Certain medical conditions, such as being overweight, can increase the strain on the heart. The excessive amount of weight on a person’s body frame causes the heart to exude more energy in its functioning, thus putting the person at greater risk of developing high blood pressure, which could lead to cardiac arrest. Individuals who are overweight, especially those who are considered obese, typically have higher cholesterol levels. These elevated amounts of cholesterol can lead to the development of heart disease.

A study conducted by the National Institute of Health (nih.gov) found that even subtle increases in body-mass index in overweight people can raise a person’s risk of heart failure. Researchers found that for each increment of one increased in the body-mass index, men had a 5% greater risk and women had a 7% greater risk of heart failure.

The New England Journal of Medicine (nejm.org) predicts that by the year 2020, the rates of obesity in young adults will have greatly increased, resulting in higher numbers of young adults developing heart disease. They state in their findings that obesity will affect 30 to 37% of U.S. men and 34 to 44% percent of U.S. women who are in their mid 30’s. They predict those percentages to increase by another 5 to 16% by 2035, which could result in more than 100,000 excess cases of heart disease.

Being overweight is currently an issue for approximately one out of every three Americans, and this problem should be addressed in order to avoid adverse heart conditions. Exercise and proper nutrition should be included as a regular part of everyday life.

For individuals who are considered morbidly obese (100 pounds or more overweight) medical intervention may be necessary in order to expedite the weight loss process. Procedures, such as the increasing popular lap band surgery, can aid in rapid weight loss. Weight loss surgery should only be conducted in the most extreme circumstances.

By taking care of excessive weight issues, a person can live a happy and heart-healthy life for many years to come.

Stem cells have a unique ability to transform. For instance, these cells move to an injured part of the body where they transform to the types of cells affected to help in healing damaged tissue, including heart tissue (1). A heart attack damages muscles of the heart, which can be repaired using stem cells.

While the cells may come from the bone marrow, umbilical cord stem cells can also be used. Scientists have developed ways of boosting the body’s repair function, especially in the treatment of congestive heart failure and heart attack.

The cells are harvested and implanted into affected areas after two to three weeks. The process helps in muscle substitution (2). The stem cells can restore cardiac function literally.

Different medical approaches for treating heart disease have their disadvantages. Statistics show that more than 50% of congestive heart failure patients die in less than five years from the time of their initial diagnoses. Stem cell therapy holds hope of saving more lives, as they literally replace the affected cells, enhancing the heart’s pumping power.

The stem cells primarily transform into three types of cells in the heart – cardiomyocytes, endothelial cells and smooth muscle cells, which respectively help to pump blood from the heart, form inner lining of fresh blood vessels and form blood vessel walls.

Researchers are exploring the possibility of developing the cells from different parts, especially umbilical cord stem cells. The stem cells can be developed into vascular endothelial cells and cardiomyocytes under controlled laboratory conditions. This can help in getting necessary replacement tissue to repair damaged heart.

Animal studies show that the level of regeneration depends on the time that elapses between the heart injury and application of stem cell therapy.

The use of stem cells in treating heart disease has several benefits compared to heart transplant. For example, there is always a shortage of donor hearts considering the present needs.

Using stem cells is considered ethical because it is not associated with potential loss of life. Researchers are still considering different approaches to stem cell therapy, including ‘genetic programming’ where the cells migrate to an injured site automatically.

1. Cleveland Clinic. Stem Cell Therapy for Heart Disease. Extracted on December 1, 2011 from my.clevelandclnic.org/heart/disorders/heartfailure/stemcells.aspx

2. National Institutes of Health. Stem Cell Therapy for Cardiovascular Disease. Extracted on December 1, 2011 from [url]www.ncbi.nlm.nih.gov/pmc/articles/PMC1524698/[/url]

It is important to be prepared for the possibility of experiencing either one but then again, these two problems usually present together that is why it is important to religiously visit your doctor and at the same time, to verbalize any concerns that you have. Remember that some health maladies go without precisely giving out symptoms and both diabetes and hypertension are concrete examples of these silent illnesses.

Nonetheless, a trip to your doctor will save you from the anxiety and perhaps, will also save both you and your baby’s lives.

Gestational diabetes usually happens on the 24^th to 28^th week. The symptoms are not usually manifested but some women may report the classic symptoms like excessive hunger and thirst. There are certain factors that can predispose you to this condition. For instance, if you have a family history of diabetes, then you will likely have one or if you had gestational diabetes in your previous pregnancies you are more likely to have it again. Gestational diabetes also tends to run among women who are 30 years old and above and who belong to a specific race including Hispanic, Asian and those with American descent. Being overweight can also predispose you to gestational diabetes.

When you think you have at least one risk factor, modification of your lifestyle is necessary. Concerned health care individuals will try to make your blood sugar relatively low to prevent miscarriage, C-section or fetal complications.

On the other hand, pregnancy induced hypertension or the increase in blood pressure during pregnancy is common especially to those with African-American descent. Just like gestational diabetes, you will most likely have PIH if you already have the history in your family and if you have already experienced the condition in the past. Being overweight and having certain diseases will also put you at risk. Also, if you are younger than 20 and over 35, you will likely suffer from PIH. The absolute cause of PIH is not yet determined by the medical experts but studies have linked the development of PIH when one has gestational diabetes.

Again, it is important not to delay any visit to your doctor as the symptoms sometimes appear harmless because you might mistake these as normal occurrences like headache, blurring of vision, an upset stomach, nausea and vomiting. Do not wait until the condition has already progressed to more serious levels as preterm delivery and a delayed growth for your baby can happen.

Blood pressure monitoring as well as blood sugar level checks are vital. Your doctor will prescribe medications that you should take everyday. And you will be asked to try to maintain a healthy lifestyle.

Prenatal visits undeniably play a critical role in ensuring that gestational diabetes and pregnancy induced hypertension are prevented and that the practice of healthy living even before you conceive is important.

Sixty-four patients with reproducible exercise-induced ventricular arrhythmias were enrolled in an open-label, multicenter study to assess the efficacy and safety ot oral nadolol therapy. There were 53 men and 11 women ranging in age from 19 to 75 years (mean 53.9). The severity of arrhythmias varied from frequent ventricular premature beats to nonsustained and sustalned ventricular tachycardias. Using serial treadmill exercise tests, patients underwent dose titration for 1 month and were followed up for 3 tO 6 months. Depending on drug tolerance and response to treadmill exercise testing, the single daily required dose of oral nadolol ranged from 20 to 240 mg (average 66). Twenty-three (36 %) of the patients experienced a total of 30 adverse effects of nadolol therapy; however, only 9 (14%) patients had to be withdrawn from the study. The adverse effects observed were those commonly associated wlth ,B-adrenergic blocking agents, and all were dose-dependent and reversible.

At the last patient visit, the severity ot exercise-induced ventricular arrhythmias was signiticantly decreased compared wlth pretreatment in 36 (75%) of 48 evaluable patients. Elghteen (38%) ot the patients demonstrated total suppresslon of arrhythrnlas. This was accompanied by signincant increases from pretreatment in both the mean duration of symptom-limited exercise (+1.02 ±0.41 minutes, p <0.05) and the mean time of exercise required for arrhythmia inductlon (+1,80 ±0.66 minutes, p <0.01), a signficant decrease from pretreatment in the mean peak exercise double-product ( – 4,775, p <0.001) and a decrease in the incidence ot exercise-induced ST-segment depresslon ( – 33%). Oral nadoial in once-daily doses is beneficial and efficacious in suppressing exercise induced ventricular arrhythmias and adverse effects of oral nadoiol therapy are not uncommon but are cilinically manageable.

I was born on August 7, 1931, at Stuart Circle Hospital in Richmond, and my father had entered the U.S. Army Medical Corps in 1929 upon his graduation from the Medical College of Virginia. We were subsequently stationed and transferred from Walter Reed Hospital (Washington, DC), Fort Benning (Georgia) and Schofield Barracks (Oahu, Hawaii). Interestingly enough, in Oahu, I was observed at the age of five to attend church unescorted and this could be construed as an early sign of spiritualism. However, this interpretation, naturally, could be argued. My first recollection of an increased awareness of my concern for others, occurred one late, chilly afternoon near Walter Reed Hospital in Washington, DC when I rescued a lost child. The memory of this event has been pivotal in my desire to promote public health activities in spite of criticism that continues to exist today. Interestingly enough, Dr. Richard P. Wenzel, present chairman of the Department of Medicine at the Medical College of Virginia, established a chair for the cardiovascular division to promote innovative cardiology after he explained that many of the projects I initiated were scoffed at but now accepted. He suggested that the chair that was established three years previously be entitled the Dr. Charles L. Baird, Jr. Chair for Innovative Cardiology.

At the beginning of World War II, my mother and I returned to Richmond while my father commanded the Fifth Evacuation Hospital of the First Army that landed shortly after D-Day on Omaha Beach in Normandy. During this time, in Richmond, I was confirmed at the Church of the Epiphany by the Rev. Rufus J. Womble, who touched my shoulder one day 15 years later while I was strolling outside the buildings at the Medical College of Virginia. He stated: “You don’t think you are really providing a cure for these patients, do you?” I sheepishly responded that it was God who was the true healer. Rev. Womble subsequently became leader of the Order of St. Luke of the Episcopal Church, whose major mission has been to promote healing through Christianity. We again joined forces in the late 80s as he became a patient at the Virginia Heart Institute and, through his teaching, we created conferences to educate patients and physicians in regard to spiritualism in the management of medical illnesses.    It was at this time that I became acquainted with the Rev. Stanley Baird, an Episcopal minister from Dublin, Ireland, who worked closely with Rev. Womble in Christian healing. I bring this out, since an acquaintance of Rev. Baird was Dr. J. Frank Patridge of Belfast, Northern Ireland, who was the pioneer of portable defibrillators and the developer of the mobile coronary care system in Belfast in 1965. At the end of World War II and my father’s rehabilitation at McGuire’s Army Hospital for which he was hospitalized for rehabilitative management of an injury that occurred during the Battle of the Bulge, I matriculated in 1949 as a freshman in the University of Richmond. It was at this time that I attended St. Stephen’s Episcopal Church, located a short distance from the University of Richmond campus and became aware of the major contributions of the Rev. Reno S. Harp and Mr. Granville Munson (the rector and director of music respectively). Dr. Harp delivered outstanding sermons that combined current events, art, literature and history with Christian teachings that created a very potent message— particularly to an undergraduate teenage student such as myself. In addition, Granville Munson created masterful accomplishments with the choir and under his astute guidance blended the total experience at St. Stephen’s Church and provided a deep and broad spiritual foundation that could be applied to the practice of medicine in the distant future. The subsequent clergy at St. Stephen’s have also been outstanding in this regard, providing enthusiastic and intellectual activity during formal teachings. Major contributions have been provided by the music and choral activities. Interestingly enough, the present rector at St. Stephen’s Church, the Rev. Thom Blair, attended one of my early cardiac catheterizations at the Virginia Heart Institute approximately 25 years ago, at which time, a mother of a U.S. senator from the Commonwealth of Virginia underwent this procedure. At that time, I wondered why support from the clergy was necessary, but if you contrast a walk-in/walk-out procedure with the then current standard of 3 – 5 days in the hospital due to the seriousness of the procedure, one can understand the skeptical behavior of physicians as well as other groups in regard to the appropriateness of what I was trying to accomplish.
I will now shift my discussion to the colleagues who taught me much in the area of clinical medicine as well as those who introduced me into the area of the development of innovative techniques— particularly in the bioengineering field. I subsequently attempted to create a biomedical division as well as a school of engineering. However, physicians and administrators at that time, did not see the major role that bioengineering was to have on the progress and development in the medical field.
In the mid 50s, I was a medical student and deeply impressed by the new professor of surgery, Dr. David Hume, who was also to become a member of St. Stephen’s Episcopal Church. One of my favorite activities as a medical resident was to attend the Saturday morning Ground Rounds which were very stimulating under Dr. Hume’s leadership. One morning, a cardiovascular surgeon from southern California presented rather dismal results on his attempt to correct multiple blockages by direct repair of the coronary arteries. It was clear that an improvement in this approach could be established if the patient had adequate evaluation of the degree of blockage prior to surgery. I was subsequently a cardiovascular fellow in training at the Cleveland Clinic when Dr. Hume was a visiting professor of surgery. I invited him to Dr. Sones’laboratory so that he could observe first-hand the role of cardiac catheterization and ciné coronary arteriography in the current development of anatomic analysis of patients with both valvular and coronary disease problems. Unfortunately that day, Dr. Hume was very inquisitive and disrupted the trend of the operator, Dr. Earl K. Shirey (one of Dr. Sones’able associates). Dr. Shirey asked Dr. Hume to leave the laboratory, which was very embarrassing to me, but I did realize that Dr. Hume had the opportunity to see the very best in preoperative diagnostic work and this would be employed at his institution, the Medical College of Virginia, in a short time following.
In 1965, Dean Kinloch Nelson invited me to become a member of the faculty at the Medical College of Virginia, to supervise the medical clinics in the ambulatory division as well as to allow me to develop the areas of interest I had in cardiovascular medicine. The initial area of interest was in the development of a coronary care unit, as this was not available at the Medical College of Virginia. Therefore, I went to Dr. Hume and Dr. Lower and requested that I be permitted to admit medical patients to the surgical intensive care unit in order that prompt defibrillation, pacemaker insertion and other life-saving measures be promptly instituted to the inpatient population suffering from cardiovascular events such as heart block or myocardial infarction. I was granted the opportunity to do this, and within a year, the Department of Medicine developed their own similar unit. At this time, I realized that simple defibrillation and drug management were not going to appreciably reduce the 30% inpatient mortality recorded in the management of myocardial infarction patients at the Medical College of Virginia Hospital prior to the institution of the coronary care unit. It was apparent that the majority of deaths were due to mechanical failure, and I recommended that emergency coronary arteriography be provided in order to entertain the option of cardiovascular surgery, thrombolytics and circulatory devices— projects that were rejected in 1968 but were to become routine within 10 – 20 years. I can recall one day seeing a friend of mine who was cared for by one of my cardiovascular colleagues. He had incapacitating chest pain, however, the cardiologist decided that there was nothing that could be done. I felt so bad that coronary arteriography had not been applied to this gentleman, as his life could have been saved and prolonged by the use of cardiac surgical techniques.
Furthermore, I began to look outside of the hospital, stimulated by Dr. J. Frank Pantridge’s work at the Royal Victoria Hospital in Belfast, Northern Ireland. I attempted to duplicate this project in Richmond, as had been done in several other sites in the United States. However, state and local administrative bodies (including physicians) were generally unsupportive of such programs. The Jewish Community Center arranged for a public forum to be held in the fall of 1971, at which time these issues could be reviewed. Two days prior to the meeting, I was provided the opportunity to demonstrate the portable defibrillator on local TV and how it could be used by rescue squad operators. My wife and I attended a party at the Country Club of Virginia before going to the television studio, and while we were there, a gentleman had cardiac arrest. I was able to resuscitate him with the defibrillator from my car. To further expand the application of public defibrillators in the emergency medical field, I obtained a grant from Fidelity Insurance Company. However, the Richmond Heart Association would not accept the $50,000 grant from Mr. Richards to improve the emergency system, a position similar to rescue squads at the time of the public meeting at the Jewish Community Center. This frustration led me to develop an alternative plan in the management of sudden death through the development of an ambulatory system, whereby screening, invasive and electrophysiologic studies could be established to determine the risks and the benefits in the management of these patients— particularly when death and myocardial infarction represented the first symptoms in over 60% of males.
In order to validate cardiac catheterization on an ambulatory basis and subsequently in a free-standing non-hospital unit, I went to Dr. F. Mason Sones, Jr., my former mentor and chief of the cardiovascular laboratory at the Cleveland Clinic in 1971, to present this concept to him. He agreed to support the quality assurance necessary to validate the safety of this procedure, and I agreed that the data would be withheld in order to minimize it’s impact on the practice of other physicians and hospitals— particularly if done for entrepreneurial activity solely. After ten years of collecting data and providing presentations, I began to provide consultation and advice to several of the major medical centers in the United States. In 1988, the U.S. Public Healthcare Service reviewed the data from the Virginia Heart Institute as well as multiple other ambulatory programs that had been developed, and advised that full payment for outpatient catheterization was to be implemented based upon this survey. In 1975, it became apparent that ambulatory cardiac catheterization provided observations that individuals with minimal complaints could have severe angiographic disease. This led to the development of an outpatient staging concept (i.e. modified cardiac rehabilitation program) where these patients, upon completion of cardiac catheterization, could enter pharmacologic control of arrhythmias, ischemia and heart failure in an objective way. It became apparent that those who were at low to moderate risk (yet with severe angiographic narrowing) would respond quite well to pharmacologic intervention. At the present time, there is a major shift to the medical conservative management of such patients, as the larger clinical trials show that in certain subsets of patients, neither angioplasty nor surgery are of benefit in these groups. Unfortunately, at the time of construction of the cardiac rehabilitation addition at 102 Berrington Street in Richmond, Virginia, the building burned down, and we moved two blocks away to a new site that was opened at 205 North Hamilton Street in 1977.
Although I achieved acceptance of ambulatory cardiac catheterization both at the hospital and ambulatory levels, the major reason for the implementation of this aggressive approach (i.e. identification of those prior to death or myocardial infarction) had not been accepted or even considered by the medical profession. I began to review this concern with varying leaders in the United States such as Dr. Henry Heimlich who, while visiting the Virginia Heart Institute, stated that “if all parties begin to agree, then you really aren’t accomplishing anything.” He stated that in order to create a broader and more rapid acceptance, efforts should be directed not only at the physician groups but also through public education efforts. At that time, we increased our public education program in order that individuals without symptoms but who were at risk for death or myocardial infarction, could be identified and enter into aggressive programs that would be life-saving. I also discussed with Dr. Irvine H. Page, director of research at the Cleveland Clinic and my former mentor, this particular problem of lack of acceptance in physician groups concerning sudden death problems. He stated that it requires 30 years to accept such a change. “And if it is correct, it will be accepted and you will be forgotten,” said Dr. Page, “but we at the Cleveland Clinic will always remember you.” Unfortunately, Dr. Page died in his early 90s several years later and I will be forever grateful for his long-term participation in the educational aspects of hypertension control and it’s growth and applications to other phases of cardiovascular medicine. A third person that was instrumental in the application of biotechnology and engineering was Mr. Earl Baaken, founder of Medtronic, the world’s largest pacemaker firm. Upon retirement, he transferred his interest from engineering to holistic medicine, which I found intriguing, and met with him on several occasions, as we now had a common interest. We were a relatively small group of individuals who both had backgrounds in biotechnology and engineering, but had shifted to holistic medicine— looking at the broad aspects and the improvement of the healthcare system.
Several years after the Virginia Heart Institute was established, and I had not been active in the out-of-hospital management of acute myocardial infarction, a gentleman collapsed at a restaurant, and a physician accompanying this patient, asked me to admit him (which I did). His further hospital course was uneventful. I told the patient, however, that I believed in aggressive screening and I knew that his physician would not appreciate an evaluation post discharge, but that I felt it was important. This gentleman did have multi-vessel disease, and even though the physician in charge was extremely unhappy that such a diagnosis had been established, the patient eventually underwent coronary arteriography which showed a previous unrecognized heart attack, complicated by severe multi- vessel blocked arteries, and underwent successful cardiac surgery, even though he had never experienced chest pain; his initial event was most likely cardiac arrest.

The Virginia Heart Institute continues to provide non-invasive screening and outpatient coronary arteriography with the emphasis on pharmacologic management in a structured outpatient program, previously described as cardiac rehabilitation. The next step is to develop an acute chest pain center, including the opportunity to use non-invasive imaging such as multi-slice CT and/or magnetic resonance imaging, which will localize the site of obstruction without the use of a catheterization. This particular center will be done in conjunction with existing hospitals in order to have earlier risk analysis of these patients, in order that treatment be given in the appropriate time. Treatment for stroke and heart attack must begin within a short period of time. My only regrets with regard to the development of such alternative programs has been the isolation and separation from physician camaraderie that I had created by following this aberrant path. However, this may be the same path that I took at age five, going to church alone. On a happy note, however, concepts do sometimes take up to thirty years to evolve, and I have seen some of these come to fruition. I am glad that I have been able to be a part of such exciting work, and look forward to being a part of medicine in the new millennium.

Does obesity harm the heart?
If the child is very overweight for a long time the extra work that the heart has to do can harm the heart. Frequently, obese children have high blood pressure. The extra weight is also hard on the lungs, muscles and joints of the body. In addition, extra weight can make a child feel bad about himself or herself.

Is being overweight inherited?
In some cases the answer is yes, in the sense that overweight children are usually in families where one or both parents are overweight. Eating and exercise habits are learned. Obesity is rarely caused by “gland” problems, especially if the child is growing in height as expected.

How do I get my child to lose weight?
This is a hard thing to help a child to do. Eating right and exercising more are always the way to start. Please see the section on nutrition for more details. Ask your child’s doctor if there are classes for you and your child, or if the problem is severe enough that there may be a need for hospitalization.

· premature heart disease
· high blood pressure
· diabetes
· cancer

As overweight children are at greater risk of becoming overweight adults than lean children are, the time to control and manage your child’s weight is now!

Picking the Right Foods

Children who are overweight should eat more foods that are nutrient dense, and fewer foods that are calorie dense.

Meats:
–Choose Lean meats, fish, and poultry that have been broiled, roasted or baked, not fried and lean luncheon meat (at least 97% fat-free)
– Instead of Fatty meats, commercial ground beef, regular cold cuts, hot dogs, fried meats

Milk & Dairy Products:
–Choose Low fat or preferably skim milk; low fat or fat-free cheeses (mozzarella, skim ricotta, low fat or fat-free American); low fat or fat-free yogurt or puddings
–Instead of Whole milk or cream, regular cheeses, (Cheddar, Colby, Swiss); regular ice cream or yogurts

Breads & Starches:
–Choose Whole-grain or enriched breads, and whole grain or fortified cereals with low fat and low sugar content
–Instead of Breads made with added fat (corn bread, biscuits, croissants, muffins); French fries

Vegetables:
–Choose Fresh or frozen, serve raw, steamed, or stir-fried; use herbs and spices, may use small amounts of margarine
–Instead of Vegetables made with rich sauces, heavily buttered, fried or in casseroles

Fruits & Juices:
–Choose Fresh, frozen or canned fruits or juices, packed in water or in their own juice
–Instead of Fruits in heavy syrup or those with added sugar.

Additional Food/Diet Suggestions
· Avoid fried foods
· Eat smaller portions and avoid eating seconds
· Avoid adding a lot of butter or margarine to foods
· Use sauces, gravies, dressings, and sour cream in moderation
· Serve fruit instead of sweet desserts
· Avoid calorie-dense snacks such as potato chips, soda, candy
· Avoid snacking in the evening
· Do not put your child on a “diet” without working with your child’s doctor or nutritionist. They can help set reasonable goals for your child to optimally manage his/her weight.
· When starting a plan for managing your child’s weight, be sure to follow through. Losing a few pounds and putting it back right away can be harmful.
· When choosing a weight management program for your child, be sure that it allows for a gradual weight loss.
· For children under the age of 10, it may simply be best to let them “grow into their weight”.
· If your child is working on choosing healthy foods for weight management, make sure that the whole family helps!
· Limit television watching to half an hour or less per day.
· Encourage your child to move around and play outdoors to increase the number of calories he/she burns.

Quick Lowfat Snacks

Fresh Vegetables: carrots, celery, zucchini, cherry tomatoes, green peppers. Serve plain or with dip made with fat-free yogurt or sour cream; no more than 1 Tbsp of peanut butter or low fat cream cheese

Fresh Fruits: grapes, apples, oranges, bananas. Serve fresh, sliced or whole, but with no added sugar or syrup.

Crackers/Chips: Animal crackers, graham crackers, saltines, vanilla wafers, fat-free pretzels, bread sticks, bread or bagel, baked chips, popcorn (unbuttered)

Dairy Snacks: Low fat or skim yogurt (regular or frozen), low fat or skim puddings, low fat string cheese

Gelatin: Sugar-free jello, add fresh fruit for variety

This disease, first described by Dr. Tomisaku Kawasaki in 1967, usually affects children between the ages of 6 months and 4 years, with most cases occurring between the ages of 18 and 24 months. Its causes are unknown.

Kawasaki Disease affects boys more commonly than girls (1.5 to 1) and affects Asians (especially Japanese) and children of Asian heritage more frequently than other races. It is the leading cause of acquired (rather than congenital) heart disease in the United States.

What Are the Effects of Kawasaki Disease?

The onset of Kawasaki Disease is marked by a sudden high fever that lasts for at least 5 days. This is accompanied by extreme irritability – more than would be expected from the fever alone.

Other symptoms associated with Kawasaki Disease are rashes and/or swelling that affect the extremities (feet and hands) as well as the groin area, mouth, and eyes. There may also be swelling of the glands and lymph nodes. The lips may become cracked and bleeding and the tongue becomes reddened. Also, the patient may have a stiff neck, swollen gall bladder, and abdominal pain as well as joint pain and peeling skin on the feet and hands.

The cardiac affects of this disease consist of the development of myocarditis (an inflammation of the heart muscle) and coronary aneurysms, or swellings, that develop on the coronary arteries. (The coronary arteries are the large vessels on the surface of the heart that arise from the root of the aorta and supply the heart muscle with oxygen-rich blood.) Coronary aneurysms are the most devastating result of Kawasaki’s disease occurring in 20% of untreated children and <5% of treated children. Most of the aneurysms form in the proximal coronary arteries (near their points of attachment to the aorta). They may cause a heart attack if they disrupt the supply of oxygen to the heart muscle.

If these aneurysms do not disappear after the patient has recovered from Kawasaki Disease, or if they result in weak areas in the arteries, they may cause problems later in life. For example, there may be thickening or obstruction of the coronary artery walls because of calcification or the early development of atherosclerosis (deposition of fatty materials).

How Is Kawasaki Disease Treated?

There is no test for Kawasaki Disease, which is diagnosed from the presence of the various symptoms, including the failure to respond to antibiotics and the persistence of high fever for more than 5 days.

Treatment of this disease proceeds in two stages:

Stage One – the Acute Phase. The patient is given aspirin or intravenous immunoglobulin. These medications can prevent the formation of aneurysms on the coronary arteries, especially if administered during the first 10 days of the illness. If small aneurysms form they may resolve over time.

Most children experience a full recovery after Kawasaki Disease has run its course. However, new research shows that Kawasaki patients may be prone to the development of coronary artery abnormalities in later life. Therefore it is recommended that these patients get an echo once every five years.

Stage Two – the treatment of coronary aneurysms. Those patients who develop coronary aneurysms will require regular monitoring by echocardiography and sometimes by coronary angiography and should continue taking aspirin. If the coronary aneurysm is large, other anticoagulation medications (e.g. clopidogrel, warfarin) are usually added.

If coronary stenosis develops, bypass surgery or catheter intervention, usually a rotation ablation, may become necessary. However, new coronary aneurysms may develop after balloon angioplasty if coronary arterial dissection occurred due to excessive dilatation (usually due to the use of a high-pressure balloon). Thus, if coronary dissection was confirmed by intravascular ultrasound imaging, coronary stent implantation may be indicated for prevention of new aneurysm formation.

In cases of serious coronary lesions, there is a risk of myocardial infarction (heart attack). Therefore, it is important to monitor these patients regularly for the development of adverse symptoms.

Kawasaki Disease and the Adult Patient

Most Kawasaki patients recover fully from the disease, with no complications later in life. However, approximately 20% will experience cardiac problems caused by the persistence and/or progressive change of weak areas or swellings in the coronary arteries. Also, the coronary artery walls tend to be somewhat thicker and less flexible than normal after the disease, either through calcification (hardening of artery walls) or the early development of atherosclerosis (deposition of fatty materials on the artery walls).

Normally, aneurysms resulting from Kawasaki Disease will decrease in size as the patient ages. Smaller lesions are more likely to heal completely than larger ones, and the younger a patient was at the time of outbreak, the more likely it is for the aneurysms to disappear.

Those aneurysms that persist in the older patient have a tendency to become narrow (stenotic) or blocked (occluded) over time. Larger aneurysms may contribute to the sluggish flow of blood through the artery, which may promote the formation of blood clots (thromboses). Any narrowing or blockage of the coronary arteries can lead to the disruption of the oxygen supply to the heart muscle, resulting in a heart attack.

Because of these risks, Kawasaki patients are now advised to have their condition monitored through life, with counseling by a physician and a check-up including an echocardiogram once every three to five years, in most cases. Pharmaceutical therapy may be necessary for patients with persistent aneurysms. The development of coronary abnormalities may be accelerated by smoking, hypertension (high blood pressure), and hyperlipidemia (high cholesterol and other fatty substances in the blood stream).

Exercise Concerns

Activity guidelines for the older Kawasaki patient depend upon the level of risk determined by the patient’s physician. For the majority of patients, no restrictions will apply.

For those patients with persistent coronary aneurysms, annual examination by a pediatric cardiologist, with an echocardiogram and electrocardiogram, is recommended. Stress testing with myocardial infusion will usually be applied every two years. If the stress test reveals deprivation of oxygen to the heart muscle (myocardial ischemia), then coronary angiography should be performed.

Patients with large or multiple coronary aneurysms and/or with obstruction of the coronary arteries should undergo annual stress tests, which will help determine safe levels of activity. Contact sports should be avoided – especially by those patients taking anti-coagulants because of the risk of bleeding. However, regular physical activity within safe levels should be pursued and a sedentary lifestyle should be avoided.

Anyone with congenital heart disease, repaired or non-repaired, should consult with their cardiologist about physical activity to review the risks.

What Are the Effects of Pericarditis?

Pericarditis causes chest pain that is especially acute beneath the ribcage and sternum. This pain may also be felt occur in the shoulder, neck and upper back. It is often aggravated by breathing, during which the movement of the heart and lungs in the chest cavity may irritate the pericardium. Changes in body position may increase or decrease the intensity of the discomfort. Pericarditis may be detected from an electrocardiogram (ECG).

Normally, pericarditis is not life-threatening, though it may lead to pericardial effusion in which fluid accumulates between the pericardium and the heart muscle. This may cause difficulty in breathing (dyspnea) and exert pressure on the heart chambers, making the heart work harder to pump blood to the lungs and body tissues. An echocardiogram is usually performed in patients suspected of pericarditis and will demonstrate the presence of increased fluid in the pericardial space (a pericardial effusion).

How Is Pericarditis Treated?

Anti-inflammatory medications such as aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs) are effective in treating pericarditis. In some cases, steroids may be used.

The development of dyspnea may be a sign that the build-up of fluid around the heart has become severe and a periocardiocentesis is necessary. This involves the draining of the fluid by inserting a hollow tube through the chest wall.

Aortopulmonary Window is a rare congenital heart defect in which there is a connection (window) between the aorta and the main pulmonary artery. This opening allows oxygenated blood to pass, or shunt, from the aorta into the pulmonary artery.

Aortopulmonary Window, which affects males and females equally, can occur as an isolated defect, or with other defects or more complex heart diseases.

What Are the Effects of Aortopulmonary Window?

The movement of blood from the aorta into the pulmonary artery results in excessive blood flow to the lungs, causing high pulmonary blood pressure. The larger the hole, the greater the volume of blood shunted and the more severe the symptoms.

Babies with Aortopulmonary Window generally do not feed well and tire easily and they may develop congestive heart failure or other complications. Therefore, this defect should be corrected as soon as possible once the diagnosis has been made.

If not diagnosed soon enough, some children can develop sustained high pulmonary blood pressure (pulmonary hypertension) secondary to changes in growth of the pulmonary arteries. This severe result of an Aortopulmonary Window can render some children inoperable.

How Is Aortopulmonary Window Treated?

Surgical treatment of this defect is performed as quickly as possible after the diagnosis has been made in order to avoid high pulmonary pressure.

Quite simply, the connection (window) between the aorta and pulmonary artery is closed with a patch made of pericardium (part of the membrane surrounding the heart) or of a synthetic material. This patch (pink oval in the animation) is sutured into place and the incision in either of the two vessels through which the patch was introduced is closed with sutures.

The likelihood of postoperative difficulties depends on how quickly the defect was repaired after diagnosis. The average hospital stay after surgery is 1 week to 10 days.

Aortopulmonary Window and the Adult Patient

An aortopulmonary window may be overlooked in childhood, especially if pulmonary hypertension is present, and because it often occurs with other more common defects, such as PDA, ventricular septal defect (VSD), atrial septal defect (ASD), Tetralogy of Fallot, or aortic stenosis. Most windows are large, so that, if not recognized in early childhood, they will cause a significant left to right shunt, often resulting in pulmonary hypertension. Therefore, they are frequently associated with high pulmonary blood pressures and pulmonary vascular obstructive disease (PVOD) when first diagnosed in the adult patient.

The symptoms that are associated with this defect depend on the size of the window. Small windows often cause enlargement (dilatation) of the left ventricle and/or heart failure and are characterized by a continuous heart murmur. The more common large aortopulmonary windows result in cyanosis (blueness caused by oxygen poor arterial blood) affecting the whole body, pulmonary hypertension, and Eisenmenger Complex .

Echocardiography is used to confirm the diagnosis and to determine the amount of left to right shunting. A cardiac catheterization procedure may be used to measure the degree of pulmonary hypertension and resistance, if present.

Once the window has been recognized and evaluated, it may be closed surgically or through a catheterization procedure. Regular follow-up after the repair will be necessary and lifelong antibiotic therapy is usually prescribed to guard against infection of the heart’s internal lining (bacterial endocarditis).

Exercise with Aortopulmonary Window

People who underwent repair of isolated aortopulmonary window during childhood may expect normal life expectancy and no restrictions in their activities. Safe levels of activity for patients who received treatment later in life will depend on whether pulmonary hypertension, pulmonary vascular obstructive disease (PVOD), or Eisenmenger Complex are present. Safe levels of exercise should be determined by consultation with your cardiologist.

Anyone with congenital heart disease, repaired or non-repaired, should consult with their cardiologist about physical activity to review the risks.

Pregnancy Issues with Aortopulmonary Window

Aortopulmonary windows which were successfully treated in childhood without the development of other symptoms pose no significant problems for pregnancy. However, pregnancy is dangerous for patients with extant aortopulmonary windows, with significant risks for both mothers and their unborn children.

Anyone with congenital heart disease, repaired or non-repaired, should consult with their cardiologist prior to becoming pregnant to review the risks.