CPR123 Newsletter, October 11, 2011

Why do people need heart surgery?

Each day, thousands of people in the U.S. have heart surgery. There are many different types of heart surgery. Surgeries may be used to:

Read more here.

Preventing Heart Surgery Scar Development

DIY scar treatment It is not possible to prevent a scar from developing completely. But there are factors that play a role in the creation of scar tissue. By trying to control these factors you are able to influence the outcome of the final scar appearance.

Don't overstretch the scar Before leaving the hospital you get the recommendation not to lift high or heavy the first weeks. This is not only important for the recovery of the breastbone but also for the best healing of the wound. Also when the wound has closed and has become a scar it is important not to overstretch the tissue because this might widen the scar. For this reason I quit fitness / bodybuilding for the first year. Later on I started with modified exercises.

Be especially careful with the top part of the scar. I am lucky to be not prone to infections. In fact I haven't had (wound) infections all my life. Except for when I was recovering from the surgery. The top area of the scar was infected. Whereas the rest of the wound was already closed this part was still open. Later on I learned this is one of the most delicate parts of the skin. If I had payed more attention I would have noticed earlier and could have taken measures to ward off the infection right away.

Read the entire article here.

Children's Chest Pain Rarely Signals Heart Problem

Children and teenagers who complain of chest pain only rarely have a heart problem causing it, a new study suggests.

What's more, researchers say, relatively simple steps—including a physical exam, taking a family history and doing an electrocardiogram—could pinpoint those kids who need more extensive, and expensive, testing for heart problems.

The study, reported in the journal Pediatrics, looked at records for 3,700 children older than six who came to Children's Hospital Boston to have their chest pain evaluated.

Just one percent turned out to have an underlying heart condition. The most common were inflammation of the heart muscle or its surrounding sac, which is often the result of an infection; and supraventricular tachycardia, a rapid heartbeat that is rarely life-threatening.

No child died of a cardiac cause during the 10-year study period.

"This study should be reassuring," said lead researcher Dr. Susan F. Saleeb, a pediatric cardiologist at the Boston hospital.

"Chest pain in children is very common," she told Reuters Health, "but the chance of a cardiac cause is very low."

Cardiac arrest deaths rare

It's known that sudden death from cardiac arrest is quite rare in children and teenagers. In the U.S., estimates range from less than 1 to about 6 such deaths per 100,000—about one-quarter of which happen during sports.

Despite the rarity, those deaths are tragic and—in the case of young athletes, in particular—often garner media attention. So parents may become unduly alarmed by their children's chest pain, and kids may end up getting tests they don't need, according to Saleeb's team.

Often, chest pain in kids comes from something much milder than a heart condition—like a muscular cause, respiratory conditions like asthma or a gastrointestinal problem like acid reflux.

In many cases, though, the precise cause cannot be pinpointed. That was true of 52 percent of kids in this study. Of the remaining patients, musculoskeletal causes were most common, followed by respiratory and gastrointestinal conditions, and, in one percent of all cases, anxiety.

There are no universal guidelines on how to check out children's chest pain.

Children in the current study were seen between 2000 and 2009, when the hospital had no standardized method for assessing chest pain. All of the children had their family history taken, underwent a physical exam and had an electrocardiogram (ECG); many had other tests, like an echocardiogram or exercise stress test.

'SCAMP' proves useful

Since then, doctors there have started using guidelines known as chest pain SCAMP.

Children are first screened based on their symptoms, family history, a physical exam and an ECG (also known as an EKG). If there are concerns, they go on for further testing—usually with an echocardiogram, which uses sound waves to produce images of the heart.

Of the children in this study who were ultimately diagnosed with a heart problem, the "vast majority" had concerning findings on their history, physical exam or ECG, according to Saleeb's team.

So the SCAMP screening, they say, could help get echocardiograms and other more extensive tests to the children who need them—while avoiding unnecessary tests in other kids.

Having pediatricians and other primary care doctors perform that screening would be ideal, since it would avoid referrals to a cardiologist. And Saleeb said the researchers are looking at ways to adapt their screening method for primary care.

A primary care doctor might, for example, be able to perform an ECG and have it read by a cardiologist, avoiding having a child actually visit the specialist.

Saleeb's team estimates that, in theory, more than half of the kids in the current study might not have needed to see a cardiologist if they'd had "effective screening" by a primary care doctor.

In the meantime, Saleeb said that while parents should bring up any chest pain problem to their child's doctor, they should also feel reassured that it's unlikely to signal a heart condition.

"Chest pain in children does not represent the same disease as chest pain in adults does," Saleeb said.

She did, though, point to some "red flags" that could suggest an underlying heart problem in kids, including chest pain that arises specifically during exercise, or pain accompanied by other symptoms like irregular heartbeat or fainting.

Read the entire article here.

Heart attacks hit smokers younger: study

By Genevra Pittman

Smokers tend to suffer heart attacks years earlier than non-smokers, suggests a new study from Michigan.

"Individuals who smoke are much more likely to have a heart attack, and will present with a heart attack a decade or more earlier," said Dr. Gregg Fonarow, a cardiologist at the David Geffen School of Medicine at the University of California, Los Angeles, who wasn't involved in the new study.

The findings, he said, also show that "you could have a heart attack in the absence of other risk factors if you smoke."

Researchers led by Dr. Michael Howe from the University of Michigan Health System in Ann Arbor studied about 3,600 people who were hospitalized with a heart attack or unstable angina — pain caused by low blood flow to the heart that is often a precursor to a heart attack.

One-quarter of the patients were current smokers. And on average, they were younger with fewer health problems than non-smokers with heart trouble.

Non-smoking men were 64 years old at hospital admission, on average, compared to 55 for male smokers. For female heart patients, average ages were 70 for non-smokers and 57 for smokers.

Smokers were less likely to have other health problems that are linked to heart risks, including high cholesterol, high blood pressure and diabetes.

That and their younger age explained why researchers also found that people who lit up were less likely to die in the six months following an attack than non-smokers.

That "smoker's paradox" — the idea that smokers who have a heart attack have better outcomes, including a lower risk of death, than non-smokers — didn't last. The difference in death over the next six months — five percent in male non-smokers, versus three percent in male smokers, and eight and six percent in female non-smokers and smokers, respectively — was explained by age and other risk factors.

Fonarow said the findings are just one more example of the heart dangers posed by smoking, but emphasized that kicking the habit can erase those extra risks.

"It's never too late to quit, and the benefits are very early," he told Reuters Health.

"Even within a few days of stopping smoking, there is a reduction in (heart) risk. As time goes by, within one to two years much of that risk is gone for heart attacks," he added. "From a coronary risk standpoint, there is an immediate benefit and that continues to extend over time."

The findings, published in the American Journal of Cardiology, also showed that female smokers were more likely than male smokers to have another heart attack or other heart problems in the next few months after the initial attack or angina.

"The real key messages are that smoking is a tremendous risk factor for having acute coronary events (earlier)… and that these risks may be even greater in women than in men," Fonarow said.
Read the entire article here.

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