home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
CD-ROM Today (UK) (Spanish) 15
/
CDRT.iso
/
dp
/
0369
/
03697.txt
< prev
next >
Wrap
Text File
|
1994-01-17
|
8KB
|
195 lines
$Unique_ID{BRK03697}
$Pretitle{}
$Title{Eisenmenger Syndrome}
$Subject{Eisenmenger Syndrome Eisenmenger Complex Eisenmenger Disease
Eisenmenger Reaction Pulmonary Hypertension, Primary}
$Volume{}
$Log{}
Copyright (C) 1988, 1989 National Organization for Rare Disorders, Inc.
426:
Eisenmenger Syndrome
** IMPORTANT **
It is possible the main title of the article (Eisenmenger Syndrome) is
not the name you expected. Please check the SYNONYMS listing on the next
page to find alternate names, disorder subdivisions, and related disorders
covered by this article.
Synonyms
Eisenmenger Complex
Eisenmenger Disease
Eisenmenger Reaction
Information on the following disorder can be found in the Related
Disorders section of this report:
Pulmonary Hypertension, Primary
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Eisenmenger Syndrome is characterized by a large opening in the wall of
the heart which separates the heart chambers (ventricular septal defect).
The flow of blood between the heart and lungs meets with resistance
(pulmonary vascular resistance, PVR). This resistance increases as the child
matures, resulting in high lung (pulmonary) artery pressure. Blood that has
lost its oxygen during circulation through the body needs to pass through the
lungs to take up oxygen again. The high pulmonary artery pressure in
patients with Eisenmenger Syndrome causes increasing difficulty breathing
(dyspnea), insufficient levels of oxygen in the blood, and swelling (edema)
of lung tissue. Some patients can do well until age 40 or 50 when their
condition may begin to deteriorate.
Symptoms
Symptoms of Eisenmenger Syndrome are usually not detected during the first
few months of life, although some infants may experience difficulty breathing
while feeding. Onset of noticeable symptoms usually occurs between the ages
of 5 to 15 years, when a slight blue discoloration of the skin (cyanosis) may
occur, especially during exertion.
Signs of this heart defect may be difficult to detect during infancy
since there may not be an audible murmur caused by blood flow through the
defective area of the heart. However, as the child grows older a heart
murmur may become detectable and the skin may appear bluish (central
cyanosis) because blood in the arteries does not carry a sufficient amount of
oxygen. When an abnormal opening between the aorta and the pulmonary artery
remains after birth (persistent ductus arteriosus), the feet will appear more
bluish than the hands (differential cyanosis). Swelling due to proliferation
of the soft tissue at the ends of fingers and toes (clubbing) may also occur.
Patients with Eisenmenger Syndrome have an abnormally low blood pressure
as a result of the reduced volume of blood pumped by the heart. Random
contractions of the upper heart chamber causing an irregular, often rapid
heart rate (atrial fibrillation), may also occur late in the course of the
disorder. The blood pressure measured in the jugular vein is moderately
raised. Medical examination usually reveals enlargement of the right
ventricle and closure of the pulmonary valve.
When a physician listens to the heart sounds of a patient with
Eisenmenger Syndrome, signs of high blood pressure in the pulmonary arteries
may be identified through the following clues:
1. A right atrial fourth sound reflecting enlargement (hypertrophy) of
the right atrium.
2. A high-pitched clicking sound may occur during contraction of the
heart (pulmonary ejection click), and a periodic murmur reflecting a widened
pulmonary artery.
3. A loud pulmonary second sound may be transmitted to the tip (apex) of
the heart caused by high blood pressure closing the valve forcibly.
4. A regurgitant murmur during relaxation (diastole) of the heart, down
the left edge of the breast bone (sternum) may result from backflow of blood
from the pulmonary arteries (pulmonary incompetence).
5. A heart murmur may occur throughout the period of contraction of the
heart (pansystolic murmur) caused by incomplete closure of the tricuspid
valve. (This valve normally permits blood flow from the right atrium to the
right ventricle and not in the other direction.)
Failure of the right heart ventricle to pump blood properly is
characterized by breathlessness and water retention in body tissues which
often results in swelling (edema).
Expectoration of blood (hemoptysis) may occur in advanced stages of
Eisenmenger Syndrome. Chest X-rays may show enlarged pulmonary arteries
close to the lungs and insufficient levels of blood (ischemia) in vessels
farther from the lungs. The right upper heart chamber (atrium) may become
enlarged with time. Tissue death due to lack of blood and oxygen in the
lungs (pulmonary infarction) is usually caused by an obstruction (embolus) in
a pulmonary vessel. This may occur during late stages of the disorder.
These changes may be detected by an electrocardiogram (ECG).
Causes
Eisenmenger Syndrome is a defective development of the fetal heart during
pregnancy, possibly occurring during the first trimester. Scientists do not
know the exact cause of this birth defect.
Affected Population
Eisenmenger Syndrome affects males and females in equal numbers.
Related Disorders
Symptoms of the following disorder may be similar to Eisenmenger Syndrome.
Comparisons can be useful for a differential diagnosis:
Primary Pulmonary
Hypertension is a condition characterized by high blood pressure caused by
obstruction of branches of the pulmonary artery between the lung and the
heart. Symptoms of this condition include difficulty breathing (dyspnea)
after strenuous exercise, feelings of fatigue and weakness.
Therapies: Standard
Treatment of Eisenmenger Syndrome is symptomatic and supportive. No specific
treatment is available to lower the pulmonary vascular resistance that builds
up between the heart and lungs. Once a left to right blood flow has been
established, surgical repair of the opening between the right and left
ventricles is usually not advisable because this might create symptoms
similar to primary pulmonary hypertension.
Anticlotting (anticoagulant) drugs should be avoided because of the risk
of bleeding in the lungs.
Therapies: Investigational
Combined heart and lung transplantation has been performed on patients with
Eisenmenger Syndrome with a 70% success rate. However, this procedure should
be attempted only in the most serious cases.
This disease entry is based upon medical information available through
June 1988. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Eisenmenger Syndrome, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
NIH/National Heart, Lung and Blood Institute (NHLBI)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-4236
For genetic information and genetic counseling referrals, please contact:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
ABNORMAL ARCHITECTURE OF THE VENTRICLES IN HEARTS WITH AN OVERRIDING AORTIC
VALVE AND A PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT ("EISENMENGER VSD"): A.
Oppenheimer-Dekker, et al.; International Journal Cardiol (November 1985:
issue 9,3). Pp. 341-355.
COMBINED HEART AND LUNG TRANSPLANTATION: S. W. Jamieson et al.; Lancet
(May 21, 1983: issue 1 (8334)). Pp. 1130-1132.
EISENMENGER'S SYNDROME AND PREGNANCY: S. Lieber, et al.; Acta Cardiol
(Brux) (1985: issue 40,4). Pp. 421-424.