Preparing for a Heart Surgery

It is important that you be as healthy as possible. Before surgery, protect yourself from catching a cold or flu. If you have a fever, chills, coughing or a runny nose, be sure to tell your doctor. Tell your doctors about any changes in your health that you notice before your surgery. If you smoke, you should stop at least two weeks before your surgery. Smoking before surgery can cause blood clotting and breathing problems.

Bring to the hospital a list of any medicines you are taking – over-the-counter ones (especially aspirin or medicines that contain aspirin) as well as any that have been prescribed by any of your doctors. In addition to the name of the medicine, include the amount you take, how often and when.

Be sure to follow any instructions that your cardiologist or surgeon has given you.

You rarely will be admitted to the hospital the day before your surgery (often a patient is asked to come in the morning before the surgery). Heart surgery sometimes requires that your breastbone be divided, your heart stopped and your blood sent through a heart and lung machine. Your chest will be washed, scrubbed with antiseptic and, if necessary, shaved or clipped once you are in surgery to avoid introducing germs into your body.

Do not eat or drink anything after midnight before your surgery. The anesthesia that will be used to put you to sleep during the operation is safest when given on an empty stomach. You will be given something to help you relax (a mild tranquilizer) before you are taken to the operating room.

Throughout the preparations for surgery and the surgery itself, you will be monitored using an electrocardiogram. You may be given blood tests, urine tests and a chest X-ray to give your surgeon the latest status of your heart and health.

After you are completely asleep, a tube will be inserted down your windpipe and connected to a machine called a respirator, which will take over your breathing. A second tube will be inserted through your mouth, down your throat and into your stomach. This stops liquid and air from collecting in your stomach, so you will not feel sick and bloated when you wake up. A thin tube called a catheter will be inserted into your bladder to collect any urine produced during the operation.

An intravenous (IV) line (a needle with a tube connected to it) will be put into a vein. This will be used to give you anesthesia before and during the operation. A special line will be put into an artery to monitor your blood pressure and to draw blood samples.

Causes And Treatment For High Blood Pressure

High blood pressure (hypertension) often does not cause any discomfort and is nevertheless one of the greatest dangers to the heart. If left untreated, there is a risk of heart attack, stroke or kidney damage. All about typical risk factors and the most common causes of high blood pressure.

High blood pressure shortens life

Statistically, untreated hypertension reduces life expectancy by a full eleven years. Since the symptoms are often absent or unspecific, only about one in two people with hypertension knows about their disease. Only every fourth person is treated correctly. “Everyone should have their blood pressure checked,” says Prof. Hermann Haller, Chairman of the German High Pressure League (Deutsche Hochdruckliga e.V.). Particularly important are the measurements on people over 45, overweight people and patients with other risk factors such as diabetes or fat metabolism disorders.

High blood pressure threatens stroke or heart attack

In order to supply our organs and muscles with oxygen and nutrients, our heart continuously pumps blood through the body. During exertion or stress, the pressure in the blood vessels is increased to increase performance. This does not hurt and usually does not cause any noticeable discomfort. However, if the pressure is permanently too high, the vessel walls will be damaged. Especially if other risk factors are present, the vessels can narrow. There is a risk of stroke or heart attack.

Primary and secondary hypertension

In order to differentiate the reasons for high blood pressure, doctors distinguish between primary hypertension (also called essential hypertension) and secondary hypertension. In addition to these two, there are special forms that are usually only of temporary duration. One example is pregnancy hypertension.

Primary hypertension is the most common form of high blood pressure in almost 90 percent of cases. It has no organic cause for high blood pressure. Researchers suspect that hereditary factors reduce the elasticity of the blood vessels. As a consequence, the heart muscle has to pump more. This is achieved by higher pressure. In addition to genetic disposition, too much alcohol, smoking, stress, poor nutrition and diabetes are the causes of primary hypertension.

Secondary hypertension is caused by disturbances or diseases of the organs. Possible causes include anomalies in the cardiovascular system or diseases of the kidneys. Over- or under functions in the hormone system are also possible causes.

Causes of high blood pressure

How the body regulates blood pressure is not yet fully understood. It uses biochemical messengers, organs, blood vessels and the nervous system. It is still unclear where this mechanism is so disturbed that high blood pressure develops.

However, there are some factors that favour high blood pressure:

  • Too little exercise
  • unhealthy diet
  • Overweight (abdominal girth from 102 cm for men, from 88 cm for women)
  • increased blood sugar (diabetes mellitus)
  • smoking
  • liquor
  • stress

Basically, the risk of high blood pressure increases in men aged 55 and over, and in women hormonal changes usually increase from the menopause onwards.

Drugs for high blood pressure – yes or no?

If it is not enough to change to a healthy lifestyle, the doctor will prescribe medication to keep the blood pressure in check. About every third patient even needs several different medications until the blood pressure normalizes. Both the reliable intake and regular blood pressure checks by the doctor are important.

Myocardial Insufficiency And Its Effects On The Heart And Body

The terms cardiac insufficiency, weak heart and myocardial insufficiency have one and the same meaning: the heart can no longer pump sufficient amounts of blood through the body. Ultimately, this has far-reaching consequences – not only for the heart itself, but for all organs that suffer from a lack of oxygen and nutrients. Here you can find out why you should take heart failure seriously and what consequences it has for the body.

Heart muscle weakness or normal signs of old age?

The heart has to do a lot in a human life. In a 75-year-old, it has pumped an average of almost 180 million litres of blood through the body in the course of his or her life. Isn’t it normal for the heart to weaken with age? It’s not that simple: a healthy heart can live to be 100 years old without showing signs of poor performance. For the sake of health, warning signals should be taken seriously! For example, if you feel swollen legs in the evening or breathlessness during a walk, you should not simply blame this on your advanced age. Behind this can be a heart muscle weakness, which doctors call heart failure.

Myocardial insufficiency: More than stress for heart and body

For a long time it was assumed that the heart did not have enough power to pump in the case of cardiac insufficiency. But it is not only the strength that the weak heart lacks. In the course of the cardiac insufficiency, the heart also changes – it enlarges and “wears out”. The reason for the change is that due to the lower pumping force, the heart has to exert itself over a longer period of time in order to transport sufficient blood through the body. This is an additional strain on the organism. Since the heart is a muscle, it tries to compensate for the higher effort by increasing muscle formation. The heart becomes both heavier and stiffer and less elastic.

The result: the blood supply to the heart and the body deteriorates continuously. The resulting lack of oxygen means great stress for the body and its organs. It therefore reacts with various measures to maintain normal bodily functions as far as possible. So-called compensation mechanisms ensure normal blood circulation for some time, but in the long term they continue to damage the heart and lead to the typical symptoms of heart muscle weakness.

How far has myocardial insufficiency progressed? Classification into four stages

Doctors use a New York Heart Association (NYHA) scheme to assess the severity of cardiac insufficiency. It is divided into four different stages; NYHA stages 1 to 4.

At severity 1, heart failure is medically present, but the patient hardly notices any symptoms. In stages 2 and 3, the disease progresses. Complaints arise with stronger to light strains, but not at rest. In stage 4, on the other hand, the disease is very advanced: The patient is bedridden and also has to struggle with severe symptoms such as shortness of breath at rest.

Click here for an overview of the 4 NYHA stages.

Unfortunately, cardiac insufficiency very often occurs in combination with other diseases, known as concomitant diseases or comorbidities. Frequent examples are diabetes or kidney weakness. About 50 percent of affected patients have more than five different concomitant diseases. They usually influence both the course of the heart muscle weakness and the quality of life of the patient. Therefore, not only the treatment of heart failure is important, but also the treatment of concomitant diseases. On the one hand, the progression of cardiac insufficiency is stopped in the best possible way; on the other hand, patients who adhere to the treatments agreed with their doctor are better off.

Here you will find the right contact person to turn to if you have heart failure.

What To Know About Strokes

A stroke is the result of a sudden disturbance in the blood supply to the brain because blood vessels clog, tear or burst. As a result, parts of the brain are no longer supplied with oxygen and nutrients.

Stroke symptoms vary depending on which part of the brain is affected. Symptoms include:

  • Headache
  • visual or speech disorders
  • signs of paralysis
  • numbness sensations
  • unsteady gait.

In any case, immediate action must be taken if one or more of these symptoms occur. As a patient or relative, call 112 immediately or see a doctor, because a stroke can only be treated optimally in the first three to four and a half hours.

What causes a stroke?

Most strokes are caused by reduced blood flow. This is caused by calcification of the blood vessels or by blood clots. More rarely, it is caused by a cerebral hemorrhage, for example by a burst aneurysm.

Can I reduce the risk of stroke?

You can have your personal stroke risk determined by having your doctor perform a gentle ultrasound examination of your carotid artery. If the constriction is severe, the risk of stroke can be reduced by an operation to remove deposits from the carotid artery.

Further risk factors are for example:

  • Hypertension,
  • Overweight,
  • Smoking,
  • Diabetes,
  • a high cholesterol level,
  • Tendency to thrombosis.

Some of these risk factors such as smoking or obesity can be influenced by a healthy lifestyle. This includes not smoking, exercise and a healthy diet.

Who is particularly at risk?

In general, people over the age of 60 are more at risk, but young people can also be affected and should take symptoms very seriously. Women suffer strokes more often than men because they live five years longer on average.

What is the risk of having a second stroke?

People who have already suffered a stroke have a higher risk of having another stroke. Especially in the first year after a circulatory disorder of the brain has been overcome, the risk is increased. It is therefore all the more important to reduce the risk factors after a stroke and to ensure a healthy lifestyle.

What We Know About Gene Therapy And How Can It Be Used For Heart Failure

After the flop in an important study two years ago, interest in gene therapy for the heart is growing again. A single injection could be enough to cure the problem.

For more than a decade, scientists have been trying to treat heart failure by providing the heart with a new gene to improve its ability to pump and oxygenate the body.

Renewed interest in gene therapy

A large clinical trial in 2015, in which such a therapy was to be tested, was a flop. But now that gene therapies have become a reality after years of preliminary work on other diseases, interest in their use against heart failure is growing again.

A team at the Icahn School of Medicine in New York, led by Roger Hajjar, recently tested such a therapy on pigs and the results were encouraging. Hajjar was one of the co-founders of the biotech company Celladon, which financed the failed study.

In the new study, 6 of 13 pigs with severe heart failure received gene therapy, the remaining 7 received a saline solution as placebo. Gene therapy proved to be safe and reduced heart failure in the left ventricle by 25 percent and in the left atrium by 20 percent. According to Hajjar, most heart failure patients have problems with the left ventricle. In addition, the enlarged hearts of the pigs were reduced by 10 percent as a result of the therapy.

Preparations for clinical tests

For Hajjar, pigs are good test objects for such therapies because their hearts are about as big as those of humans. Next year, he plans to start recruiting people with advanced congestive heart failure to participate in a clinical trial.

In heart failure, the heart does not simply stop beating. But it is difficult to pump enough blood through the body. It tries to balance this by growing and beating faster, but eventually it stops coming along. The consequences are fatigue and difficulty breathing.

Protein as a starting point for gene therapy

Hajjar’s new therapy uses a gene that regulates a protein called phosphatase-1. It is more abundant in people with heart failure, and too much of it reduces the heart’s ability to contract. Hajjar therefore considers this protein to be a suitable starting point for improving the pumpability of damaged hearts.

This approach differs from traditional gene therapies for inherited diseases that aim to correct a single gene mutation. Hajjar, on the other hand, targets a common consequence of a disease. “By identifying molecular targets found in all patients with heart failure, we could treat all patients instead of just those with specific gene mutations,” he explains.

The gene is packaged in an artificial virus that reaches the heart cells. The therapy would be injected via the radial or femoral artery, the largest in the human body.

More effective transport to the heart

According to Hajjar, he and his colleagues learned from the failure of Celladon gene therapy. At the time, they had tried to improve muscle contraction in the heart by restoring a protein missing from damaged hearts. However, in tests with 250 patients in more than 50 centers in the US and Europe, the therapy showed no significant effect.

Hajjar believes that the problem was that the therapy did not reach enough heart muscle cells. For the current experiment, Hajjar and his colleagues have redesigned the viral vector so that it transports the new gene more effectively to the heart.

Walter Koch, president for cardiovascular medicine and head of the Center for Translational Medicine at Temple University, describes Hajjar’s study as promising. However, the transport of the virus to the heart is not the only challenge – it also has to be “transported into enough cells”. Koch has been working on a gene therapy for heart failure for more than a decade. The aim is to cure the disease with a single injection. “We believe that only once will be enough,” he says.

Cure for heart failure?

For Koch, medicine is closer to a genetic cure for heart failure than ever before, especially now that Big Pharma is also investing in the idea – ten years ago, things were different. Pfizer, for example, concluded a cooperation agreement last year with 4D Molecular Therapeutics from California on the development of viral vectors for heart diseases.

The Dutch company UniQure, manufacturer of the first gene therapy in the western world, is also working on a therapy for heart failure. Bristol-Myers Squibb has entered into a partnership with him in 2015 to develop the drug to market maturity. Upon request, UniQure announced that its gene therapy had so far been mainly tested on miniature pigs. The company did not provide any information about the start of possible clinical studies.