Murmurs, Arrythmias, Heart Disease, & Failure

The heart is divided into four chambers. The right atrium receives unoxygenated blood which then goes past the tricuspid valve into the right ventricle. From here, blood is pumped into the lungs through the pulmonic arteries as it passes by the pulmonic valve. Blood flows to the lungs where it is oxygenated. The blood returns via pulmonary veins into the left atrium. From here, blood flows past the mitral valve into the left ventricle. From here, blood is pumped out to the rest of the body via the aorta as it passes by the aortic valve. This sequence of events is coordinated by an electric impulse triggered by the SA node to result in a regular rhythmic lup-dup of the heart as it consistently relaxes and contracts. 
 
Heart disease results from any abnormality of the heart. While heart disease can result in heart failure, it can be present and never lead to heart failure. Murmurs can be associated with heart disease that may be minor or serious in nature. Arrythmias are usually associated with serious heart disease. The heart disease may or may not necessitate treatment. 
 
Heart failure is the end-result of heart disease and occurs when the heart is decompensating from its heart disease and is working inefficiently to cope with the body’s needs. It is associated with signs of congestion/edema, poor perfusion and low blood pressure. This condition always necessitates treatment. 
 
Signs 
 
Some pets may have significant heart disease without signs. However, their condition can change quickly with stress or exertion as the heart starts to fail. 
 
Most dogs with significant heart failure will show some or all of the following signs- coughing, especially at night, fatigue, tiring with exercise, a change in gum color from pink to a bluish color, difficulty breathing or rapid, shallow breathing at rest. These signs occur due to accumulation of fluid in or around the lungs and in the abdomen. 
 
Most cats, however, show no signs before complete failure occurs. They can go from being apparently normal cats to open mouth breathing or fast, shallow breathing or having inability to use their legs when they have a clot (emboli) originating from the heart that lodges in their aorta. Cats can also suddenly die at home and pass away before anything can be done to help them. 
 
Problems with the heart 
 
Arrythmias 
 
These may be primary, that is, associated with the heart directly and resulting from a heart condition. Arrythmias can also be secondary to problems with other organs in the body or occur in reaction to toxins or anesthesia. 
 
Arrythmias may be heard during a routine physical exam where the animals shows no outward signs of a problem; they may be heard when an animal presents for fatigue, collapse or “seizure” like signs. 
 
Arrythmias are categorized according to the chamber with which they are associated. Arrythmias of the atrium are called supraventricular, while arrythmias of the ventricles are called ventricular. Bradyarrythmia is a decreased heart rate, while tachyarrythmia is an elevated heart rate. 
 
Murmurs 
 
Murmurs result when there are changes within the heart. These can be from thickening of the valves (endocardiosis), narrowing near the valves (stenosis), thickening or thinning of the chambers (cardiomyopathy) or infection of the heart (endocarditis). 
 
Murmurs may be heard during a routine physical exam where the animal has no symptoms of a problem (asymptomatic). Murmurs may be heard when the animal is showing signs of heart failure (fatigue, difficulty breathing, fainting or coughing). 
 
Sometimes, with soft murmurs in puppies and kittens, they can be “innocent”, that is, they will eventually disappear and cause no problems for the animal. A murmur that develops later in life, after six months of age, is more likely to be from disease. Murmurs are graded in loudness on a scale from 1 to 6, one being a soft, barely heard murmur to six being able to be heard without a stethoscope. While murmur loudness is useful in its description, it often doesn’t correlate directly with the severity of the heart problem. 
 
Murmurs can indicate a primary heart problem or can be secondary to other conditions such as anemia in dogs and cats (when the blood is thin and more prone to turbulence) or hyperthyroidism in cats (when having elevated levels of thyroid hormone put an excessive strain on the heart). 
 
Congenital Heart Conditions 
 
Animals can be born with a heart condition resulting from a congenital malformation. These are seen in young animals and can be hereditary. For this reason, these animals should not be bred. Certain breeds of dogs and cats are more likely to have certain congenital heart conditions, but even mixed breeds can be affected. Some common congenital heart defects are: 
 
Patent Ductus Arteriosis (PDA) 
 
A shunt is present in the fetal state that fails to close in the young animal, resulting in a direct connection between the pulmonary artery and aorta. The flow of blood is usually left-to-right; occasionally, though, if pressure builds up in the lungs, the flow can be right-to-left. These conditions are treated differently. 
 
Pulmonic Stenosis and Aortic Stenosis 
 
There are areas of constriction or narrowing near or at the pulmonic or aortic valves. 
 
Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) 
 
There are openings due to an incomplete wall between the two atria or two ventricles. 
 
Mitral or Tricuspid Valve Dysplasia 
 
There are malformed mitral or tricuspid valves that result in abnormal blood flow. 
 
In general, subaortic and pulmonic stenosis and patent ductus arteriosus are the most common congenital abnormalities in dogs, and ventricular septal defect and tricuspid valve dyplasia are the most common congenital abnormalities in cats. 
 
Hernias 
 
Peritoneopericardial diaphragmatic hernias refer to the condition in which an animal is born with an opening of the diaphragm and the pericardial sac, allowing herniation of abdominal contents into the chest cavity and into the sac that surrounds the heart. 
 
Acquired Heart Conditions 
 
Most heart disease in animals is acquired, that is, associated with a condition that develops over time. Certain breeds of dogs and cats are more likely to have certain acquired heart disease. The most common conditions are: 
 
Mitral valve disease (MVD) 
 
This occurs when there is thickening of the mitral valve on the left side of the heart; this results in abnormal blood flow. It is also known as mitral regurgitation. 
 
Cardiomyopathy 
 
These are disease of the heart muscle. This condition is common in older small breed dogs. 
 
* Dilative, the most common form in dogs, is when the chamber walls are thin and the chamber size is enlarged. There is a higher incidence in Boxers, Doberman pinschers, Cocker spaniels and Great Danes. 
 
* Hypertrophic, the most common form in cats, is when the chamber walls are thickened, and there is less room for blood inside the chamber. 
 
* Restrictive and mixed forms of cardiomyopathy are two other forms that can occur in cats. 
 
Pericardial disease 
 
This refers to accumulation of fluid in the sac that surrounds the heart (pericardial sac); this can occur from cancer, trauma, infection or for no known reason (idiopathic). 
 
Heartworm disease 
 
This can occur in dogs and is acquired via mosquitoes; cats living in areas frequented with mosquitoes carrying the heartworm larvae can occasionally acquire this disease. Heartworms, left untreated, will lead to heart failure. 
 
Cardiac Tests 
 
Tests are required to differentiate between the different forms of heart disease and indicate what type of treatment is needed. 
 
Radiographs 
 
These show the overall heart size and arteries and veins of the lungs. It can show if one side of the heart is larger than the other and suggest what chambers may be enlarged. It can also check for the presence of fluid associated with the lungs (pulmonary edema or effusion) and for the presence of abdominal fluid (ascites) and other organ enlargement, especially, the liver. 
 
Echocardiogram 
 
This is an ultrasound of the heart, the most useful test there is to determine the presence and type of heart disease. It allows for the measurement of the chambers (the wall thickness) and for the evaluation of heart valves’ efficiency. It indicates overall heart performance and helps to dictate what type of treatment is needed. Follow-up echocardiograms show if the treatment is working or not. 
 
Electrocardiogram (ECG or EKG) 
 
This shows the heart’s rate and rhythm and helps to determine what type of arrythmias are present. It can also suggest if there is chamber enlargement. 
 
Blood and urine tests 
 
A blood panel and urine test showing organ function is valuable in evaluating the body as a whole. Sometimes, the heart can affect other organs; sometimes, the animal has concurrent disease. It is important to have a “baseline” of the body’s function, before heart medication is started. Some values, especially kidney function and electrolytes, may need to be rechecked over time once treatment is started. 
 
Blood pressure 
 
Hypertension can occur with both heart and kidney disease and can make the animal’s condition worse. High blood pressure is treatable and its control may help the pet’s heart condition.

Tinnitus: It’s Not A Disease, It’s A Symptom

Tinnitus is extremely common in family medicine, especially in relatives who are either very old or very young. Surprisingly, though, this is typically a symptom of something larger – not a disease in and of itself. If you have Tinnitus then you are most probably familiar with some of the most common causes. There is a whole list of them for you to choose from. Only when you start to analyze the known facts and their probable consequences will the whole scope of Tinnitus start to unfold. 
 
There can be a million reasons why you have Tinnitus. Let’s take a brief look at some of the most common symptoms for tinnitus. How many of these symptoms can you apply to yourself?  
 
Lack of concentration, 
Headaches, 
Fatigue, 
Social retreat, 
Depressive moods, 
Lack of patience, 
Nervousness, 
Panic attacks, 
Anxiety, 
Apprehension, 
Stress and tension, 
Lack of self confidence, 
Insomnia, 
Exhaustion, 
Devaluation, 
 
Other than the hearing loss which is physical, all other symptoms listed here are of a subconscious nature. Let’s get 3 important things into perspective here.  

 
1. Tinnitus is not a disease, it is a symptom! 
2. You are not sick and you are not mentally ill. You are being warned! 
3. You will defeat tinnitus if you accept it as a part of you. 
 
As soon as you are ready to accept that the tinnitus is a part of you, the sooner you can expect to make progress. 
 
The power of the mind is extraordinary. Think about this carefully. If tinnitus succeeded in turning your life upside down then accept the fact that all it used to achieve misery was your own mind. That’s quite an achievement isn’t it? That’s how powerful your mind is. If it has the capability to make your life a complete misery then surely it can be re-programmed to do the opposite. 
 
What do we know about the causes of tinnitus? Where does it have its roots? 
 
I once tried to compile a list of all elements which I suspected may have contributed to MY own tinnitus. Obviously, I listed the negative aspects of my life over a 10 year period. Some of these things could have been avoided, most of them were linked to each other. Don’t forget, this is only a list of things that I think should be mentioned. I’ve tried not to generalize and I’ve tried my best to stay honest, even if it means confessing to some bad sins. To be perfectly honest it’s not as dramatic as it looks. It just looks outrageous when written down! 
 
Marital Stress, 
Heavy smoking, 
Drug and medication abuse, (i.e. Valium, Marijuana, Cocaine) 
Relationship crisis, 
unhealthy eating habits, 
Loud noises, 
Lack of exercise, 
High cholesterol, 
High blood sugar rate, 
Personal loss, 
Caffeine addiction ( coffee and cola ) 
Lack of sleep, 
Financial Problems, 
Overweight, 
Business pressures, 
Inclination to worry about everything. 
 
Think carefully about what you are reading on your list. If you are very honest, you will find that you don’t need a magic wand to shorten this list. The only person on this planet that can change this list to something to be proud of is YOU! 

 
Once more………Don’t forget…. 
 
1. Tinnitus is not a disease, it is a symptom. 
2. You are not sick and you are not mentally ill. You are being warned! 
3. You will defeat tinnitus if you accept it as a part of you. 

Why Data Analytics is Important in Primary Healthcare

Data analytics is expected to reduce the cost of healthcare significantly. This is a welcome solution to a serious problem of increasing cost of healthcare in the United States. The cost of healthcare is a lot higher than it should be and continues to rise. This isn’t news to most people. But data and information technology can be a bigger part of the solution than most people realize, and while electronic recordkeeping still has a long way to go, it’s only part of the potential for these types of resources. Insurance companies are also trying to implement strategies that would reduce the cost of care such as switching from fee-for-service to plans that put patient outcomes and value of care first.

Fee-for-service sounds like a great, intuitive system that would reward the rational consumer. Unfortunately, instead, this payment method too often rewards doctors for using expensive and sometimes unnecessary treatments method and for treating lots of patients in a short time frame. This payment method consistently does not put the needs of the patients first or the quality of care for that matter. While managed care health systems have proven to be better care delivery model for cost control, it too has plenty of shortcomings. Especially when it comes to family medicine. Instead of seeing their primary care physician as a true family doctor that gains a holistic view of an individual’s health priorities, people tend to see these doctors as simply the gatekeepers for specialty care for which they’ve already identified their need online.  

Better Incentives and Methods for Clinical Practices

In the past, healthcare providers had no direct incentive to share patient information with one another, which had made it harder to utilize the power of analytics. The case is different now as there is a free flow of information between and within organizations. Now that more physicians and healthcare practitioners are getting paid based on patient outcomes, they have a financial incentive to share data that can be used to improve the lives of patients while cutting costs for insurance companies.

Clinical analytics and performance metrics have also helped physicians become more evidence-based. This means that they rely on large swathes of research and clinical data as opposed to solely their schooling and professional opinion. A good doctor never stops learning and catching up on the latest advances, new procedures such as non-invasive surgeries and so on.  As in many other industries, data gathering and management are getting bigger, and professionals need help in the matter. This new treatment attitude means there is a greater demand for big data analytics in healthcare facilities than ever before.

Specific Points of Emphasis

There’s no doubt that data analytics has already transformed the healthcare industry and continues to do so. The healthcare industry slowly started adopting the new technology and innovations that were flooding the industry and now the adoption rate has quickened. The adoption of new technology is what will push health and digital health to new levels. Here is a rundown of how data technologies are contributing to healthcare:

  • Predict the daily patient income to tailor staffing accordingly
  • Use Electronic Health Records (EHRs)
  • Use real-time alerting for instant care
  • Help in preventing opioid abuse in the US
  • Enhance patient engagement in their own health
  • Use health data for a better-informed strategic planning
  • Research more extensively to cure cancer
  • Use predictive analytics
  • Reduce fraud and enhance data security
  • Practice telemedicine
  • Integrate medical imaging for a broader diagnosis
  • Prevent unnecessary ER visits

Lingering Obstacles to Better Data Analytics in Healthcare

Incompatible data systems are the biggest technical challenge, as making these data sets able to interface with each other is quite a feat. Different healthcare organizations use different technology platforms to store and process their data and also use different binding techniques such as late-binding and early-binding. Thus merging data sets stored in incompatible systems always proves problematic.

Patient confidentiality issues is another big challenge. There are different laws state by state which govern what patient information can be released with or without consent, and all of these would have to be navigated. Patient pieces of information are sensitive and the wrong move could result in a huge lawsuit that would cost the healthcare organization more money and resources. In addition, institutions which have put a lot of time and money into developing their own cancer dataset may not be eager to share with others, even though it could lead to a cure much more quickly and improved healthcare for all.