Heart disease affects more than just this vital organ. Discover how the rest of your body is impacted by the No. 1 killer.
When people talk about heart disease, the focus is almost always on the big three – heart attack, valve disease and atrial fibrillation – but the heart may suffer many other conditions as well. In truth, heart disease, the No. 1 killer of men and women, is a threat at any age, and its impact on our bodies extends well beyond the heart.
Development In Utero
For some, heart disease begins before birth. Dr. Faheem Uraizee, a board-certified neonatologist, treats the tiniest patients at Advocate Good Shepherd Hospital in Barrington.
“It’s very possible to detect at-risk infants by fetal ultrasound screening,” he says. “An obstetrician who suspects heart problems before birth allows specialists a good view of the heart, to see if all of the blood vessels align properly, and to ensure that there are no other visible problems.”
Of the heart’s four chambers, the left two pump blood throughout the body, while the right two send blood to the lungs, where vital oxygen is infused. Before birth, problems within these chambers may not be evident, but once the child is born, things can go wrong fairly quickly.
“With hypoplastic left heart syndrome, for example, the left ventricle [lower chamber] doesn’t develop properly,” Uraizee says. “This forces the right-side chambers to not only recirculate blood to the lungs but also to pump blood through the entire body. When we pick up signs that a fetus has this syndrome, we’re prepared to provide immediate treatment. Then the infant can be transferred to a medical center, where he or she will undergo corrective surgery or a heart transplant.”
If the syndrome goes undetected prior to birth, Uraizee adds, the passage between the left and right ventricles closes off. When this happens, often at the hospital or shortly after the infant goes home, the baby may turn blue and go into shock.
“Another serious condition involves the transposition of the heart’s major blood vessels,” Uraizee says. “Instead of going into the right ventricle for re-oxygenation, the blood returning from the body to the heart is returned to the body directly, without the necessary oxygen.”
This condition, known as an atrioventricular canal defect (AV canal), can be diagnosed with a level 2 ultrasound screening during pregnancy. If discovered prenatally, arrangements can be made for the baby to be delivered in a designated Level III center where pediatric heart surgeons are on site.
“AV canal is not uncommonly seen in babies with Down syndrome,” Uraizee says. “In AV canal, the heart’s chambers openly communicate with each other. Left and right ventricles normally are separated by the septum, but with AV canal, the center of the heart is open. Oxygenated and deoxygenated blood mingle. Over time, these babies can go into progressive heart failure.”
While babies with AV canal won’t get into trouble instantaneously, they need to be closely monitored for signs of heart failure. “We listen closely for heart murmurs, but we don’t always know until a crisis occurs,” says Uraizee.
Knowledge is perhaps the best defense against prenatal and infant heart disease.
“For parents with a family history of early heart disease or previous incidents of prenatal heart problems, we can be prepared,” Uraizee says. “By being aware of the potential for heart problems, and by close monitoring, especially in cases where Down syndrome is detected in utero, we can help these tiny patients to survive.”
Disease by Infection
Bacterial and viral infections are lesser known causes of heart disease, but they’re just as serious. Dr. Syed Hasan, a board-certified cardiologist practicing at Advocate Sherman Hospital in Elgin, says the most common case involves untreated or undertreated Streptococcus (strep) that can create pockets of infection around heart valves.
“This usually occurs in either of the two valves on the left side of the heart (aortic and mitral valves),” he explains. “When the affected valve is occupied by infection, a pocket of infection called a vegetation can develop and interfere with proper function of the valve. In addition, abscesses can form in the heart muscle surrounding the valve.”
According to Hasan, the heart is vulnerable to infection because bacteria flow freely through the bloodstream during a strep infection, but tend to migrate onto the heart valves. While anyone may develop such an infection, patients with congenital valve disease are particularly at risk.
“Artificial valves are also vulnerable,” Hasan says. “Patients who’ve had valves replaced are always at risk. This is why, when patients are scheduled for extensive dental work or invasive surgery, we prescribe a course of antibiotics prior to the procedures. This reduces the risk, by temporarily lowering the levels of bacteria within the bloodstream. The short-time treatment can be enough to prevent more serious infections.”
Strep bacteria also cause rheumatic fever, and if untreated, rheumatic heart disease. Untreated rheumatic fever inflames the mitral valve and, over time, diminishes the valve’s elasticity.
“Today, strep infections are promptly treated with antibiotics, before the full effects of rheumatic heart disease develop,” Hasan says. “We don’t see it much in American-born patients anymore. But in patients from underdeveloped countries, where antibiotics are not readily available or affordable, cases of rheumatic heart disease still occur, and here at Sherman Hospital, we often see such patients who have migrated to the U.S.”
Viruses also can cause heart disease, most often through an inflammation of the pericardial lining that protects the heart. Symptoms can include chest pain and fluid buildup.
“We can treat the inflammation with non-steroidal anti-inflammatory medications such as ibuprofen, but there’s a good chance the infection will resolve itself on its own,” Hasan says. “Viral infections can also attack heart muscle. This is quite rare, and we see maybe one or two cases a year. However, it is serious. In a significant proportion of cases involving young, otherwise healthy patients who suffer heart failure, we find a viral infection is the cause.”
Patients who develop heart failure due to a viral infection often recover, but Hasan warns that a significant proportion do not, and may face permanent difficulty with congestive heart failure.
Working closely with Hasan is Dr. Aristides Assimacopoulos, a board-certified infectious disease consultant with hospital affiliations that include Advocate Sherman Hospital. Assimacopoulos says that, in some cases, damage may be a result of the body’s response to infection, rather than a direct effect of the infection itself.
“When we think of infection and the heart, probably the most familiar is a bacterial infection that we call endocarditis, an infection of the heart valves,” he says. “Patients are more at risk if they have an abnormal heart valve or heart murmur.”
If left untreated, the endocarditis infection can damage or destroy heart valves and lead to life-threatening complications. According to the Mayo Clinic, patients experience a multitude of symptoms, including fever; chills; fatigue; aching joints and muscles; night sweats; persistent cough; swelling in legs, feet and abdomen; paleness and other signs that something is going wrong.
“While some bacteria are directly responsible for heart disease, others seem to spark an autoimmune response,” Assimacopoulos says. “For example, when the patient has had rheumatic fever as a child, the body’s immune response triggers inflammation in the heart.”
The same holds true for viral infections, such as myocarditis, an inflammation of the middle layer of the heart’s wall. Chest pain, heart failure and abnormal heart rhythms are its primary symptoms, similar to an impending heart attack. In severe cases, the heart weakens and is unable to adequately pump blood through the body. Blood clots can form, leading to heart attack or strokes.
“Somehow, the development of myocarditis is the result of an autoimmune reaction,” says Assimacopoulos. “Again, it’s most likely not the virus itself, but an immune response to its presence in the body.”
There’s really no way to prevent heart disease caused by bacteria or viruses, because everyone has some genetic predisposition. Also, no one fully understands how or why infections affect the heart, although some doctors and dentists suspect there’s a link between heart disease and poor dental hygiene.
“We used to have certain individuals take antibiotics before surgery or dental work, to try to avoid getting endocarditis,” says Assimacopoulos. “All of that has changed. The number of patients who are advised to do this has been substantially reduced. However, having poor oral hygiene that leads to dental infections may increase your risk of endocarditis. So, you should brush your teeth like your mother told you.”
Affecting Other Organs
During most heart attacks, the lungs and kidneys are innocent bystanders and aren’t affected. However, when a heart attack is more severe and the heart’s pumping function is impaired, it may lead to heart failure (lung water) and kidney dysfunction, says Dr. Steven Lupovitch, a board-certified specialist in cardiovascular diseases who practices at Northwest Community Hospital in Arlington Heights.
Hypertension and diabetes are much more common causes of kidney disease. However, during a heart attack, the kidneys can be harmed by the dye used to perform angiogram/angioplasty, various diuretics, anti-inflammatory medications and ACE inhibitors. This is the exception rather than the rule. In other cases, unexpected heart attacks, especially what cardiologists call “widow-makers,” may cause collateral damage.
“Heart attacks involve the coronary arteries, and the ‘widow maker’ refers to the left anterior descending coronary artery, which is a branch of the aorta that feeds the anterior [front] wall of the heart,” says Lupovitch. “A sudden occlusion [blockage] of the left anterior descending artery can cause damage to the front of the heart. This damage may weaken the heart as a pump. That weakened pump may not supply enough blood to the kidneys, which are then impaired. Restoring blood flow to the front of the heart with blood thinners or angioplasty allows that area of the heart muscle to recover. It can pump better and supply enough blood to meet the kidneys’ demands.”
Pulmonary edema, water that collects in the airspaces of the lungs, is also called congestive heart failure. When the heart is unable to pump blood sufficiently, blood backs up in the veins that deliver it through the lungs. As pressure in those blood vessels increases, fluid is pushed into the lung’s air spaces, reducing normal oxygen movement. One of the signs of an impending heart attack is the shortness of breath caused by this fluid buildup.
“High blood pressure and narrowed or malfunctioning valves can influence this fluid buildup as well,” Lupovitch says.
When a patient has a heart attack, one of the first concerns is blood clots that can form as a result of an unstable lining of the heart’s arteries.
“These clots obstruct the artery, cutting off blood supply to an area of heart muscle. The muscle gets stiff and stops moving within minutes of the clot forming,” Lupovitch says. “However, the cells don’t yet die. That takes longer. This ‘not moving/not pumping’ muscle is termed ‘stunned.’ These cells that are stunned may continue to recover for months, even though, in the immediate period after the heart attack, they aren’t functioning. This may make the heart weak and unable to pump out enough blood. It may raise pressure in the heart, which causes backup into the lungs and in turn causes congestive heart failure. Or, it may raise the risk of sudden bad heart rhythms that can cause sudden death.”
Preventive action is the best way to avoid a heart attack and its complications, Lupovitch advises. Quitting smoking and drug abuse, exercising regularly, and closely controlling cholesterol and high blood pressure may all contribute to a healthier, fuller future.
About Blood Vessels
Because the heart is the core of an extensive vascular system, every aspect of the vascular system affects the heart. Dr. David S. Bromet, a board-certified nuclear cardiologist and interventional cardiologist who serves as Chief of Cardiovascular Medicine at Presence Saint Joseph Hospital in Elgin, explains that peripheral vascular disease (PVD), sometimes called peripheral arterial disease (PAD), is an insidious form of cholesterol buildup in the blood vessels.
“As the blockages build, they clog up the ‘gas lines’ of the body, effectively choking off blood flow to the organs and parts of the body that need it,” Bromet says. “Early detection is very important, and much of what I do is directed at teaching patients, and even other physicians, what to look for to diagnose PAD. Many, if not most, of the 150,000 annual amputations of legs in the United States could be avoided with early detection and intervention.”
Risk factors for vascular disease include smoking, obesity, hypertension, diabetes, high cholesterol and family history. Non-invasive screening, good physical exams and history-taking by physicians can often find PAD in patients. Blockages can occur in all of the arteries of the body, but the most life-threatening are in the neck and head, which can lead to a stroke; the vessels of the heart, which can lead to a heart attack; the vessels in vital organs like kidneys; and the vessels in the legs, which can lead to amputations.
“Once PAD has occurred and vessels are ‘stenosed’ [partially blocked] or ‘occluded’ [completely blocked], various options exist, including medicines, surgery and intervention in a catheterization lab,” Bromet says. “As an interventional cardiologist, it’s often my job to try and restore blood flow to occluded or partially blocked leg arteries, in an attempt to relieve symptoms and restore blood flow.”
A new device, the Ocelot, has improved the procedures doctors perform to accomplish those things. Last December, Presence Saint Joseph became the the first hospital in Illinois to commercially use the new Ocelot device to cross a complete blockage in a patient’s leg artery, thus restoring flow to a threatened leg.
“Traditionally, we’ve attempted to cross complete occlusions in arteries somewhat blindly in a catheterization laboratory, using fluoroscopy, but we were unable to visualize where we were within a vessel,” Bromet explains. “This led to high failure rates. This new device crosses using a rotating soft tip, and has a forward-looking laser imager that allows me to stay in the proper part of the vessel and pass safely through the occluded artery to the open vessel beyond the blockage. I then use other devices, such as a balloon and then a stent, to clean out the blocked vessel and prop it open, restoring good blood flow.”
Hope for the Future
The field of cardiology is rapidly progressing, with new techniques and technologies for repairing damaged hearts and blood vessels. Through the combination of preventive action and modern medical advances, physicians are increasing not only the quality of patients’ lives but their longevity as well.