Acquired Heart Disease: Acquired Heart Disease: Prevention and TreatmentPrevention and TreatmentSharon L. Roble, MDAssistant ProfessorAdult Congenital Heart ProgramThe Ohio State University/Nationwide Children’s HospitalColumbus, Ohio

Congenital Versus AcquiredCongenital Versus Acquired

Congenital—any condition that a person is born with Acquired—any condition that develops after birth

Congenital Heart DiseaseCongenital Heart Disease

Bicuspid Aortic ValveTetralogy of FallotTransposition of the Great ArteriesVentricular Septal Defects (VSD)Atrial Septal Defects (ASD)Truncus ArteriosusAnomalous Pulmonary Venous Return

Acquired Heart DiseaseAcquired Heart Disease

Coronary Artery DiseaseValvular Heart DiseaseHigh Blood PressureRheumatic Heart DiseaseKawaski’s Disease

CORONARY ARTERY CORONARY ARTERY DISEASEDISEASE

Coronary Artery DiseaseCoronary Artery DiseaseAtherosclerosis◦ An active process by which blockages develop in

heart arteries due to the build up of plaques (cholesterol, platelets, inflammatory cells)

Clinical presentation varies◦ Asymptomatic◦ Chest pain◦ Shortness of breathGoal of treatment is to slow the development of significant blockages

Clinical PresentationClinical Presentation

AsymptomaticAngina = chest pain◦ Stable-occurs with exertion◦ Unstable-occurs at rest

“Heart Attack”= Myocardial Infarction◦ Heart muscle cells die due to lack of oxygen◦ Different types

Risk FactorsRisk Factors

AgeGenderHigh Blood Pressure◦ Systolic (Top number)

Treated versus untreated

SmokingCholesterol◦ Total cholesterol◦ HDL (good) cholesterol

WhatWhat’’s your risk?s your risk?

Framingham Data Risk Calculator10 year risk of “hard cardiac event”◦ Myocardial Infarction (i.e., heart attack)◦ Death due to coronary disease

Patients without known coronary diseaseCoronary artery disease equivalents◦ Diabetes◦ Peripheral Vascular Disease

How is risk calculated?How is risk calculated?

Framingham dataPoints assigned for each risk factor and points summedTotal number of points then correlates to a percentage◦ Percentage is risk of cardiovascular event

over 10 years

Example: SmokingExample: Smoking

20-39 40-49 50-59 60-69 70-79

Nonsmoker 0 0 0 0 0

Smoker 8 5 3 1 1

20-39 40-49 50-59 60-69 70-79

Nonsmoker 0 0 0 0 0

Smoker 9 7 4 2 1

MEN

WOMEN

PreventionPreventionDiet◦ Low-fat◦ High fiberExerciseWeight LossSmoking CessationTreatment of high blood pressureTreatment of cholesterol◦ Aggressiveness of treatment depends on risk

factors

DietDiet1500-2000 calories/day30% of calories from fat◦ 8-10% saturated fat◦ 1% trans fat—”partially hydrogenated”◦ Unsaturated fats, in moderation

Limit sodium to 2400 mg/dayLimit cholesterol to 300 mg/day◦ 200 mg/day if high LDL

““Good FatsGood Fats”” versus versus ““Bad FatBad Fat””Unsaturated FatsOlive OilCanola OilTrans-fat free margarineCholesterol lowering margarine

Saturated or Trans FatButterLardBacon FatGravy Cream SaucesHydrogenated margarine/shorteningCoconut/palm/cottonseed/palm-kernel oils

ExerciseExercise30 minutes of moderate exercise 4-6 days per weekLight Exercise◦ Desk work◦ Golf◦ Light housework

Moderate Exercise◦ Walking (exercise)◦ Gardening/yard work/farming◦ Cycling◦ Tennis◦ Running◦ Dancing

Heavy Exercise◦ Walking uphill◦ Construction work/physical labor◦ Basketball◦ Football

TreatmentTreatment

Medicine◦ Aspirin/Plavix◦ Cholesterol lowering agents◦ Blood pressure lowering medications

Stents◦ Cardiac catheterization

Surgery—”Bypass Surgery”◦ Arteries◦ Veins

Treatment for CholesterolTreatment for Cholesterol

Coronary Artery StentingCoronary Artery Stenting

VALVULAR HEART VALVULAR HEART DISEASEDISEASE

Calcific (Degenerative) Aortic Valve Calcific (Degenerative) Aortic Valve DiseaseDisease

As valves age, the process of atherosclerosis can affect aortic valve resulting in calcium deposition May result in stenosis or regurgitationSymptoms present in 70-80’sAccelerated in patients with abnormal valves (i.e., bicuspid valves)

HIGH BLOOD HIGH BLOOD PRESSUREPRESSURE

High Blood Pressure High Blood Pressure

“The Silent Killer”Long-standing, untreated high blood pressure damages arteries and veinsLong-term consequences◦ Heart failure◦ Heart attacks◦ Stroke◦ Kidney Failure◦ Blindness

Diagnosis of High Blood PressureDiagnosis of High Blood Pressure

2 or more elevated blood pressures on 2 separate occasions

Metabolic SyndromeMetabolic SyndromeGroup of risk factors which greatly increase risk of developing cardiovascular disease including stroke.Risk Factors◦ Abdominal obesity (abdominal waist

circumference)Men >40 inchesWomen >35 inches

◦ High fasting glucose (>100)◦ High triglycerides (>150)◦ Low HDL (Men<40, Women<50)◦ High blood pressure (>130/85)

RHEUMATIC HEART RHEUMATIC HEART DISEASEDISEASE

Rheumatic Heart DiseaseRheumatic Heart Disease

Begins with “strep throat”Inflammatory process in response to initial infection results in antibodies that attack the connective tissues of the body Approximately 2-4 weeks after initial strep infection, patients present with clinical features of rheumatic fever

Clinical Features of Rheumatic Clinical Features of Rheumatic FeverFever

Pain and swelling in large jointsFeverWeaknessMuscle achesShortness of breathChest painNausea and vomitingHacking coughCircular rashLumps under the skinAbnormal, sudden movements of arms and legsDamage to heart valves may present later and is permanent

Rheumatic Heart DiseaseRheumatic Heart DiseaseEarly recognition and treatment of strep throat has led to a significant decrease in the incidence of rheumatic heart disease in the US and other developed countriesRemains a significant cause of heart disease in developing countriesSymptoms of heart disease may not present until several years after initial Strep infection

TreatmentTreatment

Penicillin to avoid recurrent strep infectionsIf severe valvular disease, require valve replacement

KAWASKIKAWASKI’’S DISEASES DISEASE

KawaskiKawaski’’s Diseases DiseaseInflammation of the small and medium-sized vessels in the body◦ Includes coronary arteriesPresents in early childhood ◦ Ages 2-8Clinical presentation◦ Fever > 5 days◦ Rash◦ Peeling of skin on hands and feet◦ “Pink eye”◦ “Strawberry tongue

TreatmentTreatment

Treatment is designed to stop inflammatory process and prevent long-term sequelae of coronary artery aneurysms.Long-term consequence of Kawaski’s is coronary artery aneuryms which may initially be asymptomatic; however aneurysms may lead to heart attacks later in life.

KawaskiKawaski’’s Diseases Disease

Useful WebsitesUseful Websiteswww.americanheart.orghttp://hp2010.nhlbihin.net/atpiii/calculator.aspwww.mayoclinic.com/health/heart-healthy-diet/www.nhlbi.nih.gov/guidelines/cholesterolwww.kdfoundation.org