Thank you all for reading my blog. I reflect back a year and consider what blessings I am thankful for. This blog is one of them. It has provided me a good outlet for all the information I enjoy learning, sharing and teaching. So to the 11,ooo viewers to day, a very grateful thank you.
A quick primer on the electrical system of the heart followed by two major breakthroughs in pacemaker technology this year.
Boston Scientific has begun marketing a FIRST-OF-ITS-KIND DEFIBRILLATOR after receiving FDA approval in September. The implantable device, which protects against sudden cardiac arrest, was developed by a California firm purchased by Boston Scientific and is expected to be a financial win for the Natick-based company. Unlike others on the market, the S-ICD does not touch the heart, instead sending electrical pulses to correct abnormal rhythms through wires implanted just beneath the skin.
An experimental device converts kinetic energy from beating hearts into electricitythan can power a pacemaker, meaning the chance for no more batteries in the future, according to a talk at the American Heart Association’s Scientific Sessions 2012.
The study is preliminary but a piezoelectric approach is promising for pacemakers because they require only small amounts of power to operate. Batteries must be replaced every five to seven years, which is costly and inconvenient. Piezoelectricity might also power other implantable cardiac devices like defibrillators, which also have minimal energy needs.
“Many of the patients are children who live with pacemakers for many years,” said M. Amin Karami, Ph.D., lead author of the study and research fellow in the Department of Aerospace Engineering at the University of Michigan in Ann Arbor. “You can imagine how many operations they are spared if this new technology is implemented.”
Researchers measured heartbeat-induced vibrations in the chest. Then, they used a “shaker” to reproduce the vibrations in the laboratory and connected it to a prototype cardiac energy harvester they developed. Measurements of the prototype’s performance, based on sets of 100 simulated heartbeats at various heart rates, showed the energy harvester performed as the scientists had predicted — generating more than 10 times the power than modern pacemakers require. The next step will be implanting the energy harvester, which is about half the size of batteries now used in pacemakers, Karami said. Researchers hope to integrate their technology into commercial pacemakers.
Two types of energy harvesters can power a typical pacemaker: linear and nonlinear. Linear harvesters work well only at a specific heart rate, so heart rate changes prevent them from harvesting enough power.
In contrast, a nonlinear harvester, the type used in the study, uses magnets to enhance power production and make the harvester less sensitive to heart rate changes. The nonlinear harvester generated enough power from heartbeats ranging from 20 to 600 beats per minute to continuously power a pacemaker. Devices such as cell phones or microwave ovens would not affect the nonlinear device, Karami said.
http://www.science20.com/news_articles/no_more_batteries_piezoelectric_pacemaker_powered_heart-96003
The job of the kidneys is to filter the excess sodium into the urine so that the body can get rid of it. Many with heart disease and diabetes kidneys cannot handle all the extra work. The kidneys become less efficient at filtering the blood stream. This causes excess sodium to enter the bloodstream. Sodium attracts water to it and effect known as being osmotic. Water follows the sodium and is drawn into the bloodstream. Excessive salt keeps the circulatory volume higher than it should be, creating and increased pressure in the blood stream and pressing on the blood vessel walls. The stress of the pressure on the walls creates thickening and narrowing of the vessel, leaving less space for the fluid in the blood vessels and raising resistance. The body then requires higher pressure to move blood to the organs. The heart has to pump against this high pressure system.
I equate it to trying to blow up one of those kids balloons that is turned into animal shapes. They are really tough to blow air into, your cheeks get really sore – this is the resistance of air, similar to the resistance pressure of blood in the arteries. If you stretch the balloon (relax the arteries) then there is less resistance in blowing up the balloon (filling the artery with blood). Twenty percent of the blood pumped from the heart goes first to the kidneys. High blood pressure within the kidneys cause damage to the heart and to the vascular system in the kidneys. Salt makes you thirsty so limit salty foods, especially if on a fluid restriction.
I once had a patient who lost 45 lbs simply from adhering to low sodium diet. He had a very weak heart with only 10% ejection fraction meaning very limited pumping ability. So a weak heart and sodium in the diet made him retain fluid more than most. He began to measure and count sodium with every meal for a few months and was shocked by how much sodium he consumed even though he thought he ate pretty healthy. By reading labels, doing the math every day and making changes such as eating out less, ordering special, reviewing his medication he lost the fluid and added years to his life, not to mention the improved quality of life with less shortness of breath and fatigue by easing the workload of the heart.
According to the American Heart Association, eating more than the recommended 1500 milligrams a day puts you at direct risk of high blood pressure. Yet in America we consume an average of 3400 milligrams a day; more than twice what we should. While people with hypertension, heart and kidney disease are always advised by doctors to eat less salt, the AHA wants all of us to do this, whether or not our blood pressure is currently in the normal range. So if you are cooking or know the cook for pass this info on!
When holiday meal are upon us remind heart patients of being acutely aware of the sodium content in foods. The holiday meal contributes to many heart patients having increased symptoms of high blood pressure, congestive heart failure, fluid retention, shortness of breath. The holiday meals can be the culprit. Traditional foods like the turkey are often injected with approximately 8% solution sodium to enhance moistness and flavor. If you read the ingredients you will often note: turkey broth, salt, sodium phosphates, sugar & flavoring. Then many a cook will soak the already salt injected turkey in a brine solution or salt it well, prior to cooking. The turkey alone gets many into trouble, then you add pre-packaged stuffing, broth, or use canned mushroom soups in casseroles. Did I mention the relish tray with pickled foods?
1 teaspoon salt = 2131 mg sodium 1/2 teaspoon salt = 1066 mg sodium
1/4 teaspoon salt = 533 mg sodium 1/8 teaspoon salt = 266 mg sodium
75 mg—the average sodium content of 3 ounces fresh, unsalted beef, turkey, chicken, pork
240 mg sodium in 3 ounces self-basting frozen turkey, cooked (that’s without the gravy!)
580 mg sodium in 3 ounces frozen fully cooked baked turkey
820 mg sodium in 3 ounces honey baked ham
Bread is a major sodium contributor if you eat more than a couple of pieces a day unless you buy special low sodium bread. A slice (1 ounce) of loaf bread has 150 to 200 mg sodium—not including salted butter or other spreads or toppings. Consider using a bread maker to make a low sodium recipe.
Skip the gravy! But if you must go for low or reduced sodium gravy instead of regular salted gravy which has more than 300 mg sodium for 1/4 cup.
Some drugs contain high amounts of sodium.
Need an antacid after that holiday meal? Watch out there is excess sodium there too. Carefully read the labels on all over-the-counter drugs. Look at the ingredient list and warning statement to see if the product has sodium. A statement of sodium content must be on labels of antacids that have 5 mg or more per dosage unit (tablet, teaspoon, etc.). Some companies are now producing low-sodium over-the-counter products. If in doubt, ask your healthcare practitioner or pharmacist if the drug is OK for you.
Heart disease is challenging and frightful. Sometimes decisions are made very quickly regarding managing the disease process. Heart disease is a chronic condition that rears its ugly head over and over for many. As a heart patient your best off having a good knowledge of the disease process and the choices of interventions. Methods of intervention include:
Many of these decisions are based on the amount of heart tissue that is involved. If there is a large region with insufficient blood flow caused by numerous blocked vessels you most likely will be recommended to have bypass surgery. The general rule is if three vessels are involved you will most likely require surgery. You do have choices though, as the main blockage can be intervened on through stents and the other vessels can be addressed at a later time. We call this staged stents. The cardiologist do not recommend placing stents to both the right and the left side of the heart during the same intervention. They will treat the culprit, and then come back later for the others. The decision tree also takes into account what other issues (co morbidities) a patient has. If a patient has end stage renal disease or their kidneys were severely affected by the heart problem then the physician my want to avoid treatments that place a heavy burden on the kidneys such as angioplasty or stents. They may opt to treat medically until the kidneys have recovered if they can.
A single vessel blocked will more likely be treated with a stent. However the location of blockage can be very challenging. If the blockage is where the artery separates to another branch – called an anastamosis these are very difficult to deal with because a stent would block the flow to the other artery. Sometimes they require surgery, new technology in stents is coming and these may be able to be stented in the future. Some vessels are too torturous – meaning twisty and turny to allow a stent to be placed. Again surgery, treat medically or EECP therapy would be considered.
Small vessels are less likely to be treated with stents and more likely to be treated with medications. Medication includes nitro, long acting nitro, calcium channel blocker, ace inhibitors, beta blockers and occasionally EECP.
Intervention is determined by how viable the heart muscle is. If the heart muscle was severely damaged due to a heart attack and now scarred over – or remodeled, further intervention to that region is not likely to be of any help.
EECP – it is enhanced external counterpulsation therapy. The therapy consists of cuffs wrapped around legs, calves and buttocks. When the heart finishes pushing the blood flow out, the cuffs sequentially inflate to push the blood back up the heart. By doing this the heart is somewhat engorged with blood and forms collateral vessels. The treatment consists of one hour treatments 5 days a week for 7-9 weeks. Most patients find their frequency and intensity of angina is greatly diminished. Many patients hold the benefits for 2-5 years, but others will require more frequent return treatments to hold the gains. It is usually covered by insurance such as Medicare if the angina is considered functionally limited or disabling. For some people with very serious heart damage this improves the pumping ability of the remainder of the heart muscle, as it becomes stronger due to increased blood flow from collateral arteries. The EECP alone will not maintain the benefits, you must still keep physically active through exercise to maintain the benefits. The treatment is non invasive.
LVAD is a left ventricular assistive device. These are used when the heart cannot meet the demands any longer to adequately circulate the blood. For many this is now considered a destination therapy. This means they will not be a candidate for a heart transplant but will forever rely on the mechanical pump to circulate their blood. These are becoming more frequently used, and the mortality rates are decreasing with these pumps. If your health care provider is contemplating this route for you, I would strongly suggest you contact support groups of patients who already have LVADS here is a Facebook link to such a support group. https://www.facebook.com/pages/LVAD-Recipients/207915222572308
Heart transplants are necessary when the damage is such that the heart cannot meet the needs. Often the patient is repeatedly hospitalized in congestive heart failure. They are disabled due to the heart condition.
The take home is know the procedures, research the pro’s and con’s of each. Don’t walk in to the physician’s office and simply take the first suggestion. Question the efficacy, ask the probability of success and what are the limitations, what can you expect in the future. Be active in your healthcare. Most inpatient nurses will tell you they witness too many incidents where the health care provider tells the patient and family if you don’t do this you will die. Thus the patient feels compelled to have the intervention performed. You have choices.
Choices involve the above discussion, but also include risk factor modification every single day. Choose to exercise, choose to eat healthy, choose how to respond to stress, choose to take your medications, choose to not smoke, choose to monitor blood sugar.
Bypass
Stent
Left Ventricular Assistive Device
Enhanced External Counterpulsation Therapy
Common issues following hospitalization include blood clots. Patients often wonder why we force them to get out of bed and move. Prevention of blood clots in the legs and lungs is critical for recovery
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If you suspect you are in heart failure see your healthcare practitioner ASAP. Ask for a BNP to be drawn this is B-type natriuretic peptide measure which helps to quantify the seriousness of CHF. If it is over 100 it is positive, and the higher it is the more emergent it is. It also helps to determine if the treatment is effective. With long term use of diuretics it isn’t uncommon for the body to become resistant to a particular diuretic and then medications must be re evaluated. There are many diuretic out there and sometimes it is just a matter of finding the right combination for you. It is vitally important that you not rely solely on the medication but do your part in necessary prevention of CHF.
These include watching sodium intake and striving for 1500 mg in a day and no more, avoiding sitting for long periods of time, being vigilant in High heat and humidity, exercise, eat a diet rich in fruits and vegetables – dash diet. Steps to lower risk for congestive heart failure can be found here.
Rehabilitate Your Heart 