Mar 22 2024 This Week in Cardiology
PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE
PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASEPLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE
ContentsPrevious ConditionNext Condition
2g-1. Transposition of the Great Arteries (D-TGA). (Legend.)A. The heart is enlarged with a narrow "pedicle" giving the so called "egg on a string" appearance. The superior mediastinum appears narrow due to the antero-posterior relationship of the transposed great vessels and "radiologic-absence of the thymus".
B. The stress of hypoxia in the newborn period is believed responsible for thymic regression. Right posterior oblique view demonstrates widening of structures in the superior mediastinum due to the anteroposterior relationship of the aorta and pulmonary artery.
D-TGA accounts for some 5% of all congenital heart defects. D-TGA describes patients in whom there is atrioventricular concordance with ventriculoarterial discordance i.E. The pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle. Baillie is accredited with the first documented case in 1797. Prior to the introduction of atrial septectomy by Blalock and Hanlon in 1950, the mortality rate from transposition was as high as 90%. The management of these patients was further revolutionized in 1966 with the introduction of balloon atrial septostomy by Rashkind and Miller.
Pathology: Situs solitus is usually and present. In the right ventricle there is a muscular infundibulum separating the aortic and tricuspid valves, while in the left ventricle there is fibrous continuity between the leaflets of the pulmonary and mitral valves. The aorta is positioned anterior and generally to the right of pulmonary artery.
Embryology: Abnormal looping of the great vessels is believed to occur. In the normal heart a bilateral conus develops beneath both semilunar valves with progressive development of the subpulmonary conus and regression of the subaortic conus, resulting in the great vessels arising from the appropriate ventricle. In d-TGA the reverse occurs with progressive growth of the subaortic conus and regression of the subaortic conus resulting in transposition of the great arteries.
Associated lesions: These include VSDs (typically outlet or muscular septum defects) often with malalignment of the outlet septum which is deviated rightward, resulting in overriding of the pulmonary valve. If there is significant override this may represent Taussig-Bing anomaly (double outlet right ventricle with subpulmonary VSD). Other associated lesions include pulmonary stenosis (30%), patent ductus arteriosus, coarctation, coronary artery anomalies (the right and circumflex coronary arteries arising from the right sinus, the circumflex coronary from the right sinus and the right and left anterior descending coronaries from the left sinus, intramural variant and single coronary arteries).
Physiology: This lesion behaves as two separate circulations with mixing at the atrial, ventricular, or ductal level essential for survival. Patients with restrictive atrial shunting should undergo atrial septostomy to maximize atrial level mixing, and minimize acidosis prior to arterial switch operation. This may performed either by the bedside under echocardiographic guidance, or particularly in cases where the anatomy cannot be fully elucidated from echocardiography, in the cardiac catheterization laboratory
What Is Graves' Disease?
Graves' disease is an autoimmune condition that causes your thyroid to become hyperactive, making it work harder than it needs to. It is one of the most common thyroid problems and the leading cause of hyperthyroidism, a condition in which the thyroid gland produces too many hormones. The condition gets its name from the man who first described it in the early 19th century, Sir Robert Graves.
The thyroid gland is a small butterfly-shaped gland that sits in the front of your neck and releases hormones that help regulate your metabolism. When you have Graves' disease, your immune system attacks your thyroid, causing it to overproduce those hormones. This causes several problems in different parts of your body. It usually affects people between the ages of 30 and 60. It is also more common in women and people assigned female at birth than in men and those assigned male at birth, with a ratio of 4:1.
Once the disorder has been correctly diagnosed, it is quite easy to treat. In some cases, Graves' disease goes into remission or disappears completely after several months or years. Left untreated, however, it can lead to serious complications and even death.
Graves' disease is an autoimmune condition that causes your thyroid to work harder than it needs to. The thyroid gland is a small butterfly-shaped gland that sits in the front of your neck and releases hormones that help control your metabolism. When you have Graves' disease, your immune system attacks your thyroid, causing it to overproduce those hormones. (Photo Credit: WebMD)
Hormones secreted by the thyroid gland control metabolism, or the speed at which the body converts food into energy. Metabolism is directly linked to the amount of hormones that circulate in the bloodstream. If, for some reason, the thyroid gland secretes too much of these hormones, the body's metabolism kicks into high gear, causing a pounding heart, sweating, trembling, and weight loss.
Normally, the thyroid gets its production orders through another chemical called thyroid-stimulating hormone (TSH), released by the pituitary gland in the brain. But in Graves' disease, a malfunction in the body's immune system releases abnormal antibodies that act like TSH. Spurred by these false signals, the thyroid's hormone factories work overtime and overproduce.
Is Graves' disease hereditary?
Heredity, environment, and other characteristics seem to play a role in the likelihood that you'll have Graves' disease. But no single gene has been found to cause Graves' disease.
You're more likely to have the condition if someone in your family has had Graves' disease, Hashimoto's disease, or other autoimmune disorders.
Older studies show, for example, that if one identical twin contracts Graves' disease, there is a 30%-35% likelihood that the other twin will get it, too.
Aside from having a family history of Graves' disease, other risk factors that increase your chances include:
The most common symptoms of Graves' disease are symptoms of hyperthyroidism, which include:
Graves' eye disease
Graves' disease may also cause you to have symptoms that involve your eyes. In this case, your immune system attacks tissues around your eyes.
When Graves' disease affects your eyes, your doctor might tell you that you have Graves' ophthalmopathy, orbitopathy, or thyroid eye disease.
Graves' disease eye symptoms appear in 1 in 3 people with Graves' disease. These symptoms are often mild and include:
You can have these symptoms before you start having Graves' disease symptoms. You can also have them at the same time as your other symptoms. In rare cases, these eye problems may start after treating Graves' disease.
Some people can have Graves' eye disease, even when they don't have any thyroid condition.
See a doctor if you're showing any symptoms affecting your eyes.
If you have symptoms or signs of the complications of Graves' disease, your doctor will probably ask you if you have a family history of the condition and order one or more of the following tests:
A blood test to check your levels of thyroid stimulating hormone (TSH) and other thyroid hormones. With Graves' disease, your TSH levels are usually lower and other hormones are elevated.
Lab tests to look for the antibodies that cause Graves' disease. If you don't have them, that's a sign that your hyperthyroidism is caused by something else.
A radioactive iodine uptake test that uses small doses of radioactive iodine to watch how much of it is taken up into your thyroid from your bloodstream. Your body normally uses iodine to make thyroid hormones. So, if it takes in a lot of the radioactive iodine, it is a sign that it is working harder than it needs to.
A thyroid scan to see where the radioactive iodine travels in your thyroid gland. If it goes all over your thyroid, that suggests you have Graves' disease. That's because, with other causes of hyperthyroidism, only some parts of the gland are involved.
Graves' disease vs. Hashimoto's disease
Just like Graves' disease, Hashimoto's disease is an autoimmune disease. With Hashimoto's disease, the immune system makes antibodies that attack and damage the thyroid gland, making it unable to produce enough thyroid hormones. The thyroid then becomes underactive and stops working as well as it should.
You may have no symptoms at first, but later on, you might start having symptoms such as:
Graves' disease, on the other hand, causes your thyroid gland to make too much thyroid hormones, so your body's functions work faster than it should. That's why, with Graves' disease, you may have symptoms such as nervousness, anxiety, difficulty sleeping, weight loss, and more sweating.
Graves' disease and eye health
A small percentage of all patients with Graves' disease will develop a condition called thyroid eye disease in which your eye muscles and tissues become swollen. This can cause exophthalmos — your eyeballs protrude from their sockets — and is considered a hallmark of Graves' disease, even though it's rare. But having this complication doesn't have anything to do with how severe your Graves' disease is. In fact, it isn't clear whether such eye complications stem from Graves' disease itself or a totally separate but closely linked disorder. If you have developed thyroid eye disease, your eyes may ache and feel dry and irritated. Protruding eyeballs are prone to excessive tearing and redness, partly because the eyelids can't protect them as well.
In severe cases of exophthalmos, which are rare, swollen eye muscles can put tremendous pressure on the optic nerve, possibly leading to partial blindness. Eye muscles weakened by long periods of inflammation can lose their ability to control movement, resulting in double vision.
Graves' disease and skin health
Some people with Graves' disease may develop a rare skin condition known as pretibial myxedema or Graves' dermopathy. It is a lumpy reddish thickening of the skin on the shins. It is usually painless and is not serious. Like exophthalmos, this condition does not necessarily begin with the onset of Graves' disease and doesn't have to do with how severe your disease is.
Graves' disease and heart health
Left untreated, Graves' disease can change how your heart works and functions, causing you to be at a higher risk of having heart problems such as irregular heart rhythms, high blood pressure, stroke, and heart failure.
Graves' disease and osteoporosis
Another health problem you can have with untreated or poorly managed Graves' disease is osteoporosis. Osteoporosis is a condition that causes you to have weak, brittle bones, making them more likely to break. Your bones become weak and brittle when they don't hold enough calcium. Too much thyroid hormone, in the case of Graves' disease, can affect how much calcium can get into the bones.
Graves' disease and menstrual health
Graves' disease may cause people who menstruate to have changes in their period. Their periods may become irregular, light, and infrequent. You may not release an egg or ovulate each month when your periods are irregular — not ovulating as often as you should — making it hard to get pregnant.
Your period symptoms may improve as you start your Graves' disease treatment.
Graves' disease and thyroid storm
In rare cases, untreated Graves' disease can cause you to have a life-threatening condition called thyroid storm. With a thyroid storm, your body experiences a sudden and serious rise in thyroid hormones due to triggers such as an infection.
You may have symptoms such as:
Get medical help immediately if you have any of these symptoms.
Graves' disease can make it harder to get pregnant because it changes your menstrual cycle. If you do get pregnant, your symptoms may get worse in the first 3 months and then improve later. Your doctor may stop your anti-thyroid medicines in the last 4-8 weeks of pregnancy if your thyroid levels become normal. They will recheck your condition after the baby is born and adjust your treatment if needed.
Your doctor may recommend anti-thyroid medicines during pregnancy rather than radioiodine therapy. Radioiodine therapy uses radiation, which may affect your pregnancy and your unborn baby.
There are two goals in the treatment of Graves' disease. One is to stop your thyroid gland from overproducing thyroid hormone. The other is to stop the increased levels of thyroid hormone from causing problems in your body. There are several treatment options to achieve one or both of these goals.
Radioactive iodine therapy
With this treatment, you take another form of radioactive iodine by mouth than what is used in the test to diagnose Graves' disease. The iodine gets into your thyroid and the radiation kills some of the cells in your thyroid that are overproducing thyroid hormones. It's possible that this treatment could temporarily worsen any eye problems you have from Graves' disease. It may also lead to a lower production of thyroid hormone than is healthy. If that happens, your low thyroid can be treated. Because this treatment uses radiation, it's not used on pregnant or breastfeeding women.
Medications
Anti-thyroid medications make your thyroid produce less thyroid hormone. They aren't permanent treatments but can be used for long periods and sometimes help even after you've stopped treatment. They're usually the treatment of choice for pregnant or breastfeeding women who can't be exposed to radiation. They're also sometimes used in combination with radioactive iodine therapy.
Beta-blockers are medications typically used to reduce blood pressure, and they can help rapidly relieve some of the symptoms of hyperthyroidism including shaking, rapid heartbeat, and anxiety.
Surgery
Surgery is a less common treatment for Graves' disease but may be a good choice if you have a goiter or you're pregnant and can't take anti-thyroid medications. During surgery, some or all of your thyroid gland is removed. After surgery, you may need to take a daily thyroid medication for the rest of your life.
Although the symptoms can cause discomfort, Graves' disease generally has no long-term adverse health consequences if you get prompt and proper medical care.
Is Graves' disease curable?
Graves' disease is a lifelong condition that has no cure. However, with treatment, some people may stop having Graves' disease symptoms, meaning they're in remission. However, remission may only be temporary.
Though Graves' disease is a lifelong condition, it is well-treated when you follow your treatment plan. See your doctor immediately if you start having new symptoms or you become pregnant. They may need to adjust your treatment plan.
Also, speak with your doctor about dietary and lifestyle changes to manage your Graves' disease symptoms and reduce your risk of complications. Ask them about:
Graves' disease diet
Your thyroid needs iodine to make thyroid hormones. If you have Graves' disease, you need to be aware of how much iodine you get in your food or from supplements. Having too much iodine in your diet, which can come from foods like kelp and other types of seaweed, could make hyperthyroidism symptoms worse..
To be sure your iodine intake is okay, talk to your doctor about the following:
Although the symptoms can be distressing, Graves' disease generally has no long-term adverse health consequences if you get prompt and proper medical care. Some people, especially those with mild Graves' disease, may go into remission, where the disease goes away. This remission may be temporary, especially when it happens in childhood.
Graves' disease is a lifelong condition. Ensure you make it to your doctor's appointment as often as possible. They'll check your thyroid levels, see how your treatment works, and adjust your treatment plan when needed.
Also, see your doctor if you start having new symptoms.
Graves' disease is a lifelong autoimmune condition that occurs when your body makes too much thyroid hormones. It may cause symptoms such as bulging and puffy eyes, tiredness, weakness, diarrhea, irregular periods, and a fast heart rate. Treatment works well in managing your symptoms and reducing your risk of developing health problems. You may also need to change your diet and eat less food with high iodine. Go for your doctor's appointment regularly and see them immediately if your symptoms worsen or you start having new symptoms.
Is Graves' disease life-threatening?
Graves' disease can be life-threatening if it's left untreated or you don't follow your treatment regularly. It may put you at risk of developing life-threatening conditions such as a thyroid storm, stroke, and heart failure.
How long can you live with Graves' disease?
Graves' disease won't affect how long you'll live when you treat it well. However, if left untreated, it can cause complications such as heart disease, which can affect how long you can live.
What to expect when you have Graves' disease?
You can expect symptoms such as tiredness, weakness, shaking in your hands, weight loss, sleep problems, fast heartbeat, period changes, and low sex drive when you have Graves' disease. You can also expect to follow a lifelong treatment plan and make lifestyle changes.
Can Graves' disease go away?
Graves' disease can go away when you follow treatment. But it can also come back, especially if it went away when you were a child.
Major Health Organization Makes Startling Heart Disease Prediction: 'Near-perfect Storm'
Heart disease has been the world's No. 1 killer for over a century, and experts predict that it will become even more prevalent in the coming decades.
A report this month from the American Heart Association (AHA) predicts that at least six in 10 U.S. Adults could experience cardiovascular disease within the next 30 years.
The rate of hypertension (high blood pressure) — which is one of the key risk factors for heart disease — is expected to increase from 51.2% in 2020 to 61.0% in 2050.
HEART ATTACKS MORE LIKELY DURING PRESIDENTIAL ELECTIONS AND OTHER STRESSFUL TIMES, STUDY SHOWS
Diabetes, another major risk factor, is also expected to rise (16.3% to 26.8%), along with obesity (43.1% to 60.6%), according to the study, which was published in the AHA journal Circulation.
As a result, total cardiovascular disease is predicted to rise from 11.3% to 15.0% between 2020 and 2050.
Heart disease has been the world's No. 1 killer for over a century, and experts predict that it will become even more prevalent in the coming decades. (iStock)
"The landscape of cardiovascular disease in the U.S. Is seeing the arrival of a near-perfect storm," Dr. Dhruv S. Kazi, vice chair of the advisory writing group and a Boston cardiologist, said in a press release.
"The last decade has seen a surge of cardiovascular risk factors, such as uncontrolled high blood pressure, diabetes and obesity, each of which raises the risks of developing heart disease and stroke."
ANGER CAN INCREASE HEART ATTACK RISK, STUDY FINDS
Lead study author Karen E. Joynt Maddox, MD, associate professor at Washington University School of Medicine, said the magnitude of the increase was surprising.
"As a country, through lots of hard work from clinicians, patients and organizations like the American Heart Association, we have reduced mortality from heart disease by more than 50% in recent years, but we haven't made the same strides in preventing disease," Maddox told Fox News Digital.
"We have neglected prevention, chronic disease management and public health."
As a result of the risk factors identified in the study, total cardiovascular disease is predicted to rise from 11.3% to 15.0% between 2020 and 2050. (iStock)
On a positive note, the researchers determined that hypercholesterolemia (high levels of LDL, or "bad cholesterol"), will decline (45.8% to 24.0%).
They also predicted that diet, exercise and smoking habits will improve, although sleep quality is expected to worsen.
ASK A DOCTOR: 'WHY AM I HEARING MY HEARTBEAT IN MY EARS?'
The researchers analyzed data from the 2015 to March 2020 National Health and Nutrition Examination Survey and the 2015 to 2019 Medical Expenditure Panel Survey.
"We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics," they wrote.
"[The] most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black or Hispanic."
Life's Essential 8 consists of the following eight lifestyle behaviors for optimal heart health, according to the American Heart Association. (iStock/American Heart Association)
The study looked for trends in cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke.
WANT TO LIVE LONGER? FOLLOW 8 HEART-HEALTHY HABITS, SAYS THE AMERICAN HEART ASSOCIATION
Life's Essential 8 consists of the following eight lifestyle behaviors for optimal heart health, according to the AHA:
Overall, the report predicts that clinical cardiovascular disease (affecting the heart or blood vessels) will affect 45 million adults by 2050, and clinical cardiovascular disease (including hypertension) will affect more than 184 million adults.
Overall, the report predicts that clinical cardiovascular disease (affecting the heart or blood vessels) will affect 45 million adults by 2050, and clinical cardiovascular disease (including hypertension) will affect more than 184 million adults. (iStock)
"The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years," the researchers stated.
Renato Apolito, M.D., the medical director of the Cardiac Catheterization Laboratory at Hackensack Meridian Jersey Shore University Medical Center, was not involved in the AHA study but shared his insights on the findings.
"We are all under a lot of pressure and stress to work more to make ends meet."
One of the key factors is the projected increase in obesity in the coming decades, Apolito said in an interview with Fox News Digital.
"Obesity is very commonly associated as a driver of hypertension, diabetes, sleep apnea and hypertriglyceridemia," he said.
Some of the greater causes of obesity are lack of exercise and a heavy reliance on processed and fast food, he noted.
Some of the greater causes of obesity are lack of exercise and a heavy reliance on processed and fast food, a cardiologist said. (iStock)
"I suspect that as our standard of living goes up, our reliance on processed and pre-prepared food — in addition to lack of exercise and lack of sleep from our hectic work lives — will drive up obesity as the common denominator leading to all the other risk factors mentioned," Apolito predicted.
"All of those factors put together would lead to an increase in coronary artery disease, heart failure and stroke."
"We hope that this report helps spur change that is critically needed to improve the health of the population," Maddox told Fox News Digital.
The researchers recommend that people learn more about Life's Essential Eight to optimize their cardiovascular health.
"People can get involved in their communities to advocate for broader change that can help keep people healthy, like nutritious lunches and physical activity in schools, healthier options at restaurants, and better awareness of cardiovascular health," Maddox said.
The researchers recommend that people learn more about Life's Essential Eight to optimize their cardiovascular health. (iStock)
Clinicians can also talk to their patients about how to control risk factors, she suggested, and policymakers can work to pass legislation that enables better access to healthy foods, places to exercise, and affordable, high-quality health care.
Apolito agreed that change is needed.
"We are all under a lot of pressure and stress to work more to make ends meet," he said.
CLICK HERE TO GET THE FOX NEWS APP
"This typically leads to the bad lifestyle habits mentioned above."
The doctor recommends starting small, setting aside just 10 to 20 minutes per day to do some form of exercise and to make conscious decisions to avoid processed and fast foods.
A cardiologist recommends starting small, setting aside just 10 to 20 minutes per day to do some form of exercise and to make conscious decisions to avoid processed and fast foods. (iStock)
"You would maintain a healthier weight, which would mitigate your risk of hypertension, diabetes, sleep apnea, dyslipidemia and, ultimately, cardiovascular disease," he said.
CLICK HERE TO SIGN UP FOR OUR HEALTH NEWSLETTER
Apolito also pointed out that the study is speculative, using predictive models on data from the past and present to predict the future — "which is never easy to do."
For more Health articles, visit www.Foxnews/health.
"Hopefully, with increased public education, we can turn the tide and improve overall health in the coming decades by making healthy choices in lifestyle," he added.
Melissa Rudy is senior health editor and a member of the lifestyle team at Fox News Digital. Story tips can be sent to melissa.Rudy@fox.Com.
Comments
Post a Comment