Cardiothoracic and Vascular Surgery  

Causes

It has been found that cigarette smoking helps Aneurysms to grow faster. Tobacco use in any other form also causes Abdominal Aortic Aneurysms. If you are suffering from Hypertension or High Blood Pressure, then you are highly at risk of developing an Aneurysm as High Blood Pressure weakens and damages the arteries. Vasculitis is a condition in which infection occurs in the aortic wall leading to the formation of an Abdominal Aortic Aneurysm. The other reasons that lead to this Aneurysm are obesity, high blood cholesterol levels, Emphysema (disease of the Lungs), genetic factors and more in males above 60 years of age.

Diagnosis

The doctor may advise a chest X-ray to check for any problems with your Aorta. An Abdominal Ultrasound is done in which sound waves of high frequency are used to take internal images of the abdomen that are then studied by the doctor to check for any Abdominal Aortic Aneurysm. A CT (Computerized Tomography) Scan can also be done that uses X-rays to get cross-sectional images of the abdomen. In a procedure known as Magnetic Resonance imaging (MRI), magnetic waves and radio waves create images of the insides of the abdomen that are then studied by the doctor.

Treatment

In the case of small Aneurysms that measure around 4 cm, the doctor will put you on observation. You have to report to the doctor if you have any symptoms like chest pain. Ultrasound is done every 6 months to check the growth of the Aneurysm. In the case of a medium-sized Aneurysm which measures 4 to 5.6 cm, the decision is left to the doctor whether he wants to wait and watch or go for surgery. In case of large growing Aneurysms that measure more than 5.6 cm, you need to go for surgery.

In a surgical procedure known as Open Abdominal Surgery, the section of the Aorta that is damaged is replaced by a graft (synthetic tube). Recovery after the surgery takes several months. To repair the Aneurysm, Endovascular Surgery is done in which a synthetic graft is sent to the Aneurysm site with the help of a catheter (thin tube) via the artery of your leg. This graft is fixed at the site of the Aneurysm with the help of pins and hooks. The graft prevents rupture of the Aorta by strengthening the weakened section. The recovery time is less than that taken for Open Abdominal Surgery.

Symptoms

Allergic Angiitis causes a variety of nonspecific clinical signs and symptoms. Some patients have only mild symptoms, whereas others may experience severe, life-threatening complications. The disease develops into three different stages characterised by different signs and symptoms. However, not everyone develops all three phases of the disease in the same order.

Allergic stage: In this stage, the patient may experience different allergic reactions like Asthma, Allergic Rhinitis (affecting mucous membrane of the nose), and sinus pain and inflammation (sinusitis).

Eosinophilic stage: In this stage, abnormally high levels of Eosinophils (a type of white blood cell) are found in the blood, affecting the Immune System. This condition is called Hypereosinophilia and causes fever, weight loss, Asthma, loss of appetite, abdominal pain, and Gastrointestinal Bleeding.

Vasculitic stage: The severe inflammation of blood vessels (Vasculitis) occurs at this stage. The blood vessels are narrowed resulting in poor blood flow to different organs and tissues. Most of the body parts are affected including Kidneys and muscles. You may feel unwell and have unintended weight loss, swollen lymph nodes, weakness, and fatigue.

Depending on the Organs affected, you may experience rash or skin sores, joint aches and swelling, Peripheral Neuropathy, shortness of breath, chest pain, irregular Heartbeat, and blood in the urine.

Causes

The exact cause of the disease is still not known. Few experts think that “Allergies” play a significant role in causing the disease. Some people develop Allergic Angiitis after using an Allergic medication called “montelukast” or after switching from systemic oral steroids to inhaled steroid medications. However, there is no proper evidence to prove this.

Risk factors

Allergic Angiitis is a rare syndrome affecting not more than three people per million. The possible risk factors associated with the disease are:

Age: Most people are diagnosed with the disease at the age of 40.

History of nasal problems: A maximum number of people diagnosed with allergy to Angiitis have a history of Nasal Allergies, Sinusitis or Asthma which is difficult to control.

Genes: A recent study has proved that the HLA–DRB4 gene is the genetic risk factor for Allergic Angiitis.

It is very important to know that almost everyone diagnosed with Allergic Angiitis has Asthma, but not all Asthma patients develop the disease.

Complications

The complications of the disease depend on the Organs involved such as the Lungs, skin, Gastrointestinal System, joints, and Heart. Cardiac and Neurological complications are very serious and are mainly observed in patients with a delayed diagnosis.

Diagnosis

The signs and symptoms of the disease are similar to other health conditions, and hence the diagnosis of Allergic Angiitis is difficult. The doctor will check your medical history, signs and symptoms, especially Asthma. The doctor will recommend you undergo a blood test, X-ray, and urine analysis. If the doctor thinks that you have this condition, a biopsy (a small sample tissue) of an affected area is recommended.

In some cases, a Kidney or Lung Biopsy is also recommended to confirm the disease.

Treatment

The goal of the treatment is to limit or prevent damage to healthy tissues. Medications used to treat the disease are:

Corticosteroids such as prednisone are the commonly prescribed medications for this condition. In some patients with mild symptoms, corticosteroids alone may not be helpful and hence the physicians prescribe Chemotherapy medications such as azathioprine, cyclophosphamide or methotrexate.

Immunoglobulin is recommended for patients who have not responded to other treatment options. Once the disease is under control, the doctor may reduce the dose of the drugs and eventually stop it. This may take at least six months or up to several years, depending on the patient’s condition.

Self-management

Long-term treatment with medications may cause several side effects, but you can manage it efficiently by making certain lifestyle changes.

• Increase vitamin D and calcium intake in your diet. Eat green leafy vegetables, fruits, and whole grains.
• Perform bone-strengthening and weight-bearing exercises such as walking, jogging
• Avoid smoking as it causes serious health problems
• Follow up doctor’s appointments regularly without fail

Symptoms

The Aortic Stenosis symptoms are similar to those of Heart Diseases such as Heart Attack. Signs and symptoms of Aortic Dissection include:

• Severe ripping or stabbing chest pain that starts abruptly and radiates to the neck or down the back
• Shortness of breath
• Loss of consciousness
• Weakness on one side of the body
• Trouble speaking
• Dizziness or confusion
• Weak pulse

Aortic Dissection can be classified into acute, sub-acute, and chronic based on the onset. The condition is said to be acute if the onset is less than 14 days, sub-acute for 15 to 90 days, and chronic for more than 90 days or 3 months.

Causes

Aortic Dissection occurs in the area where the wall is weak. Persistent High Blood Pressure causes the walls of the Aorta to strain, making the wall more susceptible to tearing.

Marfan Syndrome, weakened or enlarged Aorta or accidental injuries to the chest can also cause Aortic Dissection.

Risk factors

The risk of Aortic Dissection increases if you have Hypertension, Thoracic Aortic Aneurysm, aortic valve defect, Marfan Syndrome (a connective tissue disease that affects blood vessel integrity), Turner’s Syndrome (a Chromosomal Disorder of a female which results in High Blood Pressure and Heart problems) or inflammation of the arteries.

Men, people above age 60, people who use cocaine, and perform high-intensity heavy lifting are at more risk for Aortic Dissection.

Complications

The complications of Aortic Dissection are:

• Severe internal bleeding that may lead to Organ Damage, Stroke, or death
• Failure of the aortic valve may result in Heart Failure
• Aortic Valve Damage (Aortic Valve Regurgitation) that may lead to Pulmonary Edema
• Rupture into the lining around the Heart
• Carotid Artery obstruction may result in neurological conditions such as ischemic cerebrovascular accident or Stroke, hemiplegia, or Hemianesthesia

Diagnosis

Your doctor performs a physical examination to measure Blood Pressure and observe abnormal noises in the Aorta. An X-ray is suggested to detect Aortic Dissection. However, more sophisticated tests are essential to confirm the diagnosis.

Computerized Tomography (CT) Scan: This scan helps to give a three-dimensional view of the Aorta and requires the injection of a contrast dye. However, the tears in the intimal layer are difficult to detect with this scan.

Magnetic Resonance Imaging (MRI): This scan provides a three-dimensional view, and the intimal tears can be detected using this procedure.

Transesophageal Echocardiogram (TEE): It is a non-invasive test and requires you to swallow an Echocardiography Probe. The test helps to identify dissections in the ascending Aorta and the involvement of the Carotid Artery.

Aortic Dissections are divided into two groups, based on the area of the Aorta dissected.

• Type A: tear in the upper Aorta or area of the Aorta where it exits from the Heart
• Type B: tear in the lower Aorta

Type A is a more severe condition than Type B, but both types of tears may extend into the abdomen.

Treatment

Aortic Dissection treatment includes medications and surgery. Often, Type B is treated with medication and Type A is treated with surgery.

Medications: Beta-blockers and nitroprusside are given to reduce Heart rate and Blood Pressure. In patients with type A Aortic Dissection, these medications are given to stabilize Blood Pressure before surgery.

Surgery: In the Aortic Dissection surgery, the dissected Aorta is removed as much as possible and blocks the entry of blood into the aortic wall. Then your surgeon reconstructs the Aorta with a graft. If the aortic valve is damaged, then it is replaced with a new synthetic valve. This valve is placed in the graft while reconstructing the Aorta. For complicated Type B Aortic Dissections, Stents are placed to repair the Aorta.

After surgery, you need to follow up regularly to monitor the condition. Your doctor recommends using Blood Pressure lowering medications for the lifetime to prevent complications.

Symptoms

Aortic Valve Stenosis has a very slow progress and may take some decades to show the symptoms. You will start having problems when the valve narrows down to nearly one-fourth of its original size. Symptoms usually appear during exercises, when there is more pressure on the Heart.

Symptoms include:

• Chest pain or pressure. You may also feel chest tightness
• Dizziness and fainting
• Tiredness and shortness of breath (especially after exertion)
• Palpitations (feeling the Heartbeat as if it is pounding, or racing)

The symptoms are different in infants and children. Symptoms may include not feeding enough or being unable to gain weight. They become easily fatigued. In some children, within a few weeks of birth, there can be difficulty in breathing which can worsen with their age.

Your condition is almost serious once you have the symptoms. So, consult a doctor immediately because there is a chance of sudden death in many patients.

Causes

The Heart valves open and close with every Heartbeat, and this is a continuous process which occurs every second till death. However, due to genetic defects or some health conditions, the aortic valve may not function effectively.

Genetics: The aortic valve is made of 3 flaps, which work together to open or close. But in some children, at the time of birth, these flaps are not separated properly or may be thick which causes a defective opening and closing.

Rheumatic Fever: This is a condition present in people with Strep Throat, a Streptococcal Infection. Rheumatic Fever can affect the skin, Heart, Brain and joints. In the Heart, it causes Aortic Valve Stenosis.

Calcification of the valves: Calcium is important for strong bones. But, when the calcium levels in the body rise much higher beyond the normal value, then it gets deposited in the Heart valves affecting their normal functioning. This is usually seen in people aged above 65 years.

Risk factors

The following factors can increase the risk of you or your child getting Aortic Valve Stenosis:

Age: With increasing age and calcium deposition, the risk of developing Aortic Valve Stenosis is high.

Gender: In males especially those aged 30 to 60 years, the risk is high when compared to females.

Diseases: Diseases such as Rheumatic Fever, and Chronic Kidney Disease can increase your chances of developing Aortic Valve Stenosis.

Some other risk factors which are similar for Aortic Valve Stenosis and Atherosclerosis include smoking, Type 2 Diabetes, High Blood Pressure, and High Cholesterol indicating a connection between the diseases.

Diagnosis

When you report the symptoms, your doctor will perform a physical examination which includes listening for any abnormalities in your Heart sounds. Following this, imaging studies are performed to understand the inside of your Heart.

MRI (Magnetic Resonance Imaging) - Gives a detailed picture of the Heart

CT (Computed Tomography) - Creates 3D images of the Heart

Chest X-ray - Gives the size and shape of the Heart. An enlarged lower chamber of the Heart is a sign of Aortic Valve Stenosis.

Echocardiogram - Provides moving images of the Heart

Cardiac catheterisation - Shows the blockages in the Heart using dyes

Complications

The Heart pumps at an extra pressure in patients with Aortic Valve Stenosis. But at some point, the Heart cannot put the extra effort to pump through the narrowed valve, which leads to life-threatening problems such as:

• Chest pain
• Fainting
• Irregular Heart rhythms
• Heart Failure
• Cardiac Arrest

Treatment

Medication can reduce the symptoms of the Aortic Valve Stenosis, but the condition can be treated by surgical repair. It is not immediately required for you to undergo surgery. Your doctor will schedule your operation based on the severity of your condition, as diagnosed through tests.

Medications: Medications are prescribed to lower your Heart rate, reduce fluid accumulation, etc. This can slow down the progress of the disease.

Surgeries:

Balloon Valvuloplasty: A soft thin tube fitted with a balloon to one end is used in the procedure. It is inserted into the narrowed valve and inflated to open the valve wide. Later the balloon and the tube are removed. This technique is majorly used in children and infants.

Aortic Valve Replacement: This is performed in severe cases. Here, the defective valve is replaced with a prosthetic valve or tissue valve.

Transcatheter Aortic Valve Replacement: Unlike the Aortic Valve Replacement which is performed during Open Heart Surgery, in the Transcatheter Aortic Valve Replacement, the prosthetic valve is inserted along the artery in your leg or along the left ventricular apex of your Heart.

Surgical Valvuloplasty: In this procedure, the surgeon uses tools to separate the flaps of the valve.

Prevention

The below tips can help you reduce your chances or prevent you from getting Aortic Valve Stenosis.

• Be proactive to prevent Rheumatic Fever by consulting a doctor when you have a sore throat.
• Resolve the risks for Coronary Artery Disease such as High Blood Pressure, Cholesterol, etc.
• Maintain oral hygiene because the infections of the teeth and the gums can spread to the Heart. The infection can lead to inflammation and the narrowing of the valves and arteries.

Signs and symptoms

The main symptoms of Apical Heart Syndrome are chest pain and shortness of breath, similar to Heart Attacks. That is the reason people get confused with ABS as a Heart Attack. In severe conditions, you may have an irregular Heartbeat or Sudden Cardiac Arrest. Nearly 10% of people develop signs and symptoms of Cardiogenic Shock such as Hypotension, abnormal mental status, and cold extremities.

How can we distinguish ABS from other Cardiac conditions?

Several factors can help distinguish ABS from other Cardiac conditions.

Causes

The exact cause of ABS is still not known. But increased stress hormones like adrenaline temporarily damage the Hearts of some people. Narrowing of the small and large arteries of the Heart also plays a major role.

Some of the emotional conditions that trigger the ABS are:

• News of an unexpected death of a loved one
• Natural disasters
• Having to perform publicly
• Car accident or major surgery
• Major loss in business

Some medications such as epinephrine, duloxetine, venlafaxine, and levothyroxine also contribute to ABS.

Complications

In most cases, ABS recovers quickly and doesn’t have any long-lasting effects. But there are chances that you may have ABS again if you have another stressful experience. There are a few complications such as:

• Pulmonary Edema - back up of fluids into Lungs
• Hypotension - Low Blood Pressure
• Irregular Heartbeat

Diagnosis

To diagnose the syndrome, your doctor will first ask you about your health history and perform a physical exam. The following tests are recommended to confirm the diagnosis.

Electrocardiogram (ECG): In this test, wires are placed on the chest that record the electrical impulses that make your Heartbeat. An ECG records these electrical signals that help your doctor determine any irregularities in the Heart rhythm and structure.

Chest X-ray: Chest X-ray is recommended mainly to see if the Heart is enlarged or has an irregular shape, or to check any problems in your Lungs that are causing the symptoms.

Echocardiogram: This test includes an ultrasound of your chest and detailed images of your Heart’s structure and function. The ultrasound waves are transmitted, and their echoes are recorded with a transducer held outside your body. The information from the transducer is then used (by a computer) to create moving images on a video monitor.

Blood tests: Certain enzymes in the blood increase in people with ABS. To detect this, your doctor suggests a blood test.

Coronary Angiogram: This test can know the blockage in the blood vessels if any. In this test, a type of dye is injected to make the blood vessels of your Heart more visible. Then, an X-ray machine takes a series of images that give a detailed look at blood vessels.

Treatment

There is no specific treatment for ABS. However, the treatment is similar to a Heart Attack until the diagnosis is clear. Once the cause is clear, your doctor may recommend Heart medication so that your Heart does not have to work as hard as usual while you recover and to prevent further attacks. The commonly prescribed drugs are Angiotensin-converting Enzyme (ACE) inhibitors, beta-blockers, and diuretics and drugs such as aspirin are prescribed in the early stages to reduce pain. You will recover fully within one to two months.

Surgery

If the symptoms are not controlled with medications, doctors suggest surgical techniques like Balloon Angioplasty and Stent Replacement for Takotsubo Cardiomyopathy treatment. These surgical techniques treat blocked arteries.

Prevention

ABS can occur again in your life, and hence managing stress in your life is crucial to prevent recurrence.

Symptoms

Smaller defects, less than 5 millimetres may not show any symptoms or not until middle age or later. In adults, the signs and symptoms usually begin at the age of 30. The symptoms include:

• Shortness of breath, with activity
• Poor appetite
• Swelling of legs, feet, and abdomen
• Irregular Heartbeat or skipped beats
• Stroke
• Frequent Lung infections
• A Heart Murmur or “whooshing” sound that can be heard through a stethoscope

When to seek medical advice?

Inform the doctor immediately when you or your child has the following symptoms. These signs could be the sign of Heart Failure or other Congenital Heart problems.

• Shortness of breath
• Getting tired easily, especially during any activity
• Skipped beats
• Swelling of legs, feet, and abdomen

Causes and risk factors

Most of the ASD occur by chance with no clear cause. Scientists are still working on that part. ASD mainly occurs when the partitioning process of the Heart is not complete during the first few weeks of conception, thus leaving a hole in the atrial septum. The reason behind this is unknown. Heredity and environmental factors play a major role in Congenital Defects like ASD.

Atrial Defects are often defined as primum or secundum.

• Primum defects are present in the lower side of the atrial septum and are linked to other defects of the Heart such as a Ventricular Septum or Mitral Valve.
• Secundum is the most common type of ASD, and it occurs in the middle of the Atrial Septal wall.

The defect may also occur in the upper part of the atrial septum (sinus vinosus) or between the coronary sinus.

Risk factors

The following conditions during pregnancy may increase the risk of developing ASD in your baby.

• Obesity
• Rubella Infection
• Drug abuse
• Exposure to certain substances like tobacco, alcohol
• Phenylketonuria - error of metabolism
• Eisenmenger Syndrome - permanent Lung damage; doctors usually recommend not to get pregnant if you have this condition because it can endanger your baby’s life

Complications

Smaller defects never cause any problems, but larger defects may cause life-threatening problems like:

• Right-sided Heart Failure
• Arrhythmias
• Increased risk of Stroke
• High Blood Pressure in the Arteries of the Lungs (Pulmonary Hypertension)
• Eisenmenger Syndrome - permanent Lung damage

Diagnosis

During the physical examination, if your doctor hears a Heart Murmur caused by ASD, he or she may recommend the following tests:

Chest X-ray: The X-ray images help your doctor to identify the condition of your Heart and Lungs.

Echocardiogram: This is the commonly used test to diagnose an ASD. This test helps the doctor to see the Heart chambers through video images produced by the sound waves.

Electrocardiogram: Heart rhythm problems are detected through this test.

Heart MRI: This test creates a 3-D image of your Heart that helps in a definitive diagnosis of the disease.

CT Scan: Detailed images of the Heart are created using a series of X-rays that help in the definitive diagnosis of the Heart defects.

Treatment

Most of the defects close on their own during childhood. The defects that do not close are treated. Once the condition is diagnosed, your doctor recommends suitable treatment options depending on the age size location, and severity of the disease.

Medications: The doctors prescribe medicines to manage the symptoms as they do not close the hole completely. The commonly prescribed medicines are beta-blockers (keep the Heartbeat regular) and anticoagulants (prevent the formation of blood clots).

Surgery: Doctors usually recommend Atrial Septal Defect Surgery for the closing of the ASD in childhood to prevent complications in life. Atrial Septal Defect Repair may not be possible if you have Pulmonary Hypertension.

Cardiac Catheterization: In this technique, the doctor inserts a catheter into the blood vessel in the groin and plugs a mash patch to close the hole. The Heart tissue grows around the mesh permanently closing the hole.

Open Heart Surgery: This surgery is recommended if you have other Heart defects including ASD. The doctor makes an incision in the chest and uses patches to close the hole. ASD Closure Surgery may also be performed with a minimally invasive technique.

Self-management

If you are diagnosed with ASD or have undergone surgery to correct the condition, do not worry about your daily activities and lifestyle changes. Try to adopt these habits to have a healthy life:

• Exercise regularly to improve your Heartbeat
• Follow a healthy diet plan. Try to add fruits vegetables whole grains to your diet.
• Avoid infections that may affect your health condition.

Causes

A progressive narrowing of the Carotid Arteries due to the formation of the plaque causes Carotid Artery Disease. The plaque is the composition of fat, cholesterol, calcium, and fibrous materials in the luminal walls of your Carotid Artery. The buildup of plaque in the arteries is called Carotid Atherosclerosis. These blocked Carotid Arteries fail to deliver adequate oxygenated blood and glucose to the Brain leading to life-threatening complications such as Stroke.

Signs and symptoms

A minor blockage may not cause any symptoms. The Carotid Artery blockage symptoms are noticed when the condition is severe, leading to Stroke. The symptoms of Stroke include the following:

• Sudden numbness in the face or limbs (Usually only one side of the body)
• Sudden trouble speaking or understanding
• Sudden vision problems
• Dizziness or loss of balance
• Sudden, severe headache
• Drooping on one side of your face

Risk factors

Several underlying medical conditions may increase the possibility of Carotid Artery Disease and Stroke, which includes;

• High Blood Pressure
• High Cholesterol
• Diabetes
• Physical inactivity
• Obesity
• Smoking
• Increasing age
• Family history of Atherosclerosis

Complications

If Carotid Artery Disease is left untreated, it can lead to fatal complications such as Stroke or Transient Ischaemic Attack (TIA).

Carotid Artery Disease causes Stroke in the following ways:

Decreased Blood Flow: The plaque formation may result in a narrowing of the Carotid Artery. Thus causing reduced blood flow to the Brain.

Ruptured Plaques: Sometimes, a lump of plaque is broken into pieces. The plaque fragments then travel through the smaller artery into the Brain and block them. This leads to blockage of blood supply to a part of the Brain.

Blood Clot Blockage: The plaques can form irregular surfaces on the artery wall. Your body responds to this by sending blood cells near the plaque as a defence mechanism. This results in the formation of blood clot that slows blood flow to the Brain leading to Stroke.

Diagnosis

The diagnosis begins with a medical history and physical examination. Your doctor may recommend any of the following tests to rule out the conditions.

• Ultrasound Scan: The Ultrasound Scan is used to assess the flow and pressure of the blood in the Carotid Arteries.
• Computed Tomography (CT) Scan or Magnetic Resonance Imaging (MRI): The CT or MRI is used to evaluate the evidence of Stroke or any other medical condition.
• CT Angiography: The CT Angiography is performed to obtain detailed images of the blood flow in the Carotid Arteries.

Treatment

If you’re diagnosed with Coronary Artery Disease, you may receive an aggressive treatment to stop further blockage. The primary goal of the treatment plan is to reduce the risk of Stroke. Your doctor may prescribe cholesterol-lowering drugs, Blood Pressure lowering drugs, and aspirin. If the blockage cannot be cleared with these drugs, your doctor may suggest surgery.

Carotid Endarterectomy is the most common and effective Carotid Artery surgery used to clear the plaques. During the surgery, your doctor makes an incision at the front of your neck and opens the Carotid Artery. Then, your doctor removes the plaque and repairs the artery by suturing.

Carotid Angioplasty and Stenting are suggested if the Carotid Endarterectomy may pose a risk due to the underlying medical condition. The Angioplasty procedure involves inserting a tiny balloon into your artery through a catheter. The affected artery is widened by inflating the balloon and then, a stent is placed to keep the artery from narrowing.

Lifestyle changes and prevention

Carotid Artery Disease can be prevented by considering the following changes in your daily life:

• Smoking cessation
• Maintaining a healthy weight
• Avoiding the intake of food rich in fats and cholesterol
• Increasing the intake of fruits and vegetables
• Limiting the intake of salt
• Avoiding alcohol consumption
• Performing regular physical activity

Causes and Risk Factors

DVT usually and commonly occurs after 60 years of age, but can occur at any age. There are many factors which are the causes of DVT. The more the risk factors the higher the chance of DVT. Damage to the inner vein due to injury during an accident, surgery, immune response, and inflammation may increase the risk of DVT.

In addition, slow or sluggish blood flow that may occur after fracture in the pelvis or leg, after surgery, prolonged illness and bed rest or travelling for a long time also increases the likelihood of DVT.

Certain inherited factors cause blood to become thicker and clot more than normal (Thrombophilia). This happens with using estrogen or birth control pills. Conditions like Heart Failure, Cancer and Cancer treatment, and Obesity are important risk factors for DVT. Smoking also increases the risk of developing DVT.

Symptoms

Deep Vein Thrombosis symptoms may be because of DVT itself or may be due to PE. If the person is experiencing any of the following symptoms they are asked to see a doctor immediately as it can result in fatal complications.

Only half of the people experience symptoms of DVT and they are:

• Blood clot in the leg
• Pain and swelling in the leg or along one single vein in the leg
• Pain while walking or standing
• Swollen area may feel warm
• The colour of the skin becomes red or discoloured
• Sudden shortness of breath
• Pain while breathing deep
• Spitting blood while coughing
• Rapid Heartbeat

Diagnosis

Being silent and difficult to find out, DVT poses a great challenge in diagnosis. But despite these hurdles, DVT is diagnosed based on medical history, physical examination and a few laboratory tests.

A detailed medical history is required to know whether the person had or still taking any medicines, any recent surgeries, any injury or whether undergone any treatment for Cancer.

Physical examination includes looking at the leg with symptoms and checking Blood Pressure and the condition of the Heart and Lungs.

Ultrasound, the most common diagnostic technique for DVT, may detect the flow of blood through arteries and veins. If ultrasound does not give any detailed picture then a Venography will be done.

Venography starts with injecting a dye into the vein and then taking an X-ray of the affected leg. The X-ray identifies the blood clot in the vein.

A D-dimer Test is done to measure the amount of a substance that is released when a blood clot is dissolved. If the substance is at a high level in the blood then the risk of DVT is more likely.

Sometimes, a blood test will be done to check whether the person has inherited clotting disorder that may cause DVT.

Sometimes MRI and CT Scans will be done to look for structures and organs inside which is useful for DVT diagnosis.

Treatment

DVT treatment aims at stopping the blood clot from growing further, preventing the breaking of the blood clot, and decreasing the chance of another blood clot. Treatment for DVT disease includes medicines and therapies.

Medicines: Medicines include

• Anticoagulant: Anticoagulants are blood thinners that reduce the chance of another blood clot but they do not dissolve the already existing blood clot; however, they can stop the already present blood clot from growing bigger. The most common anticoagulants used are heparin, which is given intravenously and warfarin which is taken orally. Warfarin usually takes 2 – 3 days to start working therefore heparin is prescribed until warfarin starts working. Warfarin is dangerous during pregnancy therefore only heparin is used.
• Thrombin inhibitors: Patients who can’t take heparin are treated with thrombin inhibitors, which hinder the clotting process.
• Thrombolytics: They are used only in life-threatening situations as they can cause sudden bleeding. Thrombolytics are given in severe cases to dissolve a blood clot more quickly.

Compression stockings: The person may be asked to wear compression stockings to reduce pain and swelling, and to avoid post-thrombotic symptoms.

Surgical treatment includes placing a vena cava filter. If the person cannot take anticoagulants or is taking anticoagulants but blood clots are still developing then a filter is inserted in the vena cava vein. This filter breaks and prevents the entry of blood clots into the Heart and the Lungs.

Side Effects of Anticoagulants

Anticoagulants are drugs that act against coagulation or clotting process. Therefore taking them may result in easy bleeding and longer clotting time. The person may be easily bruised. Any excess prolonged bleeding should be treated as an emergency. Anticoagulant warfarin can cause birth defects if taken by a pregnant woman.

Taking other over-the-counter medicines, vitamins, and foods that are rich in vitamin K can interfere with anticoagulants. Therefore, before taking any drugs or making any changes in the diet consulting the doctor is important.

Preventing DVT

If the person knows that he/she is at risk for DVT, a few tips can help them prevent DVT.

• Going for regular check-ups
• Following all instructions and medicines prescribed by the doctor
• Trying not to be in bed for a long time after illness and surgery
• Exercising or moving the lower leg during the long journey
• During long journeys, more than 4 hours, walking up and down the aisle of a bus, train or plane will help
• If travelling by car make it a point to stop and walk every hour
• Wearing loose and comfortable clothes while travelling
• Controlling Blood Pressure
• Reducing weight
• Avoiding alcohol and drinking lots of fluids
• Quitting smoking

For people who are at risk of developing DVT, and are undergoing surgery, they may be given DVT Prophylaxis to prevent DVT post-surgery.

Symptoms

Patients with Ebstein's Anomaly of the Tricuspid Valve will have symptoms associated with anatomical abnormalities and hemodynamic effects such as the following:

• Fatigue (extreme tiredness)
• Cyanosis (bluish discolouration of skin and lips)
• Dyspnea (breathing difficulty) and cough
• Palpitations, arrhythmias, and sudden Cardiac death
• Symptoms of right Heart Failure (for example, Edema and ascites which include fluid buildup)

Other less common symptoms include:

• Bacterial Endocarditis (infection of the inner walls of the Heart)
• Paradoxical Embolism, Stroke, and Transient Ischemic Attacks
• Brain Abscess due to right-to-left shunt

Causes

Ebstein's Anomaly of the Tricuspid Valve is Congenital, i.e. it is formed during the child's birth. However, the reason why it occurs is not known. The possible reasons are as detailed below:

In Ebstein’s Disease, the valve between the right atrium (upper chamber) and the right ventricle (lower chamber) is present at a lower position than normal. As a result, the lower chamber becomes a part of the upper chamber, and thus the ventricle cannot function properly.

Additionally, the leaflets of the valve are not properly formed causing a leakage of the blood back into the upper right chamber.

The other cause is the formation of a hole in the wall separating the upper two chambers. Usually, at birth, this hole closes, but if it remains open, it causes a mixing of pure blood with impure blood in the two chambers. This decreases the oxygen levels in the blood causing a bluish discoloration called Cyanosis.

Risk factors

Ebstein's Anomaly happens during the development of the baby’s Heart.

The risk factors for Ebstein’s Anomaly are not known but are believed to be due to environmental and genetic factors.

If the mother is exposed to certain medications (during pregnancy) such as lithium, it can also lead to Ebstein's Anomaly in the child.

Complications

Complications are not very common in people with Ebstein's Anomaly. The complications that can result from the condition are:

• Heart Failure,
• Heart rhythm problems (Arrhythmias)
• Stroke
• Sudden Cardiac Arrest

Diagnosis

Upon reviewing your signs and symptoms, your doctor will conduct a physical examination. If Congenital Heart Disease is suspected, then your doctor will conduct one or more of the following tests:

Treatment

The goal of Ebstein's Anomaly treatment is to reduce the symptoms and prevent complications with Ebstein's Anomaly.

Monitoring: In the case of the absence of signs and symptoms, a routine monitoring of Heart condition is done by performing a physical examination and other related tests.

Medications: If you have irregularities in the Heart rhythm, then you will be given drugs to maintain a normal rhythm.

If you have a hole in the septal wall, you may be given medications to prevent blood clots from forming.

If you have signs of Heart Failure, then you may be given diuretics, to prevent fluid retention.

Surgery: If your symptoms are affecting your quality of life, then you may have to undergo Ebstein's Anomaly Surgery. Several surgical procedures are available to treat Ebstein's Anomaly such as Tricuspid Valve Repair, Valve Replacement, Closure of the Septal Hole, etc.

In severe cases, Heart Transplantation may be required.

Self-management

By taking certain steps, you or your child with Ebstein's Anomaly can cope with the condition. They are as follows:

• Regularly going for follow-up visits to your Cardiologist to prevent worsening of the condition
• Taking the medications as prescribed without forgetting any doses to reduce the symptoms
• Staying physically active as suggested strengthens your Heart and improves circulation
• Building a support group with people having similar conditions to overcome the related stress

Symptoms

The clinical features of Tetralogy of Fallot depend on the severity of the defects.

Most often the following symptoms and signs are displayed in infants:

• Difficulty in feeding
• Failure to thrive
• Exertional Dyspnea which usually worsens with age
• Bluish-pale skin while crying or feeding which occurs in episodes (‘tet spells’)

Physical findings of the infant include:

• Smaller size of the infant than the age due to poor development
• Poor weight gain
• Cyanosis of lips and nails is usually more prominent during childbirth
• After 3-6 months of birth, clubbing of fingers and toes occurs

Causes

The exact cause of Congenital Diseases is not known.

The four defects which affect the structure and function of the Heart are:

• Thickening of the muscles surrounding the lower right chamber
• Obstruction of the blood vessel connecting the Heart to the Lungs
• The Aorta (blood vessel) lies above the hole in the lower chambers (misplaced)
• A hole in the wall separating the lower chambers

Risk factors

Certain factors which may increase the risk of the child getting Tetralogy of Fallot are:

• Poor nutrition during pregnancy
• Alcohol consumption by the mother
• A mother who has crossed 40 years of age
• Diabetes in the mother
• Viral infections such as Rubella in the mother

Complications

If Tetralogy of Fallot is not treated, it can cause the below complications

• Problems with the Heart rhythm
• A delay in the development of the baby
• Seizures (fits)
• Death (if the condition is never fixed, which is rare)

Diagnosis

Usually, the diagnosis of Tetralogy of Fallot is made soon during infancy. However, if the symptoms are not severe, then the condition may not be detected until later stages of life. An early diagnosis can help in a better treatment to allow the child to lead a normal life with certain restrictions on exercise.

The below medical tests are performed to check if the child has Tetralogy of Fallot:

Treatment

Doctors can usually identify the Tetralogy of Fallot defect early at the child’s birth and surgically repair it. Children with a simple form of Tetralogy of Fallot can have a quality of life with good life expectancy.

Surgery is the main treatment option for correcting the defects. The corrective is performed in the younger infants to widen the Pulmonary Tract and improve the blood flow to the Lungs. Surgery is usually performed within 2 years of birth. Sometimes more than one surgery is needed.

The child will be given oxygen through a mask to increase the oxygen levels in the blood.

To decrease the severity of tet spells, the child may be given medications such as morphine, propranolol or metoprolol, or, in severe cases, phenylephrine.

Precautions

People with Tetralogy of Fallot should follow certain precautions as provided below:

• They have to restrict doing certain exercises as suggested by the doctor
• Take medications as prescribed by your doctor
• Should not take any additional medications without notifying your doctor
• Get your health checked by your doctor regularly

Causes of Hemangiomas

The cause of Hemangiomas is unknown. It may involve genetic changes, but it is not an inherited condition.

Signs and Symptoms of Hemangiomas

The symptoms of Hemangiomas include

• Port-wine stain
• Extra fingers or toes
• Webbed fingers or toes
• Muscle cramps
• Joint pain
• Rectal bleeding
• Inflammation on skin

Diagnosis of Hemangiomas

The diagnosis involves a complete physical examination along with certain questions to the patient regarding familial and medical history. The diagnostic studies used are:

Duplex scanning: High-frequency sound waves are used to create detailed images of blood vessels.

Scanogram: It is an X-ray technique which takes scanned images of bones. It helps to measure the length of the bones.

Magnetic Resonance Angiography: Magnetic Resonance Angiography is used to differentiate between bone, fat, muscle and blood vessels.

CT Scan: It is used to create 3-dimensional images of the whole body, which helps to observe blood clots in veins.

Contrast Venography: In this procedure, a dye is injected into the veins to take X-ray images which help in visualizing abnormal veins, blockages or blood clots.

Treatment for Hemangiomas

The different treatment strategies for Hemangiomas are based on the affected area. The affected limbs are wrapped with bandages or elastic garments to prevent swelling, Varicose Veins and skin ulcers. Physical therapy massages will be helpful to relieve swelling in arms or legs. Patients with joint pain and Orthopaedic issues are suggested to use Orthopaedic shoes to improve health, and function, and reduce pain. The port-wine stains on the skin can be lightened or eliminated by laser therapies.

Laser or radiofrequency ablation techniques are used to open the closed veins or close off the abnormal veins. The blocks in arteries and veins are removed by a technique called Embolization. In this procedure, small catheters are placed in the arteries or veins. Sclerotherapy is also used to close the vein by creating scar tissue. Vena cava filters are used to prevent blood clots that travel to the veins. In some cases, surgery may be suggested to remove the affected veins.

The overgrowth of the lower limb can be stopped by an Orthopaedic procedure called Epiphysiodesis. The overgrown bones can also be corrected by surgery. In addition, treatment is essential for complications such as bleeding, infection, blood clots or skin ulcers.

Causes

The exact cause of MVP is still under wraps. People who are suffering from MVP are usually born with it. MVP is also seen running in families. MVP is closely associated with Marfan Syndrome (connective tissue disorder) and is more common in people who are born with Marfan Syndrome. MVP is also associated with other conditions like - Ehlers-Danlos syndrome (a group of diseases like loose joints, hyperelastic skin, easily bruised, and damaged blood vessels), Osteogenesis Imperfect (Brittle Bone Disease), Polycystic Kidney Disease (Multiple Cysts/Tumours on the Kidney).

Symptoms

MVP is a lifelong disorder but it usually does not show any signs or symptoms. A few symptoms in people who show them include:

• Clicking sound of the Heart due to the flaps of the Mitral Valve
• Heart Murmur due to leakage of blood
• Infection of the Mitral Valve called Infective Endocarditis
• Lightheadedness or feeling dizzy
• Fainting
• Chest pain
• Being anxious
• Getting panicked
• Fatigue
• Short of breath while playing or exercising
• Rapid Heartbeat or skipping Heartbeat

Diagnosis

MVP can be diagnosed at any age. Symptoms that the patient is experiencing will be considered but it does not provide any conclusive diagnosis. A simple stethoscope is used to listen to the clicking sound and Heart Murmur sound.

A test called Echocardiogram uses high-frequency sound waves to create an image of the Heart structure including the MV. The flow of blood and the amount of leakage can also be measured. An Electrocardiogram (ECG) is a non-invasive technique that records the electrical impulse of the Heart and helps to detect any abnormality in the heart rate, Heart structure, and MVP.

A chest X-ray shows the picture of the Heart, Lungs, and blood vessels, any abnormality can be easily diagnosed. (Magnetic resonance imaging MRI) uses strong magnetic waves to capture a picture of the chest region. This shows the structure of the Heart and the blood flow. Cross-sections of the chest and upper abdominal region are produced using X-rays.

A Treadmill stress test may also be done. The person’s Heartbeat and Heart function is recorded when he/she is exercising. This test is done to see whether MV Regurgitation occurs and does it limits the ability to exercise. It is done if the person complains of chest pain and to know whether chest pain is due to MVP or Coronary Heart Disease.

Cardiac Catheterization may be done if the doctor suspects that the MVP is too severe. This procedure involves injecting dye into the Heart’s blood vessels and then taking a series of X-ray images. The X-ray offers a detailed structure of Heart arteries and pressure in the Heart chamber. It also helps the doctor to determine whether the patient requires a Coronary Artery Bypass along with Mitral Valve Surgery.

Treatment

Many people with MVP do not require any treatment. But of course, people who have complications due to MVP require treatment, which will be decided by the doctor. Treatment depends on the severity of the disease and the complications it is causing. Treatment options for MVP include medication or surgery.

Medication to treat MVP-related chest pain, irregular Heartbeat, and other complications are prescribed. Beta-blockers are prescribed to correct irregular Heartbeat, High Blood Pressure, and improper blood flow. Aspirin is given to reduce the risk of blood clots in people with a high risk of Stroke. In patients with a previous history of Heart Failure or Stroke, the doctor may prescribe anti-coagulants or blood thinners to avoid blood clotting.

In case of severe MVP and severe regurgitation, the doctor will recommend surgery. Surgery includes either MV repair or MV replacement.

Outlook

Although MVP does not cause any serious complications it should be continuously monitored by the doctor. Any symptoms that seem to disturb the normal functioning of a person should be immediately consulted with a doctor. Finally, MVP should not and usually does not prevent a person from having a full and active life.

Claudicating knocks first

The hallmark symptom of PAD is claudication. It is a medical term derived from the Latin term ‘claudicare’ that means ‘to limp’. It typically describes pain in the leg, calf, thigh, or hip on walking, running or climbing stairs.

The factor that distinguishes it is that it almost always gets relieved by rest. Initially, you would experience something called intermittent claudication which happens as the narrowing of the artery usually occurs gradually, causing intermittent pain.

As the muscle’s demand for blood and oxygen increases during exercise, you experience pain as the blood supply doesn’t match the demand. On resting the muscle’s need for blood lessens, and the pain goes away. ”

Claudication progresses to the second stage of PAD, if the narrowing of the blood vessels deteriorates and is then termed CLI (Chronic Limb Ischemia) includes pain even at rest or while seated and has the potential to lead to gangrene.

Patients with buttock claudication will frequently stop walking until the pain goes away and this is also known as “Window Shopper’s Disease.

PAD and you

You are at a high risk of developing PAD or claudication, if you are an elderly person with uncontrolled blood sugars, High Blood Pressure, and High Cholesterol levels.

It could also develop if you suffer from a condition termed Atherosclerosis (hardened fat deposits lining the walls of blood vessels). However, you may need to be overly cautious if you are a chronic smoker as the risk is increased four times as compared to others.

Other factors that increase your risk of PAD are Obesity, a sedentary lifestyle, and a family history of Heart Attack, Heart Disease or Stroke.

Symptoms

There are a few Peripheral Artery Disease symptoms mentioned below. They are:

• Painful cramps in the hip, calf muscles, and thigh region
• Leg weakness and numbness
• Sores on the foot
• Change in the colour of the legs
• Hair loss on the feet
• Slower growth of toenails
• Shiny skin on the legs
• Erectile dysfunction in men

Your physician needs to evaluate you

Your physician will evaluate you for complaints of leg pain particularly on walking or exercising that disappears after a few minutes of rest, numbness, tingling, or coldness in the lower legs or feet, and sores or infections on your feet or legs that heal slowly.

Your physician would also examine your pulses in the blood vessels in your legs or listen to the blood flow with a stethoscope or a small device called Doppler. He might find low or no pulse sounds beyond the level of blockage.

Your physician will then confirm the diagnosis by doing the ankle-brachial index (ABI) test. With this test, he will compare the Blood Pressure in your ankle to the Blood Pressure in your arm. If the Blood Pressure in the lower part of your leg is lower than the pressure in your arm, it would be suggestive of PAD. Although this may confirm the diagnosis of PAD your physician would further recommend tests to identify the vessel affected and the level of block.

The other tests needed to confirm a diagnosis of PAD include a special ultrasound imaging technique called the Doppler ultrasound for the lower limbs (helps evaluate the blood flow through your blood vessels and also identification of blocked or narrow arteries), Arteriography or X-ray of the limbs after injection of a dye into the blood vessel, Computed Tomography Angiography (CTA)/ Magnetic Resonance Angiography (MRA) to detect blockages within blood vessels, and ultrasound to produce images of the blood vessels on a screen using sound waves.

Don’t lose hope – PAD is treatable

Although PAD is a serious condition, it is treatable if you seek medical advice as early as possible. Your physician will plan out a management plan that will basically attempt to provide relief from pain and also try to prevent the progression of the plaque.

The most important lifestyle changes that need to be done are to quit smoking, maintain a scheduled exercise regimen, and eat a healthy diet low in saturated and trans fats and oils.

Medicines prescribed by your doctor will include drugs to prevent clots, lower your Blood Pressure, lower your levels of Cholesterol, and control your blood sugars, drugs for healing of infected or open wounds and to provide pain relief.

Although surgery may not be the first option in the management of the condition, it may become necessary if the block in your vessel is severe enough to cause damage to the tissue.

Surgical procedures that are done to treat PAD include Angioplasty, artery bypass graft, endarterectomy, and grafting.

In Angioplasty a small tube with a balloon attached is inserted and threaded into an artery. The balloon is then inflated to help open the narrowed artery. Your surgeon may also place a wire tube or stent in place to help keep the artery open.

In an Artery Bypass Graft, a blood vessel is taken from another part of the body and is attached to bypass a blocked artery. Or a section of the blocked artery may be replaced with a graft (of another vein or artificial blood vessel) to remove the block.

In an Endarterectomy the surgeon cleans up the plaque buildup inside the artery of the affected leg or arm.

All these are the peripheral vascular treatments offered to people suffering from Peripheral Artery Disease.

Causes

The exact cause of Pulmonary Valve Stenosis is still unclear. It is believed that the defect may occur due to abnormal development of the fetal Heart during the pregnancy. The condition may also occur as a result of other Congenital Birth Defects.

In Pulmonary Valve Stenosis, one or more of the leaflets become thick leading to an abnormal opening of the valve and thus blood flow into the Pulmonary Artery is restricted.

In a few cases, Pulmonary Valve Stenosis may occur as a result of other conditions such as Carcinoid Syndrome and Rheumatoid Fever. Pulmonary Valve Stenosis may also occur as a result of genetic predisposition.

Risk factors

As Pulmonary Valve Stenosis is congenital, there are no known risk factors. However, a few conditions may increase the risk of Pulmonary Valve Stenosis which includes:

• Carcinoid Syndrome
• Rheumatic Fever
• Noonan’s Syndrome

Symptoms

Depending on the extent of blockage, the symptoms may vary. Mild Pulmonary Valve Stenosis may not cause any symptoms and remains unnoticed. If the condition is moderate to severe, then you may have the following signs and symptoms:

• Heart Murmur
• Prominent and Enlarged Jugular Vein
• Bluish discoloration of the skin
• Chest pain
• Dizziness
• Heart palpitations
• Unexplained fatigue
• Failure to thrive
• Shortness of breath

Complications

If Pulmonary Valve Stenosis is left untreated or unnoticed, it can lead to life-threatening complications such as:

• Infectious Endocarditis
• Right Ventricular Hypertrophy
• Heart Failure
• Irregular Heartbeats

Diagnosis

Pulmonary Valve Stenosis is diagnosed in childhood, but if the disease is mild, it remains unnoticed. Pulmonary Valve Stenosis is suspected when your doctor hears a Heart Murmur. To confirm the diagnosis, your doctor might order any of the following tests:

• Chest X-ray: The test provides images of the internal tissues, organs, and bones.
• Electrocardiogram: The test is used to identify the abnormal rhythms of the Heart and helps to diagnose the condition.
• Echocardiogram: The echo evaluates the structure and function of the Heart by producing the moving images of the beating Heart.
• Cardiac Catheterization: It is an invasive diagnostic procedure which provides detailed information regarding the structures of your Heart.

Treatment

The treatment of Pulmonary Valve Stenosis depends on the severity. The doctor might recommend any of the following therapies to treat the condition.

Medications: Your doctor might order certain medications that restore the normal blood flow through the valve.

• Prostaglandins - to improve the blood flow
• Blood thinners - to reduce blood clotting
• Antiarrhythmics - to prevent irregular Heart rhythms

Balloon Valvuloplasty: During the procedure, a small tube is threaded through the vein of your leg to the Heart. The tube consists of a deflated balloon at the tip. After guiding the tube in the narrowed valve, the balloon is inflated to make the opening wider.

Open-heart Surgery: During the surgery, the Pulmonary Valve is repaired, or an artificial valve is placed to restore the normal blood flow.

Self-management

The risk of other Heart problems can be reduced if you adopt the following measures:

• Smoking cessation
• Maintain a Heart-healthy diet
• Maintain a healthy weight
• Perform regular physical activity
• Undergoing regular health check-ups