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Mitral Valve Regurgitation Caused Elizabeth Taylor’s Death – Could It Affect You?

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I am saddened that Elizabeth Taylor died recently of heart failure. In his appreciation of her, film critic Roger Ebert said in the Chicago Sun-Times, “Of few deaths can it be said that they end an era, but hers does.”

She is a star that many of us felt we knew. She was a great actress and a woman of great beauty who was a hard working champion of people with AIDS and always seemed to be a determined person who knew herself. Yet she always had a vulnerable side. So many marriages, so many illnesses, so many, many surgeries, over 40, I’ve read. And then her heart problem developed. Which leads me to talk a little about that problem, mitral valve leakage.

The heart’s mitral valve

The heart has four chambers and four valves that open to let blood through to the next chamber of the heart and on out to the body and back. The valves, acting as gates, then immediately close to prevent the blood from running back where it just came from. The mitral valve looks like a mouth with leaflets that look like lips that open and close. When I saw it in action on an echocardiogram, a test that uses sound waves to show moving pictures of the heart, I thought it looked like a very sensuous mouth. Each of the valves looks different. But because it looks like a mouth, the mitral valve stands out. Blood has just left the lungs carrying oxygen and arrives at the left atrium of the heart. The mitral valve’s mouth opens to let the blood pour through into the left ventricle. As the left ventricle contracts, the mitral valve closes and the aortic valve opens to allow blood to leave the heart and get out to the body.

A mitral valve can start to leak. This can range anywhere from a condition that is minor and does not need treatment to a serious problem that leads to a weakened heart and heart failure. In Elizabeth Taylor’s case, it led to heart failure and her symptoms must have included difficulty breathing and fatigue.

I asked Edward K. Kasper, M.D., director of clinical cardiology at Johns Hopkins Hospital, to talk a little about what can go wrong with a mitral valve. I should mention for disclosure that Ed is my cardiologist and co-authored with me the book Living Well with Heart Failure, the Misnamed, Misunderstood Condition:

A leaky mitral valve – mitral regurgitation, is common and has many causes. Most people tolerate a leaky valve well, but some need surgery to correct the leak. Repair is preferred to replacement. The MitraClip (which was used for Elizabeth Taylor) is a new technique to try and fix mitral regurgitation in the cath lab rather than in the operating room. There are no long-term comparison studies of this technique compared to standard OR repair – that I know of. Repair is currently the gold standard for those who have severe mitral regurgitation and symptoms of heart failure. Outcomes are better including improvement in symptoms and survival in patients with repair rather than replacement.

What takes a person from a leaking mitral valve to heart failure?

The leakage back into the left atrium increases the pressure in the left atrium. This increased pressure in the left atrium is passed back to the lungs, causing fluid to leak into the lungs, leading to heart failure. With time, the demands of severe mitral regurgitation on the left ventricle will lead to a weakened left ventricle, a dilated cardiomyopathy (disease of the heart muscle). We try to prevent this by operating before it gets to that point.

Mitral regurgitation can also be a consequence of a dilated cardiomyopathy – the orifice of the mitral valve enlarges as the left ventricle enlarges. The leaflets of the mitral valve do not enlarge. Therefore, they no longer close correctly, leading to mitral regurgitation.

It’s easy to see why anyone would want to opt for the Evalve MitraClip over open heart surgery. The MitraClip is little different from a common test known as an angiogram in which a catheter is passed through the femoral vein in the groin up to the heart. In this repair procedure, however, the catheter guides a clip to the mitral valve where the metal clip covered with polyester fabric is positioned over the leakage and brought down below the open flaps and back up, fastening the valve’s open leaflets together. The manufacturer, Abbott, shows in a video here how blood still is able to pass through on either side of the fastening.

Elizabeth Taylor got her MitraClip repair a year and a half ago, so it must have worked for awhile. Then about six weeks ago she was hospitalized with heart failure at Cedars-Sinai Medical Center in Los Angeles where she died with her family at her bedside. For more on mitral regurgitation, see this NIH site.

Heart failure has many other causes. High blood pressure can damage the lining of blood vessels leading to deposits of cholesterol. Coronary artery disease causes heart attacks. A heart attack kills part of the heart muscle, forcing the rest of the heart to work harder and in doing so, get large and weak. Only about half the people who develop heart failure have a weak heart. In another cause of heart failure, the left ventricle becomes stiff and the heart does not fill properly. And in some heart failure, the heart itself is normal but connecting blood vessels are not or a valve may be too narrow. In all of these cases, a person is said to have heart failure because the heart and vascular system are not able to provide the body with the blood and oxygen it needs.

*This blog post was originally published at HeartSense*

Dr. Lisa Sanders: Medical Detective

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If you follow me regularly, you know I enjoy watching the Fox television drama House M.D. on Monday nights (although I often watch the recording later in the week). Doctor Gregory House (Hugh Laurie) is a sorry character but a terrific diagnostician.  In almost every episode someone is on the brink of death from an elusive illness when House’s “light bulb” goes on and, in a flash, he saves the patient’s life by proving himself to being the world’s best medical detective.

Doc Hollywood

Doc Hollywood???

Dr. Lisa Sanders is watching 3,000 miles away in New Haven, Connecticut where she teaches first and second year med students at Yale how to learn to be House-type medical detectives – but much more respectful ones. She is like that herself. She’s so good at it she writes a medical column for The New York Times Magazine. That column was actually the inspiration for the television show. And it won Dr. Sanders a job as technical adviser on the medical drama. Read more »

*This blog post was originally published at Andrew's Blog*

What Everyone Should Know About Plastics

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Information circulating about the dangers of plastic containers has created fear and confusion. Are plastic containers toxic? Do harmful chemicals leach out into its contents? Do we need to discard all plastic containers?

Recently, I interacted in a live health chat on MedHelp about the safety of plastics. Scientist, Joe Schwarcz, Ph.D., Director of McGill University’s Office for Science and Society, talked about “The Real Truth About Plastics: What You Should And Shouldn’t Worry About.”

While Dr. Schwarcz states that some plastics like those made by Tupperware and Rubbermaid are safe to use, there are other plastics made of Bisphenol A (BPA) that may cause some concern, however he did not become alarmed.

There is extensive information on the safety of plastics, and reading some of it can easily cause panic and confusion, but the smartest step health consumers can do for themselves is to remain calm and don’t become alarmed. Gather the facts and determine what’s best for you.

The Facts About Bisphenol A (BPA)

Bisphenol A (BPA) is used to manufacture polycarbonate plastics. This type of plastic is used to make some types of beverage containers, compact disks, plastic dinnerware, impact-resistant safety equipment, automobile parts, and toys. BPA epoxy resins are used in the protective linings of food cans, in dental sealants, and in other products.

General exposure to BPA at low levels comes from eating food or drinking water stored in containers that have BPA. Small children may be exposed by hand-to-mouth and direct oral (mouth) contact with materials containing BPA. Dental treatment with BPA-containing sealants also results in short-term exposure. In addition, workers who manufacture products that contain BPA can be exposed.

How Does BPA Get Into The Body?

BPA can leach into food from the epoxy resin lining of cans and from consumer products such as polycarbonate tableware, food storage containers, water bottles, and baby bottles. Additional traces of BPA can leach out of these products when they are heated at high temperatures. Read more »

*This blog post was originally published at Health in 30*

Are Plastic Products Safe? Ask Chemistry Professor, Joe Schwarcz, Ph.D.

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Have you heard the new urban legend about plastic products? A growing number of celebrities and websites have been fueling a plastic paranoia, striking fear in the hearts of parents, fitness buffs, and microwave container users. Concerns reached such a fever pitch that I wondered if there may be something to this buzz: Can certain plastics harm our bodies or even cause cancer?

But like the buzz surrounding vaccines and autism (there is NO link between the two), plastiphobia (as I like to call it) is not backed by any clear evidence of human harm. Chemist, Dr. Joe Schwarcz of McGill University (who has no financial ties to plastics manufacturers, by the way) has reviewed the scientific literature and has found plastics to be an extremely unlikely candidate for human injury. (Well, unless you hit someone over the head with a water bottle.) Dr. Schwarcz reviewed plastics safety in a live health chat on December 8th. You can review the entertaining conversation here.

Plastiphobia has fueled an entire industry of plastic-free baby bottles and “microwave safe” containers. Read more »

Swanson: Physicians Have An Ethical Duty To Participate In Social Media

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Wendy Sue Swanson, MD

Most physicians still don’t see the need to blog, Tweet, or spend time on Facebook. They groan when you ask if they participate on social media platforms. “I’m too busy seeing patients,” they say, “and why would I expose myself to legal risk? Someone might think that I’m giving medical advice, or disclosing personal information about patients online.”

While these fears are pervasive, early adopters of social media like Dr. Wendy Swanson (and yours truly, by the way) have a different view. Not only should physicians become active in social media, but they have an ethical responsibility to do so.

Wendy is a pediatrician, mother, and blogger at Seattle Children’s Hospital. My friend “ePatient Dave” deBronkart recently encouraged me to watch an excellent video of Wendy speaking at the Swedish Symposium 2010 conference. I’d like to summarize Wendy’s pro-social media arguments for you here, with the hope of luring more of my peers to join the conversation online! Read more »

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