1、VALVULAR HEART DISEASE,Shen Jieyan MD SSMU Department of cardiology,Rheumatic Fever,Definition: autoimmune disease caused by streptococcal infection, cross-react between streptococcal antigens and structural glycoprotein of heart, joints, central nerves system and connective tissue. Pathology: exudu
2、ation, proliferation (Aschoff nodes), scarring,Rheumatic Fever,Clinical Manifestations: fever, rheumatic carditis, arthritis, chorea, deformity of skin Laboratory finding:ASO500U, ASK80U, ESR,Alb,+a2 CRP(+), CPK-MB, GOT,TnT TnI, C3, IgA,Rheumatic Fever,Diagnosis: Jones standards, 1992 AHA Treatment:
3、1) rest 2) antibiotics :Penicillin 3) anti- inflammation: AspirinCorticosteroids4) others Prevention,Mitral Stenosis,Etiology:predominant cause: rheumatic fever rare cause Pathology: thickening, shortening, adhering, calcium depositing, and scarringfour forms of fusion: (1) commissural, (2) cuspal,
4、(3)chordal, (4)combinedtwo types of shape: fish-mouth shaped, funnel-shaped,Mitral Stenosis,Pathophysiology:normal cross-sectional area:4-6 cm2mild MS: 2 cm2, LAPLAH-compensated periodmoderate MS: 1.5 cm2, PVP, PCWP, interstitial edema severe MS: 1.0 cm2,PAPRVoverloadRV failure TR PR,Mitral Stenosis
5、,Clinical Manifestations (MVA1.5cm2)1. Symptom: dyspnea, hemoptysis, cough, hoarseness (ortners syndrome)2. Signs:-Mitral faces-Diastolic thrill at apex-S1(flexible), OS, Diastolic rumbling murmurat apex,-P2, splitting, Graham-Steel murmur(PR),TR,Mitral Stenosis,Laboratory Examination- ECG: 1) left
6、atrial enlargement: P wave (II,V1) 2) Af; 3) right ventricular hypertrophy - X-film: change in cardiac silhouette, Kerley B lines- Echocardiography: M-mode, Two-dimensional, Doppler,正常二尖瓣形态,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,风湿性二尖
7、瓣狭窄 Rheumatic mitral stenosis,风湿性二尖瓣狭窄 Rheumatic mitral stenosis,Mitral Stenosis,Diagnosis pulmonary infective,Mitral Stenosis,Management:- Medical treatment:Antibiotics, Diuretics and Digitalis,Antiarrhythmic drugs, Anticoagulant - Percutaneous balloon mitral valvuloplasty( PBMV)- Surgical treatmen
8、t:Closed mitral valvotomyOpen valvotomyMitral valve replacement,Mitral Regurgitation,Etiology and Pathology- Abnormalities of valve leaflets: Rheumatic, infective - Abnormalities of the mitral annulus:dilatation, calcification- Abnormalities of the chordae tendineae:congenitally, infective, trauma,
9、Rheumatic- Involvement of papillary muscle: CAD,Mitral Regurgitation,PathophysiologyIn systolic period, blood flow from LV LA, LA filling pressure; in diastolic period, LV accepts more blood LV dilation, hypertrophy LVEDP LAPPCWPPAPRHF; CO Chronic Acute,Mitral Regurgitation,Clinical Manifestations(1
10、) Symptoms: asymptomatic( gradually,20 years),palpitation, fatigue, dyspnea, pulmonary edema(2) Signs:- apical pulseleft,lower- apical beat heavy- cardiac dullness enlargedleft- pansystolic murmur at apex, radiate to left axilla, subscapular- S1,P2,Mitral Regurgitation,Laboratory Examination:- ECG:
11、LA enlargement, Af, LV hypertrophy- X- Film: chronic cardiomegaly (LV, LA)acute interstitial edema (Kerley B)- Echocardiography: two-dimensional,Doppler , color flow mapping- Angiocardiography & Magnetic resonanceimaging,二尖瓣脱垂伴关闭不全,二尖瓣关闭不全,Mitral Regurgitation,Diagnosis:systolic murmur at apex + LA,
12、 LV+ Echo Differential Diagnosis:relative MR, ventricular septal defect,tricuspid regurgitation, aortic stenosis Management:- Medical treatment- Surgical treatment,Aortic Stenosis,Etiology - LVEFischemia of peripheral、brain、heart,Aortic Stenosis,Clinical Manifestations:- Symptoms: heart failure (fat
13、igue, dyspnea), angina pectoris, syncope, sudden death- Signs: Apical impulse,to leftSystolic thrill in AV area,pulseCardiac dullnessleftEjection sound & SM in AV area, radiateto neckA2 splitting paradoxically,Aortic Stenosis,Laboratory Examination:ECG; X- film; Echocardiography; Angiography Diagnos
14、is & Differential Diagnosis:- murmur + Echo- MI, TI, VSD- other murmurs of LVOT obstruction,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosis and regurgitation,风湿性主动脉瓣狭窄伴返流 Rheumatic aortic stenosi
15、s and regurgitation,Aortic Stenosis,Complications:Sudden death, heart failure, arrhythmia, infective endocarditis, systemic embolism Management: - Medical treatment- Surgical treatment,Aortic Regurgitation,Etiology & Pathology- Valvular Disease:rheumatic, congenital, infective prolapse, ankylosing s
16、pondylitis, degenerative - Aortic Root Disease:syphilitic aoritis, Marfan syndrome,ankylosing spondylitis, degenerative- Acute AR: infective, trauma, aortic dissection,Aortic Regurgitation,Pathophysiology:- LV receives both blood from LA - Diastolic pressure,pulse pressure,Aortic Regurgitation,Clini
17、cal Manifestations:- Symptom: palpitation, angina- Sign: apical impulse left, inferiorcardiac dullness left, inferiorBoot-shaped shadowcardiac waistDM in AV2 area apexS1,A2relative MISM at apexrelative MSAustin Flint,Aortic Regurgitation,Sign: Peripheral vascular sign:- pulse pressure, carotid pulsa
18、tion- Musset sign, water hammer pulse, Traube sign, Duroziez murmur,Muller sign, Quincke sign, Laboratory Examination:ECG, X-Film, Echo, etc,Aortic Regurgitation,Diagnosis & Differential Diagnosis:AI + peripheral vascular signs + EchoComplication: infective endocarditisventricular arrthymiaheart failure,Aortic Regurgitation,Management:Medical treatmentSurgical treatment,
