Childs Heart Murmur

Many parents fear the worst when their child is diagnosed with a heart murmur, but this diagnosis is actually extremely common. In fact, many kids are found to have a heart murmur at some point during their lives. Most murmurs are not a cause for concern and do not affect the child's health at all.

What exactly is a heart murmur? By itself, the term heart murmur isn't a diagnosis of an illness or disorder. To better understand what it does mean, it's important to know how the heart works.

How the Heart Works

The normal heart has four chambers and four valves (which function like one-way doors). The two lower pumping chambers of the heart are called the ventricles, and the two upper filling chambers are the atria (singular is atrium).

Here's how blood moves in normal circulation: Blood that returns from the body to the filling chamber on the right side (the right atrium) is low in oxygen. This blood passes across a valve (the tricuspid valve) to the pumping chamber on the right side (the right ventricle) and then travels across the pulmonary valve to the lungs to receive oxygen. The oxygen-enriched blood returns to the filling chamber on the left side (the left atrium), then across a valve (the mitral valve) to the pumping chamber on the left side (the left ventricle). The blood is then pumped across the aortic valve out to the body through the aorta, a large blood vessel that carries blood to the smaller blood vessels in the body to deliver oxygen.

Using a stethoscope, a doctor examines the heart by listening to the sounds it makes. The familiar "lub-dub" sound of a normal heartbeat is caused by the closing sound of the valves as the heart squeezes to push blood through the body. A heart murmur describes an extra sound in addition to the "lub-dub." Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem.

How Are Heart Murmurs Diagnosed?

A murmur is heard during the heart listening exam, using a stethoscope held at different areas on the front of the chest as the heart beats. Heart murmurs can be heard in infants as well as older children and teens. Of course, if the child is crying, uncooperative to the examiner, or breathing loudly, it may not be possible to hear a murmur. It helps if the child is quiet when the doctor listens, since some heart murmurs are very soft. The doctor may have a parent help by calming the child or having the child sit in the parent's lap during the exam.

Heart murmurs are rated on a scale from 1 to 6 in intensity (loudness). Grade 1 is barely audible, whereas grade 6 is very loud. Your child's doctor will note where on the chest the murmur is best heard, the characteristics of the murmur (for example, whether it's harsh and high-frequency or soft and blowing), where it occurs in the heartbeat cycle, and whether it changes when your child changes position. After this initial discovery, the doctor may refer your child to a pediatric cardiologist for further evaluation.

It's not unusual for a murmur to be noticed during a check-up, even though no murmur was heard before. This is for several reasons. Innocent murmurs tend to come and go, depending on the child's heart rate, position during the exam, and the presence of fever. Some new murmurs may be a sign of a newly-developed heart problem. Finally, some heart problems present from birth (congenital heart problems) may not initially be severe enough to cause a murmur that can be detected during examination.

Because of the common misconception that all heart murmurs are serious, it's important for parents to understand which type of murmur their child has and if it needs further evaluation.

What's an Innocent Murmur?

The most common type of heart murmur is called functional or innocent. This diagnosis means the murmur is produced by a normal, healthy heart. It can come and go throughout childhood. It usually goes away on its own as the child gets older and doesn't pose any health threat.

Kids with innocent heart murmurs don't require a special diet, restriction of activities, or any other special treatment. They do not need to take a dose of antibiotic before going to the dentist. Those old enough to understand that they have a heart murmur should be reassured that they aren't any different from other kids. In other words, an innocent murmur is the sound of normal blood moving through a normal heart in a normal way. A simple analogy is that just as we can sometimes hear the sound of air moving in an air duct, or water flowing through a plumbing pipe, we can often hear the sound of blood moving through the heart even if there is not a heart problem.

What About Congenital Heart Defects?

Some murmurs may indicate a problem with the heart. If the doctor suspects something other than an innocent heart murmur, your child will see a pediatric cardiologist, who may order or perform additional tests such as a chest X-ray, an EKG (an electrocardiogram), or an echocardiogram. An echocardiogram, or "echo," is an ultrasound picture of the heart structures (chambers, walls, and valves). It records the motion of the blood through the heart and can measure the direction and speed of blood flow within the heart structures.

About 1 out of every 100 babies is born with a structural heart problem, or congenital heart defect. These babies may show signs of their defect as early as the first few days of life, or they may appear completely healthy until later in childhood. Some kids won't show any symptoms beyond a heart murmur, while others will have symptoms that could be mistaken for other illnesses or disorders.

Symptoms of a significant heart defect in newborns and infants can include:

• rapid breathing
• difficulty feeding
• blueness in the lips (called cyanosis)
• failure to thrive

Symptoms in an older child or adolescent may be:

• fatigue
• difficulty exercising or doing physical activity
• chest pain

Contact your doctor if you notice any of these symptoms.

Congenital heart defects can be seen in chromosomal disorders such as trisomy 21 (Down syndrome), or associated with specific gene abnormalities. Babies with other birth defects may also have heart defects. Exposure to certain chemicals, including alcohol, or medications before birth can be associated with congenital heart disease. While some parents may have more than one child with a heart defect, most heart defects aren't considered to be hereditary. In most cases, however, children with congenital heart defects have no known risk factors.

Maternal health also plays a role. At a higher risk of having a baby with a heart defect are pregnant women who:

• contract rubella (German measles)
• have uncontrolled or poorly regulated diabetes
• have PKU (phenylketonuria, a genetic error of the body's metabolism)

Common Heart Defects

Several different categories of heart problems can present with heart murmurs. These include septal defects, valve abnormalities, abnormalities of flow between the heart chambers and the exits (outflow tract obstruction), and heart muscle disorders.

• Septal defects involve the walls (or septum) between the upper or lower chambers of the heart. A hole in the septum can result in blood flowing through it into the heart's other chambers. This extra blood flow may cause a murmur. It can also make the heart work too hard and may cause the heart to enlarge. Some holes may be large enough to produce symptoms in addition to a heart murmur; others are smaller and may close on their own in time.
• Valve abnormalities are caused by heart valves that are narrow, too small, too thick, or otherwise abnormal. Valves that are misshapen don't allow smooth blood flow across them, and this creates turbulent flow. Sometimes, abnormal valves may allow backflow of blood within the heart. Either condition will cause a murmur. Outflow tract obstruction may be caused by extra tissue or heart muscle that blocks the smooth flow of blood through the heart.
• Heart muscle disorders (cardiomyopathy) can make the heart muscle abnormally thick or weak. This can impair the heart's ability to pump blood to the body normally.

A heart murmur is an exam finding, not a disease. Your doctor and pediatric cardiologist can determine if the murmur is innocent (which means your child is perfectly healthy) or if there is a specific heart problem. If there is a problem, a pediatric cardiologist will know how to best take care of it.

Reviewed by: Steven B. Ritz, MD
Date reviewed: November 2007
Originally reviewed by: Terrence U. H. Chun, MD

from kidshealth.org

http://our-medical-center.blogspot.com/2007/12/childs-heart-murmur.html

Heart Murmur

What Is a Heart Murmur?

A heart murmur is an extra or unusual sound heard during your heartbeat. Murmurs range from very faint to very loud and sometimes sound like a whooshing or swishing noise. Normal heartbeat sounds—"lub-DUPP" or "lub-DUB"—are the valves closing as blood moves through the heart. (Go to the How the Heart Works section for more information about how a normal heart works.)

A heart murmur is not a disease; it is a sound that the doctor hears with a stethoscope. It may be normal, or it could be a sign that something may be wrong. Most heart murmurs are harmless. Some are signs of heart problems, especially if other signs or symptoms of a heart problem are present.

Types of Murmurs

Innocent (harmless) murmurs

A person with an innocent murmur has a normal heart and usually has no other signs or symptoms of a heart problem. Innocent murmurs are common in healthy children.

Abnormal murmurs

A person with an abnormal murmur usually has other signs or symptoms of a heart problem. Most abnormal murmurs in children are due to congenital heart defects—heart defects present at birth. In adults, abnormal murmurs are most often due to heart valve problems caused by infection, disease, or aging.

from nhlbi.nih.gov
http://our-medical-center.blogspot.com/2007/12/heart-murmur.html

Heart disease

http://our-medical-center.blogspot.com/2007/12/heart-disease.html
What is it?

Heart disease is a general term that refers to a variety of acute and chronic medical conditions that affect one or more of the components of the heart. The heart is a muscular, fist-sized organ that is located in the left side of the chest cavity. It continuously pumps blood, beating as many as 100,000 times a day. The blood that the heart moves carries oxygen and nutrients throughout the body and transports carbon dioxide and other wastes to the lungs, kidneys, and liver for removal. The heart ensures its own oxygen supply through a set of coronary arteries and veins. The heart is also an endocrine organ that produces the hormones atrial natriuretic hormone (ANP) and B-type natriuretic peptide (BNP), which coordinate heart function with blood vessels and the kidneys.

Internally, the heart is essentially hollow. It is divided vertically into two halves by a septum, and each side of the heart has two internal chambers – an atrium on top and a ventricle on the bottom. Venous blood enters the right side of the heart through the right atrium and is pumped by the right ventricle to the lungs, where carbon dioxide is released and oxygen acquired. Oxygenated blood from the lungs is transported to the left atrium and is pumped by the left ventricle into arteries that carry it throughout the body. Four heart valves regulate the direction and flow of blood through the chambers of the heart. It is their opening and shutting that gives the heart its characteristic “lub-dub” beat. The heart muscle itself is called the myocardium. Lining the chambers of the heart and the valves is a membrane called the endocardium. Encasing the outside of the heart is the pericardium – a layered membrane that is fibrous on the outside and serous (fluid-secreting) on the inside. The pericardium forms a protective barrier around the heart and allows it to beat in a virtually friction free environment.

Diseases affecting the heart may be structural or functional. Anything that damages the heart or decreases the heart’s supply of oxygen, makes it less efficient, reduces its ability to fill and pump, will disrupt the coordinated relationship between the heart, kidneys, and blood vessels and will harm not only the heart but the rest of the body as well.

Signs and Symptoms

Heart diseases may be acute or chronic. They may be transient, relatively stable, or progressive. They may cause a variety of signs and symptoms that frequently change and/or worsen over time. Chronic heart diseases can have episodes with acutely worsened symptoms; these may resolve (either on their own or with treatment), persist, or even become life-threatening. Patients with early heart disease may experience few or vague symptoms, such as fatigue, shortness of breath with or without effort, dizziness, and/or nausea; however, these symptoms do not indicate the particular type of heart disease present. These symptoms may also be seen with a variety of other conditions. Other signs and complications that may arise from heart disease include:

Arrhythmia – an irregular heartbeat

Dilation – stretching of one or more of the heart chambers, causing their interiors to become larger because of increased pressure

Embolism – blockage of a blood vessel by material that has traveled from a distant body site, most often a blood clot, but it can be due to fat or air or even amniotic fluid

Inability to keep up with increased demands for oxygen and clearance of waste products, such as during physical activity

Infarction – death of muscle cells due to blockage of blood flow

Insufficient contraction – not emptying or filling completely

Pain, frequently due to ischemia – a lack of sufficient oxygen because of reduced blood flow

Regurgitation – a backflow of blood causing increased pressure on the blood vessels of the lungs and liver

Stenosis – a narrowing of the openings of the heart

Tissue death – permanent loss of heart tissue due to lack of oxygen, leading to scarring

Ventricular hypertrophy – increased thickness of the walls of the heart, causing a decrease in the size of the chambers and also a decrease in the flexibility of the heart

Heart diseases may be due to:

Alcohol use

Anabolic steroid use

Atherosclerosis

Autoimmune conditions

Bacterial infection

Cocaine use

Congenital abnormalities

Diabetes

Diet, especially when high in saturated fat and cholesterol

Hypertension

Injury or trauma

Sedentary lifestyle

Smoking

Thyroid dysfunction (under and overactive)

Toxins, such as mercury, and sometimes chemotherapy drugs or HIV/AIDS drugs

Viral infection

Common Heart Diseases

Coronary heart disease (CHD) and Coronary artery disease (CAD) are the most common forms of heart disease. They are usually part of a systemic cardiovascular disease (CVD) – a narrowing of arteries in the heart and throughout the body over time due to a build-up of fatty deposits that form plaques (atherosclerosis). This narrowing can significantly limit the amount of blood carried by the arteries and decrease the amount of oxygen supplied to the tissues. As the coronary blood vessels gradually narrow, symptoms do not appear until most of the blood flow is lost to an area of the heart, when it can cause intermittent chest pain (angina) upon exercise that worsens in frequency and severity over time. When plaques suddenly enlarge (termed unstable plaques), an acute narrowing of the coronary artery can cause chest pain to develop at rest or with minimum exertion (termed unstable angina) or can even cause death of an area of the myocardium or heart attack (myocardial infarction); these forms of acute onset of chest pain are termed acute coronary syndrome.

Heart failure, usually called congestive heart failure (CHF), causes the heart to become less effective at circulating blood and less able to completely fill or empty the chambers. As a result, blood backs up into the legs, hands, feet, lungs and liver, causing swelling, shortness of breath and fatigue. Any gradual damage to the heart can lead to heart failure over time; most commonly, it is due to coronary artery disease, high blood pressure (hypertension), or heart valve damage (which can be either congenital or due to an infection) or previous heart attack. If the cause is temporary, heart failure may also be temporary; however, it usually is a chronic condition that worsens over time, often improving after treatment.

Cardiomyopathy is an abnormality of the heart muscle. It may be congenital or it may be a response by the heart to external pressures or toxins. One or more chambers of the heart may dilate (dilated cardiomyopathy), causing an enlargement in the size of one of the chambers of the heart. In other cases, one or more of walls of the heart may thicken (hypertrophic cardiomyopathy). Occasionally, cardiomyopathy may also be due to abnormal material accumulating in the wall of the heart, reducing the flexibility of the walls of the ventricles (restrictive cardiomyopathy). Cardiomyopathy may be due to decreased blood flow to the heart, exposure to chemicals that damage the heart (such as alcohol and cocaine and some drugs used to treat cancer or other conditions), to inherited muscle problems, or may have no obvious cause (called idiopathic cardiomyopathy).

Myocarditis refers to inflammation of the muscle of the heart. It often presents with an acute onset of shortness of breath or an irregular heart beat and can cause heart failure to develop quickly. It is often due to a viral infection.

Pericardial disease is a disease of the sac surrounding the heart. It may be due to a bacterial or fungal infection, trauma, an autoimmune process, cancer, or a previous heart attack. Infections of the pericardium may quickly become serious if left untreated. Pericarditis, an inflammation of the pericardium, may cause increased friction “rub” and pain in the chest cavity.

Congenital heart disease, which arises during fetal development, may potentially affect any part of the heart. The amount of dysfunction depends on what form the abnormality takes and the extent to which it alters the shape, integrity, and functionality of the heart.

Endocarditis is an inflammation of the membrane lining the heart and heart valves. It may be due to a microorganism or to an autoimmune process. When it is due to an infection, it frequently can be difficult to treat.

Heart valve conditions may cause a variety of dysfunctions, including:

Regurgitation - backflow of blood

Prolapse - part of the heart valve protrudes into the atrium, preventing a tight seal, which may lead to regurgitation and an increased risk of endocarditis

Stenosis - narrowing of the opening, which can affect blood flow rate

Tests

The goals of testing for heart disease are to distinguish between symptoms that are heart-related and those that are due to another condition. Testing is ordered to help determine which heart disease is present, to determine whether the disorder is acute or chronic, to monitor a cardiac event that is in progress – such as a heart attack, and to determine the severity and extent of the disease.

When a patient presents to the emergency room with acute coronary syndrome – a group of symptoms that suggest heart injury due to lack of blood flow – they are evaluated with a variety of laboratory blood tests and other tests. These are used to determine the cause of the pain and the severity of the condition. Since some treatments for a heart attack must be given within a short period of time to minimize heart damage, an accurate diagnosis must be quickly confirmed.

Heart disease that is causing few symptoms may be detected during a visit to the doctor for nonspecific symptoms such as fatigue. Doctors may order a variety of blood and other tests to investigate possible causes for the patient’s symptoms. Diagnosis of heart disease in these people may take time and patience.

Testing patients for existing heart disease is not the same as cardiac risk testing (which actually mostly determines risk of coronary heart disease). Cardiac risk testing is performed to screen asymptomatic people – to help determine their risk of developing coronary heart disease.

Laboratory Blood Tests
Cardiac biomarkers, proteins that are released when muscle cells are damaged, are frequently ordered when patients have symptoms of acute coronary syndrome, such as chest pain, pain in the jaw, neck, abdomen, back, or that radiates to the shoulder or arms, nausea, dyspnea, and lightheadedness.

Tests include:

Troponin - the most commonly ordered and cardiac-specific of the markers; will be elevated within a few hours of heart damage and remain elevated for up to two weeks

CK-MB – one particular form of the enzyme creatine kinase that is found mostly in heart muscle and rises when there is damage to the heart muscle cells

Myoglobin – a protein released into the blood when heart or other skeletal muscle is injured

BNP or NT-proBNP – released by the body as a natural response to heart failure; increased levels of BNP, while not diagnostic for a heart attack, indicate an increased risk of cardiac problems in persons with acute coronary syndrome

Because BNP is also released by the heart when it is stretched, BNP is also measured in those who have swelling of the legs or abdomen, or shortness of breath, to see if heart failure may be present.

More general blood tests that may be ordered:

Blood Gases – performed to evaluate oxygen, carbon dioxide, and pH levels

Complete Metabolic Panel (CMP) – a group of tests used to evaluate organ function

Electrolytes – four tests that evaluate the body’s electrolyte balance

Complete Blood Count (CBC) – looks at the body’s cells, checks for anemia

Other Evaluations
A range of other evaluations and tests are used to assess chest pain and other symptoms. These include:

A medical history, including an evaluation of risk factors such as age, CAD, diabetes, and smoking

A physical examination

An electrocardiogram (ECG or EKG) – a test that looks at the heart’s electrical activity and rhythm

Echocardiography – ultrasound imaging of the heart

Based on the findings of these tests, other procedures may be necessary, including:

Stress testing

Chest X-ray

CT (Computerized tomography) scan

Continuous ECG monitoring (sometimes also called Holter monitoring) – the patient wears a monitor that evaluates heart rhythm over a period of time

MRI (Magnetic resonance imaging)

PET (Positron emission tomography)

Radionuclide imaging

Cardiac catheterization – in this procedure, a thin flexible tube is inserted into an artery in the leg and threaded up to the coronary arteries to evaluate blood flow and pressure in the heart and the status of the arteries in the heart

Coronary angiography – X-rays of arteries using a radiopaque dye to help diagnose CAD; this procedure is performed during coronary catheterization

Tilt table test – ordered to evaluate syncope

Treatments

Treatments for heart disease depend on the condition and its severity. Acute conditions, such as a heart attack, require prompt medical intervention to minimize heart damage. For chronic conditions, doctors may recommend that their affected patients modify their diets, lose excess weight, exercise (under supervision), manage stress, and quit smoking. Conditions such as hypertension and diabetes should be controlled to minimize their affect on the heart. Heart failure often requires treatment with low salt diet and diuretics (to try to reduce the amount of fluid accumulating) as well as drugs to improve the function of the heart muscle, such as digoxin.

Medications may be necessary to help manage symptoms and control heart diseases. Surgical procedures may be required to bypass blocked arteries, replace defective heart valves, or fix congenital abnormalities. Those with infections may need to take antimicrobial drugs.

New medications, procedures, and guidelines for addressing heart disease continue to be developed. Patients should talk to their doctor about the best treatment options for their condition.

from labtestsonline.org
http://our-medical-center.blogspot.com/2007/12/heart-disease.html

Diabetes, Heart Disease, and Stroke

http://our-medical-center.blogspot.com/2007/12/diabetes-heart-disease-and-stroke.html

Having diabetes or pre-diabetes puts you at increased risk for heart disease and stroke. You can lower your risk by keeping your blood glucose (also called blood sugar), blood pressure, and blood cholesterol close to the recommended target numbers—the levels suggested by diabetes experts for good health. (For more information about target numbers for people with diabetes, see "How will I know whether I have heart disease?".) Reaching your targets also can help prevent narrowing or blockage of the blood vessels in your legs, a condition called peripheral arterial disease. You can reach your targets by

• choosing foods wisely
• being physically active
• taking medications if needed

If you have already had a heart attack or a stroke, taking care of yourself can help prevent future health problems.

What is diabetes?

Diabetes is a disorder of metabolism—the way our bodies use digested food for energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the body’s main source of fuel.

After digestion, glucose enters the bloodstream. Then glucose goes to cells throughout the body where it is used for energy. However, a hormone called insulin must be present to allow glucose to enter the cells. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. However, diabetes develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy.

Over time, high blood glucose levels damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes. Uncontrolled diabetes can eventually lead to other health problems as well, such as vision loss, kidney failure, and amputations.

Diabetes can lead to heart and blood vessel disease.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Pre-diabetes is also called impaired fasting glucose or impaired glucose tolerance. Many people with pre-diabetes develop type 2 diabetes within 10 years. In addition, they are at risk for heart disease and stroke. With modest weight loss and moderate physical activity, people with pre-diabetes can delay or prevent type 2 diabetes and lower their risk of heart disease and stroke.

What is the connection between diabetes, heart disease, and stroke?

If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.

People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis).

What are the risk factors for heart disease and stroke in people with diabetes?

Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.

You can’t change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:

• Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.



• Having abnormal blood fat (cholesterol) levels.
  – LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries—the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.
  
  – Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.
  
  – HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.



• Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.



• Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

What is metabolic syndrome and how is it linked to heart disease?

Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:

Traits and Medical Conditions	Definition
Elevated waist circumference	Waist measurement of 40 inches or more in men 35 inches or more in women
Elevated levels of triglycerides	150 mg/dL or higher or Taking medication for elevated triglyceride levels
Low levels of HDL (good) cholesterol	Below 40 mg/dL in men Below 50 mg/dL in women or Taking medication for low HDL cholesterol levels
Elevated blood pressure levels	130 mm Hg or higher for systolic blood pressure or 85 mm Hg or higher for diastolic blood pressure or Taking medication for elevated blood pressure levels
Elevated fasting blood glucose levels	100 mg/dL or higher or Taking medication for elevated blood glucose levels

Source: Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752.
Note: Other definitions of similar conditions have been developed by the American Association of Clinical Endocrinologists, the International Diabetes Federation, and the World Health Organization.

What can I do to prevent or delay heart disease and stroke?

Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps:

• Make sure that your diet is “heart-healthy.” Meet with a registered dietitian to plan a diet that meets these goals:
  
  – Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.
  
  – Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.
  
  – Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.
  
  – Keep the amount of trans fat in your diet to a minimum. It’s a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package.



• Make physical activity part of your routine. Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven’t been physically active recently, see your doctor for a checkup before you start an exercise program.



• Reach and maintain a healthy body weight. If you are overweight, try to be physically active for at least 30 minutes a day, most days of the week. Consult a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than 1 to 2 pounds a week.



• If you smoke, quit. Your doctor can help you find ways to quit smoking.



• Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.



• Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.

How will I know whether my diabetes treatment is working?

You can keep track of the ABCs of diabetes to make sure your treatment is working. Talk with your health care provider about the best targets for you.

A stands for A1C (a test that measures blood glucose control). Have an A1C test at least twice a year. It shows your average blood glucose level over the past 3 months. Talk with your doctor about whether you should check your blood glucose at home and how to do it.

A1C target

Below 7 percent

Blood glucose targets
Before meals	90 to 130 mg/dL
1 to 2 hours after the start of a meal	Less than 180 mg/dL

B is for blood pressure. Have it checked at every office visit.

Blood pressure target

Below 130/80 mm Hg

C is for cholesterol. Have it checked at least once a year.

Blood fat (cholesterol) targets
LDL (bad) cholesterol	Under 100 mg/dL
Triglycerides	Under 150 mg/dL
HDL (good) cholesterol For men: above 40 mg/dL For women: above 50 mg/dL

Control of the ABCs of diabetes can reduce your risk for heart disease and stroke. If your blood glucose, blood pressure, and cholesterol levels aren’t on target, ask your doctor what changes in diet, activity, and medications can help you reach these goals.

What types of heart and blood vessel disease occur in people with diabetes?

Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes.

Coronary Artery Disease

Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.

Cerebral Vascular Disease

Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure.

Stroke

A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Most strokes are caused by fatty deposits or blood clots—jelly-like clumps of blood cells—that narrow or block one of the blood vessels in the brain or neck. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots.

A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall.

TIAs

TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future. See page 3 for more information on risk factors for stroke.

Heart Failure

Heart failure is a chronic condition in which the heart cannot pump blood properly—it does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult.

Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.

Peripheral Arterial Disease

Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes.

How will I know whether I have heart disease?

One sign of heart disease is angina, the pain that occurs when a blood vessel to the heart is narrowed and the blood supply is reduced. You may feel pain or discomfort in your chest, shoulders, arms, jaw, or back, especially when you exercise. The pain may go away when you rest or take angina medicine. Angina does not cause permanent damage to the heart muscle, but if you have angina, your chance of having a heart attack increases.

A heart attack occurs when a blood vessel to the heart becomes blocked. With blockage, not enough blood can reach that part of the heart muscle and permanent damage results. During a heart attack, you may have

• chest pain or discomfort
• pain or discomfort in your arms, back, jaw, neck, or stomach
• shortness of breath
• sweating
• nausea
• light-headedness

Symptoms may come and go. However, in some people, particularly those with diabetes, symptoms may be mild or absent due to a condition in which the heart rate stays at the same level during exercise, inactivity, stress, or sleep. Also, nerve damage caused by diabetes may result in lack of pain during a heart attack.

Women may not have chest pain but may be more likely to have shortness of breath, nausea, or back and jaw pain. If you have symptoms of a heart attack, call 911 right away. Treatment is most effective if given within an hour of a heart attack. Early treatment can prevent permanent damage to the heart.

Your doctor should check your risk for heart disease and stroke at least once a year by checking your cholesterol and blood pressure levels and asking whether you smoke or have a family history of premature heart disease. The doctor can also check your urine for protein, another risk factor for heart disease. If you are at high risk or have symptoms of heart disease, you may need to undergo further testing.

What are the treatment options for heart disease?

Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity. In addition, you may need medications to treat heart damage or to lower your blood glucose, blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure.

For additional information about heart and blood vessel disease, high blood pressure, and high cholesterol, call the National Heart, Lung, and Blood Institute Health Information Center at 301–592–8573 or see www.nhlbi.nih.gov on the Internet.

How will I know whether I have had a stroke?

The following signs may mean that you have had a stroke:

• sudden weakness or numbness of your face, arm, or leg on one side of your body
• sudden confusion, trouble talking, or trouble understanding
• sudden dizziness, loss of balance, or trouble walking
• sudden trouble seeing out of one or both eyes or sudden double vision
• sudden severe headache

If you have any of these symptoms, call 911 right away. You can help prevent permanent damage by getting to a hospital within an hour of a stroke. If your doctor thinks you have had a stroke, you may have tests such as a neurological examination to check your nervous system, special scans, blood tests, ultrasound examinations, or x rays. You also may be given medication that dissolves blood clots.

What are the treatment options for stroke?

At the first sign of a stroke, you should get medical care right away. If blood vessels to your brain are blocked by blood clots, the doctor can give you a “clot-busting” drug. The drug must be given soon after a stroke to be effective. Subsequent treatment for stroke includes medications and physical therapy, as well as surgery to repair the damage. Meal planning and physical activity may be part of your ongoing care. In addition, you may need medications to lower your blood glucose, blood pressure, and cholesterol and to prevent blood clots.

from diabetes.niddk.nih.gov

http://our-medical-center.blogspot.com/2007/12/diabetes-heart-disease-and-stroke.html