Midline Sternotomy Scar
Case record by Wuchereria
Examine the Cardiovascular system
This pt has a pulse rate of 80/min which is irregularly irregular. There is no radio-radial delay or collapsing pulse. There is no clubbing or peripheral stigmata of infective endocarditis. She is pale. There is no jaundice, cyanosis. JVP is not elevated and there is no pedal oedema of the legs.
On examination of the precordium, there is a midline sternotomy scar.
Apex beat is displaced, 5th intercostals space 2 cm lateral to MCL. No parasternal heave or thrills.
Metallic click of the 1st HS, normal 2nd HS
Lungs clear
I would like to complete my examination by checking the fundus for Roth spot or fundal haemorrhage, look for signs of overwarfarinization, examine the CNS for evidence of CVA, look for splenomegaly, urine dipstick for haematuria, check BP, all peripheral pulses
My diagnosis is that this pt has Mitral valve replacement and is in atrial fibrillation and is anaemic. There are no signs to suggest infective endocarditis, pulmonary hypertension, overwarfarinization or heart failure. There is also no evidence of valve leakage.
Questions:
Examine the Cardiovascular system
This pt has a pulse rate of 80/min which is irregularly irregular. There is no radio-radial delay or collapsing pulse. There is no clubbing or peripheral stigmata of infective endocarditis. She is pale. There is no jaundice, cyanosis. JVP is not elevated and there is no pedal oedema of the legs.
On examination of the precordium, there is a midline sternotomy scar.
Apex beat is displaced, 5th intercostals space 2 cm lateral to MCL. No parasternal heave or thrills.
Metallic click of the 1st HS, normal 2nd HS
Lungs clear
I would like to complete my examination by checking the fundus for Roth spot or fundal haemorrhage, look for signs of overwarfarinization, examine the CNS for evidence of CVA, look for splenomegaly, urine dipstick for haematuria, check BP, all peripheral pulses
My diagnosis is that this pt has Mitral valve replacement and is in atrial fibrillation and is anaemic. There are no signs to suggest infective endocarditis, pulmonary hypertension, overwarfarinization or heart failure. There is also no evidence of valve leakage.
Questions:
1. What are the causes of anaemia ?
*Bleeding due to anticoagulation
*Haemolysis
*Secondary to IE
*Bleeding due to anticoagulation
*Haemolysis
*Secondary to IE
2. Advantages of Porcine heart valve
*No need anticoagulation
*No need anticoagulation
3. Disadvantage of Porcine heart valve
*Degeneration with time – may need reoperation (after about 7 years)
*Calcification
*Degeneration with time – may need reoperation (after about 7 years)
*Calcification
Labels: Cardiovascular
posted by Dr. David Teoh @ 8/23/2006 09:29:00 PM
3 Comments:
Two things are important regarding weather we choose a mechanical or a bioprosthetic valve:
1- If the life expectancy of the valve is shorter than the life expectancy of the patient.
2- If anticoagulation cannot be used (difficult to achieve, bleeding tendency, questionable follow up...etc).
Another thing. Given the above findings (by Wech.), I think that there was mitral regurgitation plus minus mitral stenosis, and the regurgitation was the hemodynamically predominant lesion at that time. The presence of displaced apex and atrial fibrillation point to a moderate to severe degree of valvular pathology from the outset, so I think that absence of signs of pulmonary hypertension, or bibasilar crackles would be unusual.
Thank you
Dr. O Amin
Hey wuchereria, how come don't post urself :P
Probably the surgery was done before significant pul HPT develop. I am not surpise that there is no bibasal creps as there are no other signs to suggest HF or valve leaking.
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