心脏瓣膜病(43p).pptVIP

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↓,γ+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, LAP↑→LAH ---compensated period moderate MS: 1.5 cm2, PVP↑, PCWP↑, →interstitial edema severe MS: 1.0 cm2,PAP↑→RVoverload →RV failure →TR →PR Mitral Stenosis Clinical Manifestations (MVA1.5cm2) 1. Symptom: dyspnea, hemoptysis, cough, hoarseness (ortner’s 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 lin