COVID and cancer

 

COVID-19 vaccination in cancer patients: 

What are the vaccines being developed and nearing approval?

The World Health Organization (WHO) currently counts more than two hundred research projects for the development of a vaccine conferring protective immunity against the SARS-CoV-2 virus, among which more than fifty are in clinical development. New technologies, previous experience with vaccine projects against related viruses and the presence of a pandemic health hazard accelerated the usual development cycle from years to months. Presentation of SARS-CoV-2 antigens to the host, in the context of vaccine development, relied on technologies based on messenger RNA (mRNA), inactivated/attenuated or genetically modified viruses, synthetic long viral peptides and plasmid DNA vaccines. Four vaccines have been authorised until April 2021 for use in the European Union (Comirnaty Pfizer/BioNTech, COVID-19 Vaccine Moderna, Vaxzevria AstraZeneca, COVID-19 Vaccine Janssen) while three more are under rolling review by the European Medicines Agency (EMA; CVnCoV, NVX-CoV2373, Sputnik V). More vaccines are under clinical development and are being assessed for efficacy and safety.

Overall mRNA-based vaccines have shown >90% protection from COVID-19 disease with good tolerance, whereas non-replicating adenoviral vector-based vaccines have shown protection rates of 62%-90% conferred by different dosing regimens. Storage requirements and number of doses differ between vaccines and operational practicalities related to transport, administration, recording and follow-up of vaccinated people, and pharmacovigilance are pivotal for the successful roll-out of vaccination programmes and their optimal impact on public health. Despite some preclinical data of reduced neutralising potential of generated antibodies against new, mutated forms of the virus, available clinical evidence suggests that approved vaccines confer protective immunity against new mutational variants of SARS-CoV-2. Moreover, a rational strategy for minimising the risk of emergence of additional virus variants is based on effective mass vaccination programmes for establishment of vaccine-induced immunity in order to prevent new infections and, thus, mutations. Additional questions exist that necessitate generation of data, including long-term safety, duration of immunity, protective immunity against mild as opposed to severe cases of infection as well as immunity in the elderly, vaccine impact on contagious potential of vaccinated people and repeat vaccination intervals.  A combination of severe thrombosis and thrombocytopaenia, of possible immune pathogenesis similar to that seen in heparin-induced thrombocytopaenia, has been observed very rarely following vaccination, mostly with adenoviral vector-based vaccines (Vaxzevria, COVID-19 Vaccine Janssen), occurring during the first few weeks after inoculation. Healthcare professionals and patients should be alert to the signs and symptoms of thromboembolism and/or thrombocytopaenia, and if present, seek specialist medical treatment promptly. In view of the rarity of the side-effect and the risk from COVID-19, the risk/benefit profile of the vaccines is considered favourable by the EMA. The use of all approved COVID-19 vaccines should be in accordance with official national recommendations.

Specifically, for patients with cancer or a history of cancer, strategies of continued generation of data within trials as well in real world settings will provide more insights on vaccine activity, optimal dose and frequency, safety, potential for interaction with malignant disease, antineoplastic therapies or other comorbidities. Consequently, prospective observational studies focusing on patients with active cancer receiving chemotherapy, targeted therapy or immunotherapy, as well as in patients in the chronic phase of disease or in the survivorship phase are warranted and may lead to interventional clinical trials, if needed.

A large array of other vaccine candidates against SARS-CoV-2 are currently under investigation applying various techniques such as mRNA-, protein subunit-, viral vector- or inactivated virus vaccines.

These recommendations should be used as guidance for prioritising the various aspects of cancer care in order to mitigate the negative effects of the COVID-19 pandemic on the management of cancer patients. The situation is evolving, and pragmatic actions may be required to deal with the challenges of treating patients, while ensuring their rights, safety and wellbeing.

Statements:

• Effective and safe vaccines against COVID-19, authorised after thorough, independent and robust scientific review by regulatory authorities, should be administered in the context of operationally sound vaccination programmes [V]. A pharmacovigilance plan is mandatory in the context of the vaccination programme.
• Effective mass vaccination programmes coupled to robust pharmacovigilance are key for preventing infections and emergence of viral mutations, while safeguarding favourable vaccine risk/benefit profiles [V].
• Ongoing scientific assessment by medical and regulatory authorities underpins the safe and effective use of COVID-19 vaccines. Use of the vaccine during vaccination campaigns take into account the pandemic situation and vaccine availability at national level.
• Continued research in the context of clinical trials and registries as well as in-trial and post-trial follow-up is advised in order to generate more data on vaccine efficacy and safety in the general population as well as in special populations, including patients with active cancer or history of cancer [V].

• Patients with cancer as a group have been shown to be at higher risk of severe COVID-19 [1]. Among patients with cancer, it seems that haematological and lung malignancies and the presence of metastatic disease are associated with a persistently increased risk. Patients with solid tumours appear to suffer an increased risk, particularly in the first year after diagnosis which drops to baseline if diagnosis is >5 years ago [2]. For any malignancy, active disease confers a significantly increased risk of severe COVID-19 [IV] [3, 4]. However, the higher incidence and severity of COVID-19 in patients with cancer, as opposed to those without cancer, are observations based on non-comparative retrospective studies. Data on the true incidence and direct comparisons remain elusive. Most studies do not have the full denominator to calculate the true incidence [IV].

  Severity and mortality rates from the COVID-19 and Cancer Consortium (CCC19) registry and other cohorts have ranged from 5% to 61% (meta-analysis showed 26%) which is much higher than in the overall population (~2%-3%), but this is with caveats of unadjusted rates, while the cancer population is an older population with more comorbidities, poorer performance status, and many unmeasured confounding and selection biases [IV].

  SARS-Cov-2 infection may also result in significant and devastating delays in screening, diagnosis, treatment and monitoring/surveillance strategies in patients with cancer which can ultimately cause an increased risk of cancer-related morbidity and mortality, as well as major economic burden and high patient volumes needing care in the healthcare systems. Moreover, the impact on clinical trials accrual appears to be very significant and detrimental, although it is hard to measure.

• Although evidence regarding vaccination in patients with cancer is limited, there is enough evidence to support anti-infective vaccination in general (excluding live-attenuated vaccines and replication-competent vector vaccines) even in patients with cancer undergoing immunosuppressive therapy [5-7]. Reduced protective effects may occur in patients treated with B cell-depleting agents (anti-CD19, anti-CD20, anti-CD10 monoclonal antibodies and CD19 CAR-T cells) in view of suboptimal immune response [8-12]. The level of efficacy may be expected to be generally reduced in certain populations of cancer patients with intense immunosuppression, such as recipients of haematopoietic stem cell transplantation [V] [5-7]. However, based on data extrapolation from other vaccines and the mechanism of action of the COVID-19 vaccines (not live), it is conceivable that the efficacy and safety of vaccination against COVID-19 may be estimated to be similar to that of patients without cancer, although data from clinical trials are lacking [V]. Beyond stem cell transplantation, the efficacy of COVID-19 vaccines can also vary in patients with distinct contexts of malignant disease (tumour type, disease extent, intrinsic or therapy-induced immunosuppression); however, the benefits of vaccination seem to significantly and substantially outweigh the risks [V].

  The timing of vaccination depends on individual therapy scenarios and may ideally occur before systemic therapy starts; however, if the patient has already started systemic therapy, it is reasonable to vaccinate during therapy [V].

• Vaccinating healthcare staff against influenza has been shown to reduce nosocomial transmission of the infection in cancer care [13]. Furthermore, certain immunocompromised cancer patients might not achieve a sufficient immune response to vaccination. This provides a rationale for vaccinating healthcare staff who work in a high-risk setting against COVID-19 as well [Evidence III for influenza]

  Statements:

  • Patients with cancer have an increased risk of severe COVID-19 (i.e. haematological malignancy requiring chemotherapy or active, advanced solid tumour or history of solid tumour <5 years ago) and should be vaccinated against SARS-CoV-2 regardless of any other indications (i.e. age) and positioned at high prioritisation [V]. Patients who have received B cell depletion in the past 6 months may derive reduced protection. The time-point for vaccination after allogeneic stem cell transplantation should follow general recommendations – usually, in the absence of graft-versus-host disease (GvHD), the vaccine can be applied 6 months post stem cell transplantation [V]. Patients in clinical trials, e.g. immunotherapy, should not be deprived of COVID-19 vaccination; therefore, efforts should be made for clinical trial protocols to allow concurrent COvID-19 vaccines.
  • Healthcare workers caring for patients with cancer with increased risk should be prioritised in receiving vaccination to minimise nosocomial transmission.
  • The efficacy and duration of immunity in patients with cancer are still unknown and unexplored. Given the often-immune compromised status and the frailty of these patients, we suggest monitoring in the context of registries and dedicated clinical trials.
  • Close surveillance and monitoring of patients with cancer is required after COVID-19 vaccination to assess potential adverse events and measure clinical outcomes, e.g. infection, severity and mortality from COVID-19, complications from cancer, etc.
  • Physical distancing measures, masks, face shields, sanitizers and other hygiene measures are still required during the pandemic, including for patients with cancer, and should certainly accompany the vaccination strategies.

Source: https://www.esmo.org/

Top 5 Signs Your Blood Sugar Is High

High Blood Sugar and Diabetes

Blood sugar control is at the center of any diabetes treatment plan. High blood sugar, or hyperglycemia, is a major concern, and can affect people with both type 1 and type 2 diabetes . There are two main kinds:

Fasting hyperglycemia. This is blood sugar that's higher than 130 mg/dL (milligrams per deciliter) after not eating or drinking for at least 8 hours.
Postprandial or after-meal hyperglycemia. This is blood sugar that's higher than 180 mg/dL 2 hours after you eat. People without diabetes rarely have blood sugar levels over 140 mg/dL after a meal, unless it’s really large.

Heart palpitations?

Typically, heart palpitations are not something rare or something serious. But it's enough to feel a few times to scare and worry. Learn more about palpitations, their causes and methods of treatment!

What are palpitations and how they feel?

Palpitations feel like abnormal heart beats. Can be beat stronger as heart make a greater effort to pump blood may be a faster and less frequent beatings as if your heart skipped a beat. May occur when you exercise or when standing still when standing up or in bed. You can feel in your chest or throat somewhere. In general, palpitations are harmless, but in rare cases can be a sign of heart disease.

You have palpitations? See which causes!

Most often, the causes palpitations related to your lifestyle. May occur when you drink much coffee, you smoke, you do strenuous exercise, but also in case of strong emotions - for example if you are really stressed or suffer from anxiety. Palpitations can occur when you have a fever and you take certain medicines, such as cold and flu tablets containing pseudoephedrine. Palpitations in women can be caused by hormonal changes related to menstruation, menopause or pregnancy.

When palpitations are a sign of disease?

In rare cases, palpitations are a sign of disease - either hyperthyroidism or cardiac arrhythmia. Arrhythmia can mean beats too fast, ie tachycardia, racing rare, ie bradycardia or irregular, ie atrial fibrillation. All these diseases call to be taken seriously, so if you frequent palpitations, strong or lasting much should go to the doctor. Also, you should get help immediately if you have chest pain, you can not breathe or feel dizzy when you have palpitations.

What's the treatment for heart palpitations?

Treatment depends obviously causes palpitations. If it's an arrhythmia, only cardiologist tells you how to treat yourself after you establish the type of arrhythmia and the exact cause. If you have no heart disease, treatment consists of lifestyle change. You will need to rest more, relieve stress as much as possible, to give up coffee and other stimulants or change doses of medication if you are under treatment.

Left Ventricular Hypertrophy

Left Ventricular Hypertrophy

Left ventricular hypertrophy is the action of getting thickened the muscle of the left ventricle of the heart. Left ventricular hypertrophy is the natural result of the excessive strength straining and aerobic exercises. But the medical references prefer to regard it as the natural reaction of the heart to the cardiovascular disease. It is, basically, one of the types of heart disease.

The most amazing thing is that, left ventricular hypertrophy, by itself, is hardly considered as a severe disease, or at all a disease. But , the fact remains that it is the cause of a number of diseases that often turn to be quite serious. It can cause some diseases like Dilated Cardiomyopathy and Hypertropic Cardiomyopathy, that affect the muscles of the heart, and even leads to a sudden death of the affected person.

Left ventricular hypertrophy also causes tremendously high blood pressure. The very health problems and the health hazards are the symptoms and the signs of left ventricular hypertrophy. The person affected by left ventricular hypertrophy is found to take shorter breaths, since, he or she is simply unable to take natural length of breaths. The sufferer may also feel a pain in the chest. This pain can even turn to be very acute at times. In this condition, the patient should be given immediate treatment, since, this acute pain in the chest can even result in stroke or heart attack, either a mild one or even a severe one.

If a person suffers from left ventricular hypertrophy, he or she may also have very irregular heartbeats, which is quite sure a terrible discomfort for the person who is suffering. Dizziness is another sign of left ventricular hypertrophy. The affected person feels dizzy almost all the time. In addition to that, the person also might be feeling a reeling sensation in the head. Any person who is affected by left ventricular hypertrophy, must have the symptom of fainting frequently. The duration of the fainting may not be too long. If a person is found to be showing most of the signs and symptoms, mentioned here, he or she should be immediately given proper medication under the guidance of a veteran cardio expert.

Some of the causes of left ventricular hypertrophy are aortic stenosis, aortic valve regurgitation and extreme hypertension. Farther studies in this field have revealed that the aged persons are the easier targets of left ventricular hypertrophy, since most of the people who have been victimized by left ventricular hypertrophy are aged above 55. Therefore the older you grow, the more enriched is the possibility of getting attacked by left ventricular hypertrophy.

Take care of the weight of your body. Be healthy. But, do not gain extra weight. Have the habit of doing regular physical exercises that will help you losing extra weights, if you have gained any.

If any coronary disease prevails in the heart of a person, the possibility of his getting attacked by left ventricular hypertrophy. Coronary diseases also add to the troubles of left ventricular hypertrophy.

What is a Heart Attack?

What is a Heart Attack?

Have you ever asked yourself the question what is a heart attack? We all know that it can be deadly and that you need immediate attention if you are having one. However, many people do not know exactly what is going on with the heart during a heart attack. Unfortunately, if more people knew exactly what a heart attack was, as well as the warning signs, then there would not be so many heart attack related deaths.

A heart attack is when the blood flow to part of the heart muscle becomes blocked. When the blood flow becomes blocked it must be restored quickly or the part of the heart that is deprived of blood can die. If you think that you, or someone around you, is having a heart attack then it is important to seek out help immediately. If treatment for a heart attack is started within one hour of when the symptoms start then there is a better chance of the treatment working. Since the heart is the muscle that supplies the rest of your body with oxygen rich blood it is crucial that it is functioning properly. Even a few moments without blood flow to the rest of the body can cause major damage to other organs.

Every year over a million people in the United States have heart attacks. Most of the heart attacks can be attributed to the lifestyle of the person. For instance things such as smoking cigarettes, a lot of stress and a poor diet can contribute to the likelihood that a heart attack will occur. The above mentioned factors can put unnecessary strain on the heart muscle thus causing you to have a heart attack. It is important to call an ambulance if you feel like you are having a heart attack. Since the symptoms can come on suddenly it is best to not wait around before getting help. If you wait too long it may be too late.

Over half of the people who suffer a heart attack die. This is because they did not recognize the warning signs and seek out immediate help. Many people could make a full recover from a heart attack if they would just act a little bit quicker. When the heart is involved it is important to know the details. Being able to answer the question what is a heart attack will ensure that you know what is going on if you begin to feel symptomatic.

Irregular heartbeat causes

Irregular heartbeat causes are very diversified, beginning with heart disease and continuing with electrolyte imbalance or other medical conditions unrelated to heart pathology. Many times we wonder what is the meaning of the palpitations: Is it something wrong? Do I need to see a doctor?
In some cases, irregular heartbeat causes remain uncovered, persons with “healthy” hearts experience palpitations (also called arrhythmia in medical practice). However, each person with these complaints should have a medical examination, in order to exclude a disorder that may cause these symptoms, as we will see next.
A normal heart rate is 60 to 90 beats per minute; if heart rate is under 60 beats/minute, then we have a bradycardia and over 90 beats/minute a tachycardia. Arrhythmia occurs with a normal heart rate, but also with a low or rapid heart rate.
In order to understand the next medical terms, some specifications are necessary: sinus node, atrioventricular node and Purkinje fibers are the heart system (the heart pacemakers) which normally conducts impulse to muscle cells and make the contraction possible; a pacemaker is a group of cells capable of generating electrical impulse and heart contraction;
How many types of irregular heartbeat causes exist in medical practice?

• sinus node dysfunction (one of the pacemakers, located in the atrium is no longer working properly): e.g. sinus bradycardia, sinus node stops, sinus node blocks,
• supraventricular extrasystoles (irregular heart beats generated in the sinus node or atrioventricular node, they occur faster then a normally heart beat and are followed by a pause)
• sinus tachycardia, supraventricular tachycardia (rapid heart rate generated above the ventricular tissue)
• atrial fibrillation and flutter (irregular heart beats generated by multiple atrial pacemakers, others then the normal heart pacemakers)
• ventricular tachycardia (rapid heart beats generated in ventricles), extrasystoles (a premature heart contraction generated by a ventricle pacemaker) and ventricular fibrillation (rapid heart rate, incompatible with life, this is a heart rate that determines cardiac arrest)
• atrioventricular blocks (cardiac impulse is delayed or blocked in the atrioventricular node, and will be received by ventricles later or at all)
• torsade of points (a form of ventricular tachycardia that occurs when there is a potassium deficit)

What are the irregular heartbeat causes?

There are different disorders that can be a cause of irregular heartbeat causes including:

• Coronary artery disease ( coronary vessels that supply heart tissues with blood are blocked, usually by atheroma, the consequence of this blockage will be heart ischemia-the oxygen deprivation of heart tissues- and this can be one of the irregular heartbeat causes),

Atheroma is a swelling of the artery walls determined by an accumulation of lipidis.

• A heart attack it is common among  irregular heartbeat causes,
• Electrolyte imbalances (such as sodium, magnesium or potassium): e.g. a high level of potassium can result in cardiac arrest,
• Heart muscle changes (fibrosis-a conjunctive tissue deposit in the heart muscle- can also affect cells responsible for electrical impulse generation- the pacemakers),
• Healing process after heart surgery,
• Heart failure it is also one of the  irregular heartbeat causes, because in this condition one of the mechanism that heart uses to compensate for its diminished function is sinus tachycardia (if it can’t pump a proper amount of blood, it tries to pump a smaller amount but faster),
• Infection or fever is one of the irregular heartbeat causes, many times associated with sinus tachycardia,
• Anemia, in severe cases produces sinus tachycardia, the heart tries to pump the blood faster, in order to compensate for the lack of red blood cells and hemoglobin, the oxygen carrier,
• Thyroid disease-e.g. hyperthyroidism is associated with rapid heart beats, while hypothyroidism with low heart rate,
• Emotional stress produces irregular heartbeats, specially in people suffering from heart diseases,
• Usage of caffeine, tobacco, and alcohol are related with irregular heartbeat causes.

The usage of drugs is an important problem of the nowadays society, also with a great impact on our body: many times the usage of drugs was mentioned as one of irregular heartbeat causes and there were cases when cocaine consumption determined heart attacks and death.

If you think you have irregular heartbeat causes please see your physician.

Heart palpitations anxiety

What is heart palpitations anxiety?

Anxiety and stress are maybe the “third millennium disorders” and it has “no age” as doctors from all medical specialties have to deal patients suffering from these conditions, both young and old. In some point of our life we all suffered or will suffer from stress or anxiety and many of us deal these conditions by themselves for a long time before they finally decide to sick medical help. Those words are so often used today that it may seem they are part of our life and we must accept them as a normal reaction. But this is not how it really is, because anxiety can change our lives dramatically and make us feel sick, unable to perform our daily duties or even things that used to give us pleasure. Many times when we speak of this disorder we think of heart palpitations anxiety, as it is a frequent symptom in people suffering from anxiety. Next we will find out what anxiety and heart palpitations anxiety really mean and how to deal it.
Anxiety is a medical condition defined as a psychological and physiological state characterized by  feelings of fear, worry, dread, psychological tension or stress that can determine emotional, cognitive, somatic and behavioral changes. This disorder can determine multiple symptoms and among them heart palpitations anxiety are more frequently.
How it feels to suffer from heart palpitations anxiety? Living with heart palpitations anxiety is definitely not easy or comfortable. During heart palpitations anxiety u may feel that your heart beats are too fast or irregular, or that your heart stops for a small period. U may feel dizzy or experience shortness of breath (or suffocation sensation) or even faint. In people that already suffer from heart disease, abnormal heart beats can affect the oxygen supply of the heart muscle and determine chest pain or even a heart attack.
Next we will present the case of a 34 years old women suffering from heart palpitations anxiety:
A 34-year-old female presented with a history of anxiety for the past 20 years. When she was 14, her teacher used to embarrass her in front of the class by making her to stand-up until her face turned red and all the class would laugh. In time she becomes very nervous and fearful about social situation and activities that could draw attention to her. In the highschool she had panic attacks everytime she supposed to make presentation and communicate in peers. She describes she experienced profuse sweetening, heart palpitation and rapid heartbeats, burning in the stomach and the need to get away. These symptoms persisted during university and at the age of 25 she finally sought for professional help. The clinical psychologist diagnosed the patient with social phobia, panic disorder, and mild agoraphobia. She underwent  once- or twice-weekly sessions of psychological therapy with great improvement, slowly she could integrate into the social activities and seemed to be “cured”, convincing her therapist to stop the therapy. After 3 years as she attended the medical school, symptoms reappeared, and they were even worse then the first time and she had to seek the help of a psychiatrist and follow a medical treatment.

In conclusion, heart palpitations anxiety together with other manifestations of anxiety are not easy to deal and live with, but medical help will allow patients suffering from this condition to have a better life.

High triglycerides symptoms

Triglycerides are a form of blood fat and high triglycerides symptoms can occur at any person who have increased their level.

High triglycerides symptoms specifics

Triglycerides are the main components of vegetable oil and animal oils. Triglycerides from plasma are derived from food fats and carbohydrates. Calories ingested in a meal and not “burned” or used immediately by tissues, are converted into triglycerides and transported to cells to be stored as fat. Triglycerides and cholesterol can not dissolve in the blood circulating throughout your body with the help of proteins that carry lipids. Triglycerides play an important role in metabolism as energy sources. Excess of plasma triglycerides is called hypertriglyceridemia. High triglycerides levels usually do not causes symptoms so patients with hypertriglyceridemia do not go to the doctor for this problem. But sometimes can appear high triglycerides symptoms. People with high triglycerides (over 200 mg/dl) have an increased risk of cardiovascular disease. People with diabetes or who are obese are also likely to have high triglycerides.

High triglycerides

The most common causes of occurrence of high triglycerides symptoms are the unhealthy food that individuals consume in daily life. One of the high triglycerides symptoms are eruptive xanthomas. These are deposits of lipids that appear on the skin especially on the skin around the eyes, elbows and knees in triglyceride levels over 1000 mg/dL. They often appear in groups and may cause pain at acute levels. Another high triglycerides symptoms is acute pancreatitis. Pancreas is an organ located in the abdominal cavity and which is behind the stomach. It has two functions: exocrine and endocrine function. Exocrine pancreas produces enzymes for digesting fats, proteins and carbohydrates, so they can be absorbed by the intestine.
If levels of triglycerides are very high for an extended period of time, high triglycerides symptoms may be abdominal pain because of liver or spleen enlargement.They can be discovered at a routine abdominal ultrasound. Doctors must seek the cause of hepatomegaly or splenomegaly.
High triglycerides symptoms can be treated by non-pharmacological methods or with drugs. Non-pharmacological methods refer mainly to lifestyle changes. First, if the patient with high triglycerides symptoms consumed excess alcohol, he must reduce alcohol to lower triglyceride levels. Patients should also reduce the consumption of fatty foods (butter, cream, margarine, bacon but other foods that contain high levels of fat). Another method of non-pharmacological treatment of high triglycerides symptoms refers to the practice of physical exercise. Patients with hypertriglyceridemia and hypercholesterolemia may be overweight and then doctors recommend them to lose weight and thus decrease of triglycerides and cholesterol levels.

Treatment of high triglycerides symptoms

Doctors may also prescribe drugs to disappear high triglycerides symptoms. These are gemfibrozil or nicotinic acid. Gemfibrozil is a medicine that lowers blood cholesterol levels and that decreases the production of triglycerides from the liver. Nicotinic acid may also lower cholesterol and triglycerides levels.

 Conclusion

When patients go to the doctor for high triglycerides symptoms, they should be treated because in time can lead to several complications.

Leaking heart valve

Mortality and morbidity thought leaking heart valve are  an important part of cardiovascular pathology.  The main changes in  the study of leaking heart valve involves an evaluation of their function and etiology.
So, rheumatic etiology is declining, while the degenerative and ischemic etiology is growing.
Clinical evaluation methods have the same value (family history, physical examination), but some paraclinical methods ( cardiac ultrasound and Doppler) have an important role.

Types of leaking heart valve

Leaking heart valve may occur at the four heart valve: mitral valve, aortic valve, pulmonary valve and tricuspid valve.
The most common type of leaking heart valve is mitral regurgitation. It is characterized by regurgitation of blood in systole ( contraction of heart) from the left ventricle into the left atrium. There are two causes of mitral regurgitation: acute and chronic. The etiology of mitral regurgitation can be inflammatory, but also degenerative and structural. Chronic mitral regurgitation lead to expansion of left atrium.   Echocardiography provides important information in mitral regurgitation.
Another type of leaking heart valve is aortic regurgitation. It is incomplete closure of aortic valve in diastole (relaxation of heart). Aortic valves are affected primary by acute articular rheumatism, infectious endocarditis and degeneration and it can be acute or chronic.
Two other leaking heart valve are tricuspid regurgitation and pulmonary regurgitation. Tricuspid regurgitation is characterized by regurgitation of blood in systole from the right ventricle into the right atrium because of the incomplete closure of the tricuspid orifice.

Leaking heart valve symptoms

Symptoms of patients with   leaking heart valve depends on regurgitation grade and how to install (suddenly or gradually). Patients with small regurgitation can be asymptomatic. There are some  common  symptoms to the patients with leaking heart valve:
-          dyspnea on effort (shortness of breath or air hunger);
-          cough;
-          angina pectoris on effort (chest pain on effort) or at rest;
-          heart murmur;
-          heart palpitations (heart beats more than 90 per minute);
-          asthenia and adinamie;
-          fatigue;
-          rarely may occur syncope;
-          pale skin on  clinical examination.

Leaking heart valve diagnosis

Positive clinical diagnosis is based on present of heart murmur (systolic or diastolic) with different characters. Most used methods for diagnosis leaking heart valve are echocardiography, chest radiography, electrocardiography and Doppler exam.

Treatment and evolution of patients with leaking heart valve

Treatment of asymptomatic patients with leaking heart valve is not necessary. To the patients with symptoms should avoid exercise and salt. There are also treatments with drugs and surgery for leaking heart valve.
Evolution and prognosis of leaking heart valve depend on the importance blood reflux, of how to install (acute or chronic) and of the etiology. Patients with small or average regurgitation may remain asymptomatic a long time, but patients with complications (infectious endocarditis, atrial fibrillation) have obvious symptoms. Patients with acute leaking heart valve have serious prognosis.