Joe Lombardy is an 82-year old retired carpenter who still does “odd jobs” for friends and neighbors. His wife has pleaded with him to relax, but he ignores her. Despite having chest pains (angina) and periods of confusion, Joe doesn’t trust doctors and has stubbornly refused to have a check-up. Recently, though, after several episodes of syncope (fainting) while he was hauling lumber, Joe grudgingly agreed to see a physician.
On physical examination, the physician noted a murmur during systole (described as systolic ejection murmur). An ECG was consistent with left ventricular hypertrophy. His carotid pulse was weak and had a delayed upstroke. The physician ordered a cardiac catheterization, which showed a pressure gradient of 100 mmHg between the left ventricle and the aorta during systole, consistent with aortic stenosis.
Why does narrowing cause a murmur?
Murmurs are caused by turbulent blood flow. The narrowing of the aortic valve opening is a structural deformity that interferes with the blood’s ability to flow smoothly. When blood pumps out from the left ventricle, the narrowing creates an obstruction, making it difficult for oxygenated blood to pump throughout the body (American Heart Association, 2014).
What are the causes of aortic stenosis?
The top three causes of aortic stenosis are congenital birth defects, build up of calcium, and rheumatic fever. In a normal human, the aortic valve contains three cusps which allow blood to quietly and smoothly pump out of the heart. People with congenital birth defects have more or less than three cusps (Mayo Clinic, 2014). As these patients become older, complications can arise due to the combination of structural deformity and calcium up build that occurs with...
... middle of paper ...
...ic valve implantation (TAVI) is an excellent alternative for elderly patients who can not undergo open-heart surgery but wish to have longer results than BAV (Cioffi, 2015). As you can see from the following chart (from www.newheartvavle.com, n.d.), Joe is an excellent candidate for this procedure, as he presents with many of the symptoms that are included here.
Picture from www.newheartvavle.com
Once patients become symptomatic, prognosis is not good. Aorta valve replacement, or the less invasive trans-catheter aortic valve implantation, is vital for survival. According to Otto & Bonow, “Average time from symptom onset to death is 2 years for patients with exertional syncope, 3 years for patients with heart failure symptoms, and 5 years for those with angina” (Otto, 2009). Patient must be educated about the significance of seeking medical intervention.
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