Natural Cardiovascular Disease Cure and Treatment

The Big Heart Disease Lie

The Big Heart Disease Lie is a book written by doctors who are members of the International Truth In Medicine Council they are also the authors of The Big Diabetes Lie. In this book you will be getting over 500 pages of scientifically proven, doctor verified information that you will not find anywhere else, not even bookstores.If you have high blood pressure or cholesterol, fatigue, shortness of breath, irregular heartbeat, swollen feet or ankles, chest pain, fainting, diabetes, asthma or allergies, pain, fatigue, inflammation, any troubling health issue, or simply want to discover the most powerful health and anti-aging program, then you really need to read this book. The book is a step by step guide that contains techniques scientifically verified and proven by doctors to reverse the symptoms of heart disease, and normalize blood pressure and cholesterol levels. These techniques have been used successfully by tens of thousands of people all over the world, and allowed them to take health into their own hands, ending the need for drugs, hospitals, doctors' visits, expensive supplements or grueling workouts. Continue reading...

The Big Heart Disease Lie Summary


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48 Ischaemic Heart Disease Angina and Myocardial Infarction

IHD has a rising incidence1,2, with midwives increasingly likely to see women with angina or myocardial infarction. Smoking, obesity, diabetes mellitus, increasing maternal age and familial lipid disorders are responsible. Recent myocardial infarction Discuss genetic consequences of having a child with a hereditary genetic predisposition to premature ischaemic heart disease

Effect of HRT on cardiovascular risk

Diabetes is a major risk factor for coronary heart disease (CHD) in women and event rates increase substantially after menopause. Older individuals with diabetes are more prone to cardiovascular and peripheral vascular complications than This risk is greater in women than in men. Many observational studies have shown that HRT reduces mortality due to coronary heart disease (CHD) by c. 50 however, this has not been confirmed in RCT. Two long-term prospective randomized studies, the HERS63 and the WHI,64 suggested that HRT may actually increase the risk of coronary vascular disease. This was particularly true during the first year after the initiation of hormonal treatment. Therefore, HRT is not currently indicated for the primary or secondary prevention of CHD. However, it is important to note, that, among younger healthy post-menopausal women, aged 50-59 years at baseline, a tendency for reduced CHD was observed during a 7-year period of CEE only treatment.65 In diabetic women...

Heart Disease

Walker F 2006 Chap.5 Antenatal care of women with cardiac disease a cardiologist's perspective in Steer PJ, Gatzoulis M and Baker P (Eds) Heart Disease in Pregnancy. London RCOG Press 55-66 2. Wren C and O'Sullivan JJ 2001 Survival with congenital heart disease and need to follow up in adult life. Heart, 85 438-443 3. Vause S, Thorne S and Clarke B 2006 Chap.1 Preconceptual counselling for women with cardiac disease in Steer PJ, Gatzoulis M and Baker P (Eds) Heart Disease in Pregnancy. London RCOG Press 3-8 4. Stout K 2005 Pregnancy in women with congenital heart disease the importance of evaluation and counselling. Heart, 91 713714 7. Perloff J and Warnes C 2001 Challenges posed by adults with repaired congenital heart disease. Circulation, 103 2637 9. Siu SC and Colman J 2001 Heart disease in pregnancy. Heart, 710-715

Congenital Heart Disease

Congenital heart disease includes a number of birth defects of the heart, the blood ves sels that feed into it, or the vessels that carry blood out from it. The causes of most of these defects are unknown. Genetic factors play some role, and the risk of a child having a heart defect increases if a parent or sibling has one. In one large study, 12 percent of the cases of congenital heart malformations were related to a chromosomal defect such as Down syndrome (see Down Syndrome in this chapter), and 8 percent occurred in infants who had multiple congenital abnormalities (birth defects). Some children with congenital heart disease have an identifiable single gene defect, such as Marfan syndrome, a hereditary connective tissue disorder. Symptoms and Diagnosis Some children may show signs of a heart defect in the first few days after birth others may seem completely healthy until they are a few weeks old or until later in childhood. Generally, signs of significant heart disease in infants...

The White classification

Reading papers published by White only a year or two before the appearance of her classification so soon after is somewhat of a surprise. Although she had long recognized the importance of duration of diabetes as a risk factor for vascular disease, she did not particularly link it to pregnancy outcome and certainly not in a graded form, even shortly before 1949. In her 1946 chapter in the eighth edition of the book The Treatment of Diabetes Mellitus, edited by Joslin et al., she wrote about how quickly diabetes could cause vascular disease, noting that it was present in 70 of non-pregnant 20 year survivors of diabetes, i.e. not all patients with Type 1 diabetes lived 20 years.8 By vascular disease she meant both macro- and microvascular, e.g. coronary heart disease and retinopathy. However, she did not discuss the implications of this observation for pregnant women. Despite the generally poor prognosis it is notable that only one maternal death had occurred in 271 pregnancies between...

Cardiorespiratory System

Glioma Nasal

The proper circulatory pathways must also be established following birth in order to ensure adequate pulmonary blood flow. The normal increase in pulmonary blood flow after birth may be prevented by a failure of pulmonary vascular resistance to fall, as in persistent pulmonary hypertension of the newborn, or in congenital heart disease, where there is an obstruction of systemic venous blood flow into the lungs as occurs in pulmonary atresia. Furthermore, oxygen transport to the tissues may be inadequate because systemic arterial supply is reduced by myocardial failure, or by congenital heart lesions in which left ventricular output is impaired, as with severe aortic stenosis or aortic atresia. Figure 1.5. Differential cyanosis in an infant with congenital heart disease. Note the line of demarcation in the midabdomen showing the pink body proximally and the cyanosis distally (this infant had pink hands and blue feet). This occurs in infants with aortic obstruction (coarctation of the...

24 body weight changes after pregnancy

In a recent study of over 1,000 mother-child pairs investigators found that mothers with greater gestational weight gain had children with more adiposity at 3 years of age, measured by skin-fold thickness as well as by BMI 51 . This association was independent of parental BMI, maternal glucose tolerance, breastfeeding duration, fetal and infant growth, and child behaviors. Children of mothers who gained more weight also had somewhat higher systolic blood pressure, a cardiovascular risk factor related to adiposity even in young children. Noticeably, mothers with adequate gain, as recommended by the Institute of Medicine 1 , had a substantially high risk of having children who were overweight. This new evidence suggests that the current recommendations for gestational weight gain may need to be revised in this era of epidemic obesity.

Box 21 Priscilla Whites first classification

The White classification underwent several revisions. In her 1971 chapter in Joslin's Diabetes Mellitus, which was her last, class E, pelvic vascular calcification, was no longer used.6 This category had either been actively sought or incidentally diagnosed when X-ray pelvimetry was used. It was thought that pelvic or uterine arterial calcification caused feto-placental hypoxia and that this was important information. However, the recognition of the danger of X-rays to the fetus resulted in elimination of the category. Class G had been added some years before this was a rather vague class and included 'multiple failures in pregnancy.' Class R had been added, and women with both retinopathy and renal disease were placed in a combined class termed class FR. Class H, women with coronary heart disease, and class T, women with prior renal transplantation, had yet to be added.

Frances A BuLock Md Frcp

Frances graduated from Cambridge and Oxford, and trained in Congenital Heart Disease in Bristol, Birmingham and Liverpool before coming to Leicester in 1999. Her main clinical interests are in fetal and adult congenital heart disease, which fit remarkably well together. She is the Cardiology Associate Editor for Archives of Diseases in Childhood and has written extensively in the field of congenital and fetal heart disease. She is currently co-investigator for a large study into the genetics of Congenital Heart Disease funded by the British Heart Foundation.

Does Vascular Ring In Infants Cause Spit Up

Vascular Ring Infants

A lateral contrast radiograph of the chest in the same infant demonstrates die indentation of the esophagus by the obstructing vascular ring just below die thoracic inlet. A vascular ring is usually associated with a right-sided or double aortic arch. Usually a right aortic arch exists as an isolated anomaly but it may be associated with congenital heart disease. A double aortic arch which encircles die trachea and esophagus is the type of ring most likely to cause symptoms in early infancy. Figure 1.46. A lateral contrast radiograph of the chest in the same infant demonstrates die indentation of the esophagus by the obstructing vascular ring just below die thoracic inlet. A vascular ring is usually associated with a right-sided or double aortic arch. Usually a right aortic arch exists as an isolated anomaly but it may be associated with congenital heart disease. A double aortic arch which encircles die trachea and esophagus is the type of ring most likely to cause...

36exercise guidelines for healthy pregnancies

The exercise recommendations from the American College of Obstetricians and Gynecologists (ACOG) mirror those of the Center of Disease Control (CDC), and the American College of Sports Medicine (ACSM). The ACSM recommends moderate intensity exercise for 30 min or more on most days of the week as part of a healthy lifestyle in the nonpregnant population 4 . A moderate level of exertion for 30 min duration has been associated with significant health benefits decreasing risk of chronic diseases including coronary heart disease, hypertension, type 2 diabetes mellitus, and osteoporosis 33 . Women who are sedentary prior to pregnancy should gradually increase their duration of activity to 30 min. Those who are already fit should be advised that pregnancy is not the time to greatly enhance physical performance and that overall activity and fitness tend to decline during pregnancy. Pregnant women should exercise caution in increasing intensity, especially when an exercise session extends...

Nonpregnancy Treatment And Care

Low-dose aspirin will be prescribed for the prevention of ischaemic cardiovascular disease in those who are more at risk (ten-year cardiovascular disease risk of 20 ). This is rare in women under 50 years of age. Statins are recommended for women either who already have evidence of cardiovascular disease and hypertension or who have a ten-year risk of cardiovascular disease of 20 .

Explanation Of Conditions

Of children born with congenital heart disease, 85 now survive to adulthood1,4. There are a wide range of lesions. Isolated valve lesions are dealt with separately. Other cardiac abnormalities are associated with shunts, missing chambers + - abnormal connections. Mild conditions are outlined below, moderate and complex conditions in the next sections. Some conditions, especially atrial septal defect, may present or be detected for the first time in pregnancy. Most have previously been repaired but all require consideration and some require further management. Recurrence risks must also be addressed.

Nutrition in pregnancy

What a woman eats during pregnancy affects not only her own state of health but that of her baby as well. Optimum nutrition greatly increases the chances of having a healthy, trouble-free pregnancy. More importantly still, it can have a profound effect on the health of children for the rest of their lives, helping to prevent problems such as coronary artery disease and stroke, bronchitis, obesity and diabetes. What's more, the size, and possibly even the function, of a child's brain depends on its mother's nutrition during pregnancy (Delisle 2002, Godfrey & Barker 2001, Harding 2003, Kind et al 2006).

533 Preeclampsia and Gestational Diabetes

Frequently, GDM and preeclampsia go hand in hand. Several studies suggest that obesity may be at the metabolic core of these conditions. For example, regardless of treatment type or degree of glucose control, Yogev et al. 34 reported that the risk for developing preeclampsia in women with GDM was significantly greater in obese (10.8 ) versus normal weight women (8.2 ). Notably, in this study the risk of preeclampsia escalated in obese women with poor glucose control (14.9 ), suggesting that tighter glucose control in women with GDM may decrease risk. Barden et al. 35 found that late-onset preeclampsia in women with GDM was more likely to develop in women who were not only obese but had preexisting hypertension, more severe insulin resistance, subclinical inflammation, and a family history of diabetes and hypertension. Similar to the metabolic syndrome in the nonpregnant state, this clustering of risk factors suggests that obese women with GDM and preeclampsia may be at greater risk...

Fetal Risk Summary

Alteplase (tissue plasminogen activator t-PA rt-PA), an enzyme formed by recombinant DNA technology, is a thrombolytic agent used for the treatment of acute conditions such as myocardial infarction, pulmonary embolism, and ischemic stroke. The agent is a glycoprotein composed of 527 amino acids (1). No maternal or fetal toxicity was observed in rats and rabbits dosed with 1 mg kg (approximately 0.65 times the human dose for acute myocardial infarction) during organogenesis (1). An embryocidal effect was noted in rabbits administered an IV dose of 3 mg kg (about 2 times the human dose for acute myocardial infarction) (1). Shepard cited two studies in which no teratogenicity or other toxicity was observed in the offspring of pregnant rats and rabbits administered tissue plasminogen activator during organogenesis (2). In a 1997 case report, a 30-year-old woman at 21 weeks' gestation had an acute myocardial infarction that was treated with a total dose of 100 mg alteplase given IV for 90...

Explanation Of Condition

Ischaemic heart disease is due to inadequate myocardial blood flow related to coronary arterial narrowing. This may be temporary, angina pectoris (angina), or permanent, myocardial infarction (MI). It manifests as chest pain or discomfort, and may radiate to the left arm or jaw. It is accompanied by feelings of constriction suffocation. Angina is generally precipitated by exertion or stress, but more severe cases may present at rest. The pain of myocardial infarction is generally more severe and may be accompanied by sweating, nausea and a feeling of impending death or collapse. Coronary artery disease is due to gradual and incomplete occlusion of the coronary vessels by fatty deposits, (athero-matous plaques) accumulating in the endothelial cells lining the arterial walls. Symptoms occur when myocardial oxygen demands exceed possible supply.

Edwards G 2004 Adverse Outcomes in Maternity Care Implications for Practice Applying the Recommendations of the

Nelson-Piercy, C. (2005) Heart disease. In Handbook of Obstetric Medicine, 2nd Edn. London Martin Dunitz. Steer, P.J., Gatzoulis, M.A. and Baker, P. (Eds) (2006) Heart Disease and Pregnancy. London RCOG Press. Thorne, S., Nelson-Piercy, C., MacGregor, A. et al. (2006) Pregnancy and contraception in heart disease and pulmonary arterial hypertension. Journal of Family Planning and Reproductive Health Care, 32(2) 75-81.

Micrognathia Infant Pictures

Baby Born With Single Central Incisor

Sucking blisters (sucking calluses) on the lips are present in the newborn infant. From birth, the lips show a sharp line of demarcation where the skin meets the mucosa. The mucosa is slightly elevated, moist, glistening deep red or purple and ends abruptly with the skin which forms one-third of the visible lip. The term sucking calluses is a misnomer because they are not callosities due to pressure or friction. They have been seen at their most florid in infants who have never sucked (for example those with congenital heart disease). Efficient sucking requires a complete seal of the lips around the nipple, hence the development of these calluses.

Cornelia De Lange Syndrome

Cornelia Lange Hand

Radial dysplasia may be associated with pancytopenia as in Fanconi's syndrome but may also be associated with congenital heart disease and abnormalities of other parts of the skeleton. Radial dysplasia may be associated with pancytopenia as in Fanconi's syndrome but may also be associated with congenital heart disease and abnormalities of other parts of the skeleton.

Change from physiology to pathophysiology

More recent data have implicated adypocyte placental secreted factors such as cytokines, in particular tumor necrosis factor alfa (TNF-a) and leptin as active candidates in the alteration of insulin sensitivity in pregnancy. Adiponectin belongs to the family of adipocytokines which also includes leptin, TNF-a, resistin, interleukin-6 (IL-6), and others.8,9 Adiponectin is associated with obesity, diabetes, cardiovascular disease and dyslipidemia.10-12 From a metabolic standpoint, adiponectin produces an insulin-sensitizing effect on skeletal muscle, adipose tissue a and liver. It has been demonstrated that the level of adiponectins in class A2 and B gestational diabetes are associated with suppressed levels of adiponectins, similar to that found in other insulin-resistant states (Type 2 diabetes and obesity.)

Toxic chemicals metals and minerals

The adverse effects of ingestion and inhalation of even low levels of toxic chemicals, metals and minerals can lead to a huge range of conditions, including cardiovascular disease, renal and metabolic disease, immune dysfunction, lethargy, depression, cancer, recurrent infections, behavioural and learning difficulties and developmental abnormalities. Some specific effects are as follows.

Ebstein Anomaly In Newborns

Histiocytosis Skin

In isolated dextrocardia, the apex of the heart is in the right side of the chest. Situs solitus is the rotation of viscera embry-ologically so that the heart lies in the left hemithorax and the abdominal organs are in their proper relationships (stomach on the left side and liver on the right). Situs inversus results when the heart and stomach are on the right and the liver is on the left. Infants with isolated dextrocardia have an increased incidence of congenital heart disease. Figure 1.176. This infant presented with marked cardiomegaly and congestive heart failure from an arteriovenous malformation of the liver. In addition to congenital heart disease or myocarditis, the diagnosis of a large arteriovenous malformation should be included in die differential diagnosis of cardiomegaly. Clinical examination should include a careful auscultation for bruits over the skull, liver, and lungs and examination of the skin for shunts in large hemangiomas. Figure 1.176. This...

Jane Scullion BAHons RGN MSc

Not all mothers start pregnancy in the best of health, and others develop problems as they go along. The latest Confidential Enquiry into Maternal Deaths Report for 2003-2005, Saving Mothers' Lives, shows that more of our mothers died from pre-existing, or new, medical conditions aggravated by pregnancy than from the big obstetric killers of the past such as haemorrhage, sepsis and pre-eclampsia. These so-called 'indirect' maternal deaths have outnumbered those from causes directly related to pregnancy for more than 10 years. And each death is just the tip of the iceberg of severe morbidity and complications. In the last Saving Mothers' Lives report more women died from cardiac disease than from any other cause, including the leading 'directly' associated cause thrombo-embolism, and deaths from acquired heart disease brought on by unhealthy lifestyles and obesity are increasing at an alarming rate. These findings show that whilst the lessons for the management of common obstetric...

What are panic attacks

At some point in their life most people will have a panic attack. You may start to shake or tremble, feel your heart racing, feel short of breath or start to hyperventilate. You are likely to interpret these as signs of some imminent danger, 'I'm having a heart attack' or 'I'm going mad' and these panic thoughts will cause you to leave the situation run from the supermarket or leave the meeting at work. This extremely unpleasant experience will usually lead you to avoid the feared event or situation, 'I'll never go in a lift again'. Unfortunately the next time you approach a similar situation the panic will start again.

Pregestational diabetes

Diabetic retinopathy, nephropathy, autonomic neuropathy (especially gastroparesis), and coronary artery disease (CAD) can be affected by or can affect the outcome of pregnancy. Thus, physical examination should give particular attention to blood pressure measurement, including testing for orthostatic changes, dilated retinal examination by an ophthalmologist or other eye specialist knowledgeable about diabetic eye disease, and cardiovascular examination for evidence of cardiac or peripheral vascular disease. If found, patients should have screening tests for CAD before attempting pregnancy, to ensure they can tolerate the increased cardiac demands and a neurological examination, including examination for signs of autonomic neuropathy.

Maternal And Fetal Determinants Of Adult Disease

The notion that events occurring during the time of gestation might predispose an individual to chronic diseases later in life has recently been supported by epidemiologic data (7.1,7.2,7.3 and 74). Observations made in the United Kingdom have led to the hypothesis that adverse nutritional experiences in utero have a powerful influence on the development of degenerative diseases in adulthood. Poor fetal growth appears to be a strong predictor of hypertension, diabetes, hyperlipidemia, alteration in clotting factors, syndrome X (the combination of noninsulin-dependent diabetes, hypertension, and hyperlipidemia), and mortality from cardiovascular disease and chronic obstructive airway disease. The theory of fetal origins of adult disease proposes that early defects in the development, structure, and function of organs lead to programmed susceptibility, which interacts with later diet and environmental stresses to cause overt disease many decades after the original insult.

Role of fats in GDM therapy

Conversely, meals consumed containing saturated fat, had a shorter duration of elevated glucose levels, making them preferential with regard to glycemic control of postprandial glucose levels. Furthermore, lower postprandial durations decrease the risk of macrosomia and the need for increased insulin doses.40 Advocating saturated fats over mono-unsaturated fats is understandably controversial due to the correlation that has been made with saturated fats and heart disease in nonpregnant individuals. Further studies are needed to answer whether eating a higher proportion of saturated fat during medical dietary therapy for GDM at approximately gestation weeks 24-40 is a significant time period to have adverse long-term effects on the mother versus the benefit of controlling postprandial glucose level duration, which decreases the risk of fetal complication.

Breast Feeding Summary

Offspring of women with PKU often are afflicted with mental retardation, microcephaly, congenital heart disease, and low birth weight (16). Pregnancies of these women are also prone to spontaneously abort (16). In one study, maternal phenylalanine plasma levels above 120 pmol dL (classic PKU) were consistently associated with microcephaly, although true mental retardation was observed only when plasma levels exceeded 110 pmol dL (16). However, research has not excluded the possibility that lower concentrations may be associated with less severe reductions in intelligence (16,17 and 18). For example, in the study cited above, maternal phenylalanine levels below 60 pmol dL (mild hyperphenylalaninemia without urine phenylketones) were associated with normal intelligence in the infants (16). When maternal levels were in the range of 60-100 pmol dL (atypical phenylketonuria), most of the infants also had normal intelligence, but their mean IQ was lower than that of the infants of mothers...

2146 Calcium antagonists

Compared with other tocolytics, such as -sympathomimetics (Papatsonis 2000, 1997, El-Sayed 1998. Jannet 1997). Myocardial infarction and serious dyspnea with lung edema have been reported during tocolysis with calcium antagonists (Oei 2006, van Geijn 2005). Combined administration of calcium antagonists and magnesium may seriously potentiate the activity of magnesium, inducing hypotension and neuromuscular blockadc, and thus endangering the mother and fetus.

The dyslipidemia component

Several other metabolic disturbances, such as elevated levels of triglycerides, decreased levels of high-density lipoproteins (HDL), high cholesterol level, glucose intolerance, and hyperuricemia, have also been related to hyperinsulinemia.56 The metabolic consequences of these disturbances include changes in the lipid profile resulting in atherosclerosis, increased deposition of body fat, and proliferation of vascular smooth muscle cells, which place the hypertensive, hyperinsu-linemic individual at increased risk of cardiac complications and stroke.57 Studies of the evolution of the clinical and biological disturbances in women with a polycystic ovary (PCO) support the view that insulin resistance, dyslipidemia, and hypertension are all manifestations of a single syndrome. Often obese, these women have hyperinsulinemia which disrupts sex hormone production,58 resulting in androgenization and clinical manifestations of hirsutism and infertility. During pregnancy, they have more...

Clinical consequences of insulin resistance

Insulin resistance impairs glucose tolerance while promoting dyslipidemia, obesity, hypertension, and atherosclerosis. Its effects on salt handling by the kidneys predisposes the individual to renal dysfunction. Obesity, glucose intolerance, hyperinsu-linemia, hypertension, and dyslipidemia represent cumulative risk factors that generate an escalating cycle of vascular compromise and collapse. Patients with three or more of these risk factors have an increased incidence of stroke, nephropathy, ischemic heart disease, and peripheral vascular disease.82 Long-term diabetic complications are the most common cause of blindness, renal failure, and limb amputation in the United States today. Meticulous glycemic control has been shown to decrease the incidence of eye disease among diabetic patients. Antihypertensive therapy, specifically with angiotensin converting enzyme inhibitors (ACE-I), is effective in reducing the rate of progression of diabetic kidney disease. To prevent the peripheral...

Pathophysiology and treatment of diabetic nephropathy

Combination with other antihypertensive has improved the poor prognosis considerably. Progression of manifest diabetic nephropathy can be slowed down by strict antihypertensive treatment with angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers as first line drugs. It is often necessary to combine the treatment with diuretics, beta-blockers and or calcium antagonists in order to control the blood pressure and the albumin excretion sufficiently. Strict antihypertensive treament in patients with diabetic nephropathy results in preservation of kidney function documented by a reduction in the decline in glomerular filtration rate to less than one-third of the decline in untreated patients.4 Inhibition of the rennin angiotensin system with i.e. ACE inhibitors already at the stage of microalbuminuria prior to development of hypertension is also demonstrated effect-full in delaying the progression of the disease and might even reduce the albumin excretion to...

1472 Blue and Black Cohosh

Another herbal preparation that has been shown clinically to be associated with detrimental effects in pregnant women is blue cohosh, which has long been recommended by midwives to induce labor 134 . Use of blue cohosh, however, may be associated with neonatal congestive heart failure and ischemic infarct. Jones and Lawson in 1998 reported a case study describing a woman who had taken blue cohosh to promote uterine contractions 135 . This 36-year-old woman was otherwise healthy aside from being euthyroid, and was advised to take 1 tablet of blue cohosh beginning 1 month before delivery by her midwife however, she elected to take 3 tablets per day. No other naturo-pathic remedies were used. After a precipitous labor (1 h), a normal weight (3.66 kg) baby was delivered. However, within 20 min, the infant required intubation and mechanical ventilatory support and was later diagnosed as having acute anterolateral myocardial infarction. Of course, it is impossible to draw a true...

3I have high cholesterol level during pregnancy Is this a problem

There are no conclusive studies that show harmful effects of high cholesterol levels to the mother or the developing baby. However, as a high cholesterol level is a risk factor for heart disease and stroke in the long term, we advise you to look into changing your lifestyle if your cholesterol level remains high after delivery. Consider a diet low in cholesterol, consisting of bread, fruits, vegetables and small amounts of lean meat, fish and olive oil. Avoid smoking. See your doctor regularly to check your cholesterol level.

Cardiovascular abnormalities

Animal studies have shown that exposure to diabetes in utero can induce cardiovascular dysfunction in adult off-spring.54 Few human studies have examined cardiovascular risk factors in offspring of diabetic pregnancies. By 10-14 years, offspring of diabetic pregnancies enrolled in the Diabetes in Pregnancy follow-up study in Chicago had significantly higher systolic and mean arterial blood pressure than offspring of nondiabetic pregnancies.12 Manderson et al. reported higher concentrations of markers of endothelial dysfunction (ICAM-1, VCAM-1, E-selectin), as well as cho-lesterol-to-HDL ratio among offspring of mothers with Type 1 diabetes than among offspring of nondiabetic pregnancies, independent of current body mass index.55 Recently, the Pima Indian investigators have shown that, independent of adiposity, 7- to 11-year-old offspring exposed to maternal diabetes during pregnancy have significantly higher systolic blood pressure than offspring of mothers who did not develop Type 2...

1st Branchial Arch Syndrome

Types Branchial Cleft Skin Tag

Goldenhar's syndrome (facio-auriculovertebral spectrum oculoauriculoverte-bral dysplasia) is associated with abnormalities of the first and second branchial arches. This infant shows the antimongoloid slant, bilateral macrostomia, and skin tags. Over 90 of these infants have ear abnormalities (small or unusually shaped ears, preauricular tags, and pits). They may have abnormalities of the cervical vertebrae, particularly hemivertebra, coloboma of the upper eyelids, and epibulbar dermoids. Congenital heart disease may be present in one-third of these infants. More than 80 of the infants have normal intelligence.

Lobster Claw Syndrome

Downward Slanting Palpebral Fissures

DiGeorge malformation complex. This is a primary defect of the fourth branchial arch and the third and fourth pharyngeal pouch. In this infant note the lateral displacement of the inner canthi (hypertelorism), the anteverted nares, and short philtrum with a cupid-bow mouth. This infant also had micrognathia, microcephaly, congenital heart disease (atrial septal defect and ventricular septal defect) and hypocalcemia. Note the congenital facial palsy which is not part of the complex. The EEG was grossly abnormal and the T cell count was decreased.

Seth Guller Yuehong Ma and Men Jean Lee Abstract

Although the etiology of intrauterine growth restriction (IUGR) and preeclampsia (PE) remains unclear, most investigators attribute the initial insult to poor utero-placental perfusion due to defective trophoblast invasion that ultimately compromises fetal well-being.1 3 The resultant hypoxia curtails the remodeling of uterine vessels by invasive cytotrophoblasts in the second trimester.1,2 Our results suggest that mediators of fetal stress i.e., glucocorticoids (GC) may in fact alter placental gene expression and contribute to the destruction of the placental villous network in pregnancies with IUGR PE. We will present a molecular model through which GC, induced in response to fetal stress, promotes the placental villous damage observed in pregnancies associated with IUGR PE. This model incorporates the roles of trophoblast plasminogen activator inhibitor (PAI)-l, mesenchymal extracellular matrix (ECM) proteins, and their regulation by transforming growth factor (TGF)-(3. We will...

184 exercise and lactation

Physical activity at any stage of the life cycle is associated with a decreased prevalence of cardiovascular disease, colon cancer, type 2 diabetes, and overweight, and it decreases mortality rates from all causes. Specifically in lactation, regular activity improves cardiovascular fitness, plasma lipid levels, and insulin response 14 . Regular activity also has the potential to benefit psychosocial well-being in lactation, such as improving self-esteem and reducing depression and anxiety. Other potential benefits include promotion of body weight regulation and optimizing bone health. Engagement in regular activity by the mother may also encourage the same in her offspring, promoting a healthy lifestyle and body weight management for the entire family.

Techniques Used In Prenatal Diagnosis

Fetal echocardiography has been successful in diagnosing congenital heart disease and dysrhythmias (55). Both M-mode and real-time echocardiograms may be necessary for adequate interpretation of cardiac anatomy (56). Serial echocardiography is performed at mid-gestation on fetuses with a family history of congenital heart disease as well as for the evaluation of fetal ascites and dysrhythmias appreciated by auscultation of fetal heart tones. The association of maternal nongestational diabetes and congenital heart disease makes this group of high-risk patients candidates for fetal echocardiography. Echocardiography also should be performed as part of a complete diagnostic evaluation of fetuses found to have a major structural anomaly, such as an omphalocele. The finding of additional malformations may alert physicians to the possibility of a chromosomal anomaly and optimize intrapartum decision making. The rapid development of high-resolution ultrasonography has made other forms of...

Effect of HRT on carbohydrate metabolism

HRT reportedly contributes to the control of glucose levels. The Women Health Initiative (WHI) study, have shown that healthy postmenopausal women who took combined conjugated equine estrogen (CEE) medroxyprogesterone acetate (MPA)49 or CEE alone,50 develop diabetes at a lower rate than women who did not take hormones. Hazard ratio was 0.79 (95 CI 0.67-0.93, P 0.004) for the combined treatment and 0.88 (95 CI 0.77-1.01, P 0.072) in the only estrogen treated women. These data suggests that combined therapy with estrogen and progestin reduces the incidence of diabetes, possibly mediated by a decrease in insulin resistance unrelated to body size.49 Postmenopausal therapy with estrogen alone may reduce the incidence of treated diabetes. However, the effect was smaller than that seen with estrogen plus progestin.50 Similar results were also obtained in several other well controlled studies. In the Heart and Estrogen progestin Replacement (HERS) study data,51 a randomized double blind...

Effect of type and mode of delivery of HRT

Adding continuous progestins to oral estrogens, mostly CEE MPA57,89 or E2 NETA90-92 usually resulted in a reduction of total cholesterol and LDL cholesterol. Though, HDL cholesterol remained unchanged instead of increasing as in estrogen only treatment. No significant change was observed for triglycerides, fasting glucose, inflammatory biomarkers, and blood pressure measurements. Continuous combined E2 NETA formulations reduced total cholesterol, triglycerides and coagulation factors II, VIII and XI, while keeping LDL and HDL cholesterol, fasting glucose, and plasminogen activity unchanged.92,93 It was therefore hypothesized that the impact of combined oral E2 NETA treatment on cardiovascular risk factors in diabetic women is probably neutral.91

Hypertensive Disorders

Pitkin RM, Perloff JK, Kos BJ and Beall MH 1990 Pregnancy and congenital heart disease. Annals of Internal Medicine, 112 445454 13. Thorne SA 2004 Pregnancy in heart disease. Heart, 90 450-456 16. Thorne S 2006 Chap.13 Mitral and aortic stenosis in Steer PJ, Gatzoulis M and Baker P (Eds) Heart Disease in Pregnancy. London RCOG Press 183-190 17. Khairy P, Quyang DW and Fernandes S 2006 Pregnancy outcomes in women with congenital heart disease. Circulation, 113 1564-1571 18. Gelson E, Johnson M, Gatzoulis M and Uebing A 2007 Cardiac disease in pregnancy. Part 1 congenital heart disease. The Obstetrician and Gynaecologist, 9 15-20 4.2 Moderate Structural Heart Disease 1. Swan L 2006 Aortopathies including Marfan's syndrome and coarctation in Steer PJ, Gatzoulis M and Baker P (Eds) Heart Disease in Pregnancy. London RCOG Press 2. Warnes C 2005 The Adult with Congenital Heart Disease - Born to be Bad Journal of the American College of Cardiology, 46 1-8 5. Raja SG and Basu D 2005...

Rabin Medical Center Petah Tiqva Israel

Babies of women with diabetes are nearly five times more likely to be stillborn are almost three times more likely to die in the first three months and twice as many are born with major congenital malformations. The incidence is high - somewhere between 3 and 7 per cent of all pregnant women in the USA have diabetes - and rising the condition is often complicated by other risk-factors such as obesity and heart disease.

Baby With Low Set Ears

Micrognathia Syndrome

Severe intrauterine growth retardation (birthweight 1590 g at term) was noted in this infant with the typical findings of trisomy 18 (Edwards' syndrome). Note the low-set, poorly developed ears, micrognathia, and the typical overlapping position of the fingers. In trisomy 18 there is a preponderance of three females to one male infant. Other findings in trisomy 18 include prominent occiput, microcephaly, short sternum, congenital heart disease, abnormal genitalia, and renal anomalies (horseshoe kidney, polycystic kidneys, etc.). If the infant survives, there is severe mental retardation.

Nail Diseases And Disorders

Hypoplastic Toenails

There is marked webbing of the neck in this infant with Turner's syndrome. Note the low posterior hairline. Compare this with the webbing of the neck and high hairline in trisomy 21 (see Figure 4.47). The infant also had congenital heart disease (coarctation of the aorta). Figure 4.65. There is marked webbing of the neck in this infant with Turner's syndrome. Note the low posterior hairline. Compare this with the webbing of the neck and high hairline in trisomy 21 (see Figure 4.47). The infant also had congenital heart disease (coarctation of the aorta).

Transposition of the Great Vessels

Atrio-ventricular valve regurgitation, because the morphologic right ventricle and tricuspid valve are in the systemic circulation10. They are prone to atrial arrhythmias both tachycardias and sinus node disease can be life threatening and need drugs or pacemaker. Baffle obstruction can occur, and can exacerbate problems from arrhythmias. Following the arterial switch operation there is a potential for coronary artery ostial stenosis and early coronary artery disease. Many patients have branch pulmonary artery stenosis and some have required pulmonary or aortic valve replacement.

54 weight gain recommendations and consequences of noncompliance

Excessive gestational weight gain may lead to child adiposity. In a recent prospective study of over 1,000 mother-child pairs, mothers with greater gestational weight gain had children with greater BMI and skin fold thicknesses (triceps and subscapular) at 3 years of age 58 . This association was independent of parental BMI, maternal glucose intolerance, breastfeeding duration, gestational age at delivery, and birth weight. Children of mothers who gained more weight also had higher systolic blood pressure, a cardiovascular risk factor that has been shown to track into adulthood.

Cut down on fat and fatty foods

Most of us eat far more fat than we need. Fat is very high in calories and too much can cause excess weight gain and increase the risk of heart disease and it can contribute to being overweight. Avoid fried foods, trim the fat off meat, use spreads sparingly and go easy on foods like pastry, chocolate and chips which contain a lot of fat. Choose low-fat varieties of dairy products, for example semi-skimmed or skimmed milk, low-fat yoghurt and half-fat hard cheese.

285 Nifedipine and other calcium antagonists

Many studies have demonstrated the tocolytic effect of nifedipine. Prenatally exposed children who were followed to the ages of 5-12 months were reported to develop normally (Ray 1995). This was confirmed by another study that analyzed the long-term follow-up (until age of 9-12 years) of in utero nifedipine- or ritodrine-exposed children (Houtzager 2006). There is one case report of a myocardial infarction following the tocolytic use of nifedipine subsequent to the administration of ritodrine, but no clear causal relationship has been established (Oei 1999). Recently, the occurrence of acute pulmonary edema during nicardipine therapy for premature labor was reported in five complicated pregnancies one triplet pregnancy associated with gestational diabetes, two twin pregnancies, one with insulin-dependent diabetes, and one with a history of mitral regurgitation, No fetal-related morbidity was seen (Vaast

Ellis Van Creveld Syndrome

Ellis Van Creveld Syndrome

A radiograph of die chest of an infant with Ellis-van Creveld syndrome. Note the long narrow chest and short ribs widi cardiac enlargement. Congenital heart disease is present in 50 to 60 of cases of Ellis-van Creveld syndrome. This infant had a large atrial septal defect, the most common lesion seen in Ellis-van Creveld syndrome.

Bronchiolitis Respiratory Syncytial Virus

Treatment Most cases are mild and can be treated at home. Cases in very young infants or those with other medical problems such as prematurity, lung disease, or heart disease may require hospitalization for oxygen, intravenous fluids, other treatment, and monitoring. Antibiotics are not helpful unless there is a secondary infection caused by bacteria.

European Diab Care quality network

Network Information Sheet

The pertinent analysis provides the performance of care in both aspects of process and outcomes (intermediate and final). Demographic data (age, sex, etc.) are required for a number of purposes. True patient outcomes include the burden of the medical end points of the St Vincent Declaration (such as amputation, blindness, etc.). Symptoms of diabetes-related problems (e.g. painful neuropathy, angina pectoris, etc.) are also recorded. Specific outcomes regarding pregnancies are also included. For the measurement of quality of life, the DiabCare data sets only include information related to duration of hospital admissions and the number of days without the ability to perform normal activities. Assessment of diabetic complications (retinopathy, nephropathy, neuropathy), cardiovascular risk factors, pharmacological treatment and metabolic outcomes glycated hemoglobin (HbAlc), lipid profile were considered essential.4 The computer database (Figure 53.2)...

Intrauterine factors in metabolic syndrome The fetal origin of adult disease

Barker6 pioneered the idea that the epidemic of coronary heart disease in Western countries in the twentieth century, which paradoxically coincided with improved standards of living and nutrition, originated in fetal life. He postulated that the low birthweight and impaired fetal growth which were characteristic of deprived regions in the 1900s may have predisposed the survivors to heart disease in later life. Support was provided by studies conducted in Hertfordshire, England, showing a higher rate of cardiovascular mortality in men who had been small at birth and at 1 year of age.6 Thereafter, at least seven retrospective cohort studies reported an association of low birthweight with high risk of later ischemic heart disease7-12 and stroke,13,14 or impaired glucose tolerance and DM.15,16 It was also found to be associated with high blood pressure (BP) in childhood17,18 and adult life.19 The evidence was strongest for blood pressure and glucose tolerance,20 which could be measured...

Doppler velocimetry of fetal cardiac and venous areas

In newborns of diabetic mothers, the rate can remain smaller than one the lack of evidence of peripheral alterations (afterload) and of flow volume towards the right sections of heart may suggest an alteration of diastolic function and of ventricular compliance. These hemodynamic aspects may be responsible for the more frequent observation of transient tachypnea, pulmonary edema and cardiovascular disease in the adult (Baker's hypothesis).50

Metabolic syndrome When hypertension and diabetes meet

The striking increase in the prevalence of obesity, diabetes mellitus (DM), hypertension, and cardiovascular disease in the last two decades1 has led to the concept of the metabolic syndrome.2 Also termed syndrome X,3 insulin resistance syndrome,4 and the deadly quartet,5 metabolic syndrome is characterized by a constellation of well-documented risk factors for cardiovascular disease, namely, glucose intolerance, insulin resistance, central obesity, dyslipidemia, and hypertension, that co-occur in individuals at a higher rate than expected by chance. Extensive research has still not completely elucidated the precise cause of the syndrome, although some strong positions have been taken. Nevertheless, it is widely recognized that a combination of genetic predisposition and environmental factors, particularly those associated with socioeconomic status is involved. The environmental factors include both postnatal life habits and nutrition, and - no less important - intrauterine...

Microalbuminuria diabetes and hypertension in pregnancy

The role of microalbuminuria in DM has been established over the last 20 years. At the early stage of DM, when glucose metabolism is not controlled, the increase in glomerular plasma flow and intraglomerular pressure is probably responsible for the increased protein excretion.144 Some authors believe these hemodynamic alterations are major determinants of both the initiation and progression of diabetic nephropathy.145 Several studies have reported that patients with Type 1146 or Type 2 DM147 who have above-normal urinary albumin excretion rates are more likely to acquire diabetic nephropathy, eventually progressing to renal failure.148 Microalbuminuria is also associated with an excess of known and potential cardiovascular risk factors, and it is a marker of established cardiovascular disease in both hypertensive149 and nonhypertensive150 individuals. Its role in diabetic and hypertensive pregnancy is less clear,151 but becoming increasingly recognized. One study found that the...

121 Macronutrients 1211 Energy

The goal is to avoid both ends of the spectrum, both excessive energy intake as well as inadequate energy intake. Overnutrition and excess weight gain in pregnancy impart risk of gestational diabetes, macrosomia, delivery complications such as shoulder dys-tocia, cesarean delivery and post operative problems, difficulty initiating breastfeeding, and risk of subsequent maternal and child obesity 8-10 . Conversely, undernutrition and inadequate weight gain during pregnancy can lead to impaired intrauterine growth and consequent low birth weight of the newborn. In addition to complications at birth, intrauterine growth retardation has been associated with metabolic abnormalities in adulthood, such as hyperlipidemia, hypertension, cardiovascular disease, glucose intolerance, and type 2 diabetes 10, 11 .

Womens rights and the antenatal environment

As many letters reveal, these women were acutely aware of the link between poor nutrition in pregnancy and the later ill-health of their children. One writes, for example 'The past struggle left its mark on the physique of my children. One has since died of heart disease, aged ten years another of phthisis, sixteen years my youngest has swollen glands, and not at all robust' (pp. 37-8). Repeatedly, women comment on the ill-effects of poor nutrition in pregnancy, fully aware that, in Ballantyne's phrase, their bodies constituted their child's environment. Many had to work during their pregnancy, which, they realised, further undermined their health. One woman described a typical situation

Infectious Conditions

Forsen T, Eriksson JG, Toumilehto J, et al. 1997 Mother's weight in pregnancy and coronary heart disease in a cohort of Finnish men follow up study. British Medical Journal, 315(7112) 837-840 13. Levy H, Guldberg P, Guttlerr F, et al. 2001 Congenital heart disease in maternal PKU report from the maternal phenylketonuria collaborative study. Pediatric Research, 49(5) 636-642

Diab Card as an instrument for quality assurance

The results of the DCCT showed that in Type 1 DM strict glycemic control resulted in a significant reduction in the rate of onset and progression of retinopathy, nephropathy and neu-ropathy.17 In the United Kingdom Prospective Diabetes Study (UKPDS), the difference of 0.9 in HbAlc between the intensively treated group and the control group was associated with a 25 reduction in risk of microvascular end points 18 intensive blood glucose control did not reduce the risk of myocardial infarction or stroke, but the control of hypertension was very important in this respect.19

1351 Low Carbohydrate Diets

Normal hydration is important for body functions and physical performance and concerns regarding the impact of excessive nitrogen secretion on renal function remain an issue for healthy men and nonpregnant women 34, 35 . Although various studies have been published to document potential benefits of the Atkins Diet to reducing risk factors for cardiovascular disease 36 , there remains absolutely no premise for induction of ketosis during pregnancy. Even Dr. Atkins himself warned that his diet is not an appropriate eating plan for pregnancy 28 .


Jason trained in maternal medicine in Sheffield, New Zealand and Leicester before working as a consultant in Leicester for five years. He is now lead consultant for maternal medicine in Newcastle-upon-Tyne and has established maternal medicine training programmes for obstetricians in both cities. His current research interests are hypertension in pregnancy and renal and cardiovascular disease in pregnancy and he has published extensively in these fields as well as producing national guidelines for the management of pre-eclampsia and renal disease. He was recently made president of the UK's Macdonald Obstetric Medicine Society.

S Elizabeth Robson

4.1 Mild Structural Heart Disease 4.2 Moderate Structural Heart Disease 4.3 Severe Structural Heart Disease 4.4 Valvular Heart Disease 4.5 Marfan's Syndrome 4.6 Functional Heart Disease Cardiomyopathy 4.7 Functional Heart Disease Arrhythmias 4.8 Ischaemic Heart Disease Angina and Myocardial Infarction 4.9 Pulmonary Hypertension and Eisenmenger's


Unless you've been living on Mars for the past ten years, you no doubt are aware that smoking is a health risk for you. When you smoke, you run the risk of developing lung cancer, emphysema, and heart disease, among other illnesses. During pregnancy, however, smoking poses risks to your baby as well.

Women at risk

Certain groups of pregnant women may find their diet particularly inadequate, and their babies therefore at risk of prematurity and low birthweight (Barker 1998). (Babies whose weight at birth is below 3.13 kg (6.9 lb) have been found to be at increased risk of cardiovascular disease in later life.) Certain congenital defects and high perinatal mortality are also linked to poor nutritional status. Women at risk include those who


Pulmonary valve problems isolated mild stenosis is common and of little consequence but more severe stenosis may be revealed during pregnancy by increased cardiac output. Pulmonary regurgitation is mainly post-intervention. Residual stenosis and regurgitation are common as part of more complex congenital heart disease. Complex cyanotic congenital heart diseases Valvular heart disease and cardiac shunts


Whether additional defects are exerted further downstream from IRS-1 remains to be investigated. GDM is a predictor of diabetes (mainly Type 2) later in life. The cumulative incidence of Type 2 diabetes is 50 at 5 years. GDM is also a predictor, or even an early manifestation, of the metabolic (insulin resistance) syndrome. GDM is a cardiovascular risk factor and affected patients should be screened to prevent late complications.

Scaphoid Abdomen

Scaphoid Abdomen Diaphragmatic

This infant had minimal respiratory distress, but on physical examination was noted to have asymmetry of the chest. A chest radiograph showed a marked difference in the width of the intercostal spaces between the left and right side of the chest. The right lung is opacified and the right hemithorax is small the left lung is hyperexpanded. Hypogenetic lung syndrome (alveolar hypoplasia) is a variant of pulmonary agenesis. Congenital heart disease is apparently more common with right than with left lung hypogenesis. In this infant there was dextrocardia, pulmonary artery hypopla-sia, and anomalous systemic arterial supply to the right lower lobe with anomalous venous drainage.

Very Small Penis

Brachydactyly Birth Defect

This infant with chondroectodermal dysplasia (Ellis-van Creveld syndrome) presents with the typical short distal extremities, short ribs, polydactyly, nail hypoplasia, neonatal teeth, and congenital heart disease. Although atrial septal defect is most common, this infant had a hypoplastic left heart. Note that the extremities are plump and markedly and progressively shortened distally, that is, from the trunk to the phalanges. Birthweight was 2880 g, length was 44.5 cm (


Family planning is an important topic to discuss with the woman with preexisting diabetes. The use of contraceptive agents will depend on whether cardiovascular disease is present 51 . Low-dose combinations of progestin and estrogen or progestin-only oral contraceptive agents are recommended for women with hyperlipidemia. Intrauterine devices and barrier methods do not affect blood glucose levels.

Bells Palsy

But it is believed that Bell's palsy is caused by the inflammation of the facial nerve resulting in a one-sided weakness of the face. They may have facial drooping on the affected half. Some may even complain of excessive tear flow or a reduced sense of taste. It is important to exclude an acute stroke, brain tumor or intracranial bleeding.

Five on Fiber

Fiber-rich foods such as most fruits, vegetables, and whole grains may play a role in reducing the chances of heart disease and some cancers later in life, and fiber helps promote bowel regularity. How many grams of fiber a day should your child get Add five to your child's age, and you have a rough estimate a three-year-old, in other words, should get eight grams. If you follow the suggestions for five servings of fruit and vegetables each day and if you encourage your child to eat whole grain breads, your child will almost certainly get enough fiber. Too much fiber can cause bloating and gas.

Ann Reed Mangels

Summary A vegetarian diet, defined as an eating style that avoids meat, fish, and poultry, can be healthful and nutritionally adequate for a pregnant woman. Some vegetarians, called vegans, avoid dairy products and eggs as well as meat, fish, and poultry. Vegan diets can also be healthful and nutritionally adequate for pregnancy. Vegetarian diets can provide numerous long-term health benefits including a lower risk of cardiovascular disease, some forms of cancer, and hypertension. Key nutrients for vegetarian pregnancy include protein, iron, zinc, calcium, vitamin D, vitamin B12, iodine, and omega-3 fatty acids. Vegetarian women should also be counseled to follow standard weight gain recommendations. A vegetarian or vegan diet can meet requirements for all of these nutrients although in some instances, fortified foods or supplements can be especially useful in meeting recommendations. The nutrient content of supplements targeted to pregnant vegetarians should be evaluated to make sure...

Carbon Disulfide

More than half of the carbon disulfide used in the United States is involved in the manufacture of viscose rayon and cellophane (72). Carbon disulfide also is used in the production of carbon tetrachloride, neoprene cement, and rubber accelerators in paint and varnish products and in rocket fuel. It produces symptoms in affected persons similar to those produced by other solvents, but it also produces a characteristic group of toxic effects. It is a neurotoxicant that is capable of causing peripheral neuropathy and global central nervous system (CNS) dysfunction. Outcomes of acute poisonings may be fatal or may cause irreversible CNS injury. Prolonged exposure also has been linked to an increase in atherosclerotic heart disease and retinal microangiopathy (73).

Janets story

Eventually reflect that it had been a difficult year. Her father had died suddenly of a heart attack not long after she had become pregnant. She was terribly sad that he had not seen her baby. Her mother had no longer felt able to run the bakery that the couple had owned throughout their life and it had had to be sold. Janet had worked in the bakery throughout her life and all of the family were struggling to come to terms with the new situation.

Congenital anomalies

The sonographic detection of recognizable congenital anomalies is an important aspect of the management of diabetic pregnancy. Diabetes-associated malformations occur very early in pregnancy, usually before the eighth week of gestation. Therefore, the evaluation should be done in the first trimester of pregnancy and repeated in the second. Cardiovascular anomalies are the most common, especially conotruncal and ventricular septal defects.33-35 Indeed, maternal diabetes mellitus has been accepted as one of the indications for fetal echocardiography because congenital heart disease occurs four to five times more frequently in the offspring of women with diabetes than in the general population.36-38 Antenatal identification is important because some defects are ductal-dependent and require immediate therapy after birth.39 Fetuses of diabetic mothers are at risk for accelerated myocar-dial growth. The cardiomyopathy is mainly related to poor glycemic control. In adequately controlled...

Kawasaki Disease

Tis, and swollen lymph nodes (glands) (b) it affects only infants and young children (suggesting that adults may have developed immunity) and (c) epidemics of the disease seem to occur periodically, as if a germ were being passed through the population. The disease occurs mainly in children five years and younger, most commonly in children ages 18 to 24 months. It affects boys more often than girls, and it is more prevalent among Asian children. The major threat that the disease poses for a child's health is related to its effects on the heart. The condition can cause inflammation of the coronary arteries and other blood vessels. Untreated, 20 to 25 percent of children will develop aneurysms (balloonlike enlargements) of the coronary arteries. In rare cases, this can result in the death of the child due to heart attack. Complications In a few cases in which heart involvement is more severe, children may require treatment for heart failure or abnormal rhythm of the heartbeat. In all...

Karls story

One morning as Karl stood on the platform waiting for his train to arrive, his heart began racing and he started to sweat heavily. He sat down on a bench as he thought he was having a heart attack. He remained there while the passengers boarded the train and when he felt a bit better, he managed to walk home and spent the day in bed. Next morning he went to the station as usual but found himself sweating profusely as he approached the platform and his heart began to race. He was convinced that he was on the verge of a heart attack and went straight to his GP. His GPsent him for various tests but eventually said he was physically quite well. Karl stayed away from work and was now terrified of going anywhere near the train station. 2. 'Tm having a heart attack' serious or fatal health problems.

Inside Out Infant

Musculoskeletal Disorders

Infant with the CHARGE association. Occurrence is non-random and is characterized by coloboma, heart disease, atresia of the choanae, retarded postnatal growth and development, genitourinary anomalies, and ear anomalies and deafness. Most infants have some degree of mental deficiency. The coloboma commonly involves the retina but may range in severity from an isolated coloboma of the iris to anophthalmos. Figure 3.10. Infant with the CHARGE association. Occurrence is non-random and is characterized by coloboma, heart disease, atresia of the choanae, retarded postnatal growth and development, genitourinary anomalies, and ear anomalies and deafness. Most infants have some degree of mental deficiency. The coloboma commonly involves the retina but may range in severity from an isolated coloboma of the iris to anophthalmos.

About the Editors

Couch is an associate professor in the Department of Nutritional Sciences, College of Allied Health Sciences at the University of Cincinnati. Dr. Couch received her master's degree and Ph.D. from the University of Connecticut and was a research associate at Columbia University in the Department of Pediatrics prior to her appointment at the University of Cincinnati. Dr. Couch's research focuses on lipid alterations and nutrition-related risk factors in the prevention and treatment of cardiovascular disease. She has numerous publications in nationally recognized journals including the American Journal of Clinical Nutrition, the Journal of the American Dietetic Association, Lipids, and the Journal of Pediatrics. She has been principal and co-investigator on external grants received to support her research, including grants from the National Institutes of Health, the American Heart Association, and the American Dietetic Association. Dr. Couch's most recent funded research...

Imperforate Anus

Cloacal Deformities

Ambiguous genitalia in a female infant with VACTERL syndrome. Note the cloacal sac with a single urogenital opening. The bladder is in free communication with the rectum. This infant also had congenital heart disease, a tracheoesophageal fistula, imperforate anus, and a right hydronephrosis. Karyotype was XX. Figure 4.130. Ambiguous genitalia in a female infant with VACTERL syndrome. Note the cloacal sac with a single urogenital opening. The bladder is in free communication with the rectum. This infant also had congenital heart disease, a tracheoesophageal fistula, imperforate anus, and a right hydronephrosis. Karyotype was XX.

Mickey Mouse Pelvis

Musculoskeletal Disorders

Total radiograph of an infant with trisomy 21 shows the long narrow chest cage with downslanting ribs due to hypotonia. Any infant who is hypotonic has this appearance of the chest cage. The finding of eleven pairs of ribs, as in this infant, is common in Down syndrome but also may occur as a finding in normal infants. The pelvis is a typical mongoloid pelvis. The infant also had congenital heart disease (the most common defect being an endocardial cushion defect). Figure 4.61. In another example of Turner's syndrome in a term infant (length 44 cm) note the marked lym-phedema, especially of the lower extremities. Other findings in Turner's syndrome include a low posterior hairline with the appearance of a short neck, webbing of the neck, congenital heart disease (especially coarctation of the aorta), pig-mented nevi, and skeletal abnormalities. Figure 4.61. In another example of Turner's syndrome in a term infant (length 44 cm) note the marked lym-phedema, especially of...

Mild Microcephaly

Heart Defects Associated With Trisomy

This full-body radiograph illustrates the typical findings in trisomy 18. Note the gracile (fine, delicate) ribs and the antimongoloid (very vertical) appearance of the pelvis. The infant also had cardiac enlargement which was associated with congenital heart disease (patent ductus arteriosus).

Types of macrosomia

Pathological entity.8,9 This type of macrosomia is associated with an abnormal thoracic and abdominal circumference, which are relatively larger than the head circumference.10 These infants also differ in terms of their body proportions when compared with neonates of mothers with normal glucose metabolism.11 As a result, disproportion between the head and shoulder girdle of the fetus, causing difficulty in delivery of the shoulders, predisposes to birth trauma (shoulder dystocia, clavicular fracture, and brachial palsy) and, as a consequence, an increased rate of Cesarean sections. In addition, it has been postulated that asymmetric macrosomia could have long-term consequences for the offspring, including obesity, coronary heart disease, hypertension, and Type 2 diabetes.12-14

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