心脏瓣膜病主动脉瓣返流.ppt

Valvular Heart Disease Aortic Regurgitation Aortic Regurgitation Etiology Physical Examination Assessing Severity Natural History Prognosis Timing of Surgery Aortic Regurgitation:Etiology Any conditions resulting in incompetent aortic leaflets Congenital Bicuspid valve Aortopathy Cystic medial necrosis Collagen disorders (e.g. Marfan’s) Ehler-Danlos Osteogenesis imperfecta Pseudoxanthoma elasticum Acquired Rheumatic heart disease Dilated aorta (e.g. hypertension..) Degenerative Connective tissue disorders E.g. ankylosing spondylitis, rheumatoid arthritis, Reiter’s syndrome, Giant-cell arteritis ) Syphilis (chronic aortitis) Acute AI: aortic dissection, infective endocarditis, trauma Aortic Regurgitation: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 Peripheral Signs of Severe Aortic Regurgitation 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 Aortic Regurgitation: Physical Exam Widened pulse pressure Systolic – diastolic = pulse pressure High pitched, blowing, decrescendo diastolic murmur at LSB Best heard at end-expiration leaning forward Hands Knee position Central Signs of Severe Aortic Regurgitation Apex: Enlarged Displaced Hyper-dynamic 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 Assessing Severity of AR Assess severity by impact on peripheral signs and LV ? periphe