二尖瓣面容.PPT

Clinical manifestation: Symptoms (Area of mitrial valve ＜1.5 ㎝2) dyspnea -exertion -resting -orthopnea -paroxysmal nocturnal dyspnea Clinical manifestation: Signs Mitral facies in severe MS 重度MS常有 “ 二尖瓣面容 ” 双颧绀红 Chronic Mitral incompetence: Pathophysiology Mitral incompetenceClinical manifestation 急性 轻度仅轻微劳力性呼吸困难 严重很快发生急性左心衰竭，休克 慢性 轻度可终身无症状 严重CO?，疲乏，肺淤血症状出现晚 风心病：无症状期长，症状明显损害不可逆 二尖瓣脱垂：多无症状，晚期出现左心衰竭 Acute mitral incompetence: Signs Mitral incompetence  Laboratory Examination 急性者 心影正常或LA轻度?伴明显肺淤血，肺水肿 慢性重度反流 LA、LV?：肺淤血和间质性肺水肿 二尖瓣环钙化为致密而粗C形阴影 ECG Acute mitral incompetence Usually normal EKG,sinus tachycardia present Chronic mitral incompetence LA enlargement Atrial fibrillation LVH (50% pts. With severe MR) RVH (15%) Combined hypertrophy (5%) Mitral Incompetence :Diagnosis Dyspnea Apex region systolic murmur Chest X ray display heart may\may not to be normal but significant pulmonary congestion Notable etiological finding （Mitral valve prolapse, infectious endocarditis, acute myocardial infarction) Mitral Incompetence :Diagnosis 心尖区有典型杂音伴左心房室增大，诊断可成立 确诊有赖超声心动图 Mitral Incompetence : Management Mitral Incompetence : Management Mitral Incompetence : Management Aortic Stenosis: Pathophysiology 成人瓣口变化 主动脉瓣口≥3.0cm2 当瓣口面积减少一半时，收缩期仍无明显跨瓣压差 瓣口≤1.0cm2时，LV收缩压明显?，跨瓣压差显著 Clinical manifestation: signs Presence of thrill “Diamond” shaped, harsh, systolic crescendo-decrescendo Decreased, delay prolongation of pulse amplitude Paradoxical S2 S4 (with left ventricular hypertrophy) S3 (with left ventricular failure) Aortic Stenosis: Laboratory Examination Etiology Valve gradient and area LVH Systolic LV function Diastolic LV function LA size Concomitant regional wall motion abnormalities Coarctation associated with bicuspid AV Aortic Stenosis: Management Chronic AI Clinical Manifestation: Peripheral Signs Chronic AI Clinical Manifestation: Signs Apex Enlarged Displaced Hyper-dynamic Palpable S3 Austin-Flin