supply blood to the heart. This causes the arteries to become narrow. Narrower coronary arteries restrict your blood flow and can lead to damage in your arteries.
• VALVE CONDITIONS
  Heart valves regulate blood flow through your heart by opening and closing to let blood in and out of the chambers. Valves that don’t open and close correctly may force your ventricles to work harder to pump blood. This can be a result of a heart infection or defect.

• OTHER CONDITIONS
  While heart-related diseases can lead to CHF, there are other seemingly unrelated conditions that may increase your risk, too. These include diabetes, thyroid disease, and obesity. Severe infections and allergic reactions may also contribute to CHF.

SYMPTOMS OF CHF   

                                                        symptoms of CHD

                                       
In the early stages of CHF, you most likely won’t notice any changes in your health. If your condition progresses, you’ll experience gradual changes in your body.

• Symptoms you may notice first Symptoms that indicate your condition has worsened
• Symptoms that indicate a severe heart condition
• fatigue
• irregular heartbeat
• chest pain that radiates through the upper body
• swelling in your ankles, feet, and legs
• a cough that develops from congested lungs
• rapid breathing
• weight gain
• wheezing skin that appears blue, which is due to lack of oxygen in your lungs
• increased need to urinate, especially at night
• shortness of breath, which may indicate pulmonary edema
• fainting
• Chest pain that radiates through the upper body can also be a sign of a heart attack. If you experience this or any other symptoms that may point to a severe heart condition, seek immediate medical attention.

SYMPTOMS OF HEART FAILURE IN CHILDREEN 
It can be difficult to recognize heart failure in infants and young children. Symptoms may include:

• Poor feeding
• Excessive sweating
• Difficulty breathing
• These symptoms can easily be misunderstood as colic or a respiratory infection. Poor growth and low blood pressure can also be signs of heart failure in children. In some cases, you may be able to feel a resting baby’s rapid heart rate through the chest wall.

DIAGNOSIS OF CHD

After reporting symptoms to doctor, they may refer you to a heart specialist, or cardiologist.
Cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms. To confirm an initial diagnosis, cardiologist might order certain diagnostic tests to examine your heart’s valves, blood vessels, and chambers.
There are a variety of tests used to diagnose heart conditions. Because these tests measure different things, doctor may recommend a few to get a full picture of your current condition.

• ELECTROCARDIOGRAM
  An electrocardiogram (EKG or ECG) records heart’s rhythm. Abnormalities in your heart’s rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s chamber are thicker than normal. That could be a warning sign for a heart attack.
• ECHOCARDIOGRAM
  An echocardiogram uses sound waves to record the heart’s structure and motion. The test can determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t contract normally.
• MRI
  An MRI takes pictures of your heart. With both still and moving pictures, this allows doctor to see if there’s damage to you heart.
• STRESS TEST
  Stress tests show how well your heart performs under different levels of stress. Making your heart work harder makes it easier for doctor to diagnose problems.
• BLOOD TEST
  Blood tests can check for abnormal blood cells and infections. They can also check the level of BNP, a hormone that rises with heart failure.
• CARDIAC CATHETERISATION
  Cardiac catheterization can show blockages of the coronary arteries. Doctor will insert a small tube into blood vessel and thread it from your upper thigh (groin area), arm, or wrist.
•  
• CORONARY ANGIOGRAM. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray, helping doctors spot blockages.

Myocardial biopsy. In this test, your doctor inserts a small, flexible biopsy cord into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.
MEDICATIONS
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITOR- These drugs help people with systolic heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
ANGIOTENSIN 2 RECEPTOR BLOCKER -These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. They may be an alternative for people who can't tolerate ACE inhibitors.
BETA BLOCKERS- This class of drugs not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart if you have systolic heart failure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta).
These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer.

DIURETICS- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.
Because diuretics make your body lose potassium and magnesium, Doctor may also prescribe supplements of these minerals. If you're taking a diuretic, Doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.

ALDOSTERON ANTAGONIST- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer.
Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that's high in potassium.

INOTROPES- These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.

DIGOXIN (Lanoxin) - This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
You may need to take two or more medications to treat heart failure. Your doctor may prescribe other heart medications as well — such as nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots — along with heart failure medications. Your doctor may need to adjust your doses frequently, especially when you've just started a new medication or when your condition is worsening.
You may be hospitalized if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen long term.

SURGERY AND MEDICAL DEVICE
In some cases, doctors recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include:
CORONARY BYPASS SURGERY- If severely blocked arteries are contributing to your heart failure, doctor may recommend coronary artery bypass surgery. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
HEART VALVE REPAIR OR REPLACEMENT. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can modify the original valve to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty).
Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve.
Certain types of heart valve repair or replacement can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterization techniques.
IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)

                                                                           ICD

An ICD is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is going too slow.
SYNCHRONISATION
CARDIAC RESYNCRHRONISATION THERAPY(CRT)- or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner.
Many people with heart failure have problems with their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
VENTRICULAR ASSIST DEVICE (VADs)- A VAD, also known as a mechanical circulatory support device, is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body.
Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. VADs may also be used as an alternative to transplantation. Implanted heart pumps can enhance the quality of life of some people with severe heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.
HEART TRANSPLANT. Some people have such severe heart failure that surgery or medications don't help. They may need to have their diseased heart replaced with a healthy donor heart.
Heart transplants can improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait a long time before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.A heart transplant isn't the right treatment for everyone.
PALLIATIVE CARE AND END OF-LIFE CARE
Doctor may recommend including palliative care in your treatment plan. Palliative care is specialized medical care that focuses on easing your symptoms and improving your quality of life. Anyone who has a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the disease, such as pain or shortness of breath, or to ease the side effects of treatment, such as fatigue or nausea.
It's possible that your heart failure may worsen to the point where medications are no longer working and a heart transplant or device isn't an option. If this occurs, you may need to enter hospice care. Hospice care provides a special course of treatment to terminally ill people.
HOSPICE CARE ows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one at home or in hospice residences. Hospice care provides emotional, psychological, social and spiritual support for people who are ill and those closest to them.
Although most people under hospice care remain in their own homes, the program is available anywhere — including nursing homes and assisted living centers. For people who stay in a hospital, specialists in end-of-life care can provide comfort, compassionate care and dignity.
If you have an implantable cardioverter-defibrillator (ICD), one important consideration to discuss with your family and doctors is turning off the defibrillator so that it can't deliver shocks to make your heart continue beating.
LIFE STYLE AND HOME REMEDIES
Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make. Lifestyle changes your doctor may recommend include:
Stop smoking. Smoking damages your blood vessels, raises blood pressure, reduces the amount of oxygen in your blood and makes your heart beat faster.If you smoke, ask your doctor to recommend a program to help you quit. You can't be considered for a heart transplant if you continue to smoke. Avoid secondhand smoke, too.
Discuss weight monitoring with your doctor. Discuss with doctor how often you should weigh yourself. Ask doctor how much weight gain you should notify him or her about. Weight gain may mean that you're retaining fluids and need a change in your treatment plan.
Check your legs, ankles and feet for swelling daily. Check for any changes in swelling in your legs, ankles or feet daily. Check with your doctor if the swelling worsens.
Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins.
Restrict sodium in diet. Too much sodium contributes to water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet.
Check with doctor for the sodium restriction recommended for you. Keep in mind that salt is already added to prepared foods, and be careful when using salt substitutes.
Maintain a healthy weight. If you're overweight, your dietitian will help you work toward your ideal weight. Even losing a small amount of weight can help.
Consider getting vaccinations. If you have heart failure, you may want to get influenza and pneumonia vaccinations.
Limit saturated or 'trans' fats in your diet. In addition to avoiding high-sodium foods, limit the amount of saturated fat and trans fat — also called trans-fatty acids — in your diet. These potentially harmful dietary fats increase your risk of heart disease.
Limit alcohol and fluids. Doctor may recommend that you don't drink alcohol if you have heart failure, since it can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms.
If you have severe heart failure, doctor may also suggest you limit the amount of fluids you drink.
Reduce stress. When you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, since your heart is already having trouble meeting the body's demands.
Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
Sleep easy. If you're having shortness of breath, especially at night, sleep with your head propped up using a pillow or a wedge. If you snore or have had other sleep problems, make sure you get tested for sleep apnea.

CARDIAC ARREST

CARDIAC ARREST

Cardiac arrest is a serious heart condition. The word arrest means to stop or bring to a halt. In cardiac arrest, the heart ceases to beat. It’s also known as sudden cardiac death.
Your heartbeat is controlled by electrical impulses. When these impulses change pattern, the heartbeat becomes irregular. This is also known as an arrhythmia. Some arrhythmias are slow, others are rapid. Cardiac arrest occurs when the rhythm of the heart stops.
Cardiac arrest is an extremely serious health issue. The Institute of Medicine reports that every year, more than half a million people experience cardiac arrest in the United States. The condition can cause death or disability. If someone is experiencing symptoms of cardiac arrest, seek emergency health assistance immediately. It can be fatal. Immediate response and treatment can save a life.
CLASSIFICATION
Clinicians classify cardiac arrest into "shockable" versus "non–shockable", as determined by the ECG rhythm. This refers to whether a particular class of cardiac dysrhythmia is treatable using defibrillation. The two "shockable" rhythms are ventricular fibrillation and pulseless ventricular tachycardia while the two "non–shockable" rhythms are asystole and pulseless electrical activity.
CAUSES OF CARDIAC ARREST
A number of factors can cause sudden cardiac arrest. Two of the most common are ventricular and atrial fibrillation.
VENTRICULAR FIBRILLATION
Your heart has four chambers. The two lower chambers are the ventricles. In ventricular fibrillation, these chambers quiver out of control. This causes the heart’s rhythm to change dramatically. The ventricles begin to pump inefficiently, which severely decreases the amount of blood pumped through the body. In some cases, the circulation of blood stops completely. This may lead to sudden cardiac death.
The most frequent cause of cardiac arrest is ventricular fibrillation.
ATRIAL FIBRILATION
The heart can also stop beating efficiently after an arrhythmia in the upper chambers. These chambers are known as the atria.
Atrial fibrillation begins when the sinoatrial (SA) node doesn’t send out the correct electrical impulses. Your SA node is located in the right atrium. It regulates how quickly the heart pumps blood. When the electrical impulse goes into atrial fibrillation, the ventricles can’t pump blood out to the body efficiently.
RISK FOR CARDIAC ARREST
Certain heart conditions and health factors can increase your risk of cardiac arrest.
CORONARY ARTERY DISEASE
This type of heart disease begins in the coronary arteries. These arteries supply the heart muscle itself. When they become blocked, your heart does not receive blood. It may stop working properly.
LARGE HEART
Having an abnormally large heart places you at increased risk for cardiac arrest. A large heart may not beat correctly. The muscle may also be more prone to damage.
IRREGULAR HEART BEAT
Valve disease can make heart valves leaky or narrower. This means blood circulating through the heart either overloads the chambers with blood or does not fill them to capacity. The chambers may become weakened or enlarged.
CONGENITAL HEART DISEASE
Some people are born with heart damage. This is known as a congenital heart problem. Sudden cardiac arrest may occur in children who were born with a serious heart problem.
ELECTRICAL IMPULSE PROBLEMS
Problems with your heart’s electrical system can increase your risk of sudden cardiac death. These problems are known as primary heart rhythm abnormalities.
Other risk factors for cardiac arrest include:

• Smoking
• Sedentary lifestyle
• High blood pressure
• Obesity
• Family history of heart disease
• History of a previous heart attack
• Age over 45 for men, or over 55 for women
• Male gender
• Substance abuse
• Low potassium or magnesium

SIGNS AND SYMPTOMS
Early symptoms of cardiac arrest are often warning signs. Getting treatment before your heart stops could save your life.
If you are in cardiac arrest, you may:

• Become dizzy
• Be short of breath
• Feel fatigued or weak
• Vomit
• Experience heart palpitations                                                                                                                                          Immediate EMERGENCY care is needed if someone are with experiences these symptoms
• Chest pain
• No pulse
• Not breathing or difficulty breathing
• Loss of consciousness
• Collapse
• Cardiac arrest may not have symptoms before it occurs. If you do have symptoms that persist, seek prompt medical care.

DIAGNOSIS
difference-between-Heart-attack-and-Cardiac-arresDuring a cardiac event that causes your heart to stop beating efficiently, it’s vital to seek medical attention immediately. Medical treatment will focus on getting blood flowing back to your body. Doctor will most likely perform a test called an electrocardiogram to identify the type of abnormal rhythm your heart is experiencing. To treat the condition, doctor will likely use a defibrillator to shock your heart. An electric shock can often return the heart to a normal rhythm.
Other tests can also be used after you have experienced a cardiac event:
Blood tests can be used to look for signs of a heart attack. They can also measure potassium and magnesium levels.
Chest X-ray can look for other signs of disease in the heart.

TREATING THE CARDIAC ARREST

Defibrillator

 
 Cardiopulmonary resuscitation (CPR) is one form of emergency treatment for cardiac arrest. Defibrillation is another. These treatments get your heart beating again once it has stopped.
Medication can lower high blood pressure and cholesterol.
Surgery can repair damaged blood vessels or heart valves. It can also bypass or remove blockages in the arteries.
Exercise may improve cardiovascular fitness.
Dietary changes can help you lower cholesterol.
LONG TERM OUTLOOK OF CARDIAC ARREST
Cardiac arrest can be fatal. However, prompt treatment increases your odds of survival. Treatment is most effective within a few minutes of the arrest.
If you have experienced cardiac arrest, it’s important to understand the cause. Your long-term outlook will depend on the reason you experienced cardiac arrest. Your doctor can talk to you about treatment options to help protect your heart and prevent cardiac arrest from happening again.

PHYSICAL REHABILITATION OF CARDIOVASCULAR DISEASE

INDICATIONS
Cardiac rehabilitation should be offered to all cardiac patients who would benefit. CR is mainly prescribed to patients with ischemic heart disease, with myocardial infarction, after coronary angioplasty, after coronaro-aortic by-pass graft surgery and to patients with chronic heart failure. CR begins as soon as possible in intensive care units, only if the patient is in stable medical condition. Intensity of rehabilitation depends on patient´s condition and complications in acute phase of disease.
Cardiac rehabilitation typically comprises of four phases. The term phase is used to describe the varying time frames following a cardiac event. The secondary prevention component of CR requires delivery of exercise training, education and counseling, risk factor intervention and follow up.
Appropriate referral pathways should be set up so appropriate patients can be identified and invited to attend. Referrals should be invited by cardiologist/physician, cardiothoracic surgeon, cardiac team, cardic rehab co-ordinator, G.P., CCU nurses or members of the MDT. All referrals should include the following;
Patients name, age, address and contact number
Type of cardiac event and date of event
Cardiac history, complications and meds
Reason for referral
Referring persons name and contact number, date of request
Clinically relevant information – results of exercise stress test, echo, fasting lipid profile and fasting glucose profile
PHASES OF CARDIAC REHABILATION
PHASE 1 : IN HOSPITAL PATIENT PERIOD
2-5 days
Member of Cardiac Rehab team (CRT) should visit the patient to;
Give support and information to them and their families re: heart disease
Assist the patient to identify personal CV risk factors
Discuss lifestyle modifications of personal risk factors and help provide an individual plan to support these lifestyle changes
Gain support from family members to assist the patient in maintaining the necessary progress
Plan a personal discharge activity programme and encourage the patient to adhere to this and commence daily walks
Inform patients regarding phase II and phase III programs if available and encourage their attendance
At this stage emphasis is on counteracting the negative effects of a cardiac event not promoting training adaptations . Activity levels should be progressed using a staged approach which should be based on the patient’s medical condition. Patient should be closely monitored for any signs of cardiac decompensation.
Educational sessions should be commenced providing information re:

• The cardiac event
• Psychological reactions to the event
• Cardiac pain/symptom management
• Correction of cardiac misconceptions
• The use of educational materials such as the heart manual and leaflets from the Irish Heart Foundation should be considered.

PHASE II: POST DISCHARGE PERIOD
GOALS :
Reinforce cardiac risk factor modification
Provide education and support to patient and family
Promote continuing adherence to lifestyle recommendations.
PHASE III: CARDIAC REHABILITATION AND SECONDARY PREVENTION
Structured exercise training with continual educational and psychological support and advice on risk factors
Should take a menu based approach and be individually tailored.
Exercise class will consist of warm up, exercise class, cool down – may also include resistance training with active recovery stations where appropriate.
Patient shouldn’t exercise if they are generally unwell, symptomatic or clinically unstable on arrival;

• Fever/acute systemic illness
• Unresolved/unstable angina
• Resting BP systolic >200mmHg and diastolic > 110mmHg
• Significant drop in BP
• Symptomatic hypotension
• Resting/uncontrolled tachycardia (>100bpm)
• Uncontrolled atrial or ventricular arrhythmias
• New/recurrent symptoms of breathlessness, lethargy, palpitations, dizziness
• Unstable heart failure
• Unstable/uncontrolled diabetes

NEED TO CONSIDER THE FOLLOWING ;
Local written policy clearly displayed for the management of emergency situations
Rapid access to emergency team in hospital or via ambulance
Regular checking and maintenance of all equipment
Drinking water and glucose supplements available as required
Access to and from venue, emergency exits, toilets and changing areas, lighting, surface and room space checked to ensure they’re appropriate
Enough space for patient traffic and safe placement of equipment
Adequate temperature and ventilation