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37.22 Co-morbidity (HFrEF and HFpEF): valvular heart disease
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Published:July 2018
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Abstract
Heart failure may complicate primary valvular disease as the result of late diagnosis, too late intervention, or absence of intervention because of severe co-morbidities. The objective of the management of primary valve disease is to prevent heart failure through close follow-up, preferably in a specialized heart valve clinic. Reduction in too late intervention and the availability of catheter-based valve implantation in high- and moderate-risk patients can reduce the development of heart failure. This leads to increased expectancy of life but the patients may have redo-interventions and a risk of recurrent heart failure. Symptoms and signs of heart failure can relate to the valve disease or complications such as atrial fibrillation, ventricular systolic dysfunction, and/or diastolic dysfunction. Atrial fibrillation is frequent. The occurrence of atrial fibrillation can produce acute heart failure as a consequence of rapid heart rate and a decrease in diastolic time. This is particularly severe in patients with mitral stenosis who can develop acute pulmonary oedema. In patients with severe aortic stenosis, the left ventricle has prolonged relaxation and reduced compliance; a fast heart rate is usually not tolerated.
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