Clinical Observations of Regurgitative Valvular Heart Disease in Elderly Patients Older Than 65 Years in Age

BACKGROUND: The regurgitative valvular heart diseases are important underlying diseases that result in congestive heart failure, and the prevalence increase with the increasing age. Early detection and management of the regurgitative valvular heart disease could decrease the morbidity and mortality rate of the elderly. METHODS: We reviewed medical records of 425 patients who visited KonKuk University Medical Center ChungJu Hospital for the echocardiography between April 1994 to September 2000. 281 out of 425 patients were diagnosed with regurgitative valvular heart disease, and they were analyzed according to their age, sex, underlying disease, and accompaniment of congestive heart failure. Also the relationships between the regurgitative valvular heart disease and fractional shortening(FS), and also with ejection fraction(EP) were analyzed. RESULTS: There were 281 patients diagnosed with regurgitative valvular heart disease. Greatest number of patients was diagnosed with MR, followed by AR, TR and PR, accordingly. The prevalence of regurgitative valvular heart disease increased as the age increased. The prevalence of regurgitative valvular heart disease in male patients were 74% and for female patients, 62%. For patients with hypertension, it was 59%, and for DM patients it was 60%. For patients with past history of ischemic heart disease, or congestive heart failure, the prevalences of regurgitative valvular heart disease were high. FS for the patients with regurgitative valvular heart disease was 28.91% compared 32.69% for the patients without regurgitative valvular heart disease. EF for the patients with regurgitative valvular heart disease was 54% compared to the 60% for without regurgitative valvular heart disease. The FS for patients with symptomatic regurgitative valvular heart disease was 23.86% compared to 27.7% for asymptomatic group. The EF for symptomatic regurgitative valvular heart disease was 46.2% compared to 52.3% for asymptomatic group. CONCLUSION: When 2D-echocardiography was performed on elderly patients who were older than 65 years of age, most of them featured degenerative structural changes in valves and deterioration of valvular functions resulting in regurgitative valvular heart disease. When patients had any symptoms or underlying diseases, the decrease in cardiac function and high prevalence of regurgitative valvular heart disease were apparent. Therefore in elderly patients, even if they are asymptomatic or without any underlying diseases, aggressive diagnostic approaches and early intervention may delay the progress of valvular heart disease.

Inappropriate Secretion of Antidiuretic Hormone in a Patient with Squamous Cell Carcinoma of the Lung mimicking Pulmonary Tuberculosis

A 71-year-old man with squamous cell carcinoma of lung mimicking pulmonary tuberculosis associated with the syndrome of inappropriate secretion of ADH(SIADH). Laboratory examination showed serum sodium concentration of 108 mEq/l. serum osmolality 247 mEg/l urine sodium concentration of 141 mEq/l urine osmolality 547 mEq/l. normal levels (<0.56 pg/ml) of serum antidiuretic hormone (ADH). ADH release was regulated normally with changes in serum osmolality. SIADH was diagnosed on the basis of hyponatremia with corresponding serum hypoosmolality and a high urine osmolality due to continuous sodium excretion. In this case, SIADH was probably induced by increased renal sensitivity to ADH and suspected high serum ANP level of unknown origin.