Family History and Heart Disease

Family history and heart diseases are strongly linked to each other. A person with a family history of heart diseases is more likely to develop heart problems and complications than a person without a family history of heart diseases. However, it is not the sole factor that can contribute towards heart disease in a person; it is also accompanied with several other risks. 

A family history of heart disease implies that one or more of the blood relatives had or has heart disease. More the number of family members with heart diseases, higher the risk of a person developing heart complications. Moreover, closer the relation of the family members to a person and younger the age, higher is the risk of developing heart problems. Younger age in this perspective is a man under the age of 55 years and a woman under the age of 65 years. Along with family history, other risk factors such as smoking, diabetes, etc. increase the chances of a person contracting heart disease, as well as other complications such as genetic cholesterol abnormality, obesity, high blood pressure, diabetes, etc. 

Family history and heart diseases are co-related because of genetics. Genetics impact the cardiovascular system in multiple ways and influence many cardiac risk factors including lipid levels, obesity, Type 2 diabetes and more. However, genetics do not act alone and are triggered by multiple lifestyle factors such as diet, exercise, weight, pollution and exposure to harmful radiation, pesticides, etc. 

That said, it is possible to overcome the risk of family history and heart diseases provided some important preventive steps are followed:

Know the full family history: A comprehensive family history assessment is critical to know what puts you at higher risk and also what kind of heart problems are likely to be passed on. An extended evaluation of family will span across three generations, including children, siblings, parents, aunts and uncles, cousins, nieces/nephews and grandparents. It is important to know the current and past health status of these generations, their cardiovascular problems, and at what age did they experience the problem. 

Get tested and consultation early: Once you have the thorough family history, it is important to consult a doctor and discuss the tests required to eliminate or know risks and potential threats. Some tests and exams that can be conducted include – lipid profile, lipoprotein, C-reactive protein, coronary calcium exam, ECG, ultrasound, etc. These tests help to evaluate the overall functioning and structure of the heart, including arterial build-up. Moreover, genetic testing can be used to identify genetic issues, which can be treated early on.

Preventive approach: Based on the family history and the results of the test, the doctor will suggest targeted treatment and preventive measures to minimize the risk of developing heart diseases; such as in case a patient has premature accumulation of fat in the coronary arteries, the doctor might suggest statin therapy, even if the other values are normal. Moreover, this also helps to eliminate the risk of aggressive problems that need to be tackled in their early stages to reduce complications. 

Consider other risk factors: While evaluating the family history and the probability of heart problems, it is critical to consider the risk factors on both sides. The family history of diabetes, high cholesterol, high blood pressure, smoking, pre-diabetes, obesity, etc. must be evaluated since these factors also increase the chances of heart problems. Moreover, factors such as physical inactivity, unhealthy diet and increasing age raise chances of heart diseases.

That said, even though with all this, you cannot fight your genes, but you can alter their developing environment and lower your risk by modifying behaviours that increase chances of heart disease. Moreover, having a family history with heart diseases does not necessarily imply that the person will develop a heart problem. However, it increases the chances of occurrence, but health can be managed provided certain preventive steps are taken. These steps include – regular testing, targeted medical therapies along with preventive lifestyle measures – such as physical activeness, healthy diet, healthy weight, etc. – are very useful in reducing the risk of a person developing heart disease due to family history. 

Cardiac Catheterization: Purpose, Procedure, Risks and Results

Cardiac Catheterization is a medical procedure used to assess the functioning of the heart and check for any cardiovascular problems. Cardiac catheterization is also known as cardiac cath, heart cath or a coronary angiogram. The procedure basically evaluates how well are the blood vessels of the heart functioning. A cardiac catheterization is done by inserting a catheter into an artery or a vein in the groin, neck or arm; a catheter is a long, flexible, narrow tube which is guided through the blood vessels (via special X-Ray machines) to the heart to assess its functioning. Once the catheter is in position, it can be used to run various diagnostic tests by injecting a contrasting dye through the catheter into the blood vessels. This dye enables the doctor to assess the valves, coronary arteries and chambers of the heart by creating X-Ray videos. Moreover, in certain cases, cardiac catheterization is also used in heart procedures such as a coronary angioplasty and coronary stenting.

Technically, a cardiac catheterization is performed in an authorized medical specialty by a certified cardiologist, along with expert team of nurses, technicians and other medical professionals.

Purpose of Cardiac Catheterization

The main purpose of a cardiac catheterization is to assess the functioning of the heart and diagnose any heart conditions. However, in many cases, cardiac catheterization is also performed as a part of larger procedure to correct heart problems. Hence, cardiac catheterization is used both to find and fix heart problems and conditions.

Some problems and issues that can be easily identified via cardiac catheterization include:

  • Congenital heart defects
  • Narrowed, blocked or damaged blood vessels in the heart
  • Heart valve problems
  • Oxygen level and processing inside the heart
  • Heart muscle functioning

A cardiac catheterization can also be used to collect tissue to perform a biopsy. It is also a great method to assess and determine the need for further treatment. That said, cardiac catheterization is also used to fix some heart problems. Some of the procedures that can be performed via cardiac catheterization are:

Angioplasty: In an angioplasty, a catheter is placed in the heart mounted with a tiny balloon. Once in place, the balloon is inflated that pushes the plaque out, causing the arteries to open and widen leading to effective flow of blood and oxygen.

Repairing Heart Defects: Heart defects such as a hole in the heart or leakage in the valve – can be corrected through cardiac catheterization.

Stent Placement: Stent placement is usually followed after an angioplasty, where a tiny mesh tube –known as stent – is placed in the narrowed or blocked artery to prevent it from narrowing or being blocked again.

Heart Ablation: In this procedure, multiple catheters will be placed in the arteries and veins to direct the radiofrequency energy to correct abnormal heart rhythms.

Valve Replacement: This procedure will involve the usage of catheter to implant an artificial valve in place of a narrowed heart valve.

Procedure of Cardiac Catheterization

Before beginning the procedure, the doctor will advise the patient on certain medications that need to be avoided and if there is a need to fast before the procedure. Usually, the patient is not allowed to eat or drink anything following the midnight of the procedure. Also, all health conditions such as diabetes high blood pressure, etc. need to be discussed prior to the procedure. This is done to avoid any complications.

Once all pre-procedure rules are followed, the patient will then be required to change into the hospital gown and lie down; post this, an intravenous line (IV) will be placed which will supply food and fluid to the patient during and after the surgery. The nurse will then remove hair from the site where the catheter is supposed to be inserted into. The patient might be kept under the influence of local anaesthesia to avoid any pain and problems. The procedure is about 30 minutes long; however the preparation and recovery might take longer.

The doctor will insert the catheter into the groin, neck or arm by making minor cut over the blood vessel. Once done, the cardiologist will insert an introduce sheath (a short, hollow, plastic cover), which will be used to thread the catheter into the arteries of the heart. Once the catheter is in place, the lights of the operating room will be dimmed to allow the cardiologist to assess the functioning of vessels, valves and chambers of the heart – by inserting a special contrasting dye into the arteries and heart chambers via the catheter. Once, the dye is placed, the patient might feel some discomfort which should fade away within seconds; in case it persists, the cardiologist must be informed.

The X-Ray machines will then be used to take images of the heart’s arteries, valves, vessels, and chambers. During the process, the patient might be asked to hold cough, sneeze and breath. Once, the X-ray images are taken, the catheter will be then removed from the body. The cut will be closed and bandaged and the patient might be monitored for some hours to check for any bleeding, numbness, pain or any other issue. The doctor might also prescribe some medications to help with pain, if any. The closing procedure, the resting and supervision time also depend on the place of insertion of the catheter and the condition of the patient.

Post the procedure, depending on the condition of the patient, the doctor will suggest the further plan, which will include taking care, avoiding infections, medications, dietary changes, exercise and any other procedures that might need to be performed.

Risks of Cardiac Catheterization

A cardiac catheterization is a very safe and guarded procedure; however like any procedure related to the heart, it too can develop some complications. Though risks in cardiac catheterization are rare, they might arise sometimes, especially in patients that have diabetes and kidney disease or are beyond a certain age such as 75 years or more.

Some of the rare risks involved in cardiac catheterization are:

  • Allergic reaction to the dye
  • Allergic reaction to medicines used in the procedure
  • Bleeding, swelling pr bruising at the insertion site
  • Blood clots that might cause heart attack or stroke
  • Damage to the surrounding arteries from where the catheter was guided to the heart
  • Damage to the arteries at the site of insertion of catheter
  • Irregular heart rhythm
  • Damage to the kidneys due to the dye used
  • Low blood pressure
  • Scarred heart tissue
  • Hole in the blood vessel
  • Air embolism
  • Infection

Results of Cardiac Catheterization

Post a cardiac catheterization, the cardiologist will be able to assess the functioning of the heart and detect any heart conditions and problems such as narrowed or blocked arteries, damaged valves, heart defects, and more. In addition to this, cardiac catheterization can also be used as a part of some procedures such as heart biopsy, balloon angioplasty, stenting, heart defect repair, balloon valvuloplasty, valve replacement and heart ablation. 

Overall, a cardiac catheterization is a very safe and useful procedure to detect and correct heart conditions and problems.

A comprehensive guide on pacemaker implantation

One of the most common diseases associated with mortality is cardiovascular problems. Due to the lack of physical activity, urbanized lifestyle, unhealthy eating habits, lack of nutrition, and various other socio-economic conditions – cardiovascular problems have steeply risen. While there are multiple medical treatments available for heart problems, a pacemaker remains one of the most important advances in providing care for patients. A pacemaker is not merely a device that cures heart problems, but is also essential in retaining the patient’s peace of mind, ensuring them a quality of life and providing assurance of safety. Technically, a pacemaker is a device that continuously monitors the heartbeat to record any erratic movements and sends electrical impulses to the heart muscle to maintain a healthy heart rate. Your doctor may recommend a pacemaker in conditions such as arrhythmia, fainting spells and congestive heart failure. Depending on the severity of the heart problem, an appropriate pacemaker from the three types is recommended:

  • Single chamber: Carries electrical impulses to the right ventricle
  • Dual-chamber: Carries electrical impulses to the right ventricle and atrium
  • Biventricular: Corrects abnormal electrical systems by stimulating lower chambers of the heart. 

Purpose of a Pacemaker Implantation

The main purpose of a pacemaker is to control the irregular heartbeat. These can be temporarily implanted to treat a slow heartbeat post a heart attack, surgery or a drug overdose. In other cases, permanent transplantation of a pacemaker is made to correct a prolonged irregular heartbeat or to treat heart failure.

An implanted pacemaker mimics the natural action of the heart’s electrical system, and typically comprises of two parts:

Pulse Generator: A small metal container which hosts the battery and electrical circuitry which regulates the electrical pulse rate sent to the heart.

Leads (Electrodes): These are insulated wires which are placed in the chambers of the heart or in one particular chamber to deliver the electrical pulses to adjust the irregular heart rate.

Pacemakers only function when needed. In case, the heart starts beating slowly, the pacemaker sends electrical signals to the heart to correct the beat. Also, recent advancements in technology have offered sensory pacemakers which detect the body motion and breathing rate and send signals accordingly.

Risks of a Pacemaker Implantation

Risks of complications from a pacemaker implantation surgery are very rare, but can include:

  • Infection at the site of pacemaker implantation
  • Allergy or reaction to the dye or anaesthesia used during the procedure
  • Swelling, bruising or extensive bleeding at the site
  • Damage to the surrounding blood vessels and tissues
  • Collapsed lungs

Preparation for a Pacemaker Implantation

Before deciding the need and type of pacemaker required, the doctor will conduct several tests to know the cause of irregularity in the heartbeat. These tests include:

  • Electrocardiogram (ECG)
  • Holter monitoring
  • Echocardiogram
  • Stress test

The procedure of a Pacemaker Implantation

Before the commencement of the procedure, the doctor will place an intravenous line to provide medication to ease pain and help the patient relax. The patient will mostly be awake during the procedure and will be administered with local anaesthesia to numb the incision area.

Once the chest is sanitized and the patient is sedated, the surgeon inserts one or more flexible, insulated wires into a major vein located under or near the collarbone. Once placed, the wires are guided to the heart through X-ray images. On the end of the insulated wire is attached to the pulse generator that is implanted under the collarbone skin.

After the procedure, the patient is kept under observation for a day or more depending on the recovery and general health. The pacemaker is set to fit the pacing needs of the patient. Once the patient is stabilized, he/she is discharged but advised to be accompanied by a close friend or family to be driven home safely.

The pacemaker’s condition including the battery life, the heart rate and rhythm are monitored by the surgeon remotely. In many cases, heavy exercises or physical exertion will need to be avoided. Also, one has to not apply any pressure at the implantation site and in case of discomfort or pain, medical advice must be taken immediately.

On the other hand, the patient will be asked to take several precautions such as:

  • Using the cellphone at least at a distance of 6 inches from the pacemaker
  • Avoid unnecessary lingering near or leaning against a metal detector
  • Inform all doctors and medical professionals about your pacemaker and ensure it is registered well before any surgery, test or medical treatment
  • Keep at least a distance of 2 feet from power-generating equipment such as welding equipment, high-voltage transformers or motor-generator systems

Results of a Pacemaker Implantation

A pacemaker tends to positively improve the heart condition and rectify symptoms caused due to slow heartbeat such as fatigue, fainting, lightheadedness, etc. The pacemaker condition should be assessed every three to six months and the patient must inform the doctor about any troubling symptoms after the implantation such as puffy ankles, swollen legs, fainting, dizziness, unexplainable weight gain, etc.

Most pacemakers today last for 10-15 years, post which their battery needs to be replaced. The battery changing procedure is simple, fast and requires less recovery time as compared to the implantation one. Since most pacemakers today adjust the heartbeat according to the physical activity of the body, the overall quality of life is not hampered and the patient can resume an active lifestyle.

What is Stress Echocardiography? Know its Purpose, Procedure, and Results

Stress echocardiography, also known as an echocardiography stress test or stress echo is a test that indicates the functioning of the heart and the blood vessels. This test uses ultrasound imaging to assess how efficiently the heart muscle is pumping blood in the body. It is very useful in determining the decrease in the flow of blood to the heart due to reasons such as narrowing or blocking of the coronary arteries. This test mainly evaluates how well the heart functions under stressful conditions. This stress could be triggered by exercising on a treadmill or through a medicine known as dobutamine. The medication is used in cases where the concerned person is unable to exercise; this medication imitates the effects of exercise on the heart. 

However, in general cases, the test is performed while the patient is exercising on a treadmill or a stationary cycle. During this time, the doctor monitors the condition of the heart, including blood pressure and the rhythm. When the heart rate reaches its maximum, ultrasound images are used to evaluate if the heart muscles are receiving the required quantities of blood and oxygen, while exercising.

Purpose of the stress echocardiography test

A stress echocardiography test may be conducted in situations where the patient experiences chest pain which might be caused due to coronary artery diseases or in cases where a patient suffers myocardial infection (heart attack). The stress echocardiography test can also be used to determine the level and intensity of exercise that can be undertaken by a patient who is in cardiac rehabilitation. Additionally, the test is also used to assess the effectiveness of treatment, such as:

  • Bypass grafting
  • Angioplasty
  • Anti-arrhythmic medicines

The test is very safe and non-invasive with minimum or no complications; some rare complications might include an abnormality in heart rhythm, dizziness, lack of consciousness or heart attack. 

Procedure of the stress echocardiography test

The test takes about 45 to 60 minutes and can be conducted in the doctor’s office or at an echocardiography lab. It is a simple test with rare complications. Hence, to ensure there is no risk of problems in the test, the doctor might suggest a few measures to follow before the test, these include:

  • No eating or drinking at least three to four hours prior to the test
  • No smoking on the day of the test
  • Check with the doctor before taking caffeine in any form
  • Check with the doctor for all medications that you might be regularly taking; certain medications can hamper the results of the test and create complications; thus those might be avoided on the day of the test
  • Wear running shoes and comfortable clothes.

Once that is taken care of the actual procedure of the stress echocardiography test begins. The test is divided into three stages, including:

Resting echocardiography: This is a critical step because this will help assess the functioning of the heart at rest and compare it with the functioning when stressed. In this step, the doctor first sticks small patches on the chest, known as electrodes which are connected to an ECG (Electrocardiograph) machine. This ECG machine evaluates the functioning of the electrical activity of the heart, more specifically, the heart rate and the regularity of heart rhythms. The doctor will also monitor your blood pressure during this time. Once this is done, the patient will be asked to lie on the side to go through resting echocardiography that will provide in-depth insight into the movement of the heart and health of internal structures, while resting. This will be done by applying a special gel to the skin and using a device called a transducer to emit sound waves and produce images.

Stress test: In this step, the doctor aims to increase or maximize the rate of your heart to record and analyse its functioning. The patient will be asked to exercise on a treadmill or a stationary cycle for 7-10 minutes or until the patient feels extremely tired. This will shoot the heart rate of the patient, helping in the assessment. During this time, ultrasound images of the heart muscles are taken to analyse the condition of the heart. The mode and intensity of exercise will depend on the patient’s condition; incase a person feels dizzy, weak or has pain in the chest – the doctor must be immediately informed.

Stress echocardiography: This test is conducted when the patient is asked to stop exercising because the heart rate has significantly risen, providing enough data for analysis. When the patient is asked to stop exercising, more ultrasound pictures of the heart are recorded till the time the heart rate, blood pressure return to normal. This helps to actually evaluate the working of the heart muscles under stressful conditions. 

Results of the stress echocardiography test

A stress echocardiography test is simple and very useful to know if there are any problems with the heart’s functioning. The test is extremely reliable, and the results are simple to interpret. If the results of the stress echocardiography test are normal, it implies that the heart is healthy, it is receiving an adequate supply of blood and oxygen even in stressful conditions, and that there is no blockage or narrowing of the coronary arteries. 

However, if the results of the stress echocardiography test are negative, the reasons can be intense and would need medical attention. Abnormal results indicate that the heart is devoid of essential nutrients, blood and oxygen during times of stress due to issues such as coronary artery diseases or a previous heart attack that has damaged the heart tissues. 

This test is also very useful in determining if the current cardiac rehabilitation plan of the patient is working effectively. In case, the results indicate otherwise, a change in medications and treatment may be opted for. 

In all, stress echocardiography is very useful in the early diagnosis of heart problems and risks of heart attacks. It is a simple, non-invasive and a very reliable test.

Fetal Echocardiography: Purpose, Procedure and Risks

Fetal Echocardiography is a non-invasive that uses sound waves to assess the condition of the heart of an unborn and developing baby. The test is very similar to an ultrasound and helps in better evaluation of the structure and functioning of the heart of an unborn child. The test is usually performed on women who are in their second trimester (in 18 to 24 weeks) of pregnancy. However, it can also be done during the later stages of pregnancy, if the need arises. Fetal echocardiography is also used to check for any heart defects in the child before birth. 

In fetal echocardiography (echo) the sound waves echo back from the structure of the baby’s heart, which are then analysed by the help of a machine that converts these sound waves into images of the heart’s internal structure. This helps in a detailed analysis of the baby’s heart, its health, functioning, blood flow and also checks for any deformities or abnormalities in the heartbeat or rhythm. The test is safe and painless and is performed to minimize risks of heart defects at birth.

Purpose of Fetal Echocardiography

Fetal echocardiography is not compulsory and is recommended to pregnant women in whom a basic ultrasound might not have been able to deliver conclusive results of the child’s heart. It can also be recommended in cases, where an abnormality or an abnormal heartbeat is detected in the foetus. 

Cases where fetal echocardiography is highly recommended include, but are not limited to:

  • Women who have a family history of heart diseases
  • Women whose first child has a heart condition
  • Women who consume alcohol or drugs during pregnancy
  • Women who have taken or have been exposed to medications and drugs that can cause heart abnormalities
  • Women who have medical health conditions involving diabetes of type 1, rubella, etc.
  • Women who have certain infection during pregnancy
  • Women have abnormal test results 
  • Women who conceive using assisted reproductive technology
  • Foetus diagnosed with a genetic problem
  • Abnormalities in ultrasound
  • Women who become pregnant at an advanced stage

Procedure of Fetal Echocardiography

The test is non-invasive, safe and usually takes about 30 minutes to be performed. There are no preparations that need to be done before the test and is very similar to a routine pregnancy ultrasound. Fetal echocardiography is done through the abdomen or the vagina; if done through the former, it is called abdominal echocardiography, while the latter is called transvaginal echocardiography.

In abdominal echocardiography, you will be required to lie down. Then a special lubricating gel will be applied on the bare belly which will enable the technician to use an ultrasound transducer to send and receive signals from the sound waves over the skin. The transducers sends sound waves through the body, which eco upon hitting the child’s heart are reflected back to the transducer and are then converted into images on a screen. The transducer is moved all over the stomach to get complete images of the heart. 

In case of transvaginal echocardiography, a small probe is inserted into the vagina which sends sound waves to provide images of the baby’s heart. This method is usually sued during the early stages of pregnancy and also provided better images than abdominal echocardiography.

Post both procedures, the gel or the probe, are removed from the body, and the patient can return to a normal routine within no time. The procedure is highly safe since it uses ultrasound technology and not radiation.

The results of the test will be explained by the doctor and treatment or precautions, if any, will also be suggested. There might be a need for another echocardiography if any abnormalities are detected in the first test. In many cases, if the results of the echocardiography are non-conclusive, the doctor might suggest more tests such as MRI scan or other high-level ultrasounds to properly diagnose the condition. However, it is critical to note that a fetal echocardiogram may not be able to diagnose all health conditions; some issues such as a hole in the heart are difficult to diagnose even with advanced procedures.

Risks of Fetal Echocardiography

Fetal echocardiography is a non-invasive and safe procedure that uses high-frequency sound waves to create images of the baby’s heart. The test does not use radiation which makes it even safer. The procedure has not reported any negative effects on the development of the child and hence, does not have significant risks involved. 

Fetal echocardiography is an easy and safe test which is recommended for pregnant women in their third trimester to check for the health and functioning of the baby’s heart. The test is helpful in diagnosing issues and enabling treatment to treat the condition, if any, early on. 

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