Health Blog

Coronary Circulation

2008-03-01T13:43:00.000-08:00

Coronary

2008-03-01T13:42:00.001-08:00

Coronary Heart Disease Overview

Coronary heart disease (CHD), also called coronary artery disease, affects about 14 million men and women in the United States.

Disease develops when a combination of fatty material, calcium, and scar tissue (plaque) builds up in the arteries that supply the heart with blood. Through these arteries, called the coronary arteries, the heart muscle (myocardium) gets the oxygen and other nutrients it needs to pump blood.

The plaque often narrows the artery so that the heart does not get enough blood.

This slowing of blood flow causes chest pain, or angina.

If plaque completely blocks blood flow, it may cause a heart attack (myocardial infarction) or a fatal rhythm disturbance (sudden cardiac arrest).

A major cause of death and disability, coronary heart disease claims more lives in the United States than the next 7 leading causes of death combined.

The heart consists of 4 chambers: an atrium and a ventricle on the right, and an atrium and ventricle on the left.

Blood returning to the heart from veins all over the body flows into the right atrium.

From there the blood flows into the right ventricle, which pumps it out to the lungs for oxygenation.

The oxygen-rich blood returns to the left atrium.

From there the blood flows into the left ventricle, which pumps it at high pressure into the arteries.

This entire process constitutes one heartbeat.

The pumping, or contraction, of the left ventricle must be very powerful because that is what keeps the blood flowing throughout the body.

The strength of the heart muscle depends on the oxygen and nutrient supply coming via the coronary arteries.

These arteries are usually strong, elastic, and quite flexible.

The heart has 3 major coronary arteries.

Two of these arteries arise from a common stem, called the left main coronary artery.

The left main coronary artery supplies the left side of the heart.

Its left anterior descending (LAD) branch supplies the front part of the heart.

The left circumflex (LCX) branch supplies the left lateral and back side of the heart.

Finally, the right coronary artery (RCA) is separate and supplies the right and the bottom parts of the heart.

As a child, the inner lining of the coronary arteries is quite smooth, allowing blood to flow easily. As a person ages, the cholesterol and calcium content in the walls of the coronary arteries increases, making them thicker and less elastic.

Unhealthy habits, such as a diet high in cholesterol and other fats, smoking, and lack of exercise accelerate the deposit of fat and calcium within the inner lining of coronary arteries.

This process is known as atherosclerosis, or hardening of the arteries. The deposits, or plaques, eventually obstruct the blood vessel, which begins to restrict blood flow.

Plaque is like a firm shell with a soft inner core containing cholesterol. As blood hits it during each heartbeat, the plaque may crack open and expose its inner cholesterol core, which promotes blood clotting. Clots may further reduce blood flow, causing severe pain (angina), or even block it all together.

Alzheimer

2008-02-28T05:58:00.001-08:00

Alzheimer's disease, the leading cause of age-related dementia, affects 5 million Americans, 4.9 of which are over age 65. Dementia is a broad medical term that refers to the loss of mental functions such as memory and reasoning. Alzheimer's disease causes dementia by attacking nerve cells in the parts of the brain that control thought, memory and language. As more and more cells are destroyed, patients lose memories and the ability to reason and communicate. Personalities and behavior change. Eventually patients require total care.

The Alzheimer's Association says that people with the disease die an average of four to six years after diagnosis, but the duration of the disease can vary from three to 20 years.

Prognosis

Alzheimer's does not have a cure and is progressive. However drugs can help. One group of drugs is directed toward improving the patient's cognitive symptoms, thinking, understanding and remembering. A second group of drugs is used to treat the behavioral problems associated with Alzheimer's, such as aggressiveness, agitation, depression and anxiety.

Statins may protect against Alzheimer's, study finds

2007-09-10T10:20:00.000-07:00

Statins, drugs commonly prescribed to treat cardiovascular disease, may also protect people from getting the tangles of nerve fibers found in the brains of Alzheimer's disease patients, according to a study that examined the brains of 110 deceased Group Health Cooperative members.

Authors of the study, released Monday, said the findings are preliminary but intriguing because they could signal that statins prevent the brain changes that signal the progression of Alzheimer's disease.

Those patients who had taken statins before they died showed significantly lower levels of tangles in their brains, said researchers from Group Health, the University of Washington and the Veterans Affairs Puget Sound Health Care System.

Dr. Eric Larson, a co-author who is executive director of Group Health Center for Health Studies, said this is the first time researchers have been able to correlate years of exposure to statins with microscopic changes in brain tissue by performing autopsies.

"This has great therapeutic importance if it's confirmed," Larson said.

For now, though, Larson and co-author Dr. Thomas Montine, a UW neuropathologist, said that while the study was "hopeful news," they are not recommending everyone start taking statins.

"Our data says these drugs appear to be doing something in the human brain," Montine said. "Whether this will translate into behavioral changes, we can't say."

The study, published in the Aug. 28 edition of the journal Neurology, was not a randomized study, nor did it look at behavioral changes.

And it clearly won't be the last word on the subject. Earlier studies, including a large one at the UW published in 2005 by some of the same researchers, have found that statins had no effect on participants' abilities to think and remember.

Before that, some studies suggested statins did reduce risk of Alzheimer's.

Conflicting results

In both the earlier UW study and the current study, subjects had taken statins for only five years or less. It may be that longer use of statins would offer more protection, Larson said.

In addition, in these and other previous studies, participants had taken various types of statins. Larson said that could account for some of the conflicting results.

Both Larson and Montine said more research is needed to sort out what's going on. "There's got to be a resolution at some point to these conflicting studies," Montine said.

Generally speaking, statins lower cholesterol by inhibiting an enzyme that is needed for cholesterol to form. Just how that may or may not be related to the plaques and tangles found in the brains of Alzheimer's patients is not clear, Montine said.

"There are a lot of possibilities," he said. "We don't know the answer yet."

This latest study did not find significant correlation between statin use and formation of plaques, which are larger protein deposits that form outside nerve cells.

Researchers generally believe that the processes of plaque formation are related to the beginning of Alzheimer's, while tangle formation signals disease progression, he said.

"It's unclear how the two are linked," Montine said. "That's the million-dollar question in Alzheimer's research."

Group Health, UW

The research participants were between 65 to 79 when they died and had been enrolled in the "Adult Changes in Thought" study, a joint project of Group Health and the UW that began in 1994.

It now includes almost 4,000 people, all originally Group Health members. A smaller subset, around 1,000, have agreed to let researchers autopsy their bodies after they die.

"Their courage has allowed us to gain a new perspective, no question about that," Montine said.

Larson, like many researchers, says it's hard to overestimate the importance of finding ways to delay or completely ward off the onset of Alzheimer's disease, which is the most common cause of dementia in later life. It affects 4 million people in the U.S.

"Anything you can do to prevent or delay that disease will have a huge effect on our older population, our kids and our community, because we're all in this together," he said.

Cold reality of an artificial heart

2007-08-30T11:04:00.000-07:00

Peter Houghton is grateful for his artificial heart. It has saved his life.

He's just a little wistful about emotions.

He wishes he could feel them like he used to.

Houghton is the first permanent lifetime recipient of a Jarvik 2000 left ventricular-assist device. Seven years ago, it took over for the heart he was born with. Since then, he has walked long distances, traveled internationally and kept a daunting work schedule.

At the same time, he reports, he's become more "coldhearted" and "less sympathetic in some ways."

He doesn't feel like he can connect with those close to him. He wishes he could bond with his twin grandsons, for example. "They're 8, and I don't want to be bothered to have a reasonable relationship with them and I don't know why," he says.

He can only feel enough to regret that he doesn't feel enough.

Once a rugby player

Life took a turn

Houghton, 68, has become a man after his own heart. It is a large part of his identity. His e-mail name is Heartpump1.

When first encountered at a 2006 Oxford University conference called "Tomorrow's People," he comes across like the rugby player he once was, sturdy and broad-chested. But in 2000, due to severe heart failure at 61, Houghton was staring at death.

He knew death well. Trained as a psychotherapist, he had become a palliative-care counselor in London and Birmingham, looking after the dying. He had helped 122 people into the beyond. He'd made his peace with death.

That's one reason the heart scientists saw Houghton as a prime candidate for the first European clinical trial of their new technology.

He came to after the June 20, 2000, operation with a titanium turbine about the size of a C battery embedded in his dysfunctional left ventricle, the heart's main pumping chamber. It has only one moving part: the impeller that moves his blood.

If you listen to him with a stethoscope, you don't hear the usual loud tha-thump-thump pulse. What you hear is a whir. "Like a washing machine," he says, in one of numerous telephone interviews.

He also woke up with a titanium jack coming out of his head.

Getting power to a turbine in your chest is a life-or-death situation. Barney Clark, of Des Moines, Wash., the first artificial-heart recipient in 1982, was tethered to machinery the size of a clothes dryer. The question was whether you could make all that so portable that people could have "quality of life."

Houghton's batteries are compact enough that he carries them in a small camera bag. But if you want to get that power to the heart, you need to stretch the wire to a plug on your body that leads from the inside to the outside.

The skull is a simple, safe site, though it has its price. Someone once tried to steal his camera bag, and Houghton had to think fast and correctly to reconnect himself.

The new heart was a marvel. Soon Houghton was back on his feet and was traveling the world, giving speeches, writing books, becoming chairman of the Artificial Heart Fund and engaging in a 91-mile charity walk. Those who enthusiastically embrace bionic enhancement hailed Houghton — part man, part machine — as the model cyborg.

There were just these few nagging problems in the recesses of his soul.

"My emotions have changed. Somehow I can't help that," he says. "Being a Jungian psychologist, I would describe myself as less intuitive. More of a thinking, more rational, less intuitive person."

No one really knows why Houghton has this trouble — whether it is the machinery, or the drugs, or depression, or advancing age, or the lingering effects of major surgery, or a lack of hormones secreted by the heart, or even that human brains have always been optimized by having their oxygen delivered in pulse-driven spurts, not constant pressure.

Houghton naturally reaches for psychological explanations. "The procedure lands you in a position that no one has ever pioneered: what it does to a person as a person."

He says he can see that those close to him "can do without you. So you protect yourself against that knowledge. You're not very central to their lives anymore. This means you're much more cautious about how you use your emotions. You try not to invoke them. You become coldhearted. The thought doesn't agree with me, the fact that it happens. But I don't know what to do about it."

Clinical depression

Views on faith altered

Houghton has also developed "a careless attitude toward money. You don't care if you've overspent your credit cards or not. If you don't have any time left, you might as well enjoy it. It doesn't go away. You just sort of control it. 'What the hell,' you think, 'if I want something, I'll have it.' "

It's taken him some time to plan more than a day or two into the future. Seven years into this, he says that, with effort, he can now think all the way out to six months.

"The pump brought about some religious crises," he reports, causing him to think about his devout Catholicism: "questioning the afterlife. Who knows? These are only priests. They're not very good at being challenged on the subject." Houghton wrote up his thoughts in a book, "The World Within Me."

Five years after the operation he went through a period of clinical depression. "Several times I thought, better off if I wasn't here. Let everyone get on with their lives. I felt I'd like to put an end to it. But choosing the methods puts me off. Feel cowardly about killing yourself."

He saw a psychiatrist. "He wasn't too worried," Houghton says. "It's a perfectly rational response to a difficult set of circumstances. ... He challenged me — 'Are you sure you mean it?' I did mean it, but not sufficient to overcome my fear of the actual process."

He was prescribed antidepressants for 18 months, and was weaned off them six months ago.

There are few data on the psychology and cognition of cyborgs like Houghton, although "a lot has been reported, anecdotal," according to Timothy Baldwin, the biomedical engineer primarily involved with circulatory-support devices at the National Heart, Lung, and Blood Institute.

In the U.S., there were only 40 implants of permanent ventricular-assist devices in the last reporting year. Most are used to keep people alive until a human heart can be found for transplant. (Houghton's original condition ruled out a transplant.) No one has had one for as long as Houghton: His cardiologist reports his six other implant patients have died.

Robert Jarvik, the legendary inventor of the first permanent total artificial heart, strongly doubts Houghton's issues can be laid on the Jarvik 2000 pump.

"It's hard to measure being a human. One thing we do know is that good restoration of blood flow restores health, a good experience of life."

Implant recipients "are normal again, restoring physical conditions. How they go on with their lives is what they do, not what doctors do."

He does, however, say he doesn't recommend Jarvik 2000s for heart-attack patients. Being an apparently healthy person one day and the next day waking up as a cyborg would, he acknowledges, present psychological problems.

Mind vs. body

"Pump head" effect

Medicine has long treated body and mind as a dichotomy. The first human surgery successfully using a machine to imitate the pumplike function of the heart and lungs came in 1953.

Subsequently, cardiologists long gossiped about a side effect they irreverently dubbed "pump head," a decline in psychological and cognitive capacity associated with the procedure. It wasn't until decades later, however, that this effect on what it means to be human started being taken seriously in scientific journals. A groundbreaking New England Journal of Medicine report was published in 2001.

Chemotherapy for cancer dates to the 1940s, but a psychological and cognitive deficit known as "chemofog" only recently has been getting serious attention.

"Science guys are not attuned to this. People slough it off," notes Arthur Caplan, head of the department of medical ethics at the University of Pennsylvania. Their attitude is " 'You might be more distant? More cold? What do I care?' People who evaluate the devices spin to positive measures, not subjective ones."

Adrian Banning, Houghton's cardiologist at the renowned John Radcliffe Hospital in Oxford, said, "Psychology is tough. Why is it not explored in any great depth? Because I'm a cardiologist, not a psychologist, I guess."

Much of the original artificial-heart work was driven by the technological optimism born of the space program. Some of the current work is driven by the idea that brains and bodies are separate entities.

But in light of Houghton and other victims of psychological and cognitive trauma after intervention in their bodies, some scientists fear we are tampering not with a bodily machine but with the human spirit.

"We've got to understand the organs and systems coming into our lives. We haven't paid a lot of attention to the psychological or emotional aspects of thinking of ourselves as bodies," says Caplan.

"People interested in eternal life through body regeneration or organ substitutions" consider humans to be "a brain on top of a complicated bag of water," he says. "Ship that brain elsewhere, and it would still be you. Not true, exactly. Not that we couldn't adjust or adapt. But in some subtle ways, our sense of self — who we are — is shaped by our carcasses. Shaped by the containers we drag around."

Interventions

Effect on emotions

Heart interventions are numerous. These include quadruple-bypass surgery, coronary-stent insertion, coronary balloon angioplasty and the implantation of a cardioverter defibrillator. Vice President Dick Cheney underwent these four procedures in 1988, 2000, March 2001 and June 2001, respectively. His defibrillator was replaced last month.

Cheney's longtime friends have suggested they have detected changes in his personality. Brent Scowcroft, the former national-security adviser to George H.W. Bush, told The New Yorker: "I consider Cheney a good friend; I've known him for 30 years. But Dick Cheney I don't know anymore." Scowcroft, who made no reference to heart interventions, was unavailable for comment for this story.

Confronted with Scowcroft's observation on "Face the Nation" in 2006, Cheney said, "To suggest I've changed, or my fundamental views of the world have evolved over that time, basically, I don't think that's valid."

Heart surgeon Timothy Gardner, former co-chairman of a National Heart, Lung, and Blood Institute panel on neurocognitive changes after cardiac surgery, says the study of emotional or cognitive shifts brought on by technological implants is "of course, not nuts."

Houghton is working on a book, "Cyborg Life," based on his professional interviews with more than two dozen people who have faced death and now live with technological interventions, from heart machines to chemotherapy.

Whatever the future brings, Houghton says, being snatched from the brink of death and transformed into a symbol for cyborg life while experiencing serious psychological transformations "has been quite an experience."

"A roller coaster.

"Better than being dead, I think.

"Three days out of five."

Virus may be partly to blame for obesity

2007-08-30T11:02:00.000-07:00

In the buffet of reasons for why Americans are getting fatter, researchers are piling more evidence on the plate for one still-controversial cause: a virus.

New research announced Monday found that when human stem cells were exposed to a common virus they turned into fat cells and began storing fat.

This adds to other recent evidence that blames some expanding waistlines on more than just super-sized appetites and underused muscles.

For several years, researchers have looked at a possible link between obesity and this common virus, called adenovirus-36, from a family of viruses that cause colds and pinkeye in people. They had already found that a higher percentage of fat people had been infected with the virus than people who were not fat.

But ethical restraints kept researchers from exposing people to the virus to see what happened. So they did what would be considered the next best thing, said Nikhil Dhurandhar, who headed the research at the Pennington Biomedical Research Center in the Louisiana State University system.

They took fat tissue from people who had liposuction, removed adult stem cells from the tissue and exposed the cells to the virus in the lab. Adult stem cells can turn into different types of specialized cells to help the body heal itself.

More than half of the stem cells exposed to the virus turned into fat cells and accumulated fat, while only a small percentage of the non-exposed stem cells did the same, said researcher Dr. Magdalena Pasarica, who presented the results Monday at the American Chemical Society's annual meeting in Boston.

"It's the first time we see an effect in human cells," Pasarica said in a phone interview.

If a viral cause of obesity can be confirmed, a vaccine could be developed to prevent the virus from making some people fat, Dhurandhar said. However, it wouldn't help people who already are obese, he said.

Outside experts are intrigued but worry about people blaming all obesity on viruses.

"The cause for obesity in everyone is the same," said Dr. Samuel Klein, director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis. "You eat more calories than you burn up."

China cracks down on AIDS activists

2007-08-30T11:00:00.000-07:00

Wary of exposing China's flaws to the news media's glare before next year's Olympic Games, authorities are cracking down on groups that help AIDS patients and orphans, shuttering their offices and banning meetings and other gatherings.

In one case, an activist in Henan province, where the nation's AIDS crisis hit early, said police ordered him out of his office Thursday and suggested he flee the area for his own safety. Six other volunteers in the group were detained.

"They said our organization was illegal and our activities were illegal," said Zhu Zhaowu of the China Orchid AIDS Project's office in Kaifeng in central Henan province.

Police in the same city barred a conference for AIDS activists that had been scheduled for Aug. 19-20 by another nonprofit group, known as Grassroots.

China appears to have averted the large-scale AIDS epidemic that has hit Thailand and parts of sub-Saharan Africa. Official statistics say the nation of 1.3 billion people has 650,000 people infected with the virus.

The virus has primarily hit drug users, sex workers, ethnic minorities and migrant workers.

Henan province in central China became a hot spot in the 1990s when brokers known as "blood heads" paid farmers for blood and plasma, which they sold to unsanitary, often state-run, clinics and hospitals.

Police pulled the plug earlier this month on two other AIDS conferences in the southern city of Guangzhou — one that was to bring legal scholars from three continents and another at Sun Yatsen University.

The repression perplexes foreign experts seeking to help China grapple with the rising challenges of combating HIV infection.

"Nothing about it makes any sense," said Meg Davis, director of Asia Catalyst, a New York-based group and co-sponsor of the canceled Guangzhou legal conference.

"China is at a crossroads both in terms of its fight against AIDS and its very new and fragile civil society," Davis said.

Some domestic activists said China's leaders are clamping down because they worry that international media attention in the run-up to next summer's Olympic Games will focus on aspects of China that leaders find embarrassing.

"They hope that there will be no unharmonious voices during the Olympics period," said Hu Jia, an activist and co-founder of a nonprofit Beijing AIDS group.

Legal experts said the crackdown could backfire on China's efforts to combat HIV infection.

"If you suppress human rights, what happens is that people vulnerable to HIV are scared to be tested or seek treatment," said Mark Heywood, founder of South Africa's AIDS Law Project and chairman of the UNAIDS Human Rights Reference Group, a body offering advice on the global epidemic.

Plastic Surgery

2007-08-30T10:50:00.000-07:00

Did she or didn't she? We've all engaged in a snark-fest at one time or another, trying to guess if a certain film or television star has had "work" done. And while some — such as Kathy Griffin, Joan Rivers and Patricia Heaton — have been way public about their cosmetic surgeries, the majority opt to keep such procedures secret. After all, our pop-culture celebrities tend to have a vested interest in maintaining certain physical illusions.

But the rich and famous are not the only ones going under the knife. There were 11.6 million cosmetic procedures done in the United States in 2006, according to the American Society for Aesthetic Plastic Surgery, up by 446 percent since 1997, when the ASAPS began compiling statistics. The most popular procedure last year for men and women was Botox injections. Liposuction was the most frequently performed surgery. For women, however, breast augmentation topped the list, followed closely by liposuction.

With so many undergoing elective enhancement these days, should we reveal our choice to friends, neighbors, co-workers, relatives — our children?

Telling friends and relatives about a cosmetic procedure is a highly personal decision, says Dr. Z. Paul Lorenc, a cosmetic surgeon in Manhattan. But that decision is frequently affected by the type of procedure a patient is having.

For instance, highly popular and minimally invasive Botox or Restylane injections are simple and quickly administered procedures that require an office visit and virtually no recuperative downtime. A "lunch-hour makeover" can therefore yield subtle and natural-looking results that other people may not even notice.

"Surgery is a different story," says Dr. Steven Pearlman, who specializes in facial plastic surgery in his Manhattan practice. "That's a major decision that requires undergoing anesthesia. It's exceedingly safer than it was 30 years ago, but surgery requires healing." That means the patient will need physical and emotional support from a spouse, relative or friend during recovery, so telling someone, at least for that very purpose, is recommended by all doctors of cosmetic surgery.

But that's not why Stacy Abrams of Merrick, N.Y., told her friends about the breast augmentation and abdominoplasty (tummy tuck) she underwent last year. "I tell everyone. I'm all for it," says the 40-year-old mom of two who's also had Botox and Radiesse (a dermal filler) treatments for her face. "It's so widely accepted now, you read about it in almost every magazine."

Television makeover shows such as "The Swan," "Extreme Makeover" and "Dr. 90210" have popularized cosmetic surgery to the point where the taboo element has practically vanished, adds Abrams' surgeon, Dr. David Funt.

"For most women, it's not a taboo; they're happy to share it with people," Pearlman says. This is particularly the case when the results are a dramatically enhanced appearance.

"I couldn't stand the way I looked," confesses 59-year-old Connie Alibrandi of East Northport, N.Y. Once she decided to have cosmetic surgery, she thought she'd keep it to herself out of sheer embarrassment. But after her face-lift, she developed a heightened sense of self-confidence.

"It changes your whole personality, your self-esteem," she says happily, and now she readily comes clean to anyone who comments on her younger appearance. What's more, Alibrandi says she hasn't had any negative comments from or felt judged by anyone she's told.

Acceptance by one's peers can be a determining factor when deciding whether to tell or not to tell about plastic surgery. "My friends are in their 30s to 50s and, for my contemporaries, it's normal to talk about it," Abrams says.