Is heart disease hereditary, and if
it is what can be done to lower risks ?
The answer to that is really two questions. First of all, there
are forms of heart disease that are hereditary. Secondly, there
are forms of heart disease that are not hereditary. The speed with
which the acquired heart disease develops can be related to the
presence of risks factors. For example, patients who have ischemic
heart disease where the blood supply to the heart has decreased
- the rate at which this disease develops or progresses is influenced
by many well-known risks factors. The patient can control some of
these risks factors and some cannot. The risk factors that cannot
be controlled are advancing in age, gender, and family history.
The risk factors that can be controlled include such things as obesity,
smoking, high-blood pressure, exercise or lack thereof, and so on.
Is there much hope for a patient with end stage heart
disease? Should a patient at this stage of the disease consider cutting edge
treatments if all else is not working out in their benefit ? That
depends upon the primary disease. But in general, patients with
heart disease should seek care provided by a specialist. The heart
specialist can then recommend the appropriate therapy for the patient.
At what age do most people develop it? Does it affect
more men or women ? That depends upon the disease. Again, there are a variety of different
types of heart disease. Again, depending upon the primary disease
state, it can occur in any age group. Usually heart failure and
ischemic heart disease is associated with advancing in age.
What kind of role does diet play in preventing it ?
Appropriate diet plays an important role in the prevention of ischemic
heart disease. To lower the risk of ischemic heart disease, everyone
should avoid foods that are high in fat content and cholesterol.
Everyone should also attempt to avoid obesity by choosing an appropriate
diet associated with an exercise program. And no one who wants to
be healthy should smoke.
What does surgery entail ? What is the approx recovery
time ? There are many types of open-heart surgery, each of which has a
different recovery time. As an example, the most common open-heart
operation performed is coronary by-pass surgery for patients who
have blockages in the arteries supplying blood to the heart. Depending
upon the complexity of the operation, and the patient's pre-operative
health status, the patient usually remains hospitalized 4-6 days
after the operation. With appropriate rehabilitation, the patients
are usually back to full activity within 6 to 12 weeks.
Who is the ideal candidate for surgery ?
Again, that depends upon which operation is being performed. We
look at a variety of pieces of information related to the function
of the patient's heart, and other health related conditions in determining
the patient's operative risk.
How many bypasses are possible through minimally invasive
bypass surgery ?
That number is increasing as experience with this operation has
increased. Originally, access was limited to the front of the heart.
Now even the vessels on the back of the heart can be by-passed without
the use of the heart-lung machine.
What is the average life expectancy after bypass surgery
? That depends on the patient's age, the completeness of the by-pass
operation, the patient's underlying heart function, and the patient's
associated medical problems. In general, the by-pass operation will
correct the patient's ischemia for 10 to 15 years. At that time,
the angina may reoccur. If angina does reoccur, the patient’s
candidacy for medical and surgical therapy is re-evaluated.
What makes a surgery "minimally invasive" ?
Traditionally, open-heart surgery is performed with the patient
connected to a machine known as the heart-lung machine. The heart
-lung machine replaces the function of the patient's heart and lungs
while the operation is performed. The patient's heart is stopped
while we operate on it. Recently, there has been interest in performing
heart by-pass surgery without the use of the heart-lung machine.
In this instance, the patient's heart and lung continues to function
while the operation is performed. The patient’s anatomy and
the type of operation they require determine whether the heart-lung
machine is employed. For some time, it was thought that such an
approach would allow the operation to be performed through a smaller
incision - hence the term, minimally invasive. In fact, most "op-pump"
surgery is still being performed through the standard incision through
the length of the breastbone.
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