Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thrombotic obstruction, a rare but often fatal complication of cardiac valve prostheses, appears to occur more frequently in tilting-disc valves than in other valve designs. Its diagnosis and surgical treatment remain a challenge. Ten consecutive patients who had thrombosis of a tilting-disc valve prosthesis were treated in Chang Gung Memorial Hospital from November 1982 to August 1990. Preoperative clinical features, including exertional dyspnea, new murmur, and absence of a metallic click from the prosthetic valve, occurred in all of the patients. Symptoms were present for 1 week or more before reoperation in 70% of the patients; nevertheless, many patients were referred only after acute exacerbation of heart failure and development of pulmonary edema. Echocardiography confirmed prosthetic valve malfunction in 90% of the patients. One unconfirmed case was later documented by cardiac catheterization. Anticoagulant therapy was in the therapeutic range for only half of the patients at the time of admission. Prompt reoperation was performed for thrombectomy (8 patients, all survived) or valve replacement (2 patients, one death). Long-term outcome was satisfactory in all survivors with a mean follow-up of 31.6 months. These findings emphasize the importance of considering the diagnosis of thrombosis in patients with mechanical heart valve prostheses who are first seen with nonspecific symptoms and minor changes of their physical findings. The diagnosis could be easily made by echocardiography. Thrombectomy is an easy, fast, and safe procedure, especially for these critically ill patients.
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PMID:Surgical management of thrombotic disc valve. 841 19

Right Heart Thrombus (RiHT) management is really controversial, and appropriate guidelines are not present for the management. In patients referring with RiHT and Pulmonary Embolism (PE), there are three ways of managing these patients. Out of the three, one is thrombectomy, which is with high risk taking in mind the comorbidities these patients have. The other is using thrombolytic which, in many cases is contraindicated or with high risk. The other less effective way is full anticoagulation. It is really controversial to choose between these ways of management and no clear approach is present. The case presented is a 44-year-old morbid obese male with history of dyspnea on exertion (functional Class II) and foot oedema or the last three months, who was transferred to the emergency department with respiratory distress and hypoxia. Echocardiography was done for the patient which showed moderate Right Ventricular (RV) dysfunction with severe RV enlargement and a severe Tricuspid Regurgitation (TR) with TR gradient of 70mmHg. He also had a semi-mobile large pedunculated mass in favour of a clot in his RV cavity. With the impression of PE heparin was administered to the patient and he was admitted in the coronary care unit. Pulmonary Computed Tomography (CT) angiography showed sub-segmental Pulmonary Thromboendarterectomy (PTE) in the left lung. He had negative cardiac markers and stable vital signs and so full anticoagulation was chosen for his treatment. His clinical course was uneventful and after 10 days of treatment the RV size and function improved significantly. On follow-up after a month he was doing well. Although recent Guidelines of European Society of Cardiology in management of acute PE stated that RiHT, particularly mobile, are associated with a significantly increased early mortality risk in patients with acute PE. Immediate therapy is mandatory, but optimal treatment is controversial in the absence of controlled trials. Thrombolysis and embolectomy are probably both effective while anticoagulation alone seems to be less effective.
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PMID:Acute Right Heart Failure in a Patient with Right Heart Thrombus and Pulmonary Thromboembolism. 2779 Apr 95