Valvular insufficiency

Khan MA, Herzog CA, St Peter JV, et al. The prevalence of cardiac valvular insufficiency assessed by transthoracic echocardiography in obese patients treated with appetite-suppressant drags. N Engl J Med 1998 339 713-718. 

Hydralazine is indicated for the treatment of cardiac valvular insufficiency and ventricular septal defects in humans. It reduces afterload, thus reducing the volume of regurgitant or shimted blood and thereby improving forward flow. There are no data to support the oral administration of hydralazine to horses and it is only useful as an acute vasodilator. Hydralazine has not been critically evaluated in horses with CHF. 

Pathological cardiac hypertrophy develops in response to stresses, and can be concentric, eccentric, or both. An excess pressure load placed on the heart, for example, resulting from uncorrected hypertension or valvular disease, results in concentric hypertrophy. This hypertrophy is initially believed to be adaptive, normalizing systolic wall stress, though it is not clear that hypertrophy is necessary to maintain systolic function in the face of moderately elevated pressure loads. Eccentric hypertrophy results most often from volume loads such as those in valvular insufficiency. Einally, the hypertrophy that occurs in the remote noninfarcted myocardium, as part of the remodeling process following a myocardial infarction, may be both concentric and eccentric. 

Although anecdotal evidence suggested that prazosin might be useful in the treatment of patients with variant angina (Prinzmetal s angina) due to coronary vasospasm, several small controlled trials have failed to demonstrate a clear benefit. Some studies have indicated that prazosin can decrease the incidence of digital vasospasm in patients with Raynaud s disease however, its relative efficacy as compared with other vasodilators (e.g., Ca -channel blockers) is not known. Prazosin may have some benefit in patients with other vasospastic disorders. Prazosin decreases ventricular arrhythmias induced by coronary artery ligation or reperfusion in laboratory animals the therapeutic potential for this use in humans is not known. Prazosin also may be useful for the treatment of patients with mitral or aortic valvular insufficiency, presumably because of reduction of afterload. 

Prazosin can decrease the incidence of digital vasospasm in patients with Raynaud s disease however, its efficacy relative to channel blockers is not known. Prazosin may be useful in treating vasospastic disorders, and in patients with mitral or aortic valvular insufficiency (presumably because ofqfterload reduction). 

Identification of tumors, cysts in liver, kidneys Valvular insufficiency (flail leaflet), myocardial dyskinesis, septal defects, congenital malformations... 

In a comparative cohort study of1 048173 patients with diabetes, of whom 43 044 (4.1%) had been exposed to benfluorex, the risk of hospitalization for any cardiac valvular insufficiency was higher in those who had used benfluorex (crude RR=2.9 Cl=2.2, 3.7 adjusted RR = 3.1 Cl=2.4, 4.0) [45 =]. There was a lower risk among patients with a lower cumulative dose of benfluorex. The adjusted RRs for admission with mitral insufficiency and aortic insufficiency were 2.5 (Cl=1.9, 3.7) and 4.4 (Cl=3.0, 6.6), respectively. The adjusted RR for valvular replacement surgery was 3.9 (Cl=2.6, 6.1). 

Lower-extremity chronic venous insufficiency (CVI) is caused by venous hypertension [1], Most patients develop venous hypertension from the hydrostatic forces produced by reflux that results from primary valvular insufficiency [2] Venous obstruction, muscular pump failure, and congenital anomalies are much less common causes. In addition, 85%-90%... 

As a result of research performed by different groups dexfenfluramine was introduced as a drug for obesity treatment in the USA in 1995. Whole body calorimetry contributed to this approach. Evidence has been found later for dF being involved in generating valvular insufficiency. So in 1997 it was (at least) temporarily withdrawn from the market. 

Digoxin exhibits strong systolic action and slows heart rate. It is removed from the organism faster than digitoxin. It is used from chronic cardiac insufficiency in decompensated valvular disease of the heart, myocardium overload in arterial hypertension, tachycardia, ventricular fibrillation, and other analogous situations. Synonyms of this drug are cedoxin, lanacordin, lanoxin, and others. 

It is intriguing to try to analyze if differences in mechanochemical transduction mechanisms could explain why some tissues mineralize normally and others do not. This would make it possible to attempt to analyze why heart valves and vessel walls mineralize abnormally in diseases leading to valvular failure or cardiac insufficiency. 

Pfaundler-Hurler syndrome (type I-H) This syndrome is caused by an a-L-iduronidase deficiency (M. v. Pfaundler, 1920 G. Hurler, 1920). It is autosomal recessive and panethnic, with an incidence of approx. 1 100,000 live births. A major cause of morbidity and mortality is respiratory insufficiency together with cardiac compromise (valvular dysfunction). 

The latter case suggests that dosage is important in the production of the valvular pathology. Mitral and tricuspid insufficiency developed in a 36-year-old woman who had... 

Caution should also be exercised in patients with thyrotoxicosis and with valvular stenosis, coronary artery insufficiency (36), or other conditions in which a tachycardia is hazardous. 

Indications Central yang insufficiency phlegm rheum disease. Chronic bronchitis, bronchial asthma, pulmonary emphysema, cardiac or nephrotic edema, valvular disease, Basedow s disease, Meniere s disease, neurosis, neurasthenia, hysteria, motion sickness, rheumatoid arthritis, chronic gastritis, chronic nephritis, renal atrophy, hypertension, sinusitis, rhinitis, anemia, conjunctivitis,chronic optic nerve disorders, optic nerve atrophy, and nebula... 

The beneficial effect of steroid therapy was confirmed 8 years later in a larger group of patients [23]. Curiously, an asymptomatic aortic insufficiency was observed in one third of the patients with CHN [19, 24]. This cardiac complicafion was supposed to be the result of an extrarenal toxicity of Chinese herbs [25]. However, the attention was drawn to the role of appetite suppressants in the development of valvular heart diseases [26]. Since most of the CHN patients we have seen have been given appetite suppressants (fenfluramine, dexfenfluramine, phentermine alone or in combination) besides the Chinese herbs, the puzzling association of aortic insufficiency with CHN may more likely be linked to the concomitant use of (dex)-fenflu-... 

Streptokinase is contraindicated in patients with nlcerative wounds, active internal bleeding, recent trauma with possible internal injuries, visceral or intracranial malignancy, ulcerative cohtis, diverticulitis, severe hypertension, acute or chronic hepatic or renal insufficiency, uncontrolled hypoco-agnlation, chronic pulmonary disease with cavitation, sub-acnte bacterial endocarditis or rheumatic valvular disease, recent cerebral embolism, thrombosis, or hemorrhage, and diabetic hemorrhagic retinopathy, becanse excessive bleeding may occur. 

Moderate to severe (LVEF < 40%) Left-sided valvular heart disease Mild aortic stenosis Aortic insufficiency Mitral regurgitation Mitral stenosis... 

In a single-center non-randomized study in patients undergoing primary cardiac operations, 3334 were given aprotinin and 3417 were not [203 ]. The former were older, and had more unstable symptoms, lower ejection fractions, more preoperative hemodynamic support, more urgent operations, and more combined coronary or valvular operations. Postoperative bleeding and blood product transfusion were considerably reduced by aprotinin, as was median duration of mechanical ventilation. Aprotinin was not related to postoperative myocardial infarction, renal insufficiency, neurological dysfunction, or operative death. 

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