Valvular Heart Disease

The diagnosis of aortic dissection is made through several options. A transesophageal echocardiogram, CT angiography, or magnetic resonance angiography can be used to make the diagnosis in situations where the patient has symptoms of this problem. The tests will show an intimal flap as well as a double lumen in the aorta. If surgery is considered, a contrast aortography is recommended to specifically outline the limits of the problem. While an ECG will show abnormalities, these will not be diagnostic of the problem.

About 20 percent of affected patients will die immediately before reaching a medical facility. At 1 year, about 90 percent will ultimately die of some type of complication of their dissection. The goal of medical management is to decrease the arterial pressure, the shear stress on the artery, the contractility of the ventricles, and the patient’s pain. Beta-blockers are a first-line treatment for blood pressure control. Other choices include calcium channel blockers or nitroprusside, although nitroprusside cannot be used alone because of reflex sympathetic activation.

Ultimately, the patient will require surgical repair of their dissection unless the problem is uncomplicated and part of the descending aorta alone. Surgery is designed to remove the false channel and provide a graft through which blood can flow. Open or closed repair can be done to achieve these goals. The surgery is often complicated by stroke, paraplegia, renal failure, or death.

VALVULAR HEART DISEASE

Heart valve disorders involve either stenosis or regurgitation. Stenosis is narrowing of the outflow of the valve, while regurgitation is leakage backward of blood through the valve. Any valve of the heart can be both regurgitant and stenotic. The mitral valve might be neither but will be involved in mitral valve prolapse, in which the valve leaflets billow back but usually not enough to cause leakage of the valve itself.

A valvular disorder can be diagnosed though observation and auscultation, which can lead you to determine that a problem exists. An actual diagnosis, however, is gotten through cardiac ultrasound, such as a standard 2D ultrasound, which will show the anatomy of the valves. An ECG will detect the heart rhythm and electrical abnormalities,