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Related Concept Videos

Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Asymptomatic Severe Aortic Stenosis in the Elderly.

Robert Zilberszac1, Harald Gabriel1, Michael Schemper2

  • 1Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.

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Elderly patients with severe asymptomatic aortic stenosis (AS) face a high risk of cardiac events and death. Early surgical intervention may be beneficial for selected individuals, necessitating close clinical monitoring.

Keywords:
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Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Valvular Heart Disease

Background:

  • Aortic stenosis (AS) is prevalent in aging populations, with many elderly patients undergoing aortic valve procedures.
  • Existing natural history studies of AS often lack representation of older patient demographics (over 70 years).

Purpose of the Study:

  • To evaluate the natural history of severe asymptomatic aortic stenosis (AS) in elderly patients.
  • To determine the optimal timing for surgical intervention in this demographic.

Main Methods:

  • Prospective follow-up of 103 consecutive patients over 70 years old with severe asymptomatic AS.
  • Assessment of event-free survival, symptom onset, and outcomes after aortic valve replacement (AVR).

Main Results:

  • A high event rate was observed, with 91 events (82 AVR indications, 9 cardiac deaths) in 103 patients.
  • Event-free survival decreased significantly over time, particularly in patients with higher aortic jet velocity (AV-Vel ≥5.0 m/s).
  • Post-operative survival after AVR was favorable (89% at 1 year, 77% at 3 years).

Conclusions:

  • Elderly patients with severe asymptomatic AS have a high risk of adverse events and cardiac death.
  • Close clinical follow-up is crucial due to potential for subtle symptom onset and mobility impairment.
  • Elective aortic valve procedures should be considered for carefully selected elderly patients at low surgical risk.