Valve Diseases - DrCRaghu


Introduction

Atrial Fibrillation means the upper chambers of the heart. These upper chambers of the heart start  beating chaotically quiet irregularly that is what is called as Atrial Fibrillation. Normally a heart beats  around 60-100 times per minute so the number of beats a heart should beat is determined by the  sinus node and its function but at times when there is an enlargement of atria or sometimes there is  an infection or inflammation of the atria what happens is these atria start beating chaotically so this  chaotic beating of the atria is called Atrial Fibrillation. In this video Dr. C Raghu TAVR expert in India explains  to  you all about Atrial Fibrillation, What are  the  types in Atrial Fibrillation? What are  the  complications of Atrial Fibrillation? How to detect Atrial Fibrillation?

Atrial Fibrillation means the upper chambers of the heart. These upper chambers of the heart start  beating chaotically quiet irregularly that is what is called as Atrial Fibrillation. Normally a heart beats  around 60-100 times per minute so the number of beats a heart should beat is determined by the  sinus node and its function but at times when there is an enlargement of atria or sometimes there is  an infection or inflammation of the atria what happens is these atria start beating chaotically so this  chaotic beating of the atria is called Atrial Fibrillation. In this Atrial Fibrillation in contrast to the 60- 100 beats per minute of the atrial contraction here the atrial rate is between 400-600 per minute so  the atria start beating very fast and quiet irregularly.

 

So if the atria beat very fast and irregularly what does it mean? 

It means that if a structure is beating at 400-600 per minute the beating is quiet ineffective so that is  what we call as atrial paralysis or the atria is not effectively functioning so atrial fibrillation leads to  dysfunction of the atrium

This atrium contributes to about 20% of heart output so when the atrium is dysfunctional the heart  pumping is reduced by around 20%.

 

Onset of Atrial Fibrillation

Atrial Fibrillation can be either

  • sudden onset
  • chronic
  • paroxysmal.

Acute Atrial Fibrillation: Atrial Fibrillation sometimes it happens suddenly like in the scenario of an  acute heart attack or in a scenario of an inflammation of pericardium or sometimes when there is a  sudden pulmonary embolism that means there is a blood clot within the blood vessels supplying the  lungs. In  those circumstances  there can be a  sudden onset of Atrial Fibrillation  so  this is called an  acute Atrial Fibrillation so once after the cause for the Atrial Fibrillation has been reversed there is a strong  chance  that  this  Atrial  Fibrillation  can  revert  back  to  normal  sinus  so  the  atrium  will  start  contracting at a much lower rate.

Chronic  Atrial  Fibrillation: The  other  type  of  Atrial  Fibrillation  is  a  Chronic  Atrial  Fibrillation  or  a  Chronic Persistent Atrial Fibrillation where the Atrial Fibrillation is present for more than a week in  duration and continues to persist. So that means that the Atrial Fibrillation does not come back to  sinus rhythm but in fact is present for beyond a week and continue to remain so for rest of the life so  that is what we call as Chronic Atrial Fibrillation or a long standing Atrial Fibrillation.

Paroxysmal  Atrial  Fibrillation: There  is  another  type  of  Atrial  Fibrillation  called  Paroxysmal  Atrial  Fibrillation that means Atrial Fibrillation is present for certain duration of time and then reverts back  to  sinus  rhythm  and  once  again  might  come  up again.  It  comes  and  goes  that  is  what  we  call  as  Paroxysmal Atrial Fibrillation.

 

Which type of Atrial Fibrillation is dangerous? 

All types of Atrial Fibrillation are dangerous.

 

Why they are dangerous?  

Atrial Fibrillation as we  understood  reduces  the  pumping ability  of  the  heart  by  20% in addition a  prolonged and fast rate of the heart fatigues the heart and reduces the heart pumping ability again  that is called left ventricular dysfunction

The most dreaded complication of Atrial Fibrillation is brain stroke because the atria are chaotically  contracting  or  they  are  inefficiently  contracting  there  is  pooling  of  blood  within  atrium  and  this  pooling of blood or stasis or stagnation of blood in the atrium leads to promotion of blood clots in  the atrial chambers. These blood clots which are present in  the atrial chambers because  the heart  continues to beat every minute every second so what happens is these small clots which are present  in  the atrial chambers get dislodged and potentially lead  to a brain stroke  these dislodge and  they  gets lodged in the brain vessels so that is called a brain stroke. So a patient with Atrial Fibrillation can  develop a heart dysfunction they can develop a brain stroke they can develop a sudden reduction in  the cardiac output so these are the various complications of Atrial Fibrillation.

 

How can we detect Atrial Fibrillation? 

We have seen that if the Atrial Fibrillation is chronic and persistent that can be easily detected by an  ECG or an Electrocardiogram. This is  the simplest inexpensive  test  to detect  the presence of Atrial  Fibrillation.

But if it is a Paroxysmal Atrial Fibrillation that means it comes and goes then we might have to use a  long  term  ECG  recording  technology  to  identify  or  diagnose  or  detect  the  presence  of  Atrial  Fibrillation.  So  there  are  numerous  technologies  to  identify  Atrial  Fibrillation  on  a  long  standing  basis. Some of them are external that means we put as a patch ECG outside or we connect multiple  electrodes  as  in  the  form  of a  Holter  monitoring  or  we  have  got  a  lot  of  novel  devices  like  the  Alivecor where you can just touch with the fingertips of the thumb to identify Atrial Fibrillation. So  number of technological advances have appeared to detect the presence of Atrial Fibrillation. Even  our Apple watch also  has got an Atrial Fibrillation  detection algorithm so an apple watch also  can

detect the  presence  of  Atrial  Fibrillation.  Quite  a  few  of  my  patients  tend  to  identify  their  Atrial  Fibrillation  from  their  apple  watch  so  you  have  got  simple  technologies  you  have  got  complex  technologies

The most complex technologies like where you can put an implantable loop recorder.  A small device  is implanted into the subcutaneous tissue that means beneath the skin and the muscle or the fat and  then this recorder will continue to record the heartbeat.

So you have got the simple technology like the ECG and a moderately complex technology like the  ECG  patch  or  the  Holter  recording  or  a  14  day  ECG  patch  is  also  available  and  finally  for  those  patients where the Atrial Fibrillation is very rare you can put an implantable loop recorder that can  last for about 2 years of the time.

So what happens is if these patients tend to have one episode of Atrial Fibrillation which is persistent  for more than 30 seconds then we can say that this patient has got an Atrial Fibrillation which could  be Paroxysmal in nature.

In  conclusion  lot  of  new  technologies  are  there  one  of  the  easiest  technology  is  the  apple  watch  somebody who is a patient you can use a Alivecor type of monitor. If the patient is newly diagnosed  or you want to confirm or make a diagnosis of Atrial Fibrillation you can use a Holter monitoring, a  patch ECG  for atleast 14 days. For one to diagnose Atrial Fibrillation atleast 14 days of recording is  required before we can say that this patient does not have Atrial Fibrillation.


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Women especially at young age are experiencing an unprecedented increase in heart attacks and strokes. We attempt In this article to make the reader aware of the reasons for this.

How are women different from men for developing heart attack?

Women tend to develop cardiac disease 7-10 years later compared to men that is attributed to the protective effect of estrogen hormone, which is present till menopause.

What are the traditional risk factors for developing heart disease?

Both men and women are prone to develop cardiac problems if they have one or multiple risk factors listed below. They are called traditional because they have been in practice for the past 6 decades.

Non-modifiable risk factors Modifiable risk factors
·         Age

·         Male gender

·         Family history of cardiac disease (< 60 years)

·         Smoking

·         Diabetes

·         Hypertension

·         Hyperlipidemia

·         Obesity

 Despite the absence of many of these risk factors, women worldwide are increasingly dying due to cardiac ailments.

Do traditional risk factors confer a disparate risk for developing cardiac problems in women?

Women are sensitive than men for the development of heart diseases when they have associated traditional risk factors.

For example:

  • Diabetes: Women with diabetes have a 7-fold increase in cardiac events compared to only 3-fold increase in diabetic men.
  • Smoking and tobacco use has been shown to enhance the risk by an additional 25% in women compared to men for development of heart attacks. In fact tobacco use has been responsible for 50% of cardiac events in women and confers a 3-fold increased events. Normally women develop heart attacks 7-10 years later than men due to the protective benefits of estrogen hormone. This protective effect is lost with tobacco use and if they develop diabetes.

Unique risk factors for cardiac problems in female gender include: 

  • Pre-eclampsia (High BP during pregnancy associated with complications)
  • Diabetes during pregnancy
  • Polycystic Ovary syndrome
  • Early menopause
  • Autoimmune diseases

Early menopause and risk of heart attack:

 About 10% of women experience menopause naturally before the age of 45 years. This is called early menopause. Because of lack of estrogen in post menopausal women, it predisposes to cardiac events.

Compared to women of similar age, those who attain natural or surgical menopause (removal of uterus – Hysterectomy) less than 45 years are at 50% higher risk of developing heart attack and 20% increased risk of death.  Those women who attained surgical menopause tend to have higher cardiac events compared to natural menopause. So women should be dissuaded to undergo uterus removal surgery unless there is a clear evidence that the procedure is definitely required. Hormone replacement therapy has been tried to mitigate this risk but in vain. Current guidelines are against hormone replacement therapy for early menopause.

What can we do to prevent these cardiac events in women?

Targeting traditional risk factors – diabetes, hypertension, lipids, sedentary life styles, inappropriate food choices and obesity form the bedrock strategy for reducing the risk of developing heart attacks.

But for women further measures are needed to address the unique risk factors for women. The American College of Cardiology in its 2019 guidelines notified pre eclampsia, early menopause and autoimmune disease as “risk enhancers” for cardiac disease. They also added that physicians should have a low threshold to treat those patients with risk enhancers by life style measures and cholesterol lowering drugs to reduce the risk of developing heart attacks.

Finally women should realize that they are no longer at low risk for developing cardiac ailments and need to understand there are new risk factors that put them at “enhanced risk” for developing heart attacks.



Your heart needs to work 24/7 to keep your body systems working. Like any other body tissue, the heart too needs oxygen and nutrients to function efficiently. For this, we have a network of arteries that supply blood to the heart muscles which are called the coronary arteries. There are two chief coronary arteries:

the left and right coronary arteries, that branch out from the aorta near the point where the aorta and the left ventricle meet.

The right coronary artery supplies blood to the right atrium, the right ventricle, a small bottom area of the left ventricle and the back portion of the septum.

The left coronary artery supplies blood to the left atrium and ventricles and the front portion of the septum.

These coronary arteries give out various branches that supply blood to different parts of the heart.

Coronary artery disease:

When there is high level of unhealthy fats in the blood, they gradually start depositing in the insides of the coronary artery vessel wall and form a fatty plaque(atherosclerosis). This gradually narrows the lumen of the coronary arteries which obstructs blood supply to the heart. This condition is called as coronary artery disease. disruption of blood supply to the heart gives rise to a cluster of symptoms, the most important being chest pain or angina.

  • Warning signs of heart disease
  • Risk factors for heart disease
  • Possible complications of heart disease


Your lifestyle, age, family history and your other health condition can dictate your risk to develop a heart disease. However, the three key risk factors are- smoking, high blood pressure and high cholesterol. Learn about the risk factors and see if you are at risk:

  1. High blood pressure: It is an important factor for many diseases. Blood pressure, if not controlled, can lead to heart disease, stroke, kidney failure and other organ system disorders. Decreasing blood pressure by lifestyle changes and medication can greatly reduce your risk for heart disease.
  2. High cholesterol: Did you know that our hardworking liver can generate all the cholesterol that our bodies need? But we all do take in extra bad cholesterol from diet. These bad cholesterol tend to get deposited in our blood vessels and cause heart disease.
  3. Smoking: Cigarette smoking damages your heart and blood vessels. Nicotine present in cigarette smoke also reduces the amount of oxygen that your blood can carry. Not only that, if you smoke, the people around you are also at a higher risk of getting heart disease.
  4. Obesity: Obesity is linked with high level of bad cholesterol level and low levels of good cholesterol levels. Obesity is not only a risk factor for heart disease, but also increases risk of diabetes and high blood pressure.
  5. Diabetes: People with diabetes or high blood sugars are at greater risk of having heart disease than those who don’t have diabetes.
  6. Unhealthy diet: Oily, junk foods which are high in bad cholesterol, saturated fats and trans fats an can increase your risk of heart disease. Foods that are very salty(have high sodium levels) can also increase your risk of high blood pressure and heart disease.
  7. Physical inactivity: Physical inactivity increase your risk of having high blood pressure and diabetes and eventually heart disease.
  8. Alcohol: Excess and frequent alcohol intake can increase the risk of high blood pressure and hypercholesterolemia. Ideally, women shouldn’t have more than 1 drink a day and men shouldn’t have more than 2 drinks a day.
  9. Family history: Genetic factors seem to play a role in conditions like high blood pressure and heart diseases. However, it is also likely that the members of the family sharing common external environments and culture may be exposed to the same set of risk factors for heart diseases.
  10. Age: The risk of heart disease increases as the a person ages.


There are an array of heart diseases but they do share some common symptoms. If you experience any of these symptoms, it is perhaps a good idea to get yourself tested. Check these out here:

  1. Angina or chest pain described as heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in your chest.It is often accompanied by pain in the n the neck, jaw, throat, upper abdomen or back
  2. Shortness of breath
  3. Easy fatiguability
  4. Palpitation and rapid heartbeat
  5. Weakness/dizziness
  6. Sweating
  7. Nausea and vomiting
  8. Swelling in the lower extremities
  9. Fainting(syncope)
  10. Coughing and wheezing


For continuous circulation, the left and the right side of the heart must work together. Here are the series of steps that causes the blood to flow in the heart, lungs and body.

  • The right atria receives deoxygenated blood from two large veins- the superior and inferior venacava.
  • When the atria contracts and the blood passes from the right atrium to the right ventricle through the tricuspid valve.
  • When the ventricle fills, the tricuspid valve closes.
  • Next, the ventricle contracts and pushes blood to the pulmonary artery through the pulmonary valve.
  • The pulmonary artery carries the blood to the lungs where the blood gets oxygenated.
  • This oxygenated blood enters the left atria of the heart through the pulmonary vein.
  • Next, the left atria contracts and the blood flows from left atrium into your left ventricle through the open mitral valve.
  • When the ventricle is full, the mitral valve shuts,
  • Next, the ventricle contracts and oxygenated blood is passed to the aorta through which it is sent to various parts of the body.












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