(精编)【医学教学课件】心脏瓣膜病教学课件.pptVIP

Auxiliary examination X ray: enlarged LA and LV, pulmonary congestion and interstitial edema are common in case of left heart failure ECG: hypertrophy of LA and LV, atrial fibrillation is common UCG: confirmation of diagnosis, semiquantitative estimates of the severity of regurgitation Radionuclide ventriculography: evaluation of LV systolic function; evaluation of regurgitation degree by stroke volume ratio between LV and RV (2.5 suggests severe regurgitation) LV ventriculography: the gold standard for semiquantitative evaluation of regurgitation degree Diagnosis and differential diagnosis Diagnosis: In acute cases, dyspnea onset, apical systolic murmur, no enlarged cardiac shadow with obvious pulmonary congestion by X ray, easy to diagnose In chronic cases, apical typical murmur with enlarged LA and LV help to diagnose and final diagnosis should be confirmed by UCG. Diagnosis and differential diagnosis Physiological murmur Relative mitral incompetence Ventricular septal defect Aortic valve stenosis Tricuspid incompetence complication Atrial fibrillation Infective endocarditis Systemic circulation embolism Heart failure Complication of mitral prolapse: infective endocarditis, brain embolism, arrhythmia, sudden death, severe mitral incompetence and heart failure treatment acute Purpose: to lower pulmonary vein pressure, to improve cardiac output and to treat the underlying pathologic process. Medical therapy is usually preoperative measure. Operation is usually necessary. Therapy Chronic Medical therapy Prevention from infective endocarditis; prevention from rheumatic fever for rheumatic heart disease No special therapy for asymptomatic patients with normal cardiac function, but regular follow-up is required. Treatment of atrial fibrillation in mitral incompetence is the same as in mitral stenosis, but maintaining sinus rhythm is less important than in mitral stenosis Treatment of heart failure: sodium restriction, ACEI, diuretics and digitalis Treatment Chro