Dr. Amit Misri

Valvar aortic stenosis, commonly called aortic stenosis, is a disorder which occurs when the aortic valve of the heart becomes narrow (know Main Indicators of a Heart Disease in a Child). The narrowing of the valve prevents its full opening, and hence, blood flow from the heart to the aorta is restricted. When the aortic valve gets obstructed, the heart has to exert much more effort to pump the blood. The heart muscles get weakened as a result. This condition is more common in children.

Diagnosis of Valvar Aortic Stenosis:
Before diagnosis, we should know about the symptoms of valvar aortic stenosis in children. They include:

• Feeling breathless
• Angina or chest pain with a feeling of pressure or tightness
• Syncope of fainting
• Palpitations and enhanced heartbeats
• A steady decline in regular activities and energy levels
• Fatigue due to little exertion
• Not gaining weight
• Poor eating patterns
• Problems in breathing

The wall of the left ventricle also thickens muscularly, and the thick wall occupies more space in the lower chamber of the heart and hence, the room for adequate blood supply is reduced. This may lead to heart failure.

Echocardiogram: The initial test that is recommended for patients with symptoms of valvar aortic stenosis is Doppler Echocardiography. This test enables the doctor to estimate the aortic valve region, peak or mean transvalvular gradients and the maximum aortic velocity. These primary measures are required to assess the severity of the disease. Echocardiography provides important information on the valve function, left ventricular filling pressure and disruptions in other valves.

Other major tests which help in the diagnosis of valvar aortic stenosis include:

• MRI or magnetic resonance imaging, which provides images of internal body structures with great detail.
• CT scan or computed tomography where three-dimensional images are extracted.
• Chest X ray
• Cardiac catheterization where a dye is used to highlight blockages, if any, in the heart.

Treatment: Usually, there are no medicines for fixing valvar aortic stenosis as the disease is not reversible. Medicines can be used to treat the problems, which are caused by the condition.

Replacement of the damaged valve by surgery is the best treatment for valvar aortic stenosis. The surgery performed is called valvuloplasty. This is a cardioscopic surgery where a tube with a small balloon is inserted into a vein. The tube is guided into the heart, and the balloon is inflated. The balloon and tube are removed after the valve is opened. The damaged valve is replaced by mechanical valve or the valve of a cow or pig by an open-heart surgery.

Valvar aortic stenosis is a severe heart condition in children, and the only permanent remedy for this disease is a valve replacement surgery.

Diarrhea is a disorder that affects people of all age groups. Medically speaking, Diarrhea is a mechanism that the body uses to eliminate germs from the body. Usually this disorder lasts for a few days to a week. It is usually accompanied by nausea, fever and dehydration.

Children can be affected by diarrhea in a number of ways, some of them are:

1. Infections: Various infections, such as the ones caused by rotavirus and salmonella bacteria can lead to diarrhea. Usually diarrhea in children is caused by viruses; if it is viral in nature, then it can also cause stomach cramps, headache and vomiting. It also leads to loss of fluid from the body. Hence, the child's fluid intake should be compensated accordingly. Usually oral rehydration solution that contains nutrient such as potassium and sodium are preferred.
2. Medications: Intake of certain medications, such as antibiotics and laxatives can cause diarrhea in children. If the cause is due to antibiotic intake, then you should consult a doctor. The doctor may alter the dosage or ask to increase the child's water intake. Yoghurt may also help ease the symptoms of diarrhea if it is caused by antibiotics.
3. Food poisoning: Diarrhea may also result from food poisoning; symptoms of this type usually disappear quickly. Along with loose and watery stools, the child may vomit frequently.

The major complication that results from diarrhea is dehydration. Severe dehydration may lead to severe brain damage and seizures. It may also cause symptoms of dry mouth, fatigue, dizziness and dark yellow urine.

Certain preventive measures are:

1. Use your good judgment while eating outside. Do not consume food from places which use unhygienic modes of preparation.
2. Make sure your child does not drink contaminated water and there is access to clean and filtered water all the time.
3. Your child should be eating a balanced diet that primarily consists of vegetable and fruits. They also help in adding fiber to the diet that keeps your bowels healthy. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

It is the most common problem seen in society today. A migraine is a common neurological condition characterised by a headache, but some people have associated symptoms of eye and ear.
Classic symptoms of a migraine:

1. Severe throbbing headache on one side of head
2. Nausea and vomiting
3. Sensitivity to light and noise.
4. Prefer quite a dark room to sleep

Vestibular symptoms:

1. Vertigo
2. Dizziness
3. Imbalance
4. Unsteadiness
5. Sensitivity to motion

Hearing symptoms:

1. Muffled hearing
2. Ear fullness
3. Ringing in the ear or tinnitus

Causes of a migraine:
Migraine headaches probably relate to both abnormal discharges in cells within the brain and to the construction of the walls of the blood vessels in and around the brain. But the exact cause of a migraine is not known. Following are the provocating factors which make the condition worse

1. Hypoglycaemia (low blood sugar)
2. Stress altered sleep patterns
3. Diet fast food, oily food, processed food
4. Chocolates, cheeses
5. Coffee sodas with caffeine
6. Alcohol

Factors related to a migraine

1. More common in women than men
2. Symptoms are often worse during menstruation
3. Family history

Management

1. Avoid food, which triggers migraines e.g. Chocolate, alcohol, cheese, oily, spicy, junk and processed food
2. Relaxation exercise
3. Stress management
4. During menstrual period decrease the salt intake and take some diuretic
5. Ibruphen for pain after meal
6. Other treatment with the advice of neuro physician e.g.
   1. Beta blockers agents
   2. Calcium channel blockers
   3. Tricyclic antidepressants
   4. Seratonergic agents
   5. Gabapantin or neurontin
   6. Clongepam
   7. Acetazolamides or diamox
   8. Sodium valporate or depakots
   9. Topiramax
   10. Oxycarbazapine or trieptal