Acquired Heart Disease: Prevention and Treatment

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1 Acquired Heart Disease: Prevention and Treatment Prevention and Treatment Sharon L. Roble, MD Assistant Professor Adult Congenital Heart Program The Ohio State University/Nationwide Children s Hospital Columbus, Ohio

2 Congenital Versus Acquired Congenital any condition that a person is born with Acquired any condition that develops after birth

3 Congenital Heart Disease Bicuspid Aortic Valve Tetralogy of Fallot Transposition of the Great Arteries Ventricular Septal Defects (VSD) Atrial Septal Defects (ASD) Truncus Arteriosus Anomalous Pulmonary Venous Return

4 Acquired Heart Disease Coronary Artery Disease Valvular Heart Disease High Blood Pressure Rheumatic Heart Disease Kawaski s Disease

5 CORONARY ARTERY DISEASE

6 Coronary Artery Disease Atherosclerosis An active process by which blockages develop in heart arteries due to the build up of plaques (cholesterol, platelets, inflammatory cells) Clinical presentation varies Asymptomatic Chest pain Shortness of breath Goal of treatment is to slow the development of significant blockages

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9 Clinical Presentation Asymptomatic Angina = chest pain Stable-occurs with exertion Unstable-occurs at rest Heart Attack = Myocardial Infarction Heart muscle cells die due to lack of oxygen Different types

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11 Risk Factors Age Gender High Blood Pressure Systolic (Top number) Treated versus untreated Smoking Cholesterol Total cholesterol HDL (good) cholesterol

12 What s s your risk? Framingham Data Risk Calculator 10 year risk of hard cardiac event Myocardial Infarction (i.e., heart attack) Death due to coronary disease Patients without known coronary disease Coronary artery disease equivalents Diabetes Peripheral Vascular Disease

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14 How is risk calculated? Framingham data Points assigned for each risk factor and points summed Total number of points then correlates to a percentage Percentage is risk of cardiovascular event over 10 years

15 MEN Example: Smoking Nonsmoker Smoker WOMEN Nonsmoker Smoker

16 Prevention Diet Low-fat High fiber Exercise Weight Loss Smoking Cessation Treatment of high blood pressure Treatment of cholesterol Aggressiveness of treatment depends on risk factors

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19 Diet calories/day 30% of calories from fat 8-10% saturated fat 1% trans fat partially hydrogenated Unsaturated fats, in moderation Limit sodium to 2400 mg/day Limit cholesterol to 300 mg/day 200 mg/day if high LDL

20 Good Fats versus Bad Fat Unsaturated Fats Olive Oil Canola Oil Trans-fat free margarine Cholesterol lowering margarine Saturated or Trans Fat Butter Lard Bacon Fat Gravy Cream Sauces Hydrogenated margarine/shortening Coconut/palm/cottonsee d/palm-kernel oils

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22 Exercise 30 minutes of moderate exercise 4-6 days per week Light Exercise Desk work Golf Light housework Moderate Exercise Walking (exercise) Gardening/yard work/farming Cycling Tennis Running Dancing Heavy Exercise Walking uphill Construction work/physical labor Basketball Football

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24 Treatment Medicine Aspirin/Plavix Cholesterol lowering agents Blood pressure lowering medications Stents Cardiac catheterization Surgery Bypass Surgery Arteries Veins

25 Treatment for Cholesterol

26 Coronary Artery Stenting

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28 VALVULAR HEART DISEASE

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30 Calcific (Degenerative) Aortic Valve Disease As valves age, the process of atherosclerosis can affect aortic valve resulting in calcium deposition May result in stenosis or regurgitation Symptoms present in s Accelerated in patients with abnormal valves (i.e., bicuspid valves)

31 HIGH BLOOD PRESSURE

32 High Blood Pressure The Silent Killer Long-standing, untreated high blood pressure damages arteries and veins Long-term consequences Heart failure Heart attacks Stroke Kidney Failure Blindness

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34 Diagnosis of High Blood Pressure 2 or more elevated blood pressures on 2 separate occasions

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36 Metabolic Syndrome Group of risk factors which greatly increase risk of developing cardiovascular disease including stroke. Risk Factors Abdominal obesity (abdominal waist circumference) Men >40 inches Women >35 inches High fasting glucose (>100) High triglycerides (>150) Low HDL (Men<40, Women<50) High blood pressure (>130/85)

37 RHEUMATIC HEART DISEASE

38 Rheumatic Heart Disease Begins with strep throat Inflammatory process in response to initial infection results in antibodies that attack the connective tissues of the body Approximately 2-4 weeks after initial strep infection, patients present with clinical features of rheumatic fever

39 Clinical Features of Rheumatic Fever Pain and swelling in large joints Fever Weakness Muscle aches Shortness of breath Chest pain Nausea and vomiting Hacking cough Circular rash Lumps under the skin Abnormal, sudden movements of arms and legs Damage to heart valves may present later and is permanent

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41 Rheumatic Heart Disease Early recognition and treatment of strep throat has led to a significant decrease in the incidence of rheumatic heart disease in the US and other developed countries Remains a significant cause of heart disease in developing countries Symptoms of heart disease may not present until several years after initial Strep infection

42 Treatment Penicillin to avoid recurrent strep infections If severe valvular disease, require valve replacement

43 KAWASKI S S DISEASE

44 Kawaski s s Disease Inflammation of the small and medium-sized vessels in the body Includes coronary arteries Presents in early childhood Ages 2-8 Clinical presentation Fever > 5 days Rash Peeling of skin on hands and feet Pink eye Strawberry tongue

45 Treatment Treatment is designed to stop inflammatory process and prevent longterm sequelae of coronary artery aneurysms. Long-term consequence of Kawaski s is coronary artery aneuryms which may initially be asymptomatic; however aneurysms may lead to heart attacks later in life.

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47 Kawaski s s Disease

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49 Useful Websites