内科学精品教学课件（时国朝）08 心瓣膜病幻灯稿.pdfVIP

心 脏 瓣 膜 病 （Valvular Heart Diseases, VHD） 上海交通大学医学院瑞金医院心脏科 施仲伟 二 尖 瓣 狭 窄 (Mitral Stenosis, MS) MS: Etiology Pathophysiology • Rheumatic heart disease – Leaflet thickening, commissural fusion, chordal fusion • Rarely congenital, or severe MV calcification (elderly) • Normal mitral valve area (MVA): 4~6 cm2 – Mild mitral stenosis: MVA 1.5~2.5 cm2 – Moderate mitral stenosis: MVA 1.0~1.5 cm2 – Severe mitral stenosis: MVA 1.0 cm2 上海瑞金医院施仲伟 Mitral Stenosis: Symptoms • 呼吸困难 （dyspnea, orthopnea, SOB） • 疲乏 （fatigue） • 心悸 （palpitation） • 咯血 （hemoptysis） • 声音嘶哑 （hoarseness） • 血栓栓塞 （Systemic thromboembolism） 上海瑞金医院施仲伟 Mitral Stenosis: Physical Examination • Low pitch rumbling diastolic murmur at apex, with or without pre-systolic accentuation • First heart sound (S ) is accentuated 1 • Opening snap • Loud S : pulmonary hypertension 2 • Heart rhythm is irregularly irregular: atrial fibrillation • Mitral facies or Malar flush • RV failure 上海瑞金医院施仲伟 Mitral Stenosis: Electrocardiogram • Left atrial enlargement – Wide notched P wave in lead II (P-mitrale) – P terminal force in Lead V (PTFV ) -0.04mms 1 1 • Right ventricular hypertrophy – Right axis deviation – A dominant R wave in lead V1 • Atrial flutter and/or atrial fibrillation 上海瑞金医院施仲伟 Mitral Stenosis: Echocardiography • Diagnosis of mitral stenosis • Assessment of hemodynamic severity: mitral valve area, mean gradient, pulmonary artery systolic pressure • Assessment of RV size and function