General Topics

What are Heart Problems in Children? | Cardiology

Overview of heart problems in children

Congenital malformations are abnormalities in the formation of the heart and/or its main blood vessels. These heart problems occur at birth in eight out of 1,000 babies, but go undiagnosed for many years. The abnormalities range from simple defects, such as a small hole in the wall between the two chambers of the heart, to more complex problems.

Although congenital heart defects are one of the most common birth defects, it can be difficult to know if your child has one. Most heart problems recover during pregnancy or immediately after birth, but others may not be apparent until the baby is a little older.

Heart disease in children

Heart disease is very difficult when touched by adults, but it is especially tragic in children. Heart disease can occur for a variety of reasons, from viral infections to chromosomal abnormalities, and can arise as problems secondary to other diseases or conditions in the body. In most cases, the cause of heart disease is unknown.

The good news is that with the advancement of medicine and technology, many children with heart disease are living full and active lives.

Causes of heart problems in children

A congenital heart defect is a condition (or one of the main heart problems in children) that you are born into. Certain genetic (inherited) diseases or disorders, such as Down syndrome, are associated with congenital heart defects. Certain substances or diseases that a pregnant woman is exposed to can cause congenital heart defects in the fetus, some of which include prescription drugs, rubella (German measles), and uncontrolled diabetes.

Risk factors for heart problems in children

Risk factors for these heart problems in children are divided into two categories: major and contributing. The major risk factors of heart problems in children have been shown to increase your risk of heart disease. There is a risk of heart disease due to proportionate risk factors.

If you have higher risk factors, you are more likely to have heart disease. Some risk factors of heart problems in children can change, treat, or modify and others cannot. But by controlling as many risk factors as possible through lifestyle changes, medications, or both, you can lower your risk of heart disease.

Major risk factors for heart problems in children are:

  • High blood pressure (Hypertension)
  • High blood cholesterol
  • Diabetes
  • Obesity and Overweight
  • Smoking
  • Physical Inactivity
  • Gender
  • Heredity
  • Age

Contributing risk factors to heart problems in children are:

  • Stress
  • Sex hormones
  • Birth control pills
  • Alcohol

Symptoms of heart problems in children

  • Heart murmurs (abnormal heartbeats), depending on the location and nature of the disorder.
  • Symptoms of cardiac arrest, increased breathing rate, shortness of breath, tachycardia
  • “Blue baby” syndrome, in which the skin changes color from lack of oxygen to blue or purple.
  • Clubfoot or spread with a nail that extends the fingers and toes
  • An abnormal increase in red blood cell circulation.
  • Liver dilation
  • Pulse that is hard to hear or has no pulse
  • Cold hands and feet
  • Signs of organ failure, including low urine output or kidney failure
  • The expansion of the heart’s chambers results in the need to work harder to overcome the defect.

Diagnosis of heart problems in children

To diagnose a congenital heart defect or any heart problems in children, your doctor may recommend that you or your baby have some of the following tests and procedures:

  • Echocardiography: Track your / your child’s progress over time to diagnose or not diagnose heart failure. Fetal echocardiography can sometimes diagnose congenital heart defects before the baby is born.
  • Electrocardiogram (EKG or ECG): To evaluate the rhythm of the heartbeat.
  • Cardiac catheterization: Measure the pressure and oxygen levels within the chambers of the heart and blood vessels. This helps to know if blood is flowing from the left side of the heart to the right side of the heart instead of going to the rest of the body.
  • Chest X-ray: To show if the heart is dilated. It also shows whether there is excess blood flow or excess fluid in the lungs, which is a sign of heart failure.
  • Genetic testing: To find out if specific genes or genetic syndromes like Down syndrome are causing congenital heart defects. Your doctor can refer you or your child to a genetic testing specialist.
  • Cardiac MRI: Track your / your child’s progress over time to diagnose heart failure or not.
  • Pulse oximetry: Estimate the amount of oxygen in the blood. The small sensor is placed on the hand or foot of the baby or on the finger or toe of the elderly person.

Treatment for heart problems in children

Treatment for heart problems in children depends on the part of the heart affected. Some children do not need treatment if the effect on blood flow is minimal. Others require medication or intervention, such as cardiac catheterization or surgery. Some heart problems in children may not be treated right away, but wait until the child is an adult. Some heart problems in children are dealt with in stages. In such cases, there are options:

● Medications: Many medications help the heart work more efficiently. Some are also useful for preventing blood clots and controlling irregular heartbeats.

● Implantable heart devices: Some devices, such as pacemakers, can help control abnormal heart rates and implantable cardiovascular defibrillators (ICDs), which can correct irregular heart rates and prevent some of the problems associated with congenital heart defects.

● Catheter procedures: These allow doctors to surgically correct or repair congenital heart defects without opening the chest or heart. Here, the doctor inserts a catheter through a vein in the leg to guide the heart. Using small tools threaded through the catheter, he/she proceeds to correct the error. With the advancement of technology, many heart defects can be closed at the cathode in cathode procedures. This reduces the risks and complications of heart surgery.

● Open-heart surgery: These may be necessary if catheter procedures do not correct the error. These can close the openings of the heart, dilate the blood vessels, or repair the heart valves.

● Heart transplant: In cases where the congenital heart defect is too difficult to repair, a heart transplant may be used. In the process, the healthy donor heart replaces the patient’s heart.

Complications of heart problems in children

Congenital heart disease or heart problems in children can cause complications including:

  • Arrhythmia: The heart may beat very fast, very slow, or abnormally due to a defect or scarring after surgery.
  • Congestive heart failure: When the heart cannot efficiently pump oxygen-rich blood to the rest of the body, symptoms affect various body systems.
  • Heart infections (endocarditis): This infection of the thin layer that lines the inside of the heart occurs when bacteria or other germs enter the bloodstream from another part of the body and remain in the heart. If left untreated, it can damage your heart valves or lead to a stroke.
  • Pulmonary hypertension: This type of high blood pressure only affects the arteries in the lungs. Some heart defects cause more blood to flow to the lungs. As pressure increases, the heart has to work harder, causing the muscles to weaken and sometimes fail. Permanent damage to the pulmonary artery can also occur.
  • Slower growth and development: Children with severe congenital heart defects may be younger and learn to walk and talk later than other children.
  • Stroke: Although rare, blood clots can travel to the brain through a hole in the heart or occur during corrective surgery.
General Topics

Congenital Heart Defects in Children – an Overview | Cardiology

What are congenital heart defects in children?

Congenital heart defects in children (CHDs) are the most well-known sort of birth deformity. With advances in medical care and treatment, children with CHD live longer and healthier lives. Find out more facts about coronary heart disease below.

What are congenital heart defects (CHDs)?

Coronary artery disease is present at birth and can affect the structure and functioning of a baby’s heart. It can affect how blood flows through the heart and out to the rest of the body. Coronary artery disease can vary from mild (such as a small hole in the heart) to severe (such as missing or poorly formed parts of the heart).

About 1 in 4 babies born with a heart defect suffer from critical coronary heart disease (also known as a serious congenital heart defect). Babies with critical coronary heart disease need surgery or other procedures in the first year of life.

Types of congenital heart defects in children

Babies and children with all types of congenital heart defects receive expert diagnosis and treatment from specialists at the Pediatric Congenital Heart Program. Congenital heart defects in children occur at birth and affect the heart or blood vessels. Hundreds of heart defects can arise as a baby develops in the womb, and some infants may have more than one. Some defects cause no health challenges for years; in fact, some may never pose a health risk.

However, many infants require treatment with surgery or catheter procedures to repair congenital heart defects in children immediately or in the first few months of life. Others may need medication as a bridge to surgery or other procedures, or as the only therapy to manage symptoms.

Our experts treat babies and children with all types of congenital heart defects in children, including:

  • Aortic valve stenosis
  • Atrial septal defect
  • Ebstein’s anomaly
  • Hypoplastic left heart syndrome
  • Interrupted aortic arch
  • Coarctation of the aorta
  • Complete atrioventricular canal defect
  • Patent ductus arteriosus
  • Total anomalous pulmonary venous return
  • Transposition of the great arteries
  • Tricuspid atresia
  • Pulmonary valve stenosis
  • Tetralogy of Fallot
  • Truncus arteriosus
  • Ventricular septal defect

Symptoms of congenital heart defects in children

Serious congenital heart defects in children usually appear soon after birth or within the first few months of life. They can include signs and symptoms:

  • Pale gray or blue skin color (cyanosis)
  • Rapid breathing
  • Swelling in the legs, abdomen, or areas around the eyes
  • Shortness of breath during feeding, resulting in poor weight

Less serious congenital heart defects in children may not be diagnosed until later in childhood, because your child may not show any noticeable signs of a problem. If signs and symptoms occur in older children, they may include:

  • Feeling short of breath easily during exercise or activity
  • Fatigue easily during exercise or activity
  • Fainting during exercise or activity
  • Swelling in the hands, ankles, or feet

Causes of congenital heart defects in children

Doctors don’t always know why a child has a congenital heart defect. It tends to run in families. Things that make congenital heart defects in children more likely include:

  • Genetic or chromosomal problems in a child, such as Down syndrome
  • Taking certain medications or alcohol or drug abuse during pregnancy
  • A viral infection, such as rubella (rubella) in the mother in the first trimester of pregnancy

How are heart defects treated?

Youngsters with minor heart deformities may not require any treatment. However, some children suffer from severe symptoms that require medical or surgical treatment during the first year of life. They will be taken care of:

  • Pediatric cardiologists: Doctors who specialize in treating children’s heart problems
  • Pediatric heart surgeons: Specialists in pediatric heart surgery

Procedures performed through cardiac catheterization – such as balloon angioplasty or valvuloplasty – can dilate blood vessels or a blocked valve. Another procedure, blockage of the catheter device, can close abnormal openings or holes in the heart or blood vessels without surgery.

Some problems, such as small or medium-sized ventricular septal defects, may close or get smaller as the child grows. While waiting for the hole to close, the child may have to take medications. Complex Congenital heart defects in children detected early may need a series of processes ending when the child is approximately 3 years old.

Testing and diagnosis of congenital heart disease

Several serious congenital heart diseases are detected during pregnancy, during a routine ultrasound examination. Other conditions may be diagnosed soon after birth. Less serious heart conditions may not be diagnosed until children get older and begin to show certain signs or symptoms of congenital heart disease.

During pregnancy, if your doctor thinks your baby may have CHD, you will likely be referred to a pediatric cardiologist for further testing. The type of diagnostic tests performed will depend on the form of coronary heart disease your child may have. Examples of tests used include a fetal echocardiogram, electrocardiogram (EKG), magnetic resonance imaging of the heart (MRI), and cardiac catheterization. If you are referred to the Children’s Hospital of Philadelphia, you will be seen through the Heart Center’s Fetal Heart Program.

Risk factors for congenital heart defects in children

Most Congenital heart defects in children are caused by problems early in the development of your baby’s heart, and the cause is unknown. However, some environmental and genetic risk factors may play a role. They include:

  • Rubella (German measles): German measles infection during pregnancy can cause problems with the development of your baby’s heart. Your doctor can test for immunity to this viral disease before pregnancy and vaccinate you against it if you are not immune.
  • You can reduce the risk of Congenital heart defects in children by carefully controlling diabetes before trying to conceive and during pregnancy. Gestational diabetes generally does not increase your baby’s risk of developing a heart defect.
  • Some medications taken during pregnancy may cause birth defects, including congenital heart defects. Provide your doctor with a complete list of all medications you take before trying to conceive.
  • Medicines known to increase the risk of congenital heart defects include thalidomide (Thalomide), angiotensin-converting enzyme (ACE) inhibitors (ACE), statins, acne medication isotretinoin (Absorica, Amnstim, and Claravis), and lithium.
  • Drinking alcohol during pregnancy: Avoid drinking alcohol during pregnancy because it increases the risk of Congenital heart defects in children.
  • Smoking during pregnancy increases the likelihood of a congenital heart defect in the baby.
  • Congenital heart defects in children sometimes run in families and may be associated with an inherited syndrome. Many children with Down syndrome – which is caused by an extra chromosome 21 (trisomy 21) – have heart defects. A missing (deleted) piece of genetic material on chromosome 22 also causes heart defects.
  • Genetic testing can detect such disturbances during fetal development. If you already have a baby with a congenital heart defect, a genetic counselor can estimate the odds that your next child will have it.

Complications of congenital heart defects in children

Complications depend on the type of congenital heart defect you have. Include some potential complications:

  • Arrhythmia
  • Blood clots
  • Developmental disorders and delays: Children with congenital heart defects are more likely to have behavior problems. They are also more likely to have speech and attention-deficit / hyperactivity disorder.
  • Emotional health issues: Depression, anxiety, and PTSD are common among people with congenital heart defects.
  • Endocarditis: A type of heart inflammation
  • Endocrine disorders: Include thyroid problems, bone health problems, and diabetes. Problems with the hormones that deal with calcium can cause bone problems.
  • Heart failure: Heart failure is the leading cause of death in adults with congenital heart defects. Some children with congenital heart defects develop heart failure.
  • Kidney disease
  • Liver disease
  • Pneumonia: Pneumonia is a leading cause of death in adults with congenital heart disease.
  • Pregnancy complications: Women with congenital heart defects are at increased risk of developing complications during pregnancy and childbirth. Read more in the Living With section.
  • Pulmonary hypertension
  • Stroke

Outlook and follow-up care for congenital heart disease

Children with congenital heart disease are monitored by specialists called pediatric cardiologists. These doctors diagnose heart disease and help manage children’s health before and after surgical repair of a heart problem. The specialists who correct heart problems in the operating room are known as pediatric cardiovascular surgeons or cardiothoracic surgeons.

It is imperative that individuals born with congenital heart disease who have reached adulthood transition to the appropriate type of heart care. The type of care required depends on the type of CHD the person has. Generally, people with mild types of Congenital heart defects in children can be cared for by a community adult cardiologist. People with more complex types of coronary heart disease will need care at a center that specializes in adult congenital heart disease, such as the Philadelphia Adult Congenital Heart Center.

How can congenital heart disease be prevented?

Women who are pregnant or planning to become pregnant can take certain precautions to reduce the risk of having a baby with a congenital heart defect:

  • If you are planning to become pregnant, talk to your doctor about any prescription or over-the-counter medicines you are taking.
  • If you have diabetes, make sure your blood sugar levels are controlled before pregnancy. It is also important to work with your doctor to manage illness during pregnancy.
  • If you have not been vaccinated against rubella or rubella, avoid exposure to the disease and talk to your doctor about prevention options.
  • If you have a family history of congenital heart defects, ask your doctor about genetic testing. Certain genes may contribute to abnormal heart development.
  • Avoid drinking alcohol and using drugs during pregnancy.

Purpose and Stages of Cardiac catheterization | Cardiology

What is cardiac catheterization?

Cardiac catheterization is a procedure used to diagnose and treat certain cardiovascular conditions. During cardiac catheterization, a long, thin tube called a catheter is inserted into an artery or vein in the groin, neck, or arm and threaded into the heart through blood vessels.

Purpose of cardiac catheterization

The cardiac cath detects how well your heart is working, problems, and allows procedures to open blocked arteries. For example, during a cardiac cat, your doctor may say:

  • Take x-rays of narrow or blocked coronary arteries using a contrast catheter injected through a catheter. This is called coronary angiography or coronary arteriography.
  • Perform percutaneous coronary intervention (PCI), such as coronary angioplasty with stenting, to open narrow or blocked sections of the coronary artery.
  • Check the pressure in all four chambers of your heart.
  • Take blood samples to measure the oxygen content in all four chambers of your heart.
  • Estimate the capacity of the shrink chambers.
  • Look for defects in the valves or chambers of your heart.
  • Remove a small piece of heart tissue for examination under a microscope (biopsy).

Complications of cardiac catheterization

Like most procedures performed on the heart and blood vessels, cardiac catheterization carries some risks. Major problems are very rare.

Risks of cardiac catheterization:

  • Injuries
  • Bleeding
  • Myocardial infarction
  • Race
  • Damage to the area where the artery, heart, or catheter is inserted
  • Irregular heart rhythms (arrhythmia)
  • Allergic reactions to color or medication.
  • Kidney damage
  • Infection
  • Blood clots

If you are pregnant or planning to become pregnant, tell your doctor before doing this procedure.

Stages of cardiac catheterization

The catheter is guided by a small hollow plastic covering called a sheath. Once the catheter is in effect, your doctor will proceed with the necessary tests to confirm your condition.

Depending on what you are looking for, your doctor may do one of the following:

Coronary angiogram: During this procedure, contrast material or dye is injected through the catheter. Your doctor will use an X-ray machine as it travels through your heart’s arteries, chambers, valves, and vessels. Arteries

Heart biopsy: During this procedure, your doctor will take a sample of your heart tissue (biopsy) for a more detailed examination. If your doctor finds a malignant problem during catheterization, he may perform an additional procedure. These policies include:

Ablation: This procedure corrects cardiac arrhythmia (irregular heartbeat). Doctors use energy in the form of heat (radiofrequency energy) or cold (nitrous oxide or laser) to destroy heart tissue and stop irregular heart rhythms.

Angioplasty During the procedure: The doctor inserted a small inflatable balloon into the artery. The balloon is dilated to widen the narrowed or blocked artery. Angioplasty can be combined with the placement of a stent – a small metal coil that is placed in a blocked or blocked artery to prevent future narrowing problems.

Balloon valvuloplasty: During this procedure, doctors insert a balloon-tipped catheter into the narrow valves of the heart to open the confined space.

Thrombectomy (treatment of blood clots): During this procedure, doctors use a catheter that can remove blood clots and travel to organs or tissues.

How long does the procedure last?

The cardiac catheterization procedure generally takes 30 minutes, but preparation and recovery time can add several hours to your appointment (five to nine hours or more).

Before the cardiac catheterization

  • If you have diabetes, do not eat or drink anything for two hours before the test. Discuss this with your doctor. Not eating affects your blood sugar level and requires adjustments to your insulin dose.
  • Talk to your doctor about the medicine you are taking. They may ask you to stop taking them before the test, especially if you are taking antiplatelet medications such as comedian (warfarin) or aspirin, or Plavix. It is important to bring a list of your allergies, medications, and dosages to this procedure so the healthcare team knows what you are taking and how much you are taking.
  • We will give you a hospital gown. You will not use anything else during the process. Remove all clothing (including lingerie), jewelry, and glasses. The nursing staff or your doctor will notify you if you need to remove any dentures and/or hearing aids.
  • We ask that you sign consent forms for the process.
  • We prepare the catheter site (the area of ​​your body where the catheter enters).
  • We need to trim body hair and cleanse your skin with a special wash that kills germs.
  • We ask that you empty your bladder (P) before beginning your procedure.
  • When you are ready and ready for your procedure, we invite your family member or friend to come to the pre-operative room. They will stay with you until it is time for your policy.
  • If needed, you may have blood tests and a chest X-ray before the procedure.

During the cardiac catheterization

When you are at the Cardiovascular Intervention Center, you see television monitors, heart monitors, and blood pressure machines. You will be connected to an EKG to monitor your heart during the test.

You will be given an injection of anesthesia to numb the area around where the catheter will be inserted. It can be a bit uncomfortable. Tubes are then inserted to access the artery and/or vein. The catheter is gently passed through the artery, guided by X-rays, and reaches your heart. There should be no pain.

After the cardiac catheterization

After the procedure, your doctor will remove the catheters, sheath, and guidewire. A pressure bandage is applied to the area where the catheter is inserted to stop the bleeding. The pressure can be sustained by hand or with a sandbag or other device. You will be transferred to the recovery room, where you will lie down on the bed. Heart rate and blood pressure will be monitored.

Depending on your health before your cardiac catheterization and any additional procedures performed during your cardiac catheterization, you may need to spend the night in the hospital. You should follow your doctor’s instructions on what medications to take and when to start the activity.


Overview of Electroencephalogram (EEG) | Neurology

What is an electroencephalogram (EEG)?

An electroencephalogram (EEG), is a test that estimates the electrical activity of the brain. It can be done to diagnose or observe diseases that affect the brain, such as epilepsy and sleep disorders. Your doctor will inform you if you need an EEG. The loads are stretched and appear on the computer screen as a graph or a recording on paper. Then your healthcare provider will explain the reading to you.

During an electroencephalogram (EEG), your healthcare provider will usually estimate the activity of 100 pages or computer screens. He or she pays special attention to the primary waveform but also examines responses to stimuli such as brief bursts of energy and flashing lights.

Purpose of electroencephalogram

The electroencephalogram (EEG) is used to identify problems associated with certain brain disorders in the electrical activity of the brain. Measurements given by EEG are used to confirm or rule out various conditions:

  • Seizure disorders (such as epilepsy)
  • Head injury
  • Encephalitis (inflammation of the brain)
  • Brain tumor
  • Encephalopathy (a disease that causes brain dysfunction)
  • Memory problems
  • Sleep disorders
  • Stroke
  • Dementia

When someone is in a coma, an EEG can be done to determine the level of brain activity. This test can also be used to monitor activity during brain surgery.

Where is electroencephalogram (EEG) tests done?

The EEG is usually performed in the hospital at the outpatient clinic. People with epilepsy have told us that it would be helpful for them to go on a date with someone. Some people are very tired of this process and are less likely to have seizures during the test. It may help to plan how you will get home after your appointment.

You may be asked to bring some simple portable recording equipment with you. You will be shown how to operate it.

Risk factors

An electroencephalogram has been done for many years and is considered a safe procedure. The test does not cause any discomfort. Electrodes record activity. They do not produce any sensation. Also, there is no risk of electric shock.

Certain factors or conditions can interfere with the reading of the EEG test. Besides these:

  • Low blood sugar (hypoglycemia) created by fasting
  • Body or eye movement through the tests (but this will rarely, if ever, significantly prevent the interpretation of the test)
  • Lights, especially bright or flashing ones
  • Certain drugs, such as sedatives
  • Drinks such as coffee, cola, and tea (these beverages may occasionally alter EEG results, which does not significantly interfere with test interpretation)
  • Oily hair or the behavior of hair spray


Preparing for electroencephalogram

The patient is told when the electroencephalogram is scheduled.

  • If the patient is taking restrictive medications routinely to prevent seizures, antidepressants, or stimulants, they may be asked to stop taking these medications 1 to 2 days before the test.
  • The patient is told not to ingest caffeine before the test.
  • The patient should not use hair products (hairspray or gel) on the day of the test.
  • It is prudent to take the patient to the EEG site, especially if he or she wants to refrain from taking overdose medications.
  • If the patient has a sleep EEG, they may be asked to stay awake the night before the test.

During electroencephalogram

During an electroencephalogram, 20 electrodes are placed on your scalp while you lie on the exam table or in bed. Open your eyes first, then close them and relax. You may be asked to inhale deeply and quickly or to stare at a flashing light; both activities cause changes in brain wave patterns. If you are prone to epilepsy, you will rarely experience one during the test. If you are being evaluated for a sleep disorder, you may have a continuous EEG done at night while you sleep. This recording, which assesses other bodily functions such as breathing and pulse during sleep, is called polysomnography.

After electroencephalogram

Once the test is complete, the electrodes are removed and you are allowed to stand up. The results must be analyzed at a later stage by a neurologist (a doctor who specializes in brain disorders).

Generally, if there are no abnormalities in the electrical activity of the brain, the pattern of “peaks and valleys” traced by the electroencephalogram should be fairly regular. If excited, the pattern will show considerable variation and any deviation from the regular pattern may indicate abnormalities.


Once the electroencephalogram results have been analyzed, they are sent to your doctor, who will accompany you. The EEG looks like a series of wavy lines. The lines will look different depending on whether you are awake or asleep during the test, but each state will have a general pattern of brain activity. If the regular brain wave pattern is disturbed, it could be a type of epilepsy or another brain disorder.

Having an abnormal EEG does not mean you have epilepsy. The test records what is happening in your brain at that moment. Your doctor will do other tests to confirm the diagnosis.


Complications of electroencephalogram (EEG) include:

  • You move too much.
  • You take certain medicines. This involves medicines used to treat seizures (antiepileptic medicines), sedatives, tranquilizers, and barbiturates.
  • You took coffee, soda, or tea, or you ate extra foods that have caffeine before the test.
  • You are careless from severe drug poisoning or very low body temperature (hypothermia).
  • Your hair is dirty, oily, or treated with hair spray or other hair products. This can create a problem with how the electrodes are placed.

Diagnosis and Treatment of Atrial Tachycardia | Cardiology

What is atrial tachycardia?

Atrial tachycardia (AT) is a type of abnormal heart rhythm or arrhythmia. It happens when the electrical signal that controls the heartbeat starts from an unusual location in the upper chambers (atria) and rapidly recurrences, causing the atria to beat too quickly.

What happens during atrial tachycardia?

A normal heartbeat begins with an electrical instinct from the sinus node, a single point in the heart’s right atrium (right upper chamber). Throughout atrial tachycardia, an electrical impulse outside the sinus node fires repeatedly, often due to a short circuit – a circular electrical pathway. Electricity circles the atria, again and again, causing the upper chambers to agreement more than 100 times per minute. (A normal heart rate is between 60 and 100 beats per minute.) The rapid heart contractions prevent the chambers from filling completely between beats.

An arrhythmia placed in the upper chambers of the heart is called supraventricular tachycardia (SVT) – accurately, fast “heartbeat above the ventricles” (lower chambers). Atrial tachycardia usually occurs for brief periods and starts and stops spontaneously. That’s called paroxysmal AT. If it continues, it is called persistent AT.

Causes of atrial tachycardia

Atrial tachycardia happens most often in elderly patients and those with other types of heart disease, although it occasionally seems in children, younger people, and people with healthy hearts. Causes include:

  • A “stretched” atrium as a result of high blood pressure (hypertension) or cardiomyopathy
  • A previous heart attack
  • Excessive use of alcohol, cocaine, and other stimulants
  • An “irritable focus,” when cells outside the sinus node automatically start to generate an electrical impulse on their own
  • Sometimes atrial tachycardia is idiopathic, which means that doctors cannot find a specific cause

Symptoms of atrial tachycardia

Atrial tachycardia can cause the following symptoms:

  • Pressure or pain in the chest
  • Fainting, also known as syncope or near syncope
  • Fatigue
  • Lightheadedness or dizziness
  • Palpitations, which may jump, flap, or pound in the chest
  • Difficulty breathing

It is important to note that some children may not know how to describe what they feel during a period of atrial tachycardia. They may have trouble custody up with other children or realize that they are having “incantations” and want to sit and rest. Occasionally a child does not experience any symptoms at all.

Diagnosis of atrial tachycardia

The tests and procedures used to diagnose atrial tachycardia may include:

  • Blood tests to check thyroid function, heart disease, or other conditions that can trigger atrial tachycardia
  • Electrocardiogram (ECG) to measure the electrical activity of your heart and measure the time and duration of each beat
  • Holter monitor, which is a transportable ECG device designed to record your heart activity as you go about your routine
  • Echocardiogram, which uses sound waves to produce pictures of the size, structure, and movement of your heart

Your doctor may also try to trigger an episode with other tests, which may include:

  • A stress test, which is usually done on a treadmill or stationary bike while monitoring heart activity
  • Electrophysiological testing and plotting, which allows your doctor to see the precise location of the arrhythmia

Treatment for atrial tachycardia

Treatment of atrial tachycardia depends on the harshness of the condition and the factors that trigger it. In addition to managing any underlying conditions that may trigger your atrial tachycardia, your doctor may recommend or test:

  • Vagal maneuvers: You may be able to temporarily lower your heart rate by using particular maneuvers including holding your breath and straining, dipping your face in ice water, or coughing.
  • Medicines: Your doctor may suggest intravenous or oral medications to control your heart rate or restore a normal heart rhythm.
  • Cardioversion: If your arrhythmia (irregular heartbeat) does not respond to vagal maneuvers or medication, and if there is no identifiable and treatable condition that triggers it, your doctor may use electrical cardioversion. In the procedure, a shock is delivered to the heart through paddles or patches on the chest. The present affects the electrical impulses in your heart and can restore a normal rhythm.
  • Catheter ablation. In some cases, your physician may recommend tube ablation. For this procedure, your doctor inserts one or more catheters through the blood vessels to the heart. The electrodes on the catheter tips can use heat, extreme cold, or radiofrequency energy to damage (remove) a small part of the heart tissue and create an electrical jam along the pathway that is causing the arrhythmia.
  • If you experience common episodes of atrial tachycardia and all other treatment options are vain, your doctor may suggest implantation of a small device called a pacemaker to deliver electrical impulses that kindle your heart to beat at a normal rate. For people with AT, this procedure is usually shadowed by the ablation of the AV node.


Incessant (prolonged) atrial tachycardia can lead to cardiomyopathy (a weakening of the heart muscle) and heart failure. This type of cardiomyopathy is often reversible if the atrial tachycardia can be controlled.


Signs and Symptoms of Costello Syndrome | Cardiology

What is Costello syndrome?

Costello syndrome is a very rare genetic condition. It occurs when there is a change (mutation) in a gene called the HRAS gene. This happens in a child’s DNA before birth.

Costello syndrome causes glitches that affect the heart, muscles, bones, skin, brain, and spinal cord. There is no cure for the condition, but doctors can help children control most symptoms.

Alternate name

  • Faciocutaneoskeletal syndrome

Causes of Costello syndrome

Mutations in the HRAS gene cause Costello syndrome. This gene provides orders for making a protein called H-Ras, which is part of a pathway that helps control cell growth and division. The mutations that cause Costello syndrome to lead to the production of an H-Ras protein that is turned on (activated) in an abnormal way. The overactive protein causes cells to constantly grow and divide, which can lead to the development of cancerous and non-cancerous tumors. It is not clear how mutations in the HRAS gene cause the other features of Costello syndrome, but many of the signs and symptoms are likely the result of excessive cell growth and abnormal cell division.

Some people with signs and symptoms such as Costello syndrome do not have an identified mutation in the HRAS gene. These individuals may have CFC syndrome or Noonan syndrome, which are caused by mutations in related genes. The proteins produced from these genes interact with each other and with the H-Ras protein as part of the same cell growth and division pathway. These interactions help explain why mutations in different genes can cause conditions with overlapping signs and symptoms.

Signs and symptoms of Costello syndrome

Babies with Costello syndrome are usually of normal or high birth weight, but show poor sucking ability, have difficulty swallowing, and do not grow or gain weight at the expected rate (growth retardation). Growth delay after birth generally results in short stature during childhood and adulthood. Affected children may have a developmental delay or mild to moderate intellectual disability. In some people, the development of speech and/or the ability to walk is significantly delayed. Children with Costello syndrome generally have warm and sociable personalities.

People with Costello syndrome often have loose skin (cutis laxa) on the neck, palms, fingers, and soles of the feet. The skin in these areas may lack elasticity and become loose; Furthermore, the skin may appear wrinkled and thickened. In some cases, certain areas of the skin may turn unusually dark (hyperpigmentation). Also, most patients with this disorder develop dry, hardened patches of skin (hyperkeratosis) with unusually deep folds on the palms and soles of the feet. Some affected individuals may also have skeletal abnormalities such as disrupted hips, abnormally flexible (hyperextensible) finger joints, wrists bent toward the little finger (ulnar deviation), and/or unusual tension of the fibrous cords at the back of the heels (Achilles tendon). Other skeletal abnormalities include side-to-side curvature of the spine (scoliosis), front-to-back curvature of the spine (kyphosis), and reduced range of motion in the shoulders and elbows.

Children with Costello syndrome often develop papillomas around the mouth and nasal passages. Papillomas can develop as young as two years of age or older. In some cases, these wart-like lesions (warts) can be found near the anus. Papillomas generally become more apparent with age. Other benign tumors have also been reported.

Children with Costello syndrome have a characteristic facial appearance. Characteristic facial features may include an abnormally large head (macrocephaly); low-set ears with large, thick lobes; unusually thick lips; a large, depressed bridge of the nose; abnormally wide nostrils (nostrils); and a rough facial appearance. Also, affected children may have unusually curly hair and/or sparse, thin hair on the front (anterior) part of the head. Some children have folds of skin over the inner corners of the eyes (epicanthus folds).

In early childhood, the relative overgrowth of the rhombencephalon compared to the available space in the posterior fossa of the skull cavity can lead to thronging and neurological problems. Because severe crowding requires surgical intervention, magnetic resonance imaging of the brain and cervical spine has been suggested.

Changes in the eyes and vision are shared and include nystagmus (rapid eye movements) in younger individuals, strabismus, and rarely keratoconus (abnormal thickening of the cornea) in older individuals.

Children with Costello syndrome often have sure heart abnormalities. These may include structural malformations of the heart that are present at birth (congenital heart defects); abnormal thickening of the muscular walls of the lower left chamber of the heart (hypertrophic cardiomyopathy); valve leakage between the left upper (atrial) and lower (ventricular) chambers of the heart (mitral valve prolapse); and/or other heart defects. Symptoms and associated findings may include abnormal heart sounds (heart murmurs) that can be detected by a physician using a stethoscope; shortness of breath, particularly when exercising; weakness; chest pain; abnormal heart rhythms (arrhythmias); and/or other findings that can potentially lead to life-threatening complications without proper treatment.

Affected people have an approximately 15% lifetime risk of developing malignant tumors, such as cancer of the muscle tissue (rhabdomyosarcoma), cancer of the nerve cells (neuroblastoma), and transitional cell carcinoma of the bladder.

In some cases, the symptoms and answers of Costello syndrome overlap with two similar disorders recognized as Noonan syndrome and cardiofaciocutaneous syndrome that are caused by mutations in different genes.

Diagnosis of Costello syndrome

Costello syndrome is very rare, so a doctor is unlikely to immediately suspect it.

A doctor will begin by assessing the child’s height, head size, and birth weight.

The next stage includes molecular genetic testing. Sequence analysis is approved out on the HRAS gene to see if there is an alteration related to Costello syndrome.

Treatment for Costello syndrome

There is no cure for Costello syndrome, nor is there any specific treatment, but aspects of the syndrome, for example, heart conditions, hypertrophic cardiomyopathy, can be specifically treated.

Ways to help the individual manage the condition include:

  • Help a child overcome feeding difficulties during infancy
  • Treatment for heart problems
  • Providing special education
  • Researchers are looking for an effective way to treat the condition at the genetic level.

Other interventions include:

  • Physical therapy and occupational therapy
  • Surgery to lengthen the Achilles tendon
  • Removal of papillomas with cryotherapy


Costello syndrome is a complex, multi-system condition that can lead to a variety of complications.

Babies may not be able to feed by mouth until they are 2 to 4 years old, or around the same time, they begin to speak.

Cardiovascular problems usually appear from early childhood, although symptoms may not appear until later. These include congenital heart defects and cardiac hypertrophy. The person may experience tachycardia or rapid heartbeat and arrhythmias or irregular heart rhythms.

Macrocephaly, or overgrowth of the brain, has been observed in 50 percent of patients. This can lead to a Chiari malformation, a structural defect in the brain found in 32 percent of people, according to one study. Seizures appear to affect between 20 and 50 percent of people with the condition.

There may be delays in bone growth, low bone density, and an increased risk of bone fractures and osteoporosis. Vitamin D and calcium supplements can help.

Tumors, most commonly papillomas, small growths that resemble warts, can develop, especially around the nose, mouth, and anus.

People with Costello syndrome are prone to developing cancerous and non-cancerous tumors. Cancerous tumors include rhabdomyosarcoma, neuroblastoma, and transitional cell carcinoma.

Two other genetic conditions with similar symptoms are Noonan syndrome and cardiofaciocutaneous syndrome (CFC). Overlapping symptoms make it difficult to diagnose Costello syndrome during childhood.


Overview of Restless Legs Syndrome (RLS) | Neurology

What are restless legs syndrome?

Restless legs syndrome (RLS), also called Willis-Ekbom disease, causes unfriendly or uncomfortable sensations in the legs and a tempting urge to move them. Symptoms usually appear in the late afternoon or evening, and are usually more severe at night when a person is resting, such as when sitting or lying in bed. They can also occur when someone is inactive and sitting for long periods (for example, when traveling by plane or watching a movie). Since symptoms can increase in severity during the night, it may be difficult to fall asleep or go back to sleep after waking up. Moving the legs or walking normally alleviates the discomfort, but the sensations often recur once the movement stops. RLS is classified as a sleep disorder because symptoms are triggered by resting and trying to sleep, and as a movement disorder, people are forced to move their legs to relieve symptoms. However, it is best characterized as a sensory neurological disorder with symptoms that arise from within the brain itself.

RLS is one of several disorders that can cause exhaustion and daytime sleepiness, which can strongly affect mood, concentration, work, and school performance, and personal relationships. Many people with RLS report that they are often unable to concentrate, have memory problems, or are unable to perform daily tasks. Raw moderate to severe RLS can lead to an approximately 20 percent decrease in work productivity and can underwrite depression and anxiety. It can also make travel difficult.

It is estimated that up to 7-10 percent of the US population may have RLS. RLS occurs in both males and females, though women are more likely to have it than men. It can start at any age. Many people who are severely affected are middle-aged or older, and symptoms tend to become more frequent and last longer with age.

More than 80 percent of people with RLS also experience periodic limb movement during sleep (PLMS). PLMS is characterized by involuntary jerking or jerking movements in the legs (and sometimes arms) during sleep, which usually occur every 15 to 40 seconds, sometimes during the night. Although many people with RLS also develop PLMS, most people with PLMS do not experience RLS.

Fortunately, most cases of RLS can be treated with non-drug therapies and, if necessary, with medications.

Types of restless legs syndrome

There are two main types of SPI:

Primary or idiopathic RLS

Idiopathic means the cause is unknown.

It is the most common type and has the next characteristics:

  • It usually begins before age 40
  • It can start from childhood
  • It may have a genetic cause
  • Once primary RLS begins, it tends to last a lifetime

Symptoms can be sporadic or gradually worsen and become more frequent over time.

In mild cases, the person may not have symptoms for a long time.

Secondary RLS

A secondary disorder is caused by an additional disease or condition.

Secondary RLS usually begins after age 45 and is not usually inherited. This type of SPI is clearly different:

  • The onset is sudden
  • Symptoms do not usually get worse over time
  • Symptoms can be more severe

Illnesses and symptoms that can trigger secondary RLS include:

  • Diabetes
  • Lack of iron
  • Renal insufficiency
  • Parkinson’s disease
  • Neuropathy
  • The pregnancy
  • Rheumatoid arthritis

Exactly how Restless legs syndrome occurs is not well understood, but it may be related to the way the body processes dopamine, a neurotransmitter that plays a role in controlling muscle movements. Some medications, such as selective serotonin reuptake inhibitors (SSRIs) and antidepressants, can trigger RLS. These drugs affect the activity of dopamine.

It is also related to pregnancy. About 20 percent of women experience RLS during the last trimester of pregnancy, although the reasons are unclear.

Periodic Limb Movement Disorder (PLMD)

PLMD is a also related sleep disorder, sometimes termed periodic limb (leg) movement during sleep (PLMS). In people with PLMD, the limbs twitch or shake uncontrollably while they sleep. It is also careful a type of sleep disorder. Movement can cause the individual to wake up frequently during the night and this can undermine the quality and duration of sleep. It can cause SPI.

Symptoms of restless legs syndrome

The Restless Legs Syndrome International Study Group described the following symptoms of restless legs syndrome (RLS):

Strange itching, tingling, or “crawling” sensations occur deep in the legs; These sensations can also occur in the arms.

An urgent need to move the limbs to alleviate these sensations.

Restlessness: Walking on the floor, tossing and turning, rubbing legs

Symptoms can occur only when lying down or sitting down. Sometimes persistent symptoms get worse when lying down or sitting and improve with activity. In very severe cases, symptoms may not improve with activity.

Other symptoms of RLS include the following:

Sleep disturbances and daytime sleepiness.

Involuntary, repetitive, periodic, and jerky movements of the limbs occur during sleep or while you are awake and at rest. These movements are called periodic movements of the legs during sleep or periodic movement of the limbs disorder. Up to 90% of people with RLS also have this disorder.

In some people with RLS, symptoms do not occur every night but come and go. These people may go weeks or months without symptoms (remission) before symptoms return.

Causes of restless legs syndrome

Most of the time, the cause of RLS is a mystery. There may be a genetic tendency and an environmental trigger.

More than 40 percent of people with RLS have a family history of the condition. In fact, there are five genetic variants associated with RLS. When it is hereditary, symptoms usually begin before the age of 40.

There may be a connection between RLS and low iron levels in the brain, even when blood tests show that your iron level is normal.

RLS may be related to a disruption in dopamine pathways in the brain. Parkinson’s disease is also related to dopamine. That may clarify why many people with Parkinson’s also have RLS. Some of the same drugs are used to treat both conditions. Research on these and other theories is ongoing.

It is possible that certain substances such as caffeine or alcohol can trigger or intensify symptoms. Other potential causes include medications to treat:

  • Allergies
  • Nausea
  • Depression
  • Psychosis

Primary RLS is not related to an underlying condition. But RLS can actually be a consequence of another health problem, such as neuropathy, diabetes, or kidney failure. When that’s the case, treating the main condition can solve RLS problems.

Diagnosis of restless legs syndrome

There is no single test to diagnose restless legs syndrome.

The diagnosis will be based on your symptoms, medical and family history, a physical exam, and test results.

Your GP should be able to diagnose restless leg syndrome but can refer you to a neurologist if there is any doubt.

There are 4 main criteria that your GP or specialist will look for to confirm a diagnosis.

These are:

  • An irresistible urge to move your legs, typically with an uncomfortable sensation, such as itching or tingling
  • Your symptoms occur or are worse when you are resting or inactive
  • Your symptoms are relieved by moving or rubbing your legs
  • Your symptoms get worse in the afternoon or evening
  • Assess your symptoms
  • Your GP or specialist will ask about the pattern of your symptoms to help assess their severity

For example, they may ask you:

  • How often do you have symptoms?
  • How unpleasant you find your symptoms
  • If your symptoms cause significant distress
  • If your sleep is interrupted, making you feel tired during the day
  • Keeping a sleep diary can help your doctor evaluate your symptoms

You can use the diary to record your daily sleeping habits, such as the time you go to bed, the time it takes to fall asleep, how often you wake up during the night, and episodes of fatigue during the day.

Mild symptoms of restless legs syndrome can usually be treated through lifestyle changes.

For example:

  • Establish a regular sleep pattern
  • Avoiding stimulants, such as caffeine, alcohol, or tobacco, at night
  • If your symptoms are more severe, you may need medicine to control them

Blood test

Your GP may refer you for blood tests to settle or rule out possible fundamental causes of restless legs syndrome.

For example, you may have blood tests to rule out conditions such as anemia, diabetes, and kidney function problems.

It is particularly important to know your blood iron levels because low iron levels can sometimes cause secondary restless legs syndrome.

Low iron levels can be treated with iron tablets.

Sleep tests

If you have restless legs syndrome and your sleep is severely disrupted, sleep tests, such as a suggested immobilization test, may be recommended.

The test involves lying on a bed for a set period of time without moving the legs while monitoring the involuntary movements of the legs.

On occasion, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves, and heartbeat over the course of one night.

The results will confirm if you have periodic limb movement during sleep (PLMS).

Treatment for restless legs syndrome

Treatment of restless legs syndrome is contingent on the intensity of the symptoms. Treatment should be considered if the quality of life is affected by insomnia and excessive daytime sleepiness. In cases of RLS due to ongoing medical conditions, specific treatment is also necessary.

Non-pharmacological treatments. Non-drug treatments are tried first, particularly if symptoms are mild. Non-drug treatments include:

  • Exercise regularly, such as riding a bike / stationary bike or walking, but avoid heavy/intense exercise a few hours before bed.
  • Follow good sleep habits, such as avoiding reading, watching television, or using a computer or telephone while lying in bed; get 7 to 9 hours of sleep and follow other healthy sleep habits. Not getting enough sleep can make Restless legs syndrome symptoms worse.
  • Avoid or limit caffeinated harvests (coffees, teas, colas, chocolates, and some medications [check labels]), nicotine, and alcohol.
  • Apply a heating pad, cold pack, or rub the legs to temporarily relieve leg discomfort. Also consider massage, acupressure, ambulatory, light stretching, or other relaxation techniques.
  • Soak in a hot tub.
  • Try magnesium supplements. Can be useful.
  • Reduce stress as much as possible. Try meditation, yoga, soft music, or other options.
  • Iron supplements. Iron deficiency is a reversible cause of RLS. If blood tests reveal that you have low iron levels, your doctor may recommend taking an iron supplement.

Prescription drugs. When Restless legs syndrome symptoms are recurrent or severe, your healthcare provider will likely prescribe medications to treat the disorder. Medication options include:

Dopamine agonists switch the urge to move, sensory symptoms in the legs, and reduce involuntary jerking of the legs throughout sleep. Ropinirole (Requip), pramipexole (Mirapex), and rotigotine patch (Neupro) are FDA-approved dopamine agonists used for RLS.

Anti-seizure medications can slow or block pain signals from the nerves in the legs. Examples include gabapentin enacarbyl (Horizant), gabapentin (Neurontin), and pregabalin (Lyrica). These medications are particularly effective in patients with painful RLS due to neuropathy. Gabapentin enacarbyl is the only drug in this class that is FDA approved for Restless legs syndrome. However, the others can be effective.

Benzodiazepines, particularly clonazepam, are sometimes prescribed for RLS but are generally reserved for more severe cases due to their addictive potential and side effects, including daytime sleepiness.

Opioids, such as methadone or oxycodone, can be used to relieve the symptoms of RLS, but due to the risk of addiction, they are generally not prescribed unless the case is plain and other medications have not been effective.

You and your physician will discuss the treatment that might be best for you.


Although RLS does not lead to other serious conditions, symptoms can range from mildly bothersome to disabling. Many people with RLS have a hard time falling asleep or staying asleep.

Severe Restless legs syndrome can cause a marked deterioration in the quality of life and can lead to depression. Insomnia can cause excessive daytime sleepiness, but RLS can interfere with napping.


Causes of Ebstein’s Anomaly | Cardiology

What is Ebstein’s anomaly?

Ebstein’s anomaly is a rare heart defect in which parts of the tricuspid valve are irregular. The tricuspid valve separates the lower right heart chamber (right ventricle) from the upper right heart chamber (right atrium). In Ebstein’s anomaly, the position of the tricuspid valve and how it works to separate the two chambers is abnormal.

The disorder is congenital, which means it is present at birth.

Causes of Ebstein’s anomaly

The tricuspid valve usually consists of three parts, called leaflets or flaps. The leaflets open to allow blood to change from the right atrium (upper chamber) to the right ventricle (lower chamber) while the heart relaxes. They are closed to prevent blood from moving from the right ventricle to the right atrium while the heart pumps.

Ebstein’s anomaly

In people with Ebstein’s anomaly, the leaflets are placed deeper into the right ventricle rather than the normal position. The brochures are usually larger than normal. The defect often causes the valve to malfunction, and blood can leak out. Instead of flowing into the lungs, the blood returns to the right atrium. The backup of blood flow can lead to an enlarged heart and accumulation of fluid in the body. There may also be a narrowing of the valve that leads to the lungs (pulmonary valve).

In many cases, people also have a hole in the wall that separates the two upper chambers of the heart (atrial septal defect), and blood flow through this hole can cause oxygen-poor blood to go to the body. This can cause cyanosis, a blue shade to the skin caused by oxygen-poor blood.

Ebstein’s anomaly occurs when the baby develops in the womb. The exact cause is unknown. The use of certain medications (such as lithium or benzodiazepines) during pregnancy can play a role. The condition is rare. It is more common in white people.

Signs and symptoms of Ebstein’s anomaly

The most common sign of Ebstein’s anomaly in newborns and infants is a blue discoloration of the skin, lips, or nails (cyanosis). In some severe cases, the baby may have trouble breathing.

Older children may have the following symptoms:

  • Cough
  • Rapid breathing or shortness of breath
  • Slow growth
  • Fatigue
  • Racing heartbeat
  • Swelling
  • Arrhythmia

Diagnosis of Ebstein’s anomaly

A chest X-ray will be taken to judge the size of the heart, which may be quite enlarged. The diagnosis of Ebstein’s anomaly is often suspected because of the large size of the heart on the chest X-ray.

An echocardiogram is used to definitively diagnose Ebstein’s anomaly and identify any accompanying heart defects. This test allows the pediatric cardiologist to determine the degree of valve displacement, the severity of the valve leak (insufficiency) or valve narrowing (stenosis), the size of the heart chambers, and whether there is a patent foramen ovale. (open).

An electrocardiogram (ECG) records your heart rhythm. If the child has complained of a racing heart and the answer is not found in this initial test, they can go home with a recorder that is used to try to capture episodes of tachycardia (rapid heart rate). Your child may also have a stress test to better assess his heart function during activity. Some patients with abnormal heart rhythms may require additional electrophysiological testing to better identify and potentially treat their heart rhythm problems.

Invasive diagnostic tests are not performed as frequently today as in the past due to the availability of better non-invasive techniques such as echocardiograms and MRI. However, some patients with Ebstein’s anomaly may require cardiac catheterization to fully define their cardiac anatomy and function.

Treatment for Ebstein’s anomaly

Ebstein’s anomaly has the utmost variation in severity among all congenital heart defects. Some babies with the defect do not survive pregnancy, while other people live normal lives and never need treatment.

As an adult with mild Ebstein malformation, you may not need any treatment for years. If you have an arrhythmia, you may be treated with medicine to control your heart rate and rhythm. Depending on the severity of the arrhythmia, you may need non-surgical treatment, such as radiofrequency ablation, to correct the heart rhythm. If you grow heart failure, you may need other medications, such as a diuretic.

However, the course of Ebstein’s anomaly is unpredictable and the condition could worsen to the point where your symptoms are bothersome or your heart could enlarge, causing decreased heart function. In any of these situations, surgical treatment may be necessary.

Type of surgery is cast-off to treat Ebstein’s anomaly?

Ebstein’s anomaly is a rare heart defect, particularly in adults, so if you need surgery, you will want to choose a surgeon who is experienced in treating adults with this specific condition. The most likely place to find a cardiac surgeon with this type of experience will be in a large academic medical center.

There are several surgical procedures that are used to treat Ebstein’s anomaly:

Tricuspid valve repair or replacement

The goal of this surgery is to repair the faulty valve between the right atrium and the right ventricle so that the leaflets open and close properly.

When enough tissue is present, the valve can be repaired. This is the preferred treatment because it uses its own tissue. When the existing valve cannot be repaired, it is possible to replace it with a mechanical valve or one made from biological tissue. If you receive a mechanical valve replacement, you will need to take blood-thinning medications for the rest of your life.

Atrial communication repair

Many people with Ebstein’s anomaly have a hole in the septum (the tissue between the upper chambers of the heart [the atria]). This hole will be surgically closed at the same time as the valve repair is performed.

Arrhythmia surgery (maze procedure)

Depending on the type of arrhythmia you have, you may have labyrinth surgery in combination with valve surgery. During maze surgery, the surgeon creates new electrical pathways in the heart that restore normal heart rhythm.

Heart transplant

In the most severe cases, when the valve is severely deformed, heart function is poor, and other treatments are not effective, a heart transplant may be the best treatment option.

In a recently published study of patients ages 4 to 58 who underwent surgery for Ebstein’s anomaly, survival, and cardiac function were very good 10 years later.


Mild Ebstein’s anomaly may not cause complications.

However, the possible complications of Ebstein’s anomaly include:

  • Heart failure
  • Sudden cardiac arrest
  • Race

Taking some precautions before playing sports or getting pregnant can help prevent complications.

If your heart size is near normal and you have no heart rhythm disturbances, you can probably participate in most physical activities. Depending on your signs and symptoms, your doctor may recommend that you avoid certain competitive sports, such as soccer or basketball.

If you are planning to have a baby, talk to your doctor. Many women with mild Ebstein’s anomaly can safely have children. But pregnancy, labor, and delivery put extra pressure on your heart. In rare cases, serious complications can develop that can cause the death of the mother or the baby. Together, you and your doctor can decide how much control you need during pregnancy and delivery. In some cases, other treatments for your condition or symptoms may be recommended before you get pregnant.


Treatment and Diagnosis of Sciatica | Neurology

What is sciatica?

Sciatica is an indication of pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and glutes and down each leg. Sciatica usually affects only one side of your body.

Sciatica occurs most often when a herniated disc, a bone spur in the spine, or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes swelling, pain, and often some deadness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-surgical treatments within a few weeks. People who have severe sciatica associated with significant leg weakness or bladder or bowel changes may be candidates for surgery.

Alternate name

  • Sciatic neuritis

Symptoms of sciatica

Pain that discharges from the lower spine (lumbar) to the buttock and back of the leg is the symbol of sciatica. You may feel the discomfort almost somewhere along the nerve path, but it likely to follow a path from the lower back to the buttock and the back of the thigh and calf.

Pain can vary widely, from a mild ache to a sharp burning impression or excruciating pain. Sometimes it can feel like a shock or electric shock. It can be worse when you cough or sneeze, and sitting for a long time can make symptoms worse. Typically only one side of your body is affected.

Some people also have shudder, tingling, or muscle weakness in the affected leg or foot. You may feel pain in one part of your leg and impassiveness in another part.

Sciatica occurs when the sciatic nerve is pinched, usually by a herniated disc in the spine or by an overgrowth of bone (bone spur) in the vertebrae. More rarely, the nerve can be compacted by a tumor or damaged by a disease such as diabetes.

Causes of sciatica

Sciatica occurs when the sciatic nerve is pinched, typically by a herniated disc in the spine or by an overgrowth of bone (bone spur) in the vertebrae. More rarely, the nerve can be compacted by a tumor or damaged by a disease such as diabetes.

Risk factors

Risk factors for sciatica include:

  • Years. Age-related changes in the spine, such as herniated discs and bone spurs, are the most common causes of sciatica.
  • Obesity. By collective stress on the spine, excess body weight can add to the spinal changes that trigger sciatica.
  • Occupation. A job that requires you to turn your back, carry heavy loads, or drive a motor vehicle for long periods of time can affect sciatica, but there is no conclusive evidence for this link.
  • Sitting for a long time. People who sit for long periods or have a sedentary lifestyle are more likely to develop sciatica than active people.
  • Diabetes. This disorder, which affects the way your body uses blood sugar, raises your risk of nerve damage.

Diagnosis of sciatica

During the physical exam, your doctor can monitor your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, get up from a squat, and while lying on your back, raise your legs one at a time. The pain that results from sciatica will generally get worse during these activities.

Imaging tests

Many people have herniated discs or bone limbs that will show up on X-rays and other imaging tests, but have no signs. Therefore, doctors do not usually order these tests unless the pain is severe or does not improve within a few weeks.

  • Bone scan. An X-ray of the spine may reveal an overgrowth of bone (bone spur) that may be demanding on a nerve.
  • MRI. This way uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bones and soft tissues, such as herniated discs. During the test, you lie on a table that is moved toward the MRI machine.
  • Computed tomography. When a CT scan is used to image the spine, you may have a contrast dye injected into your spinal canal before the x-rays are taken, a procedure called a CT myelogram. The dye then circulates around the spinal cord and spinal nerves, which appear white on examination.
  • Electromyography (EMG). This test measures the electrical impulses produced by your nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated discs or narrowing of the spinal canal (spinal stenosis)

Treatment for sciatica

If your pain does not improve with self-care measures, your doctor may suggest some of the following treatments.


The types of medications that may be prescribed for sciatica pain include:

  • Anti-inflammatory
  • Muscle relaxants
  • Narcotics
  • Tricyclic antidepressants
  • Anti-seizure drugs

Physical therapy

Once your acute pain recovers, your doctor or physical therapist can design a rehabilitation program to help avoid future injuries. This generally includes exercises to correct your posture, strengthen the muscles that support your back, and improve your flexibility.

Steroid injections

In some cases, your doctor may recommend injecting a corticosteroid medicine into the area around the affected nerve root. Corticosteroids help reduce pain by suppressing irritation around the irritated nerve. The effects typically wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too often.


This option is usually kept for when the compressed nerve causes significant faintness, loss of bowel or bladder control, or when you have pain that progressively worsens or does not improve with other therapies. Surgeons can remove the bone spur or the part of the herniated disc that is pressing on the pinched nerve.


Although most people make a full recovery from sciatica, often without treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you have:

  • Loss of sensation in the affected leg
  • Weakness in the affected leg
  • Loss of bowel or bladder function


Sciatica cannot always be prevented, and the condition may recur. The following can play a key role in protecting your back:

  • Exercise regularly. To keep your back strong, pay special helpfulness to the core muscles – the muscles in the abdomen and lower back that are important for proper posture and alignment. Ask your doctor to commend detailed activities.
  • Maintain proper posture when sitting. Choose a seat with good lower back support, armrests, and a swivel base. Reflect placing a pillow or rolled towel on your lower back to maintain your normal curve. Keep your knees and hips level.
  • Use good body mechanics. If you are standing for long periods, rest one foot on a stool or small box from time to time. When lifting something heavy, let your lower edges do the work. Move up and down. Keep your back traditional and bend only your knees. Keep the load close to your body. Avoid lifting and turning simultaneously. Find a partner to lift if the object is heavy or uncomfortable.

Prevention of Enlarged Heart (Cardiomegaly) | Cardiology

What is an enlarged heart (cardiomegaly)?

An enlarged heart (cardiomegaly) means that your heart is larger than normal. Your heart expands if the muscles work too hard or the chambers expand. An enlarged heart is not a disease. It is a symptom of a heart defect or condition that causes the heart to become harder, such as cardiomyopathy, heart valve problems, or high blood pressure.

An enlarged heart does not pump blood as efficiently as an enlarged heart. This can lead to problems like stroke and heart failure. Certain conditions can cause the heart muscle to thicken, leaving one of the heart’s chambers larger. Depending on the condition, the enlarged heart can be temporary or permanent. An enlarged heart can be treated by correcting the cause. Treatment for an enlarged heart may include medications, medical procedures, or surgery.

Types of an enlarged heart

The heart enlarges because of damage to the heart muscle. Up to a point, an enlarged heart can still pump blood normally. As the condition progresses, though, the heart’s pumping ability declines. Dilated cardiomyopathy is the main type of enlarged heart. The walls of both sides (also known as ventricles) become thin and stretched. This enlarges your heart.

In the other types, the muscular left ventricle becomes very thick. High blood pressure may cause your left ventricle to enlarge (a type known as hypertrophy). The thickening (which doctors call hypertrophic cardiomyopathy) can also be inherited. An enlarged heart keeps more of its pumping ability when it’s “thick” rather than “thin.”

What are the symptoms of an enlarged heart?

Sometimes an enlarged heart doesn’t cause any symptoms. When symptoms do occur, they include:

  • Difficulty breathing
  • Irregular heartbeat (arrhythmia)
  • Swelling of the legs and ankles due to increased fluid (edema)
  • Fatigue
  • Dizziness

Symptoms that indicate a medical emergency:

  • Chest pain
  • Difficulty holding your breath
  • Pain in the arms, back, neck, or jaw.
  • Epilepsy

Causes of an enlarged heart

An enlarged heart is caused by conditions that cause your heart to pump harder than normal or damage your heart muscle. Sometimes the heart becomes enlarged and weak for unknown reasons. This is called idiopathic cardiomegaly. Damage from a congenital (congenital) heart condition, a heart attack, or an abnormal heartbeat (arrhythmia) can cause your heart to dilate. Other conditions associated with an enlarged heart include:

  • Hypertension: Your heart needs to pump hard to supply blood to the rest of your body, to stretch and tighten your muscles.
  • High blood pressure: Causes the left ventricle to dilate, eventually weakening the heart muscle. High blood pressure also expands the chambers above the heart.
  • Heart valve disease: The four valves in your heart allow blood to flow in the right direction. If the valves are damaged due to conditions such as rheumatic fever, heart defects, infections (infective endocarditis), irregular heartbeats (atrial fibrillation), connective tissue disorders, certain medications, or radiation treatments for cancer, your heart may enlarge.
  • Cardiomyopathy: This heart disease makes it difficult for your heart to pump blood throughout your body. As it develops, you can try to pump more blood into the vagina.
  • High blood pressure in the artery connecting the heart and lungs (pulmonary hypertension). Your heart needs to be pumped hard to move blood between your lungs and your heart. As a result, it can expand to the right side of your heart.
  • Fluid around your heart (pericardial effusion): Fluid buildup in the sac that contains your heart makes your heart appear enlarged on a chest X-ray.
  • Blocked arteries in your heart (coronary artery disease): With this condition, fatty plaque in the coronary arteries blocks blood flow through the coronary arteries, leading to a heart attack. When a section of the heart muscle dies, your heart must pump hard to get enough blood to the rest of your body, causing it to expand.
  • Low red blood cell count (anemia): Anemia is a condition in which there are not enough healthy red blood cells to carry enough oxygen to the tissues. Untreated chronic anemia can cause a fast or irregular heartbeat. Your heart needs to pump more blood so there is no oxygen in the blood.
  • Thyroid disorders: Both a dysfunctional thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
  • Excess iron in the body (hemochromatosis): Hemochromatosis is a disorder in which your body does not metabolize iron properly, which occurs in various organs, including the heart. It causes enlargement of the left ventricle due to the weakening of the heart muscle.
  • Rare diseases that affect your heart, such as amyloidosis: Amyloidosis is an abnormal protein that circulates in the blood and can build up in the heart, disrupting the heart’s function and causing it to expand.

Diagnosis of an enlarged heart

An early diagnosis of an enlarged heart is very necessary to control or improve the condition. On a physical exam, the doctor may hear abnormal heart sounds or fluid in the lungs or swelling in the legs, ankles, or abdomen. Advanced tests to carefully diagnose, treat, and monitor the condition effectively include:

  • Blood tests: Blood tests measure the levels of certain fats, cholesterol, sugar, and proteins in the blood, which indicate heart conditions.
  • Cardiac catheterization: A long, thin flexible tube is inserted through a blood vessel in the arm or groin and into the heart. The contrast material is injected through a tube and a kind of X-ray video is taken to show how the heart is working and to see the heart block. A small piece of the heart tissue may be taken for laboratory analysis.
  • Chest X-ray: A simple imaging test of the lungs, lungs, heart, and aorta.
  • Computed tomography (CT) angiography: This non-invasive exam shows the arteries in the abdomen, pelvis, and legs. This test is especially useful in patients with pacemakers or stents.
  • Echocardiogram: This ultrasound test uses sound waves to take moving images of the heart’s chambers and valves.
  • Electrocardiogram (EKG): An EKG measures the electrical activity of the heart and can detect an enlarged heart and determine whether the heart is overactive or damaged. The electrical currents of the heart are detected by 12 to 15 electrodes through the adhesive tape on the arms, legs, and chest.
  • Magnetic Resonance Imaging (MRI): A large magnet, radio waves, and a computer are used to create images of the heart and blood vessels.
  • Stress test: This test is done while you exercise. If a person is unable to exercise, medications are given to increase the heart rate. In addition to the ECG, the test shows changes in blood pressure along with heart rate, rhythm, or electrical activity. Exercise-The heart works harder and beats faster when heart tests are done.

How enlarged heart is treated?

Your doctor will prescribe a treatment plan for the condition that is causing your heart. For example:

  • Hypertension: ACE inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers
  • Irregular heart rhythm: Antiarrhythmic drugs, pacemakers, and implanted automatic defibrillator (ICD)
  • Heart valve problems: Surgery to repair or replace a damaged valve
  • Narrow coronary arteries: Percutaneous coronary intervention, coronary artery bypass graft (CABG), and nitrates
  • Heart failure: Diuretics, beta-blockers, inotropes, and, in some minorities, the left ventricular assist device (LVAD)
  • Other approaches can address congenital heart defects. If you try some treatments and they don’t work, you may need a heart transplant.

Changes in lifestyle

With lifestyle changes like these, you can maintain an enlarged heart:

  • Exercise: Exercise most days of the week. Ask your doctor what types of exercises are safe for you.
  • Give up smoking: Techniques like nicotine restoration products and treatment can help stop it.
  • Lose weight: Weight loss will be followed by constant fatigue and tiredness.
  • Limit certain foods: Limit salt, cholesterol, and saturated and trans fats in your diet.
  • Avoid certain things: Drugs such as alcohol, caffeine, and cocaine should be avoided.
  • Chill out: Follow relaxation techniques like meditation or yoga to reduce stress.

Enlarged heart complications

The risk of complications from an enlarged heart depends on the enlarged part of the heart and the cause.

Problems with an enlarged heart include:

  • Heart failure: An enlarged left ventricle, one of the most serious types of enlarged heart, increases the risk of heart failure. In heart failure, the heart muscle weakens and the ventricles dilate (dissociate) until the heart can efficiently pump blood throughout the body.
  • Blood clots: Having an enlarged heart is more likely to cause blood clots in the lining of the heart. If clots enter the bloodstream, they can block blood flow to vital organs and even cause a heart attack or stroke. A clot on the right side of your heart can travel to your lungs, a dangerous condition called a pulmonary embolism.
  • Heart murmur: For people whose hearts are enlarged, two of the four heart valves, the mitral and tricuspid valves, do not close properly because they rupture, causing backflow of blood. This flow creates sounds called heart murmurs. Although it is not necessarily harmful, your doctor should monitor your heart murmurs.
  • Cardiac arrest and sudden death: Sometimes an enlarged heart can lead to heart rhythm interruptions. Heart rhythms that allow the heart to beat too slow or too fast to move blood can lead to epilepsy or, in some cases, cardiac arrest or sudden death.

Prevention of enlarged heart

  • Tell your doctor if you have a family history of conditions that can cause an enlarged heart, such as cardiomyopathy. If cardiomyopathy or other heart conditions are diagnosed early, treatments can prevent the disease from getting worse.
  • Controlling risk factors for coronary artery disease (smoking, high blood pressure, high cholesterol, and diabetes) can help reduce the risk of heart enlargement and heart failure by reducing the risk of a heart attack.
  • Eating a healthy diet and avoiding alcohol abuse or illicit drug use can help lower your chances of heart failure. Controlling high blood pressure with diet, exercise, and possibly medication can prevent many people with an enlarged heart from stopping.

Recovery after dilated heart surgery

The length of your hospital stay depends on the process.

  • After a coronary artery bypass graft, you spend a day or two in the intensive care unit and another three to five days in another unit before returning home. Full recovery can take 6 to 12 weeks. Your doctor will tell you when you are physically active again, return to work, or resume sexual activity.
  • Recovery after ventricular assist device surgery depends on your condition before surgery. You spend a day or two in the intensive care unit and another three to five days in another unit before going home. You make a slow transition from the hospital to the home, which may be the first day you are home, but you return to the hospital that night. Your doctor will advise you on activities you can participate in until you fully recover.
  • After heart valve surgery, you will spend one to two days in the intensive care unit and three to five days in another unit before going home. Full recovery can take 6 to 12 weeks. Your doctor will tell you when to be active again.
  • After heart transplant surgery, you spend several days in the intensive care unit before going home and several weeks in another unit. After discharge, you must be very close to the hospital for the first six weeks for frequent subsequent visits and lab tests. Your doctor will advise you on activities you can participate in until you fully recover.