心脏瓣膜病(22p).pptVIP

Valvular Heart Disease Aortic Stenosis Aortic Regurgitation Mitral Stenosis Mitral Regurgitation Tricuspid Regurgitation (Tricuspid Stenosis, Pulmonary Stenosis, Pulmonary Regurgitation) Aortic Stenosis Valvular Aortic Stenosis Supra-valvular Aortic Stenosis Sub-valvular Aortic Stenosis Hypertrophic cardiomyopathy Sub-valvular membrane Left ventricular tunnel Valvular Aortic Stenosis Congenital Rheumatic Degenerative/Calcific Symptoms Angina Dyspnoea Syncope on exertion Signs Slow rising/anachrotic pulse Sustained apex 2nd sound quiet Ejection click Ejection type systolic murmur usually best heard 2nd RICS, into carotids. Often well heard throughout praecordium Complications Left heart failure Sudden death Investigations ECG Chest x-ray Echocardiogram Cardiac catherisation Treatment Surgical Aortic Valve Replacement TAVI Causes of Aortic Regurgitation Rheumatic fever Bicuspid aortic valve Infective endocarditis Syphillis Arthritides Reiter’s, Ank Spond, Rheumatoid Aortic Regurgitation Symptoms asymptomatic, dyspnoea Signs Pulse “collapsing”, “Water Hammer” Quinque’s, Corrigans, De Musset’s, pistol shot femorals, Duroziez’s signs Apex – displaced and hyperdynamic Early diastolic murmur usually best heard lower left sternal edge Investigations ECGCXREchocardiogram Cardiac Catherisation Complications Left heart failure Endocarditis Treatment Aortic Valve Replacement Mitral Stenosis Symptoms -Breathlessness Complications Atrial fibrillation Systemic emboli Pulmonary hypertension Chest infections Infective endocarditis Right heart failure Signs of mitral stenosis Atrial fibrillation Maybe para sternal heave “tapping” apex Loud 1st sound Maybe loud 2nd sound Opening snap Rumbling mid diastolic murmur at apex radiating to axilla Investigations ECGCXREchocardiogram Cardiac catheterisation Treatment Rhythm control – Digitalis, beta blockers, calcium antagonists Diuretics Anti-coagulants Balloon Valvotomy