Case study valvular heart disease

Normal AVA is 2. Moderate stenosis is when the AVA is within the range of 0. A patient with a large peak pressure gradient usually more than 75 mm Hg in the absence of excessively high cardiac output is usually considered to have severe AS as case study valvular heart disease.

In the setting of low case study valvular heart disease outputs, the pressure gradient may not be that great 20 to 30 mm Hgand determination of AVA is required. This can be accomplished with echocardiography. MR is graded essay animal research the amount of blood regurgitated backward into the left atrium during systole.

Doppler color flow permits quantification of this flow.

The following case study will be used for the discussion on Aortic Valve Disease. In the comments below, let Dr. Heuser know how you would manage this patient: An year-old healthy male comes to see you with symptomatic aortic stenosis.

Other methods of quantification include calculation of the area of the regurgitant jet by planimetry, by comparison of the MR jet area to the area of the left atrium, and by analysis of pulmonary vein flow profiles. It is important to remember that the amount of regurgitant blood flow in the setting of MR is determined by the amount of time spent in systole, the size of the defect in the MV, and the pressure ap english synthesis essay usps across the defect.

Thus, MR severity by Doppler color flow is load dependent. The lower pressure of the anesthetic state can often mask more severe degrees of MR seen when the patient is under his or her usual hemodynamic conditions.

The left ventricular pressures are increased in the setting of AS. Therefore, the gradient across the MV is increased often leading to more severe MR. Following replacement of the stenotic aortic valve and elimination of the case study valvular heart disease tract obstruction, left ventricular pressures are markedly reduced.

Moderate levels of MR without major structural defects in the MV apparatus usually revert to minimal or certainly less severe levels following reduction in the left ventricular outflow obstruction. Grayburn PA, et al. Quantitative assessment of mitral regurgitation by Doppler color flow imaging. Angiographic and hemodynamic correlations.

What special considerations particular to cardiopulmonary bypass CPB operations do you have for each of the four lesions? Focus on these concerns with respect to the induction and prebypass, bypass, and postbypass periods. Aortic stenosis Critical to the management of a patient with AS is the avoidance of hypotension.

Low blood pressure can initiate a cascade of how to write a great cover letter video leading to cardiac arrest.

Hypotension decreases the gradient for coronary perfusion with resultant essay on islam ki barkatein Ischemia leads to diminished cardiac output and decreased blood pressure further compromising coronary perfusion. The occurrence of cardiac arrest in a patient with AS is particularly catastrophic because closed case study valvular heart disease cardiac massage will provide little gradient for blood flow across a stenotic aortic valve.

Patients with AS are particularly dependent on their atrial kick for adequate ventricular filling volume and can rapidly become hypotensive and ischemic following the onset of an supraventricular tachycardia SVT or atrial fibrillation. These rhythms are not uncommon during atrial cannulation. Therefore, it is of particular importance that every preparation for the initiation of CPB be made before atrial manipulation.

Increased muscle mass of LVH can be more difficult to adequately protect with cardioplegia. Following aortic valve replacement, hypertension from left ventricular output now unopposed by any valvular lesion can result in stress on suture lines and excessive bleeding. It is important to remember that the compliance of the LV is unchanged by surgery and still critically dependent on adequate preload and sinus rhythm.

The usual treatment measures for hypotension -agonist may have deleterious effects by increasing regurgitant volume. The use of combined – and -agonists, ephedrine, epinephrine, or infusions of dopamine or dobutamine may be required. Although it would serve to lessen regurgitant volume, afterload reduction is beneficial in only a subset of patients with AI.

Those patients with elevated LVEDP, reduced EFs, diminished cardiac output, and systemic hypertension usually benefit from afterload reduction. In contrast, those patients without the previously mentioned constellation may experience a decrease in forward cardiac output secondary to diminished preload from reduced venous return. Systemic hypotension usually cases study valvular heart disease the utility in the acute setting.

Periods of bradycardia or ventricular fibrillation can lead to rapid volume overload of the LV through the incompetent aortic valve. Similarly, myocardial protection is compromised by AI. Generation of adequate root pressures is usually not obtainable; hence delivery of cardioplegia requires aortotomy and cannulation of the coronary ostia. Use of retrograde cardioplegia write paper for me advantageous. Inotropic support is often required. As with AS, the presence of an aortic suture line necessitates rapid response to hypertension to avoid bleeding and dissection.

Marked elevations in pulmonary vascular resistance can be present with associated right heart failure. Stasis in the left atrium necessitates the careful echocardiographic examination for the presence of atrial thrombi.

Manipulation of the heart before cross-clamping should be avoided. Following replacement, the chronically under filled, under worked LV may be unable to case study valvular heart disease the new volume load. Inotropic support is usually required. Afterload reduction and improved systemic perfusion via an IABP may be beneficial. Similarly, patients with MR may have Cover letter meeting selection criteria hypertension and right heart failure.

Case Study: Aortic Valve Disease

Diminution of left ventricular systolic pressure via afterload reduction decreases the pressure gradient from the LV to the left case study valvular heart disease during systole with resultant decreased regurgitant volume. Prebypass assessment can be misleading. Preserved EFs and elevated SVs may mask marked left ventricular systolic dysfunction. This route is no longer available after valve replacement.

Following MV replacement, dysfunctional ventricles may be unable to provide adequate forward flow into the systemic case study valvular heart disease with its elevated vascular resistance and usually necessitate the use of inotropic support. Patients previously in atrial fibrillation without marked atrial enlargement often revert to or can be converted to sinus rhythm following valve replacement.

The capacity of maintaining a person in sinus rhythm dramatically decreases when the diameter of the atrium is more than 5 cm.

The patient cannot be weaned from bypass following an aortic and mitral valve MV replacement. What are the possible causes? The adequacy of myocardial preservation should be considered. LVH without or with accompanying coronary artery disease increases myocardial oxygen demands. In addition, there may be residual cardioplegia present within the myocardium. Therefore, some degree of postbypass left ventricular dysfunction can be anticipated.

Inotropic support may be required. It is important to remember that although the obstruction to left ventricular case study valvular heart disease is acutely relieved by replacement of the stenotic valve, left ventricular compliance is largely unchanged.

Elevations in pulmonary vascular resistance may render estimation of LA pressure via the PA catheter inaccurate. In this setting, placement of an LA catheter is indicated. TEE may prove invaluable in identifying surgically correctable causes for inability to wean from CPB.

Evaluation of left ventricular filling and contractility can help resolve the situation of low cardiac output and high filling pressures. A small under-filled LV with hyperdynamic contractility and a dilated, overfilled, hypokinetic LV can both case study valvular heart disease the same hemodynamic parameters but obviously require different pharmacologic interventions.

Similarly, perivalvular leaks or aortic dissections can be readily identified. How would you diagnose right heart failure and pulmonary hypertension?

How would you treat it? Right heart failure is diagnosed by the elevations in right-sided case study valvular heart disease pressures, specifically central venous pressure CVP. Careful examination is required to rule out tricuspid insufficiency as the cause of the CVP elevation.

A high CVP indicates the inability of the right heart to adequately propel the venous return volume into the pulmonary circulation. Elevation in the PA pressures is indicative of case study zero waste hypertension.

This scenario can be difficult to manage. Attempts to elevate systemic perfusion pressure with -agonists can worsen pulmonary hypertension. Administration of vasodilators to lower pulmonary pressures results in systemic hypotension.

In this setting, it is often prudent to return to CPB, relieve ventricular distention, and improve myocardial perfusion. During this «rest period,» adjustments in inotropic therapy, ventilation, and cardiac rhythm can be instituted. Optimization of acid-base status and hemoglobin concentration should also be performed. Separation from bypass can then be reattempted. Typical inotropic cases study valvular heart disease effective in this setting are those with high degrees of -adrenergic potency.

It is not uncommon to wpp1gerard.000webhostapp.com the administration of -agonists to counteract the systemic vasodilating effects of prostaglandin E1 and the PDI-III agents.

Some selective pulmonary vasodilating action and systemic vasoconstricting effects can often be achieved by administration of pulmonary vasodilating agents such as prostaglandin E1 via the right-sided access CVP or PA catheter and infusion Service writing positions the -agonists via the LA line.

Thus, the vasoconstriction of the pulmonary arterial bed can be minimized. Nitric oxide NO is a potent, inhaled pulmonary vasodilator. Adhere to a prescribed treatment program for other forms of heart disease. If you are diabetic, maintain careful control of your blood sugar. Diagnosis During your examination, the doctor listens for distinctive heart sounds, known as heart murmurs, which indicate valvular heart disease. As part of your diagnosis, you may undergo one or more of the following tests: An electrocardiogram, also called an ECG or EKG, to measure the electrical activity of the heart, regularity of heartbeats, thickening of How to write application letter to a company in nigeria muscle hypertrophy and heart-muscle damage from coronary artery disease.

Stress testing, also known as treadmill tests, to case study valvular heart disease blood pressure, heart rate, ECG changes and breathing rates during exercise. Echocardiogram to evaluate heart function. During this test, sound waves bounced off the heart are recorded and translated into images.

The pictures can reveal abnormal heart size, shape and movement. Echocardiography also can be used to calculate the ejection fraction, or volume of blood pumped out to the body when the case study valvular heart disease contracts.

Cardiac catheterization, which is the threading of a catheter into the heart chambers to measure pressure irregularities across the valves to detect stenosis or to observe backflow of an injected dye on an X-ray to detect incompetence. Treatment The following provides an overview of the treatment options for valvular heart disease: Avoid excessive alcohol consumption, excessive salt intake and diet pills—all of which may raise blood pressure.

A course of antibiotics is prescribed prior to surgery or dental work for those with valvular heart disease, to prevent bacterial endocarditis. Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.

The classification of mitral regurgitations regarding unexplained and explained etiologies was performed on the basis of routine medical charts. It was impossible to achieve this in only 2. Classification bias is unlikely to have occurred since the whole processing was blinded to drug exposure.

Patients were identified through ICDCM codes, irrespective of the severity of mitral regurgitation, and it critical thinking activities fourth grade difficult to assess this severity retrospectively. However, a mitral regurgitation which is given a diagnosis code in the hospital discharge file is more than likely to be clinically significant.

Benfluorex and Unexplained Valvular Heart Disease: A Case-Control Study

Moreover, a mitral surgical procedure was necessary in half of the cases and the controls. Benfluorex has been marketed in France since ; hence some patients may have forgotten a former use of the medication.

However, we asked physicians to check each patient’s file for all prior medication use. Because of the retrospective design of the study, precise timing, dose and duration of exposure were not always available, and we could not study the dose-effect relationship. We have focused our main analysis explain the strengths of natural law theory essay the use or case study valvular heart disease of benfluorex, without taking into account the timing of the exposure because the data on timing of use and its relation to the exact date of diagnosis was uncertain for some patients.

If we limit the exposure to those occurring before the diagnosis of mitral regurgitation, the odds ratio is increased to infinity. Information on drug exposure was collected blindly from the patient’s status. A recall bias is unlikely to have occurred since firstly, cases and controls shared the same cardiac case study valvular heart disease, and secondly the association between benfluorex and mitral regurgitation was not known. Some patients were also previous users of amphetamine derivatives, mainly dexfenfluramine, and this could have contributed to case study valvular heart disease sateeq954.000webhostapp.com However, dexfenfluramine was withdrawn from the market insix years before the beginning of our study inclusion period.

Therefore, dexfenfluramine is unlikely to have played a role among our patients especially as the short-term effect of dexfenfluramine on regurgitation has been dani yogatama thesis our study, the association between benfluorex and unexplained mitral regurgitation was independent from dexfenfluramine exposure.

In their landmark study published inConnolly et al. One case study valvular heart disease later, the results of three studies conducted chicago booth essay pictures different settings with different designs were made available: All three studies, though differing with regard to the strength of the statistical association and clinical significance, supported an association between the use of fenfluramine derivatives and valvular heart regurgitation.

Similarly, following the identification of valvular heart disease in three patients taking pergolide [14]another serotoninergic medication, two case-control studies reported an case study valvular heart disease between the use of dopamine agonists, pergolide and cabergoline, and valve regurgitation [15][16].

Meanwhile, evidence for possible involvement of 5-HT2B receptors in the cardiac valvular heart disease associated with ergot derivatives, dopamine agonists and amphetamine derivatives fenfluramine and methylenedioxymethamphetamine has been provided [17].

Consequently, practitioners were warned of the possible side effects of potent 5-HT2B receptor agonists [3][18].

djJ1i

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