Blockages of the Arteries of the Upper Extremities

It is relatively rare for atherosclerosis to affect the upper extremities and cause symptoms. Even diabetic patients, who are frequently affected by circulation disturbances of the legs, are rarely troubled by occlusion of the arteries to the upper extremities. The reason for the sparing of the upper extremities from arterial occlusive problems is not entirely clear, but it is a well-documented observation. Having said that, there are a few exceptions. Atherosclerotic occlusive disease of the subclavian artery is seen and occasionally will cause pain in the upper extremities. This pain is typically brought on by exercise and especially with repetitive movements of the upper extremity such as brushing one's hair. For reasons that again are unclear, it is more common for the atherosclerotic plaque to accumulate on the left side than it is on the right side. An examining physician may be alerted to this phenomenon by a difference in the quality of the pulse between the left wrist and the right wrist. The pulse on the left side may appear weaker and this can be confirmed by measuring the blood pressure in both upper extremities. It is common enough for older individuals to have a difference in the blood pressure of their arms that it is a worthwhile test for a physician to check the blood pressure in both upper extremities to be certain that there is not a difference between the two sides. If in fact, there is a difference between the blood pressure in the right and left upper extremity, the arm with the higher blood pressure is considered the accurate blood pressure for that individual. As mentioned, it is rare for patients to actually notice that they have atherosclerotic occlusive disease affecting the upper extremities and most of the time this relatively uncommon condition goes unrecognized. In certain instances, however, the repetitive exercise of the left upper extremity can cause not only pain in the left arm but also dizziness and, in fact, patients have been known to actually faint. This condition is called "subclavian steal syndrome". The anatomical situation is one in which there is a build-up of atherosclerotic plaque in the subclavian artery on the left side with the decreased flow to the left arm. With exercise, the left upper extremity can actually "steal" blood from the brain through the vertebral artery by causing a reversal of blood flow from the brain and down into the left arm. This can result in "syncope". The diagnosis is suspected by the history and confirmed by the finding of a markedly decreased blood pressure in the left upper extremity compared to the right side and further confirmed by noninvasive testing and ultimately by angiography. Treatment is readily available for this condition and consists of revascularizing the left upper extremity by either balloon angioplasty/stenting or surgical bypass from the carotid artery to the subclavian artery (carotid-subclavian bypass), which is a very durable procedure and serves to restore the circulation to the left arm and eliminate the risk of syncope.

Finally, upper extremity arterial insufficiency can be caused by emboli. In this situation, clots can form on the heart valves or in the "great vessels" leading out of the heart (such as the aorta or subclavian arteries) and this can lead to particles of cholesterol debris or blood clot moving "downstream" into the arteries of the arms or hands and causing an acute decrease in circulation. This acute interruption of blood flow can sometimes create an urgent situation requiring surgical intervention. Surgical treatment is usually highly effective in removing the emboli and restoring circulation. Efforts must be made to identify the source of the emboli however, so that recurrence of the emboli can be prevented. Patients will typically undergo transthoracic echocardiography or transesophageal echocardiography and occasionally may need a formal angiogram to assess the arteries in the chest, which lead from the heart to the upper extremities.

Leg Arteries

Peripheral Arterial Disease (PAD):

PAD is blockage of the arteries in the legs, caused by accumulation of atherosclerotic plaque. Risk factors associated with development of plaque in the arteries of the lower extremities include cigarette smoking, high cholesterol levels in the blood, diabetes, and family history. Peripheral arterial disease usually presents with the symptom of "claudication," which is pain in the leg, usually in the calf or thigh, after walking varying distances. Some patients develop "claudication" after just a few steps, while others can walk up to a half of a mile or more before pain forces them to stop. Typically, after a rest period of a few minutes, the patient is able to resume walking again for an equal distance before the pain returns. PAD is most commonly associated with aging. Approximately 30% of people over the age of 70 have some degree of PAD. While claudication caused by PAD is not necessarily a reason to proceed with surgical therapy, evaluation by a vascular surgeon is necessary when a patient has claudication to ascertain the seriousness of the condition. While claudication can be extremely painful and lifestyle limiting, it does not necessarily indicate that limb loss is imminent or even likely. Most patients with claudication due to PAD do not progress to limb loss. When claudication deteriorates into a condition of "rest pain" however , limb loss is a distinct probability. Rest pain means that the patient has pain even when not walking. Typically, rest pain is most intense when a person is attempting to sleep. When we sleep, our blood pressure tends to decrease and this blood pressure reduction leads to a decrease in the head of pressure which is driving blood into the legs around the areas of blockage. 

Testing for PAD:

The patient should been seen by a vascular surgeon. A complete medical history should be obtained and the surgeon will examine the arterial pulses in the lower extremities at the level of the groin, behind the knee, and in the feet. An arterial noninvasive blood flow study may be obtained, which is a noninvasive measurement of the amount of blood which is being delivered to the legs. If a blockage is suspected on the basis of the noninvasive arterial blood flow studies (sometimes called a "Doppler test"), an ultrasound examination of the arteries may be obtained, an MRA (magnetic resonance angiogram) may be obtained, and finally an angiogram may be necessary to obtain a "road map" of the circulation.

Treatment Options for PAD:

When PAD is diagnosed, the vascular surgeon will propose a treatment plan. This plan may involve an exercise program (usually consisting of walking on a daily basis to the point of claudication to attempt to build "collateral blood vessels" around the blocked arteries). Other lifestyle changes including cessation of cigarette smoking, better management of diabetes, weight reduction, and cholesterol-lowering medications. Medications which have been shown to have some beneficial effect in patients with claudication caused by PAD include cilostazol (Pletal), which may improve the walking distance. Other drugs that may be prescribed by the vascular surgeon include aspirin or clopidogrel (Plavix). If it is the opinion of the vascular surgeon that the condition has deteriorated to the point where lifestyle changes and an exercise program are no longer satisfactory treatment options, an angiography may be obtained. If the angiogram demonstrates localized blockages of the arteries in the legs, a balloon angioplasty, stenting or bypass surgery may be recommended. The bypass procedure can be performed either using one of the "extra veins" of the lower extremities, or an artificial arterial bypass (made of Dacron or Gortex) may be used. This decision is made by the vascular surgeon and is usually discussed with the patient prior to operation.

In cases where PAD has progressed beyond the point of claudication and beyond the point of rest pain to the situation where actual gangrene of the tissues of the lower extremity has developed, it is sometimes "too late" to salvage the extremity and amputation may be necessary. More than 50,000 amputations are performed annually in the United States . The amputation level may be either at the mid foot (transmetatarsal), below the knee or above the knee. Amputation is the procedure of last resort and is rarely undertaken prior to an attempt at limb salvage, unless the situation clearly has progressed to the point where time is of the essence and the amputation must be performed as a life-saving maneuver.

Smoking, Diabetes Can Increase Risk Of Dementia; Dementia Risk Factors

Smoking is one heinous habit which is responsible for a number of health hazards. Similarly, diabetes is a chronic condition which can affect the quality of life of a person to a great extent. The two have been popular to increase risks of cancer and heart disease. Now, researchers have warned that the two can clog the region of the brain which is crucial to memory and increase the risk for dementia.

Some recent findings have shown that smoking and diabetes can increase the risk of calcification (calcium salt deposits) in the hippocampus – a brain structure which is important for short and long-term memory storage. Any decline in the functioning of the hippocampus can cause Alzheimer’s disease, which is the most common kind of dementia.

The study, which was published in journal Radiology, found out the association between cardiovascular risk factors such as smoking, diabetes, high blood pressure, and hippocampal calcifications. Around 1,991 people aged 78 years participated in the study, reports IANS. Effects of calcification on cognitive function were also assessed in the study. However, the study suggests a link between the two and does not conclusively determine if smoking and diabetes can increase the risk of hippocampal calcifications.

Link: https://vascular.org/patient-resources/what-vascular-disease

Reference: https://vascular.cmesociety.com/

#VascularConference2019    #VascularConferences   #CardiologyConferences   #HeartHealth    #VascularSurgery  #HeartSurgery   #MitralValve    #NewInnovations

Vascular Disease

What is Vascular Disease? 

Most Americans are familiar with heart disease and with the consequences of blockages in the vessels that carry blood to and from the heart. But few people realize that blockages caused by a buildup of plaque and cholesterol affect more than coronary arteries. Arteries throughout the body carry oxygen-rich blood away from the heart so blockages can occur in all arteries with serious effects. Three of the most recognized vascular diseases include:

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm (AAA) is an enlargement or “bulge” that develops in a weakened area within the largest artery in the abdomen. The pressure generated by each heartbeat pushes against the weakened aortic wall, causing the aneurysm to enlarge. If the AAA remains undetected, the aortic wall continues to weaken, and the aneurysm continues to grow. Eventually, the aneurysm becomes so large, and its wall so weak, that rupture occurs. When this happens there is massive internal bleeding, a situation that is usually fatal. The only way to break this cycle is to find the AAA before it ruptures.

Carotid Artery Disease - Stroke

Carotid arteries occur when the main blood vessels to the brain develop a buildup of plaque caused by atherosclerosis, or hardening of the arteries. When the buildup becomes very severe, it can cause a stroke. A stroke occurs when part of the brain is damaged by these vascular problems; in fact, 80 percent of strokes are “ischemic strokes” where part of the circulation to the brain is cut off, usually due to blockages in the carotid arteries. The process is similar to the buildup of plaque in arteries in the heart that causes heart attacks. Strokes are the third leading cause of death in the United States according to the National Center for Health Statistics.

Peripheral Arterial Disease

Peripheral arterial disease (PAD) occurs when atherosclerosis, or hardening of the arteries, causes a buildup of plaque in the blood vessels that carry oxygen and nutrients to all the tissues of the body. As these plaques worsen, they reduce essential blood flow to the limbs and can even cause complete blockages of the arteries. Early on, PAD may only cause difficulty walking, but in its most severe forms, it can cause painful foot ulcers, infections, and even gangrene, which could require amputation. People with PAD are three times more likely to die of heart attacks or strokes than those without PAD.

Link: https://vascular.org/patient-resources/what-vascular-disease

Reference: https://vascular.cmesociety.com/

#VascularConference2019    #VascularConferences   #CardiologyConferences   #HeartHealth    #VascularSurgery  #HeartSurgery   #MitralValve    #NewInnovations

Surgical Cardiovascular and Peripheral Vascular Procedures Volumes to 2021

This report presents procedure volumes forecasts for some of the most common cardiovascular and peripheral vascular surgical procedures performed in the five EU countries of France, Germany, Italy, Spain, and the UK (5EU). The forecast period covered by this report is for the years 2016 through 2021.
This report also presents an overview of the etiology and epidemiology of selected cardiovascular and peripheral vascular diseases/disorders, prevailing surgical approaches/techniques, and evolving procedural utilization trends.
Cardiovascular surgical procedures discussed include cardiac resynchronization therapy, congenital heart defect repair, coronary artery bypass graft surgery, implantation of implantable cardioverter defibrillators, pacemakers, and ventricular-assist devices, heart valve repair/replacement, percutaneous coronary intervention with or without stenting, thrombectomy/thrombolysis, and transmyocardial revascularization.
Peripheral vascular interventional/surgical procedures covered include femoropopliteal bypass and stenting, percutaneous transluminal angioplasty, and stent grafting.

#HeartCongress2018    #HeartConferences   #CardiologyConferences   #HeartHealth   #HeartSurgery   #MitralValve    #NewInnovations

Stress and Heart Disease

Having too much stress, for too long, is terrible for your heart.

If you’re often stressed, and you don’t have good ways to manage it, you are more likely to have heart disease, high blood pressure, chest pain, or irregular heartbeats.

The stress itself can be a problem. It raises your blood pressure, and it’s not good for your body to continually be exposed to stress hormones. Studies also link stress to changes in the way blood clots, which makes a heart attack more likely.

The way you handle stress also matters. If you respond to it in unhealthy ways — such as smoking, overeating, or not exercising — that makes matters worse. On the other hand, if you exercise, connect with people, and find meaning despite the stress, that makes a difference in your emotions and in your body.

Causes of Stress

Stress can be caused by a physical or emotional change or a change in your environment that requires you to adjust or respond. Things that make you feel stressed are called “stressors.”

Stressors can be minor hassles, significant lifestyle changes, or a combination of both. Being able to identify stressors in your life and releasing the tension they cause are the keys to managing stress.

Below are some everyday stressors that can affect people at all stages of life.

Illness, either personal or of a family member or friend.

• Death of a friend or loved one.
• Problems in a personal relationship.
• Work overload.
• Starting a new job.
• Unemployment.
• Retirement.
• Pregnancy.
• Crowds.
• Relocation.
• Daily hassles.
• Legal problems.
• Financial concerns.
• Perfectionism.
• Warning Signs of Stress

When you are exposed to long periods of stress, your body gives warning signals that something is wrong. These physical, cognitive, emotional and behavioral warning signs should not be ignored. They tell you that you need to slow down. If you continue to be stressed and you don’t give your body a break, you are likely to develop health problems like heart disease.

Coping with Stress

After you’ve identified the cause of stress in your life, the next step is to learn techniques that can help you cope with stress while fighting heart disease. There are many techniques you can use to manage stress. Some of which you can learn yourself, while other techniques may require the guidance of a trained therapist.

Some conventional techniques for coping with stress include:

Eat and drink sensibly. Abusing alcohol and food may seem to reduce stress, but it actually adds to it.

Assert yourself. You do not have to meet others’ expectations or demands. It’s OK to say “no.” Remember, being assertive allows you to stand up for your rights and beliefs while respecting those of others.

Stop smoking. Aside from the obvious health risks of cigarettes, nicotine acts as a stimulant and brings on more stress symptoms.

Exercise regularly. Choose a non-competitive exercise and set reasonable goals. Aerobic exercise has been shown to release endorphins (natural substances that help you feel better and maintain a positive attitude).

Relax every day. Choose from a variety of different techniques (see below).

Take responsibility. Control what you can and leave behind what you cannot control.

Reduce the causes of stress. Many people find life is filled with too many demands and too little time. For the most part, these demands are ones we have chosen. Effective time-management skills involve asking for help when appropriate, setting priorities, pacing yourself, and taking time out for yourself.

Examine your values and live by them. The more your actions reflect your beliefs, the better you will feel, no matter how busy your life is.

Set realistic goals and expectations. It’s OK, and healthy, to realize you cannot be 100% successful at everything all at once.

Sell yourself to yourself. When you are feeling overwhelmed, remind yourself of what you do well. Have a healthy sense of self-esteem.

Get enough rest. Even with proper diet and exercise, you can’t fight stress effectively without rest. You need time to recover from exercise and stressful events. The time you spend resting should be long enough to relax your mind as well as your body. Some people find that taking a nap in the middle of the day helps them reduce stress.

#HeartCongress2018    #HeartConferences   #CardiologyConferences   #HeartHealth   #HeartSurgery   #MitralValve    #NewInnovations

Can stress cause a heart attack?

Everyone knows that keeping stress levels low is an essential component of a healthy lifestyle. Managing stress can have all sorts of positive effects on your health, like lowering blood pressure and cholesterol levels, which can lead to a decrease in the risk of heart disease.

But have you ever wondered if stress itself can directly cause a heart attack? The answer is - not exactly. But sudden, severe stress can cause something called stress cardiomyopathy (also known as "broken heart syndrome" or " takotsubo cardiomyopathy"), an under-diagnosed health condition with symptoms that are very similar to those of a heart attack.

What is it?

The word cardiomyopathy refers to heart muscle that is weakened, resulting in the heart not working as well as it should. Stress cardiomyopathy refers to the weakening of the heart as a result of intense physical or emotional stress.

The intense grief that comes with the death of a loved one is a common cause of this condition. However, emotions like extreme anger, fear, and surprise can also cause it. Physical stress to the body includes stroke, dehydration, or low blood sugar.

What happens?

After a person experiences an intense emotional event, stress hormones (such as adrenaline) are released into the body at levels that can be 10 to 30 times the normal levels. Stress hormones usually help the body cope with stress. However, at these toxic levels of hormones, it's thought that the heart becomes overwhelmed and "stunned" to the point where it can no longer pump properly.

It is not sure what exactly happens to result in the heart pumping inadequately. It may be due to a decreased oxygen supply to the heart or due to too much calcium entering the heart cells. In any case, it can result in shock, heart failure, and heart rhythm problems, all of which can be life-threatening if not treated.

But with treatment, most patients make a full recovery, sometimes in just a matter of weeks. The effects of excess stress hormones on the heart are brief and do not cause permanent damage to the heart.

What are the symptoms?

Symptoms of stress cardiomyopathy include sudden onset of chest pain, sweating, nausea, vomiting, shortness of breath, low blood pressure, and abnormal heart rhythms. These symptoms frequently occur soon after a severely stressful event. Because many of these symptoms are also symptoms of a heart attack, it is easy to mistake stress cardiomyopathy for a heart attack.

Stress cardiomyopathy vs. heart attack

Heart attacks and stress cardiomyopathy can have very similar symptoms but they are different conditions. Most heart attacks are caused by blockages or blood clots in the coronary arteries (the blood vessels that supply the heart), resulting in a decreased flow of blood to the heart that can lead to heart muscle cells to die. This is what can cause permanent damage to the heart muscle cells.

On the other hand, the heart is not permanently damaged with stress cardiomyopathy. Stress cardiomyopathy does not seem to be a result of artery blockages or blood clots. For most people that suffer stress cardiomyopathy, the heart weakness usually stops within a couple of weeks and there is no permanent damage.

#VascularConference2019    #HeartConferences   #CardiologyConferences   #HeartHealth   #HeartSurgery   #MitralValve    #NewInnovations

What are the best foods for heart health?

Heart disease is still the number one killer in the United States. In this Spotlight, we outline 16 foods that, when consumed as part of a well-rounded diet, might help to keep your heart healthy.
There are many things you can do to help keep your heart healthy and disease-free.
You can schedule an annual checkup, exercise daily, quit smoking, or take steps to reduce the level of stress in your life.

All of these things can have a positive effect on heart health. But, one of the most straightforward lifestyle changes that will benefit your heart is watching what you eat.

Nearly 6 million people are currently living with heart failure, and around half of these will die within 5 years of being diagnosed.
The Centers for Disease Control and Prevention (CDC) warn that eating foods high in fat, cholesterol, or sodium can be very bad for the heart. So, when taking steps to minimize the risk of heart disease, diet is an excellent place to start.

In this article, we examine some of the best foods for ensuring that you keep a robust and healthy heart.

1. Asparagus
Asparagus is a natural source of folate, which helps to prevent an amino acid called homocysteine from building up in the body. High homocysteine levels have been linked with an increased risk of heart-related conditions, such as coronary artery disease and stroke.

2. Beans, peas, chickpeas, and lentils

Beans, peas, chickpeas, and lentils — otherwise known as pulses or legumes — can all significantly reduce levels of low-density lipoprotein (LDL) or "bad cholesterol." They are also packed with fiber, protein, and antioxidant polyphenols, all of which have beneficial effects on the heart and general health.

3. Berries
Berries are also full of antioxidant polyphenols, which help to reduce heart disease risk. Berries are a great source of fiber, folate, iron, calcium, vitamin A, and vitamin C, and they are low in fat.

4. Broccoli
Some studies suggest that regularly eating steamed broccoli can lower cholesterol levels and prevent heart disease.

5. Chia seeds and flaxseeds
These seeds are a rich plant-based source of omega-3 fatty acids, such as alpha-linolenic acid. Omega-3s have many beneficial effects, such as helping to lower levels of triglycerides, LDL, and total cholesterol. They also reduce blood pressure and minimize the buildup of fatty plaques in the arteries.

6. Dark chocolate
Dark chocolate is a rare example of a food that tastes amazing and is right for you (in moderation).
Scientists now believe that dark chocolate has protective benefits against atherosclerosis, which is when plaque builds up inside the arteries, increasing risk of heart attack and stroke.
Dark chocolate seems to prevent two of the mechanisms implicated in atherosclerosis: stiffness of the arteries and white blood cell adhesion, which is when white blood cells stick to the walls of blood vessels.
What is more, studies have found that increasing dark chocolate's flavanol content — which is the compound that makes it tasty and moreish — does not diminish these protective benefits.

7. Coffee
Also in the "almost too good to be true" camp is coffee. One recent study found that regularly drinking coffee was linked with a decreased risk of developing heart failure and stroke.
However, it is essential to bear in mind that this study — w which used machine learning to assess data from the Framingham Heart Study — can only observe an association between factors, and cannot conclusively identify cause and effect.

8. Fish high in omega-3s
Fish is a reliable source of heart-helping omega-3 fatty acids and protein but it is low in saturated fat. People who have heart disease, or are at risk of developing it, are often recommended to increase their intake of omega-3s by eating fish; this is because they lower the risk of abnormal heartbeats and slow the growth of plaque in the arteries.
According to the American Heart Association (AHA), we should eat a 3.5-ounce serving of fatty fish — such as salmon, mackerel, herring, lake trout, sardines, or albacore tuna — at least twice per week.

9. Green tea
A 2011 systematic review found that drinking green tea is associated with a small reduction in cholesterol, which, as we know, is a leading contributor to heart disease and stroke. But the review could not pinpoint how much green tea someone would have to drink to receive any health benefits.
In 2014, another review studied the effects of drinking green tea on people with high blood pressure. The report concluded that green tea was associated with a reduction in blood pressure. But, the authors were unable to determine if this modest reduction could help to prevent heart disease.

10. Nuts
Almonds, hazelnuts, peanuts, pecans, pistachios, and walnuts are all heart-healthy nut options. These nuts are full of protein, fiber, minerals, vitamins, and antioxidants. Like fish and flaxseeds, walnuts are also ripe with omega-3 fatty acids, making them a heart-healthy snack to have on the go.

11. Liver
Of all the organ meats, the liver is the most nutrient-dense. In particular, the liver is bulging with folic acid, iron, chromium, copper, and zinc, which increase the blood's hemoglobin level and help to keep our heart healthy.

12. Oatmeal
Because oatmeal is rich in soluble fiber, it may help to reduce the risk of heart disease. A 2008 review of the evidence concluded that oat-based products significantly reduce LDL and total cholesterol without any adverse effects.

13. Red wine (sort of)
Many studies have noted the potential health benefits of the antioxidants in red wine. However, it is unlikely that the benefits of the antioxidants outweigh the dangers of alcohol.
Recently, however, a new study proposed that these same antioxidants could form the basis of a new stent for use during angioplasty — the process where narrow or obstructed veins are widened to treat atherosclerosis.
The researchers behind that study are currently developing a new kind of stent that releases red wine-like antioxidants into the blood to promote healing, prevent blood clotting, and reduce inflammation during angioplasty.
It is worth noting that drinking alcohol, in general, is not healthy for your heart. In fact, it is vitally important for cardiovascular health to drink alcohol in moderation, if at all.

14. Spinach
You can help to maintain a healthy heart rhythm by regularly consuming good sources of magnesium. Spinach is one of the best sources of dietary magnesium, and consumption of Popeye's favorite food is associated with a raft of health benefits.

15. Tomatoes
Tomatoes have lots of nutrients that might help keep our hearts healthy. The little red fruits are chock-full of fiber, potassium, vitamin C, folate, and choline, which are all good for the heart.
As well as helping to keep heart disease at bay, potassium benefits muscles and bones and helps prevent kidney stones from forming.
Scientists have argued that increasing potassium intake while decreasing sodium intake is the most important dietary change when attempting to reduce the risk of heart disease.

16. Vegetables
The AHA advises that we eat eight or more servings of fruit and vegetables each day. Vegetables are low in fat and calories but rich in fiber, minerals, and vitamins. A healthful amount of veggies in the diet can help to moderate weight and blood pressure.

#HeartCongress2018    #HeartConferences   #CardiologyConferences   #HeartHealth   #HeartSurgery   #MitralValve    #NewInnovations

The MitraClip Shows Promise in Managing Severe Heart Failure

A clothespin-like device that reduces mitral valve leakage may offer a new treatment option to those seriously ill with heart failure.

The nearly 2 million Americans with severe heart failure face unique challenges.

Simple tasks such as short walks and climbing the stairs at home can lead to shortness of breath. Those with the condition often live in fear of heart attack or stroke.

Fortunately, there is a device that seems to offer promise in the management of severe heart failure in people for whom currently available treatments have been unsuccessful. Amazingly, the device, called the MitraClip, is similar in design to the clothespins you may use to hang your laundry to dry.

“The MitraClip is a small cardiac implant that can be opened and closed, and it is used to grasp the two leaflets of the mitral valve and bring them closer together, thereby reducing mitral regurgitation or leaking of the mitral valve,” explains Jason H. Rogers, MD, the director of interventional cardiology at the University of California Davis Medical Center in Sacramento. “The procedure [to insert the device] is done through a small catheter that is inserted into the right groin, and the recovery is rapid, with most patients being discharged home the following day.”

Half as Many Hospitalizations Observed in COAPT Study

Although the MitraClip still has to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of secondary mitral regurgitation — or mitral valve leaking due to heart disease — the results of the most recent clinical trial of the device, which were released on September 23, appear promising.

Indeed, the findings of the so-called Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial, published by the New England Journal of Medicine (NEJM), indicate that people in whom the device was used in combination with medical therapy as directed by currently accepted treatment guidelines required nearly half as many hospitalizations due to heart failure as those who received medical therapy alone.

In all, the COAPT trial enrolled 614 study subjects, 302 of whom were implanted with the MitraClip and 312 of whom continued medical therapy alone. Notably, 151 of the study participants in the medical therapy group were hospitalized for heart failure within two years of the start of the study, and 61 died. In comparison, only 92 of the participants in the MitraClip group were hospitalized over the same two-year period, and only 28 died.

An Earlier, Smaller Study Showed Higher Hospitalizations

As promising as these findings are for those with severe heart failure, though, it should be noted that not all of the studies of the MitraClip yielded the same results. Another, smaller trial, also published in NEJM, on August 27, found that hospitalizations due to heart failure increased among those who were implanted with the device.

Still, cardiologists like Dr. Rogers believe the MitraClip provides a promising new option for those with severe heart disease who may have few others. Rogers emphasizes that the MitraClip “works in conjunction with” existing and effective therapies and is not a “stand-alone” therapy for the condition.

“Until the results of the recent COAPT study were released, available options for patients with heart failure and a leaking mitral valve were limited to medications, pacemakers, and in some cases artificial heart pumps or heart transplant, which are highly invasive surgical therapies,” Rogers notes. “The MitraClip is a relatively straightforward and safe procedure that can have a profound benefit in properly selected patients by reducing death and hospitalization, and improving quality of life.”

#HeartCongress2018    #HeartConferences   #CardiologyConferences   #HeartHealth   #HeartSurgery   #MitralValve    #NewInnovations

New device offers hope for people with heart failure

(CNN)A tiny new device is offering hope of a better life for people with severe heart failure, reducing hospitalization rates and improving mortality risk within two years of treatment, a new study finds.

Heart failure affects an estimated 5.7 million Americans and more than 26 million people globally, causing shortness of breath and tiredness among those affected as their heart struggles to pump blood around the body.

One cause of severe heart failure that currently has a poor prognosis is a leaky valve, particularly the leakage of the mitral valve, which control's blood flow in the left part of the heart. When leakage is severe, the heart can enlarge.

Estimated to affect more than two million people in the US, failure of the mitral valve causes blood to flow backward when pumped out, meaning it can't reach the rest of the body efficiently.

But a new device -- called a MitraClip -- clips the faulty valve back together, helping it work properly and pump blood out of the heart. It has now shown promising results in the study published Sunday.

Drugs are available to ease symptoms of a leaky mitral valve, but the long-term effects are unknown, the authors write. Surgery is also an option, and can be curative, but brings a significant risk of complications, as patients are often older and frailer.

Implanting the MitraClip is minimally invasive, with the device transferred up through a small incision in the groin, and has now been shown to reduce recovery time and hospitalization, according to the study.

To measure the effectiveness of the device, Dr. Gregg Stone, professor of medicine at Columbia University College of Physicians, and his team enrolled 614 patients from the US and Canada with heart failure and moderate to severe secondary mitral valve regurgitation -- a leaky mitral valve -- who continued to have symptoms despite being on drug treatment for their condition. The secondary form of the condition is when a person's left ventricle is damaged, prohibiting the valve from functioning properly.

Of the participants, 302 were given the new device and 312 acted as controls. Among those who received the MitraClip, there were 32.1% fewer hospitalizations per year within to years of follow-up.

"The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group," the authors wrote.

Overall mortality from any cause within those two years was also 17% lower among patients who were implanted with the device compared with the control group, at 29.1% and 46.1%, respectively.

"It's shocking how positive it is as a new therapy for patients whose hearts are very weak," said Dr. Michael Acker, the chief of the Division of Cardiovascular Surgery at Penn Medicine. Acker, who is not connected to the research, noted the study findings were far more encouraging than the results of a similar trial reported last month. "On face value, it is very exciting," he said, but he indicated that further study was necessary to understand the differences in the population groups of each study.

The MitraClip technique was first pioneered in 2003 and approved by the FDA in October 2013 to treat the primary (or degenerative) form of mitral regurgitation, according to researchers at the University of Washington.

It's used to treat the secondary form of the condition is currently under investigation and has not yet been approved by the FDA.

The new study was part of the COAPT trial for secondary mitral regurgitation and funded by American health care company Abbott, which produces the device.

Is Exercise Bad For Your Heart?

Has Research Proven That Exercise Is Bad For Your Heart?

Exercise is good for you… right? Everyone knows eating right, exercising, reducing stress and routine maintenance check-ups are the key to living up to your genetic potential. Well, a new study just found a certain type of exercise seems to be bad for your heart. Here’s the scoop: Not too long ago, researchers conducted a study on the heart health of a group of very fit older athletes — men who had been part of a National or Olympic team in distance running or rowing, or runners who had completed at least 100 marathons. All of the men had trained and competed throughout their adult lives and continued to strenuously exercise. The results were not good. Half of these lifelong athletes showed evidence of heart muscle scarring. None of the younger athletes or the older non-athletes had fibrosis in their hearts. The affected men were the ones who had trained the longest and hardest. Now, a new study done on rats has reproduced similar findings.

In this study, published in the journal, Circulation, Canadian and Spanish scientists prodded young, healthy male rats to run at an intense pace, day after day, for three months, which is the equivalent of about 10 years, in human terms. At the beginning of the study, the rats had perfectly normal hearts. At the end of the training period, heart scans showed that most of the rodents had developed diffuse scarring and some structural changes, similar to the changes seen in the human endurance athletes. A control group of rats did not develop the heart changes, but when the rats stopped running, their hearts returned to normal within 8 weeks.

What Does All This Mean For You?

According to Dr. Paul Thompson, the Chief of Cardiology at Hartford Hospital in Connecticut, and an expert on sports cardiology, in terms of exercise, unless you are going to the extreme like the elite athletes in the study, probably not much. He was one of the peer reviewers for the British athlete study. He said, “How many people are going to join the 100 Marathon club or undertake a comparable amount of training? Not many. Too much exercise has not been a big problem in America. Most people just run to stay in shape, and for them, the evidence is quite strong that endurance exercise is good [for the heart].”

So, What IS Important For You In All Of This?

One word: Moderation. Health really seems to be all about moderation. That goes for the foods you eat, the exercise you do and the stress you deal with. Not enough is not good, but too much can be just as bad. Sadly, most people think if something is good – more is better. There is an optimal level or range for everything. Above or below that level – for any length of time – leads to abnormal stress, strain, and problems. When you are looking to get in shape and be healthy, you must first discover the proper definitions of in shape and health.

#HeartCongress2018    #HeartConferences   #CardiologyConferences   #HeartHealth   #HeartSurgery   #MitralValve    #NewInnovations