AORTIC REGURGITATION
Aortic regurgitation(AR) refers to the failure of incompetent aortic valve to prevent the flow of blood from aorta back to the left ventricle.
HEMODYNAMICS:
The backward leak of blood from the aorta to left ventricle during diastole increases left ventricular volume. The left ventricle accommodates extra volume of blood by increasing ventricular size. This regurgitation leads to impaired forward systemic blood flow reducing cardiac output. Left ventricle increases ejection during early part of systole to compensate this. In increased regurgitation, left ventricular pressure increases, which may leads to increased left atrial pressure and pulmonary congestion.
CLINICAL FEATURES:
Asymptomatic in mild form.
Palpitation, dyspnea on
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High pitched decrescendo diastolic murmur.
DIAGNOSIS:
ECG: Normal or left ventricular hypertrophy, diastolic overloading pattern of left ventricle.
Chest X-ray: Enlargement of left ventricle.
Echocardiography: Dilated aorta, enlargement of left ventricle.
Droppler study determine the severity of AR.
TREATMENT:
Calcium channel blockers.
Prevention of infective endocarditis.
Surgery: Aortic valve replacement by homograft or prosthetic valve.
AORTIC STENOSIS:
Aortic stenosis results due to narrowing of aortic valve or adjacent part of aorta. This leads to a development of pressure gradient between left ventricle and aorta increasing the left ventricular pressure and hypertrophy. It is very rare in children.
CLINICAL FEATURES:
• Classical triad of exertional dyspnea, exertional angina and exertional syncope.
• Fatigue, exercise intolerance.
• Pulsus parvus et tardus (slow rising pulse).
• Narrow pulse pressure.
• Ejection systolic murmur.
DIAGNOSIS:
• ECG: Left ventricular hypertrophy.
• Chest X-ray: Cardiomegaly in case of CCF.
• Echocardiography: Identify site of
Atrioventricular Canal Defect is an abnormality that causes the mixing of blood. There is a hole in center of heart where the wall between the upper and lower chambers meet. The tricuspid and mitral valves aren’t formed properly and one large valve crosses the defect. The defect lets oxygen rich blood pass to the heart’s right side and mix with deoxygenated blood, then go back to the lungs. Another abnormality is Atrial Septal Defect (ASD), where the walls of the upper chambers of the heart don’t close completely, causing a left to right movement of blood due to the higher pressure. The mixing of oxygenated and deoxygenated blood may cause the right atrium and ventricle to enlarge due to the higher volume of blood.
With acute aortic insufficiency, pulse pressure widens as the valve deteriorates. Signs and symptoms may include a bounding pulse, atrial and ventricular gallops, chest pain, palpitations, pallor, crackles, dyspnea, and jugular vein distention, may also be present.
The increased resistance of blood flow through the pulmonary semilunar valve from the right ventricle backs up the pressure of blood
force blood through the entire body and meets resistance. R side only does pulmonary, where it meets less res 14. Semilunar valves prevent backflow into the atria venticles ; AV valves prevent backflow into the
Oxygen poor blood fills the right atrium from either the superior or inferior vena cava.
It was established that the patient’s symptoms were due to an aortic regurgitation this was confirmed by echocardiogram. The use of the SOAPIER model is an effective means of providing rationale for a holistic clinical decision making. The findings and treatment options were discussed in a multidisciplinary meeting including Mr Jones and family. The family were informed that surgery was the safest treatment option. Complications that could happen with or without surgery were also explained ensuring that the patient had adequate understanding to make a valid choice about his treatment. Mr Jones agreed that a replacement of the aortic valve with a mechanical valve was necessary, thus it last for more than twenty years or more . Mr Jones
Dyspnea and decreased exercise tolerance- which contributes to diastolic dysfunction with an increase in left ventricular filling pressures with exercises.
A doctor may also suggest treatment later in a person’s life, if the disease worsens. If a cardiologist suggests medical treatment, two options include: Mitral Valve Repair or Mitral Valve Replacement. “If the patient chooses to have Mitral Valve Replacement, he or she should find a surgeon who satisfies three criteria; the surgeon should have a 90 percent or greater rate of successful repair, should have an extremely low rate of death from surgery (less than 1 percent) and should be proficient in operating with less invasive approaches, if your surgeon cannot provide these sorts of numbers, you need to move to another” (Gillinov 326). By reconnecting valve leaflets a surgeon can perform Mitral Valve Repair (mayoclinic.org). A surgeon can also remove excess tissue from the valve for a repair (mayoclinic.org). “The traditional approach to most aortic valve problems is to open the chest, remove the old valve, and sew in a new one” (Gillinov
Condition where the left side of the heart is unable to pump an adequate amount of blood to the body, and can be life-threatening.
Systolic heart failure is characterized by enlarged ventricles that are unable to fully contract to pump enough blood into circulation to adequately perfuse tissues. The enlargement in ventricles is due to an increased end-systolic volume. If the heart is not able to sufficiently pump the expected volume of blood with each contraction, which in a normal healthy heart is 50-60%, there will be a residual volume left in the heart after every pump (Heart Healthy Women, 2012). With the next period of filling, the heart will receive the same amount of blood volume from the atria combined with that residual volume from the previous contraction. This causes the ventricles to have to dilate to accommodate this increase in volume. The dilation causes the walls of the ventricles to stretch and become thin and weak. Also the myocardium, the muscle layer of the heart, will stretch and not be able to adequately make a full and forceful enough contraction to push blood from the ventricles (Lehne, 2010).
In systolic ventricular dysfunction or systolic heart failure the heart is not able to produce enough output for adequate tissue perfusion. Heart rate and stroke volume produce cardiac output. Contractility, preload, and afterload influence the heart’s stroke volume. These factors are important in understanding the pathophysiologic consequences of this syndrome and possible treatments. Patients with systolic heart failure usually have dilated, large ventricles and impaired systolic function.
An overriding aorta is where the major blood vessel is not in place or moved. In tetralogy
John’s long standing Hypertension causes his heart to work harder, putting more strain on his heart and arteries. In order to achieve a gradient in pressure by which blood flows from an area of higher pressure to one of lower pressure, the left ventricle must exceed the increased pressure in the arterial system (Ref).
An AAA (abdominal aortic aneurysm) is defined as enlargement of at least 3 cm of the abdominal aorta. The majority of abdominal aortic aneurysms begins below the renal arteries and ends above the iliac arteries. The exact cause of (AAAs) is unknown. However, it is thought to be due to a degenerative process of the abdominal aorta caused by atherosclerosis. Artherosclerosis represents a response to vessel wall injury caused by inflammation, genetically regulated defects in collagen and fibrillin, increased protease activity within the arterial wall, and mechanical factors (Stoelting p. 143).
The S-A node signal is delayed by the atrioventricular node to allow the full contraction of the atria that allows the ventricles to reach their maximum volume. A sweeping right to left wave of ventricular contraction then pumps blood into the pulmonary and systemic circulatory systems. The semilunar valves that separate the right ventricle from the pulmonary artery and the left ventricle from the aorta open shortly after the ventricles begin to contract. The opening of the semilunar valves ends a brief period of isometric (constant volume) ventricular contraction and initiates a period of rapid ventricular ejection.