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2.1
Rheumatic Aortic Valve Obstruction
Rheumatic Aortic Valve Stenosis

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]

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]

  • 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]

  • 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]

    Good evidence exists to demonstrate that certain characteristics of the peripheral pulse can rule in the diagnosis. [21] In particular, there may be a slow and/or sustained upstroke of the arterial pulse, and the pulse may be of low volume. [en.wikipedia.org]

Neurologic

  • 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]

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]

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]

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]

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]

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]

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]

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]

The etiology of pannus has yet to be fully clarified, 2 but is probably multifactorial. [revportcardiol.org]

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]

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]

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 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

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]

The structures supporting the heart valves weaken and stretch over time and this prevents the valves from closing properly. [patient.info]

Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after discharge from the hospital. [stanfordchildrens.org]

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