Heart Surgery

What is heart surgery?

Heart surgery can correct certain heart problems when other treatments haven't worked or can't be used.

In some cases, heart surgery may be a medical emergency. For example, surgery for a severe heart attack may need to be done right away. In other cases, you can plan heart surgery ahead of time. Some heart surgeries are major operations, such as heart bypass surgery for blocked arteries in the heart. Other surgeries are more minor heart procedures, such as putting in a pacemaker.

There are different types of heart surgery that can help treat many heart conditions:

• An implantable cardioverter defibrillator (ICD) to help prevent sudden cardiac arrest.
• A biventricular pacemaker to coordinate the heart's pumping action so it's more powerful.
• A ventricular assist device to help the heart pump blood.
• A total artificial heart to pump blood for the heart.

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

• Open-heart surgery (also called traditional heart surgery) is when the surgeon cuts the chest open to reach the heart. Because it's difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
• Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts (CABG), but only in certain cases.
• Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
• Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

Like all surgery, heart surgery has risks even though the results are often excellent. The risks include:

• Bleeding
• Infection, fever, and swelling
• A problem from anesthesia (medicine that makes you sleep during surgery)
• Arrhythmia
• Damage to the heart, kidneys, liver, and lungs
• Stroke

The risks of heart surgery tend to be higher if:

• The surgery is an emergency.
• You have other medical conditions, including:
  • Diabetes
  • Kidney diseases
  • Lung diseases
  • Peripheral artery disease (PAD)

NIH: National Heart, Lung, and Blood Institute

Heart Valve Diseases

What are heart valve diseases?

Heart valve disease happens when one or more of your heart valves don't work well.

Your heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves. The valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats they close to stop the blood from flowing backwards.

If one or more of your heart valves doesn't open or close correctly, it can affect your blood flow and strain your heart. Fortunately, treatment helps most valve diseases.

Heart valves can have three basic kinds of problems:

• Regurgitation, or backflow, happens when the flaps of a valve don't close tightly. This allows the blood to leak backwards. A common cause of regurgitation is prolapse, where the flaps of the valve flop or bulge back. Prolapse most often affects the mitral valve.
• Stenosis happens when the flaps of a valve become thick, stiff, or stuck together. This prevents the heart valve from opening all the way. Not enough blood can pass through the valve. Aortic valve stenosis is a common type of stenosis. It affects the valve that controls blood flow into the large artery that carries blood out of the heart to the body.
• Atresia happens when a heart valve did not form properly and does not have an opening for blood to pass through.

Sometimes a valve can have both regurgitation and stenosis.

Some people are born with heart valve disease. This is called congenital heart valve disease. It can happen alone or along with other congenital heart defects. Heart valve disease can also develop over time as you get older or have certain conditions that affect the heart.

Your chance of having heart valve disease is higher if:

• You are older. With age, the heart valves can become thick and stiff.
• You have or have had other conditions that affect your heart and blood vessels. These include:
  • Rheumatic fever. An untreated strep throat can become rheumatic fever, which can harm the heart valves. The damage may not show up for years. Today, most people take antibiotics to cure strep throat before it can cause heart valve damage.
  • Endocarditis. This is a rare infection in the lining of the heart and heart valves. It is usually caused by bacteria in the bloodstream.
  • A heart attack.
  • Heart failure.
  • Coronary artery disease, especially when it affects the aorta (the large artery that carries blood from the heart to the body).
  • High blood pressure.
  • High blood cholesterol.
  • Diabetes.
  • Obesity and overweight.
  • Lack of physical activity.
• A family history of early heart disease:
  • A father or brother who had heart disease younger than 55.
  • A mother or sister who had heart disease younger than 65.
• You were born with an aortic valve that wasn't formed right. Sometimes this will cause problems right away. Other times, the valve may work well enough for years before causing problems.

Many people live their whole lives with a heart valve that doesn't work perfectly and never have any problems. But heart valve disease may get worse slowly over time. You may develop signs and symptoms, such as:

• Shortness of breath (feeling like you can't get enough air)
• Fatigue
• Swelling in your feet, ankles, abdomen (belly), or the veins in your neck
• Chest pain when you're physically active
• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Dizziness or fainting

If you don't get treatment for heart valve disease, the symptoms and strain on your heart may keep getting worse.

When the valves don't work well, your heart has to pump harder to get enough blood out to the body. Without treatment, this extra workload on your heart can lead to:

• Heart failure
• Stroke
• Blood clots
• Sudden cardiac arrest or death

Your health care provider may listen to your heart with a stethoscope and hear that your heart makes abnormal sounds, such as a click or a heart murmur. These sounds may mean a valve isn't working normally. The provider will usually refer you to a cardiologist, a doctor who specializes in heart diseases.

The doctor will also listen to your heart and will do a physical exam. You will also likely need to have one or more heart tests.

Most heart valve problems can be treated successfully. Treatment may include:

• Medicines to control your symptoms and keep your heart pumping well
• Heart-healthy lifestyle changes to treat other related heart conditions
• Surgery to repair or replace a valve

It's possible that you may need surgery, even if you don't have symptoms. Fixing the valve can help prevent future heart problems.

There are many ways to do heart valve surgery. You and your doctor can decide what's best for you, based on your valve problem and general health. Heart valve repair surgery has fewer risks than heart valve replacement. So, when repair is possible, it's preferred over valve replacement.

In some cases, valve replacement is necessary. There are 2 types of replacement valves:

• Biologic valves made from pig, cow, or human tissue. These valves tend to wear out after 10 to 15 years, but some may last longer.
• Mechanical (human-made) valves usually don't wear out. But with a mechanical valve, you usually have to take blood thinners for the rest of your life to prevent blood clots. And your risk of endocarditis (a heart infection) is higher than with a biologic valve.

NIH: National Heart, Lung, and Blood Institute

High Blood Pressure in Pregnancy

What is high blood pressure in pregnancy?

Blood pressure is the force of your blood pushing against the walls of your arteries. Your arteries are blood vessels that carry blood from your heart to other parts of your body. High blood pressure, or hypertension, is blood pressure that is higher than normal. Having high blood pressure can put you at risk for other health problems, such as heart disease, heart attack, and stroke.

During pregnancy, high blood pressure can cause problems for you and your baby. To keep you and your baby healthy, it's important to get treatment for high blood pressure before, during, and after pregnancy.

There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don't have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. If it becomes severe, it can lead to a preterm birth or your baby having a low birth weight. Some women with gestational hypertension do go on to develop preeclampsia, a more serious type of high blood pressure in pregnancy.
• Chronic hypertension is high blood pressure that starts before the 20th week of pregnancy or before you became pregnant. Some people may have had it long before becoming pregnant but didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. Preeclampsia also often includes signs of damage to some of your organs, such as your liver or kidneys. The signs may include protein in the urine (pee) and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.
  • If preeclampsia becomes severe enough to affect your brain function and causes seizures or a coma, it is called eclampsia.
  • In rare cases, preeclampsia symptoms may not start until after delivery. This is called postpartum preeclampsia. If this type of preeclampsia becomes more severe and causes a seizure, it is known as postpartum eclampsia.
  • When a person with preeclampsia or eclampsia has damage to the liver and blood cells, it's called HELLP syndrome. It is rare, but very serious.

You are more likely to develop high blood pressure in pregnancy if you:

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are under age 20 or over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of high blood pressure in pregnancy
• Have certain health conditions, such as diabetes or lupus

High blood pressure usually has no symptoms. People usually find out they have high blood pressure when their health care provider measures their blood pressure.

Preeclampsia can cause other symptoms, including:

• Too much protein in your urine (called proteinuria).
• Swelling (edema) in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• A headache that does not go away.
• Vision problems, including blurred vision or seeing spots.
• Pain in your upper right abdomen (belly).
• Trouble breathing.

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output.

If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

High blood pressure in pregnancy can lead to complications such as:

• Placental abruption, where the placenta (the organ that brings oxygen and nutrients to the baby) separates from the uterus (the place where a baby grows during pregnancy)
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• Your baby having a low birth weight
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you

Your provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to order some tests. These may include blood tests and other lab tests, such as a test to look for extra protein in your urine.

If you have high blood pressure, you and your baby will be closely monitored to lower the chance of complications. You may need to:

• Check your blood pressure at home.
• Keep track of how many times you feel the baby kicking each day.
• Adjust your physical activity. Talk to your provider about what level of physical activity is right for you.
• Take medicine to control your blood pressure. Talk to your provider about which medicines are safe for your baby.
• Take aspirin in the second trimester, if you are at risk of preeclampsia and your provider recommends aspirin.
• Visit your provider more often to monitor your condition and your baby's growth rate and heart rate.

If you have eclampsia, HELLP syndrome, or a severe case of preeclampsia, you will most likely need to go to the hospital. Treatment often includes medicines. Your provider may also recommend delivering the baby early. They will make the decision based on:

• How severe the condition is
• The possible risks to you and your baby
• How far along the pregnancy is

The goal is to lower the risks to you while giving your baby as much time as possible to mature before delivery.

The symptoms of preeclampsia can last after delivery, but they usually go away within 6 weeks.

High Cholesterol in Children and Teens

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in the body. The liver makes cholesterol, and it is also in some foods, such as meat and dairy products. The body needs some cholesterol to work properly. But if your child or teen has high cholesterol (too much cholesterol in the blood), it can stick to the walls of their arteries and narrow or even block the arteries. This can put your child or teen at risk of coronary artery disease and other heart diseases.

Three main factors contribute to high cholesterol in children and teens:

• An unhealthy diet, especially one that is high in saturated fats
• A family history of high cholesterol, especially when one or both parents have high cholesterol
• Having obesity

Some diseases, such as diabetes, kidney disease, and certain thyroid diseases, can also cause high cholesterol in children and teens.

There are usually no signs or symptoms that your child or teen has high cholesterol.

There is a blood test to measure cholesterol levels. The test gives information about:

• Total cholesterol. This is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL cholesterol. LDL is often called "bad" cholesterol because it is the main source of cholesterol buildup and blockage in the arteries.
• HDL cholesterol. HDL is often called "good" cholesterol because it helps remove cholesterol from your arteries.
• Non-HDL. This number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
• Triglycerides. This is another type of fat in your blood that can raise the risk of heart disease.

For anyone aged 19 or younger, the healthy levels of cholesterol are

When and how often your child or teen should get this test depends on their age, risk factors, and family history. The general recommendations are:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high cholesterol, heart attack, or stroke

Lifestyle changes are the main treatment for high cholesterol in children and teens. These changes include:

• Being more active. This includes getting regular physical activity and spending less time sitting (in front of a television, at a computer, on a phone or tablet, etc.).
• Healthy eating. A diet to lower cholesterol includes limiting foods that are high in saturated fat, sugar, and cholesterol. It is also important to eat plenty of fresh fruits, vegetables, and whole grains.
• Losing weight, if your child or teen is overweight or has obesity.

If everyone in the family makes these changes, it will be easier for your child or teen to stick to them. It is also an opportunity to improve your health, and the health of the rest of your family.

Sometimes these lifestyle changes are not enough to lower your child or teen's cholesterol. Their health care provider may consider giving your child or teen cholesterol medicines if they:

• Are at least 10 years old.
• Have an LDL (bad) cholesterol level that is higher than 190 mg/dL, even after six months of diet and exercise changes.
• Have an LDL (bad) cholesterol level that is higher than 160 mg/dL AND are at high risk for heart disease.
• Have familial hypercholesterolemia (FH). FH is an inherited disorder that causes very high levels of cholesterol in the blood.

How to Prevent Diabetes

What is diabetes?

Diabetes, also called diabetes mellitus, is a disease that causes your blood glucose, or blood sugar, levels to be too high. There are three types of diabetes: type 1 diabetes, gestational diabetes, and type 2 diabetes. Type 2 diabetes is the most common type and may be prevented, delayed, or managed by making lifestyle changes.

If you have type 2 diabetes, your body doesn't make enough insulin or doesn't use it well. This is called insulin resistance. Insulin is a hormone that helps glucose get into your cells. Glucose is your cells' main source of energy and comes from the foods you eat. If your body is resistant to insulin, then insulin can't get enough glucose into your cells. This then leads to glucose staying in your blood, leading to high blood glucose levels.

Over time, having too much glucose in your blood can cause health problems. If you are at risk for type 2 diabetes, you might be able to prevent or delay developing it.

Many people are at risk for type 2 diabetes. Your chances of getting it depend on a combination of risk factors such as your genes and lifestyle. The risk factors include:

• Having prediabetes, which means you have blood glucose levels that are high for you, but not high enough to be called diabetes
• Being overweight or having obesity
• Being age 35 or older
• A family history of diabetes
• Being African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
• Having high blood pressure
• Having a low level of HDL (good) cholesterol or a high level of triglycerides
• A history of diabetes in pregnancy
• Having given birth to a baby weighing 9 pounds or more
• An inactive lifestyle
• A history of heart disease or stroke
• Having depression
• Having polycystic ovary syndrome (PCOS)
• Having acanthosis nigricans, a skin condition in which your skin becomes dark and thick, especially around your neck or armpits
• Smoking

Most of the things that you need to do to prevent or delay getting type 2 diabetes involve having a healthier lifestyle. Lifestyle changes include:

• Lose weight.Weight control is an important part of diabetes prevention. You may be able to prevent or delay diabetes by losing 5 to 7% of your current weight. For example, if you weigh 200 pounds, your goal would be to lose between 10 to 14 pounds. And once you lose the weight, it is important that you don't gain it back.
• Follow a healthy eating plan. It is important to reduce the amount of calories you eat and drink each day, so you can lose weight and keep it off. To do that, your diet should include smaller portions and less fat and sugar. You should also eat a variety of foods from each food group, including plenty of whole grains, fruits, and vegetables. It's also a good idea to limit red meat and avoid processed meats.
• Get regular exercise. Being physically active has many health benefits, including helping you to lose weight and lower your blood glucose levels. These both lower your risk of type 2 diabetes. Try to get at least 30 minutes of physical activity on most days of the week. The amount of exercise you need depends on your age and health. Even small amounts of exercise can be helpful. If you have not been active, talk with your health care provider to figure out which types of exercise are best for you. You can start slowly and work up to your goal.
• Don't smoke. Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. If you already smoke, try to quit.
• Talk to your provider to see whether there is anything else you can do to delay or to prevent type 2 diabetes. If you are at high risk, your provider may suggest that you take one of a few types of diabetes medicines.

If you make these changes, you will get other health benefits as well. You may lower your risk of other diseases, and you will probably feel better and have more energy.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases