Treatments for Heart disease

• Atrial flutter
  –Rate control is initial goal of therapy
  –Anticoagulation is controversial
  –Cardioversion to terminate rhythm
  –Radiofrequency ablation may be curative

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Abnormal Heart Sounds: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Innocent murmurs
  –Parental reassurance that this is a normal, common finding in children representing normal blood flowing through a normal heart, usually disappearing with age (as the patient grows, the stethoscope is farther from the heart, so the sound isn’t heard)
  –The murmur may get louder during times of increased cardiac output (i.e., illness, fever, dehydration, activity, or other stress)
  –No bacterial endocarditis prophylaxis required

• Abnormal findings requiring referral
  –Abnormal S2 (single or widely split)
  –Holosystolic/regurgitant murmur
  –Any diastolic sounds
  –Systolic ejection clicks: “Harsh” murmurs
  –Any murmur with cardiac symptoms
• Further treatment is dependent on underlying anatomy and physiology

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Heart Failure: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Increased afterload due to left-sided obstructive lesion
  –Use prostaglandins to open ductus arteriosus to relieve the obstruction, and/or use the right ventricle for systemic circulatory support
  –Inotropic support (dopamine/dobutamine) if very ill
  –Surgical intervention depending on specific anatomy

• Left-to-right shunt lesions
  –Diuretics to decrease lung fluid and improve respiratory mechanics
  –Inotropic support with dopamine/dobutamine for critically ill, digoxin for chronic use
  –Systemic afterload reduction with ACE inhibitors if systemic BP adequate
• Myocardial disease
  –Diuretics and inotropes for afterload reduction
  –β-blockers and ACE inhibitors
  –Mechanical circulatory support and cardiac transplantation for advanced heart failure

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Valvular heart disease: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment depends on the nature and severity of associated symptoms. For example, heart failure requires digoxin, diuretics, a sodium-restricted diet and, in acute cases, oxygen. Other measures may include anticoagulant therapy or antiplatelet medications to prevent thrombus formation around diseased or replaced valves, prophylactic antibiotics before and after surgery or dental care, and valvuloplasty. An intra-aortic balloon pump may be used temporarily to reduce backflow by enhancing forward blood flow into the aorta.

If the patient has severe signs and symptoms that can’t be managed medically, open heart surgery using cardiopulmonary bypass for valve replacement is indicated.

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Cardiac arrest, ventricular fibrillation: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

CPR, fluids, epinephrine, vasopressin, oxygen, mechanical ventilation, defibrillation, amiodarone, procainamide

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Cardiac tamponade: Treatment
(Professional Guide to Diseases (Eighth Edition))

The goal of treatment is to relieve intrapericardial pressure and cardiac compression by removing accumulated blood or fluid. Pericardiocentesis (needle aspiration of the pericardial cavity) or surgical creation of an opening (pericardiectomy or pericardial window) dramatically improves systemic arterial pressure and cardiac output with aspiration of as little as 25 ml of fluid. Such treatment necessitates continuous hemodynamic and ECG monitoring in the intensive care unit. Trial volume loading with temporary I.V. normal saline solution with albumin, and perhaps an inotropic drug, such as isoproterenol or dopamine, is necessary in the hypotensive patient to maintain cardiac output. Although these drugs normally improve myocardial function, they may further compromise an ischemic myocardium after MI.

Depending on the cause of tamponade, additional treatment may include:

❑ in traumatic injury — blood transfusion or a thoracotomy to drain reaccumulating fluid or to repair bleeding sites

❑ in heparin-induced tamponade — the heparin antagonist protamine sulfate

❑ in warfarin-induced tamponade — vitamin K.

Resection of a portion or all of the pericardium to allow full communication with the pleura may be needed if repeated pericardiocentesis fails to prevent recurrence.

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Heart failure: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Diuresis, digoxin, vasodilators, inotropics, angiotensin-converting enzyme inhibitors, oxygen

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Rheumatic fever and rheumatic heart disease: Treatment
(Professional Guide to Diseases (Eighth Edition))

Effective management eradicates the streptococcal infection, relieves symptoms, and prevents recurrence, reducing the chance of permanent cardiac damage. During the acute phase, treatment includes penicillin, sulfadiazine, or erythromycin. Salicylates such as aspirin relieve fever and minimize joint swelling and pain; if carditis is present or salicylates fail to relieve pain and inflammation, corticosteroids may be used. Supportive treatment requires strict bed rest for about 5 weeks during the acute phase with active carditis, followed by a progressive increase in physical activity, depending on clinical and laboratory findings and the response to treatment.

After the acute phase subsides, low-dose antibiotics may be used to prevent recurrence. Such preventive treatment usually continues for 5 years or until age 21 (whichever is longer). Heart failure necessitates continued bed rest and diuretics. Severe mitral or aortic valve dysfunction that causes persistent heart failure requires corrective valvular surgery, including commissurotomy (separation of the adherent, thickened leaflets of the mitral valve), valvuloplasty (inflation of a balloon within a valve), or valve replacement (with prosthetic valve). Such surgery is seldom necessary before late adolescence.

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Valvular heart disease: Treatment
(Handbook of Diseases)

Therapy depends on the nature and severity of associated symptoms. For example, heart failure requires digoxin, diuretics, a sodium-restricted diet and, in acute cases, oxygen.

Other measures may include anticoagulant therapy to prevent thrombus formation around diseased or replaced valves, prophylactic antibiotics before and after surgery or dental care, and valvuloplasty. If the patient has severe signs and symptoms that can’t be managed medically, open-heart surgery using cardiopulmonary bypass for valve replacement is indicated.

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Cardiac tamponade: Treatment
(Handbook of Diseases)

The goal of treatment is to relieve intrapericardial pressure and cardiac compression by removing accumulated blood or fluid. Pericardiocentesis (needle aspiration of the pericardial cavity) or surgical creation of an opening dramatically improves systemic arterial pressure and cardiac output with aspiration of as little as 25 ml of fluid. Such treatment necessitates continuous hemodynamic and ECG monitoring in the intensive care unit.

If tamponade or effusions or adhesions from chronic pericarditis recur, a portion or all of the pericardium may need to be removed to allow adequate ventricular filling and contraction. A pericardial window may be performed, which involves removing a portion of the pericardium to permit excess pericardial fluid to drain into the pleural space. In more severe cases, removal of the toughened encasing pericardium (pericardectomy) may be necessary.

If the patient is hypotensive, trial volume loading with temporary I.V. normal saline solution with albumin and perhaps an inotropic drug, such as isoproterenol or dopamine, is necessary to maintain cardiac output.

Clinical tip  Although inotropic drugs normally improve myocardial function, they may further compromise an ischemic myocardium after an MI.

Depending on the cause of tamponade, additional treatment may include:

❑ for traumatic injury: blood transfusion or a thoracotomy to drain reaccumulating fluid or to repair bleeding sites

❑ for heparin-induced tamponade: the heparin antagonist protamine sulfate

❑ for warfarin-induced tamponade: vitamin K.

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Heart failure: Treatment
(Handbook of Diseases)

The aim of therapy is to improve pump function by reversing the compensatory mechanisms that are producing the symptoms. Heart failure can be controlled by treatment consisting of:

❑ diuresis to reduce total blood volume and circulatory congestion; spironolactone, a potassium-sparing diuretic, and nesiritide, a recombinant form of human BNP, are helpful

❑ vasodilators and angiotensin-converting enzyme inhibitors to increase cardiac output by reducing the impedance to ventricular outflow (afterload)

❑ digoxin to strengthen myocardial contractility

❑ beta-adrenergic blockers to improve ejection fraction and reduce morbidity and mortality

❑ dietary restrictions, such as restricted sodium and limiting fluid intake to 2 L/day

❑ biventricular pacemaker to control ventricular dyssynchrony

❑ antiembolism stockings to prevent venostasis and thromboembolus.

UNDER STUDY: An innovative approach to heart failure that remains under investigation is cellular cardiomyoblasty, the transplantation of autologous ex-vivo expanded cells into the myocardium. The transplanted muscle cells promote heart muscle regeneration.

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Rheumatic fever and rheumatic heart disease: Treatment
(Handbook of Diseases)

Effective management eradicates the streptococcal infection, relieves symptoms, and prevents recurrence, reducing the chance of permanent cardiac damage.

Treatment in acute phase

During the acute phase, treatment includes low doses of antibiotics, such as penicillin, sulfadiazine, or erythro-mycin. Salicylates, such as aspirin, can help relieve fever and minimize joint swelling and pain; if carditis is present or the salicylate fails to relieve pain and inflammation, corticosteroids may be used.

Supportive treatment requires strict bed rest for about 5 weeks during the acute phase with active carditis, followed by a progressive increase in physical activity, depending on clinical and laboratory findings and the patient’s response to treatment.

Preventive treatment

After the acute phase subsides, the patient is maintained on low-dose antibiotic therapy, especially during the first 3 to 5 years after the initial episode of rheumatic fever, to prevent recurrence. Such preventive treatment usually continues for 5 to 10 years.

Surgery and other measures

Heart failure necessitates continued bed rest and diuretic therapy. Severe mitral or aortic valvular dysfunction causing persistent heart failure requires corrective valvular surgery, including commissurotomy (separation of the adherent, thickened leaflets of the mitral valve), valvuloplasty (inflation of a balloon within a valve), or valve replacement (with a prosthetic valve). Corrective valvular surgery is rarely necessary before late adolescence.

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Medications used to treat Heart disease:

Note:You must always seek professional medical advice about any treatment or change in treatment plans.

Some of the different medications used in the treatment of Heart disease include:

• Isoprenaline
• Isuprel

Medical news summaries about treatments for Heart disease:

The following medical news items are relevant to treatment of Heart disease:

• Antidepressant prescriptions should not be the first line of defense in treating depression
• Antioxidant in cherries and other colored fruit may increase insulin production by pancreatic cells
• Ceasing hormone replacement therapy may increase osteoporosis risk in women
• Chinese herbal company has released natural alternative for cholesterol reduction
• Co-morbidities override high blood pressure
• Combination therapy causes significant reduction in risk of heart attack
• Conflict over pros and cons of Vioxx
• COX-2 inhibitors need further analysis to determine the range of side effects
• CRP may be linked to risk of heart disease
• Death of woman after cosmetic surgery
• Depression deadly in heart disease
• Diabetes vaccine may prevent diabetes in children at risk
• Diabetic women don’t fare as well as diabetic men following a stenting procedure
• Diabetics face greater rates of mortality and post-surgical complications following coronary bypass
• Diabetics have a new line of defense against kidney disease and heart disease
• Diabetics may benefit from Vitamin E supplements
• Diabetics need to be more aware of benefits of aspirin
• Diet claims to reduce heart disease and increase life expectancy
• Elderly diet supplement carries unknown risks
• Erectile dysfunction drug acknowledged to be effective for 36 hours instead of 24 hours
• Erectile dysfunction linked to vascular problems
• Experimental weight-loss drug shows multitude of health benefits
• FDA warns consumers about dietary supplements that treat erectile dysfunction
• Heart attacks prevented with new drug regime
• Heart disease patients may benefit from blood pressure medication
• Heart medication not a restrictor to sex life assistance
• Heart operations in childhood require lifelong maintenance
• Heart suffers from diet pill
• Hibiscus flower extract controls animal cholesterol levels
• High blood pressure drugs slow kidney damage in diabetics
• High cholesterol in women needs to be given more attention
• Hospital reproached over unnecessary hysterectomy death
• How much is really known about the safety of statins
• Hypothyroidism frequently misdiagnosed or undiagnosed
• Inherited high cholesterol may be subdued by omega-3 fat
• Kawasaki disease effects reduced with steroid treatment
• Lipitor of little benefit to diabetics with renal failure
• Low dose antioxidant may reduce cancer risk in men
• Medication and hypertension
• Metabolic syndrome (X)
• Metabolic syndrome mechanism defined
• Migraines frequently misdiagnosed and underdiagnosed
• More women using natural hormones for menopause therapy
• Niacin increases HDL levels thus reducing heart disease risk
• Obesity surgery carries risks
• Omega-3 fatty acids may improve mental health as well as prevent heart disease
• Open heart surgery for 2 year old
• Over the counter drugs and older drugs should not necessarily safe
• Paracetamol a safe and effective alternative to other anti-inflammatories
• PCOS may be improved by the diet drug Xenical
• Performance of blood pressure drug being questioned
• Plaintiff awarded $115,000 in diet drug case
• Poor compliance of elderly with antihypertensives
• Proposed over the counter cholesterol drug still under doubt
• Rheumatoid arthritis and heart disease link
• Statins may benefit people at low risk of heart disease
• Statins to be trialed as asthma drug
• Study shows 88-140,000 people may have suffered from cardiovascular problems caused by Vioxx
• Study shows oral contraceptives taken before menopause may reduce risk of cancer and heart disease
• Suspension of Aleve comes as a surprise
• Tailor made anti-hypertensive drugs to order
• The Oleic acid component of the olive oil used in the Mediterranean diet may be responsible for breast cancer prevention
• Two hospitals agree to a $31 million and $395 million settlement
• Women needlessly scared off using HRT

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