PREVALENCE AND EVALUATION OF COMPLICATIONS IN VALVULAR HEART

DISEASE PATIENTS IN TERTIARY CARE HOSPITAL

AMTUL RAFEH MARIYA 19455T0001

 
ARSHIYA MUBEEN BATOOL 19455T0002
 
SUMAYYA 19455T0008
PHARM D (PB) 2ND YEAR 2020-2021
UNDER THE GUIDANCE OF

GUIDE:
DR. S. P. SRINIVAS NAYAK
DOCTOR OF PHARMACY
ASSISTANT PROFESSOR
DEPT. OF PHARMACY PRACTICE
  INTRODUCTION
  

 Valvular heart conditions are often called heart valve or heart disease involving one or more of the four heart valves (the aortic and mitral valves
on the left side of heart and therefore the pulmonic and tricuspid valves on the proper side of heart). The main causes of these disorders are ageing,
[1] However the outcomes could also be of anomaly or specific illnesses (including rheumatism of the heart and pregnancy) or of physiological

processes, such.[2]
 
The heart valves are four: tricuspid, pulmonary, mitral, aortic and valve.
●Deoxygenated blood from the heart flows into the right atrium of the heart from different regions of the body. The valve of the tricuspid is the
valve between the right atrium and the right ventricle. The tricuspid valve is responsible for the blood pump to the right ventricle.
●The pulmonary valve controls the blood from the right pulmonary ventricle to the lungs. The pulmonary bracket pumps blood into the pulmonary
artery, which enters the lungs, from the right ventricles in order to absorb oxygen. The oxidised blood then flows back to the left atrium from the
lungs.
●The oxidised blood pumps from the left atrium into the left ventricle of the heart. The mitral valve is the valve which runs between the left and left
atrium ventricles.
●The aortic valve controls the bloodstream to the aorta from the left ventricle (the main artery in the body). The aortic valve then opens up and
the body reaches different sections of the body to pump oxygenated blood into the aorta.
  TYPES OF VALVULAR HEART DISEASE:
● The heart and valves are affected by a large number of diseases and problems.
● High morbidity and mortality rates around the world are connected with valve heart
disease.
 Due to underlying problems, valvular heart disease may occur. alternatively it might be
caused by a pathological cascade of events occurring at the site (for example, valve
incompetence linked to a hypertensive cardiac disease). (e.g. rheumatic cardiovascular
stenotic valves).
 ● PREVALENCE
● The prevalence rate of the Valvular cardiovascular disease might be explained by the order of participation,
followed by the aortic, tricuspid and pulmonary valves, of mitral valves (60.2 percent). Mitral stenosis occurs
frequently in women and is virtually solely connected to rheumatism (97.4 percent ).
● MR was primarily of a rheumatic (41.1%) form, with myxomatous, mitral or atrioventricular valve crash closely
followed (40.8 percent ).
● In 7.3% of instances, the third most common valve lesion reported is isolated AS, most often in males.
● The primary prevalent reason for isolated AS (65.0 percent), followed by a bicuspid (BAV) (33.9 percent), and
RHD calcification were degenerative calcification (1.1 percent ). In addition to one third of all instances, multiple
valve heart disease (36.8 percent ).
● The order of involvement of valvular heart disease was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS
> MS + AS. Overall, 9.7% of cases had natural tricuspid valve disease or right atrioventricular valve. [7]
  CLINICAL PRESENTATION
● Dyspnoea or breathing shortage and/or breathing difficulties. This is typically seen by patients when they practise or
during day-to-day activities or sit flat in bed. For ease of breathing Patients might need to sleep up or raised on
several pillows.
● Tiredness or swelling. To perform typical everyday activities, patients may feel too weak. Disappointment can also
happen, and it may be a sign in some circumstances.
● Inconvenience in the chest. In the activity chest or in cold air and in the weather, patients may feel pressure or
weight.
● Palpitations. This can lead to fast hearts, irregular cardiac beats, skiped beats, or a chest flip..
● Edema. This could cause the ankles, feet, or abdomen to enlarge. Swelling in the abdomen can lead to their bloated
feeling.
● One of the main clinical submissions is a rapid weight gain. It is feasible for a patient to get 1  to two 2 per day.
  REVIEW OF LITERATURE
1.Thames et al 2016 conducted an observational study entitled “In patients who suffer from atrial fibrillation, prevalence, characteristics and
results of valvular heart disease" and found that significant VHD is widespread among AF patients in community practise. Most were
anticoagulated in a community cohort of patients with AF. AF persons with moderate-to-serious biological VHDs had more comorbidities
and greater risk of mortality; nevertheless, among those with or with significant VHD, Similar are strokes and main bleeding,. [61-65]
2.webemberaet al 2018 Conducted an observational study entitled “In a cohort of 15.000 Echocardiographer patients in a tertiary hospital, the
prevalence and features of primary left-side valve disease" determined that, A image of "Valve Heart disease in" has been painted in recent
years to show that "Rheumatic Heart Disease in" Our emphasis on the publication in considerable amounts of the contemporary footprint of
various forms of VHD shows that this assumption is not accurate. Rheumatic heart disease has already been targeted at national and
continental programmes. To better research, teaching and clinical management, a similarly integrated multidisciplinary approach is now
needed. [66-69]
3.fan liuet al 2014 conducted a Retrospective study entitled “Valve disease epidemiological survey: morbidity trends, etiological spectrum
and cardiovascular centre care" " And finished with this, Despite considerable changes in the incidence of ischemia, congenital and
degenerative VHS in rheumatic VHD, from 2009 to 2013, it continues to be the predominant etiological system. Rheumatic VHD remains
the most common aetiology. The major therapeutic choices are general medicine and valvular heart surgery. The VATS share rose
significantly from 2009 to 2013 and replacement of the mechanical valve and mitral valvuloplastics were shown to be growing. [70-75]
 
  AIMS AND OBJECTIVES
  

AIMS:
The purpose of the investigation is to examine the prevalence, features and assess
complications in patients with heart-valve diseases at a tertiary clinic.
 
OBJECTIVES:
1.Evaluate the prevalence rates of valvular heart diseases.
2.Evaluate the complications of valvular heart diseases.
3.Comparison of the condition of patients before and after valve replacement surgeries.
 
  MATERIALS AND METHODS

  

 STUDY SITE: This study is conducted in the care hospital, Banjara hills, Hyderabad.

 STUDY DESIGN: A retrospective observational study.

 STUDY PERIOD: This study is conducted for 6 months.

 SAMPLE SIZE: 102 patients

 STUDY CRITERIA:
 INCLUSION CRITERIA:

●Adults (patients of either sex, above 12 years of age)

●Patients suffering from valvular diseases.
●Patients with a history of certain infections that affect the heart.
●Congenital heart disease patients.
 EXCLUSION CRITERIA:

●Paediatrics
●Pregnant and lactating women
● Patients without any heart problem
● Patients on dialysis
 SOURCES OF DATA:
 The data are obtained from all relevant and required

 1.Case sheets

 2.Lab reports

 DATA COLLECTION:

 The study was started after approval from IRE committee Care hospital. Inpatient case forms were
collected which complied the inclusion and the exclusion criteria of the study. The data will be collected
using a patient profile form which was designed to include all the variables which are required for the
study. The data was collected for 6 months which includes inpatient cases from the last year. (January
2020– December 2020).
 STATISTICAL ANALYSIS:

 The statistical analysis will be performed using the version 20 of Microsoft Excel and the
Social Services Statistical Package (SPSS). P value below 0.05 was regarded as
statistically significant at 5% with an interval of trust of 95%.. All results have been given
with descriptive statistics; generally the mean and standard deviating data have been
spread (SD). Binary and categorical variables with counts and percentages were displayed.
The results have been examined by the chi-square test.

  
  RESULTS AND DISCUSSION
  
 PREVALENCE BASED ON AGE

 The morbidity and mortality associated with valve illnesses and the importance of
epidemiology and valve illnesses impacting health sources were considerable There was an
appreciation of the effects.
 In this study, patients in the Hyderabad region - Telangana are exclusively affected by the
valvular illness. A total of 102 patients in a tertiary treatment centre in India were taken in.

  
 . Distribution Based on Age

Age Interval Frequency Percentage

(Years)
21-30 7 7
31-40 8 8
41-50 15 15
51-60 31 30
61-70 16 16
71-80 18 17
81-90 7 7
 Of the total 102 subjects , 7(7%) were in the age group of 21-30, 8 (8%) were in the age group of
31- 40, 15(15%) were in the age group of 41-50, 31(30%) were in the age group 51-60, 16 (16%)
were in the age group 61-70, 18 ( 17%) in the age group 71-80, 7(7%) I the age group 81-90.
Hence it was seen that valvular diseases are more prevalent in the age group 51-60.
Distribution Based on Age
 PREVALENCE BASED ON GENDER

 45 of them (44%) were found to be male and 57 (56%) were found to be female which
indicates prevalence is more in females

Gender Frequency Percentage

Male 45 44

Female 57 56

Distribution Based on Gender

Distribution Based on Gender.
  COMORBIDITIES

 The study found that 50 subjects (49%) had Hypertension and 47 (46%) had Diabetes
mellitus as major comorbidities
  
 Psoriasis, asthma, obesity, hypothyroidism, epilepsy, hyperlipidaemia, chronic kidney
disease, respiratory tract infection, urinary tract infection, and anaemia, were the other
comorbidities seen.
 ( 2%,4%,2%,7%,1%,1%,1%,1%,4%,4% respectively)
 Comorbidity Frequency Percentage

Hypertension 50 49

Diabetes mellitus 47 46

Psoriasis 2 2

Asthma 4 4

Obesity 24 24

Hypothyroidism 7 7

Epilepsy 1 1

Hyperlipidemia 1 1

Chronic kidney disease 11 11

Respiratory tract infection 1 1

Urinary tract infection 1 4

Anemia 4 4

Comorbidities Wise Distribution

 DIAGNOSIS

Comorbidities Wise Distribution

 Among the total subjects studied ,the primary diagnosis seen were chronic
rheumatic heart disease (37%),aortic regurgitation( 4%), pulmonary atrial
hypertension(6%), tricuspid valve regurgitation(2%), mitral stenosis(28%),
decompensated heart failure(11%), atrial fibrillation with CVR (5%),heart failure
(18%), dilated cardiomyopathy (3%),valve thrombosis(1%), aortic
stenosis(24%),mitral regurgitation (10%) contributing to the study.
 Diagnosis Frequency Percentage

Chronic rheumatic heart disease 38 37

Aortic regurgitation 4 4
Pulmonary atrial hypertension 6 6

Tricuspid valve regurgitation 2 2

Mitral stenosis 29 28
Decompensated heart failure 11 11

Atrial fibrillation with CVR/FVR 5 5

Heart failure 18 18
Dilated cardiomyopathy 3 3

Valve thrombosis 1 1
Aortic stenosis 24 24
Mitral regurgitation 10 10

Diagnosis
 SEVERITY

 The study shows the severity of valvular diseases to be 48%(49), 8% moderate (8) and 48% mild (44 )

  

Severity of Disease
Age Interval Severity P Value
(years)

Mild Moderate Severe

21-30 2 0 5  
 
 
31-40 2 0 6
0.2428

41-50 5 2 8

51-60 14 3 14

61-70 6 3 7

71-80 13 0 5

81-90 3 0 4

Severity of Disease Based on Age

Severity of Disease Based on Age
 SEVERITY BASED ON GENDER
Gender Severity

Mild Moderate Severe

Male 23 5 17

Female 22 3 32

Severity of Disease Based on Gender

 Severity of Disease Based on Gender
 
REQUIREMENT OF SURGERY
It was found that not all subjects require surgery, out of 102, 58% (59) required surgery and the rest 42% (43) could
be managed with medical treatment

Surgery Frequency Percentage

Yes 59 58

No 43 42

Surgery
Surgery
 VALVES USED
 Among the 58% (59) who required valve replacement, the main valve used ,was found to be 27
SJ mechanical valve (14%), 29 SJ mechanical valve 8%(8), 31 SJ mechanical valve 8% (80),25
SJ mechanical valve ,19 EPR biological valve 2% (2), aortic valve implant 5% (5)

Valve Frequency Percentage

19 EPR biological valve 2 2

25 SJ mechanical valve 2 2

27 SJ mechanical valve 14 14

29 SJ mechanical valve 8 8

31 SJ mechanical valve 8 8

Aortic valve implant 5 5

Not used 63 61

Valves Used in Surgical Procedure

Valves Used in Surgical Procedure
 
  COMPLICATIONS BEFORE SURGERY
 Complications that were seen in patients before surgery were majorly shortness of breath
77% (79), cough 31% (32), palpitation 20% (20), chest pain 20% (20).
  
 Orthopnea, sweating, difficulty in walking, fever, pedal oedema, drowsiness, generalised
weakness, chest discomfort, vomitings were seen as other complications (8%, 5%,1%,2%,
7%,3%,3%,5%,5% respectively).
 Complications Frequency Percentage

Shortness of breath  79 77

Palpitation 20 20

Orthopnea 8 8

Sweating 5 5

Chest pain 20 20

Difficulty in walking 1 1

Fever 2 2

Cough 32 31

Swelling of feet (pedal edema) 7 7

Drowsiness 3 3

General weakness 3 3

Chest discomfort 5 5

Vomiting 5 5

Complications before Surgery

Complications before Surgery
 
 OUTCOMES OF THE SURGERY
 The outcome of surgery was found to be fairly good as 92% (94) were found to be stable
after the surgery .
  
 While some patients dealt with shortness of breath ,arm pain, stent thrombosis,
hypotension, hypertension (1%,1%,1%,1%,1%, respectively and death seen in 3% (3) .
 Outcome Frequency Percentage

Stable and discharged 94  92

Shortness of breath 1 1

Arm pain 1 1

Stent thrombosis 1 1

Hypotension 1 1

Hypertension 1 1

Death 3 3

Outcome of Surgery
 OUTCOME BASED ON DISEASE SEVERITY

Outcome Severity

Mild Moderate Severe

Stable and discharged 40 7 47

Shortness of breath 1 0 0

Arm pain 1 0 0

Stent thrombosis 0 1 0

Hypotension 0 0 1

Hypertension 1 0 0

Death 2 0 1

Outcome of Surgery Based on Disease’s Severity

Outcome of Surgery Based on Disease Severity
 LIMITATIONS:
  
 .SAMPLE SIZE:
 our sample size was small (102 patients), the statistical analysis could not identify a few significant relationships.
  

SINGLE SITE STUDY:

 We have undertaken a retrospective study in a local area, at the Care hospital. However a single site study gives
results to a single site study. The results do not apply to all Indian population
  

DATA COLLECTION:
 Due to the short duration of study, few results might be insignificant.
  
  CONCLUSION
  

 Complications are less or equal to no after the surgery is performed in patients and future efforts are to be directed towards
improving early diagnosis and minimise complications caused and reduce the mortality rate.
  
 The study concludes that valvular diseases are more prevalent in the age group 51-60, and females were more affected by
valvular diseases than males. Hypertension and diabetes mellitus were found to be the major comorbidities in valvular
heart disease patients. Mitral stenosis, aortic stenosis, mitral regurgitation, chronic rheumatic heart disease were the
majorly diagnosed conditions among the samples.
  
 The valvular diseases were either mild which could be managed with medication or very severe which needed surgery.
Very few moderately severe cases were seen.
  
 St. jude mechanical valve ( sizes 25,27,29,31) aortic valve implant , 19 EPR biological valves were used for surgeries.
  
 Shortness of breath, palpitation, chest pain ,and cough were the major complications seen in such patients which were
fairly resolved after the procedure while some patients dealt with a few complications even after the surgery.