Cardiac Valvular Disease
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Patients presenting for non-cardiac surgery may have valvular heart disease. Valvular lesions alter cardiac haemodynamics resulting in symptoms and signs. Longstanding valvular heart disease of any severity results in morphological and functional changes in the heart. The heart requires an adequate returning supply of blood and a ‘normal’ resistance to pump against to pump efficiently. An abnormal valve may result in hypertrophy, dilation or alteration in contractility of related chambers. The commonest aetiology is degenerative, others include congenital, rheumatic, or bicuspid valve calcification. A slow rising pulse of low pressure is found with concentric left ventricular hypertrophy and a systolic ejection murmur, maximal in the 2nd right intercostal space and radiating to the neck. Dyspnoea, a wide pulse pressure with a collapsing pulse, left ventricular hypertrophy, an early diastolic murmur and a quiet second heart sound are found. Papillary muscle damage following an infarct or bacterial endocarditis may cause acute mitral regurgitation.
Station 3: Cardiology
Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss in The MRCP PACES Handbook, 2017
Aortic stenosis is an ejection systolic murmur which is loudest over the aortic area and radiates to the carotids. The cardiac examination takes time. In valvular heart disease, pay attention to signs other than the murmur (e.g. character of the peripheral pulse and apex beat and association of differences in pulse pressure). It is possible that the doctors may know the diagnosis before they listen to the chest. Aortic regurgitation is an early diastolic murmur which is heard loudest over the left sternal edge with the patient sitting forward. Hypertrophic cardiomyopathy (HCM) is associated with an ejection systolic murmur heard loudest at the left sternal edge. Key clinical findings are a bifid jerky pulse, a double apical impulse and a palpable thrill. This is an autosomal dominant inherited condition which is associated with sudden cardiac death. Mitral stenosis is a mid-diastolic murmur which is heard loudest at the apex in the left lateral position.
Peripheral circulation
Burt B. Hamrell in Cardiovascular Physiology, 2018
Pulse pressure is peak arterial systolic blood pressure minus arterial diastolic blood pressure. Arterial blood pressure rises to a peak, the systolic pressure, and then falls to a minimum, the diastolic pressure. Left ventricular systolic ejection thrusts blood into the blood-filled aorta. The left ventricular volume decreases and the proximal aorta swells. The aorta and its branches constitute a confined system with the aortic valve at its proximal end and peripheral vascular resistance and peripheral runoff at the other end. The left ventricular ejection of blood into the aorta is rapid during the initial part of ejection. The increase of aortic blood pressure after the aortic valve opens results from early rapid left ventricular ejection. About 80% of the stroke volume is ejected during early rapid ejection. Aortic systolic, pulse, and mean blood pressures increase with an increase in stroke volume.
Gender difference in the relationship between uric acid and pulse pressure among Korean adults
Published in Clinical and Experimental Hypertension, 2019
Chang Eun Park, Hyun Ho Sung, Eun Young Jung, Ae Eun Moon, Han Soo Kim, Hyun Yoon
Hyperuricemia is associated with cardiovascular disease, but the relationship between uric acid (UA) and pulse pressure (PP) is unclear. Therefore, the present study assesses the relationship between UA and PP among Korean adults. Data from 6,310 subjects (2,800 men and 3,510 women) in the seventh Korean National Health and Nutrition Examination Survey (2016) were analyzed. After adjusting for related variables, the odds ratios (ORs) of hyperuricemia (UA ≥ 7.0 mg/dL in men or ≥ 6.0 mg/dL in women) in the high PP group (PP > 65.0 mmHg) in overall populations (OR, 1.563; 95% confidence interval [CI], 1.144–2.136) and women (OR, 1.631; 95% CI, 1.046–2.544) were significantly higher than those in normal PP, but not in men (OR, 1.309; 95% CI, 0.840–2.040). In conclusion, uric acid was positively associated with pulse pressure in women, but not in men.
Association of angiotensin-converting enzyme gene polymorphism with pulse pressure and its interaction with obesity status in Heilongjiang province
Published in Clinical and Experimental Hypertension, 2019
Ningning Wang, Xueyan Li, Qi Zhang, Hao Zhang, Li Zhou, Nan Wu, Ming Jin, Changchun Qiu, Keyong Zhang
Angiotensin I converting enzyme (ACE) gene is one of the most-studied candidate genes related to essential hypertension (EH). Pulse pressure (PP) may reflect vascular stiffness, especially in patients with EH, and has been used to predict EH. Previous evidence has indicated that obesity is a traditional risk factor of hypertension. The aim of the present study was to investigate the interaction between the obesity status and ACE gene polymorphisms on the development of high level of PP. A total of 1980 adults (1024 hypertensive and 956 normotensive) were included in this study and genotyped for ACE gene polymorphisms. The results showed that rs4343 and rs4351 in ACE gene were risk factors of high level of pulse pressure (p < 0.05). We also detected positive interactions between the two SNPs and obesity status in the pathway of high level PP.
Proportional pulse pressure relates to cardiac index in stabilized acute heart failure patients
Published in Clinical and Experimental Hypertension, 2018
Colin J. Petrie, Piotr Ponikowski, Marco Metra, Veselin Mitrovic, Mikhail Ruda, Alberto Fernandez, Alexander Vishnevsky, Gad Cotter, Olga Milo, Ute Laessing, Yiming Zhang, Marion Dahlke, Robert Zymlinski, Adriaan A. Voors
Aims: In chronic heart failure, proportional pulse pressure (PPP) is suggested as an estimate of cardiac index (CI). The association between CI and PPP in acute heart failure (AHF) has not been described. Methods: This was examined using hemodynamic measurements (from a trial using serelaxin) in 63 stabilized AHF patients. Results: Mean (SD) age was 68 (11), 74% male, mean (SD) ejection fraction (EF) was 33.4% (13.7), mean (SD) CI (L/min/m2) was 2.3 (0.6). CI correlated with PPP (Pearson R = 0.42; p