Saturday, February 19, 2011

Heart Health and HIV

February is National Heart Month initially proposed by the American Heart Association back in 1963. Since 1963 Congress has required the President to proclaim February "American Heart Month”. Cardiovascular diseases, including stroke, are our nation's No. 1 killer.
10 years ago this month at the age of 47 my father suffered a major heart attack. While sitting on the couch one evening he began exhibiting the classic signs of a heart attack. Pain in his right arm, shortness of breath, and perfuse sweating. With the phone by his side he dialed 911 and was taken to the local hospital where he underwent emergency triple bypass surgery.  His cardiovascular health is doing fine today, with no CV episodes since.
Two years after my father’s Heart attack at the age of 25 I began having palpitations and strange sensations in my heart. I went to my primary care physician and he referred me to a Cardiologist.  I had my first echocardiogram; and to my surprise a diagnosis.  I have a Bi Cuspid Aortic valve with severe aortic regurgitation. A bicuspid aortic valve is an aortic valve that only has two leaflets, instead of three. The aortic valve regulates blood flow from the heart into the aorta, the major blood vessel that brings blood to the body.

A Bi Cuspid aortic valve is the MOST common congenital birth defect with 1-2 percent of all babies born with it, and twice as common in males.  In many cases, a bicuspid aortic valve will cause no problems. Though, complicating my diagnosis is the severe re-gurgitation.  

Regurgitation means the valve doesn't close properly, and blood can leak backward through it. This means the left ventricle must pump more blood than normal, and will gradually get bigger because of the extra workload. Aortic regurgitation can range from mild to severe. Some people may have no symptoms for years. But as the condition worsens, symptoms will appear. These can include
  • fatigue (especially during times of increased activity)
  • shortness of breath
  • edema (retention of fluid) in certain parts of the body such as the ankles
  • heart arrhythmias (abnormal heartbeats)
  • angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)
My symptoms have been Fatigue, some abnormal heart beats, with some shortness of breath.  However, these symptoms have not been bad enough to prompt surgery on my valve, nor have they hindered me substantially from daily activities.  The idea is to maximize the heart valve for as long as possible and to monitor my condition with 6 month check-up and annual echocardiograms. As a result I also have high blood pressure, and am on losartan to keep my pressure down.   I will need a valve replacement in my lifetime, but until further symptoms persist it will not be until that time that my doctors and I will have the discussion about replacing my valve. It could happen a year from now, or 20.  Nobody can say.  Just as I could drop dead of a heart attack tomorrow with no warning, but there are indicators we can keep an eye on to prevent CVD.
As far as living with HIV and Heart Disease there are some indicators to watch for, even if you don’t have HIV these are also good indicators to go by.  Anti-Retroviral Therapy has been shown in many to increase diabetes, and insulin resistance.  Also, many experience high cholesterol and triglycerides. These are CVD risk factors. In studies by the NIH it’s been shown that lipids tend to worsen with low CD4 counts and higher viral loads. Higher rates of CVD have been seen in those who take “non-nuke” based meds vs. PI (protease inhibitors). Although people with HIV have higher rates of CVD than the general population, the overall risk factor of CVD in HIV positive individuals is still very low.  And; experts agree on the benefits of taking HAART vs. not taking HAART when it comes to weighing the risk of CVD.
Healthy guidelines to help prevent CVD:
Abdominal Obesity: In Men; no more than a 40 inch size waist; in Women no greater than 35 inches
Fasting HDL Cholesterol:  In Men less than 40mg and in Women less than 50 mg
Fasting Triglycerides: no greater than 150 mg in Men and Women
Blood Pressure: No Greater than 130/85
Fasting Glucose: No greater than 110mg
Smoking, substance abuse, not exercising, an un-healthy diet, and all the things you have been told NOT to do over the years with regard to your heath can all lead to CVD.  Because we are living long now with HIV people are not dying from HIV, but rather from co-morbidities, sometimes related, most often not.  Twenty percent of all HIV deaths are CVD reflated.
In closing I just want to say to anyone out there with HIV and heart disease, or just CVD; keep going. It’s easy to fall into hopelessness and worry wondering when the “big event” will occur. We can’t control if and when our heart will give out, but we can take precautionary measures to keep our heart as healthy as possible, and be continually monitored by our doctors.  I understand what it means to have a heart condition and for so many years, and still today I worry about this “ticking time bomb” in my chest, but I refuse to let it get the best of me.
Hepatitis C did not bring me down, HIV will not bring me down, and my CVD will not either.
I’ve attached a couple of my echocardiogram reports for you to look at, to compare and to become familiar with.  I have also listed websites below where you can read further about heart health and HIV, and other general heart health resources.

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