Valvular Heart Disease Aortic Regurgitation：主动脉瓣返流瓣膜性心脏病.ppt

Etiology *Any conditions resulting in incompetent aortic leaflets _Congenital Bicuspid AV _Aortopathy Cystic medial necrosis Collagen disorders (.Marfan Syn.] Ehler-Danlos Osteogenesis imperfecta Pseudoxanthoma elasticum _Acquired * Rheumatic heart disease *Dilated aorta [ hyperte.] *Degenerative *Connective tissue disorder _ Ankylosing spondylitis, _Rheumatoid arthritis, _Reiter’s syndrome, _Giant-cell arteritis ) *Syphilis (chronic aortitis) *Acute AR: , _Infective endocarditis, _Trauma _Dissecting aneurysm Symptoms _Dyspnea, orthopnea, PND _Chest pain. Nocturnal angina exertional angina {? diastolic aortic pressure and increased LVEDP thus ? coronary artery diastolic flow} *With extreme reductions in diastolic pressures {e.g. 40} may see angina  _Quincke’s sign: capillary pulsation _Corrigan’s sign: _Water hammer pulse _Bisferiens pulse (AS/AR AR) _De Musset’s sign: systolic head bobbing _Mueller’s sign: systolic pulsation of uvula _Durosier’s sign: femoral retrograde bruits _Traube’s sign: pistol shot femorals _Hill’s sign:BP Lower extremity BP Upper extremity by _ 20 mm Hg - mild AR _ 40 mm Hg – mod AR _ 60 mm Hg – severe AR Central Signs of Severe  Apex: _Enlarged _Displaced _Hyper-dynamicLforcible nonsustained _Palpable S3 _Austin-Flint murmur Aortic diastolic murmur _Length correlates with severity {chronic AR} _In acute AR murmur shortens as Aortic DP=LVEDP _In acute AR - mitral pre-closure  Common Murmurs and Timing ,_Systolic Murmurs _ Aortic stenosis _ Mitral insufficiency _Mitral valve prolapse _Tricuspid insufficiency Diastolic Murmurs _Aortic insuff