Hypoxemia (Low Blood Oxygen): Causes, Symptoms And Treatment
Bronny James Has Congenital Heart Defect, Probable Cause Of His Cardiac Arrest
Bronny James #6, seen here at the McDonalds All American Basketball Games on March 28, 2023, ... [+] suffered a cardiac arrest in July. (Photo by Michael Hickey/Getty Images)
Getty ImagesA spokesperson has indicated the cause of the cardiac arrest suffered by LeBron "Bronny" James last month at a University of Southern California (USC) basketball practice. And guess what? It didn't match some of the conspiracy theories that circulated soon after James, the 18-year-old son of NBA star LeBron James, was rushed to Cedars-Sinai Medical Center in Los Angeles. Instead, the probable cause was "an anatomically and functionally significant Congenital Heart Defect," according to the statement.
Here's what the statement said: "After a comprehensive initial evaluation at Cedars-Sinai Medical Center led by Dr. Merije Chukumerije and follow-up evaluations at the Mayo Clinic led by Dr. Michael J. Ackerman and Atlantic Health/Morristown Medical Center led by Dr. Matthew W. Martinez, the probable cause of Mr. James' sudden cardiac arrest (SCA) has been identified. It is an anatomically and functionally significant Congenital Heart Defect which can and will be treated." It added, "We are very confident in Bronny's full recovery and return to basketball in the very near future."
This came nearly a month after Cedars-Sinai had issued a press release on July 27 mentioning that James had been discharged from the hospital. It read, "Thanks to the swift and effective response by the USC athletics' medical staff, Bronny James was successfully treated for a sudden cardiac arrest. He arrived at Cedars-Sinai Medical Center fully conscious, neurologically intact and stable. Mr. James was cared for promptly by highly-trained staff and has been discharged home, where he is resting."
The July 27 press release was attributed to Chukumerije, a cardiologist who was actually taking care of James, as opposed to those on social media who claimed that Covid-19 vaccines were somehow involved despite the lack of that thing called evidence. These days seemingly every time there's news of a death or a serious heart problem, people and anonymous accounts on social media begin disseminating assertions that Covid-19 vaccination was the cause, even when there is no real supporting evidence. The same thing occurred after news broke of James' cardiac arrest. And billionaire Elon Musk further fueled such unfounded speculation when he tweeted or perhaps X'd, "We cannot ascribe everything to the vaccine, but, by the same token, we cannot ascribe nothing. Myocarditis is a known side-effect. The only question is whether it is rare or common," as you can see here:
From Twitter
From TwitterYeah, it should be obvious that "We cannot ascribe everything to the vaccine." For example, when you stub your toe on a life-sized Mark Zuckerberg figurine, you shouldn't say, "Darn vaccine." But beyond that, it's important to remember that the data to date have shown myocarditis to be a rare side effect of Covid-19 mRNA vaccines and not a common one. Plus, no one actually taking care of James has implicated Covid-19 vaccines as a possible cause of his condition. And while Musk may be many things, he isn't a medical doctor and was likely not directly involved in James' care.
To understand how a cardiac arrest may happen, think of your heart as a Tesla vehicle, something that requires electrical signals to run. A cardiac arrest or a sudden cardiac arrest is when the electrical signals in your heart either cease or cease to remain coordinated enough to maintain a heart beat. In many cases, the "sudden" is redundant since your heart doesn't tend to send you an Outlook calendar invite indicating, "Cardiac arrest planned next Wednesday at 2 pm."
A cardiac arrest is a life-threatening medical emergency. You'll never hear someone say, "I'm running a bit late to tour date as I'm having a cardiac arrest. Be there in 5." When your heart cannot maintain a proper heart beat, it cannot pump blood that carries oxygen to your vital organs, including your brain.
A cardiac arrest can occur when the structures of your heart are perturbed enough to really mess up this electrical system in your heart. That can happen when the muscles of your heart get stretched out of shape (which is what happens with heart failure), grow too thick and big (which is called cardiomyopathy), or die (such as when your heart muscles get starved of blood and oxygen). In each of these case, the damage to your heart muscles has to be substantial and widespread enough to really disrupt the electrical systems.
Bronny James (R) is seen here at the 2023 ESPY Awards at Dolby Theatre on July 12, 2023, with his ... [+] family: (L-R) LeBron James, Bryce James, Zhuri James, and Savannah James. (Photo by Kevin Mazur/Getty Images)
Getty ImagesMyocarditis can also lead to cardiac arrest but only if it is severe enough. The vast majority of myocarditis cases, though, do not end in cardiac arrest, especially if you are otherwise healthy. Myocarditis simply means inflammation of the heart muscle since "myo" means muscle, "card" stands for heart" and "itis" represents inflammation. A mild case of myocarditis is very different from a severe case. Again, myocarditis has been reported as a rare side effect from Covid-19 mRNA vaccination. And to date most such reported cases have been mild.
Other structure problems such heart valve defects or various congenital heart defects can also pre-dispose you to cardiac arrest. Certain medications and recreational drugs can lead to abnormal heart rhythms that can degenerate into cardiac arrest as well. Then there are abnormalities in the electrical system itself despite a normal heart structure, which is what can be seen in long QT syndrome (LQTS) and Brugada syndrome. So, yes, myocarditis is a possible cause of cardiac arrest. But it certainly is not the only possible cause or even the most common cause.
A congenital heart defect (CHD) is an abnormality of the heart that is present at birth. The word "congenital" means "present since birth," which is why the insult "congenitally stupid" is so harsh. While the fetus is developing, tissues grow and move around to form the heart. When this process is somehow disrupted, CHDs can result.
The Centers for Disease Control and Prevention (CDC) describes CHDs as "the most common type of birth defect." There are many different types of CHDs, ranging from holes the heart (e.G., Atrial Septal Defects and Ventricular Septal Defects) to abnormal narrowing of the blood vessels leading to and from the heart (e.G., Coarctation of the Aorta and Pulmonary Atresia) to problems with the valves of the heart (e.G., Tricuspid Atresia) to abnormally large or small structures of the heart (e.G., Hypoplastic Left Heart Syndrome) to structures being completely re-arranged (e.G., Transposition of the Great Arteries and Tetralogy of Fallot). These CHDs do vary in severity and not all of them bring the same risk of abnormal heart rhythms that could lead to cardiac arrest. To date, the doctors taking care of James haven't yet specified which CHD he may have.
So, without further information, it's difficult to speculate what type of treatment James may have undergone and is undergoing right now. Correction, it's not difficult to speculate. Plenty of people and anonymous social media accounts seem to be speculating about other people's medical conditions each and every day. After all, these days, who needs real information and facts to make claims on social media, right? It's just that such speculation could be way off base and really serve no purpose Unless, of course, one's purpose is to spread misinformation.
When To Choose Palliative Care For Heart Failure And What It Looks Like
The idea of palliative care can seem overwhelming, but these support systems can make life easier for those with heart failure and their loved ones.
Heart failure is a condition in which your heart can't pump the amount of blood and oxygen your body needs to function. According to the Centers for Disease Control and Prevention (CDC), roughly 6.2 million adults in the United States live with heart failure.
While there's currently no cure for heart failure, some treatment options can slow or stop the disease's progression. But when treatment is no longer effective, such as in the case of advanced heart failure, sometimes the focus may shift to supportive or palliative care instead.
This article discusses what to expect when someone chooses palliative care for heart failure and how to get end-of-life support for a loved one with end stage heart failure.
When someone has advanced heart failure, it means that treatment is no longer effective at slowing down the disease's progression. Symptoms are often severe at this stage and can significantly affect someone's overall quality of life.
Palliative care, sometimes called supportive care, describes medical care that can help improve the well-being of people living with serious, chronic health conditions. Palliative care can help improve the following areas and more:
While there are currently no specific criteria for receiving palliative care, one 2020 research review found that some of the most common reasons for referring someone to palliative care for heart failure include:
The decision to pursue palliative care is a personal one that involves various factors ― and the ultimate goal is to come to the decision that's right for the person with the condition.
According to the World Health Organization (WHO), the overarching goal of palliative care is to reduce the challenges that people with serious conditions can have, including:
By addressing the above challenges and needs, palliative care can significantly improve the overall quality of life for people with serious conditions.
Palliative care is highly individualized, depending on the person's condition and needs, but here's what this care might look like for someone with heart failure:
One of the most common misconceptions about palliative care is that it's end-of-life care. But palliative care and end-of-life care are different. Although, in some cases, palliative care may include end-of-life care.
For example, palliative care for someone with heart failure nearing the end of their life may include hospice care. Hospice care may include:
Healthcare professionals categorize heart failure into "stages" based on the severity of symptoms. There are two primary stages that the New York Heart Association (NYHA), the American College of Cardiology (ACC), and the American Heart Association (AHA) use to define advanced heart failure:
Many factors can influence how long end stage heart failure lasts, but some studies in a 2018 research review suggested that people living with stage D heart failure may have an average life expectancy of 6–12 months.
If someone you love has received a diagnosis of end stage heart failure, it can be difficult to imagine discussing end-of-life care. But hospice care is one way you can ensure your loved one has the comfort and support they need as they approach the end of their life.
Here are some questions to consider asking when choosing the right hospice care for your loved one:
You can also check out the National Hospice and Palliative Care Organization and the National Association for Home Care & Hospice to find hospice care centers near you.
Heart failure is a serious health condition that affects roughly millions of people across the United States. It can cause various symptoms that can significantly affect someone's quality of life, especially in the later stages of the disease.
As heart failure progresses to advanced stage heart failure, palliative care can help offer support for the challenges that people with the condition may experience. If you or a loved one lives with heart failure, consider contacting your care team to learn more about the palliative services available to you.
Weight-loss Drug Wegovy Produces 'largest Benefit Ever Seen' For Patients With Most Common Form Of Heart Failure, Trial Finds
CNN —
The diabetes and weight loss drug semaglutide significantly reduced symptoms and improved quality of life in people with obesity and the most common form of heart failure in a clinical trial, potentially expanding the already wildly popular drug's use beyond diabetes and weight loss and offering a new treatment option where few are available.
The study of 529 patients, funded by drugmaker Novo Nordisk, found that a 2.4-milligram weekly dose of semaglutide, sold as Wegovy for weight loss, led to an improvement of 17 points on a 100-point scale that's used to assess symptoms of a condition known as heart failure with preserved ejection fraction. By comparison, participants who got a placebo had a 9-point improvement. The study was published Friday in the New England Journal of Medicine.
In real terms, that difference means Wegovy helped people with heart failure have less shortness of breath, fatigue, trouble exerting themselves and swelling, as well as better exercise function and quality of life, all part of a scale known as the Kansas City Cardiomyopathy Questionnaire clinical summary score, said Dr. Mikhail Kosiborod, cardiologist and vice president for research at Saint Luke's Mid America Heart Institute, Kansas City, Missouri, who led the trial.
"This is the largest treatment benefit we've ever seen for that endpoint in this patient population with any drug," Kosiborod told CNN ahead of the European Society of Cardiology meeting in Amsterdam, where the results are being presented.
There are 64 million people globally living with heart failure, Novo Nordisk said in a statement about the trial results. It's a condition in which the heart can't pump enough blood to meet the body's needs.
Preserved ejection fraction means the heart can pump normally but is too stiff to fill properly. This type of heart failure accounts for more than half of all cases in the US and is increasing in prevalence, according to Kosiborod and his co-authors.
He noted that 80% of patients with this kind of heart failure in the US have obesity or are characterized as overweight. Another goal of the study was weight loss, and the drug succeeded there, too: Participants on semaglutide lost about 13% of their body weight, compared with 2.6% for those on placebo, over the course of the year-long trial.
Until recently, the main treatment options for people with this kind of heart failure were diuretics, sometimes called water pills, Kosiborod said. They increase urination to reduce the amount of fluid in the body and can temporarily alleviate symptoms, but they are "woefully insufficient," he explained.
Another class of drugs known as SGLT2 inhibitors, also used for Type 2 diabetes, has been shown to reduce the risk of heart failure hospitalization, but "it's not enough for most people," Kosiborod said. The improvements in symptoms "are relatively modest."
The trial of semaglutide assessed exercise function using a metric known as the six-minute walk test. It found that by the end of the trial, the drug helped participants walk 20 meters farther than people who got a placebo.
There were fewer serious safety events in the drug group than in the placebo group, although more patients stopped taking semaglutide, primarily because of gastrointestinal issues that are common side effects with this class of medicines, known as GLP-1 receptor agonists.
One limitation in the trial was its lack of diversity: 96% of the participants were White.
"We as a clinical trial community know that we need to do better in terms of patients that are Black, Hispanic, and from other backgrounds that are underrepresented in clinical trials," Kosiborod said.
He noted another heart failure trial of semaglutide that includes patients with diabetes should have results soon, and pooling the data together could give a better picture of how the drug works for people of different racial and ethnic backgrounds.
The new data builds on other recent results suggesting Wegovy could be prescribed for reasons beyond weight loss. In early August, Novo Nordisk announced that Wegovy reduces the risk of heart attack, stroke or heart-related death in people with cardiovascular disease and obesity by 20%, a result expected to boost use of the medicine even further. Already, the company can't keep up with demand and has had to restrict access to some lower starter doses of the medication so it can meet supply needs for established patients.
Wegovy and its sister drug for Type 2 diabetes, Ozempic, as well as a similar drug from Eli Lilly called Mounjaro, have been transforming the way doctors approach weight loss with medicines after decades of drugs with weak efficacy and dangerous safety issues.
They're also changing the way researchers think about obesity, and the results in heart failure contribute to that paradigm shift, Kosiborod said.
"Clearly, we cannot continue to treat obesity just as something that accidentally happens to occur in these patients," he said. "It's likely a root cause of the complications and should be treated as such."
He pointed out, though, that the drug may be helping in ways beyond those related to weight loss: through reducing inflammation and congestion, for example.
Kosiborod said that as a physician taking care of patients, he found the results "extremely gratifying, because what I now can tell them is that we have pretty definitive evidence that if we prescribe this medication, you will feel better and be able to do more, and it's going to have a significant impact on your quality of life."
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