More than 200,000 people are treated for cardiac arrest in the United States each year, and the number may be on the rise, according a study conducted by University of Pennsylvania researchers.

Though cardiac arrest has long been known to be a chief cause of in-hospital deaths, no prior report was able to calculate its true incidence and to study trends in mortality and resuscitation care.

In the report, the researchers suggested that many of the cardiac arrest deaths may have been prevented through better monitoring of patients, quicker response time to administer CPR and defibrillation, and improved adherence to best practices in resuscitation guidelines.

Nevertheless, patients who suffer in-hospital cardiac arrests are twice as likely to survive than the people who have heart attacks in public settings – a 21 percent survival rate versus a less than 10 percent survival rate essentially, the researchers said.

“Our study proves that cardiac arrest represents a tremendous problem for hospitals in the United States,” said lead researcher Raina Merchant, MD, MS, an assistant professor of Emergency Medicine. “Until now, we could only guess about how many patients were suffering these events. These numbers finally provide us with a roadmap for improving allocation of resources to care for these critically ill patients and improve survival.”

The study was published in the journal Critical Care Medicine.

An analysis of heart disease and stroke statistics collected from 192 countries by the World Health Organization shows that the relative burden of the two diseases is closely linked to national income.

University of California researchers found that developing countries tend to suffer more death and disability by stroke than heart disease.  Meanwhile, the United States and other countries with higher national incomes tend to experience the opposite.

This finding may help health officials design tailored interventions to best fit the needs of developing countries, the researchers say.

“In general, heart disease is still the number one cause of death worldwide, but there is quite a lot of variation across the globe,” said Anthony  Kim, MD, MAS, assistant professor of neurology at UCSF .

For instance, there was a wide variation in the mortality rate for stroke highlighted by the new research.  Rates ranged from a worldwide low of 25 deaths per 100,000 in the island nation of Seychelles to a high of 249 deaths per 100,000 in Kyrgyzstan – a rate nearly 10 times greater.

In the United States, there are approximately 45 deaths per 100,000 people due to stroke.

Heart disease and stroke are similar in that they are both are caused by reduced or restricted blood flow to vital organs and share many of the same common risk factors, such as hypertension, diabetes, high cholesterol, obesity, physical inactivity and smoking.

However, because they affect very different tissues – the heart and the brain – they diverge in terms of symptoms, approaches to critical care, follow-up treatment and the duration and cost of recovery.

“There was a striking association with national income,” Kim said.

In the United States, for instance, heart disease is the number one killer and stroke the number four, according to the Centers for Disease Control and Prevention. This also holds true for the Middle East, most of North America, Australia and much of Western Europe.

The opposite is true in many developing countries. Stroke  is more prevalent in China, many parts of Africa, Asia and South America.

Overall, nearly 40 percent of all nations have a greater burden of stroke compared to heart disease.

“This is significant,” said Kim, “because knowing that the burden of stroke is higher in some countries focuses attention on developing a better understanding of the reasons for this pattern of disease and may help public health officials to prioritize resources appropriately.”

The study was published in the journal Circulation.

For the first time in the United States, a man can credit his own stem cells with fixing his broken heart, The Denver Channel reported.

John Christy, a war veteran, suffered from severe coronary artery disease that left him with fatigue and swollen limbs.  His outcome appeared bleak: Though many surgical and technological methods exist to treat congestive heart failure, over half of patients die within five years of receiving the diagnosis.

But as more and more doctors are learning, stem cell research is opening up possibilities that can slash even the steepest odds.

In the first trial of its kind ever done in the U.S., Christy’s doctor Jon Woo from the University of Pennsylvania School of Medicine retrieved stem cells from Christy’s bone marrow and used them to grow blood vessels around his heart.

“They form brand new micro blood vessels and deliver blood flow to the heart muscle,” Woo said.

Mere hours after the surgery, Christy had a new lease on life – with much improved odds of survival.

“I noticed two days after my surgery, I had much more ‘umph,’” Christy said.

Until now, restoring the functionality of hearts damaged by congestive heart failure and heart attacks is one of the most challenging tasks doctors and surgeons face.

Research like this gives doctors hope that adult and embryonic stem cells can become the reliable standard for replacing the heart’s damaged muscle cells as well as creating blood vessels to route a steady supply of blood to the cells.

Click here to read more from the Denver Channel.

Some stories are harder to report on than others.  As a doctor and a father, I can assure you that any story involving the death of a child is the most difficult – especially when that death may have been preventable.

This may have been the case for Wes Leonard, the 16 year-old basketball star from Fennville High School in Michigan.  On Thursday night, Leonard scored the game-winning shot to conclude a perfect season shortly before collapsing on the school court.  He was rushed to Holland Hospital, but attempts to revive him were unsuccessful, and Leonard was pronounced dead at 10:40 pm.

By all accounts, Leonard was a healthy, disciplined student athlete who ate properly and lifted weights in his spare time.  Not only was he the top scorer on his basketball team – in fact, he had surpassed 1000 career points in a previous game – he was also the quarterback for the school football team.

But, as I often warn people, it can be impossible to know what may lie under the surface without the proper tests.  If Fennville is like most high schools in America, they likely require student athletes have a yearly physical on file, but it is my firm opinion that this is not enough.

To minimize the risk of devastating consequences, like death, in any sport – whether it’s track, basketball or football – students not only need a typical sports physical, they also need to have a cardiac physical done as well.  This has to involve several types of tests, including:

-       Family history of cardiac disease

-       An electrocardiograph (EKG)

-       An ultrasound of the heart

These elements, unlike a mere sports physical, would be able to shed light on hidden clinical conditions such as hypertrophic cardiomyopathy (HCM), cardiac arrhythmias and valvular abnormalities that may be present but completely asymptomatic in a young person.  These conditions could have catastrophic consequences if the child does any kind of strenuous physical exercise.

There also must be an automated external defibrillator on site in any school, town or community gym, because if something terrible does happen, without the proper equipment, you will not be able to bring that person back in time.

This is supported by data, which shows that when an AED is used within the first 10 minutes of cardiac arrest, survival rates increase to 80 percent.  However, it typically takes emergency responders at least seven minutes to arrive.

Schools in Italy have these policies and I urge American high schools to implement these procedures as well: require cardiac physical and always keep an AED handy at sporting events.  When it comes to a matter of life or death, the benefits far outweigh the costs.

Attention iPhone users, this app could save lives.

A new iPhone application launched by the San Ramon Valley Fire Protection District in California alerts citizens when someone in the area has gone into cardiac arrest.

The application also sends the location of the nearest automatic electronic defibrillator.

When a 911 dispatcher inputs certain codes after receiving a distress call, the software sends out a text to citizens who have downloaded the application and indicated that they are CPR-certified.  When users open their smartphones, a map appears indicating the location of the incident, the location of an AED, and the user’s own location.

According to Richard Price, fire chief at SRVPD, there is less than an 8 percent chance of survival if someone goes into cardiac arrest on the street.

“With a cardiac arrest, you only get about 10 minutes to help,” Price said. “On average, it takes 7 minutes for first responders from a 911 call to arrive. The reason many people are dying is because of that difference.”

The application will enable citizens who are nearby to respond during that critical time period and give them access to an AED, which increases survival rates to 80 percent when it is used within the first 10 minutes.

Currently, the application will only be in use in the San Ramon district, but the SRVPD is looking for other agencies who want to implement it.  Developers are also working on making it available to Android and BlackBerry users.

The application is available at http://firedepartment.mobi/.

Click here to read more from O’Reilly Radar.

Clench your fist—that’s about the size of your heart. Located in the center of your chest, the heart beats about one hundred thousand times a day, pumping five to six quarts of blood per minute.

Once the blood receives oxygen from the lungs, the heart sends the blood from the aorta through the arteries and into the capillaries, which are smaller, thinner blood vessels. Then, once the capillaries have brought oxygen and nutrients to every cell in the body, the blood is redeposited into the veins, and from there it goes back to the heart for the cycle to begin again.

So what we have here is a plumbing system essentially, a smart pump with different connecting parts that circulates blood throughout the body. The heart itself is made up of four chambers—the two up top are called the atria, the two on the bottom are called the ventricles—connected by a set of valves. And the whole system is set in motion, or beats, thanks to the electrical impulses sent out by a small bundle of specialized cells in the right atrium that act as the heart’s natural pacemaker, causing the muscles of this organ to contract and relax.

Any malfunction of this blood pump is known as heart disease, of which one of the most common types is coronary artery disease. It is the number-one killer of both men and women in the United States. Half a million people die of it each year, and more than 12 million people have the disease.

Coronary artery disease, also known as coronary heart disease, is a narrowing and obstruction of the coronary arteries, which are responsible for bringing oxygen and nutrients to the heart itself. As early as your teen years, fat deposits begin to develop in some of these arteries, and as time goes by, the fat deposits build up, ultimately creating an obstruction that begins to decrease the amount of blood to the heart and cause an inflammation as the artery tries to heal itself.

Over time the fat deposits in the arteries begin to harden, and you begin to get deposits of small platelets that compound the obstruction. All of this can lead not only to a significant narrowing of the arteries, but to blood clots that may either obstruct the artery or get dislodged and create further obstructions elsewhere in the plumbing system.

One of the consequences of this narrowing or total obstruction of the coronary artery is ischemia, which occurs when there is an insufficient supply of oxygenated blood for the heart muscle. Any activity—eating, excitement, or changes in temperature—can make the problem worse.

One of the most common symptoms of ischemia is angina, which is a discomfort, heaviness, pressure, numbness, or squeezing feeling in the chest. Sometimes it is mistaken for indigestion or heartburn. It is usually felt in the chest, but it can also migrate to the arms, especially the left shoulder. Other symptoms include shortness of breath, irregular heartbeats or palpitation, a very fast heartbeat, nausea, and sweating. If this ischemia is not corrected, if it lasts more than 30 minutes and does not get better, a heart attack may result.

In a heart attack, the heart muscle begins to fail, either through a very erratic electrical stimulation called an arrhythmia or by stopping altogether. It is important to recognize these symptoms because early intervention could save your life.

A doctor can tell you if you have coronary artery disease by discussing your symptoms, especially shortness of breath, taking your medical history, and looking at your risk factors, in particular, smoking, cholesterol, blood pressure, and sugar control. There are a host of diagnostic tests your doctor can do, such as an electrocardiogram (ECG or EKG); an exercise stress test; an ultrafast CAT scan, which looks for calcium deposits in your coronary artery; and cardiocatheterization, which can help determine the degree of obstruction of the artery.

If you are diagnosed with coronary artery disease, treatment is threefold. The first has to do with lifestyle changes, like quitting smoking, starting to exercise, and keeping to a low-fat, low-sodium, low-cholesterol diet.

The second aspect of treatment is medication, which may be needed to get your heart working more effectively. Other medication will be prescribed to reduce the cholesterol.

The third aspect of treatment has to do with procedures to help improve the blood flow through the coronaries. One possibility is a balloon angioplasty, in which a small balloon-tipped catheter is inserted into the coronary arteries and then inflated to open up the clogged artery. Another possibility is placing a small, metal stent inside the artery to keep it open and improve blood flow.

A heart bypass operation takes place when total replacement of the piece of the coronary that is obstructed becomes necessary.

Plumbing Vs. Electrical Problems

Other types of cardiac disease have nothing to do with obstruction of the coronaries but with the way the electrical system of the heart works. Sometimes the specialized cells that electrically stimulate the heart become dysfunctional, and you can develop an arrhythmia, where the heart beats either too slowly, too quickly, or out of sync. These conditions can be diagnosed with an electrocardiogram, and sometimes medications alone can help to regulate the rhythm.

Another common problem is heart failure. This occurs when the heart can no longer effectively pump all the blood that it receives. Heart failure affects about five million Americans, and it’s the leading cause of hospitalization of people older than 65. Many times, heart failure is due to prior damage caused by coronary artery disease, or by arrhythmias that have weakened the function of the heart. Ultimately, heart failure creates a backlog of pressure into the lungs, and people with heart failure tend to have difficulty breathing. Depending on the cause of the heart failure, different medications are available for treating it.

The valves of the heart are another source of heart problems. The valves can be damaged at birth or through infection. Abnormal or infected valves can interfere with normal blood flow and heart function and can lead to major cardiac disease. Surgery may be needed to replace the valves.

Sometimes the lining of the heart may be infected, a condition called pericarditis. If this membrane is inflamed, the heart may not beat properly. Valve abnormalities, arrhythmias, and heart failure all have a common symptom—shortness of breath or difficulty catching your breath. If you have this problem, see a cardiologist to get the correct diagnosis and treatment.

The heart is a remarkable organ. It is the core of life, and its beat is central to your survival. Keeping it in prime working order is of paramount concern.

All for One and One for All

When we talk about heart attacks, we tend to describe them in a way that suggests there are different kinds of heart attacks. But those are just words to describe our experience of the same underlying disease.

Number one is the silent heart attack. Here you don’t have major chest pain, you don’t have shoulder pains, you may have a little palpitation, but you’re not tired, you’re not fatigued, and you’re not dizzy. However, when you go in for a physical, the doctor finds that you have had a silent heart attack.

Number two is typical angina. This is the chest pressure that doesn’t go away, and you have thirty minutes to get yourself to an emergency room.

Number three is the sudden heart attack. This occurs when you have a major, catastrophic obstruction in a main branch of the coronary artery, and a very large area of your heart is instantly void of any blood.

Even though the three heart attacks described here evolve differently, the underlying theme is the same—they all involve chronic coronary artery disease. In other words, you don’t go around with a normal coronary artery one day and the next day develop a major clot. That’s just not the way it works. The heart attack may present itself differently in different people, but the cause is the same no matter how we experience the critical moment.

A Heart Test for Venusians

What works for men, doesn’t always work for women. We all know that, but medicine is just catching up to the fact.

The standard test for heart disease is known as an angiogram. In this test a dye is injected into the coronary arteries, which are then X-rayed to look for blockages. The test is very effective in detecting heart disease in men, but a new study has discovered that this test often misses the symptoms of heart disease in women. When the tests turn up nothing, women are given a clean bill of health, even though as many as 3 million women could be at risk with a buildup of fatty deposits that could ultimately interfere with blood flow to the heart and cause a heart attack.

Hidden heart disease may be a significant problem in women. It appears that one cause may be due to a phenomenon called arterial remodeling. This means that the artery dilates as plaque is deposited in the blood vessel so that, in the early stages of atherosclerosis or coronary artery disease, very little overall narrowing is seen on an angiogram. But late in the disease, the deposits may overwhelm the body’s ability to compensate by remodeling, and severe narrowing or complete blockage can occur. If this happens, a sudden heart attack can result.

To diagnose heart disease in women, physicians will now have to use the new generation of CT scanners and magnetic resonance scanners, which can visualize the heart’s blood vessels with ever-greater detail. In many cases, these tests can detect problems before a stress test or a conventional angiogram. Physicians should test for the presence of coronary artery disease in women who have risk factors for heart disease such as diabetes, hypertension, high cholesterol, a family history of heart disease or stroke, or nicotine use.

The moral of this story is: paying closer attention to the vast differences between men and women could save lives—in this case, women’s lives.

Which Fruit Are You?

Researchers have long noted the importance of body shape in determining a person’s risk factors for heart disease. They talk about the apples versus the pears. The apples tend to store their access fat in their stomach and chest. The pears store it below the hips, in their thighs and buttocks. A recent study found that a person’s waist-to-hip ratio is an even better predictor of cardiovascular risk than their body mass index, or BMI, the commonly used ratio of weight to height. It appears that a large waist size, which generally indicates large amounts of abdominal fat, is more harmful than a larger hip size.

Determine your body shape and risk for cardiovascular disease by calculating your waist-to-hip ratio. First, measure your waist at its smallest circumference; then, measure your hips at their widest. Next, divide your waist measurement by your hip measurement. For example, a person with a thirty-six-inch waist and forty-inch hips would have a waist-to-hip ratio of 0.9. Waist-to-hip ratios over 0.85 in women and over 0.9 in men are strongly associated with an increased risk for heart disease.