Heart Disease and Stress in Black People: Risks & Coping
PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE
PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASEPLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE
ContentsPrevious ConditionNext Condition
4b-1. Coarctation of the Aorta. (Legend.)A. Chest radiograph demonstrates rib notching (ribs 3-8 bilaterally). There is a figure-three sign in the left upper mediastinum secondary to hypoplasia of the aortic arch with poststenotic dilation of the aorta infra-coarctation.
A. PA chest radiograph demonstrates rib notching/erosion of ribs 5-8 bilaterally (secondary to intercostal collateral development). There is cardiomegaly, figure-three sign in the left upper mediastinum and post-stenotic dilation of the descending aorta.
B. Left anterior oblique view shows slight anterior displacement of the esophagus by the dilated aorta below the coarctation.
A. PA chest radiograph shows bilateral rib notching (rib 5-8) with figure-3 sign and significant post-stenotic dilation of the descending aorta.
Coarctation in the adult is characterized by a short segment abrupt obstruction in the postductal region secondary to localized thickening of the aortic media. This typically occurs just distal to the ductus or ligamentum arteriosum. Infantile coarctation or preductal coarctation is characterized by a diffuse narrowing or hypoplasia of the aorta also in the presence of a discrete area of constriction in the aorta just beyond the origin of the left subclavian artery but proximal to the ductus arteriosus, hence distal blood supply is fulfilled via the ductus. Typical coarctation are those cases in which there is diffuse hypoplasia of the transverse arch in association with a discrete isthmic narrowing.
Incidence: Coarctation accounts for between 5-8% of all congenital heart defects. The male:female ratio is between 2-3:1 with an increased predisposition in girls with Turner's syndrome (15-20%).
Associations: (1) Bicuspid aortic valve occurs in up to 85% of cases. (2) Ventricular septal defect (all types). (3) Mitral valve lesions including hypoplastic mitral valve, parachute mitral valve, and abnormal papillary muscles. (4) Shone's syndrome (multiple left sided obstructions; supravalvular mitral ring, mitral valve stenosis, subaortic membrane/stenosis, aortic valve stenosis, coarctation). (5) Cyanotic congenital lesions including truncus arteriosus and transposition of the great arteries, especially with a subpulmonic VSD and overriding pulmonary artery (Taussig-Bing).
Physical findings: In later life characteristic features are upper limb hypertension with reduced or absent femoral impulses. Hypertension may not directly reflect the severity of the obstruction. If there is a higher left upper limb blood pressure relative to right, one should consider the possibility of an abberant right subclavian artery. The upper torso may be well developed relative to the lower torso. In infants there is less tendency to severe hypertension and the development of collaterals. There may be a thrill in the suprasternal notch. An ejection systolic murmur may be heard in the left upper sternal region, with an ejection click if there is an associated bicuspid aortic valve. The back should be palpated for the presence of collaterals and ausculted for continuous murmurs. Fundoscopic exam in older patients may yield evidence of hypertensive changes.
ECG: Often normal in early stages progressing to left ventricular hypertrophy. 50% of older patients may develop RBBB.
CXR: Characteristic features include post-stenotic dilation of the descending aorta, "figure 3" sign, and the development of rib notching secondary to dilated intercostal collateral vessels. This is reported in 70% patients between 6-41 years. It is extremely rare in infancy. Unilateral notching should alert one to the presence of ipsilateral anomalous subclavian artery arising below the coarctation (low pressure system, hence no collaterals).
Down Syndrome And Congenital Heart Defects
When it comes to matters of the heart, some conditions involve things we can impact, but others we have no control over. About one in 100 babies born in this country have some sort of heart defect. The number is much, much higher for babies with Down Syndrome.
Since the day he was born, Devin Cannon has been a blessing, although his birth came with some unexpected surprises.
"When he was born in 1991, we were not aware that he would have Down syndrome," his mother Angie Cannon said. "When Devin was born, he did have five holes in his heart, and so it was a very scary time."
"When Devin was born, he did have five holes in his heart, and so it was a very scary time." Angie Cannon, mother
Babies with Down Syndrome have a much higher rate of heart defects, impacting between 40-60% of births.
It was a lot for the Cannon family. Devin will need heart monitoring for the rest of his life. His mother said he connected with heart specialists at Golisano Children's Hospital when he was 1 month old.
Nurse practitioner Shantelle Barta is part of his care team at the hospital's congenital heart program. "He has a small hole and between the bottom chambers of his heart, so that's what we call the VSD," Barta said. "His is kind of on top, near his heart valves, and so we follow it to make sure that there's no leaking of the valves or that there's no obstruction."
Angie and Devin Cannon, CREDIT: WINK News As Devin grew, four of the holes in his heart closed. They have continued to keep watch on the last one going on 32 years.
It's not uncommon for patients to stay with a pediatric heart program that specializes in birth defects.
"We continue to follow even adults that were born with heart defects," Barta told WINK News health and medical reporter Amy Oshier, "so about one in 100 babies is born with some kind of heart defect. It can be something very mild to something that's very complex."
Devin has grown and thrived in the three decades he's been under Golisano's care. He loves Spiderman and playing sports.
His mother said he inspires her with his huge heart. "He enjoys every minute he spends he wakes up singing and dancing, and he loves his life."
Nowadays, most congenital heart defects are picked up at birth. That wasn't the case many years ago. Thanks to comprehensive screening and treatments, patients are living longer, healthier lives.
Bronny James Has Congenital Heart Defect, Probable Cause Of His Cardiac Arrest
Bronny James #6, seen here at the McDonalds All American Basketball Games on March 28, 2023, ... [+] suffered a cardiac arrest in July. (Photo by Michael Hickey/Getty Images)
Getty ImagesA spokesperson has indicated the cause of the cardiac arrest suffered by LeBron "Bronny" James last month at a University of Southern California (USC) basketball practice. And guess what? It didn't match some of the conspiracy theories that circulated soon after James, the 18-year-old son of NBA star LeBron James, was rushed to Cedars-Sinai Medical Center in Los Angeles. Instead, the probable cause was "an anatomically and functionally significant Congenital Heart Defect," according to the statement.
Here's what the statement said: "After a comprehensive initial evaluation at Cedars-Sinai Medical Center led by Dr. Merije Chukumerije and follow-up evaluations at the Mayo Clinic led by Dr. Michael J. Ackerman and Atlantic Health/Morristown Medical Center led by Dr. Matthew W. Martinez, the probable cause of Mr. James' sudden cardiac arrest (SCA) has been identified. It is an anatomically and functionally significant Congenital Heart Defect which can and will be treated." It added, "We are very confident in Bronny's full recovery and return to basketball in the very near future."
This came nearly a month after Cedars-Sinai had issued a press release on July 27 mentioning that James had been discharged from the hospital. It read, "Thanks to the swift and effective response by the USC athletics' medical staff, Bronny James was successfully treated for a sudden cardiac arrest. He arrived at Cedars-Sinai Medical Center fully conscious, neurologically intact and stable. Mr. James was cared for promptly by highly-trained staff and has been discharged home, where he is resting."
The July 27 press release was attributed to Chukumerije, a cardiologist who was actually taking care of James, as opposed to those on social media who claimed that Covid-19 vaccines were somehow involved despite the lack of that thing called evidence. These days seemingly every time there's news of a death or a serious heart problem, people and anonymous accounts on social media begin disseminating assertions that Covid-19 vaccination was the cause, even when there is no real supporting evidence. The same thing occurred after news broke of James' cardiac arrest. And billionaire Elon Musk further fueled such unfounded speculation when he tweeted or perhaps X'd, "We cannot ascribe everything to the vaccine, but, by the same token, we cannot ascribe nothing. Myocarditis is a known side-effect. The only question is whether it is rare or common," as you can see here:
From Twitter
From TwitterYeah, it should be obvious that "We cannot ascribe everything to the vaccine." For example, when you stub your toe on a life-sized Mark Zuckerberg figurine, you shouldn't say, "Darn vaccine." But beyond that, it's important to remember that the data to date have shown myocarditis to be a rare side effect of Covid-19 mRNA vaccines and not a common one. Plus, no one actually taking care of James has implicated Covid-19 vaccines as a possible cause of his condition. And while Musk may be many things, he isn't a medical doctor and was likely not directly involved in James' care.
To understand how a cardiac arrest may happen, think of your heart as a Tesla vehicle, something that requires electrical signals to run. A cardiac arrest or a sudden cardiac arrest is when the electrical signals in your heart either cease or cease to remain coordinated enough to maintain a heart beat. In many cases, the "sudden" is redundant since your heart doesn't tend to send you an Outlook calendar invite indicating, "Cardiac arrest planned next Wednesday at 2 pm."
A cardiac arrest is a life-threatening medical emergency. You'll never hear someone say, "I'm running a bit late to tour date as I'm having a cardiac arrest. Be there in 5." When your heart cannot maintain a proper heart beat, it cannot pump blood that carries oxygen to your vital organs, including your brain.
A cardiac arrest can occur when the structures of your heart are perturbed enough to really mess up this electrical system in your heart. That can happen when the muscles of your heart get stretched out of shape (which is what happens with heart failure), grow too thick and big (which is called cardiomyopathy), or die (such as when your heart muscles get starved of blood and oxygen). In each of these case, the damage to your heart muscles has to be substantial and widespread enough to really disrupt the electrical systems.
Bronny James (R) is seen here at the 2023 ESPY Awards at Dolby Theatre on July 12, 2023, with his ... [+] family: (L-R) LeBron James, Bryce James, Zhuri James, and Savannah James. (Photo by Kevin Mazur/Getty Images)
Getty ImagesMyocarditis can also lead to cardiac arrest but only if it is severe enough. The vast majority of myocarditis cases, though, do not end in cardiac arrest, especially if you are otherwise healthy. Myocarditis simply means inflammation of the heart muscle since "myo" means muscle, "card" stands for heart" and "itis" represents inflammation. A mild case of myocarditis is very different from a severe case. Again, myocarditis has been reported as a rare side effect from Covid-19 mRNA vaccination. And to date most such reported cases have been mild.
Other structure problems such heart valve defects or various congenital heart defects can also pre-dispose you to cardiac arrest. Certain medications and recreational drugs can lead to abnormal heart rhythms that can degenerate into cardiac arrest as well. Then there are abnormalities in the electrical system itself despite a normal heart structure, which is what can be seen in long QT syndrome (LQTS) and Brugada syndrome. So, yes, myocarditis is a possible cause of cardiac arrest. But it certainly is not the only possible cause or even the most common cause.
A congenital heart defect (CHD) is an abnormality of the heart that is present at birth. The word "congenital" means "present since birth," which is why the insult "congenitally stupid" is so harsh. While the fetus is developing, tissues grow and move around to form the heart. When this process is somehow disrupted, CHDs can result.
The Centers for Disease Control and Prevention (CDC) describes CHDs as "the most common type of birth defect." There are many different types of CHDs, ranging from holes the heart (e.G., Atrial Septal Defects and Ventricular Septal Defects) to abnormal narrowing of the blood vessels leading to and from the heart (e.G., Coarctation of the Aorta and Pulmonary Atresia) to problems with the valves of the heart (e.G., Tricuspid Atresia) to abnormally large or small structures of the heart (e.G., Hypoplastic Left Heart Syndrome) to structures being completely re-arranged (e.G., Transposition of the Great Arteries and Tetralogy of Fallot). These CHDs do vary in severity and not all of them bring the same risk of abnormal heart rhythms that could lead to cardiac arrest. To date, the doctors taking care of James haven't yet specified which CHD he may have.
So, without further information, it's difficult to speculate what type of treatment James may have undergone and is undergoing right now. Correction, it's not difficult to speculate. Plenty of people and anonymous social media accounts seem to be speculating about other people's medical conditions each and every day. After all, these days, who needs real information and facts to make claims on social media, right? It's just that such speculation could be way off base and really serve no purpose Unless, of course, one's purpose is to spread misinformation.
Comments
Post a Comment