Cardiophile » General

Chest pain in children

Johnson Francis — Mon, 08 Aug 2011 06:11:48 +0000

Even though chest pain as a symptom is common in children, unlike in adults, it is seldom due to heart disease. Most often the cause of chest pain in children is not a major life threatening disease. Still chest pain can cause restriction of activities, absence from school and cause of anxiety to children and their parents. A good history and physical examination gives a lot of information to exclude any potentially serious condition causing chest pain, though it is rare. Costochondritis or inflammation of the joint between the breastbone and the ribs is a common cause of chest pain adolescent and pre-adolescent girls. It can be caused by viral illness or due to frequent coughing due to respiratory illness. It can be identified by localised tenderness at costochondral joint, the joint between the breastbone and the ribs. Injury to muscles and bones of the chest can be a cause of chest pain in children, but this cause is usually obvious from the history. But this can also occur following the lifting of heavy objects, frequent coughing or a lot of aerobic exercise. Stress or anxiety is also a common cause of chest pain though it may be difficult to elucidate because the cause of stress may not be obvious. Exam related stress and other usual causes of stress have to be thought of. Stress can also cause worsening of chest pain due to another cause. Hence other causes have to be excluded before attributing a sole etiological role for stress. Pleurisy or inflammation of the covering of the lung is another important cause of chest pain which characteristically increases on breathing in and has a catching nature. Sometimes chest pain can occur due to collection air (pneumothorax) or fluid in the pleural cavity surrounding the lungs. But in this case shortness of breath is usually a prominent associated symptom. Reflux esophagitits or inflammation of food pipe due to reflux of acid from the stomach can also cause chest paint. This causes a burning type of chest pain felt in the center of the chest.

Chest pain due to heart disease in children

Though rare, some cardiac causes of chest pain in children are worth noting. Pericarditis or inflammation of the covering of the heart can cause chest pain in children. Most cases of pericarditis are self limited, but can rarely become a serious problem. It causes a shart pain which may be relieved by sitting and leaning forwards. Fever may be associated with pericarditis. Abnormalities of the coronary arteries which supply oxygenated blood to the heart can occur as a congenital anomaly or secondary to conditions like Kawasaki disease. Thickening of heart muscles due to heritable conditions like hypertrophic cardiomyopathy have also to be thought of. Mitral valve prolapse of bending backwards of the mitral valve between the left atrium (upper chamber) and the left ventricle (lower muscular chamber) can also cause chest pain, more often in adolescent females. Most often it is only a minor abnormality though rarely it can cause a leakage of the valve which can be significant. Another rare cause of chest pain could be an aneurysm of aorta (swelling of the great vessel which arise from the left ventricle). This is quite rare in children and can occur due to a condition known as Marfan syndrome. Rarely fast heart rate due to abnormal heart rhythms may also be felt as a chest discomfort by some children.

Biodegradable coronary stents

Johnson Francis — Sat, 06 Aug 2011 02:00:46 +0000

Coronary arteries are the blood vessels which supply oxygenated blood to the heart. Blockages can develop in these blood vessels as age advances due to various disease processes. A critical blockage in the coronary artery is often removed by a procedure known as balloon angioplasty. Once the vessel is opened by balloon angioplasty a scaffolding known as a coronary stent is placed within the artery to prevent reclosure and to maintain a good vessel lumen. Currently metallic stents with or without a drug coated polymer are being used for this purpose. Coronary stents are prone for thrombosis or clotting of blood within the lumen causing obstruction of flow. Metallic stents also alter the geometry of the vessel by straitening out its natural curves and may obstruct side branches. Though drug coated (drug eluting stents) have reduced the chance of restenosis (repeat narrowing) of the vessel after balloon angioplasty, they have a higher rate of thrombosis. Moreover the polymer may irritate the vessel wall, cause dysfunction of the endothelium (inner covering of the blood vessel) and cause chronic inflammation at the stent site. Multliple stents can also cause difficulty during a future coronary bypass graft surgery and potentially interfere with imaging technologies like magnetic resonance imaging and multi slice computed tomography. To circumvent these problems new stents with bioresorbable scaffolds are being evaluated. The scaffolding of these new generation stents get bioabsorbed after a variable period of time so that what remains is only the native vessel with good endothelial function and natural vessel curves. Poly lactic acid is one of the polymers being evaluated for bioabsorbable stents. Poly lactic acid stent has been shown to hold up to 1000 mm Hg of crush pressure and is completely degraded by about nine months.

Weakness of heart muscle and pregnancy

Johnson Francis — Fri, 05 Aug 2011 08:57:21 +0000

Heart diseases during pregnancy increase the risk to the mother and sometimes to the baby. Peripartum cardiomyopathy is a rare disease of heart muscle specifically related to pregnancy occurring in the last month of pregnancy or within 5 months after delivery. Peripartum cardiomyopathy is an important cause for severe heart failure in pregnancy and it is due to decreased ability of the left ventricle (lower muscular chamber of the heart) to pump out blood effectively. Usually the recovery is fast after delivery, though some have persistent weakness of heart muscle. Those with persistent weakness of the left ventricular muscle have a high risk of recurrence of the disorder in subsequent pregnancies. There still exists a risk of recurrence in subsequent pregnancies even in those who recover fully. Peripartum cardiomyopathy is treated like any other cause of heart muscle weakness except that delivery of the baby initiates the recovery process. Medicines like digoxin which improves the pumping function of the heart muscle and those which increase the urine output (diuretics) are useful. Medicines which can reduce the work load of the heart like angiotensin converting enzyme inhibitors (e.g. enalapril) can be given once the baby is delivered. Otherwise this group of medicines may produce some defects in the baby. Intravenous medications which improve the pump function of the heart known as inotropes (e.g. dobutamine) are useful to tide over the crisis in an acutely ill patient with peripartum cardiomyopathy.

Even short term NSAID use increase risk after heart attack

Johnson Francis — Fri, 05 Aug 2011 06:43:09 +0000

It is fairly known that pain killers in the group of non steroidal anti inflammatory drugs (NSAID) increase the cardiovascular risk in healthy individuals as well as those with a prior heart attack. Olsen and associates checked whether there is a relationship between the duration of use of NSAIDs and cardiovascular risk. The study evaluated over eighty three thousand patients thirty years or more in age admitted with first myocardial infarction (heart attack) between 1997 and 2006. There were over thirty five thousand reinfarction (recurrence of heart attack) or death during the period of evaluation. About forty two percent of the subjects had received NSAIDs. They noted a hazard ratio of 1.45 with the use of NSAIDs for increased risk of death or myocardial infarction with the use of NSAIDs. While the increased risk started immediately on initiating certain NSAIDs, it occurred within one week with others. Authors suggested the limiting of NSAID use in those with prior myocardial infarction even though we need a good randomized controlled trial to clarify this issue further.

Warning symptoms of heart attack in women

Johnson Francis — Fri, 05 Aug 2011 06:18:45 +0000

Early warning symptoms of heart attack may be a little different in women. Data from a study by McSweeney and colleagues is as follows: In the weeks before heart attack unusual fatigue is noted by more than seventy percent of the women, while almost half of them have sleep disturbances. About forty percent have shortness of breath and indigestion. Chest pain is noted by only a third of them. Symptoms at the heart attack include shortness of breath in about sixty percent, weakness in a similar number, fatigue in over forty percent and chest about fifty seven percent. So chest pain is indeed an important feature in women as well at the time of heart attack, though other symptoms may predominate in some of them[McSweeney, JC et al. Circulation 2003; 2619-2623].

Study suggests better outcome for those not living alone after heart attack

Johnson Francis — Thu, 04 Aug 2011 14:49:06 +0000

A recent report published by Emily M. Bucholz and colleagues from the Yale School of Medicine in the American Journal of Cardiology [Effect of Living Alone on Patient Outcomes After Hospitalization for Acute Myocardial Infarction. Article in Press. published online 28 July 2011] suggests that though risk at one year is similar for those living alone and not, the risk is thirty five percent higher at four years for those living alone. The researches have tried to account for significant differences in the health related parameters between those living alone and not, before arriving at this conclusion. One such difference noted was that only a fifth of those living alone were having a healthy weight for their height while one third of those not living alone had it. Those living alone also tended to be more older and the likelihood of being smokers was twice as high. The authors suggest that those who alone should have facility to get enhanced social support from friends, family and neighbours to speed up recovery and improve survival. Those will less social support may also actively seek more support from community or workplace.

Watch like device for early detection of cardiac arrest being evaluated

Johnson Francis — Thu, 04 Aug 2011 14:16:07 +0000

John Rickard and colleagues from Cleveland Clinic are evaluating the utility of a wrist worn device for the early detection of cardiac arrest. Preliminary results were published in Heart Rhythm journal [The Utility of a Novel Watch-based Pulse Detection System to Detect Pulselessness in Human Subjects. Article in Press, published online 29 July 2011]. The device detects the radial pulse and alerts the emergency medical system and designated care givers by a Bluetooth signal when the pulse is absent. A motion sensor was used to block the alert unless the subject was motionless. This will reduce the number of false alarms. The false positive alarms in this study was ten percent, which has to be brought down by future developments so that unnecessary burden on emergency personnel can be avoided. Better fitting devices rather than the one size fits all could reduce the chance of the device falling off during a cardiac arrest and reduce wrong signals. The device was testing by inflating a blood pressure cuff to cut off the radial pulse and asking the subjects to stay motionless as well as during ventricular fibrillation induction testing in patients with implanted cardioverter defibrillators. Future versions may include an accelerometer which could detect motion better and an audible alarm which can alert the subject to temporarily deactivate the device to prevent unnecessary alerting of emergency service if they are fine otherwise. If the device finally comes out successful in all evaluations, then it will help in early detection and treatment of cardiac arrest. It is well known that early defibrillation is the key to survival in cardiac arrest victims.

Healthy heart, Calcium and Vitamin D

Bijoy Johnson — Tue, 05 Apr 2011 16:08:58 +0000

Is there a connection between heart health and vitamin D? Are vitamin E and heart health linked? Researchers for the Women’s Health Initiative hormone replacement therapy and heart health study also investigated the role of other vitamins and minerals.

Since the calcification of plaques on arterial walls can cause coronary disease, researchers took a look at the relationship between heart health and vitamin D enriched calcium supplementation. After seven years, women taking these supplements had neither a decreased nor an increased risk of blood clots, stroke or heart disease. Although calcium and vitamin D are important for preventing osteoporosis, they do not seem to play a role in heart health.

The hormone replacement therapy and heart health study was ended early because of the number of adverse events experienced by the women in the study. At one time, it was believed that HRT promoted heart health, helped to prevent osteoporosis and improved the general health of post-menopausal women. After the hormone replacement therapy and heart health study was published, the recommendations concerning HRT were changed. Now, it is recommended that women who choose HRT to relieve the symptoms associated with menopause should use the lowest dosage, for the shortest period of time possible.

While there may be no connection between heart health and vitamin D, vitamin E and heart health are believed by many to be clearly linked. Vitamin E is a powerful antioxidant, meaning it reduces the negative affects of oxygen on the body. Preliminary research indicates that vitamin E limits the oxidation of “bad” cholesterol in the arteries. It may help prevent the formation of blood clots. It naturally thins the blood to such an extent that high dosages should be avoided by people using blood thinning medications or with bleeding problems.

Other herbs, amino acids and vitamins are believed to support heart health. These include l-arginine, ginkgo biloba, folic acid, potassium and magnesium. While the hormone replacement therapy and heart health study did not focus on these, the better supplement manufacturers rely on the research provided by numerous groups to formulate products that support heart health.

Physiology MCQ 1

Bijoy Johnson — Thu, 20 Jan 2011 09:40:46 +0000

The nucleus involved in Papez circuit is?
A. Pulvinar
B. Infralaminar
C. VPL nucleus
D. Anterior nucleus of thalamus

Correct answer : Anterior nucleus of Thalamus

Malacia – medical terminology

Bijoy Johnson — Wed, 30 Jun 2010 17:14:48 +0000

Malacia is a suffix used in medical terminology to denote abnormal softening of tissues. eg: osteomalacia, tracheomalacia, chondromalacia patellae, laryngomalacia, oesophagomalacia