Stents in the heart

Stents in the heart are small medical devices (small mesh tubes) used to treat narrowed arteries (arteries are blood vessels that carry blood from heart to the tissues). The procedure of placing stents in the heart is called angioplasty. Angioplasty alone, without stent placement is associated with a high risk of recurrence of the arterial blockage, in months or years after the procedure. That is why placing stents in the heart solved this disadvantage of the angioplasty, maintaining blood vessels opened and avoiding heart surgery. The risk that the arteries will renarrow is 10-20%  in the first year after angioplasty, while in the absence of a stent the risk is twice as much.

Stents in the heart are usually made of metal mesh or fabric (these ones are used in larger arteries). Some of these stents contain a special substance that prevent blood from coagulating and are called drug-eluting stents.

How are stents in the heart placed? 

Doctors use a balloon inside the artery to compress the plaque (deposits of fats in the arteries wall, also called atherosclerosis) and widen the passage (the arterial lumen through which will flow blood). After this, they place the stent in order to maintain the passage (the artery lumen) opened.

How do we prepare patients before placing stents in the heart?

Patients should be well informed about the stents in the heart procedure, about the risks and the special precautions. These are a few questions u must always ask your doctor about:

•  Why is it performed?
•  How is it performed?
•  What are the risks and precautions of this procedure?
•  Is there any other alternative?
•  What happens if I refuse this procedure?
•  Always sign a consent paper.

Why are stents in the heart placed for?

The purpose for stents in the heart placement is to keep the arterial lumen opened and allow blood to flow, in this way tissues will receive enough blood and the symptoms of ischemia (oxygen deprivation) will be relieved.

• For carotid arteries blockage: fat deposits in carotid arteries wall (also called plaques, they are a manifestation of the disease named atherosclerosis) can determine neurologic symptoms like dizziness, fainting, headache, memory and concentration problems and in severe cases even stroke.
• For coronary vessels (blood vessels that supply blood for heart tissues): a special tube called catheter is introduced in the femoral artery (the main artery of the lower limb) and it is conducted in the arterial system until it reaches the coronary arteries. In that moment, a special substance is pumped into the catheter in order to view the arteries and the blockage. This catheter has a tiny balloon on its tip, which is inflated in the narrowed area, compressing the atheroma (the plaque of fats from the artery wall that blocks blood flow) and enlarging the lumen. After this a stent may be placed to keep the lumen opened.
• For kidney or leg arteries, aneurysm of the aorta.
  

What are the common precautions after placing stents in the heart?

•  blood clotting precautions: in order to prevent blood clotting, patients with stents in the heart have to take antiplatelet medication (aspirin, clopidogrel)
•  if the stent is made of metal, than the patient can’t have MRI (magnetic resonance imaging)
•  avoid vigorous effort early after the stent placement procedure.
  

What risks are related to stents in the heart?

•  restenosis- blood vessel becomes blocked and narrow again, despite the angioplasty procedure
•  about 1 or 2 percent of the patients with a stented artery are at risk of developing a cloth at the stent site; the consequence of this complication can be a heart attack. This complication is more frequent in the first year after stent placement and can be prevented by antiplatelet medication (like aspirin, clopidogrel).
•  bleeding at the site of the catheter insertion into the skin
•  damage of the blood vessel produced by the catheter
•  irregular heart beats
•  infection or allergic reaction (due to the substance used to view the arterial lumen)

Stents in the heart brought a significant contribution in cardiology, saving and improving life in patients with heart attack and coronary disease.

Heart palpitations at night

Why do we have heart palpitations at night?

Before we discuss the matter of heart palpitations at night, we have to clarify the meaning of the word “palpitation” in general. Palpitations refer to irregular heart beats, usually the heart beats to fast, or with pauses from time to time and gives us an abnormal sensation, sometimes associated with dizziness, light-headed sensation, shortness of breath, chest pain etc.
We all had palpitation at least once in our life, and this doesn’t mean we have a heart disease, because these symptoms occur in healthy people during exercise or associated to stress, smoking, coffee. Even so, if the palpitation persist or are associated with shortness of breath, chest pain, fainting, dizziness, a doctor should be consulted as soon as possible.
Some patients complain they have heart palpitations at night, which prevent them from falling asleep or wake them up in the middle of the night.

Heart palpitations at night -causes:

Normal heart rate for an adult is 60-90 beats/minute. If the heart rate is higher the 90 beats per minute, then the condition is called tachycardia and can provoke palpitation. Not only rapid heart rate can cause palpitation but also irregular heart beats, known as arrhythmia, which is the main cause behind palpitation. Why some patients experience heart palpitations at night, during rest, when heart labor is smaller?
Heart palpitations at night can be determined by one of the following cause:

• too much stress and anxiety gathered during the daytime. It is a habit now that every time we go to sleep, we think again at the daily problems and try to find a solution, as it is said night is a good adviser. If your mind is concerned about certain problems happening in your life, you may be lying down and think about it over and over again, but the emotions and the psychical tension can generate palpitation.
• excessive consumption of caffeine before sleeping can generate insomnia and palpitation, if you drink a lot of coffee, especially before sleeping, you may consider giving up.
• smoking
• alcohol consumption
• medication-some drugs used to treat different diseases (like asthma, heart diseases, high blood pressure, cold) can determine palpitation: pseudoephedrine used in cold medication, theophylline for asthma etc.
• pregnancy
• fever-it is well known that body temperature elevation is associated with rapid heart beats and sometimes with palpitations
• vigorous exercise before sleeping
• breathing problems determined by lung diseases determine a low level of oxygen in the body, which can lead to heart palpitations at night
• heart problem-patients with heart failure may develop paroxysmal nocturnal dyspnea (shortness of breath that occurs suddenly during night in patient with left heart failure) and palpitations, forcing them to wake up and search for an open window to get fresh air
• hyperthyroidism (a higher level of thyroid hormones can determine irregular or rapid heart beats)
• elevated blood pressure

If I have heart palpitations at night-how can my doctor discover if there is something wrong in my body?
Yes it is possible. For patients that have these symptoms only during night it is difficult to  diagnose them during a simple medical visit, but if a special device called holter ecg is used, then this is no longer a problem. Holter ECG is a portable medical device that the patient “wears” for 24 hours and it records heart activity during this period of time.
Heart palpitations at night-treatment
Heart palpitations at night can be treated only after proper tests are made in order to establish the correct diagnosis. In many cases, palpitations have no serious cause and a short time treatment associated with a life style change can be the “cure”.
Special precaution in patients with heart palpitations at night:

• avoid consumption of alcohol, coffee, drugs (marijuana, cocaine) or smoking
• avoid stress and anxiety-there are many types of techniques used against anxiety (psychotherapy, sports, taking vacation, travelling etc.)
• sometimes medication is needed in order to control anxiety
• respect your hours of sleep
• avoid if possible the intake of medication that stimulate palpitations

Heart palpitations at night can be very uncomfortable, but sometimes a simple change in the  daily habits can make them disappear.

Heart pain in women

Heart pain in women: a symptom that begins to trouble most frequently after menopause, when due to the absence of  estrogen hormones, women lose their „natural” protection against cardiovascular events. According to the studies made among patients with heart attack, heart pain in women is not a hallmark symptom as it is in men. This means that during a heart attack, heart pain in women is less likely to occur and we must pay attention to other signs and symptoms if we don’t want to miss a heart disorder. Although women lose their protection against cardiovascular disease after menopause, estrogen replacement must be indicated only in well selected cases, because this treatment can determine breast or endometrial cancer, blood cloths and stroke etc.

How can estrogen hormones prevent heart pain in women?

It is simple. Estrogen has an important role in lipid metabolism: these hormones decrease the level of LDL-cholesterol and increase the HDL cholesterol (also called „the healthy” cholesterol as it protects against atherosclerosis). Estrogens tend to decrease serum cholesterol concentrations and to increase serum triglyceride concentrations. The overall effect of these changes, together with the effects on blood vessels, is to protect against atherosclerosis and heart pain in women before menopause. As atherosclerosis is the most important cause for heart attacks and chronic heart ischemia (heart disease caused by insufficient oxygenation of the heart tissues, which occurs when blood vessels are blocked by atherosclerosis) it is clear now why estrogen is so important and how can this hormone prevent heart pain in women.

Heart pain in women, what does it mean?

Heart pain in women or chest pain are very often among old patients and challenge the doctor to consider a lot of differential diagnosis, although sometimes it is almost impossible to separate them. For example, a pathology of the spine that presses nerve roots can determine an intense pain, sometimes unbearable, radiating towards the abdomen or chest and can easily mimic a heart pain. An esophagitis with burning sensation in the chest, can be mistaken as a heart symptom, but it responds well to the medication used in ulcer treatment and the duration of symptoms is variable. Heart pain in women doest mean necessary that it is a heart attack, sometimes it is caused by a heart muscle infection or disorder. Other causes for heart pain are abnormal dilated blood vessels called aneurism or chest trauma. In some patients, during heart attack, the pain is felt in the upper part of the abdomen and it can be confused with a stomach or liver disease (like ulcer, gastritis etc.).

How do we manage heart pain?

Heart pain it is always a very disturbing symptom, described by patients as a sensation of pressure on the chest or constriction, but sometimes, associated with palpitations (irregular heart beats), shortness of breath, fatigue, sweating, agitation or even fainting. In conclusion, heart pain in women and men  can be treated with beta-blockers (drugs that increase heart tissues oxygenation, an example of such a drug is metoprolole), calcium channels blockers (make heart blood vessels larger; e.g. amlodipine) or the well known nitroglycerin.

Replacement heart valve surgery

Valvular diseases (lesions of the four valves of the heart) in general have some common characteristics in terms of etiology, symptoms, clinical investigations but also others such as replacement heart valve surgery used in treatment.

Replacement heart valve surgery basics

There are four valves in our heart: mitral valve, aortic valve, pulmonary valve and tricuspid valve. These valves may have opening of valve problems (stenosis) or closing of valve problems (regurgitation). Interventional treatment (especially replacement heart valve surgery) is necessary when patients have symptoms for these lesions.
We can not expect that valve lesions consists have a spontaneously regressive evolution and therefore the most common method of treatment is the replacement hear valve surgery. There are cases when multiple heart valves are affected. The surgery is performed by repairing or replacing the heart valve. Replacement heart valve surgery is surgery that is performed when the valve can not be repaired and the heart valve is replaced with a prosthetic valve. Before replacement heart valve surgery patients will receive general anesthesia during which they will be asleep and will not feel pain. The most replaced valves are mitral valve and aortic valve. There two kinds of valves used for the replacement heart valve: mechanical valves and biological valves. Biological valves may come from pigs, cows or human donor. Biological valves from human donor may be heart valves or pulmonary valve especially for aortic valve replacement. Mechanical valves are much better then biological valves. After replacement heart valve surgery with mechanical valve patients must follow treatment with anticoagulants or with aspirin for the rest of his life.
Mitral stenosis and mitral regurgitation
Replacement heart valve surgery for mitral stenosis is indicated in patients suffering from medium or large stenosis (mitral valve orifice of less than 1 inch or symptomatic patients and mitral valve opening more than 1 inch).  The most common cause of mitral stenosis is rheumatic disease. Prophylactic replacement heart valve surgery for mitral stenosis may be made to women who want to have a child.
Replacement heart valve surgery can also be done for mitral regurgitation. But this can have some disadvantages: first because replaced valve can not function as original valve and second because may be some complications of surgery (embolism, infection in the body, coagulation changes or endocarditis – infections of heart valve).
Aortic stenosis and aortic regurgitation
Aortic valves are different from mitral valves such as structure and function. Replacement heart valve surgery is done both for congenital aortic stenosis and for acquired aortic stenosis. Indications for surgery can be done to symptomatic patients or to patients with moderate aortic stenosis who have other heart surgery.
Replacement heart valve surgery for aortic regurgitation is an easy surgery to replace aortic valve. Mortality of this intervention is quite high.
Complications related to valve replacement are increasingly rare lately and when they occur is necessary a new surgery.

In conclusion replacement heart valve surgery is a very good technique to solve valvular heart problems.

7 weeks pregnant symptoms

Pregnancy is a fascinating news for the future parents, as a child is a blessing for every family and a miracle of life. But every miracle has its own price and the nine month until it is brought to real life can be very exhausting for the mother as she has to make important changes in her life, together with the changes made in her body.
This article is mainly about the 7 weeks pregnant symptoms but we should specify that many times women find out they are pregnant after they are investigated for tiredness, morning sickness, nausea and vomiting (many times confused with a digestive disorder). Once they find out they are pregnant they begin to be worried about what is going to happen next, “is the baby all right?” ”doesn’t he/she suffering from a malformation”, “when will he/she move?”, “how does it feel when u have contractions”, “how will I gave birth, where?” etc. These are only a few questions young mother ask more often, but there are many others.

The main 7 weeks pregnant symptoms

What are the 7 weeks pregnant symptoms ? Before we enumerate  the 7 weeks  pregnant symptoms we should mention some information about the baby. At this age, your baby will measure about 4-5 mm, but by the end of the week he/she will grow significantly to about 13 mm. Even if the changes in your body aren’t so obvious, you will feel pregnant as other symptoms occur. One of the 7 weeks pregnant symptoms is weight gain, even if at this point it is just 1 or 2 pounds.
Other 7 weeks pregnant symptoms-the baby’s growth: the uterus has doubled its size, the neural tube is closed and the development of brain begins in this week, also nasal cavities and mouth are forming. The heart is already formed and the heart valves are about to be completed, the future lungs are growing and the intestines and digestives system begin to take shape, as other glands. By the week 7, limbs are visible on the echography, even the future fingers and toes and by the end of the week a smooth layer of skin will develop.
The 7 weeks pregnant symptoms include varied signs and symptoms as we will see next. One of the most frequent manifestations among 7 weeks pregnant symptoms is morning sickness (a symptom that usually occurs between 2-8 weeks after conception). This is one of the 7 weeks pregnant symptoms but can occur even from the first week and will diminish in time. As it happens frequently in medicine, there are exceptions: some women don’t have morning sick, nausea or vomiting during pregnancy, while others deal these symptoms throughout all of their pregnancy. The morning sickness will grow stronger in  weeks, the nausea will be moderate, also vomiting frequently occurs. Digestive symptoms must be carefully managed, as pregnancy is often associated with appendicitis, cholecystitis (inflammation of the gallbladder) or urinary stones.

Other manifestations among 7 weeks pregnant symptoms:

• fatigue-a symptom that can occur early in the pregnancy, even from the first week. Pregnant women feel more tired, even if they don’t make any effort, and the need of lying down and sleep is more intense, but this doesn’t mean they are sick; it is simply one of the changes related to pregnancy.
• headaches-hormonal imbalance related to pregnancy is the cause of these symptoms that can occur early in the pregnancy and usually tend to go away in the second trimester. Lack of sleep or dehydration, smoking, strong odors, chocolate, coffee, stress tends to play also a role in this. Some of the women experience intense headaches or even migraine (before taking any medication, you should consult your doctor to see the risks and benefits)
• excessive salivation-it is more frequent in women that experience morning sick.
• metallic taste-it is a less frequent 7 weeks pregnant symptoms, caused by hormones imbalance, and usually goes away in the second trimester.
• frequent urination- it is normal and it is caused by hormones imbalance. Also the amount of blood is larger in pregnant women, so the kidneys have a lot more to work.
• swollen or tender breasts, darkening of areolas -may start after 1-2 weeks after conception.
• lower backaches
• food craving or food aversion to certain types of food that can last the entire pregnancy not just for 7 weeks pregnant symptoms.

As we saw above, 7 weeks pregnant symptoms vary from one woman to another and seem unbearable for outsiders, but these symptoms are all forgotten once the mother holds her “miracle” in her arms.