Congenital heart disease in adults, part 2

Article Abstract:

The treatment of congenital heart disease in adults is reviewed, focusing on heart disease that causes cyanosis. Cyanosis occurs when body tissues do not receive enough oxygenated blood. This usually occurs because blood returning to the heart for oxygenation by the lungs does not get oxygenated but is pumped back out of the heart to the rest of the body. The most common cause is a large opening in the muscle that separates the right and left sides of the heart. The treatment of Tetralogy of Fallot, Ebstein's anomaly, Eisenmenger's syndrome and transposition of the great arteries are discussed.

Care and treatment, Congenital heart disease, Congenital heart defects

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Serotonin and acute ischemic heart disease

Article Abstract:

Ischemic heart disease results when the supply of oxygen becomes insufficient for the heart's needs: in one type, the blood supply is temporarily interrupted by spasm of a coronary artery. In another, thought to be quite distinct from the first, an increased demand for oxygen outstrips the limited but constant capacity of narrowed or damaged coronary arteries to deliver blood. The former type is associated with a type of severe chest pain called variant angina; the latter, with unstable angina or myocardial infarction (heart attack). However, unstable angina can develop as a result of either transient or continuous reductions in coronary blood flow; evidence is cited to support this conclusion. Thrombolytic therapy (using drugs that dissolve blood clots) is effective in many such cases. During ischemic episodes, platelets (blood cells essential for clotting) appear to aggregate at sites in the coronary vessels where narrowing (stenosis) has occurred or where the endothelium (arterial lining) is damaged. These aggregates further narrow the lumen (inside diameter) and, in addition, secrete factors that cause intense constriction of the nearby vessel segments. Serotonin is a substance in platelets that affects the tone of coronary arteries by accelerating aggregation; it causes both vasodilation and vasoconstriction, by stimulating endothelial cells to release vasodilating factors, and by binding to receptors on the smooth-muscle cells in the blood vessel wall, causing constriction. When the endothelial cells of the coronary arteries are normal, vasodilation occurs in response to a variety of stimuli, including serotonin release. However, when endothelial cells are damaged, as in atherosclerosis (a condition where fatty plaque is deposited in the arteries), vasodilators are not released, and constriction results from smooth-muscle contraction. Two reports in the March 7, 1991 issue of The New England Journal of Medicine discuss the effects of serotonin in normal and diseased coronary arteries. The results help illuminate the abnormal physiology associated with unstable angina, and imply that effective treatments could be developed that antagonize the effects of serotonin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Physiological aspects, Atherosclerosis, Serotonin, Angina pectoris, editorial

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Current concepts: the use of aspirin in ischemic heart disease

Article Abstract:

Patients with ischemic heart disease are often treated with aspirin to prevent a heart attack. Aspirin prevents aggregation of platelets, and formation of blood clots after blood vessel injury. Treatment with aspirin reduces the risk of a heart attack or death in patients with chronic stable angina (chest pain) or unstable angina at rest. Treatment with a low dose of aspirin each day may also prevent a heart attack in individuals with no history of ischemic heart disease. Treatment with aspirin may not be as effective for preventing a second heart attack. Aspirin is used to treat patients undergoing coronary angioplasty or coronary-artery bypass grafting to prevent blood clot formation. Other antiplatelet drugs may be used alone or in combination with aspirin to treat patients with ischemic heart disease. The main side effects of aspirin are irritation of the gastrointestinal tract and increased bleeding. These side effects are more likely to occur with doses above the recommended 325 mg per day.

Health aspects, Drug therapy, Aspirin

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