Chronic mitral regurgitation accounts for 2h of mitraj valve disease in the elderly. About lh of affected patients have a history of rheumatic fever and about yk have associated aortic valve disease, usually aortic regurgitation. Isolated mitral regurgitation often results from papillary muscle dysfunction following myocardial infarction. Calcification of the mitral annulus and myxomatous valve [...]
ACUTE MITRAL REGURGITATION Acute, often massive, mitral regurgitation in elderly patients is com¬monly due lo chordal rupture or ihe development of a flail mitral leal-let. The underlying disorder may be myocardial infarction, papillary muscle rupture, infective endocarditis, or mucoid degeneration of the valve cusps. Idiopathic chordal rupture also occurs. Symptoms, Signs, and Laboratory Findings The [...]
Most elderly patients wilh mild to moderate mitral slenosis arc in sinus rhythm with few or no symptoms and respond well lo medical therapy. Although alrial fibrillation oflen prccipilales clinical deleiio-ration and sometimes pulmonary edema, digitalis, verapamil, or ?-blocker Iherapy can slow ihe ventricular response rale. The onset of atrial fibrillation may also cause peripheral [...]
The clinical features are comparable to those in younger persons and include a loud first heart sound, an apical diastolic rumble with presys¬tolic accentuation, and an opening snap. The latter may soften or disap¬pear with valvular calcification, and the diastolic murmur may become softer. A righl venlricular parasternal impulse is often palpable, and venous pressure [...]
Mitral stenosis, due predominantly to rheumatic heart disease, is usually identified before old age and accounts for about ‘h of mitral valve disease in the elderly. Its severity is usually such lhat an adequate response to medical therapy was obtained. However, this incidence may decrease because of the reduced incidence of rheumatic fever in developed [...]
Cardiac enlargement with a dilated aorta and occasionally an aorlie aneurysm is characteristic on chest x-ray. Linear calcification of the ascending aorta is typical in syphilitic aortic regurgitation. This con¬trasts with the x-ray findings of benign aortic calcification. The ECU shows left ventricular hyperlrophy. On echocardiography, Ihe left ven¬tricular cavity is enlarged, often with early [...]
Chronic aortic regurgitation may be caused by valve leaflet disease (congenital or rheumatic disease, myxomatous degeneration, or sec¬ondary to endocarditis) or by aortic annular root dilatation (eg, as in syphilis, rheumatoid spondylitis, Marfan’s syndrome). Symptoms and Signs Mild to moderate aortic regurgitation is often asymptomatic for many years, with preserved exercise tolerance, because of the [...]
Trauma, infective endocarditis, or aortic dissection may cause acute aortic regurgitation. Acute severe heart failure is precipitated by abrupt ventricular volume overload without compensatory hypertrophy or di¬latation. Symptoms, Signs, and Laboratory Findings Sudden, severe heart failure or acute pulmonary edema occurs with tachycardia and often with hypotension. The heart failure may mask the anticipated brisk [...]
Aortic valve replacement is indicated for hemodynamically significant symptomatic aortic stenosis (see VALVE REPLACEMENT in Ch. 44). be¬cause only lh of medically treated elderly patients survive > 5 yr after onset of angina, heart failure, or syncope. Patients often die suddenly. Symptomatic patients with severe aortic stenosis have a mortality rale of up to 50% [...]
AORTIC STENOSIS An abnormal narrowing of the aortic valve orifice. Aortic stenosis, the most clinically significant valvular lesion in the elderly, increases in frequency with age. The severity of (he stenosis is often underestimated because its progression is so gradual. Aortic ste¬nosis with calcification predominates. Calcification of a congenital bi¬cuspid valwfi occurs in the younger [...]
