Thursday, November 20, 2008

Researching Medical Terms Again: Aortic Stenosis

Mom texted me and asked me to research Aortic Stenosis. This is what Dad has, according to his doctors.

Roc and people with medical know-how out there, please correct me where I'm wrong! I'm simplifying this as much as I can so that *I* can understand the meaning underneath all that medical jargon!

Aortic Stenosis (AS) is the abnormal narrowing of the aortic valve. The aortic valve is what controls/pumps blood from the aorta to the arteries of the body. AS occurs when this particular valve narrows; this can be caused by birth, by age, and by rheumatic fever.

Symptoms of AS are chest pain, fainting (called syncope---pronounce the e (ee) in the end), and shortness of breath. Dad has exhibited ALL these symptoms, most especially in the past few months. In a small percentage of AS patients, sudden death can occur during strenuous exertion.

Chest pain symptoms are described as a pressure below the breast bone brought on by exertion and is only relieved by rest.

Fainting (syncope) symptoms are associated with exertion or excitement.

Without effective treatment, the average life expectancy is less than 3 years after the onset of chest pain or syncope symptoms.

Shortness of breath from heart failure is one of the worst signs for an AS patient. This shows the heart muscles' failure to compensate for the extreme pressure load of aortic stenosis. Shortness of breath caused by extreme pressure in the blood vessels of the lung is due to the increased pressure required to fill the left ventricle.

In the beginning, shortness of breath happens only during activity. As AS progresses, shortness of breath occurs even at rest. Without treatment, the average life expectancy after the onset of AS is between 6 to 24 months.

To diagnose AS, doctors use the EKG, chest xray, echocardiography and Cardiac Catheterization. This last one is the BEST thing to use to evaluate the gravity of AS in a patient. In this procedure, small hollow tubes (catheters) are advanced under xray guidance to the aortic valve and into the left ventricle.

Valve infection (endocarditis) is a serious complication of AS. Patients are given antibiotics before any and all procedures in which bacteria may be introduced into the blood stream. This includes routine dental work, minor surgery, and other procedures that may involve traumatizing blood vessels such as colonoscopy and urologic examinations.

When symptoms appear, prognosis for patients with AS WITHOUT valve replacement is not very good. The use of diuretics to reduce high lung pressure and remove lung fluids only give temporary relief to the patient.

Patients with symptoms are recommended to undergo cardiac catheterization.

A diagnosis of severe AS requires aortic valve replacement (AVR) surgery. Overall mortality rate for this type of surgery is 5%.

SOOOOO, from the above, I can infer and ask the following:
1. Dad should limit his exercise, i.e., physical therapy, to limit any extreme exertion. But should he take out his PT altogether? Wouldn't the lack of exercise make him even weaker? Is there a balance between the two?

2. Dad should see a cardiologist every 3 to 6 months. - No ifs, ands or buts for this one. His heart MUST be monitored religiously.

3. Surgery to repair/replace the aortic valve is the preferred treatment for patients with AS. - But can Dad's body take this kind of invasive surgery??? Is it possible for him to undergo a less invasive surgery for AS, called Balloon Valvuloplasty, instead? This is where a balloon is placed into an artery in the groin, then advanced to the heart, placed across the valve, and then inflated. This may relieve the obstruction caused by the narrowed valve.

4. Remember when Dad's doctors told him to always take antibiotics before going to the dentist? I guess he was already being treated for or was being prevented from developing AS.

5. Some statistics I found:

  • Approximately 35% of patients with aortic stenosis present with angina. Of these, 50% die within 5 years unless aortic valve replacement (AVR) is performed.
  • Approximately 15% of patients present with syncope; of these, 50% die within only 3 years unless the aortic valve is replaced.
  • Of the 50% of patients who present with symptoms of congestive heart failure, 50% die within 2 years without AVR.

  • And that's the end of my research. Things don't sound so good overall, but Mom will be asking for a second opinion, and Dad needs to get rid of his pneumonia before we can even consider surgery for him. How soon does he need to have this done? Not sure. But he NEEDS to have the AVR surgery, no question about it!

    The good thing about all this is that Dad has developed a sense of understanding his body, and staying attuned to it. He has never done this in the past, but he's become better at it in the past few months. So at the very least, he can tell if what he's feeling is normal, or something else entirely.

    Please remember to say a prayer for Dad! He needs all the prayers he can get right now. Thanks much!

    No comments: