Matters of the Heart
Understanding Congenital Heart Disease

By: Dr. Elizabeth Cosmal-Cintron, Florida Heart Associates

By: Dr. Elizabeth Cosmal-Cintron, Florida Heart Associates

February is American Heart Month, which is dedicated to raising awareness about heart disease and informing the public on ways of prevention.  

The general public is less aware that congenital heart disease, also known as congenital heart defects, is a group of various abnormalities affecting the cardiovascular system occurring at birth.  According to the American Heart Association, there are approximately 1.3 million Americans (nearly 9 out of every 1,000 infants born each year) who are living with a congenital heart defect.  The cause of most congenital heart defects is unknown; however, genetic syndromes and environmental exposure play a major role.

Congenital heart disease can affect the great vessels of the heart, which can have a profound effect on circulation.  Congenital heart disease can affect the structure of the valves, as well as the heart’s electrical system (rhythm).  A few common congenital heart defects include the following: aortic valve disease, such as a bicuspid valve; coarctation of the aorta, a narrowing of the aorta which impedes blood flow; atrial and ventricular septal defects, a hole in the wall that separates the chambers of the heart; L and D-Transposition of the great arteries, reversal of the great arteries and/or heart chambers; Tetralogy of Fallot, obstruction of blood flow from the heart to the lungs; and long QT syndrome, a genetic mutation affecting the heart’s electrical  activity which can lead to sudden death.

The majority of congenital heart defects are diagnosed prior to or at birth.  A fetal echocardiogram — a detailed ultrasound of a baby’s heart — is often performed during gestation for numerous reasons including a first degree relative with congenital heart disease, an abnormal amniocentesis, or an abnormal fetal heart rate or rhythm.  

Diagnosis can also occur once a baby is born and is found to be blue or is having respiratory or feeding difficulties.  A physician may hear a heart murmur, an unusual sound or noise during a heartbeat, on exam.  If a physician is suspicious of an underlying congenital heart defect, an electrocardiogram (EKG), echocardiogram (cardiac ultrasound), or even a blood test may easily detect the problem.  

February is American Heart Month, which is dedicated to raising awareness about heart disease and informing the public on ways of prevention.

February is American Heart Month, which is dedicated to raising awareness about heart disease and informing the public on ways of prevention.

In addition, CT scans and cardiac MRI modalities can quickly offer a diagnosis.  In some cases, a cardiac catheterization can be performed to diagnose congenital abnormalities.  An invasive cardiologist, who advances catheters into the circulation of the heart, performs this procedure.

In some instances, congenital heart defects are not found until much later in life.  An example of this is a bicuspid aortic valve.  In this particular disease, the aortic valve is structurally abnormal and is made up of only two leaflets rather than three.  This malformation often leads to progressive narrowing of the valve, which can eventually cause an obstruction of blood flow.  Individuals may not develop symptoms until well into their 5th decade of life.

The treatment of congenital heart defects is often dependent on the severity and type of underlying problem but can include observation, medications, catheterization-based procedures, and/or surgery.  Catheter procedures include using catheters to insert a device close to any holes, which are known as atrial or ventricular septal defects within the heart.  Catheters may also be used to repair a narrowed heart valve by delivering a balloon to the restricted valve and inflating the balloon to push apart the leaflets.  When a catheter procedure is unable to fix a severe congenital heart defect, open-heart surgery is then required. 

Advances in diagnosis and medical treatment of congenital heart disease have led to improved survival with an increase in the number of children advancing into adulthood and living normal and productive lives.  These adults, with repaired and unrepaired congenital heart defects, need close medical surveillance.  It is becoming more common for adults with congenital heart disease to develop additional cardiovascular conditions later in life, which are often due to late complications of their prior congenital heart defect.  Many adult congenital heart disease clinics are now available at tertiary care centers in an effort to provide specialized care in these particular patients.

Congenital heart disease involves a spectrum of unique cardiac conditions that require early diagnosis, treatment, and close medical surveillance from birth through adulthood.  

– Dr. Elizabeth Cosmai-Cintron is a board certified cardiovascular disease specialist with Florida Heart Associates.  She is interested in educating people on preventive heart care and maintaining good heart health through proper nutrition, exercise and reducing risk factors that leads to heart disease. For more information or to schedule an appointment, please call her office at (239) 938-2000 or visit her website at


Fighting Eating Disorders

National Eating Disorders Awareness Week "Themed I Had No Idea" is February 23 – March 1.

National Eating Disorders Awareness Week “Themed I Had No Idea” is February 23 – March 1.

Did you have any idea that up to 24 million people of all ages and genders suffer from an eating disorder in the US?  Did you have any idea that you can be too thin…that over-exercising can lead to an eating disorder…that 35% of “normal” dieters progress to pathological dieting… or that an eating disorder can kill you or lead to permanent physical damage?

An eating disorder is an unhealthy relationship with food and weight that interferes with many areas of a person’s life.  One’s thoughts become preoccupied with food, weight or exercise and the self-criticism of his or her body image begins to disrupt normal body functions and affect daily activities.  

There are three main eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.

• Anorexia Nervosa: A person with anorexia has an intense fear of gaining weight or becoming fat.  Someone afflicted with this eating disorder will practice unhealthy behaviors such as: restricting calories, only eating specific foods or skipping meals frequently.  The National Institute of Mental Health claims an estimated 0.5 – 3.7 percent of women suffer from anorexia nervosa, and research suggests that about 1 percent of female adolescents suffer have the disorder.  Anorexia also afflicts an estimated 10 – 15 percent of males.  Individuals with anorexia suffer from a negative or distorted self-image, irritability, social withdrawal, a thin appearance, abdominal pain, menstrual irregularities, irregular heart rhythms and much more.

• Bulimia Nervosa: A person with bulimia may also be intensely afraid of becoming fat or gaining weight.  Someone with bulimia nervosa may eat large amounts of food in a short period of time and then eliminate the food and calories by making themself vomit.  Bulimics may also exercise excessively or use laxatives, diuretics or diet pills to lose weight or calories.  An estimated 1.1 – 4.2 percent of women have bulimia nervosa in their lifetime, and 50 percent of people who have had anorexia end up developing bulimic patterns.  Bulimics have an excessively distorted negative body image, low self-esteem, abnormal bowel functions, swollen salivary glands, menstrual irregularities, irregular heart rhythms and much more.

• Binge Eating Disorder: This disorder involves eating very large amounts of food rapidly to the point of feeling sick or uncomfortable.  These episodes of binging occur frequently and cause the person to feel like they cannot stop eating or control what or how much is eaten.  An estimated 2 – 5 percent of Americans experience binge eating disorder, according to the National Institute of Mental Health.  Symptoms of binge eating disorder may include: eating to the point of discomfort, eating too fast, frequent solitary eating, depression and disgust with body image. 

Conclusive causes of eating disorders are not known; however, multiple factors are involved, such as genetics or metabolism; psychological issues and social issues.

The role of genetics on eating disorders is of particular interest to researchers.  Specific genes that cause eating disorders have not been discovered; however, a number of genes in the body are triggered by ones environment.  Psychological issues, such as depression and anxiety, are biological in nature, but studies show these psychiatric illnesses co-exist in patients with eating disorders. Finally, an emphasis on thinness or “ideal beauty” causes individuals with eating disorders to obsess further about body image.

Eating disorders cause a host of physical problems — everything from irregular heartbeats to organ failure, bowel and menstrual troubles to suicide.  But the most alarming aspect of an eating disorder is that mortality rates for these mental disorders rate considerably high.  The American Journal of Psychiatry reports that the mortality rates of eating disorders are: 4% for anorexia, 3.9% for bulimia and 5.2% for other eating disorders.

Early intervention is key with eating disorders.  Psychotherapy, weight restoration/nutrition education and medication are typical treatments.  Cognitive behavioral therapy is common for eating disorders, as well.  With this patients learn how to monitor what they are eating and their moods, develop problem-solving skills and explore healthy ways to cope with stressful situations.  Medically supervised weight programs help achieve a healthy weight and instill normal eating habits.  And medications help control urges or manage excessive preoccupations with food and diet.

If you or someone you know suffers from an eating disorder become informed and seek medical attention. 

– National Eating Disorders Awareness Week is February 23 – March 1.  Themed I Had No Idea, individuals can participate in NEDAwareness week to bring about public awareness of a critical problem.  For more information visit!