A 61-year-old woman came to the Emergency Department of our Hospital for fatigue and breathlessness. She was discharged from the surgery ward 2 days before, after a subtotal colectomy for adenocarcinoma had been performed 10 days before. While explaining her history, she appeared very worried because of not hearing since the day before, the usual clicking noise of her mechanical mitral valve prosthesis. The metallic bileaflet-tilting—disk valve (St Jude Medical, Inc.) had been implanted 10 years before. Anticoagulant therapy (acenocumarol) was interrupted before the colon surgery, and the patient was receiving lowmolecular weight heparin (nadroparin 5,700 UI bid). On physical examination, the heart rate was 100 beats per minute, blood pressure was 90/50 mmHg, and respiratory rate was 18 breaths per minute. Auscultation of the heart revealed an absence of a prosthetic closure sound and a grade III holosystolic murmur in the mitral area. Rales were present at both lung bases. A transthoracic echocardiogram, immediately performed, revealed severely restricted movement of the prosthetic mitral valve leaflets with an increased peak diastolic transmitral pressure gradient
Listen to your heart / Iacopo Bertolozzi;Angelo Pucci;Pietro Amedeo Modesti. - In: INTERNAL AND EMERGENCY MEDICINE. - ISSN 1828-0447. - STAMPA. - 4:(2009), pp. 133-135. [10.1007/s11739-009-0224-9]
Listen to your heart
BERTOLOZZI, IACOPO;MODESTI, PIETRO AMEDEO
2009
Abstract
A 61-year-old woman came to the Emergency Department of our Hospital for fatigue and breathlessness. She was discharged from the surgery ward 2 days before, after a subtotal colectomy for adenocarcinoma had been performed 10 days before. While explaining her history, she appeared very worried because of not hearing since the day before, the usual clicking noise of her mechanical mitral valve prosthesis. The metallic bileaflet-tilting—disk valve (St Jude Medical, Inc.) had been implanted 10 years before. Anticoagulant therapy (acenocumarol) was interrupted before the colon surgery, and the patient was receiving lowmolecular weight heparin (nadroparin 5,700 UI bid). On physical examination, the heart rate was 100 beats per minute, blood pressure was 90/50 mmHg, and respiratory rate was 18 breaths per minute. Auscultation of the heart revealed an absence of a prosthetic closure sound and a grade III holosystolic murmur in the mitral area. Rales were present at both lung bases. A transthoracic echocardiogram, immediately performed, revealed severely restricted movement of the prosthetic mitral valve leaflets with an increased peak diastolic transmitral pressure gradientFile | Dimensione | Formato | |
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