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What To Know About Pulmonary Valve Stenosis

Pulmonary valve stenosis can be both congenital (present at birth) or something adults develop later on in life. It can range in severity from mild to severe cases. Often, a person may not know they have the condition until years down the road. 

In a substantial amount of cases, the patient is able to go through life without any major issues. In moderate cases, some medical procedures may be required. It is common to see the doctor every few months in order to monitor the success of the procedures. 

In some severe cases, surgery is required, and physical activity is restricted until the patient shows signs of improvement.

Pulmonary valve stenosis (PVS) is a condition that affects the heart. The heart has the important job of maintaining proper blood flow throughout our bodies. It needs to remain strong and functioning for us to maintain good health. 

The heart is a muscle that contains four chambers: 

  • The left atrium (top left)
  • The right atrium (top right)
  • The left ventricle (bottom left)
  • The right ventricle (bottom right)
  • After its journey through the body, blood is pumped back into the heart. From there, it enters the right side. It goes from the right atrium into the right ventricle, then through the pulmonary valve. Then, it receives fresh oxygen from the lungs and continues through the body once more. 

    Picture the pulmonary valve as a one-way door. It has small flaps that allow blood to flow through it one way, with no way of getting back. 

    In people with pulmonary valve stenosis, the blood has a hard time making its way through the pulmonary valve. This is usually because the valve is too narrow. 

    The heart has its own way of dealing with this issue. Because it has to work extra hard to force blood through that small opening, it does what any other muscle might do when it gets overworked: become larger and thicker. Unfortunately, this can put a strain on heart function. 

    PVS isn't a disease; it's an abnormality that usually happens during the heart's development. Doctors don't know the exact cause of PVS, but it isn't caused by anything a mother did or didn't do during her pregnancy. 

    PVS can be present on its own or alongside other heart defects. Some known causes of PVS include: 

  • Rubella infection of the mother during pregnancy can cause PVS in the baby
  • William's syndrome, a genetic disorder that causes a child developmental delays, can also cause PVS
  • Who is at risk of developing this condition? Most people who have it are born with it. Babies' heart valves form during the first 8 weeks of pregnancy, so it's possible that this condition could be passed genetically from parent to child. 

    If a mother gets rubella, also known as German measles, during pregnancy, there is a higher chance the baby will develop pulmonary valve stenosis. 

    The illness can also occur if a baby has Noonan syndrome. Noonan syndrome is a genetic condition that is typically passed down from parent to child. It can cause short stature, unusual facial characteristics, and heart development issues. 

    In adults, rheumatic fever and carcinoid syndrome can put you at risk of getting pulmonary stenosis. Both these diseases can cause damage to your heart valves. 

    Williams syndrome is a rare disorder few babies are born with. It's characterized by certain facial features that get more pronounced with age and slow mental development. People born with Williams syndrome, also called Williams-Beuren syndrome, are at risk of developing PVS among other heart defects.

    In some mild cases of valve stenosis, you might not notice symptoms at all. You may go for a routine check-up, and your doctor might find it when they listen to your heart with a stethoscope. 

    Symptoms of severe pulmonary valve stenosis in babies may also manifest, though, in an obvious way: They may show some blue coloration (cyanosis). 

    Some common symptoms of moderate pulmonary valve stenosis can include: 

  • Feeling tired or very short of breath after a short amount of exercise 
  • Fast breathing and heart rate
  • A bluish color around the lips and fingertips 
  • Fainting 
  • Chest pain
  • Swelling in the hands and feet, legs, belly, or face
  • General fatigue 
  • Sometimes, symptoms only present during exercise. 

    Pulmonary valve stenosis can sometimes be diagnosed before birth. A fetal echocardiogram, (also known as a fetal echo) can show pictures of what a fetus' heart looks like while they're still growing inside the mother. 

    If you suspect that you or your child has pulmonary stenosis, you might visit the doctor, and they will decide which tests to perform. Some of those tests can include: 

  • X-ray. Chest X-rays can show changes to or structural problems within your heart.
  • Echocardiogram. Similar to an imaging test performed on an unborn baby, this test uses sound waves to create pictures of your heart. It is one of the most accurate diagnostic tools. 
  • Electrocardiogram (ECG). This test tracks the rhythms of the heart. It can detect areas of stress in the heart and record electrical activity. 
  • Cardiac catheterization. Doctors are usually able to diagnose pulmonary stenosis with other tests. A cardiac catheter is more invasive and will usually be used as a last option. A tube is inserted in the groin area and pushed up to the heart. They will check each of the four chambers of the heart for circulation issues and problematic blood pressure. A dye is often used to measure how efficiently the heart is pumping blood. 
  • Magnetic Resonance Imaging (MRI). MRI tests can sometimes be ordered depending on what equipment the doctor has available. 
  • Before your doctor's visit, write down any symptoms you or your child have experienced. Think of your family's health history and make note of any concerns. Also, write down any questions you have for your doctor. 

    If you are taking any medications or supplements, make a list and have it readily available. 

    If you are seeing your general practitioner or family doctor, they will likely perform a general check-up and possibly order an imaging test. Depending on the results of the test, you could be referred to a heart specialist. 

    If you see a specialist, you might consider gathering some information about how this condition can affect everyday life. For instance, you may ask:

  • Can you or your child participate in sporting activities or exercise? If so, which ones are safe? 
  • What could be a possible cause of this condition? 
  • Is there a certain heart rate number you should aim to stay under? Is a heart rate or blood pressure monitor necessary for you? 
  • What are the treatment options, and what risks and benefits does each option carry? 
  • Are there any additional educational resources such as websites or reading material that could be beneficial? 
  • The doctor will have some questions for you too. They could be related to how you or your child are experiencing the symptoms in terms of time duration or what they are doing when the symptoms appear. 

    In mild cases, no treatment is needed other than regular follow-ups with your doctor. If the symptoms are moderate to severe and are interfering with your quality of life, you might consider the following treatment options:

  • Balloon valvuloplasty. An un-inflated balloon is placed on the end of a catheter and brought into the small heart valve using imaging tests as a guide. The balloon is then inflated, stretching the pulmonary valve open. This is one of the most common treatments. It's possible that the valve can return to its original size after the treatment. 
  • Pulmonary valve replacement. The heart valve can be replaced by undergoing surgery. An artificial valve or donor valve is used. This procedure is performed on a case-by-case basis and depends on other factors the patient might be going through. 
  • Valvotomy. If there is scar tissue on the pulmonary valve causing less blood to flow through, corrective surgery can be performed to remove the scar tissue. 
  • It's important to remember that although the valve may function normally after surgery, it will need to be monitored regularly, and precautions must be taken during some medical procedures. 

    Complications can arise whether you've had corrective treatment or not. For example, if you undergo a valve replacement, there are several safeguards you must have in place to prevent inflammation or infection of the valve. 

    Endocarditis is one such risk. It's a bacterial infection that settles into the lining of the heart. It can be especially threatening to someone who's had heart surgery or has a heart condition. 

    Most people who have had valve replacement surgery will need to take antibiotics before any dental or medical procedures in order to prevent endocarditis. 

    Other complications of pulmonary valve stenosis can be: 

  • The heart muscle thickens. Because the heart has to work harder to pump blood, the walls of the heart can get thick. This can cause extra strain on the heart. 
  • Irregular heartbeat. Also known as arrhythmia, this can happen in people with valve stenosis. In severe cases, your doctor might recommend treatment. 
  • Heart failure. In severe cases, the heart could fail because it's working extremely hard to pump blood, and not enough blood is going through it. 
  • Pregnancy complications. If you have pulmonary valve stenosis, it can interfere with your pregnancy. It depends on the severity of your case and how the health of your heart valve has been maintained. 

  • Stages Of Crohn's Disease

    Crohn's disease symptoms can be mild, moderate, or severe. It's a progressive disease, but its stages are hard to determine because each person's condition progresses differently.

    Crohn's disease is a type of inflammatory bowel disease (IBD). It's considered a chronic condition, which means that you'll have it for your entire life. The exact cause of Crohn's is unknown. It most often develops in your late teens or 20s.

    Crohn's disease is marked by inflammation of the gastrointestinal (GI) tract. The inflammation can appear anywhere in the GI tract, from the mouth to the anus.

    Crohn's is a progressive disease that starts with mild symptoms and gradually gets worse. With mild to moderate Crohn's, you may experience diarrhea or abdominal pain, but you won't experience other symptoms or complications.

    You're able to move, eat, and drink as normal, and the disease has a minimal impact on your quality of life. In some cases, you won't even require treatment.

    If you have moderate to severe Crohn's disease, you may experience diarrhea or abdominal pain, as well as additional symptoms and complications, such as fever or anemia. If your Crohn's is severe, you might be in constant pain and discomfort, and you may need to use the bathroom frequently.

    That said, it's difficult to classify Crohn's disease into stages because people tend to experience ups and downs in symptoms. What progression looks like can be different for each person, and treatment can affect your outlook.

    Over time, Crohn's can cause damage to the intestines and lead to potential complications such as strictures, fistulas, and abscesses.

    Stricture means that a portion of the intestine becomes narrower due to scar tissue on its wall.

    While there's no time frame for how long it would take for such complications to develop, there are risk factors that may speed up progression. These include:

  • being under 30 years old
  • having a history of smoking
  • having ulcers found in a colonoscopy
  • having the long bowel segments affected by the disease
  • having anal inflammation
  • having symptoms that go beyond the intestinal system, such as in the eyes, skin, liver, or joints
  • having a history of bowel resections
  • At diagnosis, 10% of people already have strictures, and an additional 15% to 20% will develop them within the next 10 to 20 years.

    Five types of Crohn's disease

    Progression may also depend on the type of Crohn's disease you have. These are:

    Crohn's disease progression patterns

    The patterns by which Crohn's might progress are:

  • Chronic relapsing: With this progression type, you typically experience at least 12 months of remission before experiencing a flare. Common symptoms of a Crohn's disease flare-up may include diarrhea, abdominal pain, weight loss, blood in stool, and fatigue.
  • Remission: Remission means that your symptoms improve or disappear completely. Various studies show most people will relapse within 8 years of diagnosis, with a 43% to 45% remission rate after 10 years. But if you stay in remission for a year, there's an 80% chance remission will continue for the next year.
  • Improved and stable: This is when your condition has progressed to having no symptoms and has remained this way, though signs of the disease might still show up on tests.
  • Chronic refractory: This means you continue to show symptoms without any breaks or remission. About 10% to 15% of people with Crohn's experience a chronic refractory disease course.
  • That said, even different people living with the same Crohn's pattern might progress differently. Genetics, type of treatment, and surgery are also factors that may affect which disease course you follow.

    The earlier you treat and manage Crohn's, the more likely you are to reduce your chance of developing more severe symptoms.

    In Crohn's disease, healthy cells in the GI tract attack themselves, causing inflammation. As a result, you'll likely experience a range of symptoms.

    Early signs of Crohn's disease include:

  • frequent cramps
  • ongoing abdominal pain
  • frequent diarrhea
  • bloody stools
  • unintentional weight loss
  • As the disease progresses, you may start feeling fatigued and even develop anemia. You may also experience nausea from constant irritation of the GI tract.

    In addition, you may start experiencing symptoms outside of the GI tract. These symptoms include:

    Early diagnosis is important to help prevent damage to the intestines.

    If you experience these symptoms and have a family history of Crohn's, you should ask your doctor for testing.

    Medications can treat inflammation and stop your body from attacking its own cells.

    As your symptoms progress, your gastroenterologist may also recommend occasional bowel rest. However, not all doctors agree with this measure.

    A bowel rest involves a strict diet of only liquids for a few days. The purpose is to let the GI tract heal from inflammation and essentially take a break. To prevent malnutrition, you may need an IV.

    Talk with your doctor before switching to a liquid diet. Following this, your doctor may follow a special Crohn's diet and take supplements.

    You also may need to take pain medication. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), as these can make Crohn's worse. Instead, ask your doctor if you can safely take acetaminophen (Tylenol).

    You may need surgery if your symptoms become life threatening. Around 67% to 75% of all people with Crohn's will eventually need surgery, according to the Crohn's & Colitis Foundation.

    Surgery can't cure the disease, but it may help repair severely damaged tissues and remove blockages.

    There's no cure for Crohn's disease, but medications and lifestyle changes can help manage the condition. This is why it's crucial to identify the disease when symptoms are still mild.

    Untreated Crohn's can lead to further complications, some of which may become permanent and, in rare cases, life threatening.

    Read this article in Spanish.


    What Are The Stages Of Carpal Tunnel Syndrome?

    Carpal tunnel syndrome can be classified as mild, moderate, or severe. In the mild stage, symptoms are usually worse when you wake up in the morning. In the severe stage, symptoms may bother you all the time.

    Carpal tunnel syndrome is a group of symptoms that happen as a result of compression of your median nerve, which passes through the underside of your wrist.

    This condition can become progressively worse if you don't stop or modify the activity that's causing the compression.

    The mild and moderate stages can often be treated without invasive treatments. But the severe stage often requires surgery to take pressure off the median nerve and prevent permanent nerve damage and hand dysfunction.

    Read on to learn more about the stages of carpal tunnel syndrome, including potential symptoms and treatment options for each stage.

    Mild carpal tunnel syndrome is the least severe stage, and symptoms can often be treated by avoiding or modifying the activities that are contributing to the condition.

    Symptoms

    if you have mild carpal tunnel syndrome, you might wake up with numbness in one or both hands, with or without noticeable swelling. Your symptoms might come and go throughout the day.

    Possible symptoms include:

  • mild to severe pain
  • tingling in your hand and fingers
  • wrist pain that gets better after you shake your hand
  • hand stiffness
  • hand clumsiness
  • Learn more about carpal tunnel symptoms.

    Treatment

    Mild carpal tunnel syndrome is often manageable with conservative treatment alone.

    Conservative treatment options for mild carpal tunnel syndrome include:

  • wearing a wrist splint to immobilize your wrist, especially while you're sleeping
  • reducing or stopping the activity that led to your carpal tunnel syndrome
  • receiving a steroid injection to reduce inflammation
  • It can take up to 6 weeks of splinting before you notice an improvement in your symptoms.

    At the moderate stage, carpal tunnel syndrome causes symptoms that become more noticeable throughout the day and may affect your work or daily activities.

    Symptoms

    The symptoms of moderate carpal tunnel syndrome are the same as those in the mild stage. You might also experience pain or numbness that interferes with hand function, and you might occasionally have trouble sleeping.

    Symptoms might persist throughout the day when you perform repetitive wrist activities such as typing. They might also worsen if you maintain a flexed or extended wrist position for a long time.

    Treatment

    Like the mild stage, the moderate stage can usually be treated conservatively, without the need for surgery.

    Severe carpal tunnel syndrome causes symptoms that persist almost all the time. It may require surgical treatment to avoid permanent nerve damage.

    Symptoms

    Severe carpal tunnel syndrome can cause symptoms that seriously affect your quality of life. You may develop weakness in your thumb or shrinking of the muscles that control your thumb. You may also have difficulty gripping objects and getting a full night's sleep.

    Treatment

    If conservative treatment options haven't improved your symptoms and they return regularly, a doctor may recommend surgery to release pressure on the nerve. They will also likely recommend surgery if tests show that you have nerve damage or muscle wasting.

    Surgery typically takes around 30 minutes, and full recovery can take weeks to months. You can usually return to heavy manual labor after 4 to 6 weeks and desk work after a few days. But it's important to remember that each person's recovery timeline can look different.

    Learn more about surgery for carpal tunnel syndrome.

    Carpal tunnel syndrome is thought to affect 1% to 5% of people at any given time. You may have a higher risk of developing carpal tunnel syndrome if you:

  • are female
  • perform frequent, repetitive hand movements
  • have experienced a wrist injury such as a sprain or fracture
  • repeatedly use vibrating machinery
  • have problems with your thyroid or pituitary gland
  • have rheumatoid arthritis
  • have diabetes
  • Mild carpal tunnel syndrome often goes away with home remedies alone. But in more advanced stages, the condition might require surgery.

    Consider speaking with a doctor if treating the condition at home has not resolved your symptoms or if your symptoms are getting worse.

    How fast does carpal tunnel progress?

    Carpal tunnel may take anywhere from several days to several years to progress, depending on how much repetitive activity you engage in.

    When do you need carpal tunnel surgery?

    You'll typically need carpal tunnel surgery if your pain is constant and interferes with your daily life or if you're at risk of nerve damage.

    What is end stage carpal tunnel?

    End stage carpal tunnel is the development of hypotrophy or atrophy in your hand. Hypotrophy is an increase in muscle mass, whereas atrophy is a decrease.

    Carpal tunnel syndrome occurs when the median nerve in your wrist becomes compressed. The condition has mild, moderate, and severe stages.

    Mild or moderate carpal tunnel syndrome often goes away with home treatment such as stopping the activity that caused it and splinting your wrist. In severe cases, surgery may be necessary to reduce pressure on the nerve and prevent permanent nerve damage.






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