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Valvular Heart Disease - Aortic Disorders
Michael S. Feldman, MD, is Chairman of the Graduate Education Foundation, producer of CMELectures.com, and a Clinical Professor of Medicine at the University of Pennsylvania School of Medicine. Bernard Segal, MD, is director of cardiology at Thomas Jefferson University, where he is also director of the Jefferson Heart Institute. Here, the authors discuss the etiology and pathophysiology of aortic valve disease – its physical findings, diagnostic tools, and the indications for medical or surgical treatment. Doppler echocardiography in aortic stenosis (AS) reliably pinpoints the location of the narrowing or obstruction. The authors describe calcific degeneration of the aortic valve and list the several risk factors involved in AS, especially smoking, hyperlipidemia and such exacerbating factors as hypertension. They point out the differing symptoms of AS between younger and older patients, with older ones requiring cardiac catheterization to identify the associated coronary artery disease often present with AS. Auscultation and palpation in aortic stenosis is discussed along with the diagnostic tools of echocardiograms, chest x-rays, Doppler evaluation, and catheterization. Medical management, they conclude, is generally ineffective; but AS patients with the lowest mortality are those who undergo elective surgery for aortic valve replacement. The authors describe chronic aortic regurgitation and its causes, manifestations, and incidence ... and the indispensability of echocardiography in confirming its presence and severity. The lecture concludes with a discussion of acute and chronic aortic insufficiency and particularly its surgical management. There are more than one hundred illustrations. |
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