Aortic stenosis Wikipedia. Aortic stenosis. In the center an aortic valve with severe stenosis due to rheumatic heart disease. Original Article. Prevention of Coronary Heart Disease with Pravastatin in Men with Hypercholesterolemia. James Shepherd, M. D., Stuart M. Cobbe, M. D., Ian Ford, Ph. D. Varises adalah pelebaran pembuluh balik. Kata varises berasal dari bahasa Latin yang berarti memutar, varix. Varises Varicose Vein merupakan pelebaran vena yang. This practical and thorough review ensures youll be uptodate across all major fields of internal medicine. Ideal for MOCThe valve is surrounded by the aorta. The pulmonary trunk is at the lower right. The right coronary artery, cut lengthwise, is at the lower left. Pathophysiology Of Heart Disease Leonard Lilly Pdf' title='Pathophysiology Of Heart Disease Leonard Lilly Pdf' />Original Article. Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. Claire Bombardier, M. D., Loren Laine. The left main coronary artery, also cut lengthwise, is on the right. Specialty. Cardiac surgery. Symptoms. Decreased ability to exercise, loss of consciousness, shortness of breath, heart related chest pain, leg swelling1Complications. Heart failure1Usual onset. Gradual1Causes. Bicuspid aortic valve, rheumatic fever1Risk factors. Smoking, high blood pressure, high cholesterol, diabetes, being male1Diagnostic method. Ultrasounds1Treatment. Valve replacement surgery, balloon aortic valvuloplasty1Prognosis. Five year survival 5. Frequency. 2 of people over 6. Aortic stenosis AS or Ao. S is the narrowing of the exit of the left ventricle of the heart where the aorta begins, such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occurs due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without narrowing is known as aortic sclerosis. Causes include being born with a bicuspid aortic valve and rheumatic fever. A bicuspid aortic valve affects about one to two percent of the population while rheumatic heart disease mostly occurring in the developing world. A normal valve, however, may also harden over the decades. Risk factors are similar to those of coronary artery disease and include smoking, high blood pressure, high cholesterol, diabetes, and being male. The aortic valve usually has three leaflets and is located between the left ventricle of the heart and the aorta. AS typically results in a heart murmur. Its severity can be divided into mild, moderate, severe, and very severe based on ultrasound of the heart findings. Aortic stenosis is typically followed using repeated ultrasounds. Once it has become severe treatment primarily involves valve replacement surgery with transcatheter aortic valve replacement TAVR being an option in some who are at high risk from surgery. Valves may either be mechanical or bioprosthetic with each having risks and benefits. Another less invasive procedure, balloon aortic valvuloplasty BAV may result in benefit but this is for only for a few months. Complications like heart failure may be treated as per normal in those with mild to moderate AS. In those with severe disease a number of medications should be avoided including ACE inhibitors, nitroglycerin, and some beta blockers. Nitroprusside or phenylephrine may be used in those with decompensated heart failure depending on the blood pressure. Aortic stenosis is the most common valvular heart disease in the developed world. It affects about 2 of people who are over 6. Estimated rates are not known in most of the developing world as of 2. In those who have symptoms, without repair, the chance of death at five years is about 5. Aortic stenosis was first described by French physician Lazare Rivire in 1. Video explanation of aortic valve disease. Signs and symptomseditSymptoms related to aortic stenosis depend on the degree of stenosis. Most people with mild to moderate aortic stenosis do not have symptoms. Symptoms usually present in individuals with severe aortic stenosis, though they may occur in those with mild to moderate aortic stenosis as well. The three main symptoms of aortic stenosis are loss of consciousness, anginal chest pain and shortness of breath with activity or other symptoms of heart failure such as shortness of breath while lying flat, episodes of shortness of breath at night, or swollen legs and feet. It may also be accompanied by the characteristic Dresden china appearance of pallor with a light flush. Angina in setting of heart failure also increases the risk of death. In people with angina, the 5 year mortality rate is 5. Angina in the setting of AS occurs due to left ventricular hypertrophy LVH that is caused by the constant production of increased pressure required to overcome the pressure gradient caused by the AS. Ma 620 Infrared Driver there. While the muscular layer of the left ventricle thickens, the arteries that supply the muscle do not get significantly longer or bigger, so the muscle may not receive enough blood supply to meet its oxygen requirement. This ischemia may first be evident during exercise when the heart muscle requires increased blood supply to compensate for the increased workload. The individual may complain of anginal chest pain with exertion. At this stage, a cardiac stress test with imaging may be suggestive of ischemia. Eventually, however, the heart muscle will require more blood supply at rest than can be supplied by the coronary artery branches. Poker Bot Cracked more. At this point there may be signs of ventricular strain pattern ST segment depression and T wave inversion on the EKG, suggesting subendocardial ischemia. The subendocardium is the region that is most susceptible to ischemia because it is the most distant from the epicardial coronary arteries. SyncopeeditSyncope fainting spells from aortic valve stenosis is usually exertional. In the setting of heart failure it increases the risk of death. In people with syncope, the 3 year mortality rate is 5. It is unclear why aortic stenosis causes syncope. One popular theory is that severe AS produces a nearly fixed cardiac output. When a person with aortic stenosis exercises, their peripheral vascular resistance will decrease as the blood vessels of the skeletal muscles dilate to allow the muscles to receive more blood to allow them to do more work. This decrease in peripheral vascular resistance is normally compensated for by an increase in the cardiac output. Since people with severe AS cannot increase their cardiac output, the blood pressure falls and the person will faint due to decreased blood perfusion to the brain. A second theory as to why syncope may occur in AS is that during exercise, the high pressures generated in the hypertrophied left ventricle cause a vasodepressor response, which causes a secondary peripheral vasodilation that, in turn, causes decreased blood flow to the brain resulting in loss of consciousness. Indeed, in aortic stenosis, because of the fixed obstruction to blood flow out from the heart, it may be impossible for the heart to increase its output to offset peripheral vasodilation. A third mechanism may sometimes be operative. Due to the hypertrophy of the left ventricle in aortic stenosis, including the consequent inability of the coronary arteries to adequately supply blood to the myocardium see Angina below, abnormal heart rhythms may develop. These can lead to syncope. Finally, in calcific aortic stenosis1. If that occurs, the result may be heart block a potentially lethal condition of which syncope may be a symptom. Congestive heart failureeditCongestive heart failure CHF carries a grave prognosis in people with AS. People with CHF attributable to AS have a 2 year mortality rate of 5.