Aneurysm

Aneurysm is the swelling in the walls of blood vessels especially arteries. The swelling and widening of blood vessels causes them to weaken over time and they can rupture. The most commonly observed causes of aneurysm are congenital defects, uncontrolled high blood pressure and atherosclerosis (growing of fatty deposits in arteries). Aneurysm is usually classified by shape, size and location of the bulge. It is most common in arteries at the base of the brain referred as brain or cerebral aneurysm, and in aortic arteries known as abdominal aortic aneurysm. Although aneurysm can occur at any age it is most commonly observed in adults than children. Women are also found slightly more susceptible than men in this regard.

Aortic Aneurysm:

Aorta is the main artery that supplies blood from heart to the rest of the body. Aneurysm can develop anywhere in the aorta but they are most commonly found in aorta with in the abdominal region below the kidneys. The majority of aneurysms which actually start in the abdominal path of aorta eventually extend up to iliac arteries. It may occur in the chest near the heart as well (thoracic aortic aneurysm). The aortic aneurysm usually does not show any symptoms. Mild to moderate symptoms of aneurysm can sometimes be seen though. Pain in the effected area is a common symptom. One of the main causes of aortic aneurysm is smoking. The smokers over 60 years of age seem to have atherosclerosis. It has to be stopped immediately as it increases the risk of aneurysm's widening.

Treatment:

To treat the aortic aneurysm a procedure known as stenting is performed. After locating the position of the bulge, an X-ray guided polyester tube (stent-graft) is passed through a small cut in upper thigh leading to aorta. Now the blood instead of flowing through the damaged artery flow through the stent-graft and eliminates the chance of rupture.

Brain Aneurysm:

Brain Aneurysm usually originates from the base of the brain where the larger arteries combine. This area is known as circle of willis. The causes of brain aneurysm are generally genetic disorders which includes connective tissue disorders, polycystic kidney disease or some circulatory disorder. Patient having brain aneurysm may be found having the symptoms such as excruciating headache, problem with vision, thinking and decrease in concentration level, difficulty in speech and perception, pain in neck or eye and extreme tiredness.

Treatment:

Surgical clipping and coil embolization are methods usually applied for the treatment of brain aneurysm. Patient has to go through some test to get the right diagnosis after which the doctor will determine the method of treatment that is best suited to repair the blood vessel.

Congenital Heart Disease and Physical Therapy

Congenital Heart Disease

Congenital heart diseases refers to the structural (anatomical) or physiological defects in the normal functioning of the heart as a result of birth defects that may be diagnosed soon after birth or may take years to produce full blown cardiac insufficiency. Valvular heart defects form the most common variety of congenital cardiac defect that is associated with high morbidity and mortality in adult years if no management options are employed. This is because the metabolic demands of the body increase with growth and development that poses more pressure on the heart leading to cardiac failure or circulatory deficits. With overall prevalence of 26.6%, it was suggested that only 12.1% cases can be detected by clinical evaluation. Among the most prevalent congenital cardiac defects, ventricular septal abnormalities comprise 17.3% of all congenital anomalies followed by atrial septal defects (6.0%) and other less common cardiac diseases. The mortality is highest with cyanotic heart diseases. 

According to the research statistics reported by Julien I.E Hoffman, over 1 million patients were born with congenital heart defects (during 1940 to 2002). Considering the quality of medical services and surgical/ medical advancements, Hoffman suggested that the total number of survivors with mild heart disease (who may reach well into adulthood) is 750,000 with mild heart disease, 400,000 with moderate heart disease and 180,000 with severe disease (with treatment). Without any management or treatment the survival rate may fall to 400,000 with mild disease, 220,000 with moderate disease, and 30,000 with severe heart disease, suggesting very high mortality. 

Congenital heart diseases are also associated with stunted growth and development in children marked by poor weight gain, failure to thrive and frequent hospitalizations while growing up. In addition, these children also develop frequent episodes of shortness of breath, rapid heart rate (also known as tachycardia) and attacks of fatigue associated with decreased exercise endurance.

Physical therapy 

Physical therapy and mild exercises are helpful in the growth and development of children born with congenital heart disease. It is extremely important not to initiate exercise therapies in these children without seeking the guidance from registered physical therapists who work in coordination with the pediatric cardiologist to deliver best exercise regimens in order to optimize health without overloading the heart. Generally, children and adults can perform moderate static exercises of mild intensity without any complications; however, healthcare providers strongly restrict weight lifting in pediatric aged children and even in adults born with cardiac defects. Caution should be maintained to avoid lifting weight of more than 25 pounds in children and more than 50 pounds in adults. Physical therapist and pediatric cardiologist must assess every child individually and advice customized exercises and treatments according to the severity of illness and overall physical health. Treadmill test, bicycling and echocardiography are mainly used as assessment tools as the risk of sudden death increases if vigorous activity is attempted in children born with aortic stenosis, cyanotic heart diseases and coarctation of the aorta. 

Hardcore or traditional gym exercises increase cardiac output that may overload the heart and may increase the risk of complications or sudden cardiac death. On the contrary, exercises performed under the guidance of physical therapists serve multiple benefits. Exercise or physical activities are needed in order to build stamina and maintain exercise endurance especially in school going children who engage in physical activities with peers. Physical therapy improves the pace of mental and physical development that allows children to develop healthy social relationships with peers, muscle and motor coordination and mental concordance. Physical therapy and periodic assessments are also needed in order to know the physical capacity of child and to track worsening of cardiac defect with age (in order to avoid accidents or unwanted incidents at schools) by restricting excessive physical activity. In some children, healthcare providers delay surgery until the child crosses some developmental milestones; however, it is very important that until then child stays in best possible physical shape to lessen the risk of surgical complications. 

According to the scientific peer-reviewed journal- American Family Physician there are 5 stages of physical activity recommendations of Physical Activity in Children with CHD, ranging from no restriction to extreme limitation of physical activity (wheel chair bound). 

Without any physical therapy, the progression into the severe disability is fairly high. It is the duty of parents to promote healthy physical activity but make sure to prevent contact sports or vigorous activities that may affect cardiac functioning.