Chest Pain, Heart Diseases and Prosthetic Heart Valves by anamaulida


									Prosthetic heart valves Follow up as important as surgery itself Patients
undergoing prosthetic valve surgery need meticulous follow up in the
post-operative period. Thorough understanding of the structure of
different prostheses, their thrombogenic potential, durability and
hemodynamics is imperative for proper management during this period. The
treating cardiologist must be familiar with the use of oral
anticoagulants (VKAs), their interactions with diet and different drugs
to be able to avoid life threatening complications of over or under
coagulation. Similarly, thorough knowledge of echocardiography of the
prosthetic valves and the interpretation of the various nuances is
absolutely essential in the management of these patients.The utility of
clinical examination cannot be undermined for it is the astute clinician
who picks up the jaundice arising out of hemolysis due to a paravalvular
leak or an obstructive valve in association with abnormal sounds and
murmurs. Proper recording of all the findings and comparison with
baseline findings is of paramount importance. Special precautions should
be observed for these patients during special situations like surgery or
pregnancy. There is limited data in special populations like the elderly
(>70 years), pregnant women and with low molecular heparins, novel
anticoagulants and with newer generation valves.Stress Echocardiography
in Valvular Stenotic Heart DiseaseStress echocardiography is emerging as
an important tool in evaluation of valvular stenosis.· It aids in
clinical decision making.· It provides significant non invasive
information on dynamic changes in valve function, left ventricular
function, hemodynamic response to exercise.· Exercise gives important
information on exercise capacity and symptomatic responses.· It has the
advantage of easy availability, low cost, immediate diagnosis and
providing complete anatomic and hemodynamic information. Despite the
above, more large scale trials are needed for enhancing its applicability
in day to day clinical practice for heart diseases.What to do while
dealing with typical Angina and normal coronaries?Evaluation of chest
pain especially angina like symptoms has always been a challenging task
for clinicians at all levels, be it an experienced clinician or a
Resident in the Emergency room. The concept that all chest pains be
considered as related to coronary artery disease (CAD) can never be
ignored inspite of the documentation that coronary arteries have been
reported as normal after an angiogram. Coronary artery spasm in normal
coronaries, myocardial bridges, arteritis and stenosis of the coronary
Ostia may all contribute to chest pain with angina like symptoms. There
is no time lag defined between development of new onset CAD and normal
coronary arteries. Chest pain like angina may not always be related to
CAD but other life threatening conditions like Pulmonary embolism, acute
aortic dissection, tension Pneumothorax, may be missed and passed off as
non-cardiac conditions.Hypertrophied left ventricle of hypertrophic
Cardiomyopathy, Aortic stenosis or hypertrophied right ventricle of
pulmonary stenosis, Pulmonary artery hypertension, dilated Pulmonary
arteries as in pulmonary hypertension or idiopathic dilatation of
Pulmonary arteries may all contribute to chest pain. Other conditions
like musculoskeletal syndromes, disorders of abdominal viscera including
gastrooesophageal reflux, psychological conditions may have typical
angina like symptoms in spite of normal coronaries. Thus, the syndrome of
chest pain is a wide spectrum full of pitfalls unless timely measures are
taken for diagnosis and management.

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