The cl inical manifestations of infective endocarditis are diverse and may involve almost any organ system. Symptoms of endocarditis usu¬ally occur within 2 wk of the inciting bacteremia, although diagnosis may take much longer. Fever is the single most common finding. Non¬specific generalized complaints of anorexia, fatigue, confusion, weight loss, and night sweats are also [...]
Infective endocarditis has become more prevalent in the elderly de¬spite the development of modern antibiotics. More than half of all cases of infective endocarditis occur in persons >60yrof age. Several factors account for the high prevalence in the elderly: increases in the total number of elderly persons and in the number with prosthetic valves, a [...]
The ECG is rarely normal. It shows left atrial abnormality and left ventricular hypertrophy, with left anterior fascicular block in about 20% of patients. Septal hypertrophy may also produce nonspecific infe¬rior and apical Q waves mimicking myocardial infarction. The cardiac silhouette enlarges when ventricular systolic function deteriorates. Two-dimensional echocardiography is diagnostic, although systolic cavity obliteration [...]
Patients may present with chest pain, dyspnea, dizziness, paipila-tions. and syncope (caused by tachyarrhythmias or decreased cardiac output from outflow obstruction). Ventricular tachycardia is common and increases the likelihood of sudden death. Supraventricular tachyar¬rhythmias, more likely to occur as atrial dimensions increase, are also common. Because the atrial contribution to ventricular filling is impor¬tant for [...]
Prevalence and Pathophysiology Idiopathic hypertrophic subaortic stenosis (IHSS) is relatively com¬mon in the elderly. A disproportionate septal thickening narrows the left ventricular outflow tract. Hypertrophic cardiomyopathy may also occur without asymmetric septal hypertrophy; mitral annular calcifica¬tion may displace the mitral valve anteriorly, producing an outflow gradient. Abnormal ventricular compliance elevates the ventricular di¬astolic pressure, with [...]
Pulmonary valve disease is extremely rare in the elderly. When pres¬ent, it is characterized by Ihe murmur of pulmonary insufficiency, usu¬ally due lo pulmonary hypertension secondary to chronic pulmonary disease or left ventricular failure. Treatment of underlying disorders is appropriate.
Tricuspid stenosis is rare except in patients with multivalvular rheu¬matic heart disease or with the carcinoid syndrome. The lower left ster¬nal border diastolic rumble increases on inspiration. A diastolic eleva¬tion of ihe jugular venous pulse occurs (with poor or absent Y descent I and hepatomegaly is present, without other evidence of heart failure. Medical therapy [...]
Retrograde blood flow from the right ventricle into the right atrium caused by inadequate closure of the tricuspid valve orifice during ven¬tricular systole. Tricuspid regurgitation is most often caused by a dilated valve ring secondary lo right ventricular failure. Infective endocarditis is a less common cause (see Ch. 39). The holosystolic murmur (maximal along the [...]
Myxomatous valvular degeneration, which increases in frequency with aging, is the maior cause of mitral valve prolapse in the elderly. Mitral valve prolapse, severe enough to require surgical intervention, is more common in elderly men than in elderly women. The associated dissolution of collagen in the elongated chordae tendineae may explain the high incidence of [...]
About 6% of persons > 60 yr, predominantly women, have mitral annular calcification. Calcification prevents annular systolic contrac¬tion and may limit valve leaflet closure. Although the mitral regurgita¬tion is rarely hemodynamically significant, conduction disturbances may result from extension of the calcification. Recent data suggest thai such calcification doubles the risk for stroke, independent of other [...]
