Arthrography

Medical- Medicine

How does the procedure work?

An x-ray of the right shoulder prior to injection of contrast material.

An x-ray of the right shoulder prior to injection of contrast material.

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images are also captured and stored either on film or electronically on a computer.

Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not depend on ionizing radiation. Instead, while in the magnet, radio waves redirect the axes of spinning protons, which are the nuclei of hydrogen atoms, in a strong magnetic field.

The magnetic field is produced by passing an electric current through wire coils in most MRI units. Other coils, located in the machine and in some cases, placed around the part of the body being imaged, send and receive radio waves, producing signals that are detected by the coils.

A computer then processes the signals and generates a series of images each of which shows a thin slice of the body. The images can then be studied from different angles by the interpreting radiologist.

Frequently, the differentiation of abnormal (diseased) tissue from normal tissues is better with MRI than with other imaging modalities such as x-ray, CT and ultrasound.

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Arthrography

Medical- Medicine

What does the equipment look like?

Radiography equipment

Radiography equipment

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and an image intensifier that is suspended over a table on which the patient lies.
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a moveable examination table that slides into the center of the magnet.
Some MRI units, called short-bore systems, are designed so that the magnet does not completely surround you; others are open on the sides (open MRI). These units are especially helpful for examining patients who are fearful of being in a closed space and for those who are very obese. Newer open MRI units provide very high quality images for many types of exams; however, open MRI units with older magnets may not provide this same image quality. Certain types of exams cannot be performed using open MRI. For more information, consult your radiologist.
The computer workstation that processes the imaging information is located in a separate room from the scanner.
Other equipment necessary for performing arthrography include a variety of needles, syringes and a water-soluble contrast material.

Arthrography

Medical- Medicine

How should I prepare?

No special preparation is necessary before arthrography. Food and fluid intake do not need to be restricted, unless a sedative will be given.
You should inform your physician of any medications you are taking and if you have any kidney problems or allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.
Some MRI examinations may require the patient to receive an injection of contrast into the bloodstream. The radiologist or technologist may ask if you have allergies of any kind, such as allergy to iodine or x-ray contrast material, drugs, food, the environment, or asthma. However, the contrast material used for an MRI exam, called gadolinium, does not contain iodine and is less likely to cause side effects or an allergic reaction.
The radiologist should also know if you have any serious health problems or if you have recently had surgery. Some conditions, such as severe kidney disease, may prevent you from being given contrast material for having an MRI.
If you are scheduled to have MR or CT arthrography and have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician about being sedated prior to the scheduled examination.
Jewelry and other accessories should be left at home if possible, or removed prior to the MRI scan. Because they can interfere with the magnetic field of the MRI unit, metal and electronic objects are not allowed in the exam room. These items include:
jewelry, watches, credit cards and hearing aids, all of which can be damaged.
pins, hairpins, metal zippers and similar metallic items, which can distort MRI images.
removable dental work.
pens, pocketknives and eyeglasses.
body piercings.
In most cases, an MRI exam is safe for patients with metal implants, except for a few types. People with the following implants cannot be scanned and should not enter the MRI scanning area unless explicitly instructed to do so by a radiologist or technologist who is aware of the presence of any of the following:
internal (implanted) defibrillator or pacemaker
cochlear (ear) implant
some types of clips used on brain aneurysms
some types of metal coils placed within blood vessels
You should tell the technologist if you have medical or electronic devices in your body, because they may interfere with the exam or potentially pose a risk, depending on their nature and the strength of the MRI magnet. Examples include but are not limited to:
artificial heart valves
implanted drug infusion ports
implanted electronic device, including a cardiac pacemaker
artificial limbs or metallic joint prostheses
implanted nerve stimulators
metal pins, screws, plates, stents or surgical staples
In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure. If there is any question of their presence, an x-ray may be taken to detect the presence of and identify any metal objects.
Patients who might have metal objects in certain parts of their bodies may also require an x-ray prior to an MRI. You should notify the technologist or radiologist of any shrapnel, bullets, or other pieces of metal which may be present in your body due to accidents. Dyes used in tattoos may contain iron and could heat up during MRI, but this is rarely a problem. Tooth fillings and braces usually are not affected by the magnetic field but they may distort images of the facial area or brain, so the radiologist should be aware of them.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.
Though MRI does not use ionizing radiation, women should still inform their physician and technologist if they may be pregnant.
Children younger than teenagers may need to be sedated in order to hold still for the procedure. Parents should ask about this beforehand and be made aware of food and drink restrictions that may be needed prior to sedation.
You should plan to have a relative or friend drive you home after your procedure.

Arthrography

Medical- Medicine

What are some common uses of the procedure?

Arthrographic images help physicians evaluate alterations in structure and function of a joint and help to determine the possible need for treatment, including arthroscopy, open surgery or joint replacement.

The procedure is most often used to identify abnormalities within the:

  • shoulder
  • wrist
  • hip
  • knee
  • ankle

The procedure is also used to help diagnose persistent, unexplained joint pain or discomfort.

Arthrography

Medical- Medicine

What is Arthrography?

Arthrography is medical imaging to evaluate conditions of joints. There are several methods to do this.
Conventional arthrography is the x-ray examination of a joint that uses a special form of x-ray called fluoroscopy and a contrast material containing iodine. Alternate methods of arthrography examinations use magnetic resonance imaging (MRI) or computed tomography (CT).
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
Fluoroscopy makes it possible to see bones, joints and internal organs in motion. When iodine contrast is injected into the joint, it fills the entire joint and appears bright white on an arthrogram, allowing the radiologist to assess the anatomy and function of the joint. Although the injection is typically monitored by fluoroscopy, the examination also involves taking radiographs for documentation. The images are most often, but not always, stored or viewed electronically.
MR arthrography also involves the injection of a contrast material into the joint, just like in conventional arthrography, except that the MR contrast material is different and contains gadolinium, which affects the local magnetic field. As in conventional arthrography, the contrast material outlines the structures within the joint and allows them to be evaluated by the radiologist.
MRI uses a powerful magnetic field, radiofrequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. The images can then be examined on a computer monitor, printed or copied to CD. MRI does not use ionizing radiation (x-rays).
CT arthrography uses the same type of contrast material as conventional arthrography and may be supplemented by air to produce a double contrast CT arthrogram. CT makes cross sectional images processed by a computer using x rays.

Heart problems in babies

Heart Disease

One baby in 100 is born with heart or circulation problems. With improvements in ultrasound scan techniques, most can now be detected while the baby is still in the womb

Causes of heart problems

It’s thought that most heart problems in babies are due to faulty genes. From conception, when sperm and egg combine, a complex construction process occurs to create a human embryo. We all carry a small number of faulty genes and if there’s a fault in the gene signalling, a structural heart problem may appear.

In small communities, where relatives are more likely to marry, there is less variation in the genes and it is more likely that both parents will carry the same rare genetic faults. This situation is known as a small gene pool, and it’s dangerous because genetic conditions such as heart abnormalities are more likely to occur. In larger communities, where there’s more mixing of different genes, genetic problems are less common.

A proportion of babies with heart malformations have problems with the chromosomes, which can be detected by tests during pregnancy, providing an early clue that the child may be at particular risk. For example, many pregnant women are screened for Down’s syndrome (where there are three rather than two copies of chromosome number 21), in which up to 40 per cent of babies are born with a heart problem.

There are other causes of congenital heart disease too. For example, mothers with diabetes have a two per cent chance of having a baby with a heart problem.

However, most of the babies born with heart problems don’t come from high-risk groups. The reason is simply that this is a comparatively rare, almost unpredictable condition – and there are only small numbers of high-risk people in the population.

Diagnosing heart problems

The majority of heart problems in babies are detected at a routine ultrasound scan, usually at 18 to 20 weeks, although some aren’t discovered until after the birth. If you have worries, talk to your GP or obstetrician. If they suspect problems, they may refer you to a specialist unit for further tests.

At about 19 weeks gestation, a baby’s heart is less than 1cm across and weighs only 1g or so (compared with 500g for an average adult heart). It also beats more than twice as fast as an adult’s.

The circulation of a foetus is different from that of a newborn baby, being connected to a placenta and having three extra channels that must close or reverse at birth.

Good-quality ultrasound equipment is essential to look at the tiny, fast-moving cardiac structures. Even so, ultrasound images appear grainy – it requires practice and an experienced eye to identify problems.

Advances such as the colour flow doppler detect the movement of red blood cells, highlighting areas of abnormal blood flow that may indicate circulation problems. These may have been missed by a conventional scan.

Hardening of the arteries

Heart Disease

Symptoms of hardening of the arteries

Symptoms include:

  • Pain in the calf muscles, thighs or buttocks when walking or exercising
  • Trouble sleeping

If untreated, it can also cause:

  • Angina
  • Heart attack
  • Stroke
  • Gangrene of the leg

Causes of hardening of the arteries

The causes are unknown, but it may be due to high cholesterol and fat levels in the blood, high blood pressure and smoking. Deposits build up on the artery wall, and may stimulate the cells in the wall to produce further substances adding further layers of blockage. Fat builds up around and within these cells causing narrowing, or stenosis.

The inner layer of the artery wall thickens considerably, reducing the blood flow and starving the heart and/or brain of oxygen. A blood clot can also form, blocking off the artery completely. The arteries of the leg are often affected, as well as abdominal arteries and those near the pelvis – iliac arteries. This is called peripheral arterial disease.

Risk factors include:

  • Smoking
  • High cholesterol levels
  • Diabetes
  • Obesity
  • Family history

Congenital heart defects

Heart Disease

Causes of congenital heart defects

Causes are thought to include:

Development problems during pregnancy, sometimes as a result of a viral infection such as rubella contracted by the mother
Alcohol, illegal drugs and over-the-counter medicines can also cause defects
Maternal diabetes
Genetic conditions, such as Down’s syndrome

Diagnosing congenital heart defects

Diagnosis can be made by scans taken during pregnancy, but is usually made in the first days or weeks after birth. In some cases, however, diagnosis may not be made until much later in life.

Congenital heart defects

Heart Disease

Types of congenital heart defect

Holes in the heart can occur:

  • In the upper chambers (atrial septal defects)
  • In tower chambers (ventricular septal defects)
  • Between all four chambers (atrioventricular septal defects)
  • In the great artery, which is called patent ductal arteriosus

The holes are part of the circulation system in the foetus but should close up after birth.

More complex conditions include tetralogy of Fallot. The main symptom is cyanosis, and for this reason babies with this problem are commonly known as ‘blue babies’.

In tetralogy of Fallot, the baby has a large hole in the heart, allowing blood to pass from the right ventricle to the left without going through the lungs. There is a narrowing at or just below the pulmonary valve, the right ventricle is more muscular than normal and the aorta lies directly over the hole – the ventricular septal defect.

Babies may have rapid breathing or fall unconscious. Older children may become short of breath and faint.

An obstruction, or stenosis, can occur between the valves between the upper and lower chambers of the heart. More frequently, the obstruction is between the ventricles and trunks coming from them, either the valve to the lungs or the valve to the body.

Only severe aortic stenosis requires surgery, and some children may have the condition without showing any symptoms. The obstruction can also be within the vessels themselves. In this case, the narrowing is within the artery and effects supplies of blood to different parts of the body. This defect may not be picked up for many years.

Cardiovascular disease

Heart Disease

Cholesterol and CVD

Reducing the proportion of fat in your diet, especially saturated fat, can help to reduce blood cholesterol levels. There’s a strong link between high blood cholesterol levels and the risk of heart disease. For those who don’t have CVD or aren’t considered to be at high-risk of CVD, normal blood cholesterol levels are below 5mmol/litre. This can be measured by your GP. People with average energy needs should aim to consume no more than 70g/day of fat and less than 20g/day of saturated fat.

Trans-fatty acids are a particular kind of fat that are naturally occurring in meat and dairy products but may also be produced when plant-based oils are hydrogenated to produce solid spreads, such as margarines. They’re often found in confectionery and processed food like pastry, biscuits and cakes. They’ve been found to have the same effect on cholesterol levels as saturated fat and should be avoided as much as possible. Thankfully, many manufacturers have now modified processing techniques to keep these fats to a minimum. Check labels for hydrogenated fats.

When reducing total fat, it’s important not to cut out the heart healthy fats from your diet including mono and poly-unsaturated fats and omega-3, mostly found in plant and fish oils.

How to modify your fat intake:

  • Use butter and other spreads sparingly
  • Choose lean cuts of meat or trim fat off
  • Grill, bake or steam food rather than frying
  • Swap saturated fats such as butter for unsaturated oils such as sunflower, rapeseed or olive oil
  • Limit your intake of trans-fats from processed food
  • Eat two to three portions of oily fish each week (e.g. sardines, mackerel, fresh tuna, salmon)

Essential fatty acids

Essential fatty acids such as omega-3s, which are found in oily fish, have been shown to reduce the risk of CVD by lowering blood triglycerides, reducing blood clotting and regulating heart rhythm. For general heart health, try to eat two portions of fish per week, one of which should be oily.

Stanols and sterols

Certain plant-derived compounds, called stanol or sterol esters have been shown to reduce cholesterol levels. Spreads, yoghurts, drinks and soya ‘dairy alternatives’ are now available containing these products. These sterol enriched foods may be particularly useful for those with raised blood cholesterol which has remained elevated even after making other dietary changes. Clinical trials show that when used regularly, they can reduce high cholesterol levels.

Fruit and vegetables

Fruit and vegetables are rich in many essential nutrients including vitamins C and E and carotenoids (which are all antioxidants). They may help to protect the heart by limiting the damaging effects of cholesterol on body tissues. Aim for at least five servings of fruit and vegetables a day. (See the Fruit and Vegetables article for more information on what a serving is.)

Wholegrains and fibre

Studies of large groups of people in the US have shown that diets rich in wholegrain food can reduce the risk of CVD by up to 30 per cent. You can include wholegrain food in every meal by choosing wholemeal bread and wholegrain varieties of pasta and rice.

Soluble dietary fibre, found in oats, beans and pulses, can help to lower LDL cholesterol. These foods should be included as part of an overall healthy balanced diet, at least two to three times each week.

Soya protein

A diet that includes at least 25g of soya per day has been associated with reductions in LDL cholesterol and CVD. Soya isoflavones in particular have been shown to reduce CVD risk as they inhibit the growth of cells that form artery-clogging plaque. Soya protein is also an excellent substitute for meat and is available in a convenient and tasty form in many ready-made meals. Another good source of soya protein is soya milk and yoghurt.

The British Heart Foundation has an excellent range of resources giving information about reducing your risk of cardiovascular disease.

Rest and relaxation

While exercise can help lower blood pressure and strengthen your heart, rest and relaxation can reduce your levels of anxiety and improve your reactions to stress – both of which can affect the blood vessels and heart. All of us have to contend with major life events from time to time such as a divorce, bereavement, job loss or financial problems. However, there’s also a wide range of everyday events (being stuck in traffic, a row with your partner or a disagreement with someone at work) that can be stressful – and these everyday irritations may be even more stressful because they are constant.

Ways to manage stress

  • Keep a diary: make a note of stressful situations and how your react to them. This will help you identify what stresses you out, so you can begin to change your reactions.
  • Stay positive: your thoughts control your feelings. If you stop and listen to your emotions, you may be surprised to discover how negative they are. Replacing negative thoughts with positive ones will help you deal with stressful situations more calmly.
  • Learn to relax: pay attention to your posture and consciously relax physically. You may also want to try a technique such as yoga, massage, meditation or other complementary therapies.
  • Get as much sleep as you need: we all need different amounts of sleep and you will know how many you need to feel refreshed. Try to get this amount of sleep most nights.

Smoking and alcohol

Smoking and drinking are both linked with heart disease. But while there are no potential health benefits from smoking, moderate drinking can help to protect your heart.

Smoking

One of the most important things you can do to reduce your risk of heart disease is to stop smoking. Smokers younger than 50 are five times more likely than non-smokers to die of coronary heart disease. By stopping, you not only lower your risk of heart disease but also help reduce your risk of lung diseases such as cancer and chronic obstructive pulmonary disease (COPD). The key to successful quitting is to pick a method that’s right for you. For example, if you’re motivated by other people and enjoy their company, you may find encouragement and support by joining a group.

If you prefer to go it alone, you may find it helpful to buy a book or tape. Your GP can prescribe aids such as nicotine replacement therapy or, alternatively, you may benefit from a complementary therapy such as acupuncture.

Drinking alcohol

Consuming moderate amounts of alcohol – between one and two units a day – has been found to reduce the risk of CVD. Alcohol can increase HDL cholesterol and makes it less likely that clots will form. However, high intakes of alcohol are associated with increased risk. It’s also worth noting that saving up your weekly units for a weekend binge doesn’t offer the same benefits.

There’s no need to give up alcohol altogether but it’s important to drink sensibly.

Always eat when you drink: take a tip from the Mediterranean countries and always have a meal or snack when you drink alcohol. Know your limits: To reduce the risk of coronary heart disease, don’t exceed 1-2 units of alcohol a day. A unit is equal to half a pint of regular strength beer or lager, one small glass of wine or a small (pub measure) of spirits. Watch your glass size: it’s easy to exceed safe limits by using a bigger glass.

Mix and match: if you’re at a party or drinking socially, try to have a non-alcoholic drink for every alcoholic drink you consume. Once you’ve consumed your daily units, drink only soft or non-alcoholic drinks.

Regular monitoring

People should also have regular blood pressure readings, height and weight monitoring, and tests for cholesterol levels. Those with high levels should be encouraged to improve their diet and can be treated for poor cholesterol levels with drugs – usually, statins or niacins.

The American Heart Association recommends that blood pressure should be no more than 140 over 90 Hg. The association recommends a series of diets, with no more than 30% of calories coming in the form of fats, and limiting calories in the form of saturated fats to between 7 and 10%.

Cardiovascular disease

Heart Disease

Risk factors for CVD

Some risk factors for CVD are potentially reversible or can be modified. These include:

  • Cigarette smoking
  • Increased levels of LDL cholesterol
  • High triglycerides (caused by the build up of fats derived from foods eaten or made in the body from other energy sources)
  • Low HDL cholesterol
  • Being overweight
  • Large waist circumference (being ‘apple-shaped’)
  • High blood pressure
  • Inactivity
  • Diabetes

Diet and CVD

Making small changes to your diet is one of the simplest and most effective ways to reduce your risk of CVD. You can do this by:

  • Reducing fat in your diet, especially saturated and trans-fats
  • Eating more fruit and vegetables, wholegrain food and soluble fibre
  • Drinking alcohol in moderation
  • Reducing salt to maintain a lower blood pressure

Cardiomyopathy

Heart Disease

Restrictive cardiomyopathy

Restrictive cardiomyopathy is the least common form and occurs when the heart muscle of the ventricles, or myocardium, is excessively rigid, impairing the filling of the ventricles with blood between heartbeats. Tiredness, shortness of breath and swollen feet and hands typically occur.

Arrhythmogenic right ventricular cardiomyopathy

In another form of cardiomyopathy, the heart muscle is replaced by fibrous scar and fatty tissue. This may occur after a heart attack, where muscle is damaged – the right ventricle tends to be most affected. The right side of the heart may first thicken and later dilate – become thinner. It may lead to disordered electrical activity, and in some cases problems with the heart’s pumping action.

Cardiomyopathy

Heart Disease

Dilated cardiomyopathy

Dilated, or congestive, cardiomyopathy is more common and occurs due to enlarging and stretching of the heart cavity, weakening the heart so it doesn’t pump normally.

The heart muscle becomes weak and too flexible, preventing it pumping blood efficiently around the body. Because the heart is stretched or dilated, the valves may not close very well and may become leaky. Breathlessness results as fluid builds up in the lungs, congesting them. This is called left heart failure. There may also be right heart failure, where fluid accumulates in the tissues and organs of the body, usually the legs and ankles, and the liver and abdomen. Disruption of the heart’s electrical rhythm also often occurs.

The cause of the condition is unknown in many cases, but it can be caused by infection with a virus, auto-immune diseases such as rheumatoid arthritis, excessive consumption of alcohol or, rarely, as a result of pregnancy – peri-partum cardiomyopathy.

Shortness of breath, palpitations, tiredness, swollen ankles and angina are common symptoms. Blood clots often form because the blood is flowing more slowly through the heart. These clots may break free and move to the lungs causing pulmonary emboli or to the brain causing a stroke.

Treatment may include anti-clotting drugs to prevent emboli, and medication to prevent arrhythmias and help the heart to work more efficiently. Any underlying cause should be identified and treated too. In severe cases a heart transplant may be necessary.

Cardiomyopathy

Heart Disease

Hypertrophic cardiomyopathy

The heart muscle thickens greatly (often asymmetrically) and the muscle cells may become disorganised (which can interfere with the passage of electrical signals through the muscle), without any obvious trigger. In most cases the disease is hereditary, resulting from a gene abnormality. The disease is thought to affect at least 125,000 people in the UK.

In one form of hypertrophic cardiomyopathy (hypertrophic obstructive cardiomyopathy or HOCM) the muscle mass of the left ventricle and the wall that divides it from the right side of the heart (the septum) becomes larger than it should be. This leads to narrowing of the passage through the heart and obstruction of the blood flow out of the heart.

In addition the muscle is stiff and has difficulty relaxing, increasing the amount of pressure required to expand the heart while blood flows in. This reduces the blood holding capacity of the heart.

The altered structure may distort the mitral valve between the chambers of the heart (the left atrium and left ventricle) which may then leak. It’s also known as asymmetric septal hypertrophy (ASH) or idiopathic hypertrophic subaortic stenosis (IHSS).

The condition can be present in the foetus and cause stillbirth, or may develop in infancy. But, more usually, it develops during childhood or early adulthood.

In another form of the disease, non-obstructive hypertrophic cardiomyopathy, the enlarged muscle doesn’t obstruct the blood flow.

The symptoms of hypertrophic cardiomyopathy include shortness of breath on exertion, dizziness, fainting and angina pectoris (angina is chest pain or discomfort caused by reduced blood supply to the heart muscle.) The obstruction to blood flow from the left ventricle increases the ventricle’s work, and a heart murmur may be heard. Some people have cardiac arrhythmias. These are abnormal heart rhythms that in some cases can lead to sudden collapse and death.

Treatment, which includes anti-arrhythmia drugs, aims to control symptoms and prevent complications such as sudden collapse. Surgery may be necessary to remove some of the muscle or repair the mitral valve. A special device called an implanted cardioverter defibrillator (ICD) may need to be put into the heart to deliver and electric shock which will get the heart back into a normal heart rhythm whenever arrhythmias occur, in order to prevent sudden death.

Because there may be a genetic cause, other members of the family should be screened to check for the faulty gene.

Cardiomyopathy

Heart Disease

What is cardiomyopathy?

Cardiomyopathy is a disease that changes the structure of the muscle tissue in the heart, or makes it weaker, so it’s less able to pump blood efficiently.

Symptoms may appear suddenly with loss of consciousness, or there may be warning signs such as pain in the chest (angina), unexplained breathlessness or a rapid heartbeat (palpitations or arrhythmia).

Cardiomyopathy may be either:

  • Primary – no specific cause can be identified
  • Secondary – causes can be identified, such as hypertension (high blood pressure), heart valve disease, artery diseases or congenital heart defects, as well as disease affecting organs other than the heart. Alcohol and drug use (both street drugs and medical drugs) can also cause cardiomyopathies

There are three main types of cardiomyopathy or disease of the heart muscle:

  • Hypertrophic cardiomyopathy – the most common cause of sudden and unexpected death in people under 30
  • Dilated cardiomyopathy – the most common type of cardiomyopathy
  • Restrictive cardiomyopathy – the least common type, usually seen in the elderly
  • Symptoms of cardiomyopathy

    The symptoms may depend on the type of cardiomyopathy. It may present at any age, causing:

    • Breathlessness on exercise
    • Chest pain
    • Palpitations
    • Dizziness
    • Collapse with loss of consciousness
    • Tiredness and general lack of energy
    • Blood clot formation with pulmonary emboli or stroke
    • In the most severe cases, sudden death

Aortic stenosis

Heart Disease

Symptoms of aortic stenosis

If the aortic stenosis is mild, there may be no symptoms at all, or tiredness may be the only symptom. If the stenosis is greater, other symptoms may include chest pain and/or breathlessness during exertion, palpitations, dizziness and fainting, especially during exertion.

Heart failure may develop, causing symptoms that include tiredness, breathlessness and fluid retention in the legs, for example.

Heart attack recovery

Heart Disease

Psychological issues

Depression affects one in four people after a heart attack. It’s critical to address any depression – it won’t just go away on its own and it can make it harder for you to make any necessary lifestyle changes or follow your doctor’s advice on particular treatments. Without specific help, those who become depressed don’t recover as well as they might.

If you take part in a cardiac rehabilitation programme, it will be able to offer treatments ranging from medication to group therapy and stress management (stress and anger may contribute to a heart attack by producing changes in your body that increase your risk of blood clots).

Heart attack recovery

Heart Disease

Back to normal

In uncomplicated cases, you should be back to your normal routine after six to 12 weeks.

  • Work – exactly when you return depends on your job and how serious the heart attack was. Take it in stages and rest when you feel tired. Some very physical jobs may be beyond your ability at first.
  • Driving – avoid long journeys and stressful driving situations, such as in a city or in the rush hour.
  • Sex – many people worry that sexual activity may be too strenuous after a heart attack, but research shows these fears are generally unfounded. Like all exercise, take it slowly at first.

Heart attack recovery

Heart Disease

Rehabilitation after a heart attack

The first 48 hours after a heart attack are critical. After this, recovery begins. Within a few days, the tissues of the heart begin to heal and, if there are no complications, you may be discharged from hospital after five to seven days.

As the weeks pass, the damaged muscle is replaced by scar tissue. This process takes six to 12 weeks, during which time you should be increasing your activity levels gradually.

Many people are terrified of exercising after a heart attack for fear that it will trigger another attack, but exercise helps to speed recovery.

A gradual increase in exercise helps the heart to get back in shape and adapt to any scars left behind. It also improves general wellbeing and encourages good quality and regular sleep. It helps test out the heart, so the patient and doctor become aware of any residual problems, such as angina or breathlessness.

Always follow expert advice regarding this gradual increase in exercise. Never overdo things. Excessively vigorous exercise, especially if it includes isometric exercise, can increase the risk of another heart attack.