8/26/2020 E-Library - Information At Your Fingertips: Printer Friendly narrowed (stenosis). When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of [the] body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and [the] heart overall, and it can ultimately lead to heart failure and other problems."[58] In adults, three conditions are known to cause aortic stenosis: 1) Progressive wear and tear of a bicuspid valve present since birth (congenital); 2) Wear and tear of the aortic valve in the elderly; and 3) Scarring of the aortic valve due to rheumatic fever as a child or young adult.[59] In most elderly adults, aortic stenosis is caused by a buildup of calcium (a mineral found in the blood) on the valve leaflets. Over time, this causes the leaflets to become stiff, reducing their ability to fully open and close.[60] Respondent was just 49 years old when he manifested symptoms of the disease after eight months of working on board petitioners' vessel. Treatment of aortic valve stenosis depends on the severity of the condition, which may require surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.[61] The doctor may recommend to limit the patient's strenuous activity to avoid overworking the heart.[62] Aortic valve stenosis, once it occurs, is irreversible. Medications may be prescribed to manage the symptoms or reduce the burden on the heart.[63] In this case, respondent immediately underwent open-heart surgery for valve replacement, continued medications, and regular checkup within 130 days after his repatriation, with coronary angiogram as the last procedure performed by the company-designated physicians. Based on the foregoing, it may be concluded that respondent's heart disease has rendered him unfit for sea duty. The company designated-physician, however, refused to issue a disability grading for the reason that such illness is not work-related. On July 21, 2014, the 93rd day from respondent's signing-off and medical repatriation, the company-designated physician, Dr. Natalio G. Alegre II, issued the following medical assessment: 1. Aortic Valve Stenosis is the narrowing of the valve that conducts blood from the heart to the aorta and to the circulatory system. The etiologies of aortic valve stenosis are a deformed heart (bicuspid) [which] is hereditary or genetic in origin, and childhood infection of Rheumatic Fever. 2. The risk factors are previous infection of Rheumatic Fever, an inherited deformed heart and age. 3. Stress test and 2DEcho will detect aortic stenosis in the PEME. The ECG may provide signs but not definitive. 4. Maximum medical care has already been reached in this case as the patient already underwent Aortic Valve Replacement. https://elibrary.judiciary.gov.ph/thebookshelf/showdocsfriendly/1/65335 13/24