Valve thrombosis is a rare but very serious complication of mechanical heart valve prostheses that can result in significant morbidity and mortality. The prevalence of Mechanical prosthetic valve thrombosis ranges from 0.3% and 1.3% per patient-year depending on the type of anticoagulation used and adherence to therapy (1, 2). The severity of clinical presentation depends on the presence or absence of obstruction (3). Our patient presented with New York Heart Association (NYHA) class IV heart failure, hemodynamically significant murmur and evidence of immobile valve leaflet on fluoroscopy. The goals of management of in managing PVT are to remove the thrombus, preserve normal valve function and prevent embolization (4). Management of PVT is controversial but therapeutic options include surgery, fibrinolysis and anticoagulation with choice of therapy depending on size of thrombus, presence of valve obstruction, valve location and clinical status of the patient (5). Current guidelines rely on expert opinion and limited data from case series, retrospective cohorts and non-randomized studies due to absence of randomized clinical trials to guide therapeutic strategies for PVT. …show more content…
The American Heart Association and American college of Cardiology guidelines suggest thrombolysis only in hemodynamically stable patients with non-obstructive PVT (5) while The American College of Chest Physicians recommends thrombolysis as first line therapy for thrombi < 0.8cm2 (8). Due to the nature of the prosthesis type and thrombus, the size of the thrombusmass could not be measured in our
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4). Medtronic’s CoreValve uses similar technology and has won patent fights in Europe and has been in use internationally. However, within U.S., Medtronic has not been...
Stethoscope functionality generally has not changed over the past few decades evolving from the monaural hollowed out wooden tube first invented in the early 1800’s by Rene Laennec to the more familiar long multi tubular version, improved upon by George Cammann 50 years later, we so typically see today. The core components of a modern stethoscope are comprised of ear tips, binaural piece, tubing and a diaphragm with a bell on the back. The bell transmits low frequency waves all the way up to the ear pieces, while the diaphragm is designed to carry the higher frequency sound. The two fathers of the stethoscope left little room for improvement on the near perfect design for just over a century until a Harvard Medical School professor by the name of David Littmann turned the simple listening device into the versatile diagnostic tool resting around almost every health care professional’s neck today.
Nishimura, R. A., & McGoon, M. D. (1999). Editorial: Perspectives on mitral-valve prolapse. The New England Journal of Medicine, 341(1), 48-50. Retrieved from http://search.proquest.com/docview/223939414?accountid=158514
... Various treatment modalities have been described, including lobectomy or segmentectomy, systemic artery to pulmonary artery anastomosis and endovascular treatment. Differentiation between this condition from classic sequestration has important treatment implications as it may allow non-operative management (angiographic embolization) of the aberrant systemic artery.
Many factors can increase the risk of these clots, including prolonged bed rest (such as after surgery), sitting for long periods (such as on a plane), use of birth control pills or hormone replacement therapy, pregnancy, family history of DVT, inflammatory bowel disease, and certain genetic clotting disorders. Compression stockings are also sometimes used in people who have an acute DVT, to prevent a group of symptoms known as post-thrombotic syndrome that includes leg pain and
According to Batshaw, Roizen, and Lotrecchiano (2013), patent ductus arteriosus (PDA) is “the persistence of a fetal passage permitting blood to bypass the lungs” (p. 745). This is an inherited heart condition in which the ductus, a small pathway between the pulmonary and the aortic, valves remain open. This cardiovascular problem usually occurs in low birth weight infants. The blood vessels usually naturally closes after birth (Batshaw et al., 2013, p. 96). It becomes atypical if it remains open after the neonatal period. The structure usually closes in typical developing newborns around the initial 24 hours, and anatomical closure is supposed to follow several weeks later (Stanford Children’s Health, 2015). At the point when the ductus arteriosus stays open, the blood from the oxygen-rich aorta blends with the oxygen-poor pulmonary artery causing the higher chance of blood pressure in the lung pathways (U. S. Department of Health and Human Services, 2011). Certain children who have patent ductus arteriosus may be given medication, relying upon the circumstance to standardize the blood and oxygen levels until surgery is performed. Doctor can treat this condition by providing pharmaceutical medicine, catheter-based procedures, and surgery (U. S. Department of Health and Human Services, 2011).
After a thorough examination, J.P. was diagnosed with a deep vein thrombosis (DVT). “DVT develops most often in the legs but can occur also in the upper arms…” (Ignatavicius & Workman, 2013). Due t...
The human body is dependent on interconnectedness of its systems to maintain homeostasis. Internal and external factors can potentially contribute to a disruption of homeostasis. If the body is not returned to homeostasis by negative feedback mechanisms then complications arise which can be detected by a battery of tests (Museum of Science & Industry, 2013). For example, a 40-year-old man enters the clinic with complaining of chest pains, the negative feedback systems have not returned the body to homeostasis. A variety of tests are performed to determine what is occurring. The objective data states that the patient has elevated troponin levels, which confirm a mild heart attack. Hematocrit levels are normal; however, platelet counts are recorded at >600x 103 /µl, and there is also no direct evidence for iron deficiency. Subjective data reveals that the patient complains of a throbbing and burning sensation in the hands and feet, and his family has a history of heart problems. To determine the patient’s condition the attending physician must understand the anatomy of the body.
ECHO and CT provide great diagnostic tools in diagnosing complications associated with LVADs. The complications can further be subdivided into perioperative and late post-operative complications. In the perioperative period, low flow rates can cause hemodynamic stability which can be caused by an obstructing/malpositioned inflow cannula, hemorrhage, or tamponade (1-23). Later complications include thrombus of the inflow and outflow cannulas, bend relief malpositioning, aortic valve stenosis/insufficiency, and infection. Right sided heart failure can appear as an early or late complication (1).
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
I completely agree with Courtney about performing pulmonary vein ablation on this patient. Radiofrequency catheter ablation for AF has become a common used second-line therapy after failure of at least one antiarrhythmic drug (Bunch & Cutler, 2015). The authors stated that multiple clinical trials report arrhythmia free survival of 50-75% at 1-year post ablation in contrast to only 10-30% with antiarrhythmic drugs. Hence, there is a chance that in near future, pulmonary vein ablation should become a first-line therapy for atrial fibrillation (AF).
Smith, BJ 2011 'Thrombolysis for acute stroke in Australia', The Medical journal of Australia, vol. 193, no. 4, pp. 439-443
Ottawa Hospital Research Institute. (2010). Outcomes of saddle pulmonary embolism: a nested case-control study. International Society on Thrombosis and Hemostasis, 867-869.
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
Conveyer belt is a carrying medium to carry the objects forward. A belt conveyor system consists pulleys with an endless loop of carrying medium that rotates about them. One or both of the pulleys are powered with battery to move the belt further. The pulley which is powered is called the drive pulley while the unpowered pulley is called as idler pulley.