Heart doesn’t explode, but it can rupture – Butler County Times-Gazette

By Dr. Keith Roach

DEAR DR. ROACH: What causes the heart explosion? I heard it could be related to a heart attack. I knew two people who had it. How often does this happen? -KG

TO RESPOND: The heart doesn’t actually explode, so I suspect you’re talking about the rupture of the wall of the left ventricle, which fortunately is a rare complication of a major heart attack. When I was in medical school, one of my professors noted that people rarely survive it. The mortality rate at that time was around 95%. The most recent study showed that 75% of people with a wall rupture will die. Immediate surgery is the only hope, and even that carries high risk.

A heart attack is the death of heart muscle cells, and after a heart attack there is a period when the body absorbs the dead muscle cells and scars them. But before the scar is fully formed (almost always within two weeks of the heart attack), the dead muscle is weak and can potentially rupture under the relentless work and constant pressure of the heart. In an era where most heart attacks are treated by returning blood flow to the damaged area, the incidence of wall rupture is very low, around 0.01%.

DEAR DR. ROACH: My dad is 67 and has had keratoconus for about 40 years. He wears special contact lenses and works perfectly with them, but his ophthalmologist recommended a corneal transplant. First they want to do his left eye because of the scarring and limited vision. Later, they will perform a graft on the right, also healed but very thin and conical. The doctor recommended the left eye first so he would have some vision during the process. How successful are corneal transplants in a person his age? What is the risk of total loss of vision in one or both eyes? —CJB

TO RESPOND: Keratoconus is a thinning of the cornea with a protruding cone shape, exactly as you described it. Since the cornea is responsible for much of the eye’s focusing ability, progressive visual impairment is universal. Change can be slow or sudden. The condition is not uncommon, perhaps two in a thousand people will develop it, and there is a slight familial association. Most people can get good vision correction with glasses, but contact lenses usually become necessary. Regular contact lenses are used initially, but scleral lenses, which are larger in diameter to rest on the sclera (white of the eye), are more comfortable and have less risk of scarring or discoloration. worsening of keratoconus. These can be customized to provide better results.

When contact lenses aren’t helpful — or are uncomfortable due to scarring, which happens 10-15 percent of the time — a full-thickness corneal transplant, also called penetrating keratoplasty, is recommended. The success rate would be over 90%. Graft rejection is a serious complication, usually treated with steroid drops. Astigmatism – a cause of blurred vision – is another complication, usually treated with contact lenses or additional surgery.

Another treatment sometimes used is called collagen cross-linking, which uses the vitamin riboflavin with ultraviolet light to strengthen corneal tissue. This is often used in people with progressive keratoconus, but cannot be used if the cornea is too thin, as might be the case with your father.

Permanent vision loss after surgery is rare.

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