The document discusses various types of valvular heart disease, including aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. It provides details on the causes, symptoms, physical exam findings, diagnostic tests and treatments for each condition. For aortic stenosis, the case describes a 67-year-old male with symptoms of dyspnea and chest pain, who is found to have a systolic thrill and murmur, indicating severe aortic valve stenosis. Diagnostic tests and treatments are outlined for each valvular disease.
AR, or aortic regurgitation, occurs when the aortic valve does not close properly, allowing blood to flow backward into the left ventricle. It can be caused by damage to the aortic valve leaflets or distortion/dilation of the aortic root. In developed countries, the most common causes are aortic root dilation or a congenital bicuspid aortic valve. AR is more common in men than women. Symptomatic patients or asymptomatic patients with reduced ejection fraction or increased left ventricular dimensions require surgical treatment such as aortic valve replacement. The prognosis depends on symptoms and left ventricular function, with asymptomatic patients having normal ejection fraction having an excellent long-term prognosis.
This document discusses ventricular septal defects (VSDs), including their anatomy, types, clinical presentation, diagnostic workup, and management. The key points are:
1. VSDs allow blood to pass abnormal from the left to the right ventricle. The patient presented has symptoms of a long-standing moderate VSD.
2. Echocardiography is the primary imaging modality used to characterize VSD location, size, complications like pulmonary hypertension.
3. Treatment indications for VSDs include the presence of heart failure symptoms or pulmonary hypertension. Surgical closure or catheter device closure are options.
The document discusses several types of congenital heart diseases including patent ductus arteriosus (PDA), pulmonary stenosis, coarctation of the aorta, transposition of the great arteries, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome, and double outlet right ventricle. For each condition, it describes the anatomy, signs and symptoms, diagnosis, and management approaches including medical, catheter-based, and surgical treatments.
Electrocardiography in Adult Congenital Heart DiseasesSaleh AL-Hatem
The document discusses various types of congenital heart defects seen in adults, including their typical ECG presentations. For ostium secundum atrial septal defects, unrepaired defects are commonly associated with sinus rhythm on ECG, though atrial fibrillation risk increases with age. Surgical closure may reduce but not eliminate postoperative atrial arrhythmias, especially in older patients. For ventricular septal defects, ECG findings depend on the degree of left and right ventricular overload. Large unrepaired defects can cause right and left atrial enlargement and right axis deviation on ECG. Atrioventricular canal defects are associated with first-degree atrioventricular block and left axis deviation on ECG due to
This document discusses aortic valve stenosis, including its anatomy, function, causes, pathophysiology, classification, signs and symptoms, diagnostic evaluation, and treatment options. Key points include:
- Aortic stenosis is caused by calcification and stiffening of the aortic valve leaflets, restricting their opening and increasing the pressure gradient between the left ventricle and aorta.
- It can be congenital due to a bicuspid aortic valve or acquired from degeneration, rheumatic fever, or radiation exposure.
- Symptoms include angina, syncope, and dyspnea as the left ventricle hypertrophies and diastolic function declines in response to the increased
Atrial septal defect (ASD) is an abnormal opening in the wall separating the left and right atria of the heart. There are several types of ASDs including secundum, ostium primum, sinus venosus, and coronary sinus defects. ASDs are usually diagnosed through echocardiography which can determine the size and location of the defect. Small, asymptomatic ASDs may not require treatment, but larger defects with evidence of right heart strain often warrant closure either through open heart surgery or a nonsurgical approach using an implantable device delivered through catheters. Both methods effectively close the defect to prevent long-term complications like heart failure and pulmonary hypertension.
Atrial septal defect (ASD) is an abnormal opening in the wall separating the left and right atria of the heart. There are several types of ASDs. Secundum ASDs, which occur in the fossa ovalis, account for 75% of cases. ASDs are usually diagnosed with echocardiography. Small, asymptomatic ASDs may not require treatment, but larger defects can cause heart failure and pulmonary hypertension if left untreated. Larger ASDs are often closed either surgically or non-surgically using devices delivered through catheters. Both methods are generally effective though surgery carries risks of complications.
AR, or aortic regurgitation, occurs when the aortic valve does not close properly, allowing blood to flow backward into the left ventricle. It can be caused by damage to the aortic valve leaflets or distortion/dilation of the aortic root. In developed countries, the most common causes are aortic root dilation or a congenital bicuspid aortic valve. AR is more common in men than women. Symptomatic patients or asymptomatic patients with reduced ejection fraction or increased left ventricular dimensions require surgical treatment such as aortic valve replacement. The prognosis depends on symptoms and left ventricular function, with asymptomatic patients having normal ejection fraction having an excellent long-term prognosis.
This document discusses ventricular septal defects (VSDs), including their anatomy, types, clinical presentation, diagnostic workup, and management. The key points are:
1. VSDs allow blood to pass abnormal from the left to the right ventricle. The patient presented has symptoms of a long-standing moderate VSD.
2. Echocardiography is the primary imaging modality used to characterize VSD location, size, complications like pulmonary hypertension.
3. Treatment indications for VSDs include the presence of heart failure symptoms or pulmonary hypertension. Surgical closure or catheter device closure are options.
The document discusses several types of congenital heart diseases including patent ductus arteriosus (PDA), pulmonary stenosis, coarctation of the aorta, transposition of the great arteries, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome, and double outlet right ventricle. For each condition, it describes the anatomy, signs and symptoms, diagnosis, and management approaches including medical, catheter-based, and surgical treatments.
Electrocardiography in Adult Congenital Heart DiseasesSaleh AL-Hatem
The document discusses various types of congenital heart defects seen in adults, including their typical ECG presentations. For ostium secundum atrial septal defects, unrepaired defects are commonly associated with sinus rhythm on ECG, though atrial fibrillation risk increases with age. Surgical closure may reduce but not eliminate postoperative atrial arrhythmias, especially in older patients. For ventricular septal defects, ECG findings depend on the degree of left and right ventricular overload. Large unrepaired defects can cause right and left atrial enlargement and right axis deviation on ECG. Atrioventricular canal defects are associated with first-degree atrioventricular block and left axis deviation on ECG due to
This document discusses aortic valve stenosis, including its anatomy, function, causes, pathophysiology, classification, signs and symptoms, diagnostic evaluation, and treatment options. Key points include:
- Aortic stenosis is caused by calcification and stiffening of the aortic valve leaflets, restricting their opening and increasing the pressure gradient between the left ventricle and aorta.
- It can be congenital due to a bicuspid aortic valve or acquired from degeneration, rheumatic fever, or radiation exposure.
- Symptoms include angina, syncope, and dyspnea as the left ventricle hypertrophies and diastolic function declines in response to the increased
Atrial septal defect (ASD) is an abnormal opening in the wall separating the left and right atria of the heart. There are several types of ASDs including secundum, ostium primum, sinus venosus, and coronary sinus defects. ASDs are usually diagnosed through echocardiography which can determine the size and location of the defect. Small, asymptomatic ASDs may not require treatment, but larger defects with evidence of right heart strain often warrant closure either through open heart surgery or a nonsurgical approach using an implantable device delivered through catheters. Both methods effectively close the defect to prevent long-term complications like heart failure and pulmonary hypertension.
Atrial septal defect (ASD) is an abnormal opening in the wall separating the left and right atria of the heart. There are several types of ASDs. Secundum ASDs, which occur in the fossa ovalis, account for 75% of cases. ASDs are usually diagnosed with echocardiography. Small, asymptomatic ASDs may not require treatment, but larger defects can cause heart failure and pulmonary hypertension if left untreated. Larger ASDs are often closed either surgically or non-surgically using devices delivered through catheters. Both methods are generally effective though surgery carries risks of complications.
NATURAL HISTORY, HEMODYNAMICS AND SURGICAL MANAGEMENT OF AORTIC STENOSIS.pptxShivani Rao
1) Natural history, hemodynamics, and surgical management of aortic stenosis is discussed. Aortic stenosis results from various etiologies and causes a reduction in aortic valve area, increasing pressure gradients and left ventricular hypertrophy.
2) Symptoms of aortic stenosis include angina, syncope and heart failure. Surgical aortic valve replacement is recommended for severe symptomatic stenosis to improve survival. Asymptomatic patients with severe stenosis may also benefit from early surgery, particularly if the stenosis is very severe or rapidly progressing.
3) Hemodynamic parameters like aortic jet velocity and mean pressure gradient determined by echocardiography are used to classify the severity of aortic stenosis and guide
The document discusses aortic regurgitation, including its anatomy, etiology, pathophysiology, epidemiology, clinical manifestations, diagnosis, and management. Key points include:
- Aortic regurgitation occurs when the aortic valve fails to close properly, allowing blood to flow back into the left ventricle during diastole.
- Causes include conditions like infective endocarditis, bicuspid aortic valve, hypertension, and Marfan syndrome.
- In acute severe cases, a rapid increase in left ventricular preload can cause pulmonary edema and cardiogenic shock. Chronic cases involve left ventricular dilation and hypertrophy to compensate for the increased preload over time.
- Physical exam may
Valvular heart disease refers to abnormalities of the heart valves that result in obstruction of blood flow or backflow of blood. Echocardiography plays a key role in evaluating valve function and structure non-invasively. Common valvular abnormalities include aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Treatment depends on severity and symptoms, ranging from medical management to surgical repair or replacement of the affected valve.
This document discusses valvular heart disease, focusing on aortic stenosis, mitral stenosis, aortic regurgitation, and mitral regurgitation. It covers the etiology, pathophysiology, presentation, evaluation, and management of each condition. For aortic and mitral stenosis, the goals are to recognize symptoms of severe disease and identify patients who need valve replacement. For regurgitant lesions, treatment focuses on supporting cardiac function medically until symptoms appear or structural deterioration occurs, then referring for surgical intervention. Echocardiography plays a key role in diagnosing severity and monitoring progression.
Congenital heart diseases are abnormalities present at birth that obstruct blood flow or alter the pathway of blood circulating through the heart. They originate during embryonic development between weeks 3-8.
The document discusses various types of congenital heart defects such as atrial septal defects (ASD), ventricular septal defects (VSD), and endocardial cushion defects. It provides details on the anatomy, symptoms, diagnosis, and treatment of these conditions. Echocardiography plays a key role in the evaluation and management of congenital heart diseases.
Adult Congenital Heart Disease can affect over 1 million adults in the US. Common conditions include Atrial Septal Defects, Ventricular Septal Defects, Patent Ductus Arteriosus, Bicuspid Aortic Valve, Coarctation of the Aorta, Tetralogy of Fallot, and Transposition of the Great Arteries. Clinical presentation and treatment depends on the specific condition and degree of severity. Long term monitoring is important for complications. Pregnancy can also pose additional risks for some congenital heart conditions.
The document discusses diseases of the aorta, including congenital anomalies, aortic aneurysms, and aortic dissections. It describes the structure and function of the aorta and risk factors for diseases like smoking and hypertension. Symptoms, investigations, and treatments are outlined for different aortic conditions such as thoracic and abdominal aortic aneurysms. Surgical and endovascular repair options are discussed for larger aneurysms at higher risk of rupture.
Valvular heart disease refers to disorders that affect one of the heart's valves, causing stenosis (narrowing) or regurgitation (leakage). The major types are aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, and tricuspid regurgitation. Symptoms depend on the specific valve affected and include shortness of breath, chest pain, fatigue, and heart failure. Diagnosis involves listening for murmurs, ECGs, echocardiograms, and cardiac catheterization. Treatment ranges from medication and lifestyle changes to surgery depending on severity, with valve replacement or repair being done for severe cases.
Single ventricle physiology involves a heart with only one functional pumping chamber. The document discusses the anatomy, physiology, and surgical management of various types of single ventricle hearts. Key points include: the goal of initial surgery is to provide unobstructed systemic outflow and pulmonary blood flow while limiting pulmonary pressures; manipulation of pulmonary and systemic vascular resistances is important for balancing blood flow; and inotropic support can increase cardiac output while adjusting pulmonary to systemic flow ratios.
This document discusses coarctation of the aorta, a congenital heart defect where the aorta is narrowed or constricted. It accounts for 5-8% of congenital heart defects. Coarctation can occur isolated or with other defects like bicuspid aortic valve or ventricular septal defect. Clinical presentation depends on age - infants may present with heart failure while older children and adults often present with hypertension. Imaging like chest x-ray and echocardiogram are used for diagnosis. Treatment involves surgery to repair the coarctation.
This document discusses several types of congenital heart diseases including their etiology, pathophysiology, clinical manifestations, diagnostic evaluation, and management. It covers tetralogy of fallot, persistent ductus arteriosus, atrial septal defect, and ventricular septal defect. For each condition, it provides details on the anatomical defects involved, characteristic signs and symptoms, relevant test findings, and treatment options including surgical repair when indicated.
Congenital Heart Disorders (TOF, TGV, COA) Kishore Rajan
This document discusses several congenital heart defects including coarctation of the aorta, tetralogy of Fallot, and transposition of the great arteries. Coarctation is a narrowing of the aorta near the ductus arteriosus. Tetralogy of Fallot consists of four defects that result in deoxygenated blood mixing with oxygenated blood. Transposition of the great arteries is a condition where the pulmonary artery and aorta are connected to the wrong ventricles, preventing proper oxygenation of blood. The document provides details on the pathophysiology, clinical presentation, diagnostic workup and management of each of these conditions.
Tricuspid atresia is a congenital heart defect where the tricuspid valve is absent or not formed, preventing communication between the right atrium and right ventricle. It occurs in approximately 0.06 per 1000 live births with no gender predominance. The condition ranges in severity from complete absence of the tricuspid valve to stenosis. Early presentation includes severe cyanosis, hypoxemia, and acidosis in infants with low pulmonary blood flow, while those with higher flow present with heart failure symptoms later in infancy. Echocardiography can identify the absent tricuspid valve and associated defects. Without surgical intervention, few infants survive beyond 6 months, but current treatments including shunts and the
This document summarizes various heart diseases including coronary heart disease, stable angina, acute myocardial infarction, valvular heart diseases, and their appearances on chest radiographs. Coronary artery disease is caused by atherosclerosis and presents as coronary calcification or cardiomyopathy. Acute MI can cause pulmonary edema on CXR. Valvular diseases like aortic stenosis present with left ventricular hypertrophy and calcification while aortic regurgitation causes cardiomegaly. Mitral stenosis presents with left atrial enlargement and pulmonary hypertension.
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare congenital heart defect where the pulmonary valve is blocked, preventing blood flow to the lungs. It is characterized by an underdeveloped right ventricle and connections between the right ventricle and coronary arteries. Newborns present with cyanosis and rely on a patent ductus arteriosus for pulmonary blood flow. Without intervention, most infants will die within the first few months of life. Treatment involves surgical procedures like the Blalock-Taussig shunt, bidirectional Glenn procedure, and Fontan operation to redirect blood flow to the lungs without using the right ventricle.
Congenital heart disease is a general term for a range of birth defects that affect the normal way the heart works. The term "congenital" means the condition is present from birth.
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...Azad Haleem
This document provides information on various types of congenital heart defects (CHDs), including descriptions, classifications, pathophysiology, clinical manifestations, investigations, and management. It discusses ventricular septal defects (VSDs), atrial septal defects (ASDs), patent ductus arteriosus (PDA), coarctation of the aorta, tetralogy of Fallot, and cyanosis. VSDs, ASDs, and PDA are examples of acyanotic left-to-right shunt lesions, while tetralogy of Fallot is a common cyanotic heart defect. Clinical features, imaging findings, and treatment approaches are described for each condition.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
NATURAL HISTORY, HEMODYNAMICS AND SURGICAL MANAGEMENT OF AORTIC STENOSIS.pptxShivani Rao
1) Natural history, hemodynamics, and surgical management of aortic stenosis is discussed. Aortic stenosis results from various etiologies and causes a reduction in aortic valve area, increasing pressure gradients and left ventricular hypertrophy.
2) Symptoms of aortic stenosis include angina, syncope and heart failure. Surgical aortic valve replacement is recommended for severe symptomatic stenosis to improve survival. Asymptomatic patients with severe stenosis may also benefit from early surgery, particularly if the stenosis is very severe or rapidly progressing.
3) Hemodynamic parameters like aortic jet velocity and mean pressure gradient determined by echocardiography are used to classify the severity of aortic stenosis and guide
The document discusses aortic regurgitation, including its anatomy, etiology, pathophysiology, epidemiology, clinical manifestations, diagnosis, and management. Key points include:
- Aortic regurgitation occurs when the aortic valve fails to close properly, allowing blood to flow back into the left ventricle during diastole.
- Causes include conditions like infective endocarditis, bicuspid aortic valve, hypertension, and Marfan syndrome.
- In acute severe cases, a rapid increase in left ventricular preload can cause pulmonary edema and cardiogenic shock. Chronic cases involve left ventricular dilation and hypertrophy to compensate for the increased preload over time.
- Physical exam may
Valvular heart disease refers to abnormalities of the heart valves that result in obstruction of blood flow or backflow of blood. Echocardiography plays a key role in evaluating valve function and structure non-invasively. Common valvular abnormalities include aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Treatment depends on severity and symptoms, ranging from medical management to surgical repair or replacement of the affected valve.
This document discusses valvular heart disease, focusing on aortic stenosis, mitral stenosis, aortic regurgitation, and mitral regurgitation. It covers the etiology, pathophysiology, presentation, evaluation, and management of each condition. For aortic and mitral stenosis, the goals are to recognize symptoms of severe disease and identify patients who need valve replacement. For regurgitant lesions, treatment focuses on supporting cardiac function medically until symptoms appear or structural deterioration occurs, then referring for surgical intervention. Echocardiography plays a key role in diagnosing severity and monitoring progression.
Congenital heart diseases are abnormalities present at birth that obstruct blood flow or alter the pathway of blood circulating through the heart. They originate during embryonic development between weeks 3-8.
The document discusses various types of congenital heart defects such as atrial septal defects (ASD), ventricular septal defects (VSD), and endocardial cushion defects. It provides details on the anatomy, symptoms, diagnosis, and treatment of these conditions. Echocardiography plays a key role in the evaluation and management of congenital heart diseases.
Adult Congenital Heart Disease can affect over 1 million adults in the US. Common conditions include Atrial Septal Defects, Ventricular Septal Defects, Patent Ductus Arteriosus, Bicuspid Aortic Valve, Coarctation of the Aorta, Tetralogy of Fallot, and Transposition of the Great Arteries. Clinical presentation and treatment depends on the specific condition and degree of severity. Long term monitoring is important for complications. Pregnancy can also pose additional risks for some congenital heart conditions.
The document discusses diseases of the aorta, including congenital anomalies, aortic aneurysms, and aortic dissections. It describes the structure and function of the aorta and risk factors for diseases like smoking and hypertension. Symptoms, investigations, and treatments are outlined for different aortic conditions such as thoracic and abdominal aortic aneurysms. Surgical and endovascular repair options are discussed for larger aneurysms at higher risk of rupture.
Valvular heart disease refers to disorders that affect one of the heart's valves, causing stenosis (narrowing) or regurgitation (leakage). The major types are aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, and tricuspid regurgitation. Symptoms depend on the specific valve affected and include shortness of breath, chest pain, fatigue, and heart failure. Diagnosis involves listening for murmurs, ECGs, echocardiograms, and cardiac catheterization. Treatment ranges from medication and lifestyle changes to surgery depending on severity, with valve replacement or repair being done for severe cases.
Single ventricle physiology involves a heart with only one functional pumping chamber. The document discusses the anatomy, physiology, and surgical management of various types of single ventricle hearts. Key points include: the goal of initial surgery is to provide unobstructed systemic outflow and pulmonary blood flow while limiting pulmonary pressures; manipulation of pulmonary and systemic vascular resistances is important for balancing blood flow; and inotropic support can increase cardiac output while adjusting pulmonary to systemic flow ratios.
This document discusses coarctation of the aorta, a congenital heart defect where the aorta is narrowed or constricted. It accounts for 5-8% of congenital heart defects. Coarctation can occur isolated or with other defects like bicuspid aortic valve or ventricular septal defect. Clinical presentation depends on age - infants may present with heart failure while older children and adults often present with hypertension. Imaging like chest x-ray and echocardiogram are used for diagnosis. Treatment involves surgery to repair the coarctation.
This document discusses several types of congenital heart diseases including their etiology, pathophysiology, clinical manifestations, diagnostic evaluation, and management. It covers tetralogy of fallot, persistent ductus arteriosus, atrial septal defect, and ventricular septal defect. For each condition, it provides details on the anatomical defects involved, characteristic signs and symptoms, relevant test findings, and treatment options including surgical repair when indicated.
Congenital Heart Disorders (TOF, TGV, COA) Kishore Rajan
This document discusses several congenital heart defects including coarctation of the aorta, tetralogy of Fallot, and transposition of the great arteries. Coarctation is a narrowing of the aorta near the ductus arteriosus. Tetralogy of Fallot consists of four defects that result in deoxygenated blood mixing with oxygenated blood. Transposition of the great arteries is a condition where the pulmonary artery and aorta are connected to the wrong ventricles, preventing proper oxygenation of blood. The document provides details on the pathophysiology, clinical presentation, diagnostic workup and management of each of these conditions.
Tricuspid atresia is a congenital heart defect where the tricuspid valve is absent or not formed, preventing communication between the right atrium and right ventricle. It occurs in approximately 0.06 per 1000 live births with no gender predominance. The condition ranges in severity from complete absence of the tricuspid valve to stenosis. Early presentation includes severe cyanosis, hypoxemia, and acidosis in infants with low pulmonary blood flow, while those with higher flow present with heart failure symptoms later in infancy. Echocardiography can identify the absent tricuspid valve and associated defects. Without surgical intervention, few infants survive beyond 6 months, but current treatments including shunts and the
This document summarizes various heart diseases including coronary heart disease, stable angina, acute myocardial infarction, valvular heart diseases, and their appearances on chest radiographs. Coronary artery disease is caused by atherosclerosis and presents as coronary calcification or cardiomyopathy. Acute MI can cause pulmonary edema on CXR. Valvular diseases like aortic stenosis present with left ventricular hypertrophy and calcification while aortic regurgitation causes cardiomegaly. Mitral stenosis presents with left atrial enlargement and pulmonary hypertension.
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare congenital heart defect where the pulmonary valve is blocked, preventing blood flow to the lungs. It is characterized by an underdeveloped right ventricle and connections between the right ventricle and coronary arteries. Newborns present with cyanosis and rely on a patent ductus arteriosus for pulmonary blood flow. Without intervention, most infants will die within the first few months of life. Treatment involves surgical procedures like the Blalock-Taussig shunt, bidirectional Glenn procedure, and Fontan operation to redirect blood flow to the lungs without using the right ventricle.
Congenital heart disease is a general term for a range of birth defects that affect the normal way the heart works. The term "congenital" means the condition is present from birth.
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...Azad Haleem
This document provides information on various types of congenital heart defects (CHDs), including descriptions, classifications, pathophysiology, clinical manifestations, investigations, and management. It discusses ventricular septal defects (VSDs), atrial septal defects (ASDs), patent ductus arteriosus (PDA), coarctation of the aorta, tetralogy of Fallot, and cyanosis. VSDs, ASDs, and PDA are examples of acyanotic left-to-right shunt lesions, while tetralogy of Fallot is a common cyanotic heart defect. Clinical features, imaging findings, and treatment approaches are described for each condition.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
2. Introduction
• Valvular heart disease (VHD) is any disease process involving one or more of
the four valves of the heart (the aortic and mitral valves on the left and the
pulmonary and tricuspid valves on the right).
• There are two types of heart valve disease:
• Valvular stenosis, that occurs when a heart valve doesn’t fully open due to
stiff or fused leaflets.
• Valvular insufficiency (regurgitation,incompetence, "leaky valve“), that
occurs when a valve does not close tightly
3. case
• A 67-year-old male complains of dyspnea on exertion, attacks of retrosternal
pain, dizziness. He has no history of rheumatism.
• Objectively: pale skin, acrocyanosis.There are rales in the lower parts of
lungs.There is systolic thrill in the II intercostal space on the right, coarse
systolic murmur conducted to the vessels of neck.AP- 130/90 mm Hg, heart
rate - 90/min, regular rhythm.The liver extends 5 cm under the edge of costal
arch, lower limb edema are present. Specify the assumed valvular defect?
4. Aortic stenosis
• an obstruction that impedes blood flow from the LV to the aorta and is mostly
secondary to aortic valvular disease.
• Aortic valvular stenosis is the most common valvular ds.
• It can be congenital, rheumatic, or calcific or degenerative.
• A bicuspid aortic valve leads to flow turbulence and valve trauma, which in
return precipitates fibrosis, stiffness, and calcification.
• Atherosclerosis.
• statin therapy?
• streptococcal infection
5. • The aortic valve surface area is normally 3.0 to 4.0 cm2.
• Symptoms typically do not appear unless the valve is narrowed to at least one
fourth of its normal surface area.
• Stenosis is graded as :
• mild (valve area >1.5 cm2)
• moderate (>1.0-1.5 cm2)
• severe (≤1 cm2) .
• The valve area narrows at an average rate of 0.12 cm2 per year .
6. • As the valve narrows, cardiac output remains stable at rest but diminishes with
exercise.
• As disease progresses, LV mass increases, and diastolic dysfunction becomes
evident with an increase in LV filling pressure.
• Patients withAS have a good prognosis if they do not have symptoms of angina,
CHF, or syncope during activity.
• Surgical management of the valve becomes necessary in symptomatic patients
because the incidence of sudden cardiac death increases in these patients.
7. • Patients with severe aortic valve stenosis describe progressive dyspnea; chest
pain and syncope with exertion; and symptoms of HF, including orthopnea,
paroxysmal nocturnal dyspnea, and edema.
• Syncope at rest is typically arrhythmia induced.
• Patients with severe aortic valve stenosis have an approximate 5% history of
sudden cardiac death.
8. physical signs of severe aortic valve stenosis
A. diminished carotid pulses (delayed and weak)
B. a sustained apical impulse
C. a single second heart sound
D. S4 gallop
E. a midsystolic crescendo–decrescendo murmur .
• Aortic valve stenosis can be distinguished clinically from dynamic left
ventricular outflow tract (LVOT) obstruction such as in hypertrophic
obstructive cardiomyopathy (HOCM) by certain clinical maneuvers at the
bedside.
9. Diagnostic tests
chest radiography:
• which could show a calcified valve, pulmonary venous congestion, or an increase
in ascending aortic root size secondary to poststenotic dilation.
• 12-lead ECG may show LVH and conduction abnormalities.
• An echocardiogram typically confirms the diagnosis (presence of calcification,
reduction in cusp motion, and congenital abnormalities )
• A gradient can be measured across the valve and the valve area can be determined
using Doppler flow with reasonable accuracy .
• The presence of concomitant aortic valve insufficiency can also be visualized using
color Doppler flow characteristics.
10. • echocardiography : - the presence or absence of LVH and assessment of LV
compliance, atrial size, and associated other valvular abnormalities.
• If noninvasive findings support the diagnosis of severeAS and the patient is
symptomatic, then diagnostic angiography is indicated to confirm the presence
of severe aortic valve stenosis and assess the coronary arteries.
• Stress testing is contraindicated in the setting of symptomatic, severe aortic
valve stenosis.
11. Treatment
• aortic valve stenosis depends on the presence or absence of symptoms.
• Symptomatic severe aortic valve stenosis carries a poor prognosis, with an average
life expectancy of 2 to 3 years .
• The 5- and 10-year mortality rates are approximately 52% to 80% and 80% to
90%, respectively
• Aortic valve surgery with or without coronary artery bypass grafting is the
treatment of choice
12. • Aortic valvuloplasty carries a poor outcome and is reserved as a palliative
therapy for inoperable patients.
• Typically, the improvement in the aortic valve gradient is mild with
valvuloplasty, and a recurrence of severe stenosis can be expected within 6
months
• Surgery is typically not advised for patients with asymptomatic severe valvular
stenosis
13. • Patients with dyspnea and progressive LV dysfunction need to be considered for
valve replacement.
• Most patients with asymptomatic, severe aortic valve stenosis will, however,
develop symptoms within 5 years of follow-up.
• A low threshold to intervene in patients with asymptomatic severeAS may be
considered, particularly when peak systolic velocity (PSV) is 4.5 m/sec or
greater on Doppler echocardiography if associated with moderate or severe
valvular calcification
• It is currently recommended that patients with severeAS undergo aortic valve
replacement if they have symptoms (chest pain, syncope, or HF), if EF is less
than 50%, or in conjunction with another valve surgery or bypass surgery (even
if the aortic valve is moderate in severity).
14. • European guidelines currently favor aortic valve replacement in patients with
severeAS with a valve area less than 0.6 cm2 (irrespective of symptoms),
rapidly progressing valve area severity, or an abnormal response to exercise
testing
• Patients need to be advised about antibiotic prophylaxis to prevent
endocarditis, especially with rheumatic valve disease.
• Patients with moderate to severe aortic valve stenosis need to avoid moderate
to severe physical exertion
• Arrhythmias need to be corrected promptly in patients with severeAS.
• Follow up
16. • Aortic valve replacement can be performed with a mechanical valve or a tissue
valve.
• Mechanical valves are more durable than bioprosthetic valves but require
lifetime anticoagulation.
• The choice of the valve depends on the patient clinical situation but takes into
consideration the patient’s age, need for future pregnancies, ability to take
anticoagulants, compliance, and preference.
• Antibiotic prophylaxis to prevent endocarditis is strongly recommended in
patients with prosthetic valves.
17. • Transcatheter aortic valve replacement (TAVR) using a stent valve has recently
emerged as a less invasive procedure to replace severe aortic valve stenosis in
patients who are deemed inoperable or are at high risk for conventional aortic
valve surgery.
• No difference in mortality was seen with both modalities, but there was more
bleeding and atrial fibrillation (AF) with surgery and more vascular
complications withTAVR.
• TAVR is approved at this time for both inoperable and high-risk patients for
open aortic valve replacement.
18. Aortic valve regurgitation
• (AR) is defined as blood flow from the aorta to the LV in diastole because of an
incompetent aortic valve .
• Aortic valve insufficiency is generally acquired because of valve infection,
dilation and dissection of the aortic root, trauma, or long-term degenerative
change of the valve, particularly in the setting of HTN.
• Patients with a history of prosthetic valves) can also have aortic valve
insufficiency.
• Aortic insufficiency can also be caused by a congenital bicuspid aortic valve.
19. • Aortic valve regurgitation leads to volume overload of the LV and an increase in
LV end-diastolic pressure.
• In chronicAR, symptoms might not appear before LV cavity dilation, and a
reduction in LV function develops.
• Patients will have a long diastolic murmur, a wide pulse pressure, and bounding
pulses.
• AcuteAR
20. • Patients are generally acutely symptomatic with HF.
• Patients have a short diastolic murmur and a soft S1 with tachycardia.
• Patients with severeAR will eventually become symptomatic, displaying
symptoms of dyspnea and CHF.
• Angina is less common, but it can occur as a result of reduction in coronary
perfusion pressure.
21. • Physical signs of severeAR include a rapid and quick arterial pulse (Corrigan
pulse); a wide pulse pressure; an early high-pitched, blowing diastolic murmur
heard best over the left sternal border; an S3 gallop.
• The ECG shows LVH and possibly conduction abnormalities.
• Echocardiographic:
• Stress testing can provide information about functional capacity and
hemodynamic response to exercise.
• Diagnostic angiography allows the verification of the severity of theAR and helps
in the assessment of the aortic root size, cavity size, and the presence or absence
of CAD.
22. • The surgical treatment ofAR is indicated in symptomatic patients with dyspnea,
angina, or CHF .
• Asymptomatic patients should undergo surgery if the LVEF is 50% or less, LV
end-systolic dimension approaches 5.5 cm, or there is an LV end-diastolic
dimension of more than 75 mm.
• Patients also should be advised on prophylaxis against infective endocarditis
• Patients with moderate to severeAR should avoid competitive sports, heavy
workloads, and weight lifting.
• After valve replacement forAR, the use of β-blockers may improve cardiac
performance
23. Mitral stenosis
• is defined as the reduced ability of blood to move from the left atrium to the LV
in diastole.
• It is mostly caused by dysfunction in the mitral valve, which lacks the ability to
open its leaflets in diastole.
• MS is predominantly caused by rheumatic carditis and is more prevalent in
females.
• Acute rheumatic carditis leads to valvular disease in approximately 50% of
affected patients.
• The mitral valve is the most commonly affected by rheumatic heart disease,
followed by the aortic valve, and then combined aortic and mitral valves.
24. • MS is considered severe if the valve area is less than 1 cm2 (normal mitral valve
area is 4 to 6 cm2).
• A valve area of 1.5 cm2 or smaller associated with severe dyspnea class or
severe pulmonary HTN is also considered clinically significant and warrants
therapy.
• The main symptom of MS is slowly progressive dyspnea and fatigue.
• Patients might complain of orthopnea and paroxysmal nocturnal dyspnea.
Pulmonary HTN can become severe, and right-sided ventricular failure can
then lead to dependent edema, hepatomegaly, and right upper quadrant pain.
25. • An increase in left atrial size can lead to palpitations secondary toAF as well as
subsequent cardioembolic strokes if not recognized in a timely fashion.
• auscultatory of MS(left lateral decubitus position).
• A low-pitched diastolic rumble, heard with the bell of the stethoscope over the
apex, is also present.
• The high-pitched opening snap (OS), caused by the abrupt stopping of the
domed mitral valve into the LV, is also appreciated in most patients midway
between the left sternal border and apex.
• A shorterA2–OS distance indicates a more severe MS.
• Signs of pulmonary HTN such as a loud P2 and right ventricular hypertrophy
(RVH) can also be present as MS becomes more severe.
26. • The ECG findings in MS might show a biphasic P wave inV1, a large P wave in
lead II, and possiblyAF.
• Chest radiography could show evidence of an enlarged left atrium and an
increase in pulmonary congestion with interstitial edema.
• An echocardiogram can accurately diagnose MS and assess valvular and
subvalvular structure and valve area .
• different causes such as tumors, vegetations, extreme calcification of the
annulus, left atrial myxoma, cor triatriatum, or presence of a large thrombus.
27. • estimate pulmonary pressures and assess for right-sided enlargement.
• Typically, LV function is preserved in MS.
• In addition, echocardiography can help in calculating a mitral valve score that
takes into account leaflet mobility, thickening, valve calcification, and distortion
of the subvalvular apparatus.
• The interventional cardiologist typically uses the valve score to determine the
feasibility of balloon valvuloplasty.
• a transesophageal echocardiogram
• a left and right heart Catheterization
28. Treatment of Mitral Stenosis
• All patients with rheumatic mitral valve disease require bacterial endocarditis
prophylaxis before dental, genitourinary, or GI procedures.
• β-blockers or verapamil .
• Patients withAF need to be aggressively treated with rate control and
anticoagulation with warfarin to reduce embolic strokes.
• Chemoversion (with amiodarone or other antiarrhythmics)
• Transesophageal echocardiography can be performed before cardioversion to rule
out the presence of a left atrial thrombus
• Even when a thrombus is excluded, patients need to be heparinized for at least 48
to 72 hours before cardioversion then maintained on warfarin afterwards.
• The target international normalized ratio (INR) in patients withAF needs to be 2.0
to 3
29. • Patients with moderate to severe symptoms (NYHA class II to IV) or asymptomatic
patients with severe MS (valve area <1.5 cm2) and pulmonary HTN (pulmonary
pressure >50 mm Hg at rest and ≥60 mm Hg with exercise) require percutaneous
valvuloplasty, mitral valve repair, or mitral valve replacement.
• Balloon valvuloplasty leads to commissural separation as the main mechanism that
leads to an improvement in valvular function.
• Mitral valvuloplasty is currently the preferred method of treating severe MS when
no contraindications
• Mitral valve surgery is reserved for those patients with a calcified valve and a high
valve score on echocardiography who are essentially excluded from balloon
valvuloplasty.
30.
31. Mitral regurgitation
• abnormal blood flow into the left atrium in systole as a result of an abnormal closing
of the mitral valve.
• In chronic mitral insufficiency vers acute MR
• Chronic MR is generally asymptomatic or associated with minimal symptoms of
dyspnea or generalized fatigue Later become symptomatic, with symptoms and signs
of HF.
• Patients might provide a history of rheumatic fever, endocarditis, CAD, or CHF.
Acute MR needs to be in the differential diagnosis of a patient with a sudden onset of
pulmonary edema.
• On examination, patients display a systolic murmur, most often holosystolic, high
pitched, and present at the apex with radiation to the axilla, left scapula.
32. • The ECG often displays an enlarged left atrium (biphasic P wave inV1), large
QRS complex secondary to LV enlargement, and possibleAF, and, in ischemic
MR, evidence of old or acute inferior infarcts can be seen.
• The chest radiograph may show an enlarged cardiac silhouette, a calcified mitral
valve, or increased pulmonary vascular congestion.
• Echocardiography provides the diagnosis by assessing the presence of the MR; its
severity; and its cause, such as severe prolapse, endocarditis, calcification,
papillary muscle or chordae rupture, or a degenerative valve.
33. • Regurgitant volume (30-59 mL is moderate; ≥60 mL is severe) and effective
regurgitant orifice (20-39 mm2 is moderate; ≥40 mm2 is severe) can be
calculated.
• Left and right heart catheterization is indicated before corrective surgery to
determine the presence of CAD and confirm the diagnosis of MR with the use
of left ventriculography.
34. Treatment of Mitral Regurgitation
• Patients with a history of mitral insufficiency need to have bacterial endocarditis
prophylaxis.
• Those with chronic MR benefit from long-term afterload reduction?
• Aggressive treatment ofAF with rate control and warfarin anticoagulation is
needed.
• Patients with moderate to severe MR need to be closely monitored for EF and
LV cavity size.
35. • Symptomatic patients (NYHA class II-IV) or asymptomatic patients with a LV end-
systolic dimension approaching 4.0 cm or LVEF of 60% or less should undergo
intervention.
• Patients with lower EF and a bigger cavity size carry a poorer outcome after surgery.
• Asymptomatic patients with preserved LV function and cavity size but with AF might
benefit from surgery.
• Patients with acute MR should be treated aggressively with afterload reduction such
as sodium nitroprusside.
• ?surgery after compensation
• Most regurgitant mitral valves can now be repaired instead of replaced.
Percutaneus repair of mitral valve.
36. Mitral Valve Prolapse
• bulging of one or more of the mitral leaflets into the left atrium in systole .
• MVP carries a benign course . In rare occasions, it can be associated with
significant arrhythmias and sudden cardiac death.
• When associated with MR, patients need to be carefully monitored for
progressive left atrial and LV cavity dilation andAF.
• familial and is inherited as an autosomal dominant trait versa Secondary MVP
37. • Patients with MVP are often asymptomatic. However, some patients describe
palpitations, chest pain, dyspnea, and fatigue with or without MR.
• A high-pitched midsystolic click is often heard that occurs shortly after the
first heart sound and can be associated with a systolic murmur.
• Baseline ECG is quite often unrevealing, and routine stress testing carries a
high false-positive rate.
• Stress imaging is more accurate in evaluating these patients for myocardial
ischemia.
38. • An echocardiogram is the most helpful methodology for making the diagnosis
of MVP.
• Cardiac catheterization is generally not needed for diagnostic purposes.
• Asymptomatic patients with MVP generally do not require treatment unless
they have severe associated MR .
• Symptomatic patients with MVP can be treated with β-blockers.
• Flail mitral leaflets caused by chordae rupture or severe MR associated with
MVP needs to be followed, and mitral valve repair becomes indicated if
patients develop symptoms of dyspnea (NYHA class III or IV), the EF and
cavity size become adversely affected, orAF appears.
39. Tricuspid Valve Disease
• Tricuspid regurgitation (TR) is commonly present on echocardiography in the
majority of patients and therefore, when mild, is considered a normal variant.
• SevereTR can occur, however, and can create significant symptoms of right-
sided CHF (cor pulmonale) and dyspnea.
• IsolatedTR is commonly seen in drug addicts secondary to tricuspid valve
endocarditis but can also be caused by carcinoid syndrome, trauma, RV
infarction, and certain congenital anomalies.
• The most common etiology ofTR is, however, annular dilation caused by RV
cavity dilation.
40. • Typically, dyspnea, right- and left-sided failure, and in the case of endocarditis,
fever and night sweats can be present.
• The RV is generally dilated, and a precordial lift is present.
• The jugular veins are pulsatile and increased.
• A systolic murmur is generally heard along the left sternal border that
increases with respiration.
41. • Patients with severeTR are treated with diuretics and digitalis to treat the
associated right-sided failure.
• ACE inhibitors are indicated if LV dysfunction is present.
• It is recommended that tricuspid valve replacement or repair be performed if
severeTR is present and the patient is undergoing simultaneous mitral valve
surgery or if severeTR is present as a primary disorder in a symptomatic
patient.
42. • mostly caused by rheumatic heart disease and is typically associated with other
valvular involvement.
• TS can also be caused by the carcinoid syndrome (most commonly causesTR)
and certain connective tissue diseases.
• Secondary causes ofTS such as tumors or thrombi can also precipitate
secondaryTS.
Tricuspid valve stenosis
43. • InTS, patients can be dyspneic with activity.
• Typically, there is an increase in the jugular vein, with a large a wave indicating
atrial contraction against a stiff tricuspid valve.
• TS is typically treated with percutaneous valvular commissurotomy unless it is
unfeasible.
• Open commissurotomy is then performed, or valve replacement is then
performed if the leaflets and subvalvular structures are not repairable.
• Bioprosthetic valves are typically used, and patients are generally prescribed
warfarin after tricuspid valve replacement.
44. Pulmonic Valve Disease
• Pulmonary valve regurgitation (PR) is typically acquired because of increased
pulmonic pressures (pulmonary HTN).
• Primary valve abnormalities caused by endocarditis can also cause PR.
• PR due to pulmonary HTN causes a diastolic murmur along the left sternal
border (Graham Steel murmur).
• Surgery on acquired PR is rarely performed.
• Pulmonic valve stenosis (PS) is mostly congenital, but secondary causes such as
tumors, endocarditis, or carcinoid can also cause PS.
• PS is best treated with percutaneous valvuloplasty with good long-term results.
45. Endocarditis
• Endocarditis is defined as an oscillating intracardiac mass without alternate
anatomic classification, the presence of an abscess, or dehiscence of a new
prosthetic valve .
• Endocarditis is treated with a prolonged course of IV antibiotics.
• Surgical management can be considered in patients who develop HF or LV
dysfunction, damage to the valve annulus with an abscess or perforation of the
leaflet, or isolating a resistant organism to antibiotics after 1 week of treatment.
46. • Large vegetations, particularly those that are increasing in size and recurrent
emboli, are to be considered as indications for valve surgery.
• Prophylaxis for endocarditis is now limited to patients with prosthetic valves
or rings, a history of prior endocarditis, congenital heart disease, or transplant
with valvular heart disease.
47. Prosthetic Valves
• Echocardiography (transthoracic, transesophageal, or both) is indicated to evaluate stenotic or
regurgitant prosthetic valves.
• Prosthetic valves are associated with several complications, including infective endocarditis, a
paravalvular leak, thrombosis and embolization, pannus formation, and hemolytic anemia.
• Prosthetic valve thrombosis requires surgery if it is a left-sided valve and is associated with
advanced HF (class III and IV NYHA) and there is large clot burden.
.
48. Rheumatic fever
• systemic inflammatory process initiated by groupA β-hemolytic streptococcal
pharyngitis.
• Often, younger children in particular do not recall antecedent pharyngitis,
which usually occurs 2 to 4 weeks before symptom onset.
• Rheumatic fever most often affects children 4 to 9 years of age, and the onset
is usually characterized by an acute febrile illness that can cause large-joint
migratory arthritis, CNS involvement (Sydenham chorea), characteristic rash,
and carditis with inflammation of heart valves and subsequent damage.
• Antibiotic treatment of GAS pharyngitis greatly reduces the development
of rheumatic fever.
50. • Rheumatic fever–related arthritis is often preceded by arthralgias out of
proportion to frank swelling, lasting approximately 1 week.
• Arthralgias
• Carditis .
• Rheumatic heart disease is the most common serious sequela and usually occurs
10 to 20 years after the original attack.
• Patients might also have erythema marginatum
• The antistreptolysin O (ASO) titer is the most useful laboratory .
• TheASO titer rises 4 to 5 weeks after the onset of GAS pharyngitis or 2 to 3
weeks after development of rheumatic fever.
• antistreptococcal antibody, such as anti-DNase, anti-DNase B, and
antihyaluronidase antibody tests.
51. • Aspirin is the drug of choice for acute rheumatic fever and usually results in a
dramatic response.
• Penicillin should also be given for a 10-day course whether or not pharyngitis
is present, and family members and other close contacts should be cultured
and treated if necessary.
• IM penicillin is more effective than oral penicillin in clinical trials.
• No benefit has been shown from IV immune globulin (IVIG) or
corticosteroids for rheumatic fever, but studies continue.
52. • Patients who have had documented rheumatic fever and who develop
subsequent GAS pharyngitis are at high risk for a recurrent rheumatic episode
and thus at increased risk for worsening rheumatic heart disease.
• For this reason, prevention of recurrent episodes requires continuous
antimicrobial prophylaxis .
• Before prophylaxis initiation, a full treatment course for GAS pharyngitis
should be completed.
• typical prophylactic therapy is with long-acting IM benzathine penicillin G
every 4 weeks until early adulthood (≈18 years of age).