Tag: CHD

Congenital Heart Disease and Physical Therapy

Congenital heart diseases refers to the structural (anatomical) or physiological defects in the normal functioning of the heart as a result of birth defects that may be diagnosed soon after birth or may take years to produce full blown cardiac insufficiency. Valvular heart defects form the most common variety of congenital cardiac defect that is associated with high morbidity and mortality in adult years if no management options are employed. This is because the metabolic demands of the body increase with growth and development that poses more pressure on the heart leading to cardiac failure or circulatory deficits. With overall prevalence of 26.6%, it was suggested that only 12.1% cases can be detected by clinical evaluation. Among the most prevalent congenital cardiac defects, ventricular septal abnormalities comprise 17.3% of all congenital anomalies followed by atrial septal defects (6.0%) and other less common cardiac diseases. The mortality is highest with cyanotic heart diseases.

According to the research statistics reported by Julien I.E Hoffman, over 1 million patients were born with congenital heart defects (during 1940 to 2002). Considering the quality of medical services and surgical/ medical advancements, Hoffman suggested that the total number of survivors with mild heart disease (who may reach well into adulthood) is 750,000 with mild heart disease, 400,000 with moderate heart disease and 180,000 with severe disease (with treatment). Without any management or treatment the survival rate may fall to 400,000 with mild disease, 220,000 with moderate disease, and 30,000 with severe heart disease, suggesting very high mortality.

Congenital heart diseases are also associated with stunted growth and development in children marked by poor weight gain, failure to thrive and frequent hospitalizations while growing up. In addition, these children also develop frequent episodes of shortness of breath, rapid heart rate (also known as tachycardia) and attacks of fatigue associated with decreased exercise endurance.
Physical therapy and mild exercises are helpful in the growth and development of children born with congenital heart disease. It is extremely important not to initiate exercise therapies in these children without seeking the guidance from registered physical therapists who work in coordination with the pediatric cardiologist to deliver best exercise regimens in order to optimize health without overloading the heart. Generally, children and adults can perform moderate static exercises of mild intensity without any complications; however, healthcare providers strongly restrict weight lifting in pediatric aged children and even in adults born with cardiac defects. Caution should be maintained to avoid lifting weight of more than 25 pounds in children and more than 50 pounds in adults. Physical therapist and pediatric cardiologist must assess every child individually and advice customized exercises and treatments according to the severity of illness and overall physical health. Treadmill test, bicycling and echocardiography are mainly used as assessment tools as the risk of sudden death increases if vigorous activity is attempted in children born with aortic stenosis, cyanotic heart diseases and coarctation of the aorta.

Hardcore or traditional gym exercises increase cardiac output that may overload the heart and may increase the risk of complications or sudden cardiac death. On the contrary, exercises performed under the guidance of physical therapists serve multiple benefits. Exercise or physical activities are needed in order to build stamina and maintain exercise endurance especially in school going children who engage in physical activities with peers. Physical therapy improves the pace of mental and physical development that allows children to develop healthy social relationships with peers, muscle and motor coordination and mental concordance. Physical therapy and periodic assessments are also needed in order to know the physical capacity of child and to track worsening of cardiac defect with age (in order to avoid accidents or unwanted incidents at schools) by restricting excessive physical activity. In some children, healthcare providers delay surgery until the child crosses some developmental milestones; however, it is very important that until then child stays in best possible physical shape to lessen the risk of surgical complications.

According to the scientific peer-reviewed journal- American Family Physician there are 5 stages of physical activity recommendations of Physical Activity in Children with CHD, ranging from no restriction to extreme limitation of physical activity (wheel chair bound).

Without any physical therapy, the progression into the severe disability is fairly high. It is the duty of parents to promote healthy physical activity but make sure to prevent contact sports or vigorous activities that may affect cardiac functioning.

Symptoms Of Coronary Heart Disease

All of our muscles need a continuous supply of oxygen carried by the blood and the heart is no exception. However, due to diet, age, and other factors such as high blood cholesterol, high blood pressure and smoking, our coronary arteries may become smaller or clogged. When the blood flow to the heart is restricted, it results in coronary heart disease, sometimes known as CHD. Angina occurs when not enough blood carrying oxygen can get through to the heart. This often causes a pain in the left arm or chest. When the blood flow is cut off completely, a heart attack occurs. Any part of the heart that is not receiving the oxygen it needs begins to die and permanent damage to the muscle can be done.

What are the symptoms of coronary heart disease?

Some people may not experience any symptoms. Others may feel short of breath or experience a mild discomfort in their chest area. Still others suffering from coronary heart disease experience a constant chest pain that may hinder their everyday activities.

Those that suffer from angina say they feel a pressure or heaviness on their chest. This can sometimes include a burning sensation or they may say it feels like their chest is being squeezed. Other symptoms associated with coronary heart disease include dizziness, queasiness, shortness of breath, and can include heart palpitations. Pain may spread to their neck, jaw, or arms.

If you suffer from angina, the doctor will try to diagnose what type you have stable or unstable. Just like the names, stable angina tends to occur at certain times such as after you exert yourself, after a large meal, or when you get upset. The pain lasts between one and five minutes and usually resting helps alleviate the symptoms. If you have no pattern as to when you experience the pain, it is known as unstable angina. This is the more severe type of the two.

Once the doctor establishes that you do have coronary heart disease, he may ask you to take some tests to see to what damage has been done. One test he may order is the electrocardiogram (ECG). This will show him the electrical activity of the heart. A stress test is normally done on a treadmill. This forces the heart to work harder, a time when problems often show up. Your blood pressure and heart rate will also be monitored while taking the stress test. A nuclear scanning involves the doctor inserting a small amount of radioactive material into your vein. He can then see damage done by using a scanning camera. Finally, a coronary angiography is a test where a catheter is inserted into an artery (usually in your arm or leg) and it films the heart while it pumps. The picture it takes is known as an angiogram.

What is the treatment for coronary heart disease?

That depends on the severity. If it is less severe, the doctor will probably suggest lifestyle changes. Many people do not care for this treatment because it involves giving up things they love. You will need to change your diet so it is lower in fat and cholesterol. You will also need to start on an exercise regiment as well. Even a small amount of exercise can lower your risks of a heart attack. Smokers can drastically reduce their chances of a heart attack when they quit smoking. Even if you have already suffered from one heart attack, stopping smoking can prevent another.

Those with more severe cases of coronary heart disease may need to undergo surgery. Coronary angioplasty is one type of surgery for coronary heart disease. Often referred to as balloon angioplasty, this involves a catheter going through the artery that is blocked. The balloon on the end is inflated to help open up the artery. If the artery cannot be opened, you will need a coronary artery bypass operation. In this, the surgeon removes a blood vessel from another part of the body and graphs it onto the blocked artery. The blood is then able to go around the blockage by way of this new vessel. Even after having these surgeries, you will be asked to change your lifestyle.

If you experience any type of chest pain, it is imperative that you visit your doctor to get a checkup. Chances may be it is nothing life threatening, but it is always better to be safe than sorry.

Preventing Heart Attack

DID YOU KNOW?

In 2008, heart related diseases accounted for 24% of all deaths caused by non-communicable diseases. In other words 12,57,936 people died of heart diseases or cardiovascular diseases (CVDs).

In 2004, total number of deaths due to ischaemic heart disease (IHD) was 5,54,194. Out of that 2,55,782 people died in urban areas while 2,98,412 died in rural areas.

The total number of DALYs for IHD in 2004 was estimated at 1,60,00,808. (1 DALY equals one lost year of healthy life.) The total number of YLL (Years of Life Lost due to premature death) for IHD stood at 49,52,150.

Cardiovascular disease (CVD) related deaths are expected to rise from 27 lakh in 2004 to 40 lakh by 2030.

The prevalence of coronary heart disease (CHD) ranges from 6.6% to 12.7% in urban and 2.1% to 4.3% in rural India, among those aged 20 years or older.

It is estimated that there are currently 3 crore CHD patients, with 1.4 crore residing in rural and 1.6 crore in urban areas. But these are likely underestimates given that surveys do not include those CHD patients without the symptoms.

As compared to other countries CVD in India is characterized by early onset and premature death and higher cases of deaths related to complications from CVD. Also the diseases manifest more easily in Indians than their Western counterparts, particularly from risk-factors like overweight and obesity.

CVD disproportionately affects the young in India with 52% of deaths occurring under the age of 70 years compared to just 23% in Western countries.

Consequently, the country suffers a very high loss in potential productive years of life because of premature CVD deaths among those aged 35 to 64 years: 92 lakh years lost in 2000 and 1.79 crore years expected to be lost in 2030.

HOW DO I KNOW IF I’M HAVING A HEART ATTACK?

A heart attack takes place when blood supply to a part of the heart is interrupted, causing heart cells to die. The interruption is caused by accumulation of fatty particles called plaque inside the walls of the pipes (arteries) carrying blood to the heart. A lack of blood supply results in the shortage of oxygen, which if left untreated for a sufficient period of time leads to death.

A heart attack is a medical emergency and should be attended to with highest priority. The most common symptom for a heart attack is chest pain. The sensation is often described as tightness, pressure or squeezing. The pain may be felt in only one part of the body or it may also move from the chest to the left arm (most often), lower jaw, neck, right arm, back, and upper central region of the abdomen. Other symptoms of a heart attack include anxiety, cough, fainting, light headedness/dizziness, nausea or vomiting, palpitations, shortness of breath and sweating which may be heavy.

HOW CAN I PREVENT IT?
Cardiovascular diseases such as coronary heart disease (CHD) or ischaemic heart disease (IHD) lead to a heart attack. Such diseases are non-communicable, i.e., they do not spread through infection or contamination. Also known as lifestyle diseases, their onset depends on health habits in most cases. Keeping the blood pressure in strict control by eating food that is less in fat and oil content, cessation of smoking, limitation of alcohol intake and regular physical exercise can reduce the incidence of heart diseases and heart attacks by a great margin. In addition, regular screening of the heart with a preventive health check-up helps in early detection of blockage. Some of the tests commonly recommended are lipid profile, 2D echocardiogram, CT scan, etc.