From the Heart
February is an ideal time to think about the heart—not just in a Valentine way, but in the context of keeping your blood circulating and your body functioning. As wonderful and complex a machine as the human heart is, it’s also subject to potential health problems. This month, we’re looking at three types of conditions that affect this magical muscle—and how modern medicine can address them.
congenital heart defects
These are genetic problems with the structure of the heart or major blood vessels, and they can range from serious to hardly noticeable, doctors say. Common congenital conditions include abnormal valves that don’t push blood properly through the heart’s chambers, and holes in the heart muscle wall.
Dr. R. Mark Grady, associate professor of pediatrics at Washington University School of Medicine, says congenital heart defects are more common than you might think. “Babies born with heart defects can be as many as 75 out of every 1,000 live births,” he notes. “With really serious conditions, it’s about six out of every 1,000.”
In the past, Grady says, a patient’s only option for a bad valve or other defect was to have open-heart surgery. Newer procedures, however, are far simpler and involve much less recovery time. “Now, we can fix a heart valve through a cardiac catheterization,” he says. “The catheter goes in through a blood vessel in the leg and up into the heart. Through the catheter, we implant a new valve, either a transplanted human or animal one, or an artificial one.”
The catheter procedure is a real boon for young patients, Grady says. It can save them from needing multiple open-heart valve replacement surgeries as their bodies grow. And it usually requires only an overnight hospital stay compared to several days for an open-heart procedure, he notes. “In general, the insurance companies are willing to approve these catheter procedures because they are much less invasive, and they certainly beat a long and expensive stay in the hospital.”
Dr. David Kardesch, an interventional cardiologist at SSM Health St. Joseph Hospital-St. Charles, says many people have minor congenital heart defects that don’t show up until later in life when they have tests for other conditions. “As a young adult, the person may be fine,” he notes. “Then he or she develops diabetes, high blood pressure or an arterial blockage later, and tests for those conditions uncover a congenital heart problem.”
Minor defects are more common because people tend to survive them and may not even know they have them, according to Kardesch. “Small septal (heart wall) defects or holes and valve problems may have very little consequence for the person’s health,” he says. “They may require nothing more than regular monitoring by a doctor. It’s like having a birthmark: it’s not harming you, but it’s there.”
Grady says there is a recent push to screen all newborns for congenital heart problems, which don’t always produce obvious symptoms. “The American Board of Pediatrics is advocating a pulse oximeter test to look for oxygen saturation levels in every newborn’s blood,” he says. Doctors don’t have to take blood for this test; it involves a sensor placed on the hand and foot, and uses light wavelength technology to detect low oxygen levels that may be a subtle sign of heart defects.
Patients with more prominent congenital heart problems may see symptoms like irregular heartbeats, shortness of breath, dizziness and weakness, Kardesch notes. When these occur, it’s important to see a doctor right away.
Dr. Jeremy Leidenfrost, a cardiothoracic surgeon at St. Luke’s Hospital, says mitral regurgitation is a serious heart condition that can be congenital and may require surgery. But it also can go undetected if the patient doesn’t have noticeable symptoms.
He describes it as an incomplete closing of the heart’s mitral valve that causes blood to leak backward toward the lungs instead of being pumped out to the rest of the body. It happens when the valve, a double flap between the heart’s left atrium (upper chamber) and left ventricle (lower chamber), is misshapen. When working properly, the valve keeps blood flowing smoothly from the atrium to the ventricle; when not, it can lead to heart failure, Leidenfrost says.
“Mitral regurgitation is first diagnosed by listening to the heart,” he notes. “After that, the patient may have an echocardiogram to look at the valve and see if it’s leaking. If it is, and it’s severe, it’s usually treated with surgery.” The abnormal valve tissue can be surgically cut away, replaced with an artificial valve or repaired with stitches, he says. There’s also a less-invasive catheter procedure called MitraClip that can help correct the problem for patients who are too ill for surgery. And less serious cases of the condition may be treatable with drugs, Leidenfrost adds.
Newer mitral valve surgeries involve smaller incisions and are less invasive than past procedures, he notes. And the latest diagnostic technology, including 3-D echocardiography, can help doctors get more detailed images of the valve so they can understand how to fix it before the patient goes into surgery. “With earlier procedures, the surgeon had to open up the patient, see the problem and then decide what to do,” he says.
Symptoms of mitral regurgitation can include chest pain, shortness of breath and irregular heartbeat, according to Leidenfrost. Again, it’s important to see a doctor if you experience this.
‘Statins’ are a class of drugs that control cholesterol, a waxy substance that your body makes and that is also found in some foods. It can cause blood vessel blockage and contribute to serious cardiovascular disease, doctors say. Cholesterol-lowering drugs like atorvastatin, simvastatin and rosuvastatin are called ‘statins’ because of their common suffix. The medicines are used to treat patients who have high cholesterol, and to help prevent it in people who are at risk.
Statins have been around for many years and are considered effective and safe, says Dr. Denise Janosik, a Mercy Hospital St. Louis cardiologist and medical director of its Lipid Center. “Statins lower the risk of heart disease and stroke,” she notes. “One reason they work so well is that they’re not just about lowering cholesterol; they also reduce inflammation, which has a positive effect on blood vessels.”
Dr. Mark Friedman, a cardiologist at SSM Health St. Mary’s Hospital, says the patents on some statins such as Crestor (rosuvastatin) recently have expired, and they now can be dispensed as generics at a lower cost. “You might find a generic statin on the $4 price list at your pharmacy,” he says. Friedman explains that there have been recent advancements in other drugs to combat high cholesterol, but statins likely will remain the medical profession’s main choice because of their long safety record and affordability. “The new drugs, PCSK9 inhibitors, recently were approved for use and can lower LDL cholesterol by a significant amount,” he says. But they’re generally for patients in the highest disease risk categories, and they haven’t yet established the long safety history that statins have. Plus, their cost is still far higher than that of statins, Friedman notes.
Although statins are known to be safe, there are some patients who shouldn’t take them, Janosik says. These include people with allergies to the medicine, some patients with liver or kidney disease, pregnant and nursing women, and those who plan to get pregnant.