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心脏瓣膜病 (22p).ppt

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1、,Valvular Heart Disease,Aortic Stenosis Aortic Regurgitation Mitral Stenosis Mitral Regurgitation Tricuspid Regurgitation(Tricuspid Stenosis, Pulmonary Stenosis, Pulmonary Regurgitation),Aortic Stenosis,Valvular Aortic StenosisSupra-valvular Aortic StenosisSub-valvular Aortic StenosisHypertrophic ca

2、rdiomyopathySub-valvular membraneLeft ventricular tunnel,Valvular Aortic Stenosis,CongenitalRheumaticDegenerative/Calcific,Symptoms,AnginaDyspnoeaSyncope on exertion,Signs,Slow rising/anachrotic pulse Sustained apex 2nd sound quiet Ejection click Ejection type systolic murmurusually best heard 2nd R

3、ICS, into carotids.Often well heard throughout praecordium,Complications,Left heart failureSudden death,Investigations,ECG Chest x-ray Echocardiogram Cardiac catherisation,Treatment,Surgical Aortic Valve Replacement TAVI,Causes of Aortic Regurgitation,Rheumatic fever Bicuspid aortic valve Infective

4、endocarditis Syphillis ArthritidesReiters, Ank Spond, Rheumatoid,Aortic Regurgitation,Symptoms asymptomatic, dyspnoeaSignsPulse “collapsing”, “Water Hammer”Quinques, Corrigans, De Mussets, pistol shot femorals, Duroziezs signs,Apex displaced and hyperdynamicEarly diastolic murmurusually best heard l

5、ower left sternal edge,Investigations,ECG CXR EchocardiogramCardiac Catherisation,ComplicationsLeft heart failureEndocarditisTreatmentAortic Valve Replacement,Mitral Stenosis,Symptoms-Breathlessness Complications Atrial fibrillation Systemic emboli Pulmonary hypertension Chest infections Infective e

6、ndocarditis Right heart failure,Signs of mitral stenosis,Atrial fibrillation Maybe para sternal heave “tapping” apex Loud 1st sound Maybe loud 2nd sound Opening snap Rumbling mid diastolic murmur at apex radiating to axilla,Investigations,ECG CXR EchocardiogramCardiac catheterisation,Treatment,Rhyth

7、m control Digitalis, beta blockers, calcium antagonistsDiureticsAnti-coagulantsBalloon Valvotomy or Valve repair/replacement,Mitral Regurgitation,Rheumatic fever Prolapsing valve Infective endocarditis Papillary muscle dysfunction Ruptured chordae Left heart dilation Connective tissue disorders,Apex displaced Quiet first sound Pan systolic murmur at apex If severe, 3rd heart sound,Investigations,ECG CxR EchoCardiac catheter,Treatment,DiureticsVasodilators(Anti-coagulation)Mitral valve repair/replacement,

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