Julia Steel Case
Mrs. Julia Steel is a patient I have had the pleasure of meeting with recently. As discussed during the appointment, Mrs. Steel is a 72 year old retired, married woman. Collectively, Mrs. Steel's family history includes the following information: one son at the age of 40 who is being treated for high blood pressure, father's record showed background of heart disease and deceased at the age of 90 due to a brain aneurysm, mother's record provided extensive history with heart disease and deceased due to congestive heart failure at the age of 92, brother who passed at the age of 81 due to heart disease, sister at the age of 76 who has suffered multiple minor heart attacks. According to the biographical data collected, her family history exhibits a
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significant lineage of cardiovascular disease.
Upon exploring her personal health history, Mrs. Steel reports she is a former smoker, has chronic migraines, which she takes the drug Methysergide to relieve, and has chronic anxiety. Habitually, the patient would walk her dog around the neighborhood; however, she has felt rather fatigued and dizzy lately and has experienced dyspnea as a result of this activity. For this reason, Mrs. Steel has diminished her physical exercise substantially and rarely will leave her home— fearing she could pass out and hurt herself. Also, the patient has gained a substantial amount of weight.
I began the examination by checking her vitals; however, I couldn't help but take notice as I measured her pulse and it felt weak. As I evaluated her heartbeat via auscultation, I placed the stethoscope on top of her second right intercostal space and could hear a heart murmur. In order to analyze her case further, I scheduled Mrs. Steel for an exercise electrocardiogram so we could evaluate her heart rate, any rhythmic irregularities, and the strength of the electrical impulses in different parts of the heart during exercise. Her results indicate she has a blood pressure reduction during strenuous activity, which causes her to become faint and experience severe heart palpitations as well as moderate to severe diastolic dysfunction due to the enlargement of the left ventricle.
Upon reviewing Mrs.
Steel's test results, I had reached a diagnosis as to what is likely to be her condition. According to the signs, symptoms, and test results in addition to the family history provided, Mrs. Steel portrays strong indications for having aortic valve stenosis. Generally, the occurrence of valvular stenosis is a result of the flaps stiffening or thickening; therefore, preventing the heart valve from fully opening, which, as a result, reduces the rate of blood flowing through the valve. In this case, stenosis of the aortic valve affects the outflow, diminishing the amount of blood reaching the rest of the body vessels as well as the heart itself. In Mrs. Steel's situation, she may have acquired the disease genetically in addition to having been a smoker for multiple years and taking medication that promotes valvular heart disease. Overall, etiology of aortic valve stenosis includes—but is not limited to-- the following examples: degeneration due to age, rheumatic fever, smoking, bacterial endocarditis, calcium deposits forming on the valve, damage due to atherosclerosis, damage of the heart muscles due to heart attack, medication or drugs that may promote valvular heart disease, radiation therapy,
etc. Depending on the severity of the valvular disease, treatment options may vary from case to case. According to the data collected for Mrs. Steel's, her condition seems to be in the later stages, which limits her range of treatment options. In order to counter further affects, I recommend that she consider a transcatheter aortic valve replacement, also known as TAVR, which is significantly less invasive than open-heart surgery and more than likely results in an easier recovery. In general, the procedure involves a stent-based valve fixed on a balloon catheter that is inserted into the body through a small incision in the groin or chest wall. Once in the aortic valve, he artificial valve pushes the old valve against the wall, remaining anchored to allow for normal blood flow to occur once again. Other methods of treatment for different cases include— but are not limited to— the following options: balloon dilation in order to widen a stenotic valve, usage of anticoagulant and antithrombotic medications, long-term antibiotic therapy, undergo a Ross procedure, practice a more heart-healthy lifestyle, quit smoking, etc.
significant lineage of cardiovascular disease.
Upon exploring her personal health history, Mrs. Steel reports she is a former smoker, has chronic migraines, which she takes the drug Methysergide to relieve, and has chronic anxiety. Habitually, the patient would walk her dog around the neighborhood; however, she has felt rather fatigued and dizzy lately and has experienced dyspnea as a result of this activity. For this reason, Mrs. Steel has diminished her physical exercise substantially and rarely will leave her home— fearing she could pass out and hurt herself. Also, the patient has gained a substantial amount of weight.
I began the examination by checking her vitals; however, I couldn't help but take notice as I measured her pulse and it felt weak. As I evaluated her heartbeat via auscultation, I placed the stethoscope on top of her second right intercostal space and could hear a heart murmur. In order to analyze her case further, I scheduled Mrs. Steel for an exercise electrocardiogram so we could evaluate her heart rate, any rhythmic irregularities, and the strength of the electrical impulses in different parts of the heart during exercise. Her results indicate she has a blood pressure reduction during strenuous activity, which causes her to become faint and experience severe heart palpitations as well as moderate to severe diastolic dysfunction due to the enlargement of the left ventricle.
Upon reviewing Mrs.
Steel's test results, I had reached a diagnosis as to what is likely to be her condition. According to the signs, symptoms, and test results in addition to the family history provided, Mrs. Steel portrays strong indications for having aortic valve stenosis. Generally, the occurrence of valvular stenosis is a result of the flaps stiffening or thickening; therefore, preventing the heart valve from fully opening, which, as a result, reduces the rate of blood flowing through the valve. In this case, stenosis of the aortic valve affects the outflow, diminishing the amount of blood reaching the rest of the body vessels as well as the heart itself. In Mrs. Steel's situation, she may have acquired the disease genetically in addition to having been a smoker for multiple years and taking medication that promotes valvular heart disease. Overall, etiology of aortic valve stenosis includes—but is not limited to-- the following examples: degeneration due to age, rheumatic fever, smoking, bacterial endocarditis, calcium deposits forming on the valve, damage due to atherosclerosis, damage of the heart muscles due to heart attack, medication or drugs that may promote valvular heart disease, radiation therapy,
etc. Depending on the severity of the valvular disease, treatment options may vary from case to case. According to the data collected for Mrs. Steel's, her condition seems to be in the later stages, which limits her range of treatment options. In order to counter further affects, I recommend that she consider a transcatheter aortic valve replacement, also known as TAVR, which is significantly less invasive than open-heart surgery and more than likely results in an easier recovery. In general, the procedure involves a stent-based valve fixed on a balloon catheter that is inserted into the body through a small incision in the groin or chest wall. Once in the aortic valve, he artificial valve pushes the old valve against the wall, remaining anchored to allow for normal blood flow to occur once again. Other methods of treatment for different cases include— but are not limited to— the following options: balloon dilation in order to widen a stenotic valve, usage of anticoagulant and antithrombotic medications, long-term antibiotic therapy, undergo a Ross procedure, practice a more heart-healthy lifestyle, quit smoking, etc.