倪超瓣膜病ppt课件.pptVIP

Valvular Heart Disease Ni Chao, M.D. Division of Cardiology Objectives To understand the pathophysiology of the major VHDs To learn how to examine the patient To understand the principles of laboratory diagnosis To learn the fundamentals for treatment of cardiac valve abnormalities Mitral Stenosis Etiology Almost always the result of rheumatic fever Less common causes Congenital MS Systemic lupus erythematosus Rheumatoid arthritis Atrial myxoma Bacterial endocarditis. Epidemiology Rare in industrialized countries in patients 40 Very common in developing countries, esp. South Asia with severe disease often at early age (20) 2/3 of all patients with MS are female. The onset of symptoms is usu. between the 3rd and 4th decades. Pathology The mitral valve area (MVA) is normally 4-6 cm2 in adult Acute rheumatic fever causes immune-medi-ated inflammation of the mitral and other valves The leaflets thickened and the commissures fused along with thickening and shortening of the chordae tendineae ? narrowing of the mitral valve orifice Pathophysiology MVA reduced to 2 cm2: increased left atrial pressure (LAP) is necessary for normal trans-mitral flow MVA reduced to 1cm2: a LAP of 25 mm Hg is required ? a rise in: Pulmonary venous preesure (PVP) Pulmonary capillary wedge pressure (PCWP) ?exertional dyspnea Pathophysiology Progressive dilation of the LA predisposes mural thrombi and atrial fibrillation Chronic elevation of LAP ? pulmonary hypertension, tricuspid and pulmonary re-gurgitation ? right heart failure Pathophysiology Patients at high risk are of mural thrombi over 35 years old atrial fibrillation with a low cardiac output (CO) having a large left atrial appendage. Atrial fibrillation in up to 40% of patients decreases CO by 20%. Clinical Manifestations Histories of rheumatic fever, murmur Dyspnea Palpitations Chest pain Hemoptysis Edema Thromboembolism Physical Examination Low-pitched diastolic rumble Opening snap S1?, atrial fibrillation, P2