Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

954 Marfan’s Syndrome Measles

■refraction for myopia

■psychological and genetic counseling

Specific Treatment

■Beta-blockers for all patients to reduce rate of aortic root dilatation

and risk of dissection as blood pressure tolerates

Side Effects and Contraindications

■side effects: fatigue, excessive bradycardia or hypotension, bron-

chospasm, depression, erectile dysfunction, insensitivity to hypo-

glycemic symptoms

■contraindications:

➣absolute: decompensated congestive heart failure, severe COPD,

heart block

➣relative: CHF, COPD, diabetes with frequent hypoglycemia

follow-up

During Treatment

■Annual EKG and echocardiogram to monitor aortic root size until

aortic root=45 mm, then more frequently

■Prophylactic aortic valve replacement and ascending aortic conduit

surgery if moderate aortic insufficiency, aortic root >50 mm, or aortic

root increases >1 cm/year

complications

■dilated aortic root in 50% of children and 80% of adults

■aortic dissection (usually ascending) in 44% at autopsy

■pregnancy increases risk of dissection; avoid if aortic root >40 mm

■nondissecting aortic aneurysms common

prognosis

■Mortality from untreated heart disease or aortic dissection

■20-year survival after aortic valve and root surgery 65%

MEASLES

CAROL A. GLASER, MD

history & physical

History

■RNA virus, morbilliform virus within the Paramyxovirus family

■Humans only host