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Rheumatic Aortic Valve Obstruction


Presentation

  • A rationalisation of the 1350 boxes used throughout the book gives a simpler and clearer presentation of the various categories.[books.google.de]
  • A 67-year-old female patient of North African origin, with a history of rheumatic fever during childhood, presented with exertion dyspnoea.[academic.oup.com]
  • Dobutamine stress echocardiography can help determine if truly severe aortic stenosis is present (with a falsly low gradient) or if mild/moderate aortic stenosis is present.[healio.com]
  • The chest pain increases with exercise and eases with rest, and is present under the chest bone - although it may move to other areas of the chest.[disabled-world.com]
  • Heart valve problems can be congenital, which means present at birth, or acquired after birth. A heart valve problem is classified as congenital when some factor during fetal development causes the valve to form abnormally.[health.harvard.edu]
Physician
  • The ICD-10-CM for Physicians & Hospitals 2018 is brimming with new and revised ICD-10-CM codes and their descriptors, along with expert guidance and the vital features you need for correct coding and reimbursement.[books.google.de]
  • New ‘In Adolescence’ boxes recognise the fact that many chronic disorders begin in childhood and become the responsibility of physicians practising adult medicine.[books.google.de]
  • All airlines have physician consultants and this might require the patient's physician talking directly with the airline's physician.[cnn.com]
  • Search Physicians View All Physicians Your Visit Your Visit We want your visit to go smoothly.[heart.phoenixchildrens.org]
  • Employees Volunteer Services Philanthropy Contact Us Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician[wakehealthse3.adam.com]
Heart Disease
  • disease · 398.0 Rheumatic myocarditis · Rheumatic degeneration of myocardium · Excludes: myocarditis not specified as rheumatic (429.0) · 398.9 Other and unspecified rheumatic heart diseases · 398.90 Rheumatic heart disease, unspecified · Rheumatic:[cairdtech.com]
  • […] of pulmonary valve I09.9 Rheumatic heart disease, unspecified Rheumatic: · carditis · heart failure Excludes: rheumatoid carditis ( M05.3 ) Processed on 29.10.2004 M.S.[apps.who.int]
  • Rheumatic heart disease is found in less percentage still FULL TEXT[annals.org]
  • Aortic stenosis is the most common valvulopathy , present in up to one-quarter of all patients with chronic valvular heart disease 1,2 .[radiopaedia.org]
  • .- ) I05-I09 Chronic rheumatic heart diseases I06 Rheumatic aortic valve diseases Excludes: • aortic valve disease not specified as rheumatic ( I35.- ) • aortic valve disease with mitral and/or tricuspid valve involvement ( I08.- )[coding-pro.com]
Heart Murmur
  • The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem.[icdlist.com]
  • They will listen to the person's heart with a stethoscope, listening for a heart murmur, click, or any other form of abnormal sound.[disabled-world.com]
  • A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. The provider may be able to feel a vibration or movement when placing a hand over the heart.[medlineplus.gov]
  • This is known as a heart murmur. It often indicates valve trouble, but not always. Continued After a full exam and a review of your medical history, your doctor may order a few tests.[webmd.com]
  • Patients with moderate to severe obstruction may have bluish discoloration of the skin, breathing difficulties, chest pain, fatigue, and heart murmur When treatment is necessary, the condition is treated either with balloon valvuloplasty or an open heart[dovemed.com]
Mitral Valve Prolapse
  • Cases of mitral valve prolapse were divided into 4 subgroups : rupture of chordae tendinea (15), absence of chordae (7) (complicated with chordal rupture), looping chordae (5) and idiopathic mitral valve prolapse (4).[ci.nii.ac.jp]
  • If they don't, you could have Regurgitation - when blood leaks back through the valve in the wrong direction Mitral valve prolapse - when one of the valves, the mitral valve, has "floppy" flaps and doesn't close tightly.[icdlist.com]
  • Most commonly affecting the mitral valve, it is a progressive process that represents slow degeneration from mitral valve prolapse (improper leaflet movement), a condition that affects 4-5 percent of the general population.[yourheartvalve.com]
Systolic Murmur
  • Ejection systolic murmur in aortic stenosis is preceded by a click and is best heard over the right upper sternal border, radiating into the suprasternal region and neck.[link.springer.com]
  • ) murmur that is heard on praecordial auscultation 1,2 .[radiopaedia.org]
Narrow Pulse Pressure
  • Clinical examination classically reveals a narrow pulse pressure, a slow-rising peripheral pulse, pulsus parvus et tardus (weak and delayed pulse) in the carotid pulse, a pressure loaded ('heaving') apex beat, and a crescendo-decrescendo mid-systolic[radiopaedia.org]
Denial
Stroke
  • A new chapter specifically on Stroke Disease recognises the emergence of Stroke Medicine as a distinct clinical and academic discipline.[books.google.de]
  • The latter is defined by an increase of stroke volume for at least 20% during dobutamine infusion [Figure 12].[wikiecho.org]
  • LV dysfunction stroke volume relatively fixed: falls in heart rate and in SVR believed to be poorly tolerated. In the case of the latter, a fall also reduces coronary perfusion pressure which may result in a reduction of cardiac output.[aic.cuhk.edu.hk]
  • Diastolic dysfunction necessitates stronger left atrial (LA) contraction to augment preload and maintain stroke volume. Loss of LA contraction by atrial fibrillation can induce acute deterioration.[unboundmedicine.com]
  • COMPENSATORY MECHANISMS: Frank-Starling: Increased preload -- LV Dilatation -- increased stroke volume Initially -- Increased LV Ejection Fraction -- increased stroke volume (Eventually -- LV systolic function deteriorates and CHF ensues) The severity[brown.edu]
Dizziness
  • They are decreased exercise tolerance, shortness of breath and fatigue -- all symptoms of chronic heart failure -- as well as dizziness, fainting, and chest pain. Once symptoms develop, even if they are mild, the AS is considered severe.[cnn.com]
  • The person can experience weakness, fainting, or dizziness with activity, or palpitations of their heart. Infants and children can experience symptoms such as fatigue, or becoming tired more easily than others.[disabled-world.com]
  • Fainting, weakness, or dizziness with activity.[medlineplus.gov]

Workup

  • Laboratory workup showed no inflammatory markers. Autoimmunity tests were all negative. A computed tomography angiography was performed in order to visualize the aorta, the main arteries ( Panel D ) and the valves ( Panel E ).[academic.oup.com]
Staphylococcus Aureus
  • A case of life‐threatening staphylococcus aureus endocarditis involving percutaneous transcatheter prosthetic pulmonary valve. Congenital heart disease , 8 (6), E161-E164. Kumar, R. K., & Tandon, R. (2013).[dovemed.com]
Left Ventricular Hypertrophy
  • In people with LVH, this PMI can actually move medially, or towards the sternum, and that would be a sign of left ventricular hypertrophy, meaning the muscle has kind of gotten thicker.[khanacademy.org]
  • A S4 heart sound is also often present due to the severe concentric left ventricular hypertrophy that develops in aortic stenosis.[healio.com]
  • This gradient may progressively increase without any significant changes to left ventricular function because of compensatory left ventricular hypertrophy, appreciated clinically by the pressure loaded apex beat 1,2 .[radiopaedia.org]
  • The classic triad of symptoms of significant aortic stenosis: (EFFORT ASD) (a) Effort A ngina (b) Effort S yncope (c) Effort D yspnoea (and Fatigue) Concentric left ventricular hypertrophy is an independent risk factor for operative mortality at aortic[cthsurgery.com]
  • Compensatory concentric left ventricular hypertrophy -- reduced LV compliance. Thus, LV is "stiff" (noncompliant) and LVEDP rises rapidly with increases in LV end-diastolic volume.[brown.edu]

Treatment

  • Conversely, even if no symptoms are present, it may be advisable to proceed with treatment or repairs based on the test results. Possible treatments may include valve repair or valve replacement .[heart.org]
  • Medications and surgery are the two possible treatment options for aortic valve disease. Your doctor would recommend appropriate treatment depending on the condition.[gleneaglesglobalhospitals.com]
  • Medical mild cases: prophylaxis against SBE moderate: above plus treatment of LVF.[aic.cuhk.edu.hk]
  • People with aortic stenosis should receive treatment for high cholesterol and quit smoking. They should also see a cardiologist every three-to-six months.[disabled-world.com]
  • Treatment for mitral valve stenosis can vary greatly, depending on your symptoms and the severity of the condition. If you have no symptoms and only mild mitral valve stenosis, you might not need any treatment.[healthline.com]

Prognosis

  • , prognosis, and additional useful information HERE .[dovemed.com]
  • LAD and/or QRS prolongation suggest diffuse myocardial disease, generally associated with patchy fibrosis, and usually indicate a poor prognosis CXR: LV dilatation, pulmonary venous hypertension.[aic.cuhk.edu.hk]
  • Paradoxical low-flow aortic stenosis may often be misdiagnosed, leading to an underestimation of symptoms and an inappropriate delay of aortic valve replacement surgery, without which the patients' prognosis is poor [5].[wikiecho.org]
  • Failure to normally increase BP and development of ST segment depression are less predictive of adverse prognosis. Exercise testing is contraindicated in symptomatic patients.[merckmanuals.com]
  • […] increased LV mass dynamic assessment on cine GRE or b-SSEP thickened valve leaflets with reduce excursion during systole size and extent of the high-velocity jet into the ascending aorta hyperdynamic LV contraction in compensated state Treatment and prognosis[radiopaedia.org]

Etiology

  • Classification and etiology There are numerous other predisposing factors and causes of aortic stenosis.[radiopaedia.org]
  • Increased LA pressure - Pulm HTN - RV Pressure Overload - RV failure & Tricuspid Regurgitation Etiology: Rheumatic Heart Disease Symptoms: Dyspnea, Orthopnea, PND Cough & Hemoptysis Atrial Fibrillation, LA thrombus and systemic Embolization RV failure[brown.edu]
  • The case against its being of rheumatic etiology. Am J Med 1970;49:151–159. Falcone MW, Roberts WC, Morrow AG, Perloff JK: Congenital aortic stenosis resulting from unicommissural valve. Clinical and anatomic features in twenty-one adult patients.[karger.com]
  • Etiology and Pathophysiology Progressive aortic leaflet thickening and calcification results in LV outflow obstruction. Obstruction causes increased afterload and, over time, decreased cardiac output.[unboundmedicine.com]
  • Etiology – Aortic Stenosis The most common cause of aortic stenosis in a person over age 70 years is calcification of a normal trileaflet aortic valve; this process is sometimes referred to as “senile degeneration.”[healio.com]

Epidemiology

  • Epidemiology Most common cause of LV outflow obstruction in both children and adults Predominant age 30 to 65 years: congenital or rheumatic fever (RF) 65 years: degenerative calcification of aortic valve Prevalence Affects 1.3% of population 65 to 74[unboundmedicine.com]
  • Aortic stenosis Epidemiology tends to present in fith to seventh decades 80% of patients with severe aortic stenosis are men Aetiology congenital: may lead to stenosis as birth or aortic stenosis may develop in later life due to haemodynamic stresses[aic.cuhk.edu.hk]
Sex distribution
Age distribution

Pathophysiology

  • Figure 3 -- Pathophysiology of acute and chronic mitral regurgitation Fig 3: Pathophysiology of mitral regurgitation .[brown.edu]
  • Etiology and Pathophysiology Progressive aortic leaflet thickening and calcification results in LV outflow obstruction. Obstruction causes increased afterload and, over time, decreased cardiac output.[unboundmedicine.com]
  • Aetiology congenital: may lead to stenosis as birth or aortic stenosis may develop in later life due to haemodynamic stresses on congenital bicuspid valve rheumatic heart disease idiopathic valve calcification: rarely leads to significant aortic stenosis Pathophysiology[aic.cuhk.edu.hk]
  • Pathophysiology The haemodynamic hallmark of aortic stenosis is the elevated gradient across the aortic valve which can be indirectly measured with doppler echocardiography.[wikiecho.org]
  • Pathophysiology Aortic regurgitation may accompany aortic stenosis, and about 60% of patients 60 yr with significant AS also have mitral annular calcification, which may lead to mitral regurgitation .[merckmanuals.com]

Prevention

  • Like valves used in house plumbing, the heart valves open to allow fluid (blood) to be pumped forward, and they close to prevent fluid from flowing backward. Human heart valves are flaps of tissue called leaflets or cusps.[health.harvard.edu]
  • In the normal heart, left ventricular (LV) contraction during systole forces blood exclusively through the aortic valve into the aorta; the closed mitral valve prevents regurgitation into the left atrium (LA).[brown.edu]
  • Prevention You can’t always stop aortic valve stenosis from happening. For instance, there’s nothing you can do about a heart defect from birth.[webmd.com]
  • In patients with valve replacement the prognosis is generally better Please find comprehensive information on Pulmonary Valve Stenosis regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention[dovemed.com]
  • With severe forms of aortic stenosis, enough blood is prevented from reaching the person's brain and the rest of their body that they may become light-headed and could potentially faint.[disabled-world.com]

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