Aortic Stenosis Introduction Background With the aging of the United States population, diseases in the elderly are a major interest among health care professionals. Valvular aortic stenosis (AS) is no exception; senile degenerative AS is now the leading indication for aortic valve replacement (AVR). The favorable long-term outcome following aortic valve (AV) surgery and the relatively low operative risk emphasize the importance of an accurate and timely diagnosis. Pathophysiology
Aortic Regurgitation Introduction Background Primary disease of the aortic valve leaflets, the wall of the aortic root, or both may cause aortic regurgitation (AR). With the decline in the incidence of syphilitic aortitis and rheumatic valvulitis in the second half of the 20th century, various aortic root disorders such as Marfan disease and degeneration of bicuspid aortic valves have become the most common causes of AR. Pathophysiology
Aortitis Introduction Background Aortitis is literally inflammation of the aorta, and it is representative of a cluster of large-vessel diseases that have various or unknown etiologies. While inflammation can occur in response to any injury, including trauma, the most common known causes are infections or connective tissue disorders. Infections can trigger a noninfectious vasculitis by generating immune complexes or by cross-reactivity. The etiology is important because immunosuppressive therapy, the main treatment for vasculitis, could aggravate an active infectious process.
Aortic Coarctation Introduction Background Coarctation of the aorta is a narrowing of the aorta most commonly found just distal to the origin of the left subclavian artery. Most patients with coarctation have juxtaductal coarctation. Older terms, such as preductal (infantile-type) or postductal (adult-type), are often misleading. Pathophysiology The vascular malformation responsible for coarctation is a defect in the vessel media, giving rise to a prominent posterior infolding (the “posterior shelf”), which may extend around the entire circumference of the aorta….
Pericarditis, Constrictive-Effusive Introduction Background Effusive-constrictive pericarditis is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction where constrictive hemodynamics are persistent after the pericardial effusion is removed. The mechanism of effusive-constrictive pericarditis is thought to be visceral pericardial constriction. Pericardial effusions vary in size and age and may be transudative, exudative, sanguineous, or chylous. An effusion persisting for months to years may evolve into effusive-constrictive pericarditis.1, 2, 3, 4, 5, 6, 7, 8, 9, 10
Pericarditis, Constrictive Introduction Background The thousand mysteries around us would not trouble but interest us, if only we had cheerful, healthy hearts. –Nietzche If we all had healthy hearts, the mysteries of the heart would not trouble us; however, constrictive pericarditis certainly has been a mystery and remains a diagnostic challenge to this day.
Pericarditis, Acute Introduction Background The pericardium is composed of the parietal pericardium (an outer fibrous layer) and the visceral pericardium (an inner serous membrane made of a single layer of mesothelial cells). The visceral pericardium is attached to the epicardial fat and reflects back on itself to form the parietal pericardium. The pericardium normally contains as much as 50 mL of an ultrafiltrate of plasma. Drainage occurs via the thoracic duct and the right lymphatic duct into the right pleural…
Pericardial Effusion Introduction Background Pericardial effusion defines the presence of an abnormal amount and/or character of fluid in the pericardial space. It can be caused by a variety of local and systemic disorders, or it may be idiopathic. Pericardial effusions can be acute or chronic, and the time course of development has a great impact on the patient’s symptoms. Treatment varies, and is directed at both removal of the pericardial fluid and alleviation of the underlying cause, which usually is…
Cardiac Tamponade Introduction Background Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. Cardiac tamponade is a medical emergency. The overall risk of death depends on the speed of diagnosis, the treatment provided, and the underlying cause of the tamponade. Pathophysiology The pericardium, which is the membrane surrounding the heart, is composed of 2 layers. The parietal pericardium is the outer fibrous layer; the…
Pulmonary Edema, Cardiogenic Introduction Background Pulmonary edema refers to extravasation of fluid from the pulmonary vasculature into the interstitium and alveoli of the lung. The formation of pulmonary edema may be caused by 4 major pathophysiologic mechanisms: (1) imbalance of Starling forces (ie, increased pulmonary capillary pressure, decreased plasma oncotic pressure, increased negative interstitial pressure), (2) damage to the alveolar-capillary barrier, (3) lymphatic obstruction, and (4) idiopathic or unknown mechanism.