scholarly journals Anaesthetic Management of a Case of Pregnancy with Rheumatic Heart Disease

2021 ◽  
Vol 6 (3) ◽  
pp. 278-280
Author(s):  
Shallu Chaudhary ◽  
Neha Atwal
Keyword(s):  
Heart Disease ◽  
Case Report ◽  
Rheumatic Heart Disease ◽  
Mitral Stenosis ◽  
Intraoperative Monitoring ◽  
Low Dose ◽  
Anaesthetic Management ◽  
Emergency Caesarean Section ◽  
Intravenous Fluids ◽  
Rheumatic Heart

We present a case report of a 28 year old pregnant female with moderate mitral stenosis who was posted for emergency caesarean section. The patient was given low dose subarachnoid block with injection bupivacaine (H) 7.5 mg and injection fentanyl 20 micrograms. Adequate intraoperative monitoring, optimum sedation, analgesia, oxygenation was done. Judicious use of intravenous fluids was considered. The patient maintained smooth intraoperative vitals. Postoperatively also the patient was monitored in the ICU and adequate analgesia was provided. Keywords: Rheumatic Heart Disease, Anaesthetic Management, Pregnancy, Mitral stenosis of rheumatic origin

Impact of the Severity of Mitral Stenosis on the LV Systolic function as assessed by 2D Strain using Speckle tracking

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Adel ◽  
Tarek K Mosa ◽  
Ahmed Yehia ◽  
Ahmed Shawqi
Keyword(s):  
Heart Disease ◽  
Ejection Fraction ◽  
Healthy Volunteers ◽  
Rheumatic Heart Disease ◽  
Mitral Stenosis ◽  
Speckle Tracking ◽  
Systolic Function ◽  
University Hospitals ◽  
Lv Systolic Function ◽  
Rheumatic Heart

Abstract Background Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries and mitral stenosis is the most common valve affection of rheumatic heart disease worldwide.The left ventricular ejection fraction is the most widely used index of contractile function, but due to the visual component, assessment of endocardial excursion is subjective leading to inter-observer variability.Speckle-tracking echocardiography is an imaging technique developed as a method to objectively quantify myocardial function and analyzes cardiac motion and deformation by tracking naturally occurring speckle patterns in the myocardium. Objective To evaluate the effect of the severity of mitral stenosis on LV systolic function as assessed by speckle tracking. Patients and Methods This study was a case-control study involving 80 individuals which included 60 patients having mitral stenosis who presented to the outpatient clinics of Ain Shams University Hospitals and 20 healthy volunteers, The patients suffering from mitral stenosis were subdivided into 3 sub-groups: GROUP(1) 20 Patients having severe mitral stenosis (MV Area less than 1 cm²) GROUP (2) 20 Patients having moderate mitral stenosis (MV Area more than 1 cm² and less than 1.5 cm²) GROUP(3) 20 Patients having mild mitral stenosis (MV Area more than 1.5 cm²) A Control group involved 20 healthy volunteers recruited from health care workers in Ain Shams University hospitals. Results Study included 60 patients,16 males (26.7%) and 44 females (73.3%), with mean age of 41.30 ± 8.64 years. Patients living in rural Areas were 34 (57.7%) while those in urban areas were 26 (43.3%).Which was significant.There was no significant difference between gender or habitat and the severity of mitral Stenosis.There was a strong significance between the duration of the disease and its severity. The more the duration of mitral Stenosis, the more severe the mitral stenosis.A strong positive relation was noticed between the severity of mitral stenosis and both RVSP and LA diameter, while a strong negative relation between severity of mitral stenosis and GLPS. GLPS was affected in severe mitral stenosis only. Conclusion Subtle LV systolic dysfunction is present in large number of patients with severe mitral stenosis even in patients with normal ejection fraction by conventional 2D echocardiography.There was a significant relationship between the duration of mitral stenosis and its severity. The longer the duration of mitral stenosis, the more severe the mitral stenosis.Speckle tracking echocardiography (STE) can play a great role in identification of higher risk subgroups in whom earlier and more aggressive intervention could have a significant impact on their prognosis.

scholarly journals Hemorrhagic Transformation of Embolic Stroke in Pediatric Rheumatic Heart Disease: A Case Report

2019 ◽  
Vol 16 (4) ◽  
Author(s):  
Jeslyn Tengkawan ◽  
Titi Pambudi Karuniawaty ◽  
Zulfikar Ihyauddin ◽  
Ayu Anandhika Septisari
Keyword(s):  
Heart Disease ◽  
Case Report ◽  
Rheumatic Heart Disease ◽  
Hemorrhagic Transformation ◽  
Embolic Stroke ◽  
Rheumatic Heart

scholarly journals Mean Levels of B-type Natriuretic Peptide (BNP) in Patients with Mitral Stenosis Caused by Rheumatic Heart Disease

2021 ◽  
pp. 96-102
Author(s):  
Altaf Hussain ◽  
Faraz Farooq Memon ◽  
Iftikhar Ahmed ◽  
Syed Ahsan Raza ◽  
Lajpat Rai ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Natriuretic Peptide ◽  
Mitral Stenosis ◽  
Final Analysis ◽  
Severe Intensity ◽  
The Mean ◽  
Valvular Lesion ◽  
Rheumatic Heart ◽  
Valve Area

Objective: Mitral stenosis caused by rheumatic heart disease (RHD) is the most common cause of valvular lesion in adults and prevalent in developing countries like Pakistan. Higher natriuretic peptide (BNP) levels can be observed in patients with moderate to severe untreated mitral stenosis and are associated with higher rates of morbidity and mortality. That is why this study aims to determine the association between levels of pro-BNP with severity (mild. Moderate, and severe) of mitral stenosis. Patients and Methods: This was a clinical prospective study carried out in the department of adult cardiology, national institute of cardiovascular diseases, Karachi from 8th august 2019 to 7th February 2020. Total 68 patients of either gender with age between 25-70 years had mitral stenosis of moderate to severe intensity (mitral valve area ≤1.5 cm2), diagnosed on echocardiography were included for final analysis. A simple blood sample was taken for the assessment of pro-BNP levels. Questionnaire was used for demographic & clinical data collection and analysed using SPSS version 22.0. Results: The overall mean age of study subjects was 42.21±11.50 years, ranging from 25 – 70 years. Among them, females were prevalent (n = 43, 63.2%). The overall mean serum BNP level was 1071.12±807.26 pg/ml and the mean difference of serum BNP level was not significant among groups of gender, age, and diabetes mellitus with p>0.05. Significantly raised levels of BNP were observed in patients with severe mitral stenosis as compared to moderate mitral stenosis, p<0.05 Conclusion: In conclusion, the mean BNP levels were higher in patients with severe Mitral Stenosis. Therefore, BNP may be used to complement the clinical and echocardiographic assessments in patients with Mitral Stenosis.

scholarly journals Anaesthetic management of a young primigravida with 8 months amenorrhea, rheumatic heart disease, hypothyroidism and met-hemoglobinimea schedule for cesarean section

2020 ◽  
Vol 9 (6) ◽  
pp. 2602
Author(s):  
Misha Katyal
Keyword(s):  
Methylene Blue ◽  
Ascorbic Acid ◽  
Heart Disease ◽  
General Anesthesia ◽  
Rheumatic Heart Disease ◽  
Good Alternative ◽  
Anaesthetic Management ◽  
Supplemental Oxygen ◽  
Postoperative Treatment ◽  
Rheumatic Heart

A young patient, primigravida with rheumatic heart disease, hypothyroidism and met-hemoglobinemia had central and peripheral cyanosis was scheduled for caesarean section under general anesthesia in two days. Author managed met-hemoglobinemia with ascorbic acid keeping methylene blue as standby. Haemoglobin saturation was 89% at room air and 92% with supplemental oxygen. Initial met-haemoglobin levels were 31.54% (normal values <1%). After optimizing thyroid and RHD status (moderate MR and mild MS), she was given tablet ascorbic acid 2 gram thrice a day with methylene blue as standby. Conventional balanced general anesthesia technique was used and she was followed up in postoperative period with ICU care. A healthy live female baby was extracted and mother had stable vital parameters. Postoperative treatment with ascorbic acid was continued. Repeated methaemoglobin levels showed a drop from preoperative value of 31.54% to 11.39% by 3rd postoperative day and 8.05% at the end of 1st week. At the time of discharge, she did not have any cyanosis. Ascorbic acid is a good alternative drug with limited experience in met-hemoglobinemia. Author present a case of a met-hemoglobinemia treated with ascorbic acid successfully to emphasize the use of ascorbic acid as an alternative method without any adverse effects.

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