内科学教学课件：Valvular Heart Disease.pptVIP

Valvular Heart Disease Mitral valve is involved most commonly, secondly is aortic valve. rheumatic heart disease: caused by rheumatic inflammation injuring valve, mainly involve person younger than 40 years old. Mitral stenosis (MS) 2/3 of all patients with mitral stenosis are female. MS and mixed MS and mitral regurgitation are generally rheumatic in origin; very rarely, MS is congenital. PATHOPHYSIOLOGY In normal adults the mitral valve orifice is 4 to 6cm2. In the presence of significant obstruction, i.e., when the orifice is less than approximately 2cm2, blood can flow from the LA to the left ventricle (LV) only if propelled by an abnormally elevated left atrioventricular pressure gradient, the hemodynamic hallmark of MS. manifestation Symptoms dyspnea: dyspnea and cough may be precipitated by severe exertion→paroxysmal nocturnal dyspnea and orthopnea（端坐呼吸）→acute pulmonary edema Hemoptysis（咯血）: sudden massive hemoptysis（severe） bloody sputum massive pink foamy sputum（acute pulmonary edema） emboli:rare Trachyphonia（声嘶）: rare, enlarged LA and pulmonary artery press left recurrent laryngeal nerve Sign “mitral face”（double malar颧 flush） (1) cardiac signs inspection：apex beat is normal palpation：thrill in dilating period Auscultation:a low-pitched, rumbling, diastolic murmur, heard best at the apex with the patient in the left lateral recumbent position. It is accentuated by mild exercise . In general, the duration of this murmur correlates with the severity of the stenosis. complications Atrial fibrillation Acute pulmonary edema Embolism and thrombus Right Heart Failure Infective endocarditis Lung infection Lab exam X-ray The earliest changes are straightening of the left border of the cardiac silhouette, by an enlarged LA. Kerley B lines are fine, dense, opaque, horizontal lines that are most prominent in the lower and midlung fields and that result from distention of interlobular septa and lymphatics with edema when the resting mean