Posts Tagged ‘Heart’

Back to School

November 12, 2010

“Trouble is, there’s not enough of us to go around – we’re spread thin, so sometimes, important things get ignored or don’t get said.” – Judge Tolliver (John Goodman), The Jack Bull (1999)

Yesterday I had the chance to go back to school – I went back to my Alma Mater to our School of Nursing!

I asked for directions just to be sure – when I graduated the School of Nursing didn’t exist. And I didn’t want to assume I could find it only to discover that it was in a back corner of the campus. But it wasn’t a problem; as soon as I turned off of the main highway and scanned the campus, there it was. Everything was exactly as described, which usually doesn’t happen – more often than not, I get twisted up and turned around but everything went perfectly.

After meeting the instructor for the first time, we went upstairs and into a classroom where I met the students (about 30 of them) and talked about myself and my heart defect. If you’re a reader of this blog, you know I usually post the printed text of my presentation. Not the case this time – as I told the students, when I make a presentation to Heart Families, I’ve got a plan and am pretty sure what I will say. With them, I wasn’t sure what they wanted or needed to know, so I’d just talk about myself. If they had a question, feel free to break in.

Someone had a really good question about did I need oxygen. Technically no, I don’t need oxygen, but I sleep with a flow of four liters per hour. It was originally prescribed to keep my Hemoglobin down, and I can skip it for several days without problem. When I take a weekend trip, I don’t take it with me. But I’m like a rechargeable battery and the O2 is like my charger – after about 4 days of sleeping without oxygen, I feel run down.

After I talked about myself and the Question and Answer session, we moved over a larger room set up as a hospital ward. When I walked in there was a bed to my right with a medical mannequin in the bed, tucked under the covers neatly. I saw him/it out of the corner of my eye and for a moment there I thought it was a real person!

We didn’t bother Earl (or whatever the mannequin’s name was), he looked comfortable. I took another bed, and in pairs and threes the students came in and examined me. My heart was listened to more times than I can could count, and everyone took a close look at my blue fingernails. My right hand is a little more blue than usual because of the swelling associated with my wrist, but my left hand is better suited to observe Capillary Refill (press down on the fingernail until it turns white, then release. Observe how long it takes for the blood to flow back.)

More than one student seemed to be very interested in the fact that you can’t read my pulse in my left arm – a side effect of the Blalock-Taussig Shunt, the surgery I had in 1977. In the Blalock-Taussig, the Left Subclavian Artery is cut and sewn into the Pulmonary Artery. The Left Subclavian normally passes near the shoulderblade (the Clavicle), and down the left arm. Because it has been disconnected, you can’t get a pulse in my left arm, can’t take an accurate blood pressure reading, and blood draws and vaccine injections should be done in the right arm.

(NOTE: If you have the Modified Blalock-Taussig Shunt, a small artificial connection is used to connect the Subclavian Artery to the Pulmonary Artery and the Subclavian is left intact. You usually can feel the pulse bilaterally on a patient with the Modified Blalock-Taussig!)

When the students weren’t listening to my heart, the instructor was – with an electronic recording stethoscope. I’ve had this done before, back in 1977 at the University of Alabama at Birmingham (recounted in this post.) But back then it was a Stethoscope head connected to wires that ran to a machine the size of a toolbox, that recorded my heart on a cassette tape. This one looked like a regular Stethoscope, perhaps a little thicker around the head. It would record (sensitive enough that it recorded a cough!) and then transmit the recording to a laptop computer via Bluetooth! My Geek side started getting the best of me, and I was developing a very, very bad case of STEVE WANT! But I knew that if I asked how much it cost, the instructor would inject me with 1000 cc’s of reality. Reality is a difficult drug to take – it’s good for you, but can make you feel pretty lousy.

I enjoyed my visit to the Nursing School and I’d like to thank everyone for making me feel so welcome. Even if none of the students chose to work in Congenital Cardiology, they’ll bump into other patients like me – it’s estimated that in the United States, there are slightly more adults living with a Congenital Heart Defect than there are children. Adults with Heart Defects are living longer and better, and we’ll have “normal” medical problems in addition to our bad hearts. And today’s Cardiac Kids are growing into tomorrow’s Heart Warriors.

So its important for those of us with a heart defect to “meet the public” – and not just to raise awareness, but to educate. To guide new Heart Families through this scary world we never expected to enter, but also to give the professionals who will be taking care of us a chance to learn from us. it doesn’t matter if someone is the best Heart Surgeon, the best Cardiologist, or the very best Cardiac Care Nurse… sometime in the past, these people had no idea that Heart Defects even existed.

Someone had to teach them.

Rebuilding a damaged heart

June 29, 2010

I’ve written about the Wake Forest Institute of Regenerative Medicine and the Bioprinter, both attempts to create organs in the lab. But instead of creating entire organs from scratch, doesn’t it also make sense (or sometimes make more sense) to just rebuild the damaged section?

CorMatrix has just received approval to market its bioscaffold material in the European Union. It’s been available over here since 2006, which makes it unusual. Medical devices almost always come into use in Europe before they are introduced over here.

Bioscaffold means “living framework” and that is just what the new material is. If you were to take a piece and have it analyzed, you’d learn that it is made mainly from pig intestines. But when you use it to patch an Atrial Septal Defect (ASD) for example, it changes. Oh it is still the pig innards, but instead of truly repairing the ASD, it just covers it. The material encourages cell growth, and before too long the patch will be completely covered by heart tissue.  As time passes the patch material will dissolve, leaving… nothing. No ASD, no patch, only cardiac cells. And since the cells are the patient’s own body, they’ll grow right along with the patient and never be rejected.

Personally, I’m looking forward to the day when scientists can build an entire heart in the lab! But it is a complex organ, and before they get that far they’ll do things like this – figure out what parts of the heart are working and rebuild the damaged sections. It just makes sense.

The Heart of the Matter

June 1, 2010

“The more I know, the less I understand” – Don Henley, The Heart of the Matter (1989)

Here’s quite an unusual post for Funky Heart! readers – the subject today is not the human heart, but the heart of a kitten. This kitten was, unfortunately, found in a trash can. He was taken to a Vet where it was found that he had a severe upper respiratory infection.  Sad to say, the kitten died the next morning. To everyone’s surprise, the autopsy revealed that the kitten had a Congenital Heart Defect – Tricuspid Atresia!

Here are some photographs of the kitten’s defective heart. (WARNING: GRAPHIC IMAGES!) First take note of how small it is. In the last two photos you can see a hand, so use the fingernail for comparison. The Ventricular Septal Defect is smaller than an adult Human’s thumbnail. Now imagine that is a human heart and you are the surgeon. Whatever you do, you had better be precise. There is absolutely no room for error here.

Next, notice the form of this heart. Many people seem surprised and shocked at just how “natural” a defective heart appears. In their mind they assume that it is full of ragged holes and jagged edges, almost like something that just doesn’t quite fit but has been forced together. More often than not, holes and malformed parts are nicely formed with smooth edges, and look perfectly natural. That can’t be wrong, you are lulled into thinking. It looks like it is supposed to work like that! Oh, how so many of us wish that were true!

The human heart is an amazing thing. It is designed to contract at a rate of 70 to 100 beats a minute, 24-7, 365, for over 70 years. Even defective hearts usually function for a while before they need help. They can expand when there is a problem and if that problem is corrected soon enough, they can shrink back to normal size without any permanent damage. And it is so interconnected – a heart problem can not only affect the heart and lungs as one might expect, but can also affect the liver, and the kidneys, and even the brain.

In the average adult human, it is the size of two fists and weighs roughly a pound, but everything – literally and figuratively – comes back to the heart.

And that is the heart of the matter.

All the organs that are fit to print!

March 15, 2010

There are several new technologies being developed to create replacement body parts in the lab. We’ve discussed Stem Cells and the Wake Forest Institute for Regenerative Medicine (WFIRM), but here’s an idea we haven’t mentioned yet: The Bioprinter.

Imagine a printer – much like the Inkjet or Laser printer that is connected to your computer – that prints out human organs rather than letters or photos! It’s not such a dream!

Dr. Gabor Forgacs is the creator of this particular Bioprinter (There are several; each uses a slightly different process) and it works much like a standard printer. But instead of ink, the printheads fire a mixture of human cells (collected from the organ you want to reproduce) and a growth medium Dr. Forgacs calls “Bioink”. Instead of regular paper, the Bioprinter uses a gelatin sheet called (What else?) Biopaper.

One sheet of Biopaper won’t do it – you print several sheets, align them properly, and wait six weeks. During that time the human cells grow and fuse together as the Biopaper dissolves. The result is a human organ ready for transplant – with a 0% rejection rate. This may not be such a pipe dream – Dr. Forgacs thinks we are five years from a major breakthrough with Bioprinters.

CLICK HERE for Dr. Forgacs’ description of the process in an interview with National Public Radio’s All Things Considered. And while you are doing that, I’m going to make some “adjustments” to my printer….!

Devil in the Slot

March 2, 2010

BONUS: 100 Karma Points to the first person who can leave a comment telling me where the title of this post originated!

You have a heart defect.

No, I’m not talking about the 1 in 125 of us who live with a Congenital Heart Defect, I’m talking about YOU. Mr. or Mrs. Average. You were born with a heart defect. Two of them, actually.

Obviously, you don’t need to breathe while you are still in your mother’s womb. You can’t breathe, unless you can somehow magically breathe fluid. So your lungs are “turned off” and you have two small defects that allow the heart to function but blood to bypass the lungs and pick up its oxygen from your mother. When you are born and you take your first breath, the body sends a signal to those two defects to shut down and for the lungs to take over.

(Pretty cool, huh?)

One of these small defects is called the foramen ovale and it is really a very small Atrial Septal Defect. In fact, it isn’t really a hole in the septum, it is two overlapping flaps. When you begin to breathe and blood begins to flow properly, these two flaps will eventually seal closed and everything will be great. In about 30% of people, however, it doesn’t close. When that happens, it is called a patent foramen ovale, sometimes called a PFO (“patent” means “stuck open”).

Many times this doesn’t cause much of a problem; sometimes it is even undetectable unless the patient coughs while having an ultrasound.

Now here is the problem: when a person has a PFO, or when it is slow to close, occasionally a small “pouch” forms in the wall of the Left Atrium. Doctors at the University of California at Irvine recently found that pouch while doing autopsy research, and it could be the source of several problems.

That little pouch is nice and quiet; any blood that gets in there settles down – it’s no longer part of the normal blood flow, and it is pretty calm in there. While the heart is pumping and blood is churning all around it, it’s a nice quiet little neighborhood… almost a gated community. (This Link has a good explanation and has a nice drawing of the pouch about halfway through the article. )

That’s not good. Blood can settle in the pouch and form a clot. And since it is on the left side of the heart, the clot skips the lungs (which not only add oxygen to the blood, but they also act as scrub brushes, too!) and then it is off on a tour of the body. Round and round she goes, where she stops nobody knows. But if it stops in the wrong place….

STROKE!

So if the doc tells us we have a PFO, we should get it closed, right? Perhaps, and perhaps not. The medical evidence isn’t in yet. We know what might happen, what could happen – but how many times is the pouch really the cause of a stroke? We don’t know yet. A clinical study (the RESPECT trial) is being conducted right now to determine if a PFO causes more strokes. At least one doctor isn’t waiting to find out – she’s full steam ahead. The Food and Drug Administration is saying wait a minute, slow down, catch your breath… let’s see what the evidence says. Then we can decide. (You really need to read what Isis has to say about PFOs, she gets the point across quite well, in simple English and with a lot of humor, too!)

So, is there really a devil hiding in that “slot” that could be in your heart? And if there is, what are the chances of him coming out? No one knows… yet.

New way to create an ASD!

February 20, 2010

Here’s a report of a novel procedure that will hopefully come into use soon: creating (or enlarging) an Atrial Septal Defect (ASD) without breaking the skin.

I had a small ASD at the time of my first surgery but it needed to be larger. Back then (1967), ASDs had to be created or enlarged the old fashioned way – with a scapel. This was known as the Blalock-Hanlon Procedure, and it was pretty straightforward: cut into an Atrium, look for the ASD, and enlarge it. If you couldn’t find an ASD, make one.

Surgeons don’t perform the Blalock-Hanlon very often these days. (When I read my operative notes just a few months ago I had never even heard of the Blalock-Hanlon, much less knew that I had one!) Today the majority of ASDs are created by a balloon atrial septostomy, which is done by a catheter.

But this new procedure wouldn’t cut the skin at all. Histotripsy is “tissue liquification by ultrasonic wave” – the same technology they use when your uncle has his gallstones crushed. The suffix “-tripsy” is a Greek word that means “to massage” or “to crush.”

This was a small study of only ten dogs. Ultrasound was used to locate an appropriate point for an ASD and then the defect was created by Histotripsy. In nine out of ten cases, the shockwaves created an ASD, and later examination showed that there was “minimal damage” to surrounding cardiac tissue and no damage to the outside of the heart.There is also evidence that Histotripsy could be used for some cardiac ablations.

Much more research needs to be done before this becomes an accepted procedure, but the initial results are promising!

Never trust your heart to the Network News

February 3, 2010

Did you happen to see NBC’s The Today Show segment concerning catheter ablation of atrial fibrillation? It looked all snazzy and cool, and the patient was cured!

Or was she? As will often happen, TV news manipulated the presentation for maximum effect. In other words, they lied.

You see, there are different types of atrial fibrillation (A-Fib; or AF).You can also have Atrial Flutter, which is what I have. Flutter responds much better to an ablation procedure. The medical literature reports that Flutter patients have better success rates – Paroxysmal AF (Flutter) patients can have a successful ablation 38% to 78% of the time, with most programs reporting a success rate of 60% or higher. (The awesome Dr. Wes has the numbers). For persistent AF (A-Fib), the numbers are lower: 22% to 45%; most centers reporting 30% or less.

Bummer! However, there was NBC’s “expert”,  Dr. Nancy Snyderman, standing there telling us how great this new technology was.  Nancy must not have read the Medicare report that said more research was needed to see how effective it was in the Medicare-age population.

Also, an ablation is a two- step process. Once the catheter is in, the first thing doctors do is stimulate the heart to find the source of the A-Fib or Flutter. Once that is done, then you use the catheter to deaden the source and prevent the irregular heartbeats from happening again. Yet there was Dr. Snyderman, saying that the procedure was a success before the mapping procedure had even been completed.

Here’s the bottom line: Medical advances are the result of a lot of work and slow, steady progress. unfortunately, people want results now.  It doesn’t always work that way… in fact, it rarely works that way.

Remember, the public relations department is trying to sell you something, and they usually don’t let a little thing like science get in the way. A few weeks ago an article appeared that said that pomegranates could help reduce breast cancer. Adding pomegranates to your diet would help you avoid that dreaded disease.

But what they didn’t say was located further down in the story:

“It’s not clear that these levels could be achieved in animals or humans because the (compounds) are not well absorbed into blood when provided in the diet.”

Say what? This only works in a test tube? It hasn’t been tested in animals or humans? Obviously someone is trying to sell pomegranates.

TV based health reporting is usually limited to one 5 minute segment per newscast and is almost always upbeat. (This is a reason why Congenital Heart Defects are rarely covered by TV news; the issue is much too complicated cover in 300 seconds.) So before you get too excited about the latest “We’ve found the cure for cancer!” story being broadcast on the six o’clock news, take a deep breath. Do some research.  Find out the advantages and disadvantages of the new treatment. If it’s the real thing, it will still be there after you’ve taken the time to research it.

Why wait for transplant when you can grow your own?

January 28, 2010

When you think of medical advances, Iran is probably not one of the countries that comes to mind.

But the Islamic Republic of Iran is one of the leaders in kidney transplant – in fact, there is no longer a waiting list for a kidney transplant there. How do they do it? They have a kidney matching system and they pay donors.  Singapore plans to pay donors up to 50,000 Singapore Dollars (Almost $36,000 US dollars!)

If paying for a transplant organ seems a bit unethical, there are other ways to obtain one – legally, that is! At the Wake Forest Institute for Regenerative Medicine, you can grow your own organs. Need a new bladder? It will be ready for you in about six weeks! And since it is grown using your own cells as the base, rejection won’t be a problem.

And bladders are just the start – scientists are also working on ears, arteries, heart valves, fingers and toes. If we don’t watch out, our local hospital is going to start looking like an auto parts store!

Fantasy? Wishful thinking? Perhaps one day – 2107, if we’re lucky? The bladders are being replicated now, and the rest is on the way.

They’re even coming up with better ways to transport livers meant for transplant. The traditional method is Cold Storage – seal the liver in a sterile bag and place it in a cooler full of ice. Hypothermic Machine Perfusion (HMP) gives the liver its own “life support system” by simulating a human body. In a limited study,  HMP seems to keep livers viable longer than the accepted Cold Storage technique.

If this technology works it will be transferred to other organs. And growing replacement organs, along with improvements in transporting organs for donation, will improve your chances of getting an organ if you need a transplant.

Pumps your blood!

January 1, 2010

Funky Heart! reader (and  longtime friend!) Laura reminded me of another way to learn the path of blood through the body: The Pump your Blood! song, from the TV show Happy Days!

Below is a clip from the TV show with Anson Williams singing the song. Here are the lyrics:

Pump, pump, pumps your blood!

The right atrium’s where the process begins, where the C02 blood enters the heart. Through the tricuspid valve, to the right ventricle, the pulmonary artery, and lungs.

Once inside the lungs, it dumps its carbon dioxide and picks up its oxygen supply. Then it’s back to the heart through the pulmonary vein, through the atrium and left ventricle.

Pump, pump, pumps your blood!

Pump, pump, pumps your blood!

The aortic valve is where the blood leaves the heart, then it’s channeled to the rest of the bod. The arteries, arterioles, and capillaries too bring the oxygenated blood to the cells. The tissues and the cells trade off waste and C02, which is carried through the venules and the veins. Through the larger vena cava to the atrium and lungs, and we’re back to where we started in the heart!

Pump, pump, pumps your blood!

Becoming a Heart Warrior, Part III

December 31, 2009

The most important step to becoming a Heart Warrior is probably the most difficult: You will have to be able to discuss your heart defect intelligently.

This doesn’t mean that you’ll need to go to medical school and get an MD after your name. (Unless you want to – I know two CHDers who are physicians!) There are different ways to discuss something intelligently. You will need to know some medical terminology to discuss your CHD with a doctor, but you’ll use a different mindset when you discuss your heart with a potential boyfriend/girlfriend. And if a child asks you a question about your heart, you’ll answer their question in an entirely different way.

The first thing you should do is learn the anatomy of a normal heart. It doesn’t have to be a detailed knowledge, but you need to know the four chambers, the four valves,  and the major blood vessels. The heart has four chambers: two on the top and two on the bottom, and a wall (called the septum) right down the middle that divides them into left and right. The top chambers are the Left and Right Atrium, and the bottom chambers are the Left and Right Ventricle. The right side of the heart captures blood returning from the body and pumps it to the lungs. The left side of the heart takes blood coming from the lungs and pumps it back out to the body. So when people tell you that the heart is a pump, they’re wrong. It’s really two pumps in one case.

You need to understand the Cardiopulmonary cycle. Cardiopulmonary is a big word, but it’s really two smaller words: Cardio, from the word Cardiac, means anything having to do with the heart. Pulmonary means anything having to do with the lungs. And the Cardiopulmonary cycle is the path the blood follows as it moves through the heart and lungs.

A normal Cardiopulmonary cycle looks like this:

Vena Cava→Right Atrium→ Tricuspid Valve→ Right Ventricle→ Pulmonary Valve→Pulmonary Arteries→Lungs→Pulmonary Veins→Left Atrium→Mitral Valve→Left Ventricle→Aortic Valve→Aorta

Note that the first step is simply labeled “Vena Cava”, because there are two Vena Cavas: the Superior Vena Cava and the Inferior Vena Cava. The Superior Vena Cava brings blood from the upper half of the body and the Inferior Vena Cava brings blood from the lower half of the body. Both vessels send blood into the Right Atrium.

The Pulmonary Arteries and Veins seem to be backwards: The Pulmonary Arteries carry deoxygenated blood, while the Pulmonary Veins carry oxygenated blood. It doesn’t make any sense until you remember another definition of arteries and veins: arteries carry blood away from the heart, while the veins carry blood towards the heart. Since the Pulmonary Arteries carry blood from the heart to the lungs, and the Pulmonary veins carry blood from the lungs to the heart, this conundrum is solved!

Once you understand how a heart is supposed to work, you need to know how your heart works. Ask your parents, and ask your Cardiologist.

Your parents are going to be a great source of information, but remember something important: They were riding a wave of emotion when you were born, when you were diagnosed, and any time you went through an operation. Their memories are going to be clouded by that emotion. So ask your Cardiologist too, and use your critical thinking skills to combine the information you get from both sources.

Your doctor can also draw diagrams to help you understand, and you can test your knowledge of the medical terminology by talking with him or her. And if the doctor throws something at you that you don’t understand, you can always ask them to explain it in plain English!

If you have a Cyanotic heart defect, you should learn why it is called Cyanosis (From the word Cyan, which means blue) and what causes you to be Cyanotic.

You should learn what might happen to you down the road – any future operations that you may have to prepare for, and new medical advances. So read the medical literature. This is easier now than when I was trying to learn about my heart. Medical Journals are expensive, but a lot of information is available on the internet. Just enter your diagnosis into a search engine and click the enter button. Back in the old days I had to have a medical dictionary to figure out what some of the words meant, now you can just Google whatever you don’t understand. Be prepared to do a lot of Googling, especially at first! But don’t let that discourage you.

You will have to learn how to read carefully to see what an article is really saying. As I have mentioned before, if you do an internet search for Congestive Heart Failure, you’ll see that the  average time of survival after diagnosis is five years. That can be depressing… until you read further and learn that the study group included some very sick patients. So the “five years” isn’t true, a lot of it depends on how motivated the patient is. There’s really no way to teach this skill, you just have to read and learn.

And be prepared to find out some information that you may not want to know. You doctor may tell you that they have done all the surgical procedures that are possible, and from here on your life is going to be based on how well you take care of yourself. You may find a study that says CHDers don’t live as long as heart healthy people. That’s true – and almost every CHDer who has thought about it realizes that we might not be around as long as everyone else.

But remember that those medical journals can not account for the medical advances of the future. Seventy years ago, a kid with a heart defect lived a sad, miserable life and the vast majority of us died before our first birthday. And twenty five years ago, children born with Hypoplastic Left Heart Syndrome (HLHS) didn’t live a week. All that has changed! And Medicine makes new advances every day!

But it is not about length of life, but quality of life – and as long as you live your life to the fullest, figure out how to do what you want to do despite your health limitations – never give up and never give in! – then you will have become a true Heart Warrior!