Most common heart-related
conditions
- provided by America's leading
cardiologists
Congenital Heart Defects
Although many types of heart disease are acquired,
some are present at birth. While these congenital
problems can be serious, there are many treatments
available to help people with congenital heart defects
live long and healthy lives. Select a program below
to learn more about congenital heart problems and
the treatments available.
Mitral Valve Prolapse
Mitral Valve Prolapse: When the Heart Keeps Ticking
but Keeps on Clicking
Heart trouble may sound like a click away
if you have mitral valve prolapse (MVP). But this
common misfiring in the heart is seldom serious.
Learn what can be done if your MVP is out.
Participants:
Richard Blyton Devereux, MD
Professor of Medicine, Weill Medical College of
Cornell University
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Webcast Transcript:
ANNOUNCER: Millions of Americans have it. And most
don’t discover it until they visit their doctor
for a routine exam. It’s a heart condition
called mitral valve prolaspe also known as MVP.
DOLPH HUTTER, MD: Mitral valve prolapse is quite
common. Perhaps 3 to 4 percent of the population
have it. It’s more common in women than in
men, and it’s a totally benign situation for
the vast majority of people.
RICHARD DEVEREUX, MD: In the normally functioning
heart, blood returning from the body goes to the
lungs to get oxygen and then comes back through
a chamber called the left atrium to get to the main
pumping chamber of the heart, the left ventricle.
In between those two chambers sits one of the heart’s
valves, the mitral valve, which opens wide to let
blood through while the left ventricle is relaxing,
and then normally closes and stays within the left
ventricle during the contraction of that chamber.
DOLPH HUTTER, MD: People with mitral valve prolapse
have a little redundancy of the valve. So instead
of opening and closing, part of the valve can actually
bulge up a little bit. And when it bulges up, it
can cause a little sound called a "click." and
when it bulges up, it can pull away from the other
valve and cause a little leak through the valve,
and we can hear that as a murmur. And so we call
it the click-murmur syndrome.
RICHARD DEVEREUX, MD: Mitral valve prolapse is
diagnosed in either of two ways: by a physician
listening to the heart and hearing characteristic
sounds called a click and murmur; or by an echocardiogram,
a high-frequency sound test that visualizes the
abnormal motion of the heart valves.
ANNOUNCER: The exact cause of MVP is unknown but
doctors believe it’s a genetic condition and
may have to do with certain body types. It has also
been associated with the connective tissue disorder
Marfan syndrome.
DOLPH HUTTER, MD: People with mitral valve prolapse
are more likely to have other musculoskeletal abnormalities
or connective tissue abnormalities. They may be
taller, thinner people. They may have scoliosis,
or curvature of the spine. So there is a bit of
a body build association with mitral valve prolapse.
ANNOUNCER: Although most people with MVP don’t
feel different, people with a more pronounced defect
can experience symptoms.
RICHARD DEVEREUX, MD: It is associated with an
increase in the frequency of palpitations, awareness
of extra heartbeats or runs of rapid heart-beating.
A small percentage of people with mitral prolapse
develop significant leak of blood across the mitral
valve
ANNOUNCER: This leak is called mitral regurgitation
and people with mitral regurgitation may present
symptoms of fatigue, exhaustion, lightheadedness,
palpitations, cough, and shortness of breath. But
there are some people with it that don’t present
symptoms right away.
Chest pain is another symptom sometimes found in
people with mvp, but this symptom along with some
of the others may be coincidental and are not necessarily
caused by the condition itself
RICHARD DEVEREUX, MD: What turns out to be the
case is that people with chest pain seek out cardiologists
for evaluation and, therefore, if they have mitral
prolapse, it’s diagnosed. It’s just
like people with headaches seek neurologists and
so any condition that they might happen to have
would be disproportionately be diagnosed by the
neurologist.
ANNOUNCER: The majority of people with mitral valve
prolapse don’t need treatment. However, there
are situations that require precautionary measures.
DOLPH HUTTER, MD: If they have a structural abnormality
of the valve, if they have a leak there, sometimes
bacteria that can get into your bloodstream when
you have teeth work done can sit out on the valve
and cause an infection. So that’s one called
bacterial endocarditis.
And this is why we recommend that people with mitral
valve prolapse and the click and the murmur should
take antibiotics before they have teeth work done.
Every time you have teeth work done, bacteria get
into the bloodstream. So we take antibiotics before
that and other procedures that can introduce bacteria
into the bloodstream.
The other complication is if some of those cords
that hold the mitral valve together tear, or if
the redundancy gets worse, then the leak can get
worse. That’s called mitral regurgitation.
It’s a leak. It’s a leak of the blood
going back where it shouldn’t be going. Sometimes
that can get quite severe and require surgery.
RICHARD DEVEREUX, MD: These days, most severely
prolapse valves can actually be repaired by taking
out some of the extra valve tissue and reducing
the size of the ring that supports the mitral valve.
This procedure works very well, has good durability
and leaves one with their own valve made more normal,
so that it functions very well. Once in a while,
that’s not possible and there are very good
forms of artificial heart valves that can be put
in, but sometimes do require use of special medicines
to prevent blood clots from forming.
ANNOUNCER: Most people with MVP live very normal
lives, with no long term complications.
RICHARD DEVEREUX, MD: For the overwhelming majority
of people who are diagnosed with mitral valve prolapse,
there are no problems at all, no limitations of
activity, no need for specific treatment and no
risk of major medical complications. It’s
something that we would tend to recommend doing
a echocardiogram at intervals, maybe every five
years, so it does entail a little bit of nuisance
in terms of surveillance.
DOLPH HUTTER, MD: I will instruct you to take antibiotic
to prevent any infection on the valve when you undergo
a procedure that introduces bacteria into the bloodstream.
The second thing is that I want to prevent that
valve, those cords that hold the valve together,
from tearing, from causing a bigger leak. And therefore,
I don’t want you to have hypertension. I want
to keep your blood pressure under control.
I always tell the patient, "This is a benign
thing. You’re perfectly fine otherwise. Do
all the things you’re doing. You can play
football, go skating, run, etc." Enjoy your
life. Do everything you want to do, but don’t
get an infection of the valve and keep your blood
pressure under control.
Patent foramen ovale (PFO)
What is a Patent Foramen Ovale?
Before birth, every developing fetus has
a hole in the upper chamber of the heart, called a
foramen ovale. After birth, this opening usually closes,
but for some people it remains open causing a heart
defect called PFO.
Before birth, every developing fetus has a hole
in the upper chamber of the heart, called a foramen
ovale. After birth, this opening usually closes,
but for some people it remains open causing a heart
defect called PFO.
Participants:
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart
Institute, Minneapolis, MN
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Alfred A. Bove, MD, PhD, FACC
Chief of Cardiology; Temple University Medical School
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University,
Columbus, Ohio
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
The transcript of this event will be available shortly.
Please return back in a few days.
Should I have my PFO closed?
Most individuals with patent foramen ovale
live normal lives without closing their PFO however
in some cases closure is necessary. Join experts to
find out why.
Participants:
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart
Institute, Minneapolis, MN
Alfred A. Bove, MD, PhD, FACC
Chief of Cardiology; Temple University Medical School
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
The transcript of this event will be available shortly.
Please return back in a few days.
Endocarditis
What is the Prophylaxis for Endocarditis?
Learn what factors may dictate whether you need treatment
to prevent an infection in your heart.
Participants:
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Webcast Transcript:
ANNOUNCER: For those with structural heart disease,
and important question is: What is the prophylaxis
for endocarditis?
JACQUELINE NOONAN, MD: Well, the prophylaxis for
endocarditis is medicine that you take when you
are undergoing a procedure that would put you at
risk for what we call bacteremia. That is, something
happening where there are germs that are likely
to get into your blood. And we know now that, if
you go into the dentist, and he scrapes all your
tartar away or if he pulls your teeth that, if you
checked somebody's blood right afterwards, they
will find that there are germs in your blood, some
bacteria, which usually the body clears. But if
you have any kind of structural heart disease, unfortunately,
those bacteria, as they're in your bloodstream,
might land on this area in your heart and set up
housekeeping there, and you could get an infection
on your heart, which is called endocarditis.
So it's recommended when you go to the dentist,
when you get dental work done, most kinds of dental
work, not everything, it's also recommended when
you have procedures where they are going to be intubating
you, where there might be some risk, where they're
going to have urologic procedures.
You don't want to put a lot of people at risk who
have very little chance of getting endocarditis
from what they're doing and have the chance of perhaps
having them have a allergic reaction to the drug,
to perhaps having a drug then become resistant when
they really need it. So I think most physicians
would feel obliged to recommend prophylaxis for
somebody with structural heart disease when they
undergo invasive procedures of any kind.
Ventricular Septal Defect
What is a Ventricular Septal Defect?
A ventricular septal defect, or VSD, is a
hole in the wall between the heart's lower pumping
chambers, the ventricles. Find out if you have the
warning signs of VSD
Participants:
Julie A. Kovach, MD
Director of Adult Congenital Heart Disease at the
University of Michigan
Webcast Transcript:
ANNOUNCER: Ventricular septal defect, known as VSD,
is a hole in the heart wall between the left and
right ventricles, which are the lower pumping chambers
of the heart. VSD is usually diagnosed and treated
in infancy, but if it is not diagnosed until adulthood,
serious problems can arise.
JULIE A. KOVACH, MD: The symptoms associated with
VSD vary, depending on the size of the ventricular
septal defect. In the majority of cases in children,
the VSDs that are found in infancy can be moderate
to large in size, and the symptoms for the baby
can be symptoms of heart failure. For example, breathing
rapidly while feeding, becoming sweaty while feeding
or being otherwise distressed.
In adulthood, large VSDs typically have already
been identified in childhood and are repaired. But
if it has not, by the time they've reached adulthood,
then irreversible damage to the lungs has been done.
And these adults actually will usually present with
blueness of the lips, blueness of the fingers, blueness
of the toes, and shortness of breath when they walk.
ANNOUNCER: A VSD is usually suspected when a physician
hears a heart murmur or when they see an abnormal
echocardiogram, which is an ultrasound of the heart.
Doctors can recommend a variety of treatments for
VSD, depending on the size of the defect.
JULIE A. KOVACH, MD: For some people who have very
small holes in the wall between the lower two chambers,
no treatment at all is necessary at this time, with
the exception of taking antibiotics prior to any
dental procedures or other procedures that could
introduce bacteria into the bloodstream. Generally,
those holes are fairly benign for many, many years
and no intervention may be necessary.
Children and adults with larger holes in the heart
will generally need to have those holes closed in
some fashion. Traditionally, closing those holes
has been done with an operation in which the chest
is opened, the patient is put on the heart-lung
bypass machine and a patch is sewn over the holes.
Newer techniques are being developed, however,
which will allow closing many of these holes with
catheters in a same-day procedure in the catheterization
laboratory in the very near future.
Atrial Septal Defect
What is an Atrial Septal Defect?
Learn about the treatment of atrial septal
defect, ASD, a serious heart defect.
Participants:
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center, Piedmont Hospital, Atlanta, GA.
Webcast Transcript:
ANNOUNCER: If you or someone you know has been diagnosed
with atrial septal defect, here are some basic facts
about this type of heart condition.
JACQUELINE NOONAN, MD: An atrial septal defect
is a relatively common kind of congenital heart
defect. That means it's a heart problem that you're
born with.
SPENCER B. KING, III, MD: An atrial septal defect
is a hole between the two upper chambers, the two
atria. They are divided normally by a septum, that
is, a wall, a division between the two chambers.
But when the septum grows together, sometimes it
leaves a hole, and that's called an atrial septal
defect.
The result of that is, if it's a large hole, there
is blood going from the high-pressure side of the
heart, that's the left side, across that atrial
septal defect to the right side, so it increases
the blood flow to the lungs, and it increases the
amount of blood being handled by the right side
of the heart.
JACQUELINE NOONAN, MD: In a very large atrial septal
defect, it can cause symptoms, but a small atrial
septal defect may not cause any symptoms, and in
fact this is one of the few kinds of heart disease
where somebody might not be diagnosed with it until
they were already an adult. Most kinds of congenital
heart disease are recognized sometimes as early
as right after birth or even before birth.
SPENCER B. KING, III, MD: Many people tolerate
them forever, their whole life, and die of something
else and never know they have them. But in general,
when they're discovered, if there is a substantial
shunt of blood, the blood flowing from the left
to the right, then those are recommended for closure.
The information
published on this page has been provided by the
Heart Authority
in collaboration with Cardiosource – American College of Cardiology
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