Memory Loss After Heart Valve Surgery

Track Your Symptom Progression

Its important to ask yourself about symptoms.. When doing so, don’t simply think in terms of yes or no, but consider the degree to which you experience symptoms.

What causes you to become short of breath? Is it walking 3 miles? Or has that walk gotten shorter and shorter over time, and do you now feel breathless after going to the mailbox?

Do you ever feel lightheaded? Do you ever notice a sudden urge to lie down until you feel steady? How often do you have this sensation?

What about chest pain or unusual swelling in the feet or ankles? Its important to track your symptoms and remind yourself to review them every 6 months or at least annually. Because most valvular heart problems progress slowly, with good notes you’ll probably be able to see evidence of your condition if it begins to worsen.

What if Im just out of shape?

It can be hard to separate habits from the mechanics of the heart, which is one important reason you need a health care professional to monitor your progress regularly. Your health care provider will rely on your reportsto help them make treatment decisions. The better you are at noticing what’s going on, the better you can advocate and participate in building a longer and healthier life.

) and makean appointment with yourself every six months to review and repeat the exercise. You never know when being attentive may save a life.

What Is Vascular Dementia

Vascular dementia is the second most common form of dementia after Alzheimer’s disease. It’s caused when decreased blood flow damages brain tissue. Blood flow to brain tissue may be reduced by a partial blockage or completely blocked by a blood clot.

Symptoms of vascular dementia may develop gradually, or may become apparent after a stroke or major surgery, such as heart bypass surgery or abdominal surgery.

Dementia and other related diseases and conditions are hard to tell apart because they share similar signs and symptoms. Although vascular dementia is caused by problems with blood flow to the brain, this blood flow problem can develop in different ways. Examples of vascular dementia include:

• Mixed dementia. This type occurs when symptoms of both vascular dementia and Alzheimer’s exist.
• Multi-infarct dementia. This occurs after repeated small, often “silent,” blockages affect blood flow to a certain part of the brain. The changes that occur after each blockage may not be apparent, but over time, the combined effect starts to cause symptoms of impairment. Multi-infarct dementia is also called vascular cognitive impairment.

Researchers think that vascular dementia will become more common in the next few decades because:

Heart Problems Tied To Early Signs Of Dementia

Jan. 29, 2013 — Older women with heart problems may be at greater risk for mental changes that are thought to signal the beginnings of a type of dementia, a new study shows.

Called vascular dementia, it is a type of mental decline thatâs thought to be caused by problems in blood flow to the brain. It is believed to be different from the loss of memory and function that happens in Alzheimerâs disease, which is linked to the buildup of proteins in the brain.

The study, which is published in the journal JAMA Neurology, followed 1,450 men and women in the Rochester, Minn., area. At the start of the study, all participants, who were in their 70s and 80s, were free of memory loss or thinking difficulties. Researchers gave them tests to measure brain function every 15 months.

After about four years, 348 people in the study had developed some form of mild cognitive impairment . This can include problems such as memory loss, having trouble making decisions, coming up with the right words, or navigating a familiar neighborhood.

Of those people, 94 had developed the type of mild cognitive impairment linked to vascular dementia. This type does not include memory loss, but does include the other problems such as with decision making, reasoning, and visual-spatial relations.

The link was particularly strong in women. Women with heart problems were about three times more likely to develop it than women without heart concerns. The link was not significant in men.

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Local Vs General Anesthesia

Dr. Gayatri Devi, a neurologist at Lenox Hill Hospital in New York City, said the study revealed how much more needs to be done to understand all of the effects of anesthesia, especially if a patient is already at risk for memory disorders.

I have always been leery of general anesthesia in my memory disorders practice because I have found that it worsens cognition in my patients, Devi, also the author of The Spectrum of Hope: An Optimistic and New Approach to Alzheimers Disease and other Dementias, told Healthline.

Devi said that she recommends local anesthesia if possible to help diminish the associated risk of general anesthesia.

There are, of course, unavoidable surgeries without any option but general anesthesia, she said. But whenever possible, I advocate for local or regional anesthesia.

This study underlines that anesthesia, even for uncomplicated procedures, in younger patients in their fifties, may transiently worsen cognition, although the long-term effects are not known, Devi explained. More studies need to be done on the effects of anesthesia on long-term cognition.

When Do You Need Heart Valve Replacement Surgery

A heart valve disease develops when the valve becomes either stiff, narrow , or leaky . These two disease states of the valve disrupt the flow of blood in and out of the heart.

Heart valve diseases can be present by birth or occur as a complication of other health conditions, such as rheumatic heart disease.

Many people who have heart valve disease may never experience any symptoms. Sometimes, the valve disease is diagnosed when a woman is pregnant. Doctors may still recommend heart valve replacement surgery to prevent the worsening of the heart condition.

With a diseased valve, heart valve replacement surgery becomes an emergency if you experience:

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Saving The Heart Can Sometimes Mean Losing The Memory

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James Haneman believes his surgeons sacrificed his mind in saving his heart.

In 1989, Mr. Haneman had a law practice in New Orleans, earned a six-figure salary and sat on several important state and federal law committees. Then he had a heart attack and surgery to bypass blockages in his coronary arteries.

He came through the surgery fine — physically. But since then, Mr. Haneman says, he has had memory problems and even simple tasks, like writing letters, elude him. His doctors told him the problems would be only temporary. ”They told me not to make any important decisions for a month,” he recalled.

But when he returned to work, he recalled, ”I could study something and not be ready to say it the next day, particularly in the order it had to be presented.” The doctors told him to wait another month.

Frustrated, he turned to self-help tapes and books on memory enhancement. He tried computer exercises and reading nonfiction. But his problems persisted and after two years he quit practicing law. ”When you can’t remember anything, you can’t practice law,” he said. ”I was doing my clients an injustice.”

These patients are apart from the approximately 2 percent to 5 percent of patients who suffer strokes after bypass surgery, a procedure 600,000 Americans undergo each year.

Power And Sample Size Estimation

Cognitive training for patients undergoing heart surgery administered by de Tournay-Jette et al. revealed medium-to-large effect sizes . We have decided to use the smaller effect size for calculation so as not to underestimate the required sample size. Using this effect size, 37 patients per group are needed to obtain statistical power of 80% at a significance level of p=0.05 . Based on previous cardiosurgical studies, we estimate a dropout rate of 20% between each of the four assessment time points. Thus, the number of study patients recruited at baseline assessment was fixed at 72 patients per group. For sample size and statistical power calculations, we used G*Power-3 analysis software.

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Your Personality And Mood May Change After Open

After open-heart surgery, many people experience personality and mood changes. The most commonly experienced emotions are depression, fatigue and anxiety. These can be caused by being on bypass, anesthesia, or medication such as oxycontin. You may experience mood swings like crying or getting angry or easily frustrated.

I mostly experienced this after my second open heart surgery when I was a teenager and my third open-heart surgery. After both of them, I experienced depression, anxiety and PTSD. Before my second open heart surgery, I was more outgoing but afterward, my personality changed and I was quieter and self-reflective. I struggled with suicidal thoughts and mood swings. After my most recent surgery, I finally got the therapy I needed after years of not seeking help. If you are struggling, please find help, be open with your doctor and make sure you have someone to talk to.

Open Heart Surgery: Memory Problems Are Common In The First Month

Memory problems are prominent during the first month after the open heart surgery, but these problems tend to go away after 6 Months, finds a new study. The findings of this study are published in the Journal of American Geriatrics Society.Most people who need open heart surgery to repair damaged heart valves are aged 65 or older. The American Heart Association estimates that nearly 8 million people have had heart surgeries. However, we don’t fully understand the effects of heart surgery on an older adult’s cognition .

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Number Of Arteries Bypassed

The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure. In other words, a double bypass means two coronary arteries are bypassed coronary artery and right coronary artery ) a triple bypass means three vessels are bypassed ) a quadruple bypass means four vessels are bypassed while quintuple means five. Left main coronary artery obstruction requires two bypasses, one to the LAD and one to the LCX.

A coronary artery may be unsuitable for bypass grafting if it is small , heavily calcified, or located within the heart muscle rather than on the surface. A single obstruction of the left main coronary artery is associated with a higher risk for a cardiac death and usually receives a double bypass.

The surgeon reviews the coronary angiogram prior to surgery and identifies the number of obstructions, the percent obstruction of each, and the suitability of the arteries beyond the obstruction as targets. The presumed number of bypass grafts needed as well as the location for graft attachment is determined in a preliminary fashion prior to surgery, but the final decision as to number and location is made during surgery by direct examination of the heart.

Assessment Of Cognitive Dysfunction

Cognitive dysfunction can be detected by neuropsychological testing. Important heterogeneity in the assessment, however, may exist due to differences in the selection of neuropsychological tests, the timing of postoperative measurements, and the definition of cognitive dysfunction. Several attempts to standardise the assessment, starting with the Statement of Consensus in 1995 , have only provided a platform from which a comprehensive assessment can be developed. In general, the use of a battery of approximately 10 standardised neuropsychological tests selected to measure varying domains of cognitive functioning, including verbal and non-verbal memory, attention, higher-order executive ability, and visuospatial ability, is recommended. The tests should be selected on the basis of their psychometric properties and should be sensitive to small changes in cognitive functioning. Typically, patients perform the tests before surgery to obtain a baseline measure, and one or more times after surgery.

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Delirium Following Cardiac Surgery

Postoperative delirium is a common complication of cardiac surgery and is associated with increased mortality, morbidity, and long-term cognitive dysfunction.11 Delirium following cardiac surgery is estimated to have an incidence likely between 26% and 52%.12-15 Advanced age is a known predictor of delirium occurrence after cardiac surgery, and in the general population.16,17 Independent risk factors for the development of delirium following cardiac surgery are outlined in TABLE 1.

A recent study has found ICU stay, hospital stay, and intubation time were significantly longer in patients aged 65 years and older with delirium following cardiac surgery.11 Using the Diagnostic snd Statistical Manual of Mental Disorders, fifth edition , criteria for delirium , all patients were screened for the presence of delirium by ICU physicians, attending cardiac surgeons, and nurses during the postoperative course, with data regarding the first 5 days after the operation included in the analysis.11

With regard to postoperative outcome, both elderly and very elderly patients had longer hospital length of stay if they developed postoperative delirium. The LOS in the cardiac surgery ICU was longer for elderly patients with delirium intubation time was longer in patients older than age 65 years with delirium.11

Ethics Approval And Consent To Participate

Central ethical approval has been confirmed from the Justus Liebig University Giessen and we will not begin recruiting at other centers in the trial until local ethical approval has been obtained. All amendments to the protocol will be submitted to the ethics committee of the Justus Liebig University Giessen. Each patient will give written informed consent. The written informed consent form is available from the corresponding author on reasonable request.

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What Causes Cognitive Impairment After Bypass Surgery

The exact cause of cognitive impairment following bypass surgery is unknown. There are probably several factors that can bring it about.

Originally it was presumed to be caused by small blood clots to the brain associated with usage of the heart-lung bypass pump. However, more recent studies have shown that employing more modern, off-pump bypass surgery has not reduced the incidence of cognitive impairment.

The theory that has the most traction today is that the manipulation of the heart and aorta can generate tiny blood clots, called microemboli, that can travel to the brain and cause damage there . Intraoperative studies using transcranial Doppler techniques have confirmed that showers of microemboli to the brain are common during bypass surgery, and other studies using pre-and-post-operative MRI scans have shown tiny ischemic lesions in the brains of people who experience cognitive decline. However, even these studies have yielded mixed results, and the causative role of microemboli is not yet proven.

Other potential causes, such as drops in blood pressure, hyperthermia , and a prolonged reduction of oxygen levels in the blood, all of which can occur during heart surgery or immediately postoperatively, may also play a role.

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How To Recognize The Condition

There is no short, simple test for POCD. Typically, a series of neuropsychological tests are administered before and after surgery a time-consuming process. Often, tests are given one week and again three months after surgery. But the tests used and time frames differ in various studies. Studies also define POCD differently, using varying criteria to assess the kind and extent of cognitive impairment that patients experience.

You May Experience Collarbone And Sternum Pain After Open

Sometimes you can have prolonged collarbone and sternum pain. Collarbone pain and sternum pain can be caused by the trauma of the surgery on your body or sternal wires. This pain can be sometimes helped with cardiac rehab or a resternotomy. However, make sure to communicate with your doctor about your pain to make sure its normal. After this past open heart surgery, Ive had a lot of pain and clicking in my shoulders and chest. Its caused a lot of chronic pain but working with physical therapy has helped me regain strength.

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