An assistant professor of medicine, and associate director of the Mount Sinai Hospital echocardiography laboratory, Dr. Lori Croft is a cardiologist who specializes in pregnancy and the heart.

Who's at risk

Although pregnancy causes no cardiac problems for the vast majority of women, certain groups of women have an ­elevated risk of heart complications during pregnancy.

"A woman who has a history of heart disease, heart murmur, rheumatic fever or high blood pressure is potentially at risk during pregnancy," says Croft. "If you fall into one of these groups, you should talk with your doctor before becoming pregnant."

Overall, less than 1% of pregnancies are complicated by heart disease.

"Far and away the majority of women will have no cardiac issues and will not need to see a cardiologist during pregnancy," says Croft. "However, though rare, heart problems when present can affect anyone — age and ethnic background aren't a factor."

In particular, women with certain complex congenital heart problems have an elevated risk. "For some rare conditions, pregnancy is not advised at all," says Croft.

In a very small number of cases, previously asymptomatic women discover they have a heart defect when it shows symptoms for the first time due to the additional stress of pregnancy.

There are three heart-related conditions that are most likely to develop in otherwise healthy women during pregnancy: heart murmur, arrhythmia and hypertension.

"Women often develop a murmur from the extra blood flow in the heart, but only rarely is it pathologic," says Croft. "An arrhythmia is a heartbeat that may be too fast or too slow, regular or irregular, and usually no treatment is required."

The most common cardiac complication during pregnancy is hypertension, or high blood pressure. "This affects about 8% of all pregnancy women, most often after the 20th week," says Croft.

"High blood pressure during pregnancy can affect the supply of oxygen to both the mother and the baby, putting them both at risk," she says. If you develop hypertension during pregnancy, the most serious form it can take is pre-eclampsia, which requires immediate attention because it can be life-threatening. Certain risk factors place you at increased risk of developing hypertension during
pregnancy and pre-eclampsia.

Those most at risk are first-time mothers, women carrying multiple babies, teenage mothers, women older than 40 and women who had high blood pressure or kidney disease before pregnancy.

Signs and symptoms

Pregnancy is a physiological state that places a burden on the heart. "The heart has to work harder for nine months," says Croft. "A pregnant woman's heart pumps 30%-50% more blood than before pregnancy."

While a healthy heart can handle this extra load, a diseased heart can't always cope. "Different kinds of heart diseases may cause different problems during pregnancy," says Croft.

Even normal pregnancies produce cardiac and respiratory symptoms that can mimic more serious complications. "So it's vital to differentiate normal signs and symptoms of pregnancy from a true problem during pregnancy," says Croft.

Symptoms that can arise during a normal pregnancy include fatigue, shortness of breath, swelling in lower extremities, dizziness, lightheadedness, palpitations and increased heart rate.

"Pregnant women should tell their physician if they experience any of these symptoms, so their physician can determine if any evaluation is needed," says Croft.

It's good to keep an eye out for the symptoms of a significant problem. The warning signs for pre-eclampsia include visual disturbances, severe headaches, abdominal pain and lower-extremity swelling. Arrhythmias can cause palpitations, dizziness, fainting, shortness of breath and chest discomfort.

Traditional treatment

Providing medical care for pregnant cardiac patients poses extra challenges. "Some patients may only require reassurance, while some more require in-depth counseling," says Croft. "And if you take medications, it's key that your doctor advises you about which are best for pregnancy."

Good medications are available for treating chronic and gestation hypertension, though the only treatment for pre-eclampsia is delivering the baby.

Only in rare cases do pregnant patients require cardiac surgery.

"Some women may be surgical candidates because they have acute aortic dissection, an acute regurgitant valve or severe valvular stenosis," says Croft. "But a much more common part of my job is reassuring women with low-risk cardiac pathology about their condition, thus eliminating unnecessary anxiety."

Research breakthroughs

Thanks to surgical and medical management advances, many women with congenital heart disease now live to childbearing age and can successfully carry a pregnancy.

"The medical care of a pregnant cardiac patient is a considerable challenge," says Croft. "But with good communication between obstetricians and cardiologists, we can successfully manage care for these patients despite their elevated risk."

Questions for your doctor

A great question for every woman to ask, is "Do I have any restrictions during my pregnancy?" If you have a diagnosed heart problem, ask: "Is my child at risk to inherit my heart condition?"
Another good question is, "Am I at increased risk of C-section?

What you can do

Make sure that your doctor knows about any medications you're taking, including over-the-counter ones. If you have a known heart problem, talk to your physician going through pregnancy.

Watch your blood pressure.

Dr. Lori Croft advises patients to have their blood pressure checked often throughout pregnancy.
Stay healthy.

The rules everyone knows about are indeed essential: Don't drink or smoke, eat healthy and exercise if your doctor allows it.

nydailynews.com

-->Read more...

Treatment for high blood pressure in African-Americans needs to start sooner and be more aggressive, according to a consensus statement by the International Society on Hypertension in Blacks (ISHIB) that is published in Hypertension: Journal of the American Heart Association.

"Evidence from several recently completed studies converged to convince our committee that we were waiting a little bit too long to start treating hypertension in African-Americans," said lead author John M. Flack, MD, of the Department of Internal Medicine at Wayne State University in Detroit, MI, in an online report of the study.

The update to the ISHIB's 2003 consensus statement—for which Flack and colleagues reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure-lowering trials in African-Americans—includes two major recommendations:

* The thresholds at which treatment is initiated in African-American patients should be lowered.
* Physicians should move quickly from single-drug therapy to multi-drug therapy to keep a patient's blood pressure comfortably below the thresholds

"We believe that these recommendations will lead to better blood pressure control, and a better outlook for African-Americans with high blood pressure," Flack said.

Currently, blood pressure below 120/80 is considered normal for healthy adults. However, the ISHIB is proposing that physicians recommend lifestyle changes to lower blood pressure in otherwise healthy African-Americans with blood pressure at or above 115/75. Those changes include reduced dietary sodium and increased potassium from eating more fruits and vegetables, as well as losing weight, getting regular aerobic exercise, and consuming alcohol in moderation, Flack said.

"Epidemiological data shows that 115/75 is the critical blood pressure number for adults, and every time that figure goes up by 20/10 the risk of cardiovascular disease essentially doubles. We think it makes perfect sense to start lifestyle changes at that lower threshold," he said, pointing out that from age 50 and up, Americans have a 90% chance of developing hypertension.

The ISHIB also recommends that physicians tighten the primary prevention threshold to 135/80 for African-Americans, and begin secondary prevention when blood pressure is at or above 130/80, according to the statement, which provides step-by-step guidance on the best second, third, and fourth drugs to add based on individual patient characteristics, along with charts with alternate multi-drug combinations so physicians have several options for keeping patients' blood pressure under targets.

hcplive.com

-->Read more...

As the chair of pediatrics at the Mount Sinai School of Medicine, Dr. Lisa Satlin is a kidney specialist who sees patients from birth to age 21. Since starting her career as a pediatric nephrologist in 1982, she has treated children and their families for problems like hypertension.

Who’s at risk

Hypertension, or high blood pressure, is an extremely common health risk familiar to any American over the age of 50. But it can be present in childhood and adolescence as well.

Blood pressure measurements are reported as two numbers: systolic blood pressure (blood pressure when the heart contracts) over diastolic blood pressure (blood pressure when the heart is relaxed). "In a pediatric patient, hypertension is defined as at least three readings showing a blood pressure level above the 95% percentile" higher than 95 out of 100 children of the same age, gender, and height, says Satlin.

"Having a blood pressure below 90% is normal, and between 90% and 95% is considered prehypertension." According to national guidelines, blood pressure measurements should be a routine in office visits for children over age 3.

"For children, we almost never make a diagnosis of hypertension based on a single casual blood pressure measurement, unless it is extremely high. Instead, this diagnosis usually is made only if the blood pressure is above 95% on three separate occasions, because many situations can lead to a single or temporary elevated blood pressure," says Satlin.

"Children may be in pain from an illness or get anxious or frightened going into the doctor’s office, and the blood pressure might be normal at other times."

Checking the blood pressure at home when the child is more relaxed can help determine whether a child has true hypertension or whether it is only high when seeing a doctor — "White Coat Hypertension." Satlin’s team often has a child use a take-home, wearable, "mini"- blood pressure machine to check the pressure during an entire day.

There are two main types of hypertension. "Primary, or essential, hypertension has no identifiable cause and is most common in children beyond puberty," says Satlin. "Often these children have a family history of high blood pressure and are overweight or obese."

"Secondary hypertension is due to an underlying cause like kidney, hormonal or heart disease, or medication," says Satlin. "This is more common in younger children, under the age of 5-10 years."

Elevated blood pressure in secondary hypertension cases tends to be more severe and consistent than in primary hypertension and may require a variety of special diagnostic tests for identification.

Risk factors for pediatric hypertension include obesity and family history. Up to 80% of children with primary hypertension have a family history of the disease.

Gender and ethnicity also can be risk factors. "We have learned from studies of children in their second decade of life that boys are twice as likely to have prehypertension as girls," says Satlin. "Blood pressures tend to be higher in Hispanic and African-American children, compared to Caucasian children."

Signs and symptoms

One of the difficulties of treating childhood hypertension is that it is frequently a silent disease. "Hypertension typically does not present with any major symptoms in children, except perhaps headache," says Satlin. "This is a big problem, because hypertension that begins in childhood and goes untreated can persist into adulthood, increasing the risk of heart disease, stroke and kidney disease." Because pediatric hypertension is often asymptomatic, it’s usually diagnosed through routine screening.

If pediatric hypertension is severe, it can lead to a variety of symptoms and in rare cases cause seizures, kidney disease, eye disease or heart failure.

Traditional treatment

When a child is diagnosed with hypertension, it is important to determine if there is an underlying cause. "The evaluation usually includes a full history and physical exam, blood pressure measurements in both arms and legs, blood and urine tests, and frequently ultrasounds of the heart and kidneys," says Satlin.

In children, secondary hypertension is often the result of kidney, heart or
hormonal conditions. "Depending on what is found, besides a nephrologist, a child might see a pediatric cardiologist or endocrinologist," says Satlin.

For children with primary prehypertension or hypertension, lifestyle modification can be enough to reduce blood pressure. "The key steps are a healthy diet with low salt intake and more fruits and vegetables, avoiding obesity and getting regular exercise," says Satlin. "Children with more severe hypertension also need to do these things, but their doctor might also need to treat the blood pressure with medications until the blood pressure improves or if it does not improve enough."

Children with an identifiable cause may need a specific treatment. For instance, children with the kidney disease called nephrotic syndrome, which can cause hypertension, often respond well to temporary use of diuretics or oral corticosteroids. "If we can treat the underlying disease, the blood pressure will usually return to normal" says Satlin, "and since the long-term consequences of hypertension can be very significant, it’s important to identify and treat this early in life."

Research breakthroughs

Scientists have vastly enhanced our understanding of the causes of hypertension in children as well as adults by studying patients with extreme elevations of blood pressure or a family history.

"It has become clear that high blood pressure is the end product of an interaction of genes and environment," says Satlin. "Thanks to major research breakthroughs, we’ve finally uncovered the genetic basis for a number of causes of hypertension."

Questions for your doctor

A good way for some parents to start a conversation with their child’s pediatrician is, "I have high blood pressure. Is my child at risk?"

Parents also may want to ask specifically about their child’s blood pressure percentile. If your child is at risk or already has higher-than-normal blood pressure, ask, "What can I do to lower my child’s blood pressure?" There is a lot that doctors and parents can do to prevent or treat childhood hypertension, so get prepared to ask the right questions.

nydailynews.com

-->Read more...

American researchers are one step closer to developing a vaccine against the deadly AIDS virus.

Government scientists discovered three potent antibodies – including one that neutralizes more than 91% of HIV strains – in cells of a 60-year-old African American gay man dubbed Donor 45, the Wall Street Journal reports.

The man's body made the antibodies naturally.

Researchers are now hoping to create a vaccine that would allow anyone's body to make those antibodies. The research could pave the way to create vaccines that would be effective not just against the AIDS virus but other viral illnesses as well.

Coming up with a vaccine "will require work," Gary Nabel, who directs the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, told the Wall Street Journal.

Added Nabel, who was a leader of the research, "We're going to be at this for awhile," before any benefits are apparent. Vaccines, thought to work by turning on the body's own ability to make antibodies, have been an important part of AIDS research.

Last year, the first HIV vaccine to show any effectiveness proved to be a disappointment. Success rates on that vaccine, following a trial in Thailand, ranged from statistically insignificant to 30%. But the discovery of these new antibodies may yield a more promising treatment.

"The antibodies attach to a virtually unchanging part of the virus, and this explains why they can neutralize such an extraordinary range of HIV strains," Dr. John Mascola, a study researcher, said in a statement, according to AOL News.

Turning the discovery of the antibodies into an effective HIV vaccine would be difficult, since researchers would have to zero in on a crucial part of the virus that the antibodies fasten onto, and then design a vaccine using that viral part to prod the body to make the antibodies found in Donor 45.

The new discovery, described in the online edition of the journal Science, comes just days before a large International AIDS Conference in Vienna.

Prevention science is expected to be the focus at the meeting. More than 33 million people had HIV at the end of 2008, according to United Nations estimates reported in the Wall Street Journal, and some 2.7 came down with the virus that same year.

In the case of Donor 45, whose antibodies did not save him from getting HIV, researchers screened some 25 million of his cells to find the dozen that produced the powerful antibodies. He most likely already had contracted the virus before his body started to produce antibodies.

The man is still alive, and had been living with HIV for two decades at the time his blood was drawn.

nydailynews.com

-->Read more...

Kim-Schluger, the associate director of the Recanati/Miller Transplantation Institute, is a hepatologist who oversees the running of the multiorgan transplant center and specializes in liver problems.

WHO’S AT RISK

Hepatitis C is a disease of the liver; there are five hepatitis viruses, and this one has one of the highest rates of progression to chronic disease. “Hepatitis C is a viral infection that causes inflammation of the liver that can lead to increased scar tissue and eventually to cirrhosis,” says Kim-Schluger. “About 4 million Americans are infected with hepatitis C — 1.6% of the population.”

Hepatitis C is a blood-borne disease whose underlying virus was only isolated in 1989. “If you look the number new infections through the decades, a large percentage of patients were infected before 1992, when we developed a good test for hepatitis C,” says Kim-Schluger. “Infection rates dropped precipitously after that.” Because the blood supply wasn’t being reliably screened for hepatitis C until 1992, many americans were infected as the result of blood transfusions.

The two groups at highest risk of the disease are people who received transfusions before 1992 and IV drug users. Other groups at risk are people who have used intranasal cocaine, hemodialysis patients, and health-care workers who are pricked by needles. The virus can also be sexually transmitted. “The risk increases with high-risk behaviors like multiple partners,” says Kim-Schluger. “It’s a low risk, but it’s not zero.”

SIGNS AND SYMPTOMS:

For many patients, the diagnosis of hepatitis C comes without warning signs. “The tricky thing is that the majority of people are asymptomatic, or only have vague symptoms like feeling fatigued,” says Kim-Schluger. “So it is up to the doctor to ask about the risk factors and then screen people who are at risk.”

Up to about 15% of people infected by the hepatitis C virus are able to clear it from their bodies spontaneously. “The other 85% will continue to have virus within their blood,” says Kim-Schluger. “Of that group, about 20% of will develop cirrhosis and 1% to 5% will develop liver cancer related to cirrhosis.” With an infected population of 4 million, these percentages indicate that there will be hundreds of thousands of cases of severe liver disease caused by hepatitis C in the next 10 to 20 years.

Hepatitis C usually has a long latency period, during which the virus lies dormant. “The delay between infection and end-stage liver disease varies a lot, depending on factors like when you were infected and your gender,” says Kim. “It’s usually about 30 years from infection to cirrhosis.” Using alcohol and marijuana shortens this lag. The disease also progresses faster in people who are older than 40 when they get infected. Premenopausal women are slightly protected by estrogen, which may slow fibrosis, the growth of damaging scar tissue in the liver.

nydailynews.com

-->Read more...