心脏瓣膜病（43p）

VALVULAR HEART DISEASE,Shen Jieyan MD SSMU Department of cardiology,Rheumatic Fever,Definition: autoimmune disease caused by streptococcal infection, cross-react between streptococcal antigens and structural glycoprotein of heart, joints, central nerves system and connective tissue. Pathology: exuduation, proliferation (Aschoff nodes), scarring,Rheumatic Fever,Clinical Manifestations: fever, rheumatic carditis, arthritis, chorea, deformity of skin Laboratory finding: ASO500U, ASK80U, ESR,Alb,+a2 CRP(+), CPK-MB, GOT,TnT TnI, C3, IgA,Rheumatic Fever,Diagnosis: Jones standards, 1992 AHA Treatment: 1) rest 2) antibiotics :Penicillin 3) anti- inflammation: Aspirin Corticosteroids 4) others Prevention,Mitral Stenosis,Etiology: predominant cause: rheumatic fever rare cause Pathology: thickening, shortening, adhering, calcium depositing, and scarring four forms of fusion: (1) commissural, (2) cuspal, (3)chordal, (4)combined two types of shape: fish-mouth shaped, funnel-shaped,Mitral Stenosis,Pathophysiology: normal cross-sectional area:4-6 cm2 mild MS: 2 cm2, LAPLAH -compensated period moderate MS: 1.5 cm2, PVP, PCWP, interstitial edema severe MS: 1.0 cm2,PAPRVoverload RV failure TR PR,Mitral Stenosis,Clinical Manifestations (MVA1.5cm2) 1. Symptom: dyspnea, hemoptysis, cough, hoarseness (ortners syndrome) 2. Signs: -Mitral faces -Diastolic thrill at apex -S1(flexible), OS, Diastolic rumbling murmur at apex, -P2, splitting, Graham-Steel murmur(PR),TR,Mitral Stenosis,Laboratory Examination - ECG: 1) left atrial enlargement: P wave (II,V1) 2) Af; 3) right ventricular hypertrophy - X-film: change in cardiac silhouette, Kerley B lines - Echocardiography: M-mode, Two- dimensional, Doppler,正常二尖瓣形态,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,Mitral Stenosis,Diagnosis pulmonary infective,Mitral Stenosis,Management: - Medical treatment: Antibiotics, Diuretics and Digitalis, Antiarrhythmic drugs, Anticoagulant - Percutaneous balloon mitral valvuloplasty ( PBMV) - Surgical treatment: Closed mitral valvotomy Open valvotomy Mitral valve replacement,Mitral Regurgitation,Etiology and Pathology - Abnormalities of valve leaflets: Rheumatic, infective - Abnormalities of the mitral annulus: dilatation, calcification - Abnormalities of the chordae tendineae: congenitally, infective, trauma, Rheumatic - Involvement of papillary muscle: CAD,Mitral Regurgitation,Pathophysiology In systolic period, blood flow from LV LA, LA filling pressure; in diastolic period, LV accepts more blood LV dilation, hypertrophy LVEDP LAPPCWPPAPRHF; CO Chronic Acute,Mitral Regurgitation,Clinical Manifestations (1) Symptoms: asymptomatic( gradually,20 years), palpitation, fatigue, dyspnea, pulmonary edema (2) Signs: - apical pulseleft,lower - apical beat heavy - cardiac dullness enlargedleft - pansystolic murmur at apex, radiate to left axilla, subscapular - S1,P2,Mitral Regurgitation,Laboratory Examination: - ECG: LA enlargement, Af, LV hypertrophy - X- Film: chronic cardiomegaly (LV, LA) acute interstitial edema (Kerley B) - Echocardiography: two-dimensional, Doppler , color flow mapping - Angiocardiography & Magnetic resonance imaging,二尖瓣脱垂伴关闭不全,二尖瓣关闭不全,Mitral Regurgitation,Diagnosis: systolic murmur at apex + LA, LV+ Echo Differential Diagnosis: relative MR, ventricular septal defect, tricuspid regurgitation, aortic stenosis Management: - Medical treatment - Surgical treatment,Aortic Stenosis,Etiology - LVEFischemia of peripheral、brain、heart,Aortic Stenosis,Clinical Manifestations: - Symptoms: heart failure (fatigue, dyspnea), angina pectoris, syncope, sudden death - Signs: Apical impulse,to left Systolic thrill in AV area,pulse Cardiac dullnessleft Ejection sound & SM in AV area, radiate to neck A2 splitting paradoxically,Aortic Stenosis,Laboratory Examination: ECG; X- film; Echocardiography; Angiography Diagnosis & Differential Diagnosis: - murmur + Echo - MI, TI, VSD - other murmurs of LVOT obstruction,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,Aortic Stenosis,Complications: Sudden death, heart failure, arrhythmia, infective endocarditis, systemic embolism Management: - Medical treatment - Surgical treatment,Aortic Regurgitation,Etiology & Pathology - Valvular Disease: rheumatic, congenital, infective prolapse, ankylosing spondylitis, degenerative - Aortic Root Disease: syphilitic aoritis, Marfan syndrome, ankylosing spondylitis, degenerative - Acute AR: infective, trauma, aortic dissection,Aortic Regurgitation,Pathophysiology: - LV receives both blood from LA - Diastolic pressure,pulse pressure,Aortic Regurgitation,Clinical Manifestations: - Symptom: palpitation, angina - Sign: apical impulse left, inferior cardiac dullness left, inferior Boot-shaped shadowcardiac waist DM in AV2 area apex S1,A2 relative MISM at apex relative MSAustin Flint,Aortic Regurgitation,Sign: Peripheral vascular sign: - pulse pressure, carotid pulsation - Musset sign, water hammer pulse, Traube sign, Duroziez murmur, Muller sign, Quincke sign, Laborat