Early occurrence of aortic valve regurgitation in a youth with systemic-onset juvenile rheumatoid arthritis
Article Abstract:
Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory disease that may cause joint or connective tissue damage and lesions of the internal organs throughout the body. It commonly develops before the age of 16 years and resolves in 75 percent of affected persons. JRA may be associated with heart-related complications, including inflammation of the heart muscle and its surrounding membrane, and disease of the valves that direct blood flow within the heart. Pericarditis, the inflammation of the membrane surrounding the heart, often occurs in the early stages of the disease, whereas valvular disease is less common and develops years after the onset of JRA. The most common type of valvular disease associated with JRA is aortic regurgitation, the backflow of blood from the aorta (a major blood vessel carrying oxygenated blood to vessels throughout the body) to the left heart ventricle. A case is described of a 13-year-old boy with severe aortic regurgitation, which developed a few months after the onset of JRA. The patient was treated with indomethacin, a nonsteroidal anti-inflammatory drug, and his joint disease and fever resolved. Six years after the initial hospital admission, the aortic regurgitation had not worsened and the patient was without symptoms of JRA. Among eight previous cases of aortic regurgitation in patients with JRA, valvular disease developed about 10 years after the onset of JRA. This case is unusual in that aortic regurgitation developed four months after the onset of JRA in the patient. Further investigation of the pathology of valvular disease in JRA is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Prognostic significance of valvular regurgitation in patients with infective endocarditis
Article Abstract:
Infective endocarditis is the inflammation of the lining of the heart due to infection with microorganisms. This disease is associated with a high rate of disability and death. Congestive heart failure, an inability of the heart to pump leading to congestion of the lungs, is associated with a poor prognosis, and is often treated by heart surgery. Surgery can improve survival if patients with endocarditis and a high risk of congestive heart failure can be identified early. Doppler ultrasonography is a diagnostic method in which sound waves are used to provide images of the heart and blood flow through the major blood vessels. This technique may be used to identify impaired function of the heart valves, indicated by backflow of blood through the valves. This valvular regurgitation causes an overload of blood volume, leading to congestive heart failure. Doppler ultrasonography may be used to detect valvular regurgitation, and thereby identify patients at risk of developing congestive heart failure. The effectiveness of Doppler-detected valvular regurgitation in identifying 49 patients with endocarditis at risk of developing congestive heart failure was assessed. Valvular regurgitation was detected in 23 patients, but was not correlated with congestive heart failure, death, or need for surgery. However, the development of congestive heart failure was correlated with the need for surgery and occurrence of death. These findings suggest that the presence of valvular regurgitation alone does not predict the development of congestive heart failure. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Bacterial endocarditis presenting as acute myocardial infarction: a cautionary note for the era of reperfusion
Article Abstract:
An embolism is the obstruction of a blood vessel by foreign substances or a blood clot. This is a common complication of bacterial endocarditis, the inflammation of tissue lining the heart cavities which results from bacterial infection. One study showed that embolism developed in 55 of 107 attacks of endocarditis, and heart attack occurred in eight patients. In another report, a patient with endocarditis of the aortic valve suffered a heart attack and was treated by aortic valve replacement and surgical removal of the embolus. Thrombolytic agents, or drugs that dissolve blood clots, and angioplasty, the widening of a narrowed artery using an inflatable balloon, are methods of renewing blood supply to the heart after a heart attack. The cases are described of two patients who suffered heart attacks after bacterial endocarditis and were treated with coronary angioplasty. The patients developed complications resulting from reperfusion, or the renewal of blood supply to the heart. One patient developed an aneurysm, or dilation, of the coronary artery at the site of balloon angioplasty, whereas the other patient developed bleeding. Because of the need for immediate management of coronary embolism, the bacterial endocarditis was not diagnosed before starting treatment. This report illustrates the importance of clinically confirming bacterial endocarditis before beginning reperfusion in patients who may have developed the heart attack from bacterial endocarditis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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