21. Valvular Heart Disease Case 4: Mitral Stenosis Study of a 46 year old woman who presents to the emergency room with palpitations and severe dyspnea. http://edcenter.med.cornell.edu/Pathophysiology_Cases/96-97_Pathophysiology_Case

Valvular Heart Disease Case 4 A 46 year old woman presents to the emergency room with palpitations and severe dyspnea. The woman recalls at least one, possibly more episodes of acute rheumatic fever during her childhood. She tolerated two pregnancies without difficulty. She was normally active and asymptomatic until age 42 when she noted dyspnea on moderate exertion. Evaluation at that time revealed a diastolic rumble at the LV apex, an EKG with normal sinus rhythm , and signs of left atrial hypertrophy. An echocardiogram revealed normal left ventricular internal dimensions but moderate left atrial enlargement. The mitral valve leaflets were thickened and motion of the valve leaflets was reduced. The mitral valve orifice was reduced to 1.5 cm (normal > 3 cm She was treated with diuretics and digoxin with improvement in her exertional dyspnea. Over the next 4 years her symptoms of exertional dyspnea increased gradually and she noted that she slept more comfortably if she elevated her head on several pillows. She also noted increased leg swelling over the past several months. On the night of admission, she awoke from sleep with palpitations and difficulty breathing. PHYSICAL EXAM: HR 120-130 irregular , BP 110/70

22. CNN - Valvular Heart Disease Associated With valvular heart disease associated with fenfluraminephentermine. July 8, 1997 Web posted at 258 p.m. EDT (1858 GMT) http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

23. Management Of Patients With Valvular Heart Disease Guidelines H. valvular heart disease Associated With Anorectic Drugs Management of valvular heart disease in Adolescents and Young Adults A. Aortic Stenosis http://www.acc.org/clinical/guidelines/valvular/dirIndex.htm

var showMenu="ExpandMain:clinical;"; // document.modified = "Tuesday March 12, 2002"; document.modified = "03/12/2002"; Table of Contents Print a PDF References BONOW ET AL., ACC/AHA TASK FORCE REPORT JACC Vol. 32, No. 5, November 1998:1486-1588 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease) COMMITTEE MEMBERS Robert O. Bonow, MD, FACC, Chair , Blase Carabello, MD, FACC, Antonio C. De Leon, Jr., MD, FACC, L. Henry Edmunds, Jr., MD, FACC, Bradley J. Fedderly, MD, FAAFP, Michael D. Freed, MD, FACC, William H. Gaasch, MD, FACC, Charles R. Mckay, MD, FACC, Rick A. Nishimura, MD, FACC, Patrick T. O'Gara, MD, FACC, Robert A. O'Rourke, MD, FACC, Shahbudin H. Rahimtoola, MD, FACC TASK FORCE MEMBERS James L. Ritchie, MD, FACC

24. Cardiovascular Disease 101 Know Your Heart And Blood Vessels an enlarged heart without a known cause. valvular heart disease These are diseases of the heart valves. A series of valves within your heart http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

25. The Howard Gilman Institute For Valvular Heart Diseases For more than 20 years, a team of physicians and researchers at the Weill Medical College of Cornell University has been pushing the frontiers of valvular http://www.gilmanheartvalve.org/

For more than 20 years, a team of physicians and researchers at the Weill Medical College of Cornell University has been pushing the frontiers of valvular heart disease research, evaluation and treatment. Today, the benefits of their labors are available at The Howard Gilman Institute for Valvular Heart Diseases of the Weill Medical College of Cornell University. The Institute and its William and Donna Acquavella Diagnostic Suite help cardiologists, cardiothoracic surgeons and other physicians take advantage of the most current concepts in evaluation and treatment of patients with heart valve diseases. The Howard Gilman Institute for Valvular Heart Diseases ..opening the doors to a healthy heart.... The Howard Gilman Institute for Valvular Heart Diseases of the Weill Medical College of Cornell University New York - Presbyterian Hospital New York Weill Cornell Center 525 East 68th Street New York, NY 10021

26. MedlinePlus Heart Valve Diseases Dental Care and Heart Disease (American Heart Association) Heart Murmur (National Heart, Lung, and Blood Institute) http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

27. Medem: Medical Library: Valvular Heart Disease valvular heart disease Overview Page 1 - HeartCenterOnlineAnswers to your questions about valvular heart disease and more! Information you can trust patient guides, the latest news, tips, tools, animations and http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZLNKW728C&sub_cat=2

28. Valvular Heart Disease Investigation of valvular heart disease will require Goldsmith I, Turpie AG, Lip G Y. valvular heart disease and prosthetic heart valves. http://www.surgical-tutor.org.uk/core/ITU/valve.htm

Up Cardiovascular monitoring Resusitation Haemorrhage and shock ... Physiological scoring systems Valvular heart disease Aetiology Principal causes vary between Western and developing countries Common causes are: Congenital valvular abnormalities (e.g. bicuspid aortic valve) Infective endocarditis Rheumatic fever Degenerative valve disease Ischaemic heart disease Pathology Rheumatic fever results from immune-mediated inflammation of heart valve Results from cross reaction between Group A haemolytic strep and cardiac proteins Valve disease results in either stenosis or incompetence Stenosis causes pressure load on proximal chamber Incompetence causes volume load proximal chamber Thrombus may form in dilated left atrium resulting in peripheral embolisation Clinical features Aortic stenosis Angina pectoris Syncopal episodes Left ventricular failure Slow upstroke to arterial pulse Ejection systolic murmur in 2 nd right intercostal space Aortic regurgitation Congestive cardiac failure Increased pulse pressure Water-hammer pulse Early diastolic murmur at left sternal edge Mitral stenosis Pulmonary hypertension Paroxysmal nocturnal dyspnoea Atrial fibrillation Loud first heart sound Mid diastolic murmur at apex Mitral regurgitation Pulmonary oedema Apex beat displace laterally Apical pansystolic murmur Tricuspid stenosis Fatigue and peripheral oedema Hepatomegaly and ascites Increased JVP with prominent a waves Diastolic murmur at left sternal edge Tricuspid regurgitation Pulsatile hepatomegaly and ascites Right ventricular heave Prominent JVP with large v waves

29. Virtual Hospital: University Of Iowa Family Practice Handbook, Fourth Edition: C Cardiology valvular heart disease. James M. Fox, MD Table 32 summarizes valvular heart disease. Mitral Valve Prolapse (MVP). http://www.vh.org/adult/provider/familymedicine/FPHandbook/Chapter03/03-3.html

University of Iowa Family Practice Handbook, Fourth Edition, Chapter 3 Cardiology: Valvular Heart Disease James M. Fox, MD Division of Cardiology, Department of Internal Medicine University of Iowa College of Medicine Peer Review Status: Externally Peer Reviewed by Mosby General. Can present with a spectrum of symptoms based on the valve involved, stenosis or regurgitation, right- or left-sided, and single valve or multivalvular disease. An echocardiogram is critical to the evaluation of a patient with a heart murmur to determine if the murmur is the result of a valve lesion. Table 3-2 summarizes valvular heart disease. Mitral Valve Prolapse (MVP). May result from leaflet billowing, progressive expansion of the mitral annulus, or valve-leaflet myxomatous degeneration. Most patients with MVP are asymptomatic and will have a benign clinical course. Symptoms may include palpitations, fatigue, dyspnea, syncope, atypical chest pain, and episodes of supraventricular tachycardia. However, these symptoms are as common in the general population as in those with MVP and many patients with MVP found incidentally on echocardiography do not have these symptoms.

30. Valvular Heart Disease valvular heart disease. Damage to the heart valves, leading to either narrowing of valvular heart disease is diagnosed by hearing heart murmurs with a http://www.tiscali.co.uk/reference/encyclopaedia/hutchinson/m0031601.html

// Show bread crumbs navigation path. breadcrumbs('four'); //> From: www.tiscali.co.uk/reference/ ENCYCLOPAEDIA Hutchinson's Encyclopaedia Men's Health ... Wildlife Frames not supported Frames not supported Encyclopaedia Search Click a letter for the index A B C D ... Z Or search the encyclopaedia: valvular heart disease Damage to the heart valves, leading to either narrowing of the valve orifice when it is open (stenosis) or leaking through the valve when it is closed (regurgitation). Worldwide, rheumatic fever is the commonest cause of damage to the heart valves, but in industrialized countries it is being replaced by bacterial infection of the valves themselves (infective endocarditis) and ischaemic heart disease as the main causes. Valvular heart disease is diagnosed by hearing heart murmurs with a stethoscope, or by cardiac ultrasound Related Links rheumatic fever ischaemic heart disease coronary artery disease influenza ... surgery Mongolia Flag Red represents progress. Blue is Mongolia's national colour. Effective date 12 February 1992. Buy Cheap Games Gran Turismo 4 Win £500 cash Volunteer to take part in our Tiscali survey and you could win £500 to spend on whatever you want.

31. THE MERCK MANUAL OF GERIATRICS, Ch. 89, Valvular Heart Disease In elderly patients, the predominant causes of valvular heart disease are Most often, valvular heart disease is suspected when murmurs are detected http://www.merck.com/mrkshared/mmg/sec11/ch89/ch89a.jsp

32. THE MERCK MANUAL, Sec. 16, Ch. 207, Valvular Heart Disease http://www.merck.com/mrkshared/mmanual/section16/chapter207/207a.jsp

33. Aortic Valvular Heart Disease Penn State Hershey Medical Center provides world class care and services to patients. http://www.hmc.psu.edu/healthinfo/a/aorticvalve.htm

34. Valvular Heart Disease Heart and Lung Surgery USC Department of Cardiothoracic Surgery. http://www.cts.usc.edu/studenthandout-valvularheartdisease.html

Home Student Handout Cardiothoracic Surgery Service LAC+USC Medical Center Student Handout Student Handout Links Introduction Coronary Artery Disease Valvular Heart Disease Prosthetic Valves ... Cardiac Neoplasms Valvular Heart Disease The Aortic Valve The usual AV Area (AVA) is 2.5-3.5 Cm2. The aortic valve is a trileaflet structure that sits at the junction of the left ventricular outflow tract and the beginning of the aorta. The coronary ostia may be found one to two centimeters above the annulus to both the right and left. The valve has a common corridor of tissue with the mitral valve and the conduction system is located near the junction of the right and non-coronary leaflets. The usual pathology of the valve is either calcification with functional and structural stenosis or destruction of the leaflets with resultant insufficiency. Aortic Stenosis (AS): The most frequent etiology for aortic valve stenosis is senile calcific stenosis, second is calcification of a congenital (bicuspid) valve , the third most frequent is rheumatic heart disease. The incidence of rheumatic disease has decreased in the last few decades but it is still prevalent. The pathology is that of CONCENTRIC LEFT VENTRICULAR HYPERTOPHY.

35. Cardiothoracic Education: Valvular Heart Disease Heart and Lung Surgery USC Department of Cardiothoracic Surgery. http://www.cts.usc.edu/educationfellowships-studenthandout-valvularheartdisease.

Home Student Handout Cardiothoracic Surgery Service LAC+USC Medical Center Student Handout Valvular Heart Disease The Aortic Valve The usual AV Area (AVA) is 2.5-3.5 Cm2. The aortic valve is a trileaflet structure that sits at the junction of the left ventricular outflow tract and the beginning of the aorta. The coronary ostia may be found one to two centimeters above the annulus to both the right and left. The valve has a common corridor of tissue with the mitral valve and the conduction system is located near the junction of the right and non-coronary leaflets. The usual pathology of the valve is either calcification with functional and structural stenosis or destruction of the leaflets with resultant insufficiency. Aortic Stenosis (AS) The most frequent etiology for aortic valve stenosis is senile calcific stenosis, second is calcification of a congenital (bicuspid) valve , the third most frequent is rheumatic heart disease. The incidence of rheumatic disease has decreased in the last few decades but it is still prevalent. The pathology is that of CONCENTRIC LEFT VENTRICULAR HYPERTROPHY.

36. NEJM -- Valvular Heart Disease Review Article from The New England Journal of Medicine valvular heart disease. http://content.nejm.org/cgi/content/short/337/1/32

HOME SEARCH CURRENT ISSUE PAST ISSUES ... HELP Please sign in for full text and personal services Previous Volume 337:32-41 July 3, 1997 Number 1 Next A correction has been published: N Engl J Med 1997;337(20):1474 A correction has been published: N Engl J Med 1997;337(7):507 A correction has been published: N Engl J Med 2001;345(22):1652 Valvular Heart Disease Blase A. Carabello, M.D., and Fred A. Crawford, M.D. Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings. Full Text PDF Letters Add to Personal Archive ... PubMed Citation The past 15 years have brought a remarkable improvement in the clinical outcome of patients with valvular heart disease. It is impossible to attribute the change to any single advance in the field. However, it is likely that more effective noninvasive monitoring of ventricular function, improvement in prosthetic valves, advances in valve-reconstruction techniques, and the development of useful guidelines for choosing the proper timing of surgical intervention have all worked in concert to improve prognosis. Moreover, advances in minimally invasive surgical

37. NEJM -- Valvular Heart Disease In Pregnancy Clinical Practice from The New England Journal of Medicine valvular heart disease in Pregnancy. http://content.nejm.org/cgi/content/short/349/1/52

HOME SEARCH CURRENT ISSUE PAST ISSUES ... HELP Please sign in for full text and personal services Previous Volume 349:52-59 July 3, 2003 Number 1 Next Valvular Heart Disease in Pregnancy Sharon C. Reimold, M.D., and John D. Rutherford, M.B., Ch.B. Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings. Full Text PDF PDA Full Text Letters ... PubMed Citation This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. A 29-year-old woman with a history of mitral stenosis who has a St. Jude Medical mitral-valve prosthesis presents for evaluation before attempting to conceive. She is concerned about the risks that pregnancy will confer on her and her child. How should she be evaluated and followed? The Clinical Problem Valvular heart disease in young women is most commonly due to rheumatic heart disease, congenital abnormalities

38. Valvular Heart Disease - Heart Conditions - Strong Heart And Vascular Center valvular heart disease is the general term applied to any dysfunction or disease Early valvular heart disease usually shows no symptoms, or has symptoms http://www.stronghealth.com/services/cardiology/Conditions/valvedisease.cfm

@import "/css/Strongw3c.css"; Search: Search Help Cardiology Call 911 Our Providers ... Pediatric Cardiology More Information Cardiology News Strong Heart and Vascular Center Heart Conditions Valvular Heart Disease What is Valvular Heart Disease? Valvular heart disease is the general term applied to any dysfunction or disease of any of the four valves of the heart In a healthy heart, the four valves keep the right amount of blood flowing in one direction, either into or away from the heart, and at the right time. The valves are the mitral and aortic valves, on the right side of the heart, and the tricuspid and pulmonic valves on the left side. Most valvular disease occurs in the mitral or aortic valves. Types of Valvular Heart Disease There are four main types of valvular heart disease: Valvular stenosis - Valve narrows, hardens, or becomes blocked, and interferes with blood flow. Valvular regurgitation - Valve does not close completely, allowing blood to leak in the wrong direction.

39. Heart Conditions & Diseases - Cardiac (Heart) Surgery There are a number of different types of valvular heart disease including valvular stenosis, Surgical treatment for valvular heart disease Contact Us http://www.stronghealth.com/services/surgical/Cardiothoracic/conditions.cfm

@import "/css/Strongw3c.css"; Search: Search Help Cardiac Surgery Cardiac Surgery Home Our Surgeons ... Pediatric Cardiac Surgery More Information Cardiac Surgery News Strong Heart and Vascular Center Division of Cardiac Surgery As Western New York's leading provider of cardiac care, the Strong Heart and Vascular Center treats every kind of heart condition. Below are brief descriptions of the most common, in alphabetical order. Each includes a link to surgical-related treatment procedures. About 75% of all heart patients have one of these conditions. In order to better understand your cardiac condition or disease, you may want to learn about the normal functioning of the heart. Read more about understanding the heart Arrhythmia (Dysrhythmia) An abnormal (too fast, too slow, or irregular) heartbeat rhythm may be a very minor problem or may indicate a serious condition. There are many types of arrhythmias with a variety of causes, detection methods and treatments. Learn more about arrhythmia Atrial Fibrillation (AF) Atrial Fibrillation (AF) is a type of arrhythmia in which the two small upper chambers of the heart, the atria, quiver instead of beating effectively. Symptoms vary from minor to disturbing, but AF can lead to a stroke.

40. BHF Heart Health - Heart Conditions: What Is Valvular Heart Disease? The British Heart Foundation (BHF) is the leading national charity fighting heart and circulatory disease the UK s biggest killer. The BHF funds research, http://www.bhf.org.uk/hearthealth/index.asp?secID=1&secondlevel=77&thirdlevel=47

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