Presentation
A rationalisation of the 1350 boxes used throughout the book gives a simpler and clearer presentation of the various categories. [books.google.de]
Three patients presented mild tricuspid stenosis and one patient had moderate tricuspid stenosis. Two patients presented with mild pulmonary regurgitation and one patient presented with severe insufficiency. [ncbi.nlm.nih.gov]
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]
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]
Entire Body System
- Underweight
Characteristics Nº % Sex (n=104) Man 60 57.7 Woman 44 42.3 Origin (n=104) Capital 34 32.7 Interior 70 67.3 Body Mass Index (n=97) Underweight 8 8.2 Normal 67 69.1 Overweight 18 18.6 Obesity Grade 1 4 4.1 Diabetes Mellitus (n=104) Present 3 2.9 Absent [ncbi.nlm.nih.gov]
Cardiovascular
- Heart Disease
I1311Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease I132Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or [cms.gov]
Heart valve disease occurs when one or more of the heart valves do not open or close properly. When it affects more than one heart valve, it is called multiple valvular heart disease. [heartandstroke.ca]
heart disease is degenerative 2,3. [bcs.com]
· carditis · heart disease NOS · Excludes: carditis not specified as rheumatic (429.89) · heart disease NOS not specified as rheumatic (429.9) · 398.91 Rheumatic heart failure (congestive) · Rheumatic left ventricular failure · 398.99 Other [cairdtech.com]
Rheumatic disease 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]
- Hypertension
Pre-systolic accentuation (except in AF). � Graham Steele murmur (pulmonary regurgitation 2� to pulmonary hypertension) Investigations ECG p mitrale (notched and > 0.12 sec) � RVH 2� to pulmonary hypertension CXR enlarged LA and LA appendage upper lobe [aic.cuhk.edu.hk]
Commonly Associated Conditions CAD (50% of patients) Hypertension (40% of patients): results in “double-loaded” left ventricle (dual source of increased afterload as a result of obstruction from AS and hypertension) Aortic insufficiency (common in calcified [unboundmedicine.com]
Pulmonary Hypertension increases. Symptoms of the CHF appear. Efficient medical treatment of aortic stenosis does not exist. [cthsurgery.com]
Differentiation with hypertension can usually be made as in hypertension the entire descending aorta is enlarged 2, 5. [radiopaedia.org]
The systolic hypertension further increases left ventricle afterload. [textbookofcardiology.org]
- 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]
They are also at risk for a heart infection called bacterial endocarditis. A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. [medlineplus.gov]
A doctor listening to your heart with a stethoscope may hear a “whooshing” sound or an extra heart beat sound. This is known as a heart murmur. It often indicates valve trouble, but not always. [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
For more information: mitral valve prolapse Mitral Stenosis Mitral stenosis is a narrowing or blockage of the mitral valve, which causes blood to back flow into the left atrium instead of flowing down into the left ventricle. [my.clevelandclinic.org]
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]
Mitral valve prolapse is also called click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome. Tricuspid, pulmonary and aortic valve prolapse These prolapses are less common than mitral valve prolapse. [heartandstroke.ca]
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]
(or ejection systolic) murmur that is heard on praecordial auscultation 1,2. [radiopaedia.org]
Auscultation of this patient reveals a normal S 2 or a split S 2 sound, and often, a typical crescendo-decrescendo systolic ejection murmur that peaks early in systole. [emedicine.medscape.com]
On admission, he was apyretic, and cardiac auscultation revealed metallic heart sounds from the prosthetic valves and a systolic murmur of varying intensity throughout the precordium. [revportcardiol.org]
Musculoskeletal
- Arthritis
Rarer causes include inflammatory aortitis (associated with rheumatoid arthritis, ankylosing spondylitis, giant-cell arteritis and syphilis), aortic root aneurysm, silent chronic dissection and acute regurgitation- this is usually due to infective endocarditis [bcs.com]
Other rare causes of aortic stenosis include inflammatory diseases (i.e. systemic lupus erythematosus or rheumatoid arthritis), severe familial hypercholesterolemia, ochronosis, Paget’s disease of the bone and Fabry’s disease. [healio.com]
Appendix C: Principal diagnoses which convert CC/MCC to non-CC PDX Collection 0638:72 codes A0100Typhoid fever, unspecified A0101Typhoid meningitis A0102Typhoid fever with heart involvement A0103Typhoid pneumonia A0104Typhoid arthritis A0105Typhoid osteomyelitis [cms.gov]
Other systemic arteritides and connective tissue disorders such as Marfan syndrome, Reiter disease, Ehlers-Danlos syndrome, osteogenesis imperfecta, and rheumatoid arthritis can lead to annular dilatation and valvular insufficiency. [textbookofcardiology.org]
Neurologic
- 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]
For example, it may get stuck in a blood vessel going to the brain and cause a stroke. See the separate leaflet called Stroke. Endocarditis sometimes develops. This is an infection of the valve. [patient.info]
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]
This helps Heart & Stroke to deliver the greatest impact for Canadians living with structural heart disease and their families. [heartandstroke.ca]
- 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]
Fainting, dizziness or tiredness. If the amount of blood getting through to the ventricle is reduced, the output of blood from the left ventricle to the body is then reduced. Chest pains (angina). [patient.info]
Symptoms may include: Fatigue Dizziness with exertion Shortness of breath Irregular heartbeats or palpitations Chest pain The symptoms of aortic stenosis may look like other medical conditions or heart problems. [stanfordchildrens.org]
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]
Two-dimensional (2D) Doppler echocardiography is the imaging modality of choice to diagnose and estimate the severity of aortic stenosis and localize the level of obstruction (see Workup ). [emedicine.medscape.com]
T Wave
- T Wave Inversion
The ECG may show the strain pattern of lateral ST depression and T-wave inversion that marks left ventricular hypertrophy. As well, the P waves may show evidence of left atrial enlargement. [emedicine.medscape.com]
At this point there may be signs of ventricular strain pattern (ST segment depression and T wave inversion) on the EKG, suggesting subendocardial ischemia. [en.wikipedia.org]
A variety of ST-T-wave changes, including T-wave inversion and sometimes ST-segment depression, particularly in the inferior leads, can be found in patients with symptomatic mitral valve prolapse. [textbookofcardiology.org]
Hypertrophy
- 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]
- Development of left ventricular diastolic dysfunction. [cthsurgery.com]
Due to increases in left ventricular pressure from the stenotic aortic valve, over time the ventricle may hypertrophy, resulting in a diastolic dysfunction. [en.wikipedia.org]
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]
Medical mild cases: prophylaxis against SBE moderate: above plus treatment of LVF. [aic.cuhk.edu.hk]
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]
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]
Men with MVP are more likely than women to require surgical treatment, and the need for surgery increases with age. Overall, 60 percent of people with MVP will not require treatment. [my.clevelandclinic.org]
Prognosis
prognosis, and additional useful information HERE. [dovemed.com]
Congestive heart failure [ edit ] Congestive heart failure (CHF) carries a grave prognosis in people with AS. [en.wikipedia.org]
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]
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]
[…] ses ) an abnormal narrowing or contraction of a body passage or opening; called also arctation, coarctation, and stricture. aortic stenosis obstruction to the outflow of blood from the left ventricle into the aorta; in the majority of adult cases the etiology [medical-dictionary.thefreedictionary.com]
The etiology of pannus has yet to be fully clarified, 2 but is probably multifactorial. [revportcardiol.org]
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]
Epidemiology
Pulmonary/ Tricuspid Valve Disease The elderly population rarely presents with primary disease of these valves and there are no meaningful epidemiological data available. [bcs.com]
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]
Clinical and epidemiological characteristics of the study population are shown in Table 1. Table 1 Clinical and epidemiological characteristics of the study population. Salvador, 2007-2011. [ncbi.nlm.nih.gov]
[…] of 50-60% and a 3-year survival rate of less than 30%. [33] Prognosis after aortic valve replacement for people who are younger than 65 is about five years less than that of the general population; for people older than 65 it is about the same. [30] Epidemiology [en.wikipedia.org]
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]
Pathophysiology of Heart Disease (3rd ed.). Lippincott Williams & Wilkins. ISBN 0-7817-4027-4. ^ G. Morris, Innasimuthu A L, J.P. Fox, R.A. [en.wikipedia.org]
"Pathophysiology of Aortic Valve Disease." Cardiac Surgery in the Adult. Ed. Cohn L.H. Third Edition ed. McGraw-Hill Education, 2012. 825-40. [textbookofcardiology.org]
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]
Prevention
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]
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]
The possible impact of secondary prevention measures, particularly lipid lowering with statins, on the progression of aortic stenosis has been investigated. [columbiasurgery.org]
Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after discharge from the hospital. [stanfordchildrens.org]
The structures supporting the heart valves weaken and stretch over time and this prevents the valves from closing properly. [patient.info]