Deadly ‘irreversible’ heart condition reversed for first time in major breakthrough

 Three patients who suffered from potentially deadly heart failure were remarkably freed from their symptoms after their condition was found to have spontaneously reversed, found a new study that reported on the unprecedented cases.

Vishwam Sankaran

Thu, 8 June 2023 at 3:12 pm GMT+8·2-min read

Deadly ‘irreversible’ heart condition reversed for first time in major breakthrough

Three patients who suffered from potentially deadly heart failure were remarkably freed from their symptoms after their condition was found to have spontaneously reversed, found a new study that reported on the unprecedented cases.

Transthyretin cardiac amyloidosis, the deadly condition, is caused by the build-up of sticky, toxic proteins in the heart. Until now, it was thought to be irreversible as half the patients suffering from the condition died within four years of diagnosis.

But the new study, published recently in the journal The New England Journal of Medicine, reported the cases of three men, aged 68, 76 and 82, who were diagnosed with the condition but later recovered.

Researchers, including those from University College London (UCL), confirmed the symptom reversal using heart scans that showed the build-up of amyloid proteins had cleared.

“We have seen for the first time that the heart can get better with this disease. That has not been known until now and it raises the bar for what might be possible with new treatments,” said study lead author Marianna Fontana from UCL.

Researchers also found evidence that the three men had antibodies that specifically targeted the amyloid proteins – an immune response that was not found in other patients whose condition progressed as normal.

“Whether these antibodies caused the patients’ recovery is not conclusively proven. However, our data indicates that this is highly likely and there is potential for such antibodies to be recreated in a lab and used as a therapy,” said UCL’s Julian Gillmore, another study author.

The condition is known to be caused by deposits composed of a blood protein called transthyretin, and can be either hereditary or non-hereditary.

While current treatments aim to relieve the symptoms of heart failure such as fatigue, swelling in the legs or abdomen and shortness of breath, they do not tackle the amyloid, scientists said.

With advancements in imaging techniques over the decades, clinicians have been able to diagnose substantially more people with the disease.

In the latest study, researchers looked through records of 1,663 patients diagnosed with the deadly condition after one man, aged 68, reported his symptoms improving.

Two more cases were identified after which all three men’s recoveries were confirmed via blood tests and imaging techniques like echocardiography.

Then a heart muscle tissue analysis of one of the patients revealed a strange inflammatory response surrounding the amyloid protein deposits in the heart – a response that was not seen in biopsies from patients in whom the condition had not reversed.

On further analysis, researchers found antibodies in the three patients that bound specifically to the heart protein deposits.

Scientists believe these proteins could be harnessed to build therapies that can suppress the toxic, sticky protein’s production.

“This work not only represents a major breakthrough in our understanding of cardiac amyloidosis, but crucially opens up new possibilities for more effective treatment options,” said Jon Spiers, chief executive of the Royal Free Charity.

https://uk.news.yahoo.com/deadly-irreversible-heart-condition-reversed-055058928.html

Turmeric - The Spice That Could Save Your Heart

November 29, 2012

 

The Spice That Could Save Your Heart

 People tend to think that bypass surgery is pretty safe. But the reality is, patients who undergo coronary artery bypass graft surgery—its official name—are vulnerable to an in-hospital heart attack in the first few days after the operation.

 

Now here’s good news: Curcuminoids, chemicals in the spice turmeric (the spice that gives curry its yellow color), may help prevent many of these post-op heart attacks, according to new research from Thailand.

 

 

 

HEART OF THE MATTER

 

I love this sort of news—don’t you? Here’s a natural spice accomplishing something that no drug has yet to do as effectively.

 

In the study, beginning three days prior to their bypass surgery, participants were given either a placebo or 4,000 milligrams (mg) of a curcuminoid supplement daily. They remained on that dose for five days after surgery, along with any necessary medications that they were given before, during and after surgery. The results were striking—30% of the patients who took the placebo had heart attacks in the 72 hours following the surgery...while only 13% of those who took the supplement had heart attacks.

 

“We believe that the anti-inflammatory and antioxidative effects of curcuminoids are mainly what helped prevent heart attacks,” the study’s lead author, Wanwarang Wongcharoen, MD, told me.

 

It’s possible that curcuminoids might also help patients who aren’t undergoing bypass surgery but are at high risk for heart attack, said Dr. Wongcharoen.

 

SHOULD YOU EAT MORE CURRY?

 

Before you head to the nearest Indian or Malaysian restaurant thinking that a great-tasting, curry-flavored meal will help protect your heart, keep in mind that the amount of curcuminoids that you get in such a meal is typically less than 10 mg—which is very, very little compared with the massive amount that patients in the study received (4,000 mg). So it’s unlikely that consuming curcuminoids through foods would have anywhere near the dramatic effect seen by the bypass patients in the study. Curcuminoid supplements, however, would be more likely to help because they contain much higher amounts, said Dr. Wongcharoen—usually about 250 mg to 500 mg per capsule.

 

If you’re about to undergo bypass surgery, ask your doctor whether taking 4,000 mg of a curcuminoid supplement daily—for three days before the operation and for five days after it—is a good idea, said Dr. Wongcharoen. Just be sure not to abandon your surgery meds. “I do not recommend replacing any drugs with a curcuminoid supplement,” Dr. Wongcharoen said. “But it might be a helpful addition.” You can buy a curcuminoid supplement at a health-food store or at many health-food and vitamin Web sites—there are many different types, so just make sure that the word “curcumin” is on the label, said Dr. Wongcharoen.

 

It’s generally considered to be a very safe supplement, said Dr. Wongcharoen. Potential side effects include nausea, dizziness and/or diarrhea, and it can slow blood clotting, so if it’s taken with other drugs or supplements that may also slow blood clotting (including clopidogrel, ibuprofen, naproxen, warfarin, garlic, ginger, ginkgo and/or ginseng), that could be dangerous. (Dr. Wongcharoen found in his study that the supplement group did not bleed any more than the placebo group, which suggests that the anticlotting effect of these curcuminoids may not be very strong—therefore, in his opinion, the reduction in heart attack risk outweighs an additional risk of bleeding.) Keep in mind that taking any supplement in an extreme amount does raise the risk for side effects and adverse interactions—so definitely check with your doctor first.

 

And if you had bypass surgery more than 72 hours ago, the danger of having an operation-related heart attack has passed, so Dr. Wongcharoen does not recommend that you take a curcumin supplement to prevent heart attacks until future research shows whether it’s helpful.

 

Source: Wanwarang Wongcharoen, MD, department of internal medicine, faculty of medicine, Chiang Mai University, Chiang Mai, Thailand.

http://www.bottomlinepublications.com/content/article/health-a-healing/the-spice-that-could-save-your-heart?

Aspirin helps prevent post-op kidney failure

 

June 13, 2012. The results of a study presented at the European Anaesthesiology Congress in Paris on January 9, 2012 suggest that aspirin consumed during five days prior to heart surgery could reduce the number of cases of post-operative acute kidney failure by 50 percent. Acute renal failure or injury is a frequent complication following cardiac surgery which lowers the chances of survival. “It significantly increases hospital stay, the incidence of other complications and mortality," explained Jianzhong Sun, MD, PhD, of Thomas Jefferson University, who presented the finding. "From previous reports, up to 30% of patients who undergo cardiac surgery develop acute renal failure. In our studies, about 16-40% of cardiac surgery patients developed it in various degrees, depending upon how their kidneys were functioning before the operation. Despite intensive studies we don't understand yet why kidney failure can develop after cardiac surgery, but possible mechanisms could involve inflammatory and neurohormonal factors, reduced blood supply, reperfusion injury, kidney toxicity and/or their combinations."

The study compared 2,247 patients who consumed aspirin within five days before cardiac surgery to 972 who did not use the drug. While 6.7 percent of those who did not use aspirin developed acute renal failure, the condition occurred in only 3.8 percent of aspirin users. "Thus, the results of this clinical study showed that preoperative therapy with aspirin is associated with preventing about an extra three cases of acute renal failure per 100 patients undergoing coronary artery bypass graft or/and valve surgery," stated Dr Sun.

"Looking back and ahead, I believe we can say that aspirin is really a wonder drug, and its wide applications and multiple benefits are truly beyond what we could expect and certainly worthy of further studies both in bench and bedside research," he remarked.

http://www.lef.org/whatshot/2012_06.htm?

SUTURELESS: IJN's new heart surgery lowers risk

No stitches in time save lives

By CARISMA KAPOOR | carismakapoor@nst.com.my
0 comments
11 May 2012 | Last updated at 08:33AM

Chief cardiothoracic surgeon Datuk Dr Mohd Azhari Yakub (left) and clinical director
of adult surgery Dr Jeswant Dillon showing the new sutureless aortic valve prosthesis
at the National Heart Institute in Kuala Lumpur yesterday. Pic by Sairien Nafis

 

KUALA LUMPUR: THE National Heart Institute (IJN) used a sutureless valve prosthesis when operating on two heart patients with severely diseased aortic valves on Tuesday.

IJN chief executive officer Tan Sri Dr Robaayah Zambahari said it was the first time in Asia that patients had been implanted with the Sorin Percival sutureless heart valve.

Chief cardiothoracic surgeon Datuk Dr Mohd Azhari Yakub, who led the surgical team, said the technique benefited medium-to high-risk patients with co-morbid diseases.

The two patients, 66 and 67, who underwent the surgery for aortic stenosis, are recovering well.

The technique was also suitable for patients with small aortic roots as the valve was collapsible and easy to implant in a-minimally-invasive surgery, he added.

Dr Azhari said the sutureless valve technology provided patients with better outcomes and recoveries.

"Since the patient requires no stitches, there will be a significant reduction of surgical time and can be performed at a lower operative risk," he said at IJN yesterday.

He said the mortality rate would be reduced compared with the conventional suturing techniques, which could result in complications, surgical trauma and post-operation complications.

He said the prosthesis valve could last for 10 to 15 years.

"Since patients are usually 60 and above, the valve gives good durability for the age group." He added the valve would last longer in older patients because of their lower metabolism.

Aortic stenosis is a heart disorder found in 20 per cent of elderly people

http://www.nst.com.my/nation/general/no-stitches-in-time-save-lives-1.82742

Gene test that could save lives of heart operation patients

By Rachel Ellis
Last updated at 4:02 AM on 6th December 2011


Doctors have developed a new test to identify patients at risk of complications following heart surgery.

More than 120,000 people undergo coronary artery procedures a year including heart surgery and angioplasty (where a tiny balloon is inserted into the blocked artery to clear it).

Following these procedures, it’s vital that patients take blood-thinning drugs to prevent the formation of blood clots which can cause a new heart attack or stroke.

Clopidogrel, also known as Plavix, is one of the most commonly prescribed clot-busting drugs.

However, to prevent blood clots forming, the drug has to be turned into its active form in the liver.

Recent studies show that about a third of patients have a genetic defect which prevents clopidogrel from working properly, leaving them three to five times more likely to die from a stroke or heart attack within a year of surgery.

Now doctors and scientists at London Bridge Hospital have developed a new screening programme to identify those at risk.

This tests patients’ blood to make sure it is clotting properly and screens for the genetic defect using a swab from the inside of the cheek.

Results are available in less than an hour and, if a problem is found, patients are put on alternative medication.

Currently, patients undergoing heart surgery are monitored for side-effects of the drugs.

 

Alan Rayner, a surgical assistant who operates the heart-lung machine during surgery, developed the programme alongside cardiologist Dr Cliff Bucknall and says routinely screening all patients requiring coronary intervention will save lives.

‘Until now, patients have been given clopidogrel with no monitoring of its effect. It’s been a one-size-fits-all approach,’ he says.

‘In many cases, the first time doctors are aware that it is not working properly is when a patient gets symptoms such as chest pain.

‘For some, waiting until then may be too late.

‘By screening all patients before, during and after surgery or intervention, we can provide individualised care and ensure they are on the correct medication from the start.’

 

Research carried out in New Zealand found that preventing just two
heart attacks would more than pay for 100 patients to be screened

Similar tests are available in other private hospitals and on the NHS.

However, they are not routinely offered to heart surgery patients and the results can take weeks.

The older technology they use means the blood samples have to be sent to specialist laboratories for analysis — and cost at least £500.

Instead, patients are monitored for signs — such as high blood pressure or bleeding after treatment — that the drugs are not working properly. The new test costs around £200.

Research carried out in New Zealand found that preventing just two heart attacks would more than pay for 100 patients to be screened.

But says Professor Jeremy Pearson, associate medical director at the British Heart Foundation, there is not yet enough evidence for the new test to be made available nationwide, as it is not clear how many side-effects the tests would avoid.

‘The principle is a good idea and this kind of personalised genetic testing will increase in the future,’ he says.

‘But there is controversy over whether these tests are cost-effective.’



Meanwhile, a study of 1,000 patients by U.S. scientists has revealed that early-morning heart attacks — those that occur between 1am and 5am — are the most damaging.

The research team, who also factored in the amount of time it took each patient to seek help, suggest that the ability of the heart to protect itself against damage fluctuates with our 24-hour body clock.

These powers of protection are at their lowest between 1am and 5am, as this is when we are in deep sleep; the heart does not need to prepare for any stresses, and so it can reduce the number of protective chemicals and focus on repair.

‘It is important to understand that the heart’s ability to protect itself against more severe damage varies over a 24-hour cycle,’ said the study’s author Jay Traverse, a cardiologist at the Minneapolis Heart Institute Foundation, whose findings were published in the journal Circulation Research.
He believes the findings may help researchers develop more effective heart drugs.


Read more: http://www.dailymail.co.uk/health/article-2070418/Gene-test-save-lives-heart-operation-patients.html
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How sticking a camera through your ribs can save you from open heart surgery

By Carol Davis

Last updated at 3:39 AM on 1st November 2011



Thousands of Britons have open heart surgery each year for heart defects, such as valve problems or a hole in the heart.

Micki Garvey, 56, an adult education manager from Queen’s Park, London, underwent a less invasive procedure.

THE PATIENT

'Mine was a particularly rare form, but it hadn't ever caused me any
problems before,' said Micki Garvey of her hole in the heart

Sitting in a meeting in November 2009, I suddenly had severe chest pains and couldn’t breathe properly.

Colleagues called an ambulance, which took me to hospital; they kept me in overnight while my breathing returned to normal.

It was terrifying for my son Tuli, then 16, because his father died in hospital a few years earlier.

The doctors weren’t sure what had caused the problem, but I knew I was born with an atrial septal defect — a hole in the heart — which was diagnosed when I was 19 and experienced chest pains.

Around a quarter of all people have a hole in their heart, but don’t know it. Mine was a particularly rare form, but it hadn’t ever caused me any problems before, and even after this second episode, doctors said I didn’t need anything done.

However, I was referred to Hammersmith Hospital in London, and in the months before my first appointment in July last year, I started feeling exhausted. My job is physically demanding, and I work over 50 hours a week: I’d always coped with it, until then.

At Hammersmith two weeks later the doctors did more tests and explained a hole can cause blood to travel straight from one side of the heart to the other, rather than through the lungs. It was likely to cause more problems as I got older, because of the extra strain on my heart.

I was also at risk of a stroke, because a blood clot could reach my brain instead of being filtered out in the lungs, and they said I really needed something done.

In August I had an operation where the surgeons fed a device like a tiny umbrella up through my veins to close up that hole.

Camera technology means surgeons can see the heart
in 3D, and treat even larger holes with keyhole techniques

But my consultant said the operation hadn’t worked because the hole was too big.

Worse still, I’d now have to have open heart surgery, to fix a patch over the hole. It needed a recovery of up to three months as the breastbone which was broken for the operation healed, and risks including stroke, bleeding, infection and respiratory failure — and a one per cent risk of death.

But just before the operation I saw a surgeon at Hammersmith called Marco Solinas who told me about a new procedure where they could make just a 5cm incision in between my ribs and use a tiny camera to look at my heart in 3D colour, and fix the patch on. I’d recover in a few weeks, the risks were less, and I’d have much smaller scars.

I had the operation in September last year. I needed powerful painkillers for the first two weeks, but I was hobbling around after three days, and went home on the fifth day.

Five weeks after surgery, I was back at work part-time, since the scars under my right breast and under my arms were healing nicely.

I feel so much better — the exhaustion has gone, I’m back to my full-time job, and out of danger.

THE SURGEON

Marco Solinas is senior lecturer at Imperial College London and visiting consultant at Hammersmith Hospital. He says:

Any defect of the heart such as a hole or heart valve failure used to result in open heart surgery, which meant breaking the breastbone and an incision of up to 30cm.

Atrial septal defect is one of the most common congenital heart defects, affecting one in 1,500 newborns. For some reason the septum, the wall of tissue which divides the two upper chambers of the heart, fails to develop properly.

Normally, blood travels out the right side of the heart, through the lungs, which filter out any debris and clots, before it goes back to the heart on the left side.

However, with atrial septal defect, the hole allows blood to travel straight from the right to the left side, short-circuiting the lungs. Blood clots can get to the brain, giving patients a high stroke risk.

These abnormal holes can be up to 2cm wide and 6cm long, as big as a thumb. If we don’t treat them by the time patients are in their 30s or 40s, the abnormal blood flow through the hole can damage the lower chamber of the heart, which can enlarge and eventually cause heart failure.

Untreated patients have an average life expectancy of just 50.

Over the past two decades, we’ve developed minimally invasive techniques for this — cardiologists can slide an umbrella-like device up through the veins to close the hole. But this can fail, sometimes because the hole is too big, meaning we’ve had no choice but to do a full sternotomy — opening the breastbone to fix a patch on to the hole.

But the latest camera technology means we can see the heart in 3D, and treat even larger holes with keyhole techniques.

This is now being done at just a few UK centres, but could help thousands of patients — not only those with atrial septal defect, but also with valve problems (6,000 Britons have surgery for this every year), and also some forms of persistent atrial fibrillation — an irregular heartbeat.

The new technique is less traumatic and painful for patients, because we don’t need to break the breastbone. And patients have a far smaller scar which in women can be hidden under a breast.

They stay in hospital for just five or six days, instead of ten to 12, and can even go back to work in two to three weeks instead of up to three months when bone needs to heal.

The operation takes around three hours. With the patient under general anaesthetic, I make an incision in the right side of the groin and feed a flexible tube up to the heart and connect the patient to the heart-lung machine, which will pump oxygenated blood back into the body through another tube in the left side.

Then I make a 5cm incision in the right hand side of the chest between the ribs, and use an expander to part the ribs (without breaking them) and expose the heart. I make an incision in the heart wall and introduce a camera into the heart through a port or valve in the chest which will give us a 360-degree view of the heart on a monitor.

Using the camera images to guide me, I sew a special polymer patch slightly bigger than the defect over the hole — within two months, tissue will grow over this.

We make sure the heart is working properly again and disconnect it from the heart-lung machine. Chest drains are left in place for a day or so to take away any fluids.

While cardiac surgery is a wonderful thing because it saves so many lives, this new technique is exciting and so much better for patients because it leaves less scarring, carries fewer risks and has a far shorter recovery.

The operation costs around £12,000 privately or to the NHS.

http://www.dailymail.co.uk/health/article-2055871/How-sticking-camera-ribs-save-open-heart-surgery.html

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